Outsourcing Health Care

A friend informed me of a new concept that has implications for childbirth: outsourcing healthcare. Evidently, there is a new trend for insurance companies, to cut costs, to send patients outside of the United States with cheaper healthcare services for procedures, etc. The example my friend told me about was patients being sent to India for heart transplants. While there, patients are given "gold-star treatment", first class flights, nice hotels, limos to and from the hospitals, gift baskets, etc.

I have heard about the birthing mother's receiving celebrity treatment for extra cash-- $15,000 for continuous labor support provided by an obstetrician, extra special hospital accomdations, incentives, etc. but outsourcing takes it to a whole new level.

Next, will there be reports of U.S. insurance companies sending birth women to India, France, Spain, etc for gold-star scheduled inductions to decrease costs?

In order for that outsourcing to be effective in the case of labor and birth, the birth would have to be scheduled, otherwise women might be living out of hotels for 2-6 weeks waiting to go into labor. I can't imagine how that could still be cost-effective. So let's assume that a woman is put on airplane at 38 weeks and the induction is schedule for a day or two after arrival.

Would that be cost effective?
Do we need to see more inductions of labor and scheduled c-sections?
Would those births be granted dual citizen status?
How would the birth stats be reported--in the country of birth or in the United States?
Will this be a new trend or will common sense prevail?

Damages Granted in PTSD after Childbirth Case

I have wondered if there is a legal precedent of a case where a woman successfully sued a doctor or hospital for malpractice and medical negiligance that caused Post Traumatic Stress Disorder in the patient. I would like to take my case to court in an effort to bring awareness to birth attendants, health care providers and the public that doctors are abusing laboring women in their care. Women's personal dignity and privacy is being impinged upon, as well as their patient's right to informed consent is being violated. Women are then suffering mental anguish, sometimes on top of a physically debilitating recovery. This is not an issue about alive and healthy mothers and babies, but its a human rights issue where women are being subjected to forms of torture and rape at the hands of their "care" providers.

In Meader vs. Stahler and Gheridian, $1.5 million was awarded to a family after a women suffered PTSD after an unneccessary C-section which she was coerced into by her doctors. Her lawyers argued that the doctors violated her right to informed consent and their negiligance in turn caused her months of agonizing physical and emotional recovery.

An article written about the case in Forensic Psychiatry and Medicine states:

Thus, it was not simply the physically disabling consequences of the surgery, but the loss of personal decision-making power concerning her body, her health, and the birth of her child, that caused Meador to suffer from Post-Traumatic Stress Disorder. Similarly, her husband's experience of loss of consortium was exacerbated by the physicians' failure to consult him to interpret his wife's wishes during labor. Instead of having participated in a true informed-consent process, he was left to feel powerless and helpless. In this way, forensic psychiatric testimony established a persuasive causal link between the lack of informed consent and the physical and emotional damages suffered by the patient and her family.

So there's my precedent! If a lawyer were to take on my case, he/she would be able to use Meaders case as evidence that others in our society and judicial system have viewed PTSD afterchild birth as a preventable condition and poor outcome caused by doctors who are not doing their jobs correctly. It was just that which lead to me experiencing PTSD after birthing in an abusive, manipulative hospital environment.

The above cited article goes on to discuss the relationship between informed consent and managed care (remember that labor care in hospitals is called aggressive management). It states that malpractice litigation based on violations of informed consent will become more frequent as medical care becomes more managed. The article mentions that "physicians may also be held liable for failing to inform patients about the conflict of interest they experience between their duties to patients and the dictates of managed care."

It was that conflict of interest that I encountered, where the manipulative and coercive treatment I received to convince me to either leave the hospital or consent to procedures against my wishes was done with the intent to clear the labor and delivery room faster so other patients (and their money) could come in, and in turn the hospital wouldn't be "wasting" money on me holding up their room.

A publication is currently being drafted by the American Medical Association that asserts that"physicians must serve their patients' best interests regardless of financial incentives." And if they do not, physicians can be held liable for damages.

Recognizing Birth Rape

As my readers know, I experienced PTSD (post traumatic stress disorder) after the birth of my first child. It was because the process of giving birth was particularly grueling or painful, but it stemmed from feeling like my bodily integrity and autonomy was taken away from my by hospital staff during the vulnerable time when I
was bring my child into the world.

Since his birth, I have learned alot about PTSD after childbirth and found something surprising: the treatment I received can be considered a form of rape. And my considering that term, I can say that exactly what it felt like to have strangers forcing me to do or submit to certain practices.

Amity Reed, blogger of TheFWord describes birth rape in these terms:

A woman who is raped while giving birth does not experience the assault in a way that fits neatly within the typical definitions we hold true in civilised society. A penis is usually nowhere to be found in the story and the perpetrator may not even possess one. But fingers, hands, suction cups, forceps, needles and scissors… these are the tools of birth rape and they are wielded with as much force and as little consent as if a stranger grabbed a passer-by off the street and tied her up before having his way with her. Women are slapped, told to shut up, stop making noise and a nuisance of themselves, that they deserve this, that they shouldn’t have opened their legs nine months ago if they didn’t want to open them now. They are threatened, intimidated and bullied into submitting to procedures they do not need and interventions they do not want. Some are physically restrained from moving, their legs held open or their stomachs pushed on.

The writer goes on to describe that many women who experience birth rape also suffer from post traumatic stress disorder like I have and something called tokophobia or fear of childbirth. If, and they often do, women find themselves pregnant and facing the birth of another child, Reed states that their actions include:

Those who experienced trauma or rape in their first births are either electing for planned caesareans (which have their own, very real risks), terrified of going through the pain and degradation again, or forgoing hospitals altogether and birthing their babies at home, sometimes even unassisted by any professionals (called ‘unassisted childbirth’ or UC).

Those who are familiar with my plans for my next birth know that I refuse to experience that type of abuse and degradation again and instead am opting for a homebirth that may or may not be attended by a birth professional. I do not want to be exposed to another person trying to exert their will or exhibit control over my body when I'm working and allowing the process of birth to take place.

I wish that more birth professionals and hospital birth attends will learn that their actions have the same psychological effects as rape on the women they treat in that way. I would like to see trainings and seminars for obstetricians, midwives, nurses, family doctors and pernatoligists that discuss ways to prevent this result from happening to other women. As Danell Swim of TrueBirth states, "these Birth Rapes are perpetrated by an individual, or several individuals. It is not medically necessary, and yet the act is horrific, and leaves emotional and sometimes physical scars." Birth professionals need to be aware of this, in order to prevent it.

And wouldn't it be nice if the individuals who perpetrate these actions are held accountable? Reed states that attempts for complaint or criminal persecution are often "remote and insignificant." I hope that someday a birth rape case will be won on behalf of the victim and that the financial and liability wake-up call will be enough for birth professionals to change their ways.

That's Why?

It is known that anxiety interferes with the hormones of labour - and what perfect sense this makes. In nature if a woman is anxious it may not be safe for her to birth - safety is obviously paramount in birth and this feeling of withdrawing is natural to ensure a woman finds a safe place. We have indoctrinated women that hospital is the place of safety so no wonder this is where most women choose. Also it follows why many women go to hospital very early in labour - they wish to settle into their chosen place of birth.

Excerpt from Anna Berkely's home birth story on Birth International.

The above quote resonated with me because its a thought that I have been unable to put into words previously. When I was in labor with my son, I thought I was doing so well to not go to the hospital early in labor. The labor sensations started at 1 am in the morning, and by 11 am I was still having regularly spaced contractions. I had had an midwife appointment scheduled that day so I had waited for that visit before deciding to go the hospital. At that appointment, the midwife advised me to check into Labor and Delivery because I was already 3 cm dilated and contracting regularly. With that recommendation and the knowledge that labor had started some hours earlier, I figured I wouldn't be checking into the hospital during early labor and that I'd be able to hole up and find my space to birth my baby. I went to check in but L&D was full. They were full for another 5 hours. It was then that my labor seemed to go into a holding pattern, it didn't stop, it didn't slow down, but it also didn't progress or intensify as it should.

So no surprise that at 4 pm, when I was permitted to enter the birthing unit, there had been no further progress (in spite of walking to stimulate contractions and resting to conserve energy). I was very frustrated when after another 4 hours in the hospital filled with constant monitorring, interruptions and conflict with staff, I was told to leave because I was refusing interventions that would artifically stimulate the labor to progress.

I found that the hospital wasn't a safe place for me where I could feel comfortable to birth my baby. After the preceeding anxious hours before going into the hospital, I encountered even more anxiety when being pressured by the attending midwife to interfere with my baby's birth against my wishes. I strongly belief that standard procedures and "admission criteria" are a causative factor to my stress filled early labor which continued on in total for over 30 hours. From that point on, active labor and the birth went smoothly. An easy and straightforward 8 hours later, the sunshine in my life was born.

If I could go back and do it all over again, my birth plan would be much different. I would have chosen a home environment as the birth setting and a supportive, encouraging midwife. I know that I need a emotionally safe and nurturing environment to enable the process of birth to proceed from my body. And a hospital is not where I will find it.

Hospital Practices Interfere with Breastfeeding

This kind of piggy backs on my earlier post about hospitals giving free formula samples to new mothers leaving the hospital postpartum.

Birth NETWORK has posted an article orginally published by the Center for Disease Control (CDC). It mentions the appropriate interventions that hospitals should employ to encourage breastfeeding for newborns born in hospitals. It also mentions obstetrical interventions during birth that interfere with breastfeeding. Those include the use of labor analgesics (pain medications like demoral, morphine, etc) epidural anesthesia, and cesarean birth.

The article also addresses the benefits of breastfeeding and why it should be encouraged, both for babies and mothers. It advocates extending breastfeeding through the first year as the benefits possibly include lower obesity rates in childhood and adolescence, and lower rates of childhood illness and infection.

These findings ought to make obsetricians and hospital staff to question the use of routine pain relief given to women in labor and prevent hospitals from lining their pocketbooks from formula companies intent to sell their product to women who ought to focussing their efforts on establishing a healthy and normal breastfeeding relationship. Trust me, women who need to formula feed their babies, know where to find it. It doesn't need to be sent home with them.

NPR Discusses Breastfeeding

Yesterday, the NPR news reported on hospitals giving formual to new mothers as they leave the hospital. They stated that women who received freee formula samples were less likely to breastfeed than those mothers who did not receive the samples. They discussed the conflict of interest for OBs and hospitals who get money from formula companies to give out these samples and what has been empirically proven to be better for babies and mothers. In my area, 4 local hospitals have stopped giving formula samples to mothers leaving the hospital postpartum. I believe that the hospital where I gave birth is one of those because they were very encouraging of establishing a breastfeeding relationship and I did not receive any samples.

It seems an appropriate place to mention the "Ten Steps to Successful Breastfeeding". Although, giving out free formula samples in not expressly mentioned, I believe that doing so is against the spirit of the initiative.

The Business of Being Born

The Business of Being Born, a documentary about birth in the US, is currently showing across the country. It is produced by Ricky Lake, who was disappointed to see how birth was treated in the hospital system. She resolved to have a completely different birth for her next child and planned a home birth with a midwife. The documentary shows the birth of her water baby as well as the stories of other families and the process of welcoming their children into the world. It also questions how birth is treated in the US, and that normal birthing is practically disappearing.

I am very excited to see this film. I have been waiting for it for MONTHS to come to a theater near me. And I was crushed when I missed a screening put on by the Seattle Midwifery School.

But finally, I have ample opportunity to see it! The Seattle Film Festival is doing 8 screenings of it between February 29 to March 6.

On a more personal note: My respect for Ricky Lake as a person has grown tremendously knowing that she's taken on this project. Our birth stories are pretty similar--non complicated vaginal hospital deliveries that left us feeling empty, that something was missing, or being treated wrongly in the birth process. We have both started on a path of advocating natural birth options for women who are low-risk. I intend that my next birth will be much like her second birth, out of hospital with minimal interventions, and to truly experience what normal birth is like.

The Complaint Process

After a traumatic hospital experience in January of 2007, I have been trying to heal myself and advocate for prevention of traumatic experiences for other women birthing in American hospitals.

First I asked the midwives at the hospital who I would send a complaint to. I was told the nurse manager. I took my complaint to her who said it would go to an internal review board with the midwifery practice at the hospital and their supervisory obstetrician. I wrote a letter to them detailing the outcomes of the care they provided me. It was 5 months from the initial phone call to the nurse manager to the response sent from the review board.

The response I got back ignored my case of PTSD and that it was caused by their treatment. Instead, I was told that I had "received a clinically appropriate standard of care."

I wrote back pointing out this discrepancy in handling my complaint. I was told that my case was being forwarded to the Grievance Committee conducted by the Risk Management department of the hospital. I was also given the contact information for the Joint Commission and the State Department of Health. Both have official complaint processes for patients and family members who believe that their care was not conducted well for whatever reason.

Currently, a year after the initial trauma, I have complaints lodged with the Joint Commission, my state department of health and the risk management department of the hospital. I'm waiting to hear what they will say. And who knows if my complaint with have an effect.

For others interest in making a writen complaint about care they have received go to:
Joint Commission Complaint Form

The Joint Commission is a non-profit accredidation and quality assurance organization for over 15,000 hospitals and medical care centers in the US. They have some clout in getting hospitals to change their policies.

I will update when further progress has been made.

Home Birth Safer Than Hospital Birth?

This new study hesitates to say that home birth is actually safer than hospital birth (for low risk pregnancies, which most pregnancies are). But the findings can be interpretted that giving birth at home is safer than giving birth in a hospital.

It depends how one wants to define "safety." Is safety the outcome that mom and baby come out alive? Or is safety the outcome that mom and baby are alive and unharmed?

Is a mother unharmed when she leaves the hospital with sutures from an episiotomy, or a healing C-section incision? Is she unharmed when she experiences spinal headaches for weeks, months or even years after giving birth? Is a baby unharmed when he has injured neck muscles from being pulled out by forceps, or when he has a scab from the internal fetal monitor gouged into his scalp or an accidental nick from a surgeon's scalpel?

For moms birthing babies at home, these injuries aren't even possible because there has been no epidural or internal monitorring or abdominal surgery. She's 32% less likely to have an episiotomy showing that midwives are not as cut happy as the hospital birth attendants.

As for mortality rates, the study showed that the rates were very similar between home births and hospital births (1.7% or 14 in 5,418 babies). It important to note that the percentage of fetal or neonatal deaths was comparable to deaths of babies in the hospital, showing that location of birth doesn't make a difference in those cases.

An interesting note was the researchers explanation of the mortality rate in the study. They said, "Although the crude mortality for low risk babies weighing over 2500 g intended at home was 2.4 per 1000 and intended in hospital was 1.9 per 1000, when standard methods were employed to adjust for differences in risk profiles of the two groups (indirect standardisation and logistic regression), both methods showed slightly lower risk for intended home births."

To explain the technical mumbo jumbo, they were comparing results of other studies investigating infant mortality rates in home births and hospital births. They had to use some statistical analysis to fairly compare the studies and in their comparisons, they found slightly lower risk for intended home births. Suggesting that home birth is actually safer for babies too, than hospital birth.

My experiences of PTSD after childbirth

Some of my friends may have noticed that I have not been myself in the last few weeks. There are a lot of reasons for this, some of which I understand and I'm sure some I don't. Since Willem was born, I have been plagued with memories from his birth. I have experienced flashbacks where memories loop over and over again and I cannot stop them. I experience flashes of anger as I recall the way I was treated by the hospital staff. I can recount the ways in which I felt violated, belittled, and ignored. These feelings are strongest when I'm trying to fall asleep at night so I have spent many times (such as this one) awake, struggling to fall asleep but I can't because I cannot get these thoughts out of my head.

For many months, I couldn't talk about my experiences or even birth in general without a flood of memory. My husband and I would spend hours whenever the topic came up (which was frequently) going over the time when I was laboring to give birth to our son. A couple of times, my sleepless nights resulted in my husband being awoken by my crying and then together we would talk through the whole experience again.

I was sad and hurt because of the treatment I received but afraid that other women everyday since then, maybe even as I'm writing this, are experiencing the same type of degradation and disrespect. I don't want that to happen to another woman and so I know that some action is needed to prevent it.

I began considering becoming a midwife so I could ensure that I never was as insensitive to a laboring woman's needs as the midwives who were responsible for my prenatal care, labor and delivery. I realized that they weren't responsible for my care and my ability to give birth. They were supposedly assisting me in my responsibility as a woman, and a new mother. I wanted to be sure that I was also a help and a support, not an authoritarian, imposing figure of punishment and manipulation. I quickly realized that I am not prepared or willing for a complete career and educational change as going into the medical field from child development. But I realized that the role of a doula or labor assistant would be a complimentary type of family and parenting education to the type of educator that I am already trained to be. I started looking into the educational requirements that a doula needs to be certified and found that a strong understand of the physiological process of birthing as well as the ability to comfort and support a laboring woman in the way she feels she needs to be comforted is necessary. So I started researching and learning about the process of birth, how it is best accomplished without medical interventions and "aggressive management."

In this period of learning and thinking of changing direction in my education, I began to be more verbal about my experience which I realized could be considered traumatic since I was still dealing with negative emotional effects from it. I joined some online groups for women who dealt with traumatic birth experiences and found that I was not alone. I knew I was not depressed because I only became angry or hurt when recalling those events, and did not feel down at any other time. In my research and learning, I discovered that it is not uncommon for women who endured difficult birth experiences to display symptoms of Post Traumatic Stress Disorder. I read some the definitions and descriptions and found that I do display many of those symptoms. Since realizing that, it seems that a Pandora's Box of recollection and feeling has been opened. The thoughts and memories that once plagued me intermittently now wouldn't go away. They were always there, on the periphery of every thought and action of my day. I had a diagnosis, a reason, an explanation for why I was broken and dysfunctional.

I was able to give birth to my beautiful almost 7 pound baby without drugs and in a hostile environment where I had people telling me that I couldn't give birth without drugs, that I would need to be induced, that they—"the experts", the doctors, midwives and nurses—could take over and make my body do what it couldn't do on its own. But I believed that my body was capable of giving birth safely, naturally, without the "help" of interventions that could potentially harm me or my baby. And because I was able to be strong, to stand my ground and endure, I was treated that there was something wrong with me. That if I didn't receive their "help," my baby would be hurt, or killed or that I could die. And then I come away from that experience knowing that I can allow a baby to grow within my body and then pass through my body as he/she enters the world, feeling vindicated. I learned that it can be done, that it's not scary, or unbearable. But I was still scarred. By people who instead of helping me though a time of tremendous effort and concentration did everything in their power to make it harder for me, by insisting I remain in positions that are empirically shown to be ineffective and more difficult for a laboring woman, by pushing drugs and interventions that are shown to increase the occurrences of complications and needed interventions, when I could do it on my own. I needed people who would offer me confidence, strength, encouragement and measures to help me be more comfortable to make the process easier. Instead they made the whole experience harder and as I come to find out—traumatic.

And then there are other issues. Why am I having such a hard time putting this experience behind me when other women have experienced much worse? Giving birth to a child is always an emotional event and every woman I know has been able to put it behind her. No one that I know of has ever "suffered" long lasting emotional effects like I have. So what's wrong with me? This sense of inadequacy is probably why its taken so long for me to start talking about this with other women, especially other women who have given birth and are mothers.

Another thing that has kept me from talking about this experience (outside of the people who were there) is that it's been too painful for me to do so. I still have a hard time talking about it without breaking down, yelling, crying and having the bitter resurgence of anger rise up within me. I've even tried to refrain from talking about it with my husband and my friend who acted as my doula because I don't want to annoy or alienate them. I don't want to expose people whom I love and care for to a flood of negative emotion, anger and drama. I'm also especially cautious to share my feelings with friends who have not yet had children or encountered the mentality of doctors and hospital staff when it comes to pregnancy and birth. I don't want to scare them.

A couple of weeks ago, I was finally able to express to the hospital where Willem was born that their staff may have been responsible for the maltreatment of me as a patient. In telling my story to the nurse manager, I was very proud of myself that I was able to remain calm. Upon hearing my description of the events, she promised me that she would call a review board with all the midwives and supervisory OBs to review my case as it sounded to her like there was some breech of hospital policy and violations of my rights as a patient. I have been waiting to hear about the results of that meeting (it will be in the form of a letter that will tell me nothing, but I still want to know that it happened). In the last two weeks, my emotional distress has reached a new height causing me to act in ways that I wouldn't typically act.

I have become very vocal about distrust for doctors, especially OBs, midwives and nurses and the medical interventions they routinely offer to laboring women, as well as my disappointment in the number of women who trust their doctors without understanding the potential risks of those interventions. I had learned some about the side effects of interventions in childbirth and knew that I didn't want to expose myself or my baby to them. I also looked at childbirth in a spiritual way—women were created by a Divine Creator who made women's bodies to be capable of giving birth without medical interventions and put medical technology on the earth to help treat women and babies in case something went wrong. I believe in the power of women to carry, nourish and birth their babies and I was sad to hear of so many of my sisters who were so scared of the pain of childbirth and instead opted for an "easier" way. Even though that easier way often leads to complications that make the whole process more difficult and potentially damaging to mothers and babies. Some women I talked to experienced stalled labor, C-sections, seizures, long term pain and difficulties, had babies born who were not breathing or had to spend weeks in the NICU because of the "care" they received. I am worried about my friends and the countless other women who are not informed of the potential side effects of standard ..:namespace prefix = st1 ns = "urn:schemas-microsoft-com:office:smarttags" />OB care during childbirth. Since I had a difficult experience without any of that, I just don't want anyone to experience anything similar or worse to my experience.

I feel that I was spared from a set of problems that I would rather do without. Because of the curvature of my spine (scoliosis) I am pretty confident that an epidural would not have been able to be placed properly in my spine so the likelihood of nerve damage and the resulting complications were high for me. I consulted with my chiropractor on this and was validated in my concern. Her professional recommendation was that it was a good thing that I didn't get the epidural.

Who knows is this explanation is helpful in explaining my actions of the last few weeks. I am seeking help to deal with the PTSD. I start meeting with a psychologist on Wednesday and hopefully, I'll be able to let go of the anger and hurt and I feel. I want to be able turn that bad experience into something good and channel my energies into making birthing more comfortable and safer for other women. I also know that I can turn to my Savior to find comfort and peace, where he can help me let go of my grief because he has suffered it for me. Unfortunately, it's not as simple as it is to say it. There is a process that I need to work though and I am making progress and starting to be able to move forward.

Many of my current decisions are being based on that experience to make things better. The main reason why I am seeing a chiropractor is to reduce the curve of my spine so my next labor will not have as much back labor. My current focus in my scripture study is to understand more about the resources God intends to use for our health and well-being, part of that the use of drugs in childbirth. As I also talked about, I'm studying a new area for my education as I am working to become a doula. I'm also starting research on PTSD that occurs after a traumatic birth experience and how it can be prevented in the future. One of the big answers to that question is by having supportive, sensitive birth attendants (doulas in particular), which is a big reason why I'm heading in that direction.

I hope I have not offended anyone with my actions of the last few weeks. I am trying to make sense of a difficult period of my life and that is why I've written this explanation—to explain to my friends why I've said and done some of the things that I have. I hope you can understand.

The Midwife Search

After my experience with CNMs (Certified Nurse Midwives) in a hospital setting, I feel very strongly that I cannot plan another birth in a hospital. That leaves me with two other settings: a dedicated birth center or at home. The attendants at births in those settings are midwives, whether LMs or CNMs. They are also much more likely to support the Midwifery Model of Care. That's the standard of care I thought I would be getting from the UW Midwives program, but I was mistaken and suffered because of my own ignorance.

This time around, I am interviewing potential midwives BEFORE I get pregnant so I don't feel any pressure to pick one because I have a time bomb in my uterus with a deadline. I started doing internet searches in my area. Living in Seattle(home of the pioneering Seattle Midwivery School), there are lots of midwives around.

Most out of hospital midwives will provide a free consultation appointment where a woman can interview with questions and get a feeling for a particular midwife's philosophy and style. I learned its important to be able to trust a midwife at the vulnerable time during labor and birth where a woman needs loving support and is easily open to suggestion.

Here is a sample of the questions I asked:

How do you employ the Midwifery Model of Care in your practice?

How do you empower women?

What positions do you suggest for birthing?

How do you support a laboring woman?

If a transfer is needed, what do you do? Where to?

What complications necessitate a transport?

Describe the prenatal care.


I interviewed four midwives initially and got enough information where I felt I could compare and choose of those four which I felt most comfortable. Tentatively, I have chosen one who also provides Naturopathic care to families and children. However, the search does continue while I continue to think through my wants while weighing what I feel is safest for me and my next baby.

Willem's Birth Story

Thursday night, sex is what did it. Within a couple of hours the contractions started (around 1:30am). I tried to sleep but gave up at 5:30 when I woke Peter up and told him what was going on. We waited until my appt at 11:00 to give me more time to progress. At the appt, I was at 3 cm. That's when they told me I could go up to L&D and then a few minutes later found out they were full so they were sending me home. At that point, I just wanted to be in one place where I could get comfortable. I definitely had the urge to hole up so I could relax and just focus. I wasn't comfortable at home because it is such a small space that I felt trapped, my bed wasn't comfortable, the bath is too small, etc. I think if they had let me get comfortable at the hospital, things would have progressed a whole lot faster. But I got stressed out and I think that really slowed me down.

At 4:00pm Friday I went back to the hospital. My contractions were closer together and stronger but I was only at 3 1/2 cm. I was comfortable, relaxed and happy to finally settle in somewhere. I was looking forward to the bath and just focusing on the Hypnobirthing techniques. I got about 3 hours of that and then the evil midwife Cindy started harassing me about "moving things along." I was given a few options, none of which appealed to me. I might have considered having my water broken but I felt like I needed to progress more on my own. I was given an hour to "wait and see." After the hour was up, they came back and told me that my only options included drugs. That just pissed me off.

I was told that I could 1) get my water broken and started on a pitocin drip. 2) be given sleep medications and go home. 3) be put on a morphine drip and stay in the hospital. What did I want? To be left alone and stay in the hospital so I could focus on the Hypnobirthing techniques. When I made that clear, the chief resident came in and flat out told me that all my options had been taken away and that I needed to go home. No "come back when your water breaks" nothing. I was PISSED. To add insult to injury, the medical charts from that day said that I was told to leave but left before any direction or follow-up could be given. Hello!? They didn't offer it.

The next few hours at home were some of the worst of my life. All the reasons why I wasn't comfortable before were so much worse. The contractions were stronger and closer together and most of them were in my back at that point. I hadn't slept in 24 hours, I was stressed and scared and panicky after the conflict with the hospital staff. Laying down was miserable because I was having back contractions, my bed was too soft to be on my knees and that was making the back contractions worse, flat was bad, on my side was bad. The birthing ball was okay but my legs were so tired that I couldn't keep myself up. I called my friend who was acting as a doula (she had been there at the hospital with us) and she came back. Without her, I don't know what I would have done. I was scared and Peter was scared. She helped us figure out some things to do. I still can't believe the hospital sent me home then without any support. When I called to ask for some help, the only thing I was told was I could come in and they could augment my labor (i.e. breaking the water and pitocin) and received no sympathy. It was either I go in and let them take over or I stay at home. This was about 2 am. By then I had been in labor for 24 hours and I felt like I had been kicked out on the street with no one other than my friend to turn to. It was a hellish experience and I hope I'm not scarred for life. I was so stressed out by then I started vomiting. I seriously started considering giving birth at home but felt like the conditions I was in was second world at best. For goodness sakes, Peter and Shawnette were having to heat water on the stove to put it into my bath, the only place where I was semi-comfortable.

All through this time, I was able to use the Hynobirthing techniques which was basically breathe through each contraction and visualization labor progressing, my cervix opening and the baby moving down. Those mental cues weren't as powerful as I think they should have been because of all the stuff I described in the paragraph above. The breathing kept me sane and Shawnette and Peter helped me focus on that.

By 7 am Saturday, my contractions were much stronger and closer together. I was completely distrusting of the hospital but couldn't keep going like I had been so I basically resigned myself to letting them take over. I went into the hospital at 8 am and found out that I was 5 cm dilated and fully effaced. That was disappointing and I would have been very discouraged if it weren't for the midwife and nurse (the good Cindy) who were on the shift. They were excited to help me and wanted to make sure that I was able to get comfortable. Everything was 1, 000 times better with those two looking out for me. They let me progress for another few hours and then suggested that they could break my water so I could get to the next phase of labor. After contracting furiously for 35 hours, I was open to that, especially since there was no mention of pitocin.

They broke my water at 11:30 Saturday morning. Things really started picking up from there and by 2:00 pm I was fully dilated. I was exhausted but was much more relaxed than I had been in the previous day. I was still breathing through contractions pretty well.

I should probably mention that Willem was doing fine through all of this. His heartrate was strong and stable. I was surprised to find out that he was sleeping through some of my strongest contractions.

At 2:00, I felt like I wanted to start pushing. I expressed that to the nurse and midwife who insisted that I move from my comfortable spot in the tub to the bed. The nurse cajoled and insisted on having me lay down and be monitorred. I was bothered and annoyed and told her repeatedly to take the monitors off. They were making me uncomfortable and I couldn't move into a position that I felt I needed to be in.

In the Hypnobirthing method, pushing is not encouraged and a technique called "breathing the baby down" is used. But because of my exhaustion and the stress of fighting off the nurse and recalling the stress of the day before, I just couldn't figure out how to do it, so I did the only thing I knew I could do- push, in the position they wanted me to be in, on my back, with my legs being held by Peter and the nurse. After 45 minutes of pushing, he was out. I had always heard that after the head is out, that it takes another push or two to get the rest of the body out. Nope, not with this kid. He went flying out in that last push, his head and everything else flying at a surprisingly high velocity. Sad for Peter, he missed taking a picture of the baby's first breath because he was moving so fast. Pushing intimidated me and my intensity in that situation intimidated me. I didn't feel like myself and I still can't describe what it was like. The best I can come up with is primal. The scream that tore through my body was not one of pain, but of sheer effort and the fear that I was actually expelling a child from me and with a vague sense of familiarity like the scream accompanying an intense orgasm.

So after 38 hours of labor, Willem was born at 2:45 pm Saturday afternoon. At birth, he weighed 6 lbs. 13/4 oz. and was 20 1/2 inches long. The only medical assistance I got was having my water broken, something looking back on I regret. How I know that AROM rarely does not speed labor along in statistical tests and wouldn't have have affected my labor in any substantial way.

I did tear a little bit in a couple of different places but I was assured repeatedly that its not that bad and only required one or two stitches in each place. At the time I asked if it was neccessary for the stitches because I would have preferred any small tears to heal on their own. The midwife responded that they probably weren't neccessary but she was going to do them anyway. Before I had a chance to refuse, she had started. I laid back, again, exhausted and tired of fighting and let the whirlwind of activity take place as my baby was taken from my arms and kept away from me while a needle was being pulled through my flesh over and over.

I stayed in the postpartum ward at the hospital on Saturday night but got really tired of the constant monitoring and interruption. The bed was too short for me to get comfortable and I was really looking forward to going home. I'm so glad that home was appealing to me because after Friday night... I was worried that I never want to go back there. Now its the hospital that I never want to go back to.

I feel like I was treated unfairly and unprofessionally by the hospital staff on Friday and am so glad (and the hospital should be too) that I got better care on Saturday, when even then my rights were violated when treatment was forced on me when I was clearly voicing or even before I could voice my refusal.

Since then I've learned that the care I received was standard procedure at that hospital and at most hospitals in the United States. I have experienced months of Post Traumatic stress from that ordeal where I feel like control of my body was taken away from me and my freedom restricted. One reaction I had to that experience was wanting to have another baby as soon as possible to do it better next time, like a do-over. And the next time will be out of hospital with either a hands off midwife, midwife on call for an emergency or completely unattended by midwife or doctor.