Procedures in Childbirth

[roundthehouses]

Sorry in advance if this is a bit garbled..

I am really confused by talk of birth plans and "being assertive" and knowing your rights etc while birthing in hospital. Things like no episiotomy, no continuous monitoring etc. What confuses me is how am I supposed to know if I need e.g. an episiotomy? Do I just make a blanket decision beforehand that I don´t want one no matter what? I had one in my last birth and wouldn´t have had a chance to say no. it was like "ok now I am going to make a cut" CUT. done. And how am I to know if they hadn´t done that I would have torn really badly?

I´d like to not have CFM but how do I know if it is necessary or not? Maybe they don´t have the staff to come in and do intermittant monitoring?

i read an Ina May book and while i thought it was very inspirational the overwhelming feeling i was left with was that its all well and good if you have a midwife who is herself, like Ina May, confident in your body´s natural ability and her ability to support you without resorting to standard hospital procedures. But if you don´t have the option of home birth then you have to accept to a certain degree that you are going to get the best care in the hospital you attend. But then the message seems to be that we have to go in ready armed to defend ourselves against outdated and unnecessary procedures?

There´s smaller things like in my hospital you "have" to wear a hospital gown and have a canula inserted as standard. You are not "allowed" to eat or drink. Ok, they can´t stop me, I presume, from refusing any of this. But it could make the staff antagonistic towards me as a "difficult patient" from the start when what you want is to feel they are on your side, don´t you think?

I find it all just a bit confusing - can anyone even make sense of what it is I am asking?!

I never wrote out a birth plan. IMO they are a waste of paper. My advice would be to be open minded and go with the flow.

I didn't have any strong opinions about what I wanted and trusted the health professionals entirely.

In my mind I felt that should I need pain relief I would start with TENS and then progress on to something stronger if I needed it. As it turned out I didn't. My waters broke at 2pm, so I went to hospital, had a completely straightforward labour with just TENS for pain relief, and DD popped out at 8pm without any complications.

Every labour is different so, as I said before, just keep an open mind.

I had my baby in a birth centre, they were really kind and laid-back (but very professional) and I could wear and do what I liked and ate & drank whenever I felt like it. It was as relaxed as possible & I had a great birth experience. Is there a birth centre near you or do you have to go to hospital?

I do have an open mind and I did last time but I did feel out of control and as if everything was happening TO me. "just going to break your water" POP. "just going to do an exam" .. and i am just not sure if this time i´d like to feel a little more in control and confident of refusing certain things.

I don´t have any alternative to hospital (apart from freebirthing! which we are not up for) a birth centre would be AMAZING.

where do you live??

you have to have a canula?
You can't eat or drink?
You have to wear a gown?

This does not sound like any British hospital I have heard of for a standard non complicated birth.

anyway, the phrase that DH and I had drummed into our heads before hand was the question "what happens if we wait 15 minutes"
"what happens if we dont d that"
Our decision was that if the response was it will take longer then bugger off
if the response was "your baby won't make it"
then obviously we would agree.

Sorry, no I am not in the UK. I like that reasoning..

What kind of hospital is that?

I know that lots some have outdated policies but what you're describing is out of the 1950s!

Tackle them on these policies now and/or move to another hospital.

Makes more sense.

I think understanding is a great way of feeling the control level shifts.

It isn't that these things are being done without your consent.

Just going to pop your waters,
answer
"can you explain to me the reasoning for us needing to do that?"
once you can understand you can decide, you have opened a dialogue.

Just going to do an exam
"do you mind me asking what it is you are measuring" is there another way of finding that out?

These things dont have to be goodies and baddies in conversation terms,

The other thing is that when you get there just generally get chatty / get your DH to be chatty with the staff and generally open dialogue with them you are more likely to understand them and they you.

Are you in the UK, roundthehouses? (As those rules from hospital seem very old fashioned)

I am a huge advocate of birth plans. Most important though, is using them to think through what you want and why, and make sure your birth plan understands, and can advocate for you where necessary.

Of course, writing "no episiotomy" would be a bit foolish; if the baby is at risk unless it is delivered quickly via forceps, they'll need to do one. However, what increases your risk of an episiotomy can be avoided; I'm not a medic but I imagine avoiding an epidural and keeping upright to labour and push would both minimise the risk.
Something they'd want to do CFM for, for example, is if you are induced. So, not accepting being induced if you go 10 days overdue (as many hospitals offer), but instead opting for expectant management from 14 days overdue, would be a way of minimising that risk.

Don't know if I'm explaining this very well.

Just make sure anything you want to avoid/want to do is well understood by your birthing partner, and that they can stand up for you if you can't for yourself.

yeah, that sounds about right (1950s). what´s more this is a fairly new hospital and is considered to be of the more modern approach. I can´t choose another hospital. I can pitch up at another on the day if I want to and if I am over x cms they can´t refuse me but they are all much of a muchness to be honest. The general attitude here is of great reverence towards anyone in a white coat, they must know best and we must do as we are told. And dh mostly believes this too which kind of doesn´t make him the best birth partner in that respect but there is NO WAY I can ask him not to be there in favour of someone else.

There´s no hope for me, is there?

ok, answer, stay at home and cope on your own for as long as you can. (was your fist birth straightforward?)

I'm absolutely flabberghasted. Do you mind me asking what country/state you're based in?

I'd suggest staying at home until the absolute last min and going in late so that they have no chance to do anything! Or hiring a midwife who works outside of the system/possibly "underground" to support you at home.

Doesn't sound hopeful...is there no way you can have the baby at home, or at least find another birth partner who will stand up for you (unless there's some rule about only having one BP)

thanks, that is helpful re. opening dialogue with staff and just feeling I know WHY things are being done.

I am in spain, yes there is only one birth partner allowed. Baby is currently breech so I may have to have a caeserean anyway in which case am not allowed anyone into theatre with me . private midwives do home births but they are rare and cost far more than we can afford.

i do think staying at home as long as poss. is pretty much the solution, last time I was induced, epidural etc. Last time I DID.NOT.COPE with the pain so I think I am a bit worried it will be the same this time, I can say I´ll stay at home but could go wailing to hospital thinking THIS IS IT and find I am 2cms

Last time was the typical avalanche of intervention. I thought my waters had broken (i now think it was just a leak) so i went in. they confirmed this so said I had to stay in and would induce if I did not go into spontaneous labour within 24 hours.

at this point I should have just gone home. instead i felt i had to stay.

they later broke my water (?? errr... see above)

oxytocin to speed it up

epidural to help with the above.

strapped on back to monitors because of above.

When I think back there are just so many points where I should have gone Woah. stop. wait. hold on a sec. but I just felt totally swept along.

In the UK the nurse/doctor has to ask for your consent before doing anything otherwise it is considered assault. It's your body and you have the right to say what happens to it.

Perhaps think of your birth plan as more of a wish list? We all know what we would like to happen in ideal circumstances but it's usually a good idea to listen to the professionals.

It might be an idea to think BRAIN.

Benefits
Risks
Alternatives
Instinct
Nothing

Would you mind telling us which country you're in? Maybe being assertive might mark you down as a bit awkward but in the end, you are paying in some way for the service. I hope it goes well. Maybe you can meet the medical staff beforehand to discuss what they think will happen and what you would like to happen.

Sorry - x-post.

Going back to birth plans. I didn't show anyone my birth plan, but it was very useful to have made a concious decision about what I wanted/didn't want - and to have discussed it with my husband.

And I think having thought about what we would do in different eventualities helped prepare me for when things inevitably went 'off piste'.

And in having researched what I wanted and why, I understood what was happening enough to have a conversation with the midwives about the pros and cons of doing different things. And in a couple of things the midwives agreed to try things the way I wanted first (ie no drip induction, which they wanted but would have meant not being able to move around)

Spain sounds a bit draconian, so not sure if you would be able to negotiate compromises etc?? But I guess I am trying to say that if you try to plan for every eventuality, you won't feel it has gone out of control when one of those eventualities happens.

Roundthehouses would you be interested in talking to a Spanish doula if I can find one for you?

Just to add 2 points onto the BRAINS acronym to make it TBRAINS:

Do we have Time to Talk about this:
What are the Benefits?
What are the Rsisks?
What are the Alternatives?
What does your Intuition say?
What happens if we do Nothing?
Smile!

I'm also of the school of thought that says a birth plan is a useful tool to make you think about what might happen and why, how you feel about it and what you'd accept (possibly only under certain circumstances) - whilst fully accepting that it might all go out the window on the day. Going through it with your DH might be a way to make him understand why you're loathe to just accept everything without question as then he'll hopefully see that every procedure has a risk attached, even if that risk is small.

At the end of the day, though, I think being communicative with the MWs is the best course of action - with DD2 things were miles away from our "birth wish list" (induced hospital birth for a start), but because we asked a lot of questions and felt that things only happened once we'd agreed I walked away feeling as though it was as good an experience as it could have been. If that makes sense .

I'm a HypnoBirthing Practitioner and teach BRAINS to my couples - the S standing for Smile i.e. deliver all your questions with a smile to avoid looking confrontational.

roundthehouses your post about your previous birth and you feel like you might end up going in at 2cm cos so much pain etc reminded me of me, my first birth also induced - really really painful, i had the drip thing, epidural, lots of interventions and overall it was quite difficult
so i was expecting for the 2nd one that no way can i manage without epidural, i'll definitely need it, and expecting i would be in so much pain by 1 or 2cm because with the induction i was in a lot of pain and they were like you're not even 1cm! but it was totally different with the 2nd one. i did manage to stay at home for most of it because it was just so so much more manageable and very different, by the time i went in i was something like between 8-9cm. so possibly could go the same for you, the difference of being at home, upright and not been induced, not stuck to monitors so can stand up and move around etc, makes quite a bit of difference ime, in addition to 2nd birth generally tends to be quicker and a bit easier than the first one, so hopefully you may be okay with your plan of staying at home until you really need to go in. and hopefully if you arrive almost ready to push they are not going to have that much time to do all their interventions or unnecessary things that they normally like to do?

thanks squiggleywriggler, that's really sweet of you. I do have the number for an english midwife who does antenatal classes in your home so I think I might just get her over for a couple of sessions with me and dh where we can discuss all of this. I do think staying at home as long as possible is really the only option so hopefully she will be able to give us some guidance as to how to acheive this.

thanks all for your input