Saturday, March 13, 2010

Proactive Medical Consumers

I come from the Lamaze generation of medical consumers who changed the way we got care when we were delivering our babies. I delivered my firstborn son almost thirty nine years ago at a large maternity hospital in a very progressive facility in the upper Midwest. I was fully prepared to labor and deliver without the aid of obstetrical anesthesia and episiotomy was routinely performed. Babies were taken to the nursery immediately after birth and there was no rooming -in or sibling visits.

I labored for a short time in a labor room and was moved to a delivery room that resembled an operating room. My hands and ankles were strapped with leather and I was fully conscious again, with no anesthesia, my choice. I knew what my body was supposed to do and how to push effectively. I had been training, just like when we train for any athletic event. I insisted that the restraints weren't necessary and was told it was for my safety and for the safety of the baby. I was flat on back with no way to use gravity to aid the delivery. The episiotomy was completed and my baby was delivered.( Because I had routinely done the perineal massage I was taught, I did recover from the surgical procedure quickly effortlessly ). He was cleaned and measured in the operating room and removed to the nursery. I think his dad followed him there. But I am not really sure. I think I was given some sort of medication so I could sleep.

When I delivered my second son, three years later, things had changed a lot. The women in my community formed a medical consumer's group and we made tremendous changes in how we have given birth in this culture since. We now have labor and delivery suites where we labor and deliver in a large and commodious room with family members free to join us for part or or all the experience. Our choice. Our baby is delivered, our choice, as to anesthesia and positioning and comfort measures and that baby is brought to our breast to facilitate the delivery of the placenta. Episiotomy is used only when the surgical incision is necessary to prevent a perineal tear.

Baby stays with the new parents to accomplish all the first important tasks of bonding. And then the family is moved together to the postpartum area for the remainder of the hospital stay which is usually 48 hours after delivery. The benefits of keeping baby at bedside are for learning who you are going to be taking home with you in two days and how to administer infant care. Siblings are encouraged to visit their brother or sister so that they have a clue that someone is moving in with them. And lactation consultants and nurses are there to foster breastfeeding and teach pumping too.

We have come a long way in forty years. Although I am not the first childbirth educator to encourage epidural as opposed to un-medicated birth, I am one that recognizes ( by virtue of experience ) the need for women and their partners to have choice in how they want to labor, deliver and recover from one of life's most challenging and dear transitions. I believe that it makes a difference to all of us to have the knowledge we need to make informed choices to take advantage of all the wonderful changes and innovations made possible by the pioneers of forty years ago.

We must continue to be good medical consumers. We must expect that the providers we choose are the best able to make the medical decisions necessary for us to achieve the best outcomes. But we must be aware of what our choices are and to make informed choices and decisions based on solid information. Birth plans are more an exercise in gaining information for you and not a contract for your doctor or midwife to follow. They know how to deliver babies and they know that you want a safe and uneventful experience that is warm and feely. Classes are for reassurance to minimize the fear of the unknown. Not a prescription that is closely followed. Books and videos and e-classes are the up and coming trend in this over- busy world where information is out there ( all kinds ) for the asking. I believe that we will be good medical consumers when we invest in a personal comittment to gain the best, most personal information we need in order to make the choices that we can, for how we best want it to be--for us and our families. Do your homework, take your tour and your classes and let's not let the pendulum swing back to the old days when women just showed up for their orchestrated labor and delivery. Every labor and delivery is different but every labor and delivery has a lot in common that should be taught and recognized and understood, so that we feel like we have choices to make for the sakes of ourselves and our families. Be proactive medical comsumers.