Well many women who read the account of my first labor would notice much to criticize, and it does not all have to do with the epidural. For one thing, as I pointed out, my doctors were very controlling. Now I will admit that the hour of pushing my daughter was such a blur, and it's possible that Dr. G rushed because he feared the baby was in distress. It would definitely be understandable that having a mother run a fever for over 6 hours might not be good for the baby. But if that was the case, it was not made at all clear to me or to my husband (who was under no influence of drugs and had actually slept a little the night before). All we knew was that the doctor was not satisfied with how I was pushing, and there was no discussion of whether to cut and vacuum or to give me a few more minutes of pushing.
Another naughty OB behavior was when the other OB, Dr. J, stripped my cervical membranes without consulting with me. Stripping the cervix can present many risks, including leaking waters or even occasionally a full-on breaking of the bag of waters. It's an optional procedure that can effectively kick a woman into labor, but it should be a procedure to which informed consent is actually given rather than something snuck up onto a patient.
As far as my hospital care went, many complaints could be made about the nursing staff. Considering I was a first time mom and was receiving a great amount of IV fluids, it was unwise to decatherize me so soon, and the post-partum nurse (the young, well-intentioned one) should have been mindful of that and at least catheterized me again before going at my abdomen the way she did. She was also such a novice and should've considered that a brand new mom in terrible pain might be frightened by hearing so much detail about her loss of blood. (Don't get me wrong - this was at least more disclosure than I'd received much of the morning, but perhaps it was done in an unprofessional and insensitive manner).
I could go on and on. The biggest problem with the entire situation - the prenatal care, the labor, the delivery, and the post-partum care, etc. - was my lack of knowledge. As I previously mentioned, I had purchased and made a valiant effort at reading What to Expect While You're Expecting. The book is difficult to read, though, and is set up in a way that you won't really learn about something unless it occurs to you to look it up and study it. It is also a book that makes a great effort to avoid having an opinion on anything, and so it waters down much of the information. An excellent example of this is the entry on "episiotomy." I'm not sure if a new edition of the book has changed the view (I hope so), but it essentially states that episiotomy assists birthing, prevents tearing, and in order to avoid 3rd and 4th degree tearing, the best option is a "hockey-stick" cut. Now, at the time when my edition was published, "hockey-sticks" might have looked great on paper, but most doctors in my area still wouldn't consider doing them for one very big reason - that's a lot of cutting that might not be necessary. Midline cuts (a small cut straight toward the rectum) might carry a risk of tearing into the rectum, but they were still minimum cutting. Mediolateral (a cut toward the side at an angle) automatically create too much tissue damage, some of which is irreversible. And there is plenty more that I can say about episiotomy, when it's right and when it should be avoided, but it deserves it's own post. At any rate, I did not learn what I now know about episiotomy from What to Expect, I'll tell you that.
So having purchased a slightly useless, difficult to read book (which for some reason made me extra nauseated for my first few months) was the bulk of the my education. The other resources I had were the internet (again a "look it up when it occurs to you" resource), a one-day prenatal class offered through our doctors' office (more of an orientation than a class intended to educate couples), and a lot of intimidating conversations with friends and family. There was so much that I did not understand about pregnancy and labor. It was no wonder that I took poor care of myself during the pregnancy and was terrified of childbirth.
Here's a funny punchline though: Even after my horrible delivery with Dr. G and his practice, upon learning that I was pregnant with my second baby, I returned to the same practice. I had no idea at the time how much a part they had played in my "bad luck" labor.
It was only when my husband, daughter, and I moved into our new house that doors opened for me learning more about natural childbirth. In the years following our daughter's birth, I had many conversations with other moms about labor, and very occasionally I had an exchange with a mom who enjoyed having "Bradley" births with her babies. I knew nothing about Bradley, only that when I met a mom who had experienced a successful Bradley birth, she was extremely enthusiastic about it and would talk your ear off about how great it was (if you let her). When I met my new, very cool neighbor and learned that she had done a Bradley birth, I was very curious. She shared her first birth experience with me, which was very similar to mine with my daughter. Then she shared about her second birth experience after she and her husband had attended a Bradley class together. It wasn't without it's challenges, but the experiences were night and day, and she was so grateful to have been able to birth that way. It peaked my interest big-time. I couldn't ignore the fact that most of the women I met or knew who had planned and prepared unmedicated births were very happy about them, even when the experience wasn't complication free.
The next part of the story is history, as they say. My husband and I arranged for and attended a Bradley class (he was reluctant at first, but soon after enjoyed being so well informed and prepared). I read all of the suggested material, kept a diet log, and did prenatal exercises like crazy. Preparing for natural childbirth became one of my great goals in the coming months and weeks.
The most difficult and sobering part of the journey was the realization that many of my complications in my first labor, delivery, and post-partum were not simply a case of terrible luck. Many of them were the offspring of procedures I had been subjected to or consented to. For example, as I stated, stripping the cervix brings a risk of premature rupture of membranes and possible infection. It might still be the best choice for a woman, but even if the doctor chooses or suggests it, it is not "risk-free." The epidural, which I'd like to discuss/vent about another time, has a risk of a negative reaction (i.e. fever) for some women. The use of antibiotics during labor or afterward with baby brings a risk of yeast over-growth in the milk or thrush infection in the baby's mouth. These procedures are not necessarily bad and are sometimes necessary for a safe delivery, but they always bring risks with them. And women deserve to know about those risks in order to give truly informed consent. I mean no offense to other women when I say that I believe a large percentage of birthing moms are not well-informed on the risks as well as the benefits of medical intervention in childbirth.
After several weeks in the Bradley class, I couldn't NOT think about my labor with my daughter, and when I thought about it I was angry - at my doctors and nurses, at every mom who had ever frightened me away from pursuing natural childbirth, at my husband for shooting it down once when I expressed an interest in natural childbirth, and mostly at myself for not taking control of my pregnancy, taking a good prenatal class (ideally for me, a Bradley class), and having the courage to consider better care-providers. I'm not saying that it was healthy to become so angry at everyone. I just was, and one thing was more clear than anything - if I didn't change doctors soon, I might end up repeating my first labor experience or having one similar to it.
This might sound silly to some people, but one of the biggest things I learned in my class is that the provider is half of the experience. If you are with a provider who understands and respects your desires, communicates well with you, and wants you to be a part of the decision making, you stand a better chance at a positive, safer labor experience regardless of whether you plan to go with or without an epidural. But if your providers are unwilling to consult with you and are willing to take your entire labor into their hands, you could end up the way I did - confused, in terrible pain, and with a difficult recovery.
Okay, some might ask, "But isn't the safety of your baby the most important thing?" Of course it is, and if the safety of my baby was unimportant to me, then I wouldn't be going to a health-care provider and delivering in a hospital at all. Actually, even saying that is somewhat unfair, because I know a few mothers who always birth their babies at home, unless it's medically impossible to do so, and they are very conscientious about the safety of their babies. One of them is a registered nurse who even chooses not have a doctor or midwife at all, and it is her husband who delivers the baby. Sounds crazy? Well I wouldn't feel comfortable doing it, but she is extremely well educated about childbirth, as is he, and they have had at least 1 or 2 excellent home births just this way. The need for an ambulance, midwife, or doctor hasn't arisen and hopefully never will.
This doesn't mean that I'm advocating unassisted home births. I just won't condemn them. For some women, it's the right decision, and it honestly sounds amazing. I just haven't ever felt right about it for myself.
So, back to the issue of a baby's safety - of course it's important. I don't know a single woman who is willing to carry a baby for 9 months just to gamble their safety away like it's nothing. And yet, it is slightly debatable what could be considered a "safer" delivery method/locale. You could definitely argue that a hospital and an OB are the safest - best equipment, highest qualified, etc. During most hospital labors, however, the doctor is not present during the labor and is not visually supervising the patient in their labor. The laboring portion is left in the hands of the labor and delivery nurses on staff, and let's hope they're great! Chances are, however, they are dividing their attention between at least two or more women (especially in Utah county!).
On the other hand, with a lay or nurse midwife, either in a birthing center, hospital, or home birth, the midwife is supervising not only the delivery of the baby but mom's labor. Once it's clear that mom is in labor, the midwife comes to her side. Attending so many labors with typically undivided attention makes for incredibly expert eyes (between experience and training), and, in my opinion, you have the absolute best authority on how the labor is really progressing. The midwife is much more likely to notice if something is not right. She is also more likely to have "seen it all" so to speak, and she'll know if it's a normal part of the unpredictability of childbirth (and if there's anything consistent about childbirth, it's that it's unpredictable), or if it's something that merits medical intervention. Some people panic at the thought that a midwife is not licensed to perform cesarean sections. This might sound like a big red-flag. As one who has delivered with midwives in a fairly complicated delivery, however, I can attest that they are not insensitive to the possible need for cesarean, and they will have a qualified OB in the room during the pushing stage to ensure that a cesarean can be safely performed if necessary. (Happily, in my case, it wasn't necessary! Though that OB had magic hands and turned my posterior baby like a charm!)
Returning to my experience with the Bradley class, at 32 weeks into my 2nd pregnancy, I contacted my Bradley teacher, gave her permission to say "I told you so" (she had warned me against staying with my OB's), and asked for some suggestions. After considering a couple, I decided to try and get the wonderful family practitioner who had delivered my sweet relative's baby years before. He was very popular even as just a family practitioner, but he was only accepting obstetrics patients on certain recommendations. He accepted my reference from my Bradley instructor, and I enjoyed the remainder of my visits very hopeful that everything would go better with this delivery.
I will not go into great detail in this post on the birth of my 2nd child (my first son), but I will say upfront that I did not receive an epidural. My husband and I enjoyed this labor more and felt like active participants. That alone was a blessing and a confirmation that my personality is better suited to unmedicated childbirth. I'm not joking when I relate that my husband actually said to me at one point during the labor, "This is actually a lot more fun." Of course, he was pretty exhausted by the time our son was born, but we both felt good about how our labor went.
I will also be plain and point out that it was not an uncomplicated delivery. I had hoped that a labor free of unnecessary intervention would minimize the complications in the delivery, but there are some things which you cannot prevent - like passing of and aspiration of mechonium. (More on this next time). I will say that, in light of the challenges my handsome boy faced during his first trying hours and days in the real world, I believe that it served him well that he came into the world drug free.
By the way, that same boy is still ridiculously handsome and has a passion for Legos and Wii, which I swear we only let him play on the weekends...