I am not out to make anyone a bad guy here. OK, maybe a little. I have worked as a Natural Childbirth Educator for long enough to make some generalities and feel pretty comfortable with saying them. I am fully aware that there are exceptions to what I am about to say, but they are so few and far between. I hope what I am about to say will be listened to and not just heard.
There are two types of maternity care: the Medical Model and the Midwifery Model. Briefly, the Medical Model perceives pregnancy, labor, and birth as a disaster waiting to happen; something a woman needs to be rescued from. Medicine improves upon the "natural" process. Labor is all about the cervix and birth canal, always looking for something to go wrong.
The Midwifery Model of Care, on the other hand, trusts a woman's body to grow her baby, start labor at the appropriate time, and labor without time constraints. A midwife takes into consideration, not just the cervix and birth canal, but the entire woman and her environment. Birth is as much mental as it is physical. Medical doctors almost always ignore this fact, usually because the hormones are not working properly when a woman has an epidural. They just don't see natural normal birth often enough to know what to do -- or more appropriately, what not to do!
So when couples come to take my Bradley class, I worry about those that have an OB. And rightfully so. Most of them will see the light and switch to a midwife, but sometimes the couple is fed so many lines by their OB and hospital nurses, they don't switch, believing their doctor is different.
From the L&D nurses:
"We have birth balls, showers, tubs, squat bars, dim lights -- everything you want for your natural birth." (In labor, these things are nowhere to be found. Only one room has a tub that works, no one can find the squat bar, lights are bright so the doctor can see -- it's all about him, right? The atmosphere is not what was promised.)
Some of my favorite lines from OBs are:
"As long as everything is going fine, you can do whatever you want."
"As long as your water isn't broken, you can walk around as much as you want."
"We can do intermittent monitoring as long as baby is handling labor okay."
"We don't need to talk about induction unless you are more than a week past your due date." (No one thinks they will be 'overdue' when they are pregnant. No one. They believe this won't apply to them.)
Don't these sound great? I've got a great OB, right? Did you hear the clause in each statement? Remember, an OB is trained to look for things to go wrong. Statements like these pacify the pregnant woman at monthly/weekly appointments because it seems like she is hearing what she wants to hear. The problem is, an OB can make up all kinds of reasons to keep you on a monitor in labor, or restrict food and water, or induce labor for a million different reasons. Seeing this as often as I do, a local doula called this the "Bait and Switch."
Something happens at 38 weeks with an OB, where all-of-a-sudden pregnancy becomes very dangerous. The placenta starts to deteriorate, amniotic fluid levels rapidly drop, blood pressure is through the roof, and vaginal exams must be done to ensure that your body knows what to do. Oh yeah, and your baby is getting much too big to fit through your pelvis. We either need to look at inducing right away or just scheduling a c-section to save you from having to go through the trials of labor. You'll probably just end up with surgery anyway.
I wish I was making this stuff up. I'm not. I see it all the time. If you stay with an OB who makes "reassuring" statements with a clause and you ignore these red flags, and then you have a c-section, you will always wonder if you really "needed" surgery. If you change care, even at 39 weeks, to a midwife who trusts birth and encourages you along the way, and then end up with surgery, then you probably did need it.
I recently had a mom who changed care from an OB at 39.3 weeks to a group of CNMs. Her baby was over 10 pounds and she pushed for nearly 4 hours. She had back labor most of her labor and did have an epidural. Had she stayed with the OB, I am 100% certain she would have had surgery. Her previous hospital has a 60% c-section rate and they would never have allowed her to push that long. Sure, she did not have an unmedicated birth, but the switch saved her from surgery. A good move.
Be on the lookout for these statements from your OB. The end of pregnancy is so exciting. You are about to meet your baby for the first time! A good care provider will reassure you that your baby and body know just when the time is right for labor to begin. Your care provider should fill you with reassurance, not fear. And that, really, is the difference between a good care provider and a bad one.
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