Monday, January 3, 2011

Obstetric Lie # 97- Your Care Provider is Psychic!



I hate to break the bad news to everybody- but somebody has to do it. No, your care provider is not psychic. He/she can not see the future. He can not predict outcome flawlessly. He can not tell you what your pelvis is capable of or when your baby MUST be born or even when it was conceived.

This topic actually covers many topics that I will delve into more in-depth at a later date. But, to start, here are a few things that your doctor/midwife/nurse CANNOT know for sure before they happen: (although believing they will happen can have an amazing impact on MAKING them happen)

1) They can not know how big your baby is near term-
This study found that, "approximately 40% of estimates were off by more than 10% of actual BW" (birth weight).

Here is a very sad story of a real life mama convinced by her care provider that he knew beyond a doubt that she had a baby much too big to birth. It happens every day folks. The truth is, even if the baby is 10 pounds, that doesn't mean you can't safely birth it vaginally.

This is not to say that the wonders of modern medicine and your doctors unique skills are not amazing and capable of gathering information. Diagnostic medicine is pretty neat right? I mean, they can actually see inside your body. This appears to be a miracle beyond compare right? It is a miracle to see inside the human body. It is not however always perfectly indicative of things like baby size or all aspects of development.

2) They can not know the size of your pelvis or if it is capable of birthing that particular baby.
During a vaginal exam your care provider can get some idea about he shape and size of your pelvic outlet. This is why we sometimes hear that a first time mom is scheduled for a c-section by 32 weeks. Her doctor has decided that she is too small to birth.

There can be some information gathered this way- it is not however fool proof. I have no idea how many women are told this and then go on to birth BIGGER babies vaginally than the one cut out of their abdomen. There is great harm done with this procedure, even if a healthy baby results. Sometimes this is diagnosed while pregnant, and it often happens after a short trial of labor or induction. Run away if your OB is already talking about your ability to fail.

3) They can not know exactly when your baby is supposed to be born.
Due dates just make me want to spew my lunch. It is an estimate of average gestation. It is not the only date that your baby can be born healthy. Nobody knows when your baby is fully ready except for- THE BABY!

4) They can not know exactly when you got pregnant.
Sometimes mama knows this, but all other calculations are a guess or an estimate based on averages (unless in-vitro is used.)
Even if the conception date date is known, refer to number three.

5) They can not know how long your labor will be. Even if they check your vaginal dilation, they can not know when the baby will get there.
Dilation does not tell you when baby will be born. It simply tells you how far dilated you are. That is all. I don't know how many women have told me that they were checked and measured five centimeters and had a baby 5 minutes later. There are also countless women who are "stuck" at a particular dilation number for hours and yet go on to have their babies vaginally much later.
~
The care provider/patient relationship should be one of trust and respect. It should not be one in which you feel bullied, pushed around, scared, uncomfortable, or guilted into doing things that feel wrong to you.

Yes, science, medicine, and diagnostics can sometimes predict outcome very well- but not always. Birth is a powerful and emotional time, don't let the doubts of others determine the kind of birth you will have.

We may appear as a culture to worship medicine and the apparent miracles that occur because if it. It is not however our church and those that practice it are not prophets. They are men and women doing a very hard job and trying to do it well, but they can not read the future.

14 comments:

Bea said...

This is so well said!
I have a friend who thinks her OB know's all... I am currently pregnant and am constantly being told that if I make a big baby, no biggie, they'll just do a c-section. Just get an epidural, there's no risks...I told her I don't think my due date is very accurate and she thought that was rediculous, the OB (or midwife in my case) knows when the baby is supposed to be here! (She is not really open to hearing anything I have to say on the matter) It is so sad that that's the kind of information our society is pooring out. Keep up the good work!!!!

Natural Birth Goddess said...

I cannot tell you how happy our OB practice was to finally get rid of me after the birth of my first baby (and how happy I was to never have to deal with them again). They wanted me to induce my 1st at 40 weeks on the dot, but I refused. And every time they tried to talk me into it, I kept asking..."How does one know when a baby is ready to be born?" and the answer was always the same, "The baby sends a signal to the mom's body to go into labor." "So, since I have not gone into labor yet, that would mean that my baby is not ready, correct?"

They hated me. She was born a very happy, healthy baby at 43 weeks, despite their assurances that she would probably be born dead, etc, etc, etc.

The sooner people realize that birth is not an exact science, the sooner they'll begin to trust that their bodies will go into labor when it's ready.....says the mama almost 38 weeks pregnant with twins and hoping that they come soon!! :D

Krista Eger said...

Amen! :D
And just to testify, I was dilated to a 5 and 16 minutes later she was born. Yep. I am one of those! And it's a DANG good thing I wasn't at the hospital where they would make me hold back pushing until the almighty doctor got there!

Monika said...

I am a case of having a bigger baby by weight VBAC. My first born by c-section after being induce on my due date (I was not as smart back then). I had a bitty nurse. ANd after 4 hours of pushing and a heart rate starting to drop. Had a c-section. DS was 8lbs 3oz/ Fast forward 26 months I had a VBAC. My Dr was supportive and everyone I saw at the clinic was too. ( minus one guy I saw once who feared I would never go into labor and could not believe I said I did NOT want to be induced even if I went past my due date.) (I did not) I VBACed a beautiful DD who was 8lbs 13oz. Despite the OB on call who tried to talk me out of it, when I got to the hossy at 8.5sm dilated. I showed her. Hahaha Give it my son was BIGGER in every other way then my daughter. I will never know if his giant head was just to big ( 16in.) Or if he was just not ready. ( which I think was the cause) But you live and learn. I just wish more women we1re aware with their first.

Heather said...

This is great! I have had many types of OBs, hospital midwives, and homebirth midwives. My most recent son being born a week ago with an OB who was patient enough to let me labor 28 hours before even discussing pitocin (my water had been broken 12 hours at that point and after 7 hours I was still unchanged with contractions that would not pick up and a very high baby), but only after suggesting we try nipple stim, more walking, and lunges. After 18 hours of my water being broken (with mec staining) she suggested antibiotics, which I declined and they were never suggested again. At one point, the baby's heart rate started deceling a lot with each contraction, and they mentioned c-section, but first wanted to monitor them better. After 3-4 contractions she said they were "U" decels and caused by cord compressions, not placenta issues and my baby was okay. Finally, after a 43 hour labor, 26 of those with ruptured membranes, I had a vaginal delivery. My baby's cord was wrapped around his neck and body, and he had a nuchal hand and his head was in the asynclitic (cocked to one side) presentation.

I am so happy to have found an OB who trusted birth. She was recommended by my home birth midwife who risked me out at 8 months because of a couple high blood pressure readings. My blood pressure never did elevate again, but I have no doubt I would have been a home birth transfer and probably ended up with a cesarean section. Never once did my OB pretend to have a crystal ball. She trusted my "proven pelvis", my determination, and my choices to labor as long as I chose before starting pitocin (I delayed it several times).

Tiana said...

This is great! Thanks!

During my most recent birth (6 weeks ago), I labored for over 24 hours to get to 2.5cm...then birthed my baby in 3 short pushes a mere two hours later:

http://godmadehomegrown.blogspot.com/2010/12/eliora-graces-birth-story.html

She was also 8 days "late", and a tiny 6lbs 3oz. She was born when she was ready! :)

Birth Smart said...

thank you. Thank you. could i use this as a guest post on my blog, linking back to you?
www.birth-smart.com.
let me know.

Mama Birth said...

Birth Smart-
Yes of course- just mention me and link back- Thanks!
Thanks all of you for your stories!

samson said...

dear mamabirth, I think I have found my twin - in you ! I am a bradley teacher in Calgary Canada, received a link to your most recent post via fb and see that we recommend all the same books and reference the same sites, wise words, videos . .. what joy!
I recently put up a website, but don't have a very loving relationship with my computer. working on that, and in the meantime will add you to my list of folks who inspire ! thanks ~

Natalie said...

My midwives were not too concerned about the size of my baby nor that she was born at 41 weeks.

Lovely 10 lbs girl child was born vaginally with no drugs in three hours from first contraction to first nursing. No tears, no horrible, just an easy and stress free birth where my daughter came as she was when she was ready.

Kimberly O. said...

This post was almost a year ago, but still so important! When I went into L&D with my second daughter, I had been having contractions for a long time. They were irregular for what the doctors "like" (2-3 minutes apart, lasting for 60-90 seconds) and when checked I was told I was 5cm. The attending OB (gave birth at a military hospital where you don't know who is going to deliver you and midwives were not there yet) told me "You're not in active labor, go home or go for a walk". 45 minutes later I was in transition, 15 minutes after that my water broke, and 10 minutes after than my daughter was born.

They don't know what is going to happen and it made me so mad!

Camilleta said...

This is all so true! I got an ultrasound almost a week before my daughter was born and they measured her to be almost 9 pounds. She was only 7 pounds 10 ounces at birth! It's crazy how much blind faith we put into the medical professionals. They were harassing me the entire 2 weeks and 3 days after my due date to be induced and made me feel like I was risking my baby's life for waiting. When I was in labor, they hurried me along, making me feel like if the labor lasted longer than a few hours, the baby would surely not make it. Well, I managed to resist a c-section somehow, and she was born perfectly healthy! Now I want to do my next birth at home!!

mom2sh said...

It seems as though you think that if a woman choses a C-section she is a bad person or made a bad choice when in fact it could have been the best choice for her and her child. How about we all just follow our body cues and do what our hearts tells us to do. A doctor is really only there to give a professional opinion based on statistics. I laboured 72 hours, pushed forever and ended up in C-Section...baby would not come out. I was out of energy and decided along with my doctor that C-section was the best option. I do not feel that it was a mistake in any way.

Unknown said...

When my daughter was born, it happened so fast that my Dr didn't have time to get there. The nurses delivered her! It was a very foggy night, and it slowed him down quite a bit. I told them I was needing to push, one checked me, looked at the other one and said, this baby is coming now. They didn't try to stop it, they just let it happen. I had the same Dr for my next one. He was so disappointed at missing my daughter's birth that when I told him I was on my way to the hospital, he went right away so he wouldn't miss it! Of course, that labor went a lot slower, but he still never left the hospital lol

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