Here's Why

So when you're a home-birth birth junkie sort-of type - like me - it's safe to say people assume you just don't like hospitals. Or maybe you just don't like doctors, male doctors more specifically.

They might conclude you had some bad experience in your childhood and can't get over it. Or that maybe you're a femi-nazi type whose fist is raised at the patriarchal establishment of the women's health arena.

Maybe they think you're a ridiculous hippy type trying to turn childbirth into some incense-and-music spiritual experience.

Well, none of those fits me. And I don't really care too much what people think.

But here is one birth's worth of why I hate hospitals and the attending practices for birthing babies:

> Day before birth: Clients arrive *not* in labor. No one suggests - save me - that they might go home instead of succumb to a bunch of medical stuff done to a perfectly healthy woman who's not going to have a baby any time soon and needs only to sleep if she can.

Thankfully, the clients go home.

> Clients arrive at the hospital the next day in decently active labor after an office visit with her doctor, who didn't ask who I was or introduce himself to me. (He also performed a visibly rough vaginal exam, likely stripping her membranes without her consent.) The nurse is friendly enough, though she doesn't acknowledge the dad or me - never asking or saying our names at any time during her shift. This nurse literally ignores my questions completely, perhaps feeling threatened or otherwise uncomfortable with someone asking for anything outside their standard protocol - like an explanation of risks and benefits, even.

> Wait - the nurse did answer me once. It was a terse "No" when I asked if the client could wear her own nightgown. She didn't explain why not.

> The client is informed - not asked or given counsel so she can offer her informed consent - of what will be done to her. That includes vaginal exams, continuous electronic fetal monitoring and the inability to eat or drink anything beyond ice chips. [Aside: It's estimated the average labor and delivery burns 32,000 calories. Sure, it makes *complete* sense to not eat or drink. Sarcastic eye roll.] This is a completely healthy mom with no risk factors.

> The nurse does not explain why continuous EFM is now ordered when before it hadn't been. The client is confined to bed or to the two feet around it. Well - except when she uses the bathroom, which I'm now thinking she should do quite a bit, locking the door behind her. Studies show there's a higher likelihood of cesarean section in women forced to be on the continuous EFM.

> After a gazillion questions - asked and attempted to be answered through painful contractions - the nurse gets IV access with ease and starts running antibiotics after explaining how scary Group Beta Strep is but offering no explanation about any risks of antibiotics or alternatives. Nothing is presented as optional.

The nurse introduces her shadowing nursing student, who looks terrified.

> Finally, the clients and I are alone - and for a decent amount of time. At first I think, "Wow, they're not even checking on her." And then I think, "Cool. They're not even checking on her." (The more they "check on" people, the more likely interventions become.)

> I step out to get the dad a cup of awful hospital coffee. As I'm pouring it, I overhear the nurse teaching her student how to watch a woman in labor. They're staring at a computer screen that monitors contractions and fetal heart tones - a computer screen at the nurse's station. Let me say that again: They're staring at a *computer screen* to learn about women in labor. I almost cry as I realize this nursing student is not going to learn how to feel a woman's belly or look into her face to assess labor. Instead, she'll learn how to read squiggly lines on a computer monitor. So sad for the student and her future clients.

> And so the clients and I labor. The client's getting distant. She looks like a woman in labor but with an added dimension - like a woman who's been through some kind of trauma. She's withdrawing, I can tell, and I'm not sure, precisely, how to help her. I'm struck - and not for the first time - about the differences how a woman is treated and the environment around her can make. At home, this woman would feel safe. I can tell that here, she does not. Her fears later prove valid.

> The client endures several more announced - not asked-for - vaginal checks and is told she's making some progress but not very much. It's a subtle detail, but in reality she had labored very well and made fine progress, slipping a bulging bag down through a cervix whose dilation number - only *one* factor to assess "progess" - hadn't changed much. When the nurse leaves, I give this precious, young, first-time mom my best pep talk ever.

> The unspoken tension begins to build. We all know the *doctor* - who has had no contact with his client since the rough vag exam in his office many hours ago - is coming shortly. If there's not more change, he's "not gonna be happy about it," something he'd told the client earlier. Now I'm thinking about my midwife friends. Never in a million years would they put that kind of expectation on a woman, recognizing the processes of labor and delivery are not about pleasing anyone - least of all the baby catcher.

> A half hour before shift change, the nurse announces she'll be doing a vag exam because she has to give "report." Just for kicks, I firmly ask the client, "Is that OK with you, M?" The client breathes out a resigned, "OK." The nurse ignores me.

> Once the nurse leaves, I tell the client I think we should work on a couple of positions to encourage the bag of waters to break. She's quiet but compliant. She's tired. I simply unhook the monitors - Just let them come running in! - and walk her around the room. She collapses into a hanging squat into her husband's arms during contractions.

> New nurse! She's perky and friendly and I know we need to like each other. Of course she needs to do a vag exam. I downplay the invasion by explaining to the client that each person's assessment is different and this nurse needs to get her own baseline. And yay and yay! That movement helped, as the mom's now a nice 8 cm. The client offers the briefest of smiles on her flushed face. It's the first one I've seen in a long time. Wryly: I'm so glad to know we'll make the doctor happy.

> But when he - the *doctor* - comes in, I can't tell he's if he's happy or not. HE SAYS NOTHING TO THE CLIENT. He goes directly to the computer, dons a glove, asks for an amniohook, plops himself at the end of her bed and breaks her bag of waters without even *telling* her what he's doing except to say, to no one in particular, "Let's get this done." I notice she jumps whenever someone touches her "down there" without telling her, and I get a sick feeling inside. He peels off his glove and leaves the room.

> In fact, everyone leaves us alone again. I'm glad but struck by the fact that this is transition, one of the hardest parts of labor. At a home birth, we'd all be next to the mom's side, as this is when she'll likely start to feel scared and doubtful - among other things. The client lays in bed and labors. I tell her husband to talk to her and tell her she can do it. I'm leaving for a few minutes to let them be alone.

> When I come back in after a few painful minutes, I notice both mom and dad are crying. It's not really the time to process it, but I wonder if they're feeling violated - not feeling just the normal transition stuff. This doctor, after all, had delivered this woman 21 years ago. I had hoped he might show her extra care because of it. My hopes were in vain.

> The client labors through. She's doing well, and I'm so glad no one's coming in.

> Alas, they do come in, and I'm again disgusted how no one has *ever* asked the client if she wants a vag exam, only announced that's what they'd be doing. So the nurse - though she's friendly - announces such and commences. She doesn't tell the client what she finds, either, only says she needs to contact the doctor to see what he wants to do. Argh. In midwifery care, we consult the mother's *body* to see what it wants to do. Then we follow *it*.

> A couple minutes later, the nurse pushes back in the room and announces, "Dr. So-N-So wants you to start pushing." I frown, holding back my sarcasm. I'm thinking, "Who gives a flip what he wants? She doesn't have the urge to push." The nurse's declaration means the client is likely completely dilated, but she doesn't tell her so, which would have been a great encouragement. So I tell her so, not even sure I'm right. (But who would suggest she push unless she were completely dilated, right?) Then I say, boldly, "I think she should get up to use the bathroom one more time before she starts." I'm buying time and hoping she'll get the urge on the toliet. See, she doesn't have the compulsion to push yet, and I think she could have benefitted from the "rest-and-be-thankful" stage I theorized she was getting. Further, they'll chart the onset of pushing too early and - heaven forbid - won't "let" her push too long. As she sits on the toliet, I stand between her and the staff chattering on about the break she's getting and how there's no rush and (to the client) you don't have to push if you don't want to. I go on and on about how her bladder should be empty to make room for the baby. I probably talked about the weather.

> But I only buy about 10 minutes until the nurse is ansty and wants the client back on *the bed* to start pushing. And so she does. Right away I catch on that - though she's nice - we have a "purple pushing" nurse. Crap. The client is so tired, and I'm suspicious she doesn't really have the urge to push. TURNS OUT, after the doc comes to check her, THAT MY CLIENT WAS DOING ALL THIS AWFUL PUSHING AGAINST A CERVICAL LIP. I want to *scream* when I hear that. My sweet client was too tired or too naive or too traumatized to speak up about what must have been excruciating pain. Dammit! Once the doc - who heretofor had been reading the sports section at the nurse's station (not kidding) - pushes back the lip - also without permission or explanation - she makes progress. By now the client is so battered I'm trying not to lose her and praying hard she gets the strength to get done before things go south.

> So she pushes. It starts to feel a little more normal. She passes stool (yay!) and there's obvious progress, typically slow for a first-time passage through those bones. The doctor peeks in and, apparently, sees enough head to want to stay. I'm just wishing they'd all get called to an emergency or something and I could accidentally catch the baby while they were gone. Maybe I and the nursing student - who looks ever more terrified.

> There's this big awful flurry and the doctor dons his HazMat suit, joking, "You know it's serious when I put this on." At first I think, "I much prefer jeans, a T-shirt and bare feet," but after the third-stage hemmorhage he likely caused, I get why he needed it.

> Mom does some great pushing. She's found that last surge of strength and she's doing it. The doctor keeps reaching over and touching all his instruments (um, they're supposed to be sterile), and I'm especially eyeing his scissors. If he starts to cut her, I'm going to cry out. I don't care what they say. She's stretching beautifully, in spite of the fact that she could have used a hot cloth and some oil. I wanted to touch her so bad, and I prayed that her good nutrition will be enough to keep her tissues intact.

> Finally, a head. Routine suctioning on the perineum, but I expected that. Then the baby. Not given to mom, but held in the dirty-gloved hands of the doctor who says, "Don't worry that she's not breathing." He actually said, "She'll breathe when I make her breathe." I've worked with a lot of doctors and often joked about the "God Complex" some of them have. Oh, doctor, you might have caught 3,000 babies, but it is not you, sir, who authors the breath of life. There is One Who has All Power, and you are not he. So the doctor roughs up the baby, finally making her cry. I said in my sweetest baby voice, "You tell that doctor how mean he is. You tell him."

> After what seemed like days later, mom finally gets to hold her baby, which they've already announced is a girl. (At home births, we don't announce it but let the couple have that special moment of discovery themselves.) The doctor bullies the dad into cutting the cord. The dad had said ahead of time he didn't want to. I spoke up and said so. The doctor said, "Come on! No, really! Come on!" The dad did it reluctantly while everyone clucked and cooed. I just hoped he wouldn't faint. The staff didn't know this dad had witnessed a bloody death of a friend after an accident and was not interested in cutting the cord. I wonder if they would have cared. Besides, not everyone wants to do it - it's not that big of a deal - and it floors me why they would push it so.

Here's where it gets awful.

> I watch the doctor drain the umbilical cord of the rest of its blood and think, "That should be going into the baby. Why is it going into the trash?" Whatever. He reaches for a hemostat and clamps the cord, and I just know he's going to pull on the placenta. He starts telling the nursing student he learned not to pull on the cord because the cord could break. And I throw in, "Yeah, and you can cause heavy bleeding if you pull on the placenta." I don't think he hears me. AND YET, the doctor says, you *can* pull lightly with steady pressure. I'm thinking, "Yes, if the placenta's separated." But if it's not ...

> So he's does his steady pressure thing, sometimes known as controlled cord traction, and Mom starts to bleed. I ask her, loudly, "Are you having a cramp?" Turns out she was. So he pulls and pulls and out comes the placenta. Mom's already been given pitocin in her IV (without her knowledge). He reaches in. Nurse pushes hard on her belly - all with no one explaining what they're doing, why or why it hurts. She's obviously in agony.

> So she bleeds. And bleeds. And bleeds. He quick does a single-stitch repair with no anesthesia and without telling her. (I had to tell her.) I'm sick. She might have opted for no stitches. She might have liked a little lidocaine, which the doc later said takes too long to wait for to work.

> She keeps bleeding. He announces, "You're not making me very happy." If I hear that one more time, I might smack him, but I realize I need to keep my cool to help mom, who's heart is beating 150 times per minute (twice as fast as it should be) and whose blood pressure is 80/64. The nurse is looking nervous and asking, "Should I start her IV?"

> The doctor then does things I can only describe as horrendously painful. He reaches in the mom, scrapes and scrapes, pulls out blood clots and placental tissue. He uses instruments, barking at the nurses to find larger ones so he can really get in there. He must have done, essentially, a D&C (without the "D" as she was already dilated). It was awful. And he had dirty gloves (like dirty with baby poop). Apparently, pieces of the placenta were retained. The doctor ruminates about a septum, a bicornate uterus, tough uterine wall and, basically, everything but the obvious: He'd pulled on the placenta, which likely left some of it sticking there.

> The mom tolerates this as best she can. It's like having surgery without any anesthesia. I'm cringing. The nurse is cringing. The doctor's babbling on. The mother is about to pass out. When I comment about how much it hurts, the doctor actually says, "Well, my hand is a lot smaller than that baby, and she just pushed the baby through there." Even in retrospect, I think, "Does this man *really* not understand?" Bizarre.

> In the mean time, another nurse has taken the baby. I see her giving it shots, administering antibiotics to her eyes - all without consent from the parents. Dad is a bit shell-shocked, roaming from baby to mom, not sure what to do. I'm holding mom's leg, which, on top of the other torturous things happening to her, is cramping up.

> Finally, the doctor announces he's "happy" with mom's bleeding, or eventual minimalization of. She's lost 1,000 ccs, he estimates. (That's a lot.) I'm thinking about her recovery, her ability to produce milk. Dammit.

> The doctor turns to the nursing student. "Usually I'm long gone by now," he says. "This one's just giving me a hard time." Mom, whose eyes are puffy and who looks simply awful, gives a trite smile.

> Oh, one more thing, he says. With all his "messing around" (his words), he's busted open the stitch he'd put in and needs to redo it. He figures he could wait a long time for a little lidocaine to kick in or just get it done quickly without it. By now, I believe my client was so traumatized she didn't care what he did to her. "Do whatever you need to do," she croaked out. I want to scream. With a little common-sense prevention and compassion, he likely wouldn't have needed to do a lot of what he did.

> Back when he'd been tugging at the placenta, I'd been working to get the baby latched on to no avail. I thought again of the quiet, gentle home births I'm more likely to be at. We're at least 90% successful at helping babies latch in the first hour - with or without some "management" of third stage. Now the baby was alert and in the arms of her father, but mom was so wiped out, I whispered in her ear, "Wait until a little later. Ask C. [the nurse] to help you. See the lactation consultant in the morning."

> I got my things and excused myself quietly. I needed to get my children and get home. The dad looked at me, his dark brown eyes pooling. He shook my hand, his grip lingering a bit, and said, "Thank you for all you've done."

We have so much to talk about.

> I walked briskly past the nurse's station, where the doc was back to the sports section. He didn't look up. I didn't strike him.

> But I did hit my midwife friend's number on my cell phone before I left the building, knowing she was at a home birth right then. "Hi," I said to her voicemail. "I hope you're in the middle of a great delivery. I have so much to tell you."