Consumerism and (hospital) birth – Part II – A Labor Intensive Process

Save for a passing introduction at the desk as I moved to a room, I never saw the OB on call because I had chosen the midwife practice.  I’m assuming that he/she  knew what was going on and likely signed off at that desk because the OB names are all over my discharge paperwork.  Which is how I wanted it.  And it makes sense from an efficiency standpoint of running a L&D wing with mostly midwives: use the less expensive labor when things are going as one would expect and save the more expensive (due to many more years of med school and their specializations) OB labor for when they are really needed.  But, surprisingly, intake wasn’t exclusively the midwives’ or the nurses’ domain.

For this second birth, I moved through active labor VERY quickly – like from entering hospital dilated a 3 to baby on chest in less than 2.5 hours.  The good news is that the midwives realized this right away and immediately started the water going in the labor tub after the obligatory 20-minutes triage monitoring period.  I was thrilled that this hospital allowed – actually encourage! – the use of a big tub for natural labors.   I was laboring in the tub about 45 minutes from walking in the door and was able to stay there for about an hour before we started draining the tub since I was pushy.

The bad news is that I  spent literally half of my time in the tub talking to the anesthesiologist.  For a birth where I explicitly had said no drugs with a track record of no drugs from the previous birth….where every nurse and midwife respected my request that drugs not be brought up unless I initiated the conversation!

So, when the anesthesiologist walks in the door, even in my hazy labor brain, I kept thinking “why is this guy here?”

His presence felt invasive.  I just wanted him to leave and let me get on with the business of being in ‘my labor space.’   But I did what so many women do when they enter the hospital doors – instead of telling him outright to leave, I answered the questions.  I told him thanks but no thanks, that I wanted to birth this child without his help. And then proceeded to answer his questions in the 90-120 seconds between contractions for at least a half hour!

Looking back with a non-labor brain, I know that the anesthesiologist was there to document ‘just in case’ of the crash C-section.  I’m sure it is hospital protocol.  But it still seems odd that an anesthesiologist did the majority of the intake patient history paperwork.  I question the efficiency of having such a specialist doing that for a ‘just in case’ scenario that seemed unlikely to play out.  Every single stinking thing he asked me was already (or could have already been) in my chart.  And, if I really was in need of a crash C-section, he could have done it without many of those questions.

Less invasive (and certainly less costly) were the many middle of the night vital checks by all the nurses.  Again, probably just hospital protocol intensified by the fact that I transferred to recovery just after midnight.  After the second round of vitals that first night, my husband looked at me and said ‘if we were home, we would all be cuddling in our king size family bed and the midwives would have already packed up and gone home.’   I couldn’t decide if I wanted to kiss or kick him for stating the obvious.  It did make me pause to think that (if things have gone relatively well) in a homebirth, the professional is more than comfortable leaving a new mom and baby to sleep and come back the next day for a check-in.  The hospital, in order to cover their ass, is far more labor intensive and resource consuming during birth than it probably needs to be.  Maybe some people find that comforting; I found it annoying.

So, why didn’t I tell the anesthesiologist (and the nurses at 3 am, etc) to leave? I can only explain it as the path of least resistance.  I kept thinking that this question, this wake-up would be the last.  I didn’t want to make a scene, didn’t have the energy to make a scene, just wanted to get people out of my space as quickly as possible.

This is yet another reason why women are choosing to birth at home.  Birth is such an intimate and personal thing; but as much as hospitals are increasingly paying lip service to this, it is very difficult to achieve that intimacy in an institution governed by protocol and the threat of lawsuits.  Only in your own home are you able to control who is in your space; you aren’t bombarded with a stranger asking you questions about something you don’t want to discuss.  Perhaps that is one of the things that scares the medical establishment about homebirth the most?

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