common obstretrics & pediatric practices - Page 2

[the_lissa]

Well yeah, nobody should be forcing women to do anything.

[Equuskia]

Well, when I gave birth in a hospital in 2005, enemas and shaving were still done, no eating or drinking, continual monitoring and pushing on your back in stirrups. For my second birth, I said no thanks to all that and had a UC at home.

[MegBoz]

Originally Posted by Equuskia

Well, when I gave birth in a hospital in 2005, enemas and shaving were still done

No!! In the US? Wow. I thought that wasn't the case anymore. Wow. Just.... wow.

Although I will say I asked one of my MWs about those 2 things just to be sure. If some nurse came at me trying to either shave me or shove something up my bum, I DEFINITELY would have hurt her! My MW actually laughed. She said something about shaving like, "Yeah, that's the style now to shave the hair & if you want to shave it, that's your choice. But we won't do it for you."

[wombatclay]

My local hospital offers enemas... it's totally up to the mama though, and they aren't, um, "assisted". Apparently the nursing staff just gives you an enema kit if you'd like one. Some mamas do!

I did had some shaving prior to my c/s, but that was just a little at the top so there wouldn't be hair in the suture area/caught in the steri-strips.

[Kappa]

Enemas aren't all bad, hard compact stools can obstruct labor (and I'm sure it does all the time).

In addition to the eating/drinking rule and episiotomies, I also think the Unnecessary Scheduled My-Momma-got-Work-Leave-and-Already-Bought-a-Plane-Ticket Convenience Induction will go the way of the Dodo. There is/will be too much fear of pre-maturity and scheduled convenience procedures will be the first to go.

[*MamaJen*]

Er, how about 31 percent of births being C-sections? I think that'll rank up there.

[Equuskia]

In PR, we have a 48% c/s rate. And it was as late as 2007 that a law was passed to guarantee women the right to have a birthing partner (a spouse, friend, doula, etc). When I gave birth to DD1 in 2005, I labored alone. It was horrible. I didn't see dh until I was ready to push.

[AlexisT]

Routine episiotomies are definitely going. What's interesting to me is that in my area, the big teaching hospitals (famously interventionist) have lower episiotomy rates than the community hospitals--which indicates that students aren't being taught to cut. (NYC trains more doctors than anywhere else in the US so this will have a fairly big effect.) Rates at those hospitals are 10-15% which is probably not far off right (since they will need to cut sometimes, eg for forceps). Meanwhile there's community hospitals (oh, and ONE teaching hospital, which I may have to use next time with rates near 45%!

The no eating or drinking rule is out of date--AIUI having a full stomach was a bad thing back in 1940 when they came up with the rule, but anesthesia techniques are now safer and it's no longer an increased danger. I think it will go though it will take a few years.

I don't see the convenience inductions/sections going yet--in my area I see women asking for them without prompting from their doctors and the OBs are too afraid to say no. I think people's expectations of birth also have to change.

[Storm Bride]

Originally Posted by Kappa

Enemas aren't all bad, hard compact stools can obstruct labor (and I'm sure it does all the time).

Enemas aren't necessarily bad, but doing them on every labouring woman, with or without consent, is bad.

Originally Posted by AlexisT

I don't see the convenience inductions/sections going yet--in my area I see women asking for them without prompting from their doctors and the OBs are too afraid to say no. I think people's expectations of birth also have to change.

This just makes me furious. They're "afraid to say no" to a patient request c-section...but they have no problem saying no to a woman who wants a VBAC...or ignoring a "no" from a woman who doesn't want a c-section. Interesting how standards change, depending on who's asking what.

[AlexisT]

It's all about which one will end up with a lawsuit, really. Which is sad, but OB malpractice premiums are now near $200K a year and it's completely dictating how they practice.

[spero]

I think a lot depends on where you are birthing, the nursing staff (in general older nurses seem to favor "traditional" practices) and who is managing your birth, as well. I had my kids in a birthing center within a hospital in 1990, 1993, 1997, and 2000. (The youngest two were waterbirthed.) While I never had an IV, I was never shaved, I wasn't offered any pain relief, I nursed my kids immedaitely after birth, and I was discouraged from being flat on my back - there were some differences with each birth, and it was interresting to see how the "routine" practices evolved over 10 years. The first time I did get an enema, I had bloodwork upon arrival, I had my water broken and a routine episiotomy, I was continuously monitored, and they wouldn't allow me to get out of bed post-birth for 12 hours, among other dumbass things. The second time, I came in around 2 AM and had to deal with the horrible OB who was on call overnight. He was extremely old fashioned, broke my water way too early, and then insisted that I stay in bed and hooked up to the monitor, even though I was having a normal labor. I NEED to be ambulatory during labor, especially during that time when it really picks up, so that really sucked and I had a rough time - in fact, I was thrashing around so much that the monitor belt wouldn't stay in place so, the OB ordered INTERNAL monitoring. (Nowadays, I would pretty much tell them to shove it and get out of bed anyway.)

By the time I had my youngest two, the BC had a birthing tub/pool, I was encouraged to eat and drink, I wasn't discouraged from pushing when I had the urge to do so, routine episiotomies were no longer the norm, and I could shower right afterward as long as I ate something substantial first. The babies were monitored every couple of hours with a Doppler, which my MW recommended and to which I consented.

With #3 we discovered that my bag of waters won't rupture on its own, until the pushing stage. My MW left it alone and it broke just before DS's head crowned. I consented to artificial membrane rupture with #4, because I'd been in labor for about 16 hours and I wasn't progressing - but that was totally my choice.

As to the subject of birthing positions - barring complications, I think women should birth in a position in which THEY are instinctively comfortable, and this will vary from woman to woman. Michael Odent, a pioneer in birthing techniques (esp waterbirth), let his patients labor in quiet, comfortable rooms with just big cushions all over the floor, if they chose. Some women are more comfortable pushing on their backs. I always thought I'd prefer to squat, until I tried it; and I was surpirsed to find that I just felt too open and vulnerable. For pushing, supported from behind and semi-reclined work best for me.

[Storm Bride]

Originally Posted by AlexisT

It's all about which one will end up with a lawsuit, really. Which is sad, but OB malpractice premiums are now near $200K a year and it's completely dictating how they practice.

It's a big factor. It's not "completely dictating", though - at least imo. I've seen too many OBs make their comments about how convenient c-sections are...including one lovely discussion about how great it would be to work in a c-section only hospital. I don't believe for one minute that is driven by malpractice insurance.

[billikengirl]

Originally Posted by Kelly1101

I am pretty sure that pushing flat on your back isn't encouraged anywhere anymore (I'd be shocked if it was). When I toured my hospital, the nurse made a point to say "when you push, we have a squatting bar that goes over the bed *here*, or if you don't want to do that, we can take off the bottom of the bed so that you can sit up like *this*".

When my sister wanted to have her baby in a side lying position, the OB got all hateful and--because she knew my sister wanted to deliver without drugs--told my sister that "if you don't get on your back right now I'll give you an epidural"

This was a year ago.

[Kelly1101]

Originally Posted by billikengirl

When my sister wanted to have her baby in a side lying position, the OB got all hateful and--because she knew my sister wanted to deliver without drugs--told my sister that "if you don't get on your back right now I'll give you an epidural"

This was a year ago.

UGH. I would likely say "Try it, I dare you."

But bullying like that is why I think it's important to have people there who can defend you.

[Turquesa]

I'm hoping to see routine electronic fetal monitoring become a thing of the past. I cannot imagine what an observer from another time or culture would say on seeing this practice. "What a strange, tech-obsessed people!"

[nia82]

I birthed at a birthing center within a hospital. While they were cool with eating and drinking, they sort of chased me with their monitoring.
I then birthed with the midwife on call who I had never seen before. She respected my wish to tear instead of an epi and did all the stretching of tissue and hot compresses, but since she was in a practice with my obgyn (my insurance wouldn't cover her, only him, and as she was on call for him, they paid luckily). They discussed via phone and the obgyn prohibited me to push upright. They would not let me get up. Next time DH and I will know better. My "outrageous" blood pressure of 140/90 - 120/70 was a contraindication to pushing upright. I was flat on my back pushing for 2.5 hours. It was ridiculous! The squat bar just was there and I was never allowed to use it. Homebirth it is the next time, for sure.

[texaspeach]

Originally Posted by wombatclay

My local hospital offers enemas... it's totally up to the mama though, and they aren't, um, "assisted". Apparently the nursing staff just gives you an enema kit if you'd like one. Some mamas do!

I did had some shaving prior to my c/s, but that was just a little at the top so there wouldn't be hair in the suture area/caught in the steri-strips.

my bestfriend had her baby at a fsbc and wanted an enema, the mw said no (bf's water had broken, so I think that might have contributed to the mw saying no). I just could not believe she WANTED an enema, but hey, some people do. they should be optional and not forced on everyone. how humiliating to be forced to get an enema

[MegBoz]

Originally Posted by billikengirl

When my sister wanted to have her baby in a side lying position, the OB got all hateful and--because she knew my sister wanted to deliver without drugs--told my sister that "if you don't get on your back right now I'll give you an epidural"

This was a year ago.

Has your sister taken the birth survey?

Interesting, because an OB can't give an epidural anyway! That's only done by an anaesthesiologist, I thought.