Is birth becoming too managed?

[Erika]

Over here in Ireland, there are talks about starting up a birth lobby group because our birth choices are quickly being taken away due to fear and possibly due to some arrogant hospital masters. We are also the country that devised the Active Management of Labour :rolleyes. The master of the hospital that devised this (long before his tenure, mind) has even been on television debates with homebirth midwives denoucing the practice. With my own birth, while it was wonderful, I did have to be firm and refuse to allow them to actively speed it up.

Now, my question: Has birth become too managed and medicalised over the past years? If so, is it justified or could it be causing mental and physical harm to mothers? Should there be more birth choices? How much say should a mother have over her birth experience? and how much say should the medical establishment have?

[Kami]

I do feel as if it is becoming to managed with some doctors. I was induced all 3 times, they were all for medical reasons. I do feel that my deliveries with the last 2 would have been better for me, had they waited to induce me. However after delivering Brock, they should have done a c-section. IT was a horrible situation and at one point they told Chad he may have to decide whether to save me or Brock. I think that the dr.'s were in such a hurry to go about their day that they lost sight of what was important.

[Kristi]

I do think that this is the case with some drs. I think some dr's feel since they are the expert they have the right to tell a mother what she should or not do during labor. I had wonderful dr's with Caleb who let me make all the decisions about what I wanted to do. Same when I had Dylan. But when I got pregnant with Isabella since i ended up with an emergency Csection with Caleb my OB pretty much refused to let me have a VBAc and unfortunately since we were overseas and Tim is in the Navy and he was the only oB in the hopsital on base at the time I really did not have much say. I am all for the mothers deciding what they want to do. If you want to have things speeded up fine. If not fine. If you want pain relief then fine. If you want to do it without good for you. The dr's can give suggestions but i feel like sometimes they come off more forceful.

[Beka]

Yes- yes it is (and you know how manic my views on this are LOL we have had many a discussion over it) I think as a society and medical profession we have become far too keen on terrifying first time mothers making them chose high level pain relief and even c-section without ever experiencing if they can/can't handle the pain.

I was petrified about my first birth and if i hadn't have had a doctor who was kind enough to laugh at me and say "you're a woman you were designed to do this" i WOULD have taken a c-section or at the very least an epidural as early as they would have allowed, as a result of him "making" me go into labour naturally (in other words refusing my over zealous request for a c-section LOL) I have now had 4 fantastic drug free active births, though i acknowledge this isn't for everyone, nor does everyone had a threshold of pain that could encourage it i do believe there is a % of women out there scared about trying it with out ever knowing they couldn't handle it.

I do believe ultimately we should have choice as women but i do wish the medical profession would do more to make women see pain relief is still an option if they try natural birth and then realise they wish to have pain relief - it's very much put accross as an all or nothing scenerio and it doesn't have to be. My first birth i went in thinking it was going to get alot worse and i kept delaying drugs until it got too bad to handle- when it got to that stage i was told "Baby has lots of dark hair rebecca, one more big push" and i had my baby girl... 5 months before i had been sat in my doctors sobbing asking for a section.

I do believe we push too many women into induction for no medical reason which statistically is more likely to end in an emergency section, stitches, retained placenta and all other sorts of horrid stuff.

I think we massively fail women who have had a traumatic birth experience by not providing adequate counselling and support after it- i am sure many women would consider another child after a traumatic birth experience IF we gave enough after care and support to work through the events they endured.

I hate the fact it is largely happening through fear of law suits being pressed upon hospitals in the event something goes wrong in a birth- the more protected hospitals need to be over this the less choices women are left with as doctors will go with the option that offers less risk even if there isn't a signficant risk with the womans personal choices. Hospitals here are also becoming so crowded they are attempting to manage more births so they can shedule the freeing up of beds with enfuriates me! (when i had loks i met several women who were due over christmas week like myself who had been pressured into induction or schedule c-section to allow minimal staffing of the unit over christmas vacation!!!!!!!!- Loki was probably the only naturally starting, vaginally delivered baby on the ward.

In all of my labours (except my final one where they went all over my hallway) I have refused ARM (artificial rupture of membraines or breaking of waters by a dr) because there was no medical need other than them wanting to speed things up- ARM can increase risk of cord entanglement, increase the chances of back labour as the artificial breaking of waters can mean the baby isn't into the position he/she wants to be in for birth and makes it more difficult (I don't consider it coincidence that my only child where the waters went waaaaay before the pushing stage was the most difficult to come through and had his hand up by his head)

I have no objection to high medical management in high risk cases but the fact is many are now over managed purely for hospital logistics and the most amazing natural process we go through as women is robbed from some and traumatised for others.

I have issues truly i do.

Also i might add for our USA programs the majority of women in England sit watching American birth programs in complete state of jaw-drop as American births we see on television seem alot lot more managed than the majority here (something like over 80% of vaginal births in england are MW only ones- very rare you see a doctor in a delivery room in England, if you do here it's time to panic.)

[Cyndi]

Yes I do think it is. I think alot of choices are being taken away from mothers on how they want to do their births. Everything seems so rushed anymore.

[Lori]

I'd say "Yes, but..." ;)

Yes, I do think that in many ways both pregnancy and childbirth are too managed, but I think there are both valid and invalid reasons for doing it.

When it comes to tightly managing births for economic reasons--rushing moms through labor and delivery to make more room for new patients, inducing labor so that it's more convenient for a given doctor, or forcing a mother into a certain type of birth because it's most cost efficient--then I think it's just wrong, and it does happen way too much.

But, in other ways, I can understand why we manage birth so much. Women have been having babies since women have been around, but it used to be much more dangerous for both the mother and baby. We really do owe a lot of the safety we have in birth today to medical advances and medical management of prenatal care and delivery. Even if not every birth needs to be that medically managed--and I don't think they do--having the resources available is a great advance and is why giving birth is so, so much safer today than two hundred years ago, or why it's so much safer in the industrialized world than in developing nations.

I think the difficulty comes in balancing the choices that should be available to a woman when doing a very natural thing that usually goes just fine on it's own, and being as medically cautious as one can be. I think there are good and bad ways to work that out. I think simply making decisions based upon possible malpractice suits isn't a good practice, but it is understandable. When medicine is a for-profit enterprise, than a multi-million dollar lawsuit is a huge, huge loss that the insurance company or medical provider is not going to be able to take. That doesn't make it right, but it makes it logical. But, I do think that a doctor or nurse or whoever is doing the prenatal care and delivery might have genuine, non-cost-related concerns about a woman giving birth in a particular way, and while I wouldn't want to see any woman legally forced to do what they want, I do think it's wise to take that advice into consideration. Too much medical management in all cases seems like a bad idea, but in some cases medical management is necessary to ensure a safe pregnancy and delivery, and I can see a rationale for erring on the side of caution when we're talking about women's and newborn's lives being at stake.

[Mary]

Lori said it all for me! I know people have been "doing this for millennia" but how high was the survival rate for those babies? There is a reason for a lot of what they do and a good reason to err on the side of caution. But then there's a lot that they do that is simply for their own convenience and that's what I have a problem with.

What really tees me off is how they completely remove the choices from the mothers/parents. They come in with this attitude like they're the principal of the high school and you are going to do what they say or get expelled or something. They did it to me when I got to the hospital after Eliza was born. The nurses are in there telling me that the pediatrician was going to keep her for a while. Um, no, she wasn't. She was perfectly welcome to suggest Eliza stay a while and give me her reasons why and I was going to listen. But it was MY decision, ultimately, and if I wanted to take my baby and leave that night that's what would've happened. In the end we decided it was better to be safe than sorry as we felt she did have some legitimate concerns. They act like they have the authority to do all these things to you whether you want them or not and then they act like you're some kind of ignorant fool if you do question it or try to refuse. That attitude is what gets me most upset.

[Kate]

I fully agree that thanks to medical science maternal and neonatal mortality rates have fallen dramatically...but that ultimately, the one thing that did most to cut morbidity rates was thanks to Semmellweiss and handwashing and genral improved hygiene.

That said, when I look at the c-section figures here rising higher every year, and have it reported that the biggest reason for this happening is "convenience" c-sections in mostly private hospitals, I do have to agree things are being over managed.

I still look back at Maia's birth, and am grateful knowing that while it was managed, and a lot of things that happened weren't what I wanted, I'm still okay with them, because everything was done with my consultation, and when she was born it was obvious that they needed to be done - induction for post-maturity at 10 days overdue, Maia had no vernix left, and the placenta was calcifying, -forceps delivery due to heart rate dropping very dramatically and her cord was wrapped around her neck three or four times, and she was also in deep transverse arrest.

So while I had a managed birth, I'm grateful for that, but I'm even more grateful for a team of midwives and a doctor who were perfectly content to let me labour my own way, yet were able to help us when (not if) we needed it, and for that reason, I don't feel "robbed" of my birth the way I've heard other women describe their overly managed births...for that reason, I wish every woman were able to have the options I had.

[Erika]

It really is wonderful that the mortality rates have dropped so much. But it really does disturb me that so many choices are taken away from mothers. While physically the survival rate might be good, the mental health of a mother is very important and seems to be forgotten about in the rush to follow hospital and doctor protocol and get as many women in and laboured and babies out.

I had to really fight to get off the monitors, to be able to walk the corridors rather than be confined to bed. I had to quite firmly decline pain meds as that was the first thing they tried to push on me. I have no problem with a mother using pain meds. I just didn't like the feeling that I was expected to have some and I was somehow wierd for not having it.

I think doctors and hospitals are fabulous for high risk births. I will always be grateful for how well Sasha was taken care of in the NICU afterwards (although I do have issues with the way I was treated by some of the staff). But I do not like the way we are expected to go by their policies rather than what works for us during labour. Pushing interventions leads to more interventions which leads to longer recovery periods and higher post-birth mental trauma.

[Erika]

I also want to add though that over here the main problems are that there are no alternatives. You either have a hospital birth and go with their policies or you go for a homebirth. There are no birth centres.

In the hospitals there are now midwife-led births and you will see only a team of midwives and will have as non-medicalised birth as you wish, although in the hospital. I think this is a great development but unfortunately there are restrictions on it. So for someone like me, the only option is the hospital birth. My OB was mostly dismissve of my views and wishes and seemed to think birth plans were unneeded. He even told me rather than ask me, that I would be induced (thankfully that didnt happen). I am so glad that he wasn't around the day I gave birth as I doubt it would have gone as well.

As for other alternatives, waterbirths have been suspended due to a fatality a few years ago. It was tragic but I think suspending all waterbirths was a knee-jerk reaction. In one of the main hospitals, all homeopathic treatments have been banned (reflexology, arnica, etc). In another, you aren't allowed give birth anywhere bar your bed. Active births are discouraged or not followed at all. This is what really gets to me.

Most births are problem-free and not emergencies and thus shouldn't be treated as such. And maybe if less interventions were pushed on labouring mothers, there would be far less birth problems. It also galls me that policies seem to be made by men who will never go through the birthing policies rather than women and midwives. That is not to say that male OBs are a problem. They are highly skilled in the birth process and save lives. But they will only ever see birth from a medical side, never the actual experience.

[Kate]

I agree with you entirely, Erika...and you've expressed what I was trying to say, but so much more eloquently.

I tried to use a precis of Maia's birth as an example of how a birth that needed intervention could still be handled sensitively, and with full choice, but I neglected to touch on the other side.

I think a big part of what made things go so well for me is that I was delivering in a hospital that was aiming for UN Baby-Friendly status, and part of that involved doing something radical - treating the babies mother's like they were human beings, so while I had an epidural, it didn't happen until I was in labour for 24 hours, and only then after I specifically requested it, before then I had the midwives getting me hotpacks for my back pain, and massage, and wallowing in the spa, and walking, and I'm so very glad I was able to have that kind of support...and I wish that every woman was able to have that.

[Lori]

Kate and Erika, ITA with what you're saying. I guess I'd see the problem less as being medical management of birth, and more of being bad medical management, where the woman is just seen as a body the doctors are going to do their work on, rather than as a fully capable human being who can be an active participant in her care.

As I said on another thread, that's a big reason why I'm so wary to TTC here. So far I haven't found a health care provider who I feel treats me as a capable human being, and I have a feeling it would be worse if I were pregnant.

[Kristen]

I'm sort of on the same page as Lori. I'm happy the mortality rates have dropped so much, but it does seem that there are an awful lot of unecessary C-sections happening.

In my own case, I felt, for the most part, like I could do what I wanted to do. I got to be out of bed to squat and push, I got to get up and walk when I wanted to, I didn't get bugged that much to have an epidural, I got to have perineal massage instead of an episiotomy, etc.

I had good, uncomplicated labors, though, so maybe my opinion is colored. and the hospital at which I gave birth all four times is just really, really outstanding and wonderful.

I was induced twice, but the decision was left up to me, and inducing me consisted of popping my bag of waters, and that was all. No gel, no pitocin. My induced labors were just like my non-induced ones, except I didn't have to go in the middle of the night and finish packing my bag while in labor. :p