Birth options here (DC area, USA):
In looking into birthing options here, what I've discovered is that it is much less common to be able to have an active natural birth within a hospital setting, even for low-risk patients. By this I mean, there are systems in place that prevent or make it difficult to choose this as an option.
This is also the case in parts of Australia, however, it is becoming a more common practise to have a midwife-operated birth centre within major hospitals catering particularly for women who are considered 'low-risk'. This provides the option of having an active, intervention free birth with the backup of immediate medical assistance if it is required.
For example, in such settings (birth centres), rather than using Electronic Fetal Monitoring (which requires the labouring woman to lie or sit in a reclined position with her legs raised), Doppler devices are used. This is according to evidence based practice, which shows that Doppler devices are a more appropriate monitoring device for low-risk pregnancies than EFM (see link).
In fact, despite the prevalence of EFM (85% of births in the USA in 2002), much evidence (including very good quality studies) have indicated that it neither reduces infant mortality or the incidence of Cerebral Palsy (actually, it has a 99% false positive rate of identification of CP!). The only positive evidence for using EFM was a reduction in neonatal seizures (which shouldn't be discarded). However, the use of EFM was also associated with significant increases in caesareans in assisted vaginal delivery. A summary of this evidence has been published by WHO (see link).
I don't find it surprising that use of EFM is associated with increases in assisted vaginal deliveries and caesareans. Anyone who has laboured in an active birth position will tell you that having to lie or sit in a reclined position is much more painful. I don't know whether I would have been able to deliver P without medication had I been required to be reclining for 20 minutes out of every hour of labour! It seems counter-productive to me, especially as there are other ways to monitor fetal heart rates that don't require restricting a woman to an uncomfortable birth position (for P's birth, a Doppler was used and didn't require me to move positions or get out of the shower).
However, while birth centres within the hospital setting is becoming more common in Australia, it doesn't appear to be so common in the USA. Perhaps this is linked to insurance or medical indemnity, I don't know. Where I live, there is only one birth centre in 2 states and one district. This birth centre is not at the hospital. If I was to go to my local hospital, even as a low-risk patient, I would still be required to follow hospital guidelines which require increased interventions, including EFM for 20 minutes out of every hour.
So, in light of all of this, and due to the fact that I am currently in a low-risk category and have had an active natural birth with P, I've chosen to book into the midwife-run birth centre, rather than the hospital. Personally, I would prefer to have the confidence of knowing medical aid is close-by should it be urgently required, but am trusting that they have good systems in place for hospital transfer should it be needed.
And while I'm praying for a good delivery and healthy newborn, I'm also looking longer term. I'm praying that this baby will know it's Creator and that God will give us wisdom as parents.
This is a follow-up to my previous post on health care reform in the USA, but this one is more personal, relating to my quest for health care with the birth of our second baby due in December.
To avoid a super-duper long post (I've been thinking a lot about this), I'll break it into smaller parts. This post will deal with some of my overall beliefs about birth.
- I am not anti-caeareans. I think they definitely have their place and am grateful for the lives of friends and their babies who have been saved through this procedure.
- I'm pro-choice (when it comes to baby delivery that is). I respect the informed choice of women to decide on birthing options that suit them, their baby, their health, their family. This may mean induction, drugs, caesareans. It might also mean none of these.
- I'm also pro-choice in that I think women should have the choice of a natural, active childbirth if they are healthy and able to do so. They should be able to do so without unnecessary interventions if they so choose.
- I think that children are a blessing from God; birth is but the process of them coming into the world. Although this issue has taken quite a lot of my thought space over the last few weeks, I'm reminded again that we are having a baby, not a birth. In my mind, focusing on the birth is like focusing on the wedding day over the marriage. Having children is so much more than the means by which they enter the world (ask anyone who has adopted!!)
Trust in the LORD with all your heart
and lean not on your own understanding
in all your ways acknowledge him,
and he will make your paths straight
Proverbs 3: 5-6
And for next week:
I think it's time I did some New Testament. I'd like to memorise more than an odd verse here and there, so my goal is to memorise Philippians 2: 1 - 11. But, to do this, I have to make it manageable, so I'll be breaking it down into smaller parts each week.
I have a cold this week, so I'm going to be slightly unorthodox and start with a small verse in the middle. It will be easier to memorise, but I've also chosen it, because for me it is a good summary of the whole passage:
Your attitude should be the same as that of Christ Jesus: (Philippians 2:5)
Anyone else want to join along?
I'm pleased to announce that our very clever 20 month old can now hold her wee-wees.
She will sit for 20-30 mins on the potty, even with the bath running, and hold it all in.
Then, as soon as her feet touch the bathroom floor or the bath water, voila!
Ha! Now we just have to figure out how to reverse that order...
