Birth Sense on The Impact of Labor and Delivery Nurses

Every once in a while a post comes along that's just so good I have to write a post that consists of just about nothing but "Read this post!" And so it is with the latest from Birth Sense, a.k.a. The Midwife Next Door, with How a Labor Nurse Impacts Your Birth. Everything she writes is a home run, frankly, but this is a grand slam, I think.

You are pregnant, and excited! You like the idea of a home or birth center birth, but think that, for your first baby, it would be a good idea to be in the hospital just in case there are any problems. After all, you don’t know yet if your pelvis is big enough, or if you’ll have other complications. Maybe with your second you’ll consider a home birth.

You’d like to have a midwife, but there aren’t any midwives with hospital privileges in your area. But you’ve found a great OB who definitely has the heart of a midwife. She even encourages you to write up a birth plan! You’ve toured the hospital labor unit, and the rooms are beautiful. Some even have large jacuzzi tubs to labor in. You’re confident you will have a lovely, home-like birth in the hospital. You’ve done your homework, and are looking forward to a beautiful experience.

Wait a minute. . .factor in your labor nurse. Or nurses. No problem, you think. The nurses have to follow whatever orders the doctor gives them, right? Right?

The conversation in the comments is very much worth reading, too. There is, of course, the expected "But I had/am a wonderful L&D nurse! Therefore this isn't true!" There are ABSOLUTELY some wonderful nurses out there. No question. At Your Cervix is definitely one of them, but she's certainly not alone. If you had one of these, or are one of these, awesome. I say that with zero sarcasm or snark - really, that's awesome. But we all know people whose births were derailed by someone who was not so wonderful.

You can have done ALL your homework, taken the best classes, and selected a truly supportive provider in OB/CNM choice, and even hired a doula - and if you get one of these nurses, you're still going to have to battle for your birth . And who you wind up getting is a total crapshoot. Having a doula IS probably your best defense here, though as discussed, if you have a nurse who is hostile to them, it can actually backfire in some rare cases, I'm sorry to say. I don't mean to diminish the importance of childbirth preparation, using a doula (obviously), or especially careful choice of care provider, but it is still true that whether you go with an OB or a CNM, they are going to be present the least amount of time. This may be different with some CNMs, but despite their best intentions, many others are just as overscheduled and likely to have to be running-in-at-the-last-minute to catch, snip & run as an OB. (Again, there are exceptions.) And in the meantime, the nursing staff can make it or break it.

Many a post or article written about the pitfalls of hospital birth results in commenters sharing their own positive hospital birth experiences. I have no doubt that these stories are true; with some, their hopes and criteria for their birth might be quite different than mine, but with some, they might be quite similar. I firmly believe the biggest factor in those positive stories is the roll of the dice that is the L&D nurses. If you're choosing hospital birth, hire a doula to improve your odds, absolutely, but be very aware of the impact they can have, and follow Birth Sense's advice in her post on how to get your best chance.

Rally for Dr. Wonderful on Mother's Day

Dr. Robert Biter was given the name Dr. Wonderful by the well-known and loved blogger Navelgazing Midwife. We birth bloggers often make disclaimers (either preemptively or when directly accused of being 'anti-doctor') when criticizing common obstetric practices and attitudes, stating variations upon the theme of "We know there are exceptions, we know there are good, caring, incredible doctors out there who honor birth and babies and understand the pitfalls of intervention." This man IS the exception. He embodies it. Let me give you a taste, from the aforementioned blog. The text and beautiful photography are all hers. Her homebirth-planning client needed to change to a hospital setting, and lucky for everyone, Dr. Biter was there:

The (wonderful, amazing) nurse (we had) did a vaginal exam and found mom to be 3 cm. The nurse and I began preparing mom for a cesarean - physically and emotionally. I explained the cesarean procedure, the epidural... and the nurse said the anesthesiologist would do a spinal because the spinal would be faster... and I explained things to dad, tried to get his garb for him to put on, but we were busy getting consents signed and all. Waiting for the doctor seemed endless. Fetal heart tones were dipping into the 90's and not getting any higher than 110 with accelerations. I kept calm, but was clear and sharp with the information.

My dear doctor was on the phone at the nurse's station when I went out to go ask his ETA and our nurse said, "Do you want to talk to him?" and I emphatically said, "YES!" before the other nurse hung up and said he was on his way in.

Dr. Wonderful floated into the room like a silk scarf on perfumed air, filled with more confidence and hope than I carried - more like a midwife than I was at that moment. He did a vaginal exam and immediately, the baby's heart rate jumped to 148! She loved his touch on her head. Oh, and how I did, too. Mom had also progressed to 6 cm. in the last 30 minutes. Amazing!

Tears fell from my eyes as I watched the baby's heart rate settle back down into the low 100's (90's/100's) and the doctor suggested taking a whiff of oxygen every few minutes when she felt like it instead of keeping it on all the time like she had been. He also told her she didn't have to lie on her left side... to move wherever she wanted to - oh, how she wanted to be on her hands and knees! He said the baby was just low, having a vagal response and there was no need for a cesarean at all.

And me, thinking he needed a scalpel. How precipitous I would have been as a surgeon! Thank the goddess it wasn't me making that decision.

Interjection from me: How moving is that shot? Believe it or not, there's an OB in that picture: Dr. Wonderful is on the left. Yes, really. Sitting patiently on the bed with her, calmly being the essence of watchful waiting. Lights lowered, mom upright and naked and doing her own thing, as support simply stands by without being intrusive. This photograph is equally revealing:

As Navelgazing Midwife writes of her shot:

I love, Love, LOVE this photo. It speaks of the beauty a hospital birth can actually attain when given a chance with the right doctors, nurses and hospital. And supportive midwife as doula. Because we thought she would need a cesarean, we had mom take off her gorgeous Hawaiian dress and mom was then naked. The great nurse handed mom a hospital gown once mom knew she was going to stay laboring in that room and she promptly took the gown, put it in front of her and puked all over it. I thought I was going to pee in my pants from laughing so hard. No one ever offered her another gown.

The birth unfolds further (you really must read the whole thing; I'm cutting it up for length and space), with more description and wonderful photography, and then this:

Dad wasn't sure about catching, was going to help me catch when we were having a homebirth, but wasn't so sure about it at the hospital. Once there, though, I'd talked him into helping the doc and even had him practice washing his hands with the fancy foot soap and water thingie at the sink. Once the doctor was there, though, he was more nervous, but as things got closer, I put my midwife voice on and said, "You will only birth this child ONE TIME, so I HIGHLY suggest..." and that was as far as I needed to go before he jumped up and washed his hands and got ready to help the doc catch his baby.

Do you see the doctor in this picture? He's the one not in scrubs. The one in the yellow shirt.

In 24 years and 8 months of assisting women in birth in the hospital, I have never seen a woman birth on hands and knees. I've never seen an OB or a CNM allow a woman to birth in the hands and knees position. I have never seen an OB do a vaginal exam on a woman in any position except on her back until this birth when this doctor did a vaginal exam with mom on her hands and knees. I actually wondered if he could even find her vagina with her on her hands and knees! He didn't have any problems at all. Shocking. I think I've seen a CNM do a vaginal exam on a woman in an "alternative" position maybe 20 times in all these years, so even that is a sad commentary. I tell women I can find their vagina or fetal heart tones if they are hanging from chandeliers! How did I get so good at it? PRACTICE!

Anyway, so here my client has her baby on her hands and knees... her husband helps the doc catch and it is amazingly wonderful, but now mom needs to see her new daughter. How does that happen?

In most hospital worlds (as if any of the above would have happened in the first place), the cord would be cut, mom would be flipped over, the bed would be broken, mom would have her feet placed in the stirrups so she could have her vagina checked and she'd get her baby that way. Instead, Dr. Wonderful, who's not wearing scrubs and only a pair of surgical gloves, doesn't cut the cord and knows how important it is to just give mom her kidlet says, "Okay, mom... here comes your daughter... ready?" And then passes her between her legs.

I love, Love, LOVE that I have this picture! There won't be many times in my life that I will have a photo such as this. This is a DOCTOR (I know, I shouldn't be shocked anymore, should I? But I am. I am mostly shocked that I am blessed to be in the same room and photographing such an awe-inspiring event that brings hope to hospital birth everywhere).

I end the series with a tender surprise photo I took of Dr. Wonderful with my client. He embraced her, then she him. He with tears in his eyes and both of them whispering thanks to each other.

Utterly incredible, right? The way hospital birth should be all the time, whenever possible, right?

So why am I going on and on about this right now? I mean, the post and story and photography are all sublime and could be marveled at anytime, so why the urgency?

Well, I'm sorry to report that Dr. Wonderful has just lost his privileges at Scripps hospital in San Diego, leaving expectant mothers without care (though other care providers are stepping up to fill the formidable void, including the Navelgazing Midwife herself, who has a long history with Dr. Biter) and, equally important, taking one of the most progressive OB's in existence out of the picture, for reasons that have everything to do with his willingness to support mothers, for being "too slow on the decision-to-incision".

This is an absolute TRAVESTY. THIS is one of the good guys. THIS is one of the doctors who has the guts to stand up for women in the face of our largely atrocious maternity care system. THIS is one of the few OB's to whom I would ever entrust my or my child's well-being - and that's saying a lot. He stood with mothers and gave them and their babies time and care and choices. So of course this was inevitable. The timing of this, by the way, comes on the heels of the recent closing of St. Vincent's in New York, the hospital to which many home birth midwives could transfer. The battle claims another casualty.

His supporters in San Diego and surrounding areas have pulled together a rally for tomorrow, on Mother's Day. If you are in the area, GO! If you know anyone in the area who cares about birth SEND THEM! I wish I were in San Diego to fight the good fight with and for him. We cannot take this lying down. Literally or figuratively.

INFO:

Come and show your support for Dr. Biter tomorrow (MOTHER'S Day) by attending a protest in front of Scripps Encinitas: Scripps Encinitas: 354 Santa Fe Drive, Encinitas, CA 92024
11AM-1:30PM Wear Green! Bring Signs! (and a lunch, snacks, water, etc.) Babies and kids welcome.

Dr. Biter, if by any odd chance you read this, PLEASE do not give up caring for women in exactly the way you have been. Please take heart and know that there are women across the country who know what you do and how vitally important it is. We need you, and others like you. And our babies need you.

*****

Edited to add:

More news. Here's how awesome he is, as if you needed more evidence: For the time being, he "is now offering to attend his patients as an unpaid doula at Sharp Mary Birch so that he can offer his patients the support they need, until this gets resolved."

AS AN UNPAID DOULA. How many doctors do you think would ever even THINK of doing such a humble, gracious thing? That says everything there is to say about this man's intentions and character.

Edited yet again to add:

Here's what we non-locals can do to help from a distance:

Write a letter to the CEO of Scripps Encinitas:
Chris Van Gorder--President & CEO of Scripps
4275 Campus Point Court
San Diego, CA 92121

Please send copies to awelllivedlife[at]hotmail.com

And, of course, spread the word.

All I can think is "Annie, Annie, are you okay?"

Remember that SimONE Birthing Simulator I was grumbling about a few weeks back? The one that was just a torso, pelvis and a couple of amputated stumps for legs? Thought that was creepy, did ya?

Good news! Or not? From the Discovery Channel:



Eventually "Noelle" will turn on some hapless resident, oh yes, she will . . .

(Thanks to Passion for Birth. As she said, "No voice, on her back, how many infractions can you see of the Healthy Birth Practices? The non-evidenced based practices keep on rolling...")

Much, much kinder.

Weekend Movie: "We Can Be Much Kinder", a short film on delayed cord clamping.


We Can Be Much Kinder - Birth Matters Video Contest - More amazing video clips are a click away

This will be old hat to many of y'all, but for those who haven't seen it, it's a must! Bonus: a lovely appearance by one of the grand dames of the birthbloggin' community, Barbara Herrera, a.k.a. the Navelgazing Midwife.

Laboring Under an Illusion

Weekend Movie:

This past week's episode of Mad Men, titled "The Fog", included an extended plotline about the main character's wife giving birth to their third child. This series is set on the cusp between the fifties and sixties, and thus very much in the grip of the Twilight Sleep era.

Sure enough, Betty Draper was wheeled away from her husband (left to drink and smoke in the father's waiting room, both cliched and authentic), and injected with scopalamine in short order, and in no time, her mind drifts off, free-associating, while the restrained body left behind writhes in pain and snarls at the staff, freed from the inhibitions of consciousness. Asked later how it was by another mother, she replies distantly, "Oh, you know. It's a fog."

I thought this treatment was a bit more historically honest than many other shows and films set in the same time period, which was refreshing in a way (appalling as the treatment actually was). We've all been influenced by the media's portrayal of childbirth - asked to think of the earliest impression of birth I have, Little House on the Prairie comes to mind, followed by a medley of sitcoms.

Think about the stereotypical sitcom scenario - how many times have we seen a woman "go into labor" by falling instantly to the ground and writhing and screaming like she's being attacked by invisible panthers? And of course, the baby is arriving immediately, and she has to be rescued from this by the nearest male. Another cliche is the naive woman who foolishly think she's going to labor naturally, and initially refuses medication - and is later shown begging for it, only to be told it's TOO LATE! Ha ha, joke's on her. Message clear: don't be one of these silly feminists, just get the drugs ASAP like we told you.

And don't even get me started on the reality "birth drama" shows like A Baby Story, Maternity Ward, Birth Day, and the like. "Reality"moniker aside, they're about as helpful to birth as The Bachelor is to actual dating. I yell at the TV like a disgruntled soccer hooligan. (You can probably picture this.) I was thinking that if I ever worked as a childbirth educator (springing out of doula work), I would show some clips of these shows to my clients and we could discuss them critically. But with this new film, I might just be able to loan out this DVD!

So without further ado, enjoy this peek at Laboring Under An Illusion, which looks both insightful and entertaining:



Looks like it's slated to be shown at the upcoming Lamaze conference, as well as some other dates some of you might want to check out.

And while we're on it . . .

. . . if medical students are being trained using this:


Is it any wonder things like the Labor Pro and the Birth Track are making their way into the delivery room?

I came across this "SIMone Birthing Simulator" while reading the latest comments from Nursing Birth's aforementioned post on the Labor Pro.

Simulate high stress situations with the SIMone™ birthing simulator!

Using patented haptic response technology, SIMone™ gives you a unique training experience. The level of realism is additionally heightened though a specially developed visual and audio interface . . . SIMone™ gives the opportunity to practice an instrumental delivery in a realistic manner - over and over again with little or no set up time! In fact it takes less than 60 seconds to commence a new birthing scenario.

Accessories included:

• 1 Vacuum extractor Menox 60mm
• 1 Vacuum hand pump
• 1 Naegele forceps

So, basically a Real Doll for OB students. Tell me, what's the first thing you notice about the picture above? But of course "Simone" is poised cooperatively in lithotomy position. How else are they going to learn? Their whole catalog could be seen as disturbing by some, but I actually find a lot of these models interesting, and useful in a classroom situation (and not so different in spirit than Madame Coudray's creations). The SIMone Simulator just takes it to a whole new level, revealing a clear - and quite revealing - set of assumptions and beliefs.

But. There's a big but. It's tempting to just react emotionally and recoil in understandable, outraged horror at this dehumanized, computerized, amputated facsimile of the miracle of birth - after all, that was my first response - but: This is something that is being marketed, if one believes the sentiment expressed in the video (there's no separate link, just look for it in the left column on the main page by the top paragraph), specifically to help avoid cesareans. I think it's true that situations that used to call for forceps or vacuum extractors (in the obstetric mindset, of course) are now more frequently just skipping that step and going straight for the c-section, due in part to the fact that these skills aren't being taught as much anymore, from what I understand (like breech birth, which has all but been lost and is only now starting to make its way back into the hospital in Canada; we can only hope the US comes to its senses and follows suit).

Now, the question that's NOT being asked by Simone and her attendants: were the factors that led to the situation that calls for forceps or vacuums often created by hospital practices in the first place? I would say so. Are there other ways of handling these situations, ways practiced by midwives? Ways that, incidentally, usually don't involve being supine with your legs conveniently hoisted and splayed? I would also say yes. But if the mother insists on buying the hospital ticket, and going for the hospital ride, would it not be better to have some of these tools and more importantly, skills in handling these tools, available if the mother wants to avoid a cesarean? I think that's a fair question.

Oh, it's all so complicated. What IF the rate of c-sections were to drop (instead of continuously rising as it has been) as a result of increased vaginal intervention in the form of vacuums and forceps? Would American women - if I can make such a sweeping generalization - be happy with this development? If we were to say that, okay, this is the lesser of two evils, but it's still not great, it's still not addressing the dysfunction of "active management" in the obstetric standard of practice - I could see doctors everywhere throwing up their hands and saying "See? It's impossible to please them! First they complained about forceps and vacuums, and we started doing more c-sections in those circumstances. We did that. Then they wanted the c-section rate to be lowered. We did that. Now they want fewer instrumental deliveries again! WOMEN! Impossible. Whatever."

So maybe Simone isn't all bad, if she/it helps lead to an increase in the lesser of two evils, and a decrease in the greater. But is this really all women should get to choose between?

Brave New Birth

This is one of those DANG, she beat me to it posts, but she did it so well I can hardly begrudge her. I had been plotting a post comparing recent birth innovations I liked . . . and ones I most definitely don't like. A few years ago, when I first read "Pushed" by Jennifer Block, I was horrified to read about the a new technology she said was actually under development, which would track dilation by way of sensors placed on a woman's cervix, adding yet another branch to the tangle of wires hooked up to virtually every woman who labors in a hospital (external fetal monitors, IVs, epidurals, catheters, pulse oximeters, blood pressure cuffs, and if you're extra-lucky, maybe an intrauterine pressure gauge and an internal monitor - the last of which is a nice way of saying an electrode screwed into your baby's scalp).

All the better to distance ourselves even more from unpredictable, messy contact with a woman in labor. We already monitor her contractions from a screen at the nurses' station, but what a burden it's been to have to check her cervix ourselves. Now we can view both from a comfortable, remote distance! (By the way, yes, I do think that internal exams can be way overdone, but that's another issue; the point to me is the augmented loss of actual human contact.)

I had a hard time believing that such a product could ever exist - it seemed as chauvinistically, fancifully implausible as the Blonsky device mentioned in the same book. But then . . . it came true. The Birth Track. Stand and Deliver inveighed powerfully upon it, and Hathor made satirical light of it, but still, it came to be. I don't know how many hospitals and doctors are currently using it, and I'm a little afraid to find out, but if anyone has that info, I'd still like to know . . . I think.

Then, mere days ago, labor & delivery nurse-turned-blogger-extraordinaire Nursing Birth made it known, with her usual aplomb, that a competing, almost identical device had actually been developed. The Labor Pro, video demo here, currently trying to make it into the US. Her post here is a must-read: The WORST Idea Since Routine Continuous Fetal Monitoring for Low Risk Mothers. Her every point completely covers my own thoughts on this, though this is my absolute favorite part:

I’m telling you right now, I will UP AND QUIT my job and never look back if either LaborPro or BirthTrack EVER appears in even just one, JUST ONE of my hospital’s labor rooms. QUIT ON THE SPOT! And I will make a Hollywood exit too! A HUGE scene!!! Hooting and hollering! You just wait!! LOL! As if our moms aren’t already strapped down enough with the often unnecessary and sometimes downright harmful technology we already have. This is just TOO MUCH TO BEAR!

I commented there that we need to start spreading the word about this insanity, and let it be known that women are not going to stand for this, so here I am, doing my part. Most of you reading this no doubt completely grok why this is so crazy-making, but in case you're not sure what the fuss is all about, please read the links above. (I would go through it all here myself, but honestly, it would be redundant, as Nursing Birth and Stand and Deliver have done it all already.)

As for my originally planned post on innovations I like and innovations I don't, well, the latter has been well-covered above. Of the former, I think the Contraction Master site is pretty innocuous and potentially handy, since it's something you can use on your own right at home. I could see myself doing this for some period of time, maybe moving my laptop around with me as I changed position, or having a partner or doula click the timer at my cue, instead of writing each of the start times on a piece of paper (which has been lovingly saved for a scrapbook someday) and trying to guess at the duration. This is available in the online version linked above or as as an iPhone app.

Speaking of, I also think some of the iPhone apps for birth - in the right hands - could be helpful. Check these 5 out. I like the "OB" Patient Tracker the most. Obviously, it doesn't have to be used by an OB - it was a midwifery student on MDC who first pointed this out to me, actually; her preceptor was using it. (See above re: right hands.) The DueDateCalc seems fine, if just a tricked out version of the simple due date wheels everyone has been using since the dawn of, well, at least the 70's. And the Weight Converter, well, being severely math-challenged, I could see myself using this. At least while in school. (Yeah, I know, I should really learn to do it in my head, it's good for me, but still.) Nothing spooky about using it. The Bishop's Score calculator is more problematic. Not the calculator itself - again, it could be used appropriately, but click here and look at the conclusion that is drawn for the example on the right. Now excuse me while I retrieve my eyeballs that are rolling across the floor. Overall, though, I could totally see making use of one or two of these, especially the patient tracker, once I had a lively enough clientele.

Also in the category of technology that is actually helping birth: YouTube videos. Think about what a huge impact that has had already, and how it continues to be a vital resource for championing natural birth. It used to be that if you wanted to see something resembling normal, low-intervention vaginal birth, you had to know someone who had a relatively obscure and coveted VHS tape - and I don't know what they did before the advent of video, short of a disturbing film they showed us in 8th grade health ed. And now, the whole smorgasbord of birth is available right there: home births, birth center births, hospital births, twins, water births, unassisted births, you name it. Women who are curious about what "natural" means, and looks like, can connect with example after example after example. It's really remarkable, and we owe a huge debt of gratitude to the women who are willing to share their most intimate triumphs with us this way.

Which leads me to what's possibly the best technological boost to empowered normal birth of all, the one that connects you and I right here and now: the internet. From message boards to websites like ICAN and My Best Birth spreading the word to the whole birthing blog community, just to name a few of many stellar examples, where would birth be today without it?

I fear it might look a lot more like the picture above.

Third time's the charm!

WEEKEND MOVIE TIME:

Cesarean vs. VBAC: A Dramatic Difference from Alexandra Orchard on Vimeo.

This is one of the best chronicles of a VBAC - specifically a HBA2C - I've ever seen. This does include graphic footage of the two surgeries, which is a rarity now, as the legal climate prevents filming these days. So just be warned if you're squeamish.

Be sure to watch all the way to the mom's letter to her doctor at the end.

If you need to birth in a hospital, for whatever reason . . .

. . . you must view these videos! Unnecessarean posted the other day about these FABULOUS videos, put up by Mother's Advocate, and I can't not pass them along. These are short and very well done, broken down into 6 components:

1: Let Labor Begin on Its Own
2: Walk, Move, and Change Positions
3: Have Continuous Support
4: Avoid Unnecessary Interventions
5: Get Upright and Follow Urges to Push
6: Keep Your Baby With You

Obviously, I'm a home birth advocate (uh, have I mentioned that?), and these 6 items are pretty much a given with home birth, but I certainly recognize that it's not for everyone and not appropriate in all circumstances. These videos are a GREAT tool. It's especially helpful to see all of this in action IN a hospital setting, as Unnecessarean points out. True, you could see all of this in YouTube home birth videos (assuming they remain uncensored), but I can see how someone planning for a hospital birth could watch those and be thinking, "Well, that's all lovely and good, but how is that possible in a hospital?"

But I'll pipe down and let the videos speak for themselves! Really, I think this could be enormously helpful towards optimizing a hospital experience.

And after all, optimizing a hospital experience is my entire raison d'etre as a doula. I admit that the thought of entering the belly of the beast gives me pause. Home birth is where my heart is, and where I hope to end up eventually, as a midwife, when my children are old enough for me to undertake such a calling - because I do feel it as a calling. But doula work is what makes the most sense for me in the present, given my family circumstances (FYI, I plan to focus on postpartum work initially, sort of working backwards, because while it still revolves around the mother's schedule, it's not quite as spur-of-the-moment as labor support). And doula support, let's face it, can be a bit, well, redundant in a home setting. With good midwives and family and friends around, the role is pretty much covered in most cases.

It's hospitals where they - we - are most needed. This is where a woman and her spouse or partner need to have an anchor, helping them navigate the labyrinth. Whether this calls for advocating or not is up for some debate, but either way, empowering them to assert their rights and make their own choices. I know I'm going to have to grit my teeth at times. I know I'm going to witness things that make me cringe, I know I'm going to have to support choices I don't necessarily agree with (frankly, this last part will be good for me). I'm aware that a lot of doulas eventually get fed up and burnt out at seeing the crap they've had to see over the years.

But I also know they DO make a difference, so come hell or high water, I'm committed to it until I burn out myself or until I can take the next step towards CPM-land. Sharing videos like these with my clients (see how nicely I brought that tangent full circle?) will be immensely helpful.

Article on swanky new L&D departments

The esteemed Navelgazing Midwife posted this on Facebook: "Definitely Not Your Mother's Maternity Ward" - and I found it very revealing. An excerpt:

At Ridgeview Medical Center in Waconia, women can now give birth in rooms with whirlpool tubs and wi-fi. At Fairview Southdale, new moms can hire a massage therapist or a portrait photographer.

Even Hennepin County Medical Center has upgraded its maternity ward, with pastel decor and a deep tub for water births.

All three are part of a major marketing offensive by hospitals to win a coveted demographic: mothers.

Thanks to a cultural obsession with pregnancy and babies, new moms are more informed and more demanding than ever. Many come to the hospital clutching "birth plans" and expecting to be indulged. Make them happy, the thinking goes, and they'll become lifelong customers.

The comments are quite interesting - many of them very akin to my own thoughts on it. I'm all for improving facilities, but too often it seems redecorating is a superficial substitute for actually changing problematic POLICIES. I couldn't care less about whether or not I can get a postpartum pedicure if their policies dictate a 24 hour deadline for labor. The comments, again reflect this; one woman writing, "My experience at Fairview Riverside was that they advertised one thing but delivered another (no pun intended!) They ignored the birth plan that they had encouraged me to make, kept trying to drug me and didn't believe I was in labor until the baby was on his way out. The after care was even worse!"

Exactly as I feared. Putting considerable funding and resources into "adding frills" (as the article itself puts it) without putting any effort into overhauling policies is just perpetuating the real problem. And it's the worst kind of condescension. I can just picture a Chief of Medicine (of course, I'm visualizing Bob Kelso) glancing at some poll results and sighing with exasperation. "Hmph, it seems that more women are wanting 'birth centers'. FINE, we'll give 'em a 'birth center'. Throw up some curtains, add a rocking chair, cover the equipment cabinets with wood paneling, and hire a manicurist. That oughta do it."

Unfortunately, it seems to work. I belong to a message board with a lot of mainstream mamas - wonderful people, but just largely mainstream - on it, and it comes up again and again, how they toured a hospital that just had the nicest maternity ward, they had hot tubs and lactation consultants and everything! But - without asking a lot of very careful, critical questions (I mean critical in both the 'harshly evaluating' and the 'extremely important' senses), there's no way of knowing whether the tubs would be available, and under what circumstances (is constant fetal monitoring mandatory, or is intermittent allowed? What about ROM?), or what KIND of lactation consultants they are and what hours they work, and on and on. It's the same old bait and switch. I genuinely hope these moms have good experiences, I do. From the bottom of my heart. But I've swallowed the red pill, and can never see only the face value of the hospital world again.

And frankly, I seriously object to the characterization of women as being under the influence of a "cultural obsession" and wanting to "be indulged". Excuse me??

Here's a revealing post from Keyboard Revolutionary on the trompe l'oeil performed by these maternity ward Extreme Makeovers.