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Burgers and Birth: Can You Have It Your Way?
by Laura Lund, HCHI, AICE
www.BirthNaturally.org
Copyright 2007. All rights reserved.
.pdf version is
here.
Let’s
say you’ve decided to go out to eat. As you’re
driving around you see a few different options and
you choose to go to a burger establishment. You wait
in line and when it’s your turn you say:
1. “I’ll
have whatever she had” (pointing to the woman who
just ordered);
2. “I’d
like a number 3 meal”;
3. Or
maybe you want to customize it a bit and you say
“I’d like a number 3 with no mayonnaise, no pickles,
heavy tomato, and cheese.” No problem, right? They
should be able to handle those variations (although
you’ll probably have to repeat your instructions at
least once).
What
would happen if instead of ordering something on the
menu you said, “Hi, I’d like a fillet mignon steak,
cooked medium-well, with a baked potato, steamed
asparagus with hollandaise sauce, and garlic bread.
I’d like that served on fine china and I’d like to
sit at a private table for two with candlelight and
a white linen tablecloth.” Would the burger employee
say, “No problem, ma’am, we like you to ‘have it
your way1’?”
Unlikely, since that isn’t the type of service or
food that a fast food restaurant normally provides.
They don’t stock that kind of food and probably
don’t have the equipment or knowledge of how to
prepare it, either.
The
fast food worker would more likely say, “I’m sorry,
ma’am, we don’t have those things here.” Or maybe
he’d say, “Um, I’m sorry, ma’am, but we only serve
fast food, not gourmet food. If you want gourmet
food you should go to the sit-down gourmet
restaurant across the street. Otherwise, please
order something on the menu.”
Now, at
this point, you could decide to go with one of the
first three options and stay at the burger place.
Or, if you decide that you really want that gourmet
meal, you’ll find a restaurant that caters to
delivering that type of meal as a normal matter of
course.
The
reality of hospital births is that hospitals are not
generally set up to cater to the individual desires
of each woman that comes in to give birth there.
Certain requests can usually be accommodated without
a lot of fuss or bother, like requesting a fast food
restaurant to hold the pickles and the lettuce. If a
woman comes in wanting to wear her own clothes or
listen to CDs or turn off the lights, no one usually
cares about that.
Other
requests come closer to requesting fine dining in a
fast food joint. If a woman comes in declining a
routine IV, choosing to eat and drink as she
desires, opting for monitoring 10-15 minutes per
hour instead of all the time, declining pain
medication, avoiding pitocin or other interventions
to “speed things up”, getting into the tub or shower
even after her water has broken, and pushing in an
alternative position such as a squat,
some
doctors, nurses, or midwives are going to have a
difficult time feeling comfortable with those
requests. A few of those choices are against typical
hospital policy and the rest of them are likely to
be
very
different
from the types of births most hospital care
providers and nurses usually attend. They may not be
prepared to support that type of birth and they may
not feel comfortable with those sorts of requests.
Now,
it’s not really your problem if your requests make
anybody else uncomfortable.
The birthing mom is the boss, period.
However, as you make choices regarding your baby’s
birth, including what you would ideally like to have
be a part of that birth experience, you need to make
sure that you are
wisely
choosing a care provider and birth location that are
conducive to the type of birth you’d like to have.
Hospital birthing moms may find that they need to
exert more effort in communicating their ideal birth
preferences
and
they may find that they need to make concessions
regarding certain aspects of those birth
preferences. A hospital birthing mom may find a
compromise that is still ok or good enough for her
while also allowing her doctor or nurses to feel
more comfortable. For example, a woman who may not
have wanted any vaginal exams may find that she’ll
agree to having one upon admission and one prior to
pushing since her doctor feels very uncomfortable
about not doing any. If she feels ok about that
compromise after considering the benefits and/or
risks of that course of action, that’s fine. It’s
her birth experience.
Moms
who choose to give birth outside of a hospital
typically find that they have many more automatic
birthing options—akin to having a caterer or
personal chef create a meal that is customized for
your tastes and desires. A woman who desires to give
birth without any routine or “just because”
interventions as well as the freedom to do pretty
much whatever she likes during her birthing time
would do well to consider birthing outside of a
hospital, where that type of birth is pretty much
the norm. A woman who wants the postpartum period to
be more relaxed and low-key (no routine procedures
for the baby, no separation from the baby, etc.) may
also prefer out-of-hospital birth. Planned home and
birth center births have been proven to be at least
as safe as hospital births for most women and
babies.2
There is a very large body of research available
documenting the safety of planned out-of-hospital
births.3,
4
The
bottom line is that you
can,
for the most part, have it your way. You need to
decide for yourself what “your way” is, exactly, and
where and with whom you’re most likely to be
supported to give birth in the manner that best
suits you. Are you more likely to have your ideal
birth in a high tech hospital with a surgeon (OB/GYN)
attending? Are you more likely to have your ideal
birth in a smaller community hospital with a family
practice doctor or CNM attending? Are you more
likely to have your ideal birth at an alternative
birth center or at home with a midwife attending?
These choices are aspects of your baby’s birth that
you
directly
control
that have an
enormous
impact on what kind of birth experience you
ultimately have.
It’s really very important that you carefully
research
and consider
all
of your options and choose the option with which you
feel most comfortable, whatever that option may be.
If a
woman decides that an OB/hospital birth is her best
option, does it follow that she should just choose
any old random OB that happens to be on her
insurance list? Are all OBs the same?
I’ve
attended births with OBs that respect a woman’s
wishes and strive to meet those wishes
even if they don’t personally agree with all of her
choices.
These OBs offer their opinion and the facts and then
leave it to the woman to decide.
I’ve
attended births with OBs who use fear,
misinformation, and anecdotes to manipulate a woman
into complying with
his
wishes and desires. After all,
he’s
the expert.
He’s
the one that went to medical school. This type of OB
typically feels strongly that the only birth plan a
woman should have is, “Go to hospital. Have baby.”
He believes birth is dangerous and needs to be
carefully monitored and manipulated in order to be
“safe”. I’ve heard this type of OB say to a mom
whose progress has stalled for a few hours that
she’d better start dilating again or else she’d have
to have a c-section. After waiting an hour I heard
this OB say, “this is just Mother Nature’s way of
telling us that it ain’t gonna happen this way.” He
then proceeded to inform the mom (who was in tears)
that c-sections are actually better and safer than
vaginal birth anyway (not true!)5,
6,
so she shouldn’t be upset.
Which
type of OB more rightly deserves the trust of his
patients? Which OB would
you
rather have? How can you tell which type you have
right now?
Well,
for a start you can ask
lots
of questions. Find out what s/he thinks about
natural birth (birth without interventions or
medication). How many of his/her patients give birth
without IVs? How many need, in that OBs opinion, to
be induced? How many need, in that OBs opinion,
c-sections or episiotomies? How many give birth in
“traditional” positions such as semi-sitting vs.
“alternative” positions like squatting? How does
s/he feel about a birth in an alternative position?
How does s/he feel about intermittent vs. continuous
monitoring?
As you
have this discussion with your care provider, watch
his/her body language and be careful with your own
wording. You want to ask the questions in such a way
that you aren’t leading his/her response (you want
your care provider to be honest rather than just
tell you what you want to hear, which doesn’t help
you). You want to ask open-ended questions like
“what do you think about” instead of yes/no
questions. Of course you will want to avoid asking
questions like, “How often do you cut episiotomies?”
because s/he’s likely to respond with “only when
they are necessary”. That doesn't tell you anything
because some OBs think they are necessary 100% of
the time! Instead, you might ask, “About what
percentage of first-time moms do you think end up
needing episiotomies?” (or c-sections or continuous
monitoring or IVs, etc.).
(By the
way, Henci Goer has some excellent ideas for
questions to ask and how to interpret a care
provider’s responses in her book
The Thinking Woman’s Guide to a Better Birth.)
If a
doctor says that 80% of first-time moms need
episiotomies and you are a first-time mom, what are
your chances of “needing” (and receiving!) an
episiotomy if you choose to use this doctor? Are you
comfortable with those odds? Can you trust that
doctor’s judgment on whether or not that episiotomy
is truly necessary? Do you want to be in a position
where you have to wonder whether or not an offered
intervention is needed?
Choose your care provider carefully!
Obviously there are questions that can and should be
asked if an intervention is offered, but it is
much easier
to avoid unnecessary and unwanted interventions if
you do some legwork before the birth and choose a
care provider that doesn’t routinely offer or
perform them!
Every
woman is individual in what would make a good birth
experience just as every person has their own
individual tastes and preferences for what they want
to eat for dinner. There’s no one right kind of
birth just as there’s no one dish that will satisfy
everyone’s unique appetites. The bottom line is that
you, the consumer, need to make sure your birth
choices (all of which impact your ultimate
experience) are likely to result in the birth you
desire. You can’t go to a fast food restaurant to
get a gourmet meal, but maybe what you wanted was a
hamburger, anyway. Just make sure that what you
order is satisfying.
Laura Lund is a Hypnobabies childbirth educator,
founder of UCAN Birth support group, and doula in
Provo, UT where she lives with her husband and five
children.
Copyright 2007 by Laura Lund. All rights reserved.
Laura gives permission to print and distribute this
article freely as long as she is credited properly.
www.BirthNaturally.org
Notes
1. “Have it Your
Way” is copyrighted by Burger King Corporation.
2. Johnson KC,
Daviss BA.
Outcomes of planned home
births with certified professional midwives: large
prospective study in North America.
BMJ. 2005 Jun 18;330(7505):1416. PMID: 15961814 [PubMed
- indexed for MEDLINE]
CONCLUSIONS: Planned home birth for low risk women
in North America using certified professional
midwives was associated with lower rates of medical
intervention but similar intrapartum and neonatal
mortality to that of low risk hospital births in the
United States.
3. Anderson
RE, Murphy PA.
Outcomes of 11,788 planned
home births attended by certified nurse-midwives. A
retrospective descriptive study.
J
Nurse Midwifery. 1995 Nov-Dec;40(6):483-92. PMID:
8568573 [PubMed - indexed for MEDLINE]
This
study supports previous research indicating that
planned home birth with qualified care providers can
be a safe alternative for healthy lower risk women.
4. Olsen,
O.
Meta-analysis of the safety of
home birth.
Birth. 1997 Mar;24(1):4-13; discussion 14-6. PMID:
9271961 [PubMed - indexed for MEDLINE]
CONCLUSION: Home birth is an acceptable alternative
to hospital confinement for selected pregnant women,
and leads to reduced medical interventions.
5. Kolas
T, Saugstad OD, Daltveit AK, Nilsen ST, Oian P.
Planned cesarean versus
planned vaginal delivery at term: comparison of
newborn infant outcomes.
Am J Obstet Gynecol. 2006 Dec;195(6):1538-43. Epub
2006 Jul 17. PMID: 16846577 [PubMed - indexed for
MEDLINE]
CONCLUSION: A planned cesarean delivery doubled both
the rate of transfer to the neonatal intensive care
unit and the risk for pulmonary disorders, compared
with a planned vaginal delivery.
6. Wax
JR.
Maternal request cesarean
versus planned spontaneous vaginal delivery:
maternal morbidity and short term outcomes.
Semin Perinatol. 2006 Oct;30(5):247-52. Review. PMID:
17011394 [PubMed - indexed for MEDLINE]
INTERPRETATION: Although the absolute difference is
small, the risks of severe maternal morbidity
associated with planned cesarean delivery are higher
than those associated with planned vaginal delivery.
These risks should be considered by women
contemplating an elective cesarean delivery and by
their physicians.
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