Category Archives: Parenting

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?


Consumerism and (hospital) Birth Part I – Insurance Incentives

I’ve had a chance to birth my two kids at two of the most progressive hospitals in the nation and have some thoughts running around in my head about the pros and cons of such birthing options for the completely normal birth.  Since health care seems to be sucking up ever increasing resources and birth is a feminist issue at its core, I thought I’d use this space to pen some of my (flaky, sleep-deprived) thoughts.

To start, I suppose I should define progressive.  These are mother-centered hospitals with enormous (12+ women) CNM midwife groups that encourage doulas and natural birthing if you so desire.  Hospital #1 is a teaching hospital which also has a long-standing CNM (certified nurse midwife) degree program inside a university that is known for integrated primary care; the CNM practice is integrated into a larger ‘woman’s health center’ type place that is lovely.  Hospital #2 is the primary hospital in the region for a large HMO which has one of the longest-standing hospital midwife programs in the country; it contracts out all of its high-risk births to another hospital in the region so the midwives actually rule the roost so to speak at HMO hospital.  It is also a WHO ‘baby friendly’ hospital – so no arguing about whether or not a pacifier will be given, etc.

I myself saw only a midwife for prenatal care in both pregnancies.  In some ways, seeing a midwife within these large groups is great –  when things came up that were possibly out of the norm, a quick email to high-risk OBs quickly resolved the issue.  Everything is all coordinated with my primary care doctors; my prescriptions are seamless; even my (and the newborn’s) followup apt-making is seamless.

But there are some drawbacks of these big groups.  First, there is no guarantee (and very low odds) that your midwife will be on-call when you deliver.  This is how they keep costs down; but it also kind of wrecks (what is in my view) one of the attractions of midwife care – that you have a personal relationship of enormous trust with your provider.

The second is that you must birth in a hospital.  If I’m completely honest with myself, that wasn’t a complete drawback for the first birth.  Even though I have a mother who (for the 1980s) was pretty progressive in terms of how she interacted with pregnancy, I had my doubts and the hospital seemed ‘safe.’  My husband was even more skeptical of the process.  And even though I wanted a anesthesia-free birth, the knowledge I could change my mind at the last second was somehow comforting.  So, I had probably the best in-hospital, low-intervention birth you could want.  But it was a very lengthy labor and, despite the best care and great facilities, I found all the poking and prodding annoying during and especially after delivery.  After a 32+ hour labor (nearly 20 of it at the hospital) and less than a 30-hour post delivery stay, we walked out knowing (at least with a normal, low-risk pregnancy) why people choose to birth at home.

Fast forward 4 years and we were expecting #2.  We also had different insurance….the HMO insurance  that keeps costs down by making sure everything ‘normal’ is done within their facilities.  Well, birth is normal.  Normal enough that people like me should be able to have a baby at home.  But my house is not their facility.  We toyed with getting a homebirth midwife.  But at the end of the day, we could not justify the cost differential of home vs hospital birth.

And that is lesson #1.  We pay over $600/month in insurance premiums for our family of 3 (now 4) which is matched by my husband’s employer for great insurance.  A hospital stay copay is $100/night.  My entire birth and our 2 night hospital stay cost a $200 copay.  Sure, it was billed out at $7500 – and that is cheap because it was a midwife attended birth within an HMO that pays providers salaries rather than by procedures with no epidural (so no anesthesiologist charge), no interventions, nothing but a bag of pitocin when I started bleeding a bit more than desired and two nights of a hospital bed.  But I only had to pay $200.

A homebirth is obviously cheaper than $7500.  In this area, they seem to run $4-$5K.  But because we have an HMO (which, for the record, I actually love in so many other respects both in terms of care and in terms of overall efficiency of health care provision), none of that would have been picked up by the insurance.

Look, I had a nice birth experience and have a healthy baby.  I am incredibly happy with my prenatal and postnatal care.  But this is likely our last child, and I’m mourning my lack of homebirth this time (and I’ll tell you why in my next post).  And I’m feeling angry that I have to mourn that.   What kind of choice is that?  $200 vs $4500?  The incentives are such that I chose the less efficient option (and the more emotionally draining option) because the out-of-pocket costs.  Something is incredibly perverse in this cost structure, don’t you think?

This is not a mommy blog – But yet it is

I think all of us around OMK want to see this project continue.  We’ve all been incredibly stretched but trying to recommit to adding content over the next little bit.

My own personal excuse has been the life-affirming event of pregnancy and birth.  This event that made gardening less than desirable for a time, keeping up with more than my preschooler and teaching next to impossible, and that consumes my life right now.  So, if you’ll indulge me, I’d like to share some of my sleep-deprived thoughts over the next few weeks.  Some might argue it will read far more as a mommy blog; I’m not sure that is a terrible thing as I’d argue (probably poorly due to that sleep deprivation thing) that the links to both feminism and environmentalism are strong.  Regardless, I hope you’ll stick around and engage my musings that might be a bit mommy-centric for the next few posts.

Reverence for Nature – Part III – Radical Amazement

Find Part I and Part II here.

Last Child In The Woods has become a *must read* if you are trying to combine the environment and child rearing.  Richard Louv, the author, coined the word ‘nature-deficit disorder.’  His central thesis is that lack of outdoor time negatively impacts children’s’ physical, psychological, and spiritual well-being.  Apparently he has a new book out for adults – The Nature Principle.- which I have not read.

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Reverence for Nature – Part II – A Mormon and Humane Child

Humanists often get a bad rap in Mormon circles.  I can’t even tell you how many Sunday School lessons have derided a humanist outlook as Godless and therefore misguided and/or unethical.  Before I launch into my first book review, I feel obligated to say 2 things to this end.  First, there are really two branches of Humanism – one is actually religious and the other is secular.  Both are, by definition, steeped in a tradition of ethics.  Second, regardless of whether religious traditions are folded in or not, humanism relies heavily on reason and logic as an ethical foundation to advocate for socially just actions in order to further the human race.  Because of, rather than in spite of, the centrality of the potential of each person, most humanists understand their integral connection to the environment around them.

Zoe Weil wrote, in my opinion, one of the most helpful parenting books I’ve ever read: Above All, Be Kind – Raising a Humane Child in Challenging Times.  She suggests that raising a humane child requires constant integration of:

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Reverence for Nature – Part I

Rev’rence is more than just quietly sitting:
It’s thinking of Father parents above,
A feeling I get when I think of his blessings.
I’m rev’rent, for rev’rence is love.
When I’m rev’rent, it shows in my words and my deeds.
The pathway to follow is clear.
And when I am rev’rent, I know in my heart
Heav’nly Father and Jesus are near.

“Reverence Is Love,” Children’s Songbook of The Church of Jesus Christ of Latter-day Saints, 31

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