So what does "good" look like?
Thursday, April 15, 2010 at 7:10PM
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.
Reader Comments (19)
Sarah Stewart also Twitters by the way: http://twitter.com/SarahStewart
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.
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.
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.
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.
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.
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."
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?
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.
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?
Attitude and respect are the most important things. And avalibility of, or to bring with you, those "comforts" (ie birth ball, birth tub) that I want is also important. I think these things work together in creating the perfect birth situation. What good is having the comforts, if not allowed to use them because the people around you insist you must be in bed or on the monitor or on an IV? For the most part, you can always carry in any comforts you want. I have a friend who when she had to transfer, brought her birth pool with her and was allowed to use it! The biggest reason I'm planning a Homebirth with this pregnancy is I don't want to strapped to the monitor, so close to a tub to labor in yet so far (as a VBAC mom my CNM required CFM and I couldn't get in the tub), and I don't want a needle sticking in my arm my entire labor, just begging for IV fluids (all too tempting for my CNM, as I found).
I think everyone has such great points so far. Mine would be:
- Aura/ambience of anticipation and joy. It's amazing what the nurses, midwives, and OBs can do to a room just by their presence to make it a joyful, peaceful, welcoming place... or a stressful, fearful, unwelcoming place. A midwife who loves her job and her mamas can make even a "medical"-looking birth (necessary induction, epidural, etc) a wonderful experience... Just as one who resents her job and doesn't care for her mamas can make a candlelit homebirth a nightmare.
- True desire on the part of HCPs for mothers (and fathers!) to make truly informed decisions based on what the evidence says and what is best for them. No agendas other than to help families make their own choices.
- Holistic care -- i.e., not just focusing on medical issues, but dealing with women as human beings rather than walking uteruses and vaginas.
- A setting or layout that is conducive to the above. In other words, one that supports happy, positive nurses, midwives, and OBs. One that fits the informed wishes and choices of parents. One that encourages HCPs to deal with women as human beings.
I gave birth to my son attended by a CNM at a hospital "birth center" *read: glorified L&D unit* and my daughter at home. I prefer my house to my hospital experience.
I suppose staffed by midwives, OB's as well (but only the "hands in pockets" kind). I envision a victorian style house with bedrooms and a "common" area for attendants and family to go to when laboring women want to be left alone. There would be large beds, carpeting (my sister birthed her son at home using every possible position for pushing and I can't imagine being on all fours on a tiled floor!) Birth balls, rocking chair, comfy chair, bathroom with tub and shower (homey fixtures...none of that locked soap dispenser on the wall, paper towel malarkey). If there needs to be monitors or anything medical (oxygen etc) it should be in an unmarked closet. Radio/CD/MP3 player, dresser and mirror, small lamps, access to food and drink as mother wanted
Basically all the stuff we would want in our bedrooms and bath rooms. Oh, there would be a garden as well. A lovely garden with paths and benches.
I also think having a prenatal appointment, like say 36 weeks, in one of these rooms would be great. Touring a facility is nice but you can't really get a feel for a room unless you spend some time there.
Keeping in mind that in my dream world there is universal health care/insurance, so there is no question that ANYONE would have access.
Physically the ideal out of home birthing space for me (which is already less than ideal, being out of my home), is one that most mimics home. Rugs, control of temperature, food and water/Gatorade readily available, tub I can get whether or not my waters are broken or someone else is using it (ie, there would need to be a tub in every birthing room), large floor space in the room in case I don't want to be on the bed, ability to dim the lights if I want, or play music, or do whatever. No dinging machines or bustle in and out of my room except minimally to check on the baby. No monitors, only monitoring by intermittent fetoscope, if at all, and rare checks (every few hours) on blood pressure, heart rate, temperature, etc, except in situations that otherwise merit more frequent checks. *NO* vaginal checks except as requested by mother.
More important than all these things however, is respect. How many women do we hear want to refuse a c/sec, and are forced into one? On the other side, you hear the same story...women screaming for a c/sec knowing that something is wrong and they are ignored, with dire consequences. This second bit is why we are in the mess we are in, because care providers used to just ignore women and say "labor hurts, get over it" or something of that nature and save the c/secs for women that could afford them, not necessarily women who *needed* them...now we've gone completely the other way to where we force c/secs on everyone. The thing underlying all this is an attitude of disrespect toward women which has not changed. Women (including women in labor) are fully functioning intelligent human beings capable of directing their own care, and care should not be dictated. Yet, women who seek care must also be responded to, not ignored, and certainly not ignored with some snide comment about how you won't do this again (go and get pregnant). Until we have care providers that respect women's autonomy and right to direct their own care, the whole discussion of out of home birthing spaces is only secondary, IMO. Until care providers understand that their own trauma when something goes wrong at a birth is nowhere near what the mom and family will experience, work through their own fears themselves instead of imposing arbitrary restrictions on moms, no amount of candles, birthing tubs, dim lights, comfortable beds, birthing balls, etc. will truly change things. It's just lipstick on a pig.
HTH!
Thanks for highlighting the work we're doing in the virtual birth unit. What we have found worrying over the years is that some of our student midwives (our future midwives) have limited exposure to women-led birthing environment and practice. The virtual birth unit starts the thinking about birth environment and what it means to 'midwife' in the context of women-led birth as opposed to hospital-led birth. Please feel free to get in touch if you would like more information, or would like to be shown around the birth unit in Second Life. We will be doing tours on the Virtual International Day of the Midwife on 5 May:
http://internationaldayofthemidwife.wikispaces.com/International+Day+of+the+Midwife+2010
best wishes, Sarah
I love the book "Birth Territory and Midwifery Guardianship." The chapter on MindBodySpirit architecture is particularly pertinent for this discussion.
Sarah, if you're reading this, I watched quite a few 2nd Life virtual birth videos and was puzzled and frustrated by a couple of things. Even the births in really natural environments with birthing balls, water, midwives, etc., shared some common themes: attendants/nurses in scrubs and *masks* (which you don't even see in the most medicalized settings *all the time*), and babies being immediately whisked away from mom to be cleaned, weighed, circ'ed, etc, held by gloved/masked nurses. Is this the kind of stuff you're trying to create awareness about?
I'd add:
Caregivers who look the woman in the eye when speaking to her, who follow her cues as to when she can/can't respond (i.e. not mid-contraction), and who aren't afraid to touch the woman on the shoulder, knee, etc for encouragement.
A doula for every woman.
No "birthing bed." A place to rest comfortably, but not an uncomfortable contraption that raises/lowers/breaks apart.
Hi Rixa and Laura
What I must point out is a difference between role playing that happens in SL for fun and the virtual birth unit we have developed for midwifery education. The videos you see on YouTube are mostly posted by people role playing pregnancy & birth for fun. The use we have put SL to, is for student midwives to practice their assessment, decision-making, communication and documentation skills.
What would be fabulous would be for doulas and mums to have a look and work their way through the scenarios and give us feedback so we can continue working and developing the resource for midwifery education.
If you'd like more information, please don't hesitate to contact me.
sarahstewart07(at)gmail.com