Sunday, February 1, 2009

Why NOTJust a Hospital Childbirth Class?

After the home water birth of our third child, it was becoming evident that I was going to have to teach childbirth classes. I was bombarding every pregnant woman I encountered with information about why natural birth was the best (remember, I have done it both ways) and she shouldn't even consider the epidural. I found myself warning moms-to-be about the interventions in the hospital she was certain to encounter. I loved playgroups and baby showers, as they were places that these topics were certain to arise.

Abby was nearing her 2nd birthday when I finally decided to send in my application to be a Bradley instructor. I was consumed with information on natural birth for the next several months. I lived and breathed it. I had some anxiety about how I would get students in my class. The internet, even in the last 6 years, has come a long way. The Bradley website was in its infant stages, for sure.

I remember calling one of the local hospitals and talking to them about teaching natural childbirth classes there. She laughed and told me, first of all, that no one wants a birth without medication; and second, I would not be allowed to teach Bradley in a hospital. The curriculum was set. I would not be allowed to teach why an IV is not necessary, or why intermittent monitoring is safer for mom and baby than continuous fetal monitoring. The list goes on and on.

Yes, I would have more people in my classes, but I would be working for the hospital. Not for my couples. I could not teach them about evidence-based care. I knew immediately I couldn't teach in a hospital. Women deserve to be informed. I, as an Independent Natural Childbirth Educator, do not work for any doctor, hospital, or even a midwife. I work for the couples I teach. I am not restricted on the information I can teach. Most childbirth educators in the hospitals are extremely frustrated by this, and yet, their hands are tied.

Here is a rare-known fact: A hospital needs to maintain an 80% epidural rate in order to keep an anesthesiologist on the clock 24 hours a day. It's big money. Every intervention racks up a bigger bill. The hospital wants you to have the epidural! They don't want you to have information that will empower you to make better choices that will cost them money. This is absolutely true. U.S. hospital policies are based on financial considerations. They are not based on evidence, research, or good medical care. Birth is the largest source of income for American hospitals totaling more than $50 billion dollars on childbirth, more than any other country in the world, and yet with some of the worst outcomes in infant and maternal mortality.

Don't you see the irony? It's a natural process, that, if allowed, doesn't need intervention. But what a money-maker. It reminds me of "A Bug's Life," where the ants do whatever the grasshoppers say because they are afraid of what might happen if they don't. The grasshoppers know that the ants could overpower them in numbers, but they do everything they can to intimidate the ants to "keep them in their place." The grasshoppers even convince the ants that there are bigger bugs that they will protect them from, but in reality, the only ones they need protecting from is the grasshoppers. Don't you love the end of the movie when Flik sees the fear in Hopper's eyes and he realizes that they are stronger than the grasshoppers, that it is the grasshoppers that need them -- not the other way around?

And so it is with the doctors. They create fear. Childbirth classes in the hospital prepare you to be a good patient, not a good consumer. You are told what to expect when you get to the hospital. There is no preparation for natural birth. It's not "if" you have an epidural, but "when" you have an epidural. Notice the way it is phrased, also. The epidural is given ownership. Women say "my epidural," not "an epidural." The nurses say things like, "Honey, you better get your epidural now while you still can."

If you are giving birth in a hospital, I actually do encourage you to take your hospital's childbirth class so that you know what they expect of you. Learn their policies. I've been told by people who have done this that the hospital is like "training wheels" for my class!

People are reading this blog all over the country. If you are interested in doing my class by DVD, great. I'll get you all set up. Regardless of whether you are able to take my class, you need to be in an independent class, outside the hospital. Be sure your instructor works for you and no one else. You'll get the evidence-based information you need and deserve.

Women don't need all this craziness surrounding birth. We certainly don't need to be spending the kind of money that we do in order to get our babies out of our bodies. Your body will do that all by itself, for free.


Kristina said...

Someone I know and I argue about this sort of thing all the time. While her doctor was pro-natural birth and very progressive, she doesn't seem to get that her dr is the exception, not the rule.

Shannon and Casey said...

My husband and I learned so much taking your class through the dvds that we would have never known otherwise. We were encouraged to take a class at the hospital, but we didn't do it because we thought it would be a waste of time. I am so glad I had a midwife and not an MD!

Donna Ryan said...

Kristina, I understand your frustration. There are doctors out there who are on "our side," but they are far and few between. I know in this blog, I lump all doctors into one awful category.

But what I often see is this: even if you have a doctor who encourages natural birth, the practice he/she is in, does not. Or the hospital does not. It's frustrating to make all these birth plans with your doctor, only to get a different doctor at the time of birth.

Unfortunately, the only way women often learn this is by experience. I had a student a few years ago that "loved" her doctor. She said he was willing to "let" her do whatever wanted (based on the hospital she was at, I highly doubt that was possible), but when it came down to it, he wasn't the doctor attending her birth. The doctor she had was insistent on being the one in control of her labor. She wasn't having medication which didn't help with this doctor. Without getting into all the details, he wouldn't let her get up to go to the bathroom. He told her she could be catheterized or use a bed pan, but she was NOT getting out of the bed. To make things (much) worse, when she was pushing, the doctor started saying the baby was in distress. She said she knew she could get the baby out -- just let her squat -- and he said that he would absolutely not allow that.

Yadda, yadda, yadda, she had a C-section. He called it an emergency C-section, but if it were truly an emergency, she would have been given general anesthesia. Instead, she was given an epidural and the baby was born about 20 minutes later.

This same mom had a VBAC less than a year-and-a-half later and is now a doula to help moms who find themselves in this same situation.

I hope your friend doesn't end up with a similar story, as I'm sure you hope for the same thing.

Kristina said...

Isn't that the way it usually goes?

And the thing is, I'm not anti-doctor. I just believe they have their place. I've often said something to the tune of: If doctors would just treat their patients as human beings instead of just numbers, listen to them, and actually do what is in their best interest, they would put mws out of business. But I don't see that happening anytime soon.

I'm not saying all docs are bad. I've had some very compassionate ones that actually took the time to know your name and really care. And I've had ones like my last gyno who actually made me cry.

But like you said: There are pro-natural birth docs out there, but they are few and far between, and where they practice are often not so pro-natural.