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Cut With Kindness: Coming to Terms With Mistaken Beliefs

Dawn Thompson is founder and president of ImprovingBirth.org, and has worked as a doula for over ten years–specializing in supporting women who are seeking Vaginal Birth after Cesarean. She had three cesarean sections before a vaginal birth with her last child. This article begins with her first surgery.

At ImprovingBirth.org, we hear from women all the time who felt they were pressured or coerced into a major medical intervention in birth, like an artificial induction of labor or a cesarean section, that they just weren’t sure about. But for the majority of women, misinformation about these and other maternity care practices is often delivered quite differently: in a kind, convincing, and non-threatening way.

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Passive Labor

Take my own story, for example: I went to the obstetrician that my primary care provider recommended and insurance covered. I went to the childbirth classes offered at the hospital. I read “the” book everyone said I should read. I didn’t love my doctor, but he was fine, and I didn’t realize that it mattered that much, anyway. He was an ObGyn; they all learn the same things, right?

I went into labor six days past my due date, and ran to the hospital in the middle of the night after just a couple of hours, when my contractions were roughly five minutes apart. By the time we pulled in to the hospital parking lot, my contractions had slowed down to about ten minutes apart, but I was admitted, anyway, at two centimeters dilated.

The contractions continued to come slowly, but by morning they were spacing out even more. What I now know is that this is completely typical. Labor often starts at night, dissipates as the sun comes up, and starts again on its own after mom has had time to rest—almost like the body is revving up for a running start. I didn’t know at the time that I didn’t need to be admitted in the first place, or that I simply could have gone home that morning and waited for labor to really begin.  I didn’t know that lying in bed, as I’d been told to do, tends to slow or even stop early labor; I didn’t know and no one told me that staying mobile encourages it to progress.

The doctor stopped in that morning before his office hours and told me labor had stalled at three centimeters. “We just need to help your body out,” he said sympathetically, several times. He was kind, never pushy or bossy. We thought, “Of course, he knows better than us. If my body needs help, let’s do it!”


No one told me the risks of Pitocin, other than that it would make me have contractions.

It almost seemed like the “natural” thing to do, since my body “naturally” wasn’t having contractions on its own—right?

I always knew I would want an epidural, and I asked for one as the Pitocin-induced contractions started to get intense. Why on earth would anyone do without pain medication? That just seemed silly to me. Moments later, I was singing its praises and the anesthesiologist was my new best friend. A few hours later, however, I’d progressed very little, only another centimeter or so. My doctor came back during lunch and decided my body needed even more help. “Let’s break your water,” he said—always kind, never rude. I’d been up all night, and I wanted to see my baby. I didn’t ask questions. Instead, I said, “Let’s get this show on the road!”

After the doctor broke my water, things started moving quickly. The nurse kept coming in and looking at my baby’s heart rate strip. Then she brought in another nurse to take a look at it. No one was telling me anything. I kept asking if everything was ok. “Yes,” they would say, “We’re just keeping an eye on baby.”

They decided my baby needed an electrode on the top of her head to be sure they were getting the heart rate clearly, and I quickly agreed.

Within another few minutes, the doctor was in my room and talking about decelerations in the heart rate and saying my baby wasn’t tolerating labor well. They needed to do a c-section right away. “Your baby is in DANGER!” they said.


I did what any rational mother would do—I did what I was told was best for my baby.

CS

Cesarean

I never even questioned it. Never in a million years would I risk her life, even though the thought of having surgery left me sobbing and scared out of my mind. I was about to be cut open, but it was for the good and well-being of my baby.

I came away from that birth feeling like I had absolutely done everything I could, and that my doctor had done everything he should. I believed it when he told me I was so lucky, that I would have likely been one of those women who died in childbirth back in the days before modern medicine. I LOVED the drama of that story. I told it and retold it with all my heart.

The truth was, it felt like I needed a good reason why I just “had to have” that C-section. This belief served me well.

I carried that story for many years–through two more C-sections that happened only because I’d had that first one. I helped friends through their births and I would dream of someday being a midwife. It wouldn’t be until ten years later, in a doula training class, that I would be presented with the truth, the truth about the “snowball effect” and the “cascade of interventions” that so many first-time mothers fall victim to. I saw the truth of it, and I cried.

Luke

Dawn and Luke

My first emotion was deep sadness. Then, there was anger at the doctor for not just sending me home and potentially avoiding the whole sequence of events that led to an emergency cesarean. Any medical professional with more than a passing familiarity with childbirth would have known that early labor with my first baby needed patience and gentleness—not monitoring, confinement, and deadlines.

The emotion that stayed with me the longest was disappointment in myself. Coming to terms with my ego was, by far, the most difficult part. I had to admit that I didn’t know any better and that I just believed everything I was told. I didn’t ask enough questions. I hadn’t protected my baby like I should have. And then came indignation: “Why wouldn’t I, shouldn’t I, have believed everything my doctor told me? He was the one that is trained, the one I hired to deliver my baby because it’s his job. Why on earth wouldn’t he be giving me the most current and accurate information?”

It would take me years to understand the “why” and, honestly, even ten years after hearing the truth and being a birth professional in our system of childbirth, a simple explanation eludes me.

I think obstetricians–including the one who made so many errors in my first birth–are mostly good people. I believe they want what’s best for you and your baby. But I also think that, like anyone else, they can be susceptible to mistaken beliefs from the bigger system in which they work. Those beliefs are where hospital routines and long-time industry practice overrule common sense and current medical research. “Re-educating” care providers with the best information about science and practices isn’t as easy as just handing them that information and expecting them to change.

Recently, I read an article about how people learn and how they can learn “better,” and I think this states well the dilemma in updating U.S. maternity care practices:

“The most important thing to realize is that just telling isn’t enough. Most methods of instruction and training assume that if you provide [people] with the right information, it will replace any mistaken information they may already possess. But this just isn’t so. Especially when our previous beliefs (even though faulty) have proved useful to us, and when they appear to be confirmed by everyday experience, we are reluctant to let them go.”

This is where a fundamental issue lies. Even when presented with new and accurate information, it is difficult to let go of a previous belief, especially when the old belief proves useful. In this case, the “usefulness” is often that the hours of working birth stink. Yes, it’s much, much easier to rely on ways of “controlling” the rhythm of birth–like with artificial inductions and scheduled surgeries–rather than “working with” the rhythm of birth in a way that lets the body set the pace, even when “working with” birth is best for moms and babies.

It’s only natural that providers who work a certain way will buck the information that challenges their core beliefs and their livelihood.

Things will only change when:

1. We start allowing the next generation of providers to use current information and practice evidence-based care;

2. We present that information and those practices to the seasoned professionals in a new, convincing way; and/or

3. We create a confrontation.

“For the most tenaciously-held beliefs, it may be necessary to stage an intervention,” the article says.


The Rally to Improve Birth is just that: a massive intervention.

We are rallying to bring awareness to a glaring problem that affects most of the people in this country—mothers, mothers-to-be, and the babies being born within our system. This increasing awareness needs to take place among not just providers, but the people who are receiving the care they provide. A national survey released just this month confirmed that while large numbers of women are receiving non-evidenced base care, most of them still express satisfaction with it. So many women are unaware of just how much room for improvement there is in our maternity care system, of how much of our “routine” practices differ from what current scientific evidence tells us is best for moms and babies.

We’re also rallying to bring awareness to a solution. A big part of the solution is you: the families whose business drives the system. Can you imagine what we might accomplish if we recognized how much power we truly have? If we banded together and demanded change, and demanded to be a part of that change?

The 2013 Rally to Improve Birth is our opportunity. It’s a peaceful, family-oriented gathering to deliver a big, bold message: There’s a big problem in American maternity care, and we demand a big solution. We’re willing to be a part of it, and we’re willing to start right now.

This is our one-of-a-kind chance this year to bring our many voices together as one, and to be heard.  Join us.

Want to support ImprovingBirth.org’s mission?  Like us on Facebook, participate in our history-making 2013 Rally to Improve Birth, and donate to the cause.

Revolution

Birth Revolution


8 Comments

  1. The birth of my first daughter, had I stayed with my OB instead of switching to a midwife at almost 30 weeks, I think would have looked very similar to this story. I went into labor at 36 weeks, 6 days, and had fifteen hours of labor where I progressed to to having contractions 1 minute long and 4 minutes apart. My OB had recommended getting to the hospital when contractions were 5 minutes apart, so I would have been there by that time. My labor stalled, then. It had been a very long night, and as the sun came up the contractions stopped coming and I was able to go to sleep in my own bed. Labor didn’t start again until I was 41 weeks along. Even if I had not gone to the hospital yet, or miraculously been sent home when labor stopped as opposed to being given pitocin to restart things, it would have gotten hairy when she was finally ready to come on her own. My daughter was presenting all twisted and turned, getting stuck on my pubic bone because her hand was up on her head, and heart rate decelling because of her cord being wrapped messenger bag style around her body. It would have, without a doubt, been an emergency C-section birth in a hospital. I would have been told how lucky I was that the doctor had been able to save my baby and me. I’m sure I would have believed it and been one of the women who say that either they or their baby wouldn’t have survived if they had attempted a home birth. Instead, with the guidance of an amazingly skilled midwife and a supportive doula, I was able to birth my girl safely and peacefully in my bed. We were able to to get the support and the care we needed to have our best possible start. For that I am unendingly grateful, and because of that I hope to work to improve birth for other families.

  2. Jessie U.

    I experienced the “snowball effect” as well. I went in WAY too early, and although my first nurse let me labor naturally for about 10 hours, the “normal” nurses came in and changed all of that with blood pressure cuffs and heplocks. Despite the fact I knew it was happening it was hard to resist with all of the nurses being pushy about it and saying things like “it’s what is best for baby.” I was put on pitocin after hour 15 of labor and I had not made it past 4 cm. That led to an epidural because of being food and water deprived for 15 hours in labor tired me out so much. Fortunately I did not need a c-section and my daughter was born vaginally, but I was given an episiotomy without my consent because the OB did not bother to ask me to slow down pushing so I would not need one.

    You are not the one to blame! The poor system of treating women in labor like the same entity is what is to blame. Every woman labors differently, handles meds differently, and should experience birth differently.

  3. Kristyn Moore

    I clicked your link, “join us”, and it did not redirect me anywhere, but to a page searching for your website. I would love to join you in this effort. Thank you.

  4. Julie

    I didn’t know it at the time, but the childbirth experiences of my last two out of four were rarities. After two c-sections in the early 80’s, I fought hard for and was able to deliver my third child vaginally; a year later my fourth as well. Now, after studying the statistics for VBAC’s since that time, I am appalled at how rare they are and that VBAC’s are immediately discouraged when mother’s ask for them. C-sections are performed at an alarming 32-35% in this country. Are we to believe that a third of all mothers cannot birth their own babies? That they and their babies would have died before these modern birthing practices were “perfected?” Why aren’t mothers made aware of the dangers of surgery to them and to their surgically-delivered babies who do not receive the benefits of natural birth? I find it appalling and will work hard to educate my own daughter on evidence-based maternity care. You hit it right on when you say we need a massive childbirth industry intervention. Rally on!

  5. Thank you for explaining your situation/experience…I have heard many stories similiar to yours except most have a more “pushy” OBGYN…perhaps that is just our community here in Tampa Bay Florida, either way, hearing your story opens my eyes to even more topics I need to include in my childbirth education class. I am THRILLED to be part of the Rally…Rally On!

  6. Philomena Canning

    Hey, I practice in Dublin, Ireland as a midwife and just want to say congratulations for your efforts in making maternity care kinder to women and babies. The problems you have identified locally are global in nature, and it’s a global rally we need to address them. Lets do it…???

  7. I was in mostly pain free labor all night (I was laughing talking and even slept) and progressed from 2 cm to 100% and 10 cm in 4 hours my doctor went home and the on call doctor came in the morning and decided he would speed things up and break my water, he told me I would have my baby in an hour. My contractions stalled and baby was still high so they decided to start pitocin. Four hours later with very painful contractions the doctor decided I wasn’t progressing and I needed a c-section. I blame it partly on the fact that it was Thanksgiving (which I didn’t get to enjoy because I was nothing by mouth d/t c-section). He knew I didn’t want a c-section but he told me I was having one. I just said I really don’t want to but I will if I have to. I was sobbing and shaking the whole time they were doing the spinal block, my nurse had to help me hold still, I had told her from the beginning that having surgery was my biggest fear and I didn’t want it. I could still feel the right side of my body so they tilted the bed to the right and my blood pressure dropped that to 46/32 I felt short of breath and everything was fuzzy. I’m not sure what they gave me to bring it up but it was scary. I didn’t get the pictures I wanted of my baby and myself because my sister wasn’t aloud in the room and went home while I was in recovery. It was definitely not the birth experience I wanted.

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  1. This Week in Birth Blogs #6 | Portland MamaBaby Center - [...] Cut with Kindness: Coming to Terms with Mistaken Beliefs [...]

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