what is 'invasive birth care' to you?

[MsBlack]

If you are a fan of natural birth in any setting, what do you consider to be 'invasive forms of pregnancy or birth care'? What makes it invasive, on any level. And also, knowing that mothers might agree to some 'technically invasive' things such as amniocentesis or just a vag exam during pregnancy/birth--how and when is invasive care good--or bad? Necessary or unnecessary?

Please share!

thanks

[Breathless Wonder]

Invasive birth care, to me, are procedures done because they are "policy" or "standard procedure", instead of because there is something going that suggests the action might be warranted. It is the use of coercion or force to convince the mom she needs said procedure. It is also, of course, performing actions without the mother's consent. The actual specific thing can vary from woman to woman, but in general involves anything done "routinely", or with observation, thought, or attention given to the individual situation.

[MsBlack]

Originally Posted by Breathless Wonder

Invasive birth care, to me, are procedures done because they are "policy" or "standard procedure", instead of because there is something going that suggests the action might be warranted. It is the use of coercion or force to convince the mom she needs said procedure. It is also, of course, performing actions without the mother's consent. The actual specific thing can vary from woman to woman, but in general involves anything done "routinely", or with observation, thought, or attention given to the individual situation.

Thanks for this. Can you possibly expound a little more for me? Maybe give some examples? Also, I don't want to make assumptions, but it sounds like you are speaking of a couple different levels of possible invasions--physical, psychological...can you elaborate a bit?

Oh yes, I think maybe there is an error here: "The actual specific thing can vary from woman to woman, but in general involves anything done "routinely", or with observation, thought..." Did you mean without observation, etc? I want to be sure I understand you correctly.

Anyway, if you have time and inclination, please say more....I think I get your meaning but I want to be sure. It's an easy topic for me to make assumptions about, since I have my own strong opinions on it

[Youngfrankenstein]

Invasive birth care is treating the woman like she doesn't know anything. It is everything Breathless Wonder said as well.

My biggest problem is when spades are not called spades and that the open communication about what's "really going on" isn't there.

During my homebirth, my midwife had me lay down to get a doppler hearttone and it was horribly painful. It was the only thing I was "forced" to do during that labor and delivery. She just couldn't get the hearttones while I was standing in my prefered labor position. Having said that, it wasn't invasive at all even though I would have prefered not to do it. I knew it needed to be done and we got through it and I was back where I wanted to be in no time. Everything else was completely hands off because there was no need to do anything different. Even during pushing, I was on the birth stool, and she told me to stand and then to hands and knees. There was a SD and she had to dislodge the baby's shoulder. None of this was in a panic and I knew I could trust her and listen to her 100% and things went fine.

Contrast that against the OB I was doing parallel care with who was ready to induce me with Cytotec in a week's time. Just the mention of that was invasive and all trust flew out the window just by her uttering that word.

I know that's maybe not what you're looking for, but I guess I really look at "mental invasivness" first.

[MsBlack]

Thanks for that, Amy--

And I much agree, 'mental invasiveness' is a big part of this issue.

I hear that you felt 'mentally invaded' by a doc's suggestion of cytotec--and knowing what I know about cytotec, I fully understand the feeling! It would have been offensive and a bit scary to me, to hear that. 'Invasive' as in it's meaning of 'intrusive'--stepping in without invitation to introduce something highly unwelcome to me. Assuming authority to say those things instead of acknowledging my authority in my birth care. I also like how you mentioned your mw first asking you to adjust your position for the doppler, and then directing your movements to help with SD. Sounds like you are saying that her asking first, and also having a good reason which you agreed with, made all the difference to you. That those things were not 'invasive' to you mentally, even if not comfortable for you physically.

I'm wondering if anyone can talk about what is normal as opposed to invasive, KWIM? Amy got into this a bit with her comments. As opposed to 'invasive', what do we think is normal, physically, mentally, or otherwise, for birth in general...what *should* birth and birth care be like, as opposed to invasive? What *are* birth/birth care like, when they are not invasive? IF that makes sense....what is right, normal, preferred? Can we unpack this a little more?

[caedmyn]

I would tend to consider anything that's really unnecessary invasive. So induction without a legitimate medical reason, most VEs, many c/s's...that sort of thing. Sometimes things like those are done for mom's peace of mind or because mom actually does want them, and maybe that's not invasive (though I personally think that baby's best interests should be considered too). Really I guess I'd consider any of those things I listed invasive regardless, but obviously there are times when they are really necessary and it's a good thing they are available. They just don't seem natural to me, if that makes any sense.

A health-care-provider trying to scare, badger, or misinform someone into any procedure would be invasive as well. Or the HCP simply making the decision without discussing it with mom.

For me personally I think natural, normal birth is pretty hands-off (or as hands-off as an informed mom wants it to be). My version of hands-off is pretty much, midwife there as an observer in case of a problem. No ultrasounds, no VE's, I don't need labor support, that sort of thing. I want my midwife to be willing to discuss testing, birth choices, etc...and to respect my decisions about those things. But some people are way more comfortable with a more hands-on pregnancy & birth, and might want a couple of ultrasounds, VEs during the last few weeks to "check progress", VEs during labor, lots of labor support...to me that would feel invasive unless indicated for some reason. I do think even if mom wants a more hands-on pregnancy or birth and wants these things, a truly natural HCP would generally refuse requests for things like stripping membranes at 40 weeks because mom is over being pregnant, or VEs every week from 36 weeks to "check progress". Maybe I'm an extremist though.

[MsBlack]

Hehehehe--no more of an extremist than I am, I guess

Not that I mind doing a pre-labor or labor VE if mom wants it even when I think it won't give useful info (and might be needlessly discouraging). Though I do find usually that moms will rethink the request once I explain that the cervix can change very rapidly and therefore the info from VE is not usually very helpful--and CAN be discouraging instead. I believe in informed consent, so I try to keep to that--it's just that pre-labor VE, and in-labor VE is seen by many moms as 'standard'--believing from 'common practice and all they hear' (and/or prior experience of their own) that it IS helpful/necessary. So they are happy to be released from the 'obligation' to have VEs, most of the time. I mean, who really LOVES VE??? Even among those who aren't bothered by them...few actually like them.

So it sounds like everyone is saying that 'invasive' is anything done without good reason AND consent. And that 'invasion' can be physical as well as psychological. That is my own opinion, anyway.

Birth can only occur 'from the inside, out' (except in cases of true need for csec or other intervention)...the process is all in the mom and baby, and is a physical as well as psychological and spiritual process. Some, like caedmyn, prefer to do it pretty much on their own even with respect to labor support. Some, given our differing natures, want companionship and support of a more active person-to-person sort. So, what is 'invasive' is highly relative amongst women. But we seem to agree that any 'penetration' of the body, or the mental/spiritual 'bubble', might be invasive in our own opinion, if mom herself does not want it or at least agree it is needed or at least, potentially helpful to her process.

am I hearing you all right?

[Youngfrankenstein]

So can treatment be invasive if mom doesn't know it's invasive?


Is it all about her point of view in this?

[erin_brycesmom]

Interesting conversation. I agree that invasive birth care would be anything physical or psychological done without consent and good reason. The tricky part is that we probably all have different views of whether there is a good reason for something or not. I think of a friend's HBAC where she (not realizing she was in transition) asked for a cervical check (had not had any up to this point). Her MW reminded her that she could check for herself so she reached in and felt her baby's head 2 knuckles deep. This was amazing to her as she had never dilated past 2 with her previous birth (long induction ending in c-section). I loved this because her MW helped her to empower herself and connect with her own body/baby.

I finally had non-invasive birth care with my third and the key things that stick out to me where:

psychological - not "checking progress" during end of pregnancy despite going well beyond my due date. Not putting any expectations on me to go into labor or push things along. Never recommending/suggesting or even presenting "natural" (or otherwise) methods to get the show going as options. Continuing to act as if everything was completely normal (since it was). As a 10 month mama, this was extremely important to me and this was the first time I experienced this lack of invasive tendencies at the end of pregnancy.

physical - never touching my vagina/cervix. Keeping her hands away during 2nd stage which allowed me to follow my own instincts to support my own perineum right where I needed to. Standing back and observing as I birthed my baby's head into my own hand. Only becoming physically involved when I asked for help.

[MsBlack]

Originally Posted by Youngfrankenstein

So can treatment be invasive if mom doesn't know it's invasive?


Is it all about her point of view in this?

Excellent questions!

I say, yes to the first, and no to the 2nd. JMO.

Of course, a woman's perception of invasion is important to her experience of birth...and yet we know by now that many 'invasions' are needless/pointless in terms of safety, and many carry risks. Not knowing they are most often needless, sometimes introduce problems, and generally shift the power to practioners and away from mothers, does not mean that these things are NOT invasive, IMO. So--YES, a treatment/procedure CAN be invasive even if mom doesn't perceive it as such (most often only out of a lack of information at the time, and absolute trust in her providers).

And no, it's not just about her pt of view--because so many invasions DO cause problems for moms and babies, real risks to health/well-being. If a mom/baby get infections due to multiple routine vag exams, they've still been invaded, and harmed, whether or not mom thought it was invasive at the time those VE's were occurring, or EVER knows that they caused/contributed to infection. Perception is important, yes--but it's not 'all', IMO. Besides, I can't tell you the number of women I've heard from, who received hands off midwifery care after 'normal hospital birth' for instance, who THEN realized how 'invasive' their medical birth care had been.

Strictly speaking in medical terminology, 'invasive procedures' ONLY refer to putting hands, instruments or chemicals into the body for diagnostic or treatment purposes. Western Medicine is essentially founded on invasive practices--the manual, instrumental and chemical invasion of the body to diagnose and cure. Allopathy sees this is 'normal and necessary'...there is no judgement in their view of 'invasion', in the sense of 'condemnation', generally speaking. So, manual VE or rectal exam, a needle stick, incision, use of chemicals to enhance the view (like dyes used for seeing a thyroid or artery more clearly, for instance) or to bypass/override naturally occurring biochemical processes (such as insulin for diabetics), in THEIR view, are just 'practicing medicine as it must be practiced to be helpful'.

Mind you, I'm just stating this as a fact, not saying one way or another whether someone should/should not accept dye for angiogram, or insulin or pitocin, vax or blood draw. For me it's all about informed consent. FULLY. Informed. Consent. Belief and perception DO have an important role to play; and you might consider something invasive (in the negative sense) one time, and fully acceptable and 'non-invasive' (in the psychological sense) another time. I was glad for my csec when it was needed...and would never have stepped foot in a hospital if I didn't already think med 'invasions' were needed at that birth--and so, in my perception, were wanted, and not 'bad invasions' just 'needed care'!

Thanks for raising those questions! Anyone else care to comment on them?

[MsBlack]

Originally Posted by erin_brycesmom

Interesting conversation. I agree that invasive birth care would be anything physical or psychological done without consent and good reason. The tricky part is that we probably all have different views of whether there is a good reason for something or not. I think of a friend's HBAC where she (not realizing she was in transition) asked for a cervical check (had not had any up to this point). Her MW reminded her that she could check for herself so she reached in and felt her baby's head 2 knuckles deep. This was amazing to her as she had never dilated past 2 with her previous birth (long induction ending in c-section). I loved this because her MW helped her to empower herself and connect with her own body/baby.

I finally had non-invasive birth care with my third and the key things that stick out to me where:

psychological - not "checking progress" during end of pregnancy despite going well beyond my due date. Not putting any expectations on me to go into labor or push things along. Never recommending/suggesting or even presenting "natural" (or otherwise) methods to get the show going as options. Continuing to act as if everything was completely normal (since it was). As a 10 month mama, this was extremely important to me and this was the first time I experienced this lack of invasive tendencies at the end of pregnancy.

physical - never touching my vagina/cervix. Keeping her hands away during 2nd stage which allowed me to follow my own instincts to support my own perineum right where I needed to. Standing back and observing as I birthed my baby's head into my own hand. Only becoming physically involved when I asked for help.

Great stuff, thanks for sharing Again, the comparisons you were able to show are so helpful in bringing this to light. And again, sometimes we don't even really recognize 'invasions' until experiencing non-invasive care (or at least, far less, and only informed invasion). We don't know what is--or CAN BE--'normal-birth-oriented' care.

[Youngfrankenstein]

Originally Posted by MsBlack

I say, yes to the first, and no to the 2nd. JMO.

I agree wholeheartedly! I think the power shift is a very subtle but very real thing. I know a lady on FB who is a l & d nurse. She posted one day about a woman in labor who was just so loud! And another l & d nurse commented, "Oh man, I hate the screamers."

It really gave me a sick feeling. What do these nurses expect from birth? Have they been utterly conditioned to take "the package" (pit, epi, lithotomy, etc) and anything else is abnormal?

We aren't very close and didn't touch my homebirth with a ten foot pole other than she said it was too bad I didn't come to her hospital because she was working that day and she would have been my nurse.

Sorry, that was way off topic.

I guess now that you've mentioned power, I believe that is the true beginning of invasive care. When they think they automatically know more than you and choose to proceed with no truly informed consent.

I'm sure we've all seen The Business of Being Born. The very hardest scenes for me to watch are when the OBs are standing over the women saying "It's time to have this baby." In one case it was a vacuum delivery and in another case they were taking her away for a section. A nurse said to the mother "Come on now, no tears."

[Girlprof]

I think the point about informed consent is so important.

My second birth might have been judged as "invasive" by someone who couldn't hear what was going on and didn't have the background. I was induced on my due date, I had internal monitoring, and I pushed on my back. But there's a huge amount missing from that story.

After a normal first birth, I had two miscarriages and was diagnosed with a form of APA so I took Lovenox during my pregnancy. In the US, it is normal to switch to heparin for the last two weeks of pregnancy with the assumption of an epidural. I wanted to stay on Lovenox and plan on no epidural and my care providers (both an OB and MWs) agreed with that plan.

My blood pressure went up pretty high the last week of my pregnancy. This forced me out of the birth center, but that stipulation had been clear all along. My MW suggested a range of non-medical approaches to lowering my blood pressure, but none of them worked. I had my first VE to get a Bishop's score. My MW explained the score and the meaning of the score and she recommended induction. From her point of view, the blood pressure situation was likely to get worse, not better so an induction was her way of preserving as much of the kind of birth that I wanted as possible.

Even with all of this, I was never told that I "had" to induce and never threatened with anything if I decided against induction. I went ahead with the induction.

We switched to an internal monitor (and I had my water broken to do so) for several reasons that were discussed with me both ahead of time and when we made the decision. The external monitors weren't working well. A second VE revealed progress. Breaking the water brought on more serious contractions, which had been the point.

I don't think I had SD with my first birth, but my son's clavicle broke with the delivery. He was over 9 pounds and we were pretty sure this baby was at least that big. I don't even remember if we tried to measure size with an ultrasound, but I knew it was a larger baby and so did the MWs. My MW had me push in the McRoberts position and that worked. She didn't discuss that with me ahead of time and I was surprised that she wanted me to be in that position, but I also had a lot of faith in her ability. Indeed, her recommendation worked. Of course, it was my second baby, but my daughter, who was larger than my son at birth, was born with no injury to her or me (unlike my son).

So there you have it. Induction, internal monitoring, pushing on my back. But the first two we discussed extensively and it was clear to everyone that the ultimate decision was mine, even in the presence of some fairly intense medical issues. We didn't discuss pushing on my back ahead of time, but it didn't feel at all invasive. It felt like a skilled and caring care provider making a good decision that was best for me and my baby as things developed.

[Storm Bride]

I'll read the thread later. My "from the gut" answer is that invasive "care" is anything a woman is told is going to happen, instead of asked. (This doesn't apply, obviously, in a case of unconscious, massive unexpected bleeding, AFE, etc.). That can mean a VE or placing a scalp monitor. My first experience after checking in when I transferred with Aaron was an L&D nurse reaching between my legs and saying, "I'm just going to slip this in"...without waiting to see if that was okay or even telling me what "this" was (a scalp monitor). Sooooo not cool - and sooooo routine.

[mamabadger]

Originally Posted by Youngfrankenstein

So can treatment be invasive if mom doesn't know it's invasive?

I think it can. As a doula, I have seen nurses approach unmedicated labouring women in the appropriate manner, asking permission before touching her or doing a vaginal exam, etc., but once the woman had accepted an epidural, just going ahead and handling her without even telling her what they were doing. The implication was that the respect they showed earlier was something they set aside if and when they could get away with it.
Similarly, I once supported a woman who had an unmedicated birth in a facility where that was very rare. During second stage, a nurse did a quick exam between contractions, and the woman exclaimed "Ouch!" The second or third time this happened, the nurse said, "I'm so sorry, I keep forgetting you're a natural!"

Originally Posted by Storm Bride

I'll read the thread later. My "from the gut" answer is that invasive "care" is anything a woman is told is going to happen, instead of asked. (This doesn't apply, obviously, in a case of unconscious, massive unexpected bleeding, AFE, etc.). That can mean a VE or placing a scalp monitor. My first experience after checking in when I transferred with Aaron was an L&D nurse reaching between my legs and saying, "I'm just going to slip this in"...without waiting to see if that was okay or even telling me what "this" was (a scalp monitor). Sooooo not cool - and sooooo routine.

It really is very routine, even with a lot of midwives. However kindly and gently it is done, the words "I'm just going to..." usually precedes an invasive procedure without formal consent.

[karanyavel]

Let's see...

My first birth had a lot of procedures involved, none of which I felt were invasive because the perinatologist I had was great! Despite having two home births herself, she leaned towards medicalized birth but was always careful to ask permission before doing anything and explained everything to me. That was a hospital-attached birth center birth, and while I had an epidural and scalp monitor, I felt very much in control.

My second birth was pretty ugly and included lots of things I felt were invasive:

• Induced at 37 weeks because the OB didn't want to risk me having an accidental UC (previous birth was 1.5 hours as a primip)
• Water broke w/o permission
• Rough internal exams w/o permission
• Strong-armed into an epidural halfway through transition because I was "disturbing other patients" by vocalizing.. also the anesthesiologist was RUDE
• Not allowed to eat or drink, ice chips only
• Newborn immediately taken away to the nursery (hospital policy) for over an hour

--K

[MsBlack]

Originally Posted by Youngfrankenstein

I agree wholeheartedly! I think the power shift is a very subtle but very real thing. .....

I guess now that you've mentioned power, I believe that is the true beginning of invasive care. When they think they automatically know more than you and choose to proceed with no truly informed consent.

Right? (and your examples weren't OT at all, good illustrations of this point, IMO) The assuming of power occurs from the outset of care, usually; and it sounds like what people are saying it is

*invasion of the body itself, for diagnosis or treatment, without permission and good reason
*invasion of personal space--of the birthing space, walking in and out of the room carelessly
*invasion of 'mental space'--by assuming authority to speak of 'what is going to happen now' or 'what needs to happen now', as if provider owns/controls mom's body/birth process
*invasion of 'parental space'/authority--by assuming authority over babies rather than respecting parental right/responsibility as #1 authorities in their babies' care

Yeah, Storm Bride--sometimes so kindly/gently, that "I'm just going to..." And I agree--the provider's manner is not what is important, it's their initial assumptions of power over the woman, her body, the birth, their assumption of 'pre-given permission' to do things, that is the worst of it.

Karanyavel--your story illustrates the same point pretty well...and thanks for mentioning baby being taken away because I was forgetting how the baby, once born, and parents' rights too, are involved in all this. But the baby very much DOES figure into all of this--and I can think of so many moms who've told birth stories where the worst part--perhaps the most 'castrating' part (is there a feminine term for that?) for them is how they finally get through all the indignities and rip off of an invasive birth, only to have baby taken immediately into medical authority (routinely, I mean). It's the ultimate power rip-off, in a way, that medical assumption of authority over babies.

GirlProf--yeah, having talked things out and made a plan is a whole nother ball of string! As your story so clearly shows us. I even appreciate your mention of delivering in McRoberts--the fact that the mw suggested it at the time, without prior permission/discussion, but it felt fine to you. You had established trust with her by then, it sounds like. Birth is so intimate...and I can see how, once you feel real trust with your provider (based on consciously-developed communication/agreements together), it could feel normal and welcome to accept such a direction. She didn't have 'specific permission' for that--yet the whole context of your relationship with her set the stage for you to feel ok about it. Sounds like you probably could have questioned it at the time, and received her willingness to explain, if you'd felt the need. But you had established trust, you had already opened yourself to the mw's presence and input--and it more or less flowed as part of the intimate event of your birth in which she was included, was not an invasion of it.

MamaBadger--yeah "you're a natural", meaning: "I have to respect you in a way that is not necessary with the epi mamas" Gah!

[MsBlack]

Bump!

Anyone else have anything to add or disagree with or anything...?

[MegBoz]

Originally Posted by MsBlack

Excellent questions!

I say, yes to the first, and no to the 2nd. JMO.

Just another vote in agreement with this.

Nothing more to add, I think it's been covered really well. I also think the juxtaposition between medicalized care & true woman-centered care, as in the story of erin_brycesmom's HBAC friend does an excellent job of illustrating the point. Medicalized care usurps the woman's own control & ownership of/connection with her own body & her own birthing experience- whereas good midwifery care ENHANCES it. Great story!

[mmaramba]

Okay, I'm going to answer this as well as I can before I read other comments.

Literally (yet intuitively, LOL), something to me is invasive if it involves placing a body part or instrument inside someone else's body or psyche. Is that vague enough? A vaginal exam would therefore be invasive. An amniotomy. Episiotomy. It would also be invasive in an emotional way to barge in on a woman going to the bathroom (for example), to step in the middle of a conversation between two people, to offer an opinion when it is not wanted, or to do anything without informing a woman beforehand and getting consent.

These are not all bad things, nor always unwarranted. But they're by (my) definition invasive. Just like a C/S can be miraculous and lifesaving... doesn't mean it's not MAJOR abdominal surgery (and certainly invasive!)

To me, invasiveness even if warranted can slow down or otherwise "mess with" the process of physiological birth, so it should be kept to a minimum, even if that necessary minimum happens to be "a lot." There are some invasive procedures or behaviors that are almost never warranted (especially the emotionally invasive ones) but that's not so much because they are "invasive" but because they are otherwise unhelpful.

I don't know-- it's a bit muddled for me. Maybe I should read some comments, LOL.

I guess. in sum, I don't see "invasiveness" or "interventions" as inherently negative, just to be used sparingly, in most cases, KWIM? There's not really any moral judgment attached, just caution. Like "drugs" or "herbs" or "TV" or "butter." ;P