Please note: This post is not meant to sway clients one way or the other in terms of their childbirth choices. As a doula, I support women no matter what they choose. I simply wish to shine some light on some observations I’ve noted about the various options that women have for their births.
Each woman is different, and each birth is different. Most of the births I have attended have been in hospitals. I’ve worked with some incredible hospital births. Most go swimmingly, and I’ve seen women have wonderfully empowering experiences there.
On the other hand, I’ve been a firsthand witness to the effects of interventions. Most of the time, medical birth interventions, despite their legitimate risks, are overall safe and usually well managed.
However, I’ve seen the effects of invisible passive interventions as well. The clock is a perfect example of a passive intervention, and its effects are very real.
“Textbook birth” happens in one place, and one place only: the textbook. The range of “normal” in everything related to birth is vast, yet most hospitals tend to confine “normal” down to a rather narrow window. Women tend to be “allowed” to labor for “X” number of hours, they can push for another “X” number of hours, and the placenta must come within another “X” amount of time.
I see something very different in home births.
Homebirth midwives respect the birth process too much to restrict it down to a fixed series of allowable proceedings. They understand that the body can start and stop labor, that some phases can go unusually quickly and others can take longer. Midwives do not define labor by a set “allowable” time, since their practice is not governed by a hospital’s rigid statues. As long as the mom and baby are both doing well, labor is respected and permitted to take it’s course. When a stage of labor takes longer than normal, midwives carefully watch, listen, monitor medical safety, and let the birth proceed as usual.
Which begs the question: how does the hospital differ? What do they do when labor doesn’t always go according to the allowable textbook timeframe? In my experience, most normal, healthy women are given a myriad of interventions to force the process along, and many end up in the OR with a cesarean. They often refer to the Friedman’s Curve as a guideline to call a “arrest in labor” and a need for a cesarean. I do see differences hospital to hospital due to policy and provider to provider due to their experiences, but for the most part, cesarean for Failure to Progress according to the textbook definition of the Friedman’s curve is really happening and many times unnecessary.
Birth interventions are known to increase the risk of cesarean so this is not surprising. However, it can be devastating to women who truly wanted to experience birth, or who were frightened of having a cesarean.
I talk to a lot of women that want to hire a doula so that they can avoid the operating room – they want to avoid having a cesarean. Doulas absolutely do reduce the incidence of cesarean for many reasons. However, my encouragement for women that truly desire to impede the risk of cesarean is to carefully consider your provider. Hospitals are wonderful places for the most part. But one cannot accurately predict exactly what their birth is going to look like beforehand. If your desire is to avoid the OR, perhaps it’s time to consider other options.
The hospital is not your only option. It can certainly be a good option, but it is not your only one. New study on home birth safety concluded childbirth at home with midwives in the US to be a safe option for low risk pregnancies. I encourage you to consider exploring all of the available options during your pregnancy. You can always switch your provider – up until the moment you go into labor! Read Care Providers in Pregnancy to learn more about the difference in providers. If you are considering home birth, contact me for some great referrals and care in Massachusetts!
I support you no matter what you choose – just make sure that the choice you make is for sure the right one for you.