Dawn Thompson is founder and president of ImprovingBirth.org, and has worked as a doula for over ten years--specializing in supporting women who are seeking Vaginal Birth after Cesarean. She had three cesarean sections before a vaginal birth with her last child. This article begins with her first surgery.
At ImprovingBirth.org, we hear from women all the time who felt they were pressured or coerced into a major medical intervention in birth, like an artificial induction of labor or a cesarean section, that they just weren’t sure about. But for the majority of women, misinformation about these and other maternity care practices is often delivered quite differently: in a kind, convincing, and non-threatening way.
Take my own story, for example: I went to the obstetrician that my primary care provider recommended and insurance covered. I went to the childbirth classes offered at the hospital. I read “the” book everyone said I should read. I didn’t love my doctor, but he was fine, and I didn’t realize that it mattered that much, anyway. He was an ObGyn; they all learn the same things, right?
I went into labor six days past my due date, and ran to the hospital in the middle of the night after just a couple of hours, when my contractions were roughly five minutes apart. By the time we pulled in to the hospital parking lot, my contractions had slowed down to about ten minutes apart, but I was admitted, anyway, at two centimeters dilated.
The contractions continued to come slowly, but by morning they were spacing out even more. What I now know is that this is completely typical. Labor often starts at night, dissipates as the sun comes up, and starts again on its own after mom has had time to rest—almost like the body is revving up for a running start. I didn’t know at the time that I didn’t need to be admitted in the first place, or that I simply could have gone home that morning and waited for labor to really begin. I didn’t know that lying in bed, as I’d been told to do, tends to slow or even stop early labor; I didn’t know and no one told me that staying mobile encourages it to progress.
The doctor stopped in that morning before his office hours and told me labor had stalled at three centimeters. “We just need to help your body out,” he said sympathetically, several times. He was kind, never pushy or bossy. We thought, “Of course, he knows better than us. If my body needs help, let’s do it!”
No one told me the risks of Pitocin, other than that it would make me have contractions.
It almost seemed like the “natural” thing to do, since my body “naturally” wasn’t having contractions on its own—right?
I always knew I would want an epidural, and I asked for one as the Pitocin-induced contractions started to get intense. Why on earth would anyone do without pain medication? That just seemed silly to me. Moments later, I was singing its praises and the anesthesiologist was my new best friend. A few hours later, however, I’d progressed very little, only another centimeter or so. My doctor came back during lunch and decided my body needed even more help. “Let’s break your water,” he said—always kind, never rude. I’d been up all night, and I wanted to see my baby. I didn't ask questions. Instead, I said, “Let’s get this show on the road!"
After the doctor broke my water, things started moving quickly. The nurse kept coming in and looking at my baby’s heart rate strip. Then she brought in another nurse to take a look at it. No one was telling me anything. I kept asking if everything was ok. “Yes,” they would say, “We're just keeping an eye on baby.”
They decided my baby needed an electrode on the top of her head to be sure they were getting the heart rate clearly, and I quickly agreed.
Within another few minutes, the doctor was in my room and talking about decelerations in the heart rate and saying my baby wasn’t tolerating labor well. They needed to do a c-section right away. “Your baby is in DANGER!” they said.
I did what any rational mother would do—I did what I was told was best for my baby.
I never even questioned it. Never in a million years would I risk her life, even though the thought of having surgery left me sobbing and scared out of my mind. I was about to be cut open, but it was for the good and well-being of my baby.
I came away from that birth feeling like I had absolutely done everything I could, and that my doctor had done everything he should. I believed it when he told me I was so lucky, that I would have likely been one of those women who died in childbirth back in the days before modern medicine. I LOVED the drama of that story. I told it and retold it with all my heart.
The truth was, it felt like I needed a good reason why I just “had to have” that C-section. This belief served me well.
I carried that story for many years--through two more C-sections that happened only because I'd had that first one. I helped friends through their births and I would dream of someday being a midwife. It wouldn’t be until ten years later, in a doula training class, that I would be presented with the truth, the truth about the “snowball effect” and the “cascade of interventions” that so many first-time mothers fall victim to. I saw the truth of it, and I cried.
My first emotion was deep sadness. Then, there was anger at the doctor for not just sending me home and potentially avoiding the whole sequence of events that led to an emergency cesarean. Any medical professional with more than a passing familiarity with childbirth would have known that early labor with my first baby needed patience and gentleness—not monitoring, confinement, and deadlines.
The emotion that stayed with me the longest was disappointment in myself. Coming to terms with my ego was, by far, the most difficult part. I had to admit that I didn’t know any better and that I just believed everything I was told. I didn't ask enough questions. I hadn't protected my baby like I should have. And then came indignation: “Why wouldn’t I, shouldn’t I, have believed everything my doctor told me? He was the one that is trained, the one I hired to deliver my baby because it’s his job. Why on earth wouldn’t he be giving me the most current and accurate information?”
It would take me years to understand the “why” and, honestly, even ten years after hearing the truth and being a birth professional in our system of childbirth, a simple explanation eludes me.
I think obstetricians--including the one who made so many errors in my first birth--are mostly good people. I believe they want what’s best for you and your baby. But I also think that, like anyone else, they can be susceptible to mistaken beliefs from the bigger system in which they work. Those beliefs are where hospital routines and long-time industry practice overrule common sense and current medical research. “Re-educating” care providers with the best information about science and practices isn’t as easy as just handing them that information and expecting them to change.
Recently, I read an article about how people learn and how they can learn “better,” and I think this states well the dilemma in updating U.S. maternity care practices:
“The most important thing to realize is that just telling isn’t enough. Most methods of instruction and training assume that if you provide [people] with the right information, it will replace any mistaken information they may already possess. But this just isn’t so. Especially when our previous beliefs (even though faulty) have proved useful to us, and when they appear to be confirmed by everyday experience, we are reluctant to let them go.”
This is where a fundamental issue lies. Even when presented with new and accurate information, it is difficult to let go of a previous belief, especially when the old belief proves useful. In this case, the “usefulness” is often that the hours of working birth stink. Yes, it’s much, much easier to rely on ways of “controlling” the rhythm of birth--like with artificial inductions and scheduled surgeries--rather than “working with” the rhythm of birth in a way that lets the body set the pace, even when “working with” birth is best for moms and babies.
It’s only natural that providers who work a certain way will buck the information that challenges their core beliefs and their livelihood.
Things will only change when:
1. We start allowing the next generation of providers to use current information and practice evidence-based care;
2. We present that information and those practices to the seasoned professionals in a new, convincing way; and/or
3. We create a confrontation.
“For the most tenaciously-held beliefs, it may be necessary to stage an intervention,” the article says.
The Rally to Improve Birth is just that: a massive intervention.
We are rallying to bring awareness to a glaring problem that affects most of the people in this country—mothers, mothers-to-be, and the babies being born within our system. This increasing awareness needs to take place among not just providers, but the people who are receiving the care they provide. A national survey released just this month confirmed that while large numbers of women are receiving non-evidenced base care, most of them still express satisfaction with it. So many women are unaware of just how much room for improvement there is in our maternity care system, of how much of our “routine” practices differ from what current scientific evidence tells us is best for moms and babies.
We’re also rallying to bring awareness to a solution. A big part of the solution is you: the families whose business drives the system. Can you imagine what we might accomplish if we recognized how much power we truly have? If we banded together and demanded change, and demanded to be a part of that change?
The 2013 Rally to Improve Birth is our opportunity. It’s a peaceful, family-oriented gathering to deliver a big, bold message: There’s a big problem in American maternity care, and we demand a big solution. We’re willing to be a part of it, and we’re willing to start right now.
This is our one-of-a-kind chance this year to bring our many voices together as one, and to be heard. Join us.