Saturday, January 30, 2010

Healthy Birth Carnival: Avoid Interventions that are not medically necessary.

I'm choosing to participate in the Science and Sensibility Blog Carnival where the current topic for bloggers to address is Lamaze's Healthy Birth Practice #4: Avoid interventions that are not medically necessary

Going into Willem's birth, I was aware of and planning to avoid unnecessary interventions. I thought I was making the prudent decision of working with midwives instead of an obstetrician and on a number of occasions throughout my pregnancy attempted to discuss my desires to follow this recommendation for my son's birth. I was also under the mistaken belief that midwives would not recommend interventions that were not based in medical need. How naive I was!

My son's labor was, no surprise, lengthy and slow to progress just as is common among first time mothers. I tried to avoid the mistake of going to the hospital too soon but had a prenatal appointment the morning that contractions began. At the appointment, the midwife was very excited and counseled me to go straight to Labor and Delivery where I could be admitted. I felt at the time that it was too soon in labor to go but trusted her recommendation. I spent the next 8 hours at 3 cm. And in that time, I was bullied, harassed, threatened and manipulated into accepting pitocin augmentation and AROM. I knew it was not necessary and I felt no need--physical or emotional--to speed up my labor. I was coping well and was trusting the natural process that birth is.

Eventually as I was so adamantly refusing to consent, I was summarily kicked out of the hospital. I say it that way because there was no gentleness or supportiveness in the attitude of the attendants. They used it as a threat to get me to cooperate. When I didn't, they rudely told me to leave and left it at that.

To read my complete birth story, read here: Descent into Motherhood: Willem's Birth Story

I came away from my son's birth traumatized by the way in which I was treated by the midwife on call. I felt that she was threatening to take away my power to make decisions for myself and coerce me into giving control over my body to her. The situation felt very much like someone unjustly wielding power over another. I was able to imagine just what it would be like be threatened with rape, or with watching the murder of someone I love. To read more about my reactions to the treatment, read: I Came out With a Baby, Crash Course in Birth TRUTH, My Experiences with PTSD after childbirth and Recognizing Birth Rape.

Since then I've learned that I was fighting over the principle of informed consent. Like most rational people, I believed I had the ultimate power to make decisions over which treatments I would accept or refuse. I've come to believe that violating the principle of informed consent is a form of abuse; a violent misuse of power and authority.

Now to relate my story to the Lamaze Healthy Birth Practice of Avoid Interventions that are not medically necessary:

Since interventions in childbirth are frequently used more often than necessary, it can be beneficial to remember that pregnant and laboring women have the right to refuse treatment and to first use alternatives to interventions before consenting to a intervention.

But beware, some providers will not be respectful of that right and will attempt to manipulate a woman into cooperating, no matter how hard she tries to avoid unnecessary interventions. A woman may find that it is not possible (or severely challenging) to avoid them based on the attitudes and practices of their provider. They may have no indication beforehand that they will encounter a provider who will push these interventions and emotionally manipulate her into consenting to unneeded and unwanted interventions.

Experiencing this sort of situation can be emotionally traumatic. PTSD after childbirth can be clinically diagnosed in between 1 and 6% of women (Beck, 2004 and Ayers,2001 ) and up to 34% of women have been found to exhibit some trauma symptoms (Soet, Brack & Dilorio, 2008). If that statistic is true, that means that over 1.3 million women are traumatized by their birth experience in the United States each year. That rate is HIGHER than the C-section rate. However, birth trauma is not widely recognized.

In my experience and from what other mothers who have experienced birth trauma have told me, getting help can be very difficult and not being able to find people who understand is very lonely. It was for that reason that, when I had the opportunity, I helped created the Solace for Mothers Online Community for Healing Birth Trauma.

In my work for Solace for Mothers, we have put together a list of questions to ask maternity care providers on the topic of informed consent. Essentially interviewing a provider to determine how respectful they will be of an individual's right to determine the course of her labor and to choose which interventions to accept or refuse may be more helpful than trying to find a provider who doesn't often use interventions in their care.

Much work needs to be done to give women the due respect they deserve to make decisions for themselves. While there is power in consumers (in this case pregnant women) demanding the type of care promoted by the Lamaze Healthy Birth Practices, providers have the responsibility to change the way in which they practice so women are not having to fight off providers who are pushing interventions that are unnecessary and introduce unneeded risks.

If providers were to follow the informed consent guidelines closely and promote evidence based practice, the trauma rates would be dramatically reduced and unnecessary interventions would not be offered as often as they currently are.


Jennifer said...

I really dislike how this videos portrays interventions in hospitals. As if it is something that women are able to easily choose or refuse, and all they have to do is make the right choice and they will be respected in their decisions. That is not reality at all. This is not the way interventions are presented to women. I think that if women were offered true informed consent, they wouldn't be "choosing" these interventions. But, that is not what is happening. Women are not given informed consent, and they are manipulated, coerced, and forced into interventions that they otherwise would not have chosen. It's a bit dishonest to show women these videos and give them the impression that what interventions they get are totally in their control. That is just not how it is, and they are setting women up to have to fight. And when you go in fighting, you come out with PTSD...

Jenne said...

Thank you Jennifer for adding your comments. Its exactly what you are saying that I'm trying to highlight with this post.

I also agree that if proper informed consent, with all its requirements for stating the risks, benefits and alternatives to the intervention, that few women would choose them. As many of the women blogging about birth have experienced, this type of conversation does not happen. And to those who don't believe the sort of tactics used to get women to cooperate, one can read

Jennifer said...

Oh, yeah, I forgot to say I agree with your post and I was just adding my 2 cents to it. I get really frustrated with all the emphasis on educating the woman, when us highly educated women are the ones who end up fighting, and then the ones who end up traumatized. I think we need to educate the providers, and when women are given true informed consent, they will then start making healthy choices for themselves and their babies. They can't do that when they aren't given the opportunity, or are forced when they exercise their legal rights to refuse.

Dionna @Code Name: Mama said...

It always saddens me to hear about a midwife who is intervention-happy. Women automatically associate midwife with natural birth - but that's not always the case. I'm sorry you had such a rough experience.