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Thursday
Apr152010

So what does "good" look like?

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By Emjaybee

Ok, so we spend a LOT of our time here bitching about crappy birth experiences, it’s true. Nothing wrong with that, either.  And a lot of that talk concerns old ways of thinking, leftover bad practices, sexism, misogyny, and ignorance that perpetuate abuses or just indifference.

But, let’s talk about what we think makes a birth experience (vaginal or necessary c-section) good—or what could make it good.  What would modern birth look like if women had been in charge of setting it up from the get-go to please and help themselves?

This post, as so many are, was inspired by a heated argument I was having with Some Dude on the Internet a few months ago, about what a birth should be like; he basically told me that women were a bunch of whiny babies for wanting things like birthing pools and privacy while in labor.

If you could create a non-home* birth-space that was both respectful, comfortable, and safe, what would it look like? It can be inside a hospital or free-standing. It can include any type of fixtures, spaces, or practitioners/assistants that you would think would help laboring women.

New Zealand midwife Sarah Stewart has taken this whole idea into the virtual world of Second Life, by setting up a virtual birthing unit there. Here’s a video of what that looks like. She uses it as a teaching tool for other midwives.

 

*obviously, in your home, you’re going to set things up the way you want anyway.

 

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Reader Comments (19)

Sarah Stewart also Twitters by the way: http://twitter.com/SarahStewart

April 15, 2010 | Unregistered Commenteremjaybee

For me, it's not just a question of LOOKS. It's so amazing your wrote this today because my boyfriend initiated a conversation to me where he pondered whether more home birth advocates, or women on the fence about birthing at home, would find the hospital more appealing if they made the environment more home-like. I said, maybe a few, but in the end. You can make it look like home, but if your policies stay the same what the hell is the point.

So for me, the sounds, the attitudes, the standard of care, all of that would have to change. A birthing tub is good, but I'd have to turn off the beeps and ticks of the machinery. I'd need to be able to dim the lights and keep them dim. I'd need the nurse to either stay in or stay out. The constant opening of the door bugged me to know end during my second hospital birth. I'd need a plush rug on the floor (I like to labor on all fours towards the end), I need my midwife and doula by my side. I'd need a MUCH wider bed, birth ball, birth stool and less sterile looking bathroom. Put some flowers in the bathroom, better colors, nicer shower curtain, and plants. Make the bathrooms more inviting, perhaps with a few candles light in there.

April 15, 2010 | Unregistered CommenterPatrice

Sure, it would be great to be able to have dim lighting, homey touches, birth ball, birth tub, ability to shift the bed out of the way in the room, and the nice things Patrice said about the bathroom. However, the most important thing is having staff who realize that every woman is different and the birth is not just a boring routine part of the caregivers' day, but a hugely important day in those parent's lives. It should be respected and not manipulated and rushed for outside agendas. Why shouldn't women be able to have intermittent monitoring, refuse procedures that aren't lifesaving, and give birth in whatever position they want to? Personally, I think this is impossible in a hospital setting, and only birth centres or birthing at home can meet such expectations. Hospitals have too many routines and there is a significant fear of lawsuits, so they will almost always be conservative and inflexible in their practices.

April 16, 2010 | Unregistered CommenterB

i can say i was truly blessed with my last birth. I think a big part of it was that I knew what I did and did not want in regards to care. we asked for the nurses who were natural childbirth friendly, and i swear they handpicked the next in line.

i did labor on the floor on all fours, and in the shower and even slept on a blanket on the floor.

i know the last thing you want to do in labor is fight, but if you know what's good for you in that moment then do it. have people with you who will be supportive and not "oh honey, just listen to the doctor/nurse/midwife."

i had a birth plan, and i realized there were certain things that in the end, I had to concede on. Like needing an iv, needing continuous monitoring. (35 week baby, induction for low fluids). But they had telemetry. Her heartrate stayed beautiful the entire time, which meant they left me alone except for a couple vaginal exams.
They wanted to pop my water, but I said no. I said no to cytotec, but said yes to the foley bulb for dilation.

Like I said. I think mostly, I was blessed with doctors/nurses those few days that were angels.

I agree with the above commenter that unless we change the standard of care, making something up to look like another doesn't do anything but mask it.

April 16, 2010 | Unregistered Commentermommymichael

It would involve caregivers that allowed women to labor in whatever position they chose for as long as they wanted, with intermittent monitoring and no expectations about speed of cervical progress, so long as mom and baby were doing well. Pitocin and IVs would very rarely be used. The laboring woman would be interrupted minimally (including cervical checks). Wireless monitoring would be available. Essentially, caregivers would lean toward minimal interventions, focusing on the fact that the vast majority of women never need any. If a Cesarean section was actually necessary, the OR would be warm and friendly, with an emphasis on involving the mother as much as possible in the delivery and bonding with the newborn.

April 16, 2010 | Unregistered CommenterKK

Another mom who attended my home birth I think hit the most important difference. Everyone there was quietly waiting for something wonderful to happen. They were not treating the birth as an emergency waiting to happen. They can change the wallpaper and the furniture, and that's all good, but until the attitudes change to say, Moms, this is your space, you say who gets to come in and what gets to happen, and everyone who does come in will just be waiting for you to make a miracle, to watch you climb a mountain or win a marathon...until then, we're still going to be better off at home.

Of course, even then they can't get rid of the car ride.

April 16, 2010 | Unregistered CommenterJulie

I think the bottom line isn't what the place looks like, or what amenities they offer. It looks like respect. Why don't more practitioners initiate the conversation to find out what a woman wants and feels comfortable with while in labor? Why don't more nurses take into consideration the vulnerable state of a woman and her comfort, rather than the convenience of the hospital? No one wants to be treated like they are intentionally making trouble when they are sick. You go to a hospital for help and safety and often that is the last thing a woman finds is the priority of her "care providers."

April 16, 2010 | Unregistered CommenterChara

Did anyone see that study where they removed the hospital bed and only brought it back in if/when the mother or dr specifically requested it? The rooms were made as "ambient" as possible - equipment was concealed, there was a tv and artwork and whatnot. Compared to the control group, there were better outcomes for women in these rooms, especially in terms of their satisfaction with the birth experience. And asking for the beds to be returned? If I remember correctly, it was usually the physician who asked for it because they didn't like having to deliver the baby on the mattress in the floor.

For me, an ideal non-home birth would involve things that, well, you can only get at home. Like Patrice, I think that the nurses need to stay either in or out, which is obviously impossible in a hospital setting. Definitely no monitoring, telemetry or otherwise - I prefer intermittent auscultation or nothing. Women need to be acquainted with ALL caregivers beforehand, every nurse and every doctor that will be attending her, because the presence of strangers is disruptive. Access to a shower and bathtub. Women labor best in a private, uninterrupted, dim, familiar, and safe location. Especially at the end, when her focus is so deep inside, she needs absolutely NO commotion in the room - and once she starts pushing, in a hospital all the activity really starts. So whatever instruments and equipment and extra people they think they're going to need, they need to either get it collected beforehand or do without it altogether. Doulas would be universally treated with respect and allowed to do their work without snide comments or other combative treatment. (I know this happens only rarely in most places, but still...)

Bottom line is, caregivers need to understand that birth is a normal physiological process. And if that is the case, why are we doing it in the hospital at all?

April 16, 2010 | Unregistered CommenterKaren

Its the education analogy again. Its nice if schools and classrooms are shiny and cheerful, but much more important is a teacher who is empathetic, intuitive, and skilled. Empathy and intuition in all birthing caregivers would go a long way to improve out-of-home birth too. And a different skill set - one that emphasizes patience and trust of the body over strict routines and a pathological need to intervene with nature.

April 16, 2010 | Unregistered CommenterMegan

Excellent points from all.

Just to clarify, I focused the question on out-of-home births for a reason; not all women are going to give birth at home, even in a perfect system. Maybe because they don't feel safe that far from medical assistance (or live in a rural area), maybe because they live in a tiny apartment with no room for a tub, maybe they have lots of pets and/or kids that would be in the way. Or maybe they're living with friends, or even homeless. But there will always be women who need to give birth outside the home.

Given that, what would a good birth for that woman look like?

April 16, 2010 | Unregistered Commenteremjaybee
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