Andrea’s Weblog

I feel I need to backtrack in order for people to understand why we are considering a homebirth with our next baby. We learned a lot from Elizabeth’s delivery that opened our eyes to the how the medical community functions, particularly those involved with labor and delivery. Many of the decisions the L&D folks put in front of you are a result of the following observations:

The hospital wants to make money. A lot of things fall under the umbrella of “hospital policy.” Hospital policy is designed to make the hospital run efficiently. For example, the most efficient way to monitor a woman in labor is to hook her up to machines and monitor the information from the nurses’ station. “Hospital policy” requires nurses to hook every mom up to an IV and fetal monitor as soon as she steps in the door, because it requires more staff and time to go to a patient’s room and physically check the fetal heartbeat and mother’s blood pressure. (You can refuse to go along with a hospital policy, they might ask you to sign something, but you have the right to refuse.)

The doctors want to minimize the time they spend at the hospital–especially the trips there in the middle of the night. It is more efficient for them to keep a regular schedule which allows them to see more patients. The result is that they like to induce babies and seem to have their own opinions on how long labor should take. They don’t hesitate to speed things up if the labor is taking “too long”. The more control over labor an OB has, the more convenient it is for him. OBs have a whole arsenal of techniques and drugs to help labor “progress” such breaking your water, pitocin, and finally cesarean section.

The doctors are concerned about liability. OBs spend a bunch of money every year in insurance to protect themselves and don’t want to see that figure to go up. This is definitely a factor in the skyrocketing cesarean rate in this country (29% in 2004.) Many hospitals will not allow a woman to deliver vaginally if she’s had a cesarean due to the risk of uterine tear. This is despite a reportedly less than 1% chance of tear. (Cesareans also generate more money for the hospital and minimize the OBs time at the hospital.) In my experience, many OBs will opt for a scheduled cesarean if the baby is deemed “too big” during ultrasound examination. Seems like the best option for the doctor and hospital, but not the baby and definitely not the mom. The maternal mortality rate is 2-4 times higher with cesareans.

I’m not against hospitals staying in business, doctors having a home-life, or doctors not wanting to take risks that could increase their liability insurance, but when it comes at the expense of mothers and babies, you have to draw the line somewhere. Mothers have a right to informed consent. Would I have consented to pitocin when I did if my doctor informed me that there was an increase chance of fetal distress, uterine rupture or cesarean? We probably would have opted to keep laboring naturally despite our OBs eagerness to see labor “progress.”

It is my hope that with the next labor, no matter who is at the delivery, that we will follow the advice on this website and ask:

• Why do I need this drug or procedure?
• Will my baby and I be healthier for taking it or having it done? Or is it routine?
• What are its known side effects?
• Will the benefits outweigh the side effects?
• What is the risk to me or the baby if I don’t take it or have it done?
• Are there alternatives that can be tried before this procedure/drug?

Maybe if more people start to question the routines and policies the medical community has adopted, more moms will have better birth experiences and both moms and babies will be healthier.