Tuesday, February 08, 2011

One Born Every Minute

So there's a new Lifetime show called "One Born Every Minute" in which Labor-Delivery-Recovery (LDR) rooms at Riverside Methodist Hospital in Columbus, Ohio are fitted with fancy cameras to catch every moment and film is edited to fit specific episodes. There's no camera crew in the room, just the family and hospital staff plus a ceiling-mounted camera. I watched an episode entitled "To Medicate or Not? That Is the Question." The episode follows 3 patients from admission through delivery.

1) Woman comes into the hospital in early labor. Nurse hangs an IV of pitocin and promises an epidural when the pain kicks in. All just a matter of course, no requests from the patient for anything and no discussion of why pitocin might be needed for someone already in labor with unbroken waters and no apparent fetal distress. This is a medically managed birth.

But you know what? Pitocin is a serious drug. It can be seriously helpful at times. But it also has serious risks and potential side effects. It's really strange to me to see it just given routinely, without specific indication.

The nurse says, "Not that many women want to have a natural birth anymore, about 90% choose an epidural. It's a choice between feeling the worst pain of your entire life and not feeling anything, so it's pretty obvious what most women are going to choose . . . I guess it's just a personal preference."

Oh, sure, when you put it like that . . .

With the rest of this case, it's obvious that the mom is very comfortable with a managed birth experience. She wants IV narcotics and an epidural. She does not want to hold the baby until after she's been cleaned up. Her nurse asks her preferences and is supportive of the mother's requests. Healthy 9 pounds, 2 ounces baby girl.

2) Woman comes in who has had a previous large baby and is being induced because her physician is worried the second will be large, too. The (different) nurse questions the mother's decision not to have an elective cesarean section! But the mother does not want to have a surgical birth. The nurse says they'll break her bag of waters right away (this increases the pain of contractions and has other risks as well - including infection - but might speed labor) and asks about an epidural. The mother says she'd prefer to try to go without and expresses concerns about the drug's known side effects ("last time it really slowed down my labor"). The nurse replies, "Really?! Alright..." to the woman's request for no needle into the spine and says there's no problem with slowing down labor "if you time it right."

No implied judgment there . . .

The nurse continues to cast doubt on the mother's ability to birth this baby, saying things like, "unless he's too big..." and threatening that if her contractions stall out she'll have a c-section. I was happy when the second shift nurse came in; she was much more supportive.

But after a narcotics shot mom doesn't feel like she can do it without an epidural (no shame in that but it's too bad there was no one there reassuring her and telling her what a great job she's doing, etc.).

Unfortunately, after narcotics + epidural and lying flat on her back the baby's heart rate slows. Mom is too drugged and out of it to move over onto her side. She is freezing cold with chattering teeth and it is nearly time to push but she's pretty out of it. The doctor calls in for a c-section, saying, "I know it's scary and it's not what you want but I think it's probably safer for the baby." Healthy 9 pounds, 12 ounces baby boy.

3) Finally we have the "deliberate" couple who bring their birth plan (and a doula) and want a natural child birth. They sound really prepared, talking about cascading interventions, what's best for the baby, and mom wanting to challenge herself to see what she can do. (The parents met doing endurance sports.)

The nurses and admins at the main desk share many raised eyebrows and smirks at the mom and dad with their birth plan and shared moaning. "Oooopen..." The LDR nurse really wants to run the show and the couple (along with their doula) want time to make their own decisions. The nurse does push quite a bit, saying things like, "the longer you labor, the harder this is going to be," which probably puts unnecessary stress on the mother. The nurse wants continuous fetal monitoring and an internal contractions monitor (the former does not prove advantageous over intermittent monitoring and the latter increases risk of infection).

While offering his wife a drink of water the dad asks the nurse to be more positive (rather than saying things like, "well, she's probably dehydrated, which could be part of the problem"). (My question: what problem?!) The specially trained and very professional nurse midwife (which this couple has instead of an OB/GYN) is very supportive (though she's not in the room most of the time) even as the LDR nurse is pushy. "I'm really glad this shift is over," she says as she walks out, frustrated that the couple did not want her to "teach" them.

A little pitocin after 23 hours of natural labor to push the baby down the rest of the way work wonders and mom quickly delivers a healthy 9 pounds 2 ounces baby girl. She gleefully holds her baby right away and both parents clearly feel great about having the birth experience they wanted (annoying passive aggressive LDR nurse aside).

Disclosures. I've had two babies. My first birth experience was pretty natural in that my water broke in early labor, I labored at home all night, and went to the hospital less than two hours before giving birth. I was not given any pitocin, narcotics, local anesthetia, or an epidural. I did not have an episiotomy, forceps, or vacuum extraction. On the other hand, despite being completely healthy, hydrated, and in transition (almost ready to push) by the time I was admitted, by the time I started pushing I had an IV in my hand (just fluids, no meds), an oxygen mask over my face, a pulse oximeter clipped to my finger, and an internal fetal monitor in Ellie's scalp. It was a low-risk, routine delivery; neither of us had any complications or problems before, during, or after the birth.

My second baby was almost two weeks "late" so I was induced (at a different hospital, one closer to home). The pitocin contractions were indeed very different from the natural contractions I experienced with my first labor. I fought them for hours before asking for an epidural. (By that point I didn't care about ANY side effects, I just needed a break from the pain that never really went away, even during the "rest" period between contractions.) The epidural was awesome and I enjoyed the birth of my second child despite lying flat on my back with my legs strapped into stirrups. I had an IV, etc. etc. and the side effects of that were easily my least favorite parts of the experience. It was a low-risk, routine delivery; neither of us had any complications or problems before, during, or after the birth.

Both of my birth experiences were positive and had happy outcomes. But evidence does not support improved outcomes from so many of the routinely administered medical interventions in hospital labor and delivery. In Missouri there is only one free-standing birth center and it's across the state from me. (A local center is said to be coming soon.) Evidence supports the fact that freestanding birth centers are safe and have outcomes for mother and baby that are at least as good as births in hospitals (with much lower intervention rates). They're close to hospitals and can get patients in for surgery very quickly in the rare case of true emergency.

The U.S. has unusually high intervention rates and is behind 29 other countries in infant mortality. I feel so fortunate that the nurses I had at both of the hospitals where I delivered my first two babies were supportive of me and all my choices, unlike some of the clearly judgmental and prejudicial nurses I saw on One Born Every Minute.

Other quotes from the episode:

"You wouldn't go to the dentist to have a tooth pulled without being numb; why would you go and have a baby without an epidural?" (from a mom)

"No point in being miserable." (from a nurse)

Well, labor feels different for every woman (and every birth experience). For me, the natural contractions (as opposed to the pitocin ones) were hard work but far from the "worst pain I've ever felt in my life." Working with and through them was enormously rewarding and the endorphin rush afterward was incredible. Why do people run marathons? Why do people do anything that's challenging but also rewarding? It really is a "personal preference."

And - even more importantly - epidurals are also serious drugs (and a serious procedure) with risks and side effects for both mom and baby.

The show's editing and voice over (Sigourney Weaver) make the first labor - the most medically managed one - seem like the smoothest, quickest choice. (Obviously this is not always the case.) The tone with the "natural child birth couple" suggests that showering in labor is weird (no way; it's great!) and that thirteen hours of labor for a first child is crazy long. (Nope, not even average.)

But in the end - all happy parents, all healthy babies. So hooray for that. I've got lots more to say, but good grief I've been typing forever and I can't imagine anyone actually read this whole piece!


Anonymous said...

Haven't seen the show, but I did read your whole piece. I went into labor on a Friday night and after showing signs of distress they delivered my 8 lb 10 oz son via c-section. Aside from distress doc told us we would never have been able to deliver naturally due to his size (I'm fairly petite) and his cord was wrapped twice around his neck (hence the reduced heartbeat when contracting). They never gave me pitocin and my water never broke. They allowed things to happen naturally as long as the baby was safe. That is the school of thought that these docs/nurses should revisit. Of course, this was 22 years ago-like the dark ages.

Sarahlynn said...

I agree that letting things happen naturally as long as mom and baby are safe is the best plan! I think part of where we get hung up these days is an over-estimation of risk with natural birth (and minor complications) and an under-estimation of risk with hospital/physician interventions. E.g. c-sections can be fabulous for saving the lives of mothers and babies in certain cases. But they're not risk-free and the additional risks of surgery have to be weighed fairly against the risks of NOT performing surgery (or performing other interventions which increase the likelihood of surgery).

Carmie said...

Loved this post! Yes, I read all of it! :)

have you read Rikki Lake's book (Your Best Birth)? Also has a neat movie available too.

I agree with 100% of your post. There's nothing wrong with medicated births as long as they are thought through and the consequences are weighed out as well.

We delivered at Barnes and it was very difficult to have a drug-free birth. The staff, for the most part, was pretty great but they kept wanting to hook me up to an IV (just to be safe). It's really hard to labor with needles poking you! I had to negotiate with a Hep-Loc.

The staff ended up giving us "our" way on a lot of things (like letting me labor in the tub) but I think it was because my mom was there (she is a PNP and was an L&D nurse for 20yrs) and my husband is 6'6". I can be stubborn when I want to be and I really was trying for a drug-free birth. I read every book in the STL library system on birthing! I can't imagine what it'd be like for someone without resources, without others telling you "you're doing great!", without having prepared enough to know kinda-sorta what to expect.

Labor, for me, was awful. I don't blame anyone for not wanting to feel it! I'm still not sure what I'd do if there is a next time. But I do feel as though the suffering is worth it. Having a baby is NOT getting your tooth pulled.

Anyway, enough ranting. Great post! I saw some of that episode too and was blown away by a lot of it. (I also had to stop watching because I'll never want another baby if I see more!!)


Sarahlynn said...

Thanks for sharing your experience! I had my first at Barnes, my second at MoBap, and will have my third at St. John's. I plan to write a comparison/review of the three hospitals afterward. I've heard a lot of negatives about St. John's so I was very concerned about giving birth there, but am heartened that a) they actually offer a natural childbirth prep class taught by a nurse/doula and b) they're opening a freestanding birth center in a couple of years.

I had a "natural" childbirth at Barnes and loved it - except for the terrible triage nurse who kept asking me questions, demanding a urine sample, and moving like molasses WHILE I WAS IN TRANSITION. But like you I had to work hard for it, doing most of my labor at home and negotiating with my doc ahead of time for a hep lock instead of constant IV fluids. (Why do they think this is safer? It has its own risks and problems as I can attest from #2!) I ended up agreeing to a few things like oxygen and the internal fetal monitor to stave off MORE intrusive interventions. Though the baby was never in distress, we did know that she was more likely to have complications due to her prenatal diagnoses.

My husband is a fabulous support and partner, but he's not the type to push back against pressure at the hospital. As it's hard be a full-time self advocate in labor I'm wondering if we should hire a doula (or your mom!) this time.

I'm actually excited about laboring again! (Of course, my last one was 4 years ago so my memory might have faded a bit.)

Jennifer said...

I too read the whole post! I am apalled that the nurses think they should control the birth plan! Their job is to inform the Mom of all options without giving opinions! I chose epidurals, but I also had to have pit because of PIH, so it was a different story! Great post! I have not and will not watch the show. All birthing shows are out for me. I am not having any more babies and watching those shows makes me sad! Birth and new babies is so much fun! Enjoy your 3rd!! Such an exciting time!

Sarahlynn said...

Jennifer, having been through one labor with and one without pitocin, I agree. The two are completely different and I don't think I'd try pitocin again without an epidural!

The girls and I have been looking over photos of me in the hospital having #2 in preparation for having #3 (so they know where Mommy's going, what to expect, etc.). The look of pure bliss on my face after the epidural took the pitocin contraction pain away was glorious. (My parents and husband look similarly relieved.)

danielle.royster said...

I've watched the show and I have grown to love it. I don't have any kids and the show definitely doesn't deter me from ever having any but it's made me think about waiting a little longer. I think the show does a great job at depicting what it's like to give birth and some of the things they say are quite comical. I work and subscribe to DISH Network and I watch this show and every other show on this channel with the Google TV! The Google TV is awesome because you are given the ability to watch TV and browse the internet at the same time. You can also integrate your DISH Network HD with the gadget and search anything on your DVR. You can also tab back and forth between TV and the internet and I use it when I want to tweet about the show that I'm watching at the moment and if you are a DISH Network subscriber, you can buy the Google TV at a discounted rate of $179! That's a $120 savings from what it retails for! Another great attribute to it is the keyboard, it can be setup to function your TV and your receiver so you will never have to worry about using a remote again. It's worked flawless for me and I am always recommending that people check out DISH Network and I am inviting anyone who comes across this post to explore the endless possibilities with DISH Network and experience a value unseen by any other TV provider!


Sara said...

I'm afraid to watch this show- I've had friends who've outright told me not to watch it because my head would explode. I'm a doula, and am so frigging tired of how we treat birth in this country. I've yet to meet an L&D nurse who was truly supportive of natural birth (I've been told they exist, but I'm not sure I believe it). Looking forward to reading your birth story for #3.

Sarahlynn said...

Sara, I think your head might explode if you read by birth story for #3.