Friday, March 26, 2010

You buy the hospital ticket, you go for the hospital ride, Part 235624

The Feminist Breeder posted a link today to a friend's blog post about an OB and an L&D nurse discussing c-sections on Facebook. The OB said she was up late waiting for a baby to come out, the L&D nurse recommended "Ahhh just cut her, fuk it!" and when called out for this both the OB and the nurse defended each other, with the nurse loading on some extra distaste for "birth plans".

I actually don't think the OB's original comment was so out of line. I've (obliquely) sighed over a long induction on FB, and I have friends in many jobs (including medical ones) who vent a little bit at the end of a long shift or a tough task. It was really the nurse's response(s) that I thought deserved the ire that's being generated.

And as I was scrolling through all of said ire in the comments, I came across a great comment from Navelgazing Midwife that I wanted to repost here in part. She is responding to many of the people asking why the nurse was hating so much on birth plans.

Doctors and nurses HATE birth plans. Have for years. (There are a minute few who accept them.) The reason the nurse said it sets women up for failure is because the hospital system is not equipped to permit/allow/encourage women to have an autonomous labor and birth. The hospital assembly line moves one way - through as much technology as possible. Asking a nurse to attend to a woman "wandering the halls" (as I've heard said many times before) is unfair because she has other patients to take care of, too. If the patient wants intermittent monitoring, wants to get up periodically, wants to eat and drink in labor, wants to push out of the bed, wants to do without an IV... all of these things cramp the hospital and nurse's (and OB's) style, making their jobs much more difficult... AND, in their eyes, opens them up for some serious liability. *We* can say, "Tough caca. They need to do what we want because we're hiring them and it's my birth," but they can be quite persuasive and manipulative, threatening women in the middle of what should be a glorious experience.

I use the phrase, "You buy the hospital ticket, you go for the hospital ride" because if you want a homebirth in the hospital, you will be sorely disappointed (the "set-up for failure" the nurse speaks of). If you want a homebirth, have a homebirth. Otherwise, acknowledge the limitations, choreograph what you can and don't be surprised if your birth doesn't turn out like you envisioned.

The same can be said about doulas; hospitals, nurses and doctors generally despise them. They get in the way of the care provider's directions, they "make" women question the status quo and rock the boat of misogyny and anonymity in the hospital's birthing assembly line. Some dislike doulas so much, they refuse to work with a client who has one -and some hospitals have banned them altogether.

If a woman feels like she's going into battle in the hospital, I would *highly* encourage her to seek out other options (new doc, new hospital, etc.) if at all possible. I do understand that not everyone has that luxury, but many do. I hope they exercise their power of economics to hire someone who respects them.

I will add the caveat that I don't think that hospitals, nurses, and doctors "generally" despise doulas, birth plans, etc. because I have now worked at multiple hospitals and I would say that generally I have been well-received as a doula - the haters have been the exception, not the rule - and I haven't seen much open disdain for birth plans although I could imagine it's taking place behind the scenes.

But apart from that I will say a big YES YES YES to the rest of this. I know I've posted about it before but I just had to do it again, because I've heard a little too much lately about people's basic dignity being disrespected in the hospital and/or by care providers. Some of these people can change and do, some can and don't, some are stuck with their "hospital ticket" and the ride that it entails.

In short: it's hard to fight the tide of people, like the nurse in the post, who put quotes around the words "birth plans", coming at you in the hospital who are used to getting things done their way, who have gotten things done their way with the 15 other women they've worked with this week, and at all of the 2,500 other births they've worked at in their career. If you think you can buck the tide, ask yourself, who has more practice getting births done their way, you or them? And then prepare yourself thoroughly for resistance, because at best you won't need it and more likely, you will.

(My goodness, all my posts lately have been not very positive, have they? I blame the deadline for my master's paper putting me in a negative frame of mind.)


Anonymous said...

I love this post - thank you. I'm attending the birth (my first) of a woman who's got a very strict, Bradley inspired, Birth Plan. I'm hell bent on helping her get everything she wants, but I've tried gently explaining to her that we're going to have to work pretty hard because even the most stringent, laminated, birth plan will usually get tossed aside or laughed at by the hospital staff. She doesn't believe me though. She insists that if it's in writing, they're going to have to follow it. I don't know how to let her know that it's just not that way. I've never seen a nurse who loved a birth plan. I just don't want her to be in for a rude awakening when we get to the hospital - so what do you think I should tell the mom? How can I let her know that birth plans are fodder for comedy at most hospitals, and that her birth plan means more to her and her husband than it does to the staff attending her birth?

Rebecca said...

Thanks for the nice words! It is hard when you're concerned that what people are expecting/hoping won't match reality.

When someone asks me for advice about a birth plan they've written, or suggestions in writing a birth plan, I often send them to these links:

First, written by a L&D nurse:

Second, written by a different L&D nurse:

These posts say a lot of what I could say, better written than I could probably say it, and from the voices of experienced L&D nurses.

I also always encourage people to share their birth plans with their care providers beforehand. How the care provider reacts at that point may be an important clue/wake-up call for how things are going to go in labor. Of course, the provider may just smile and nod and then things are very different at the hospital, but it's a good start. Suggest that she go through each of her requests with the provider and ask how things are usually done and if it will be a problem if what she's planning deviates from the norm. Asking a lot of questions on the hospital tour can help as well. That gives her the opportunity to actually observe providers' reactions, and they may bear out what you're saying and help her think twice.

After that...there's only so much you can do to help people understand. As you go along, you may be able to collect personal stories and say, "Well, when I was at hospital X with a birth plan like yours, we had a little trouble with Y and Z because it's not the way they do things...let me tell you what happened and we can think about what to say/do..." but it's harder with your first birth. And you never know - maybe you guys will luck out and get some awesome nurses and docs and everything will go great! The more experience you get with that hospital/staff the more you'll be able to accurately predict what will happen. For now, I'd just try to help her investigate as well as possible in advance.