Rant on Choice

(original essay was written in 1999)

The first intervention in birth, that a healthy woman takes, is when she walks out the front door of her home, in labour. From that first intervention, all others will follow".

Dr. Michael Rosenthal - Obstetrician

One of the hardest mental exercises I ever had to do was complete my practical rotation during my perinatal nursing. I had a few run ins with my instructor when it came to understanding that *we* as nurses must respect the woman's choice when it comes to her birth and breastfeeding experience, regardless of how we feel about the issues of routine interventions and lack of "real" education regarding those birth choices.

I've learned that women come to birth with a variety of objectives (cope as best is possible, hope for the best and leave with a healthy baby), how they meet these objectives is where the nurse comes in. The woman that is uneducated about birth, and dependant upon unknown persons to see her through her travail, is guided by policies set up in hospital to ensure that she and baby are kept as safe as possible. Most often the mother makes choices based on word of mouth education and has an imperfect understanding of obstetrical intervention and those that apply them. Knowledge of things like: narcotics do not kill the labor pain, or mothers must reach active labor before the epidural is given to ensure that labor has a chance to progress, a slowed labor will get pitocin/syntocinon to speed it up and so on is usually not discovered until the mother is well advanced in labor and admitted to the labor room.

I'll admit I graduated my preceptorship with the lowest mark I have ever had during my ten years of full and part-time nursing education (I am sure this was because the nurses marking me saw that I was a rebel and did not conform with the *ways* a nurse should be (made me want to puke some days)). Speaking up and voicing my concern for the status quo in the current maternal care system made me furious.

In the end I did see that my trying to educate was a bit more up front than some nurses could handle. I eventually kowtowed (really I did, *gag*) to my instructor and *saw the light* and *the error of my ways*!!! I decided on my last day that there was no way I could work in hospital if it meant supporting interventions practiced on women with a loose sense of informed consent. I have been told that there are many women that need someone like me to help them through labor and that I could help many by working in an L and D unit. Unfortunately I *choose* not to. This is not an easy choice. But personally it would be too difficult to know that the epidural queen is my client because I'm next on the list to receive a "patient", and the nurse that pushes epidurals rather than support the mother gets the mom wanting a normal birth. It would kill me by the end of the first week.

I recently spent an evening with a girl that was due in a couple of weeks. She was pretty easy going about the whole pregnancy/birth thing, until week 36 came along and those old hormones kicked in. She began to question exactly what was to happen (yeesh!!). Well I spent all of 3 hours with her educating her on the emotions of birth and what to look for, some of the things that would indicate a quick trip to the hospital and what hoops she was probably going to have to jump through to birth with no drugs (which was her wish). Well this little girl had her baby last Sunday. She headed to the hospital in such early labor (10pm) that they gave her a shot of morphine and sent her home to sleep. After her water broke (@ 2 am) she started to feel pushy, so off to the hospital they went. They luckily are placed into a birthing room (3 am) PDQ, and the nurse dons her glove. She assess the mom at 3.5 cms. HHHHHmmmmmmm you say??? pushy at 3.5 cms... posterior baby??? what could it be. Well this girl described the nurse as an old cow and slightly incompetent as to what she was doing. The nurse is "crabbing" at the girl to not push or you'll swell the cervix, blah blah blah... (these were the moms exact words.) the doc arrives about 15 minutes later and the mom tells him she feels pushy. Doc checks her to make sure...and guess what!!!! the mom is at 8-9 cms Now if the doc had not arrived and the mom was to continue in labor with this nurse what do you think would have happened? the mom was so uptight with this nurse she tightened up, now if the nurse were to stay in the room all the time to support this young girl that did not know enough to ask for another nurse...how well do you think she would have dilated. I truly believe that this case was a perfect case of mom relaxing and dilation progressing swiftly. Once the doc had arrived and the mom felt comfortable and safe (yes safe), she let go and her true dilation showed through. I would have been scared for her if he had not shown up on the scene. As it went, she took another shot of Morphine when she was almost fully dilated, (I think if this mom had had a doula she would not have needed it). This gals only non-medical support was the father of the child who she had broken up with during the pregnancy). She only pushed for 1/2 hour until she began saying she wanted it over (her words), yup out comes the vacuum and baby born minutes later. Mom has a second degree laceration. Baby is dopey and having a hard time breathing because of the morphine, they want to give Narcan (morphine antidote) mom refuses because she doesn't know what it is!!!!!!!!

Okay I do have a point some where in here....let me find it...

Oh yeah...choice!!!!

Where were the choices during this birth? What was affecting them? Is it ethical to have a mom who is in the throes of a perfectly normal labor to make decisions that she may later regret. Do we stand by and say "you can do it, you are doing it you just have a bit more to go!!! Hang on there girl!!! Think of the baby!!!", or do apply the interventions and then we make sure that we have all the rescue measures on hand to counter-act the adverse affect the decisions have on the baby.

Do yourself a favor. trust yourself, trust your body. Don't take the chance of waiting and seeing if your birth is good, and then make different choices the next time. All births are as different as the child that is born. Place yourself in the company of familiar faces and surroundings. Don't take your chances. If you are unsure then go to a birth center. If your pregnancy is healthy seek out the advice of a wise woman (midwife, doula, alternative care physician, etc), or at least just consult with one and see the difference in attitude. It just might make a different to not just your experience, but your baby's too.

The choice is yours, but when you make that choice, please understand it will effect your baby in all ways. Educate understand and believe. That is what makes birth good.