AmericanMum

Not only did I not see very few Oscar-nominated movies, not only did I not even know it was Oscar night last night, but I was in bed at 8pm.

Kids do funny things to priorities sometimes.

This Christmas, our family received several thoughtful gifts from my brother and sister-in-law, the only faithful democrats in either of our families except for yours truly.  Inside of an “Obama for Peace” tote bag we unwrapped, among other things, the full DVD set of BBC’s Planet Earth.  Since we do not have cable we had missed the show - but let me tell you - we are in love with it.

In fact, Connor loves it perhaps even more than I do.  He saves up his screen time every day so he can watch an episode with the family at dinner.  Today, at the mall, he was the on the receiving end of several head turns when he asked me, “Mom, I want to play at the train table but if I do will we still have time to watch Planet Earth when we get home?”  Kid, you make me proud.

We have only two shows left to watch, but we’ve been blown away.  I cannot describe what it is like to see snow leopards on film that no one has seen for years, or crystal caves that are closed to humans forever, or a panda bear breastfeeding her young, or a polar bear close to starvation desperately trying to attack a herd of walruses for lack of its normal prey, or thousands of antelope or birds or whales in migration.  It’s all done in stunning beauty in a way that is hard to put into words.

But that’s not the real draw to the show.  The real draw is to see how big the world is, how complex, how detailed to the largest peak down to the smallest little bacterium’s elaborate world, and how all the pieces fit together perfectly.  And at the same time to contemplate how small the world really is, how close each species is to each other, and how easily the whole big, beautiful thing can be thrown out of whack by one species - namely, us.

With the voice of David Attenborough as our guide, our family of four has traverssed deserts together, dove to the bottom of oceans, flown over the tallest mountains, and looked over the world from the tops of rainforest trees all from our sofa.  Now we are on the last disk - where we contemplate the future of species, environments and what we can do about it.

I can’t help but think though, that the conservationalists have it a bit backward.  (Bear with me - you all know I’m an environmentalist.)

Instead of enforcing and micromanaging and preserving individual species at all costs - is there another way?  What about evolution?

What about just leaving existing habitats alone?  Really, truly alone?  Even the unglamorous ones?  And letting Darwin’s principles figure it all out?

Humans are destroying the earth and the habitats of plants and animals.  But what if we cut back - way back - on our energy use, on building roads through every available habitat, on cutting down trees for building a newer shinier planned community in previously undeveloped land.  Do we have enough faith in evolution and our planet’s natural balance to let it balance itself?  Then we wouldn’t have to be micromanaging the lives of each and every ivory-billed woodpecker, or having to cull some trees and plant others to manage forest health.

What if we put a moratorium on building where there were no buildings?   What if our national forests were no longer just a fancy name for tree farms, measured by the board-foot?  What if we just let what lives, live?

We’ve proven time and time again that humans do not excel at managing the environment.  What if we stopped?

Instead, what if we just learned how to manage - us?

I don’t know the answer - I just know that something has to be done to preserve our planet.  And what we are doing now - thinking that we can manage better than evolution - is just not working.

I received a comment on my last post, “Introducing the Mid-Columbia Birth Network” that I wanted a chance to reply to in detail. Go to my last post and read the comments there, then come back here for my reply. As it turns out, I don’t disagree with the commenter on the bulk of what they have to say. Actually I think we have quite a bit in common in our beliefs. I have no idea who this person is in real life, but chances are I’d bet we’d have a lot to not our heads in agreement over.

Like the commenter, It bothers me quite a bit when doulas, midwives and others prone to more uninterventive birth beliefs lump obstetricians and nurses into the “evil” category. I don’t for a minute believe that doctors and nurses are out to get women, wielding their evil epidural needles and their Pitocin bags as tools of torture and misogyny. I know obstetricians and L&D nurses personally and respect them immensely, although I won’t always agree with everything they practice (just as a group of nurses or a group of obstetricians might not agree on everything either).

It might surprise the poster that I have great memories of my own personal experiences with childbirth, but that they occurred at a local hospital with an obstetrician attending both times. I had planned epidurals - the first at 3 cm (it was an intense 5 1/2 hour labor, and I was just sooooo scared), and the second at 7 cm (I was able to cope the second time much better, partially because of the one-on-one support I received from the labor nurse assigned to my care).

That is not to say that there are not a ton of things I would change about the way I gave birth, knowing what I now know. (I have to wonder if I would still have a uterus if I hadn’t have chosen an epidural, consented to an episiotomy, and pushed with all my might during second stage, that resulted in uterine prolapse.) But I continue to learn about pregnancy and childbirth with every client I take, from every birth professional I meet (whether or not they share my own paradigm), and with every book I read. I do have to honor the person I was at the time of my births and remember that the hospital staff honored my wishes for what they were, and that I was treated with the utmost respect.

Doulas should never guilt a woman into not having an epidural. I never tell a woman if she should have an epidural or not. What I do is use the Pain Medications Preference Scale to assess where a woman’s desires are for epidural or other drugs. Then I help her achieve them. For a woman who strongly wants to avoid an epidural, if she says “I want an epidural!” during labor, I might bring up other things she might try, such as a bath or a massage or a change of position, or I might say “how would you like to try five more contractions and see how you feel after that”. For a woman who knows she wants an epidural as soon as she can have one, I might even tell her when she is a strong active labor pattern that it would be a good time to have her epidural now if she would like one. It is all based on her personal needs. Although I’ll tell her what the risks are with an epidural (which really, they are minimal), I have zero preference for if she has one or not.

I agree that my numbers from the World Health Organization I referred to on my last post are not stand-alone evidence to support a less interventive model of birth. As the commenter suggested, it is very hard and often unethical to perform randomized, controlled studies to determine how well a country is doing on maternal and fetal health as the topic is very complicated. However, I still think it is a valid part of the equation. I have a hard time believing that the countries that rank ahead of us don’t struggle with drug abuse during pregnancy or lack of prenatal care in similar numbers to our own country’s. It is interesting, however, to note that of the countries that the World Health Organization has labeled as “developed” countries, our country ranks toward the bottom on each of the lists. These countries can afford good health care, good drug education programs, and so forth as well as we can. Whatever the answer is, whether it be fixing the methods of birth or the health of women in general, I hope we can work toward finding the solution.

However, there is other evidence that shows that our current methods of obstetrical care might not be serving women in their best interests all of the time. Like most doulas I know, I try to keep up with what the medical evidence says so I can provide my clients with the best third-party information I have (and as I’ll expand on, let them make their own decisions with their practitioner about what is the best course of action FOR THEM). When I first started keeping up with the latest obstetrical research, I thought for sure I would find that there is solid evidence on both sides of the fence. And I vowed to support the evidence, whatever it said. I am finding that most often, the evidence I see coming through the obstetrical research news wire, shows a less interventive approach than what I currently see in the settings in my local hospitals is statistically the safest option for both mothers and babies with normal pregnancies, or at “worst”, shows that doing something and doing nothing carry about the same risk therefore the mother could choose the gentler approach if that is what works best *for her*. I often use the Cochrane reviews as a source of balanced medical research. Cochrane shows me that many interventions used in my area hospitals show no medical benefits or are actually more risky than doing nothing. For instance:

routinely breaking the bag of waters during labor actually does more harm than good

the use of continuous External Fetal Monitoring (EFM) did not reduce incidences of cerebral palsy (the primary reason EFM is used) but instead had a significant increase on the rate of the need of Cesearean birth or assisted vaginal birth

early skin-to-skin contact had greater benefits to a baby warmer alone (in a normal birth scenareo, fetal assessments can occur directly after birth just as easily on the mother’s chest, or even be delayed for an hour or so)

delayed cord clamping improves baby’s health

the risks and benefits of home versus hospital births are about equal

induction of labor before 41 completed weeks of a normal pregnancy has no medical benefit

there is not enough evidence to support using active vs. conservative management of fetal distress is a benefit

benefits to giving birth off your back include less pain, better fetal heart rate, less forceps deliveries and less episiotomies

there is not enough evidence as to the safety of misoprostol for induction of labor

If there are sources of information that I need to be checking for quality sources of obstetrical research, I sincerely want to know. I don’t want to ever give a woman information that isn’t backed by solid research.

The commenter mentioned many anecdotal stories of medical technology saving the day. I absolutely agree that these things happen all the time . I also absolutely believe that a less interventive method can save additional lives. I have many anecdotal stories where I have seen this happen or heard of stories where this has happened at births attended by people I know.  I also have seen and heard of countless stories where women were seemingly coerced into doing something that actually had the same or higher risks as the more gentle alternatives.  Or were made to feel inadequate or shamed by the medical staff.  Or were not given full medical information on which to make her own decision - or even told what was about to happen to her.

Doulas are not medical professionals, so we do not direct women what actions to take with their pregnancy. I try to present both sides of the information fairly and completely and always let the woman and her care provider make the decision together. Sometimes that means that I have to give information against my own personal belief system. I’ve given the pros along with the cons of routine use of an enema in early labor when it came up with a client, and I’ve given my unconditional support when a woman has chosen an induction based on no medical reason but because she was tired of being pregnant. But in the end, I always realize this is not my birth, it is hers. I haven’t lived her life, haven’t walked a mile in her shoes. Truly, although I might make a different decision, I feel only good will and understanding to the women I serve.As doula certified by DONA, I operate under both their “Standards of Practice” and “Code of Ethics” and it is clear that my job is never to perscribe, but to support:

“The doula should make every effort to foster maximum self determination on the part of her clients.”

The reason, though, that I and others have founded the Mid-Columbia Birth Network isn’t to attack practitioners who make decisions different than our own. (And if I see that happening, you can be sure I’ll voice my opinion to stop it.) When I said I might be a “pain in the ass out of the labor room” that was poor wording on my part. What I meant was that the Mid-Columbia Birth Network will probably be *perceived* as a pain in the ass. I sincerely hope not. I hope local obstetricians and nurses join us in our quest to improve birth outcomes and treat women as individuals in their care. We believe that the medical model of childbirth has been given over and over to women, but the less interventive midwifery model of childbirth is not so well known. We’d like to give a woman information so SHE can make her decisions based on more than pure trust in whatever her caregiver says. We’d like her to be a partner in her own care.

I should point out that when I say “medical model” and “midwifery model” I am only using those words for lack of better ones. Of course there are many doctors who operate by spending longer appointment times with their patients, who are interested in them in a holistic way (emotional health, family health, etc.), and who suggest such techniques as squatting for pushing, eating and drinking during labor instead of IV fluids, and intermittent monitoring. And of course there are midwives who practice more in line with I call the medical model - keeping labor on a timeframe with use of Pitocin or other drugs, using Cesarean birth liberally, and having shorter appointment times. And when, occasionally, I say “natural birth”, it is also because it slips out occasionally. See my older post on that subject. I try to use a term like “unhindered” or “physiological” or “mother-friendly” (refering to the Mother-Friendly Childbirth Initiative) when I am trying to get my point across - yet sometimes the old language sneaks in as it is so prevalent in the doula community.

I hope this clears things up. I think we agree on much. I’d love to hear what your thoughts are.