8.14.2007

Birth Choices

Friday marks 37 weeks, and we are all systems go. Work for one client is shifting to the replacement legal counsel over the next two weeks, and work for the other is already in transition. I feel huge.

I'm reading a lot now about the opinions people have about what sort of birth women are supposed to have. There are doctors who opine that women who seek an unmedicated birth are "odd" or attention-seeking martyrs. There are natural birth advocates who don't give equal air-time to the value of pain management via medical (as opposed to strictly non-medical) means. And lately there's a lot going on in the realm of expanding/limiting the birthing options available to women. The Rotunda, the largest birthing hospital in Ireland, recently announced a policy that birthing mothers would no longer be permitted to bring a doula (trained birthing assistant) for labor and delivery unless the doula was her designated "partner" - and she would only be allowed one partner (any person other than hospital staff) in the room. The "women's center" practice across the hall from my OB/gyn has stopped taking clients who plan to deliver using the Bradley method - a drug-free approach to pain management (this was our chosen approach). Hospitals are more than willing to make medical pain management available, but not so much the non-medical options (a birthing ball, a birthing tub, freedom to move around and change positions or walk around, the comfort of the presence of relatives and friends).

It got me to thinking about my decision, early on in pregnancy with the first cub, to seek a non-medicated birth, to hire a doula to assist during the birth, and then to breastfeed. I believe I'm making the best choices for my own and my family's long-term health and well-being. Having experienced a cesarian delivery and the prolonged, painful and extremely life-limiting recovery that followed and cast such a pallor of dull pain and suffering over the first few months of my first child's life, I am choosing the route that is less likely to lead me back down that road again, since available research indicates that medical interventions in birth have a way of spiraling to additional interventions that lead invariably to a surgical birth. This is one way of explaining the sky-rocketing incidence of surgical deliveries as opposed to vaginal deliveries.

More troubling, many of the "standard" interventions were adopted without studies to prove their effectiveness. A prime example is the practice of episiotomy - making an incision in the vaginal tissue down towards the perineum to reduce the likelihood of a tear and to present a cleaner wound for stitching. Recent studies found that when routine episiotomies were no longer given, many women actually did not tear, and those that did healed better from a rough wound than from a clean slice, which is more vulnerable to infection. So why was episiotomy adopted in the first place? Seemed like a good idea at the time, I guess. And although I have the utmost respect for the OB/Gyn profession, there are probably in reality only a small percentage of births that truly need a medical intervention, so that these highly skilled and trained professionals must actually feel a tad unnecessary at times. Hence the rise of interventions, and the subsequent rise of cesarians.

So that's why the non-medicated birth. And the doula? My chances of being successful in achieving a non-medicated birth are significantly improved with her there beside me. She has been in practice for 16 years and has assisted literally hundreds of women achieve exactly the sort of birth that I'm hoping for. She will be able to suggest things I can do to manage the pain that I wouldn't have thought of. She will be able to run interference with hospital staff to help keep intrusions into the room to a minimum. And she also frees up DH from having to manage these roles, so he can just enjoy being present with his wife for the miraculous birth of his daughter.

No doubt about it, breastfeeding is hard. It hurts of the toe-curling variety for the first couple of weeks, it puts me in the hot-seat for all of baby's wake-ups during the night, there's thrush, mastitis, and embarassing leaking to deal with, the anxiety over getting my supply up and bountiful during the first couple of months, and then once I start back to work I also start to pump 6 times a day, at 25 minutes each time to pump and clean the equipment for the next time, so that I have enough stored in bottles to send to daycare with DD the next day. And also so that my supply during the day stays primed so that on weekends there's still milk there ready for her to nurse directly. Lastly, there's the anxiety I have about nursing in public - or even in my home in front of anyone other than immediate family and very close friends. The cub was not a discreet nurser, and consequently I tended not to venture out with him when I knew he'd be needing to eat - which was a lot - unless I knew for sure that I could find a private place to go with him to nurse. Of course I could bring a bottle of breastmilk with, but then I'd become engorged from having missed the feeding and would still need to go pump somewhere, have a cooler ready for the fresh milk, and clean and dry the equipment. (I'm hoping DD will be one of those quiet nursers that can have a meal with no one who sees us even having an inkling.) But I do all of this for the superior nutritional value of the breastmilk. It's that much better. Plus, the bonding from nursing - especially now that I've experienced it once already - is sooooooo worth it. I'm not necessarily anti-formula, it's just that I'm fortunate enough that nursing is an option and I'm looking forward to doing it again, in spite of the difficulties.

I've arrived at these decisions through a rational and deliberate process, and it's simply odd to me that there are those out there who would oppose or judge or even refuse to be my doctor because of them. I don't think I'm doing anything all that radical, but in fact am being sensible and practical. So why are so many so invested in having not just opinions, but control over how women give birth and feed their infants?

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