What is it like to give birth in an American hospital? Birth plans and doulas aside, how will you feel and how will things go when the time arrives? For pregnant mamas-to-be who are aiming for a natural, unmedicated birth, will you succeed in reaching that goal?
“Michelle McSweeney in New York City had originally wanted an unmedicated birth but gave in to an epidural because ‘I couldn’t get up anyway,’ she recalls. ‘I’ve got these belts around my gigantic stomach, I’ve got a catheter, I’ve got a thing on my finger, I’ve got an IV in my arm. I felt like a science project.’” With this vignette author Jennifer Block closes her discussion of “The Machine” (aka the electronic fetal monitor) in her book Pushed: The Painful Truth about Childbirth and Modern Maternity Care (pg. 35-36).
Michelle McSweeney’s simple confession reveals the heart of the matter – whatever your intentions the hospital has a way of making you feel like a thing, not a person. Women are left alone in a room, confined to their beds not with straps, but with multiple electronic devices designed to do the job of an actual birth attendant. Routine IV’s, electronic fetal monitoring (EFM), and catheters are not indicated by medicine, nor are they part of routine maternity care in many other developed nations. In sharp contrast, “The World Health Organization recommends intermittent monitoring with either a fetoscope or a handheld Doppler ultrasound, a rechargeable cordless device that allows the laboring woman freedom of movement” (pg 35).
After reading Michelle’s vignette I understood, really for the first time, why friends of mine who had planned unmedicated births had instead chosen an epidural when faced with labor in a hospital. Dehumanized, a cog in the machine, the laboring woman is faced with the decision to pursue something natural and good in an environment simply not designed to support it. Besides the additional health risks, how is an epidural very different from what she’s already subjected herself to?
- She is already separated from her labor – the nurse, even her partner, look to “The Machine” to observe how labor is progressing. If more information is desired, she receives another vaginal exam. The doctor might visit her to tell her how she is doing. What does she know about it?
- She is already immobilized – if she wants to walk, she must get permission to take off the EFM belt and someone needs to push along the IV poll as she strolls the hospital corridors. Discouraged, she simply attempts to stay active in her room. But, the nurse cannot return constantly to adjust the EFM belt, which is disturbed by her motions. Back in bed.
- She is already birthing on their terms – they tell her what she may drink (ice chips), what she may eat (nothing), what she must wear and where she can be. She feels unspoken pressure to not be too loud, ask too much or take too long. She may discover that the nurse has not even read her birth plan, and cannot possibly do so because she is truly too busy.
I had read when pregnant with my first baby about how hard it is for a woman to give birth naturally in the hospital. I heard from mother after mother that she would do things differently next time. Some suggested hanging a sign on the door “Do not offer an Epidural.” But, most said that if I wanted a natural birth I should find somewhere else to have one. I can see now how little that sign would have accomplished.
It doesn’t have to be like that. It isn’t like that in countless other parts of the world. Imagine instead that you are supported by the constant presence of an expert birth assitant. She knows you because she’s spent an hour with you every month (and more often that that lately) for your prenatal appointments. Of course she knows your birth plan! She also knows what scares you about labor. She knows your back-up plan. She’s not surprised when you play Norah Jones. She doesn’t care that you aren’t wearing a hospital gown. She reminds you of ideas you’ve discussed for managing labor pain when you’re brain’s too foggy to think. In fact, she’s joined by a doula with whom she works regularly and whose hands know exactly how to apply effective counter-pressure. When you ask her to check on your progress, she does a vaginal exam while you’re resting between contractions. When your progress slows, she doesn’t threaten you with Pitocin. When you want to move, she moves too so she can listen to baby without slowing you down. She has an underwater doppler so you can labor in the tub and when you push the baby out in the birth tub, she’s as estatic as you are! Congratulations, mama, you did beautifully, and you did this yourself! Hold your baby, nurse your baby, the rest of us can wait.
Is the Birth Plan a joke? Certainly not to the women that create them, but what about to the nurses and doctors who provide your care? 
