We all know that choosing your doctors is important. You may be looking for different things from different kinds of care providers. If you're looking for a heart surgeon, you might want someone with lots of experience in the procedure you need, who's affiliated with a hospital with an excellent reputation, and if s/he'll also take the time to explain things to you it's a bonus. With a shrink you want someone with whom you feel safe, who's patient, and who won't talk down to you. With maternity care providers you want someone who will take the time to really answer all your questions and who shares your philosophy of childbirth. All the books say that this is the most important thing you can do to have the kind of birth you want.
With most specialists there is an ongoing relationship. If you do not feel comfortable with a doctor you can ask for another referral, you can change. With an obstetrician there is an ongoing relationship during the pregnancy, but that person may not be there for the birth. When you're giving birth there is really no option to cancel the appointment, walk out, and start looking for a different doc.
In Toronto, Ontario in the current health care environment, family doctors, obstetricians and midwives are all in short supply. Women are rarely able to interview care providers and choose one who suits them and their family - care providers just don't have time because they're struggling to see the patients/clients they already have.
Many women who would have liked to have a midwife find that if they wait until six weeks of pregnancy (which, let's face it, is when many of us are just starting to realize we've missed a period - not all pregnancies are planned to the minute) then the midwives are all booked up. There may be waiting lists, but no assurance that your name will ever make it to the top. If you do get an appointment, you take the first midwife you can see, because if you don't book with her immediately you might miss your chance. You might not think to ask about holiday schedules, about off-call time, about the chances of having your primary midwife at your birth.
Doctors are run off their feet. With the encouragement of the government and to try and balance the demands of an over-full obgyn practice and a personal life, most doctors work in group practices of varying sizes. Everyone in the group shares call. Some of my clients have doctors who are in groups of 10, 12 or more. So, their chance of seeing their own doctor on the day they give birth is 1 in 10 or worse. Meeting the other doctors in the practice is impossible under these circumstances. There are a small number who make a point of attending their own patients - some of them are extra dedicated, and some just don't play well with others.
So, that means that by far the majority of my clients are attended in labour by people they've never met before. Those who were aware that this would be the situation from early in pregnancy often don't bond with their care providers: "oh, he's okay, but he's not going to be there anyway so it doesn't matter".
As a doula I find it really frustrating to try to help families achieve the kind of birth they want. I can help them have good conversations with their doctor, I can help them write a birth plan and have the doctor give feedback, perhaps put it in their chart, we can luck out and get assigned a nurse who is interested in hypnobirthing/natural childbirth/etc and happy to support a calm environment, and then you can have an on call ob who walks in, flips on the lights, orders a woman onto her back and starts managing the birth according to their standard high-intervention operating procedure.
Even with midwifery care you can run into disconnects. A couple of times I've had clients planning water births who happened to go into labour on a day when their primary midwife was off call, or had another client in labour. The midwife who arrived was not well known to the client, was nervous about water births, and undermined the client's plan.
I can help clients plan, I can help them access information and discover options they didn't know were available. I can help them express their needs and wishes. But I can't change their birth place, their care provider or the underserved health climate we live in. If any of you have any ideas on how to work this way (other than UC!) please share.
Showing posts with label midwife. Show all posts
Showing posts with label midwife. Show all posts
Wednesday, May 13, 2009
Tuesday, July 18, 2006
Word Search - "home birth pain"
This search term has been haunting me for a week. I wish I could find out who came to me this way, and take her in a big hug.
The choices aren't really very good for women in the Ontario health system right now. Family physicians who "do" babies are a rarity. So they refer out to obs. Obs are in short supply, so you take what you can get, even if that person's so busy you see them for three minutes a month (I'm not exaggerating, really!) and have a one-in-15 chance of seeing your own doctor on your big day. Some women find their way to midwives, but they're in even shorter supply. And you have pretty much zero choice and feel grateful for finding a midwife at all, even if she's not your favourite, even if the practice model is not to your taste (meeting four midwives through pregnancy, not knowing who'll be at your birth, for instance), even if they don't do water births and you wanted that, etc.
So you've chosen a home birth. Or you're considering a home birth. Or you're reconsidering a home birth. Perhaps you chose it because of the romance of it all. Or perhaps you chose it because your midwife clearly prefers it and you like her so you think you should give it a try. Or perhaps you chose it because you came home from your hospital tour, cried for two hours, and realized you could never, ever have your baby there. (It happens.)
You made your decision, and now you're wondering what you've gotten yourself into, whether you'll be able to handle it. Maybe you're wondering what sort of pain meds midwives carry. I've actually had midwifery clients in my prenatal classes ask whether you can have an epidural at home(!) Well no, there are no pain medications in the home setting. That doesn't mean you're on your own, with no help, however.
Pain is wildly variable. No one can measure your pain. No one can say that your pain is less or more than someone else's. Some of it seems to be physical - we're all wired differently. Some of it is social - what does this pain mean to you, and what did your family feel about pain. Some of it is situational - you feel more pain when you're tired or scared.
It's this last one that can be a really important benefit of a home birth. When you're in your own home you are more likely to eat, drink and sleep when you want to. You don't need to ask anyone's permission and you don't need to worry about interruptions when you're trying to close your eyes for a minute. You are also more likely to feel calmer in a familiar environment where everything looks, feels and smells the way you like it. You won't have to deal with anyone in your space who's not welcome - everyone in your home will be there because you've invited them.
I've noticed one thing that makes this sense of comfort and safety really clear: at every home birth I've ever attended, the woman is naked by the time she's ready to push. In the hospital I rarely see a naked woman. Women will take their gowns off after the birth in order to nurse, but they'll have sheets pulled over them at that point. Feeling free enough to walk around naked comes with being comfortable in your environment. And when you feel comfortable and safe, you experience less pain.
When you do experience pain, it can be easier to roll with it when you can move, make noise and complain or celebrate freely. If you trust the people around you and you can feel their loving support, it's easier to believe that you're okay, that you will be okay, and that you can do the work ahead of you. Your midwife/partner/doula will remind you drink, to pee, to try the shower or bath, to try dancing, to try whatever makes you feel good and gives you strength. They will not tell you that you're too tired, too loud, too demanding, too out of control and that you need to take the drugs now. They will not take away your power. And if you try to hand it to them, they will lovingly help you to take it back, or carry it for you awhile until you're ready.
You'll make it.
The choices aren't really very good for women in the Ontario health system right now. Family physicians who "do" babies are a rarity. So they refer out to obs. Obs are in short supply, so you take what you can get, even if that person's so busy you see them for three minutes a month (I'm not exaggerating, really!) and have a one-in-15 chance of seeing your own doctor on your big day. Some women find their way to midwives, but they're in even shorter supply. And you have pretty much zero choice and feel grateful for finding a midwife at all, even if she's not your favourite, even if the practice model is not to your taste (meeting four midwives through pregnancy, not knowing who'll be at your birth, for instance), even if they don't do water births and you wanted that, etc.
So you've chosen a home birth. Or you're considering a home birth. Or you're reconsidering a home birth. Perhaps you chose it because of the romance of it all. Or perhaps you chose it because your midwife clearly prefers it and you like her so you think you should give it a try. Or perhaps you chose it because you came home from your hospital tour, cried for two hours, and realized you could never, ever have your baby there. (It happens.)
You made your decision, and now you're wondering what you've gotten yourself into, whether you'll be able to handle it. Maybe you're wondering what sort of pain meds midwives carry. I've actually had midwifery clients in my prenatal classes ask whether you can have an epidural at home(!) Well no, there are no pain medications in the home setting. That doesn't mean you're on your own, with no help, however.
Pain is wildly variable. No one can measure your pain. No one can say that your pain is less or more than someone else's. Some of it seems to be physical - we're all wired differently. Some of it is social - what does this pain mean to you, and what did your family feel about pain. Some of it is situational - you feel more pain when you're tired or scared.
It's this last one that can be a really important benefit of a home birth. When you're in your own home you are more likely to eat, drink and sleep when you want to. You don't need to ask anyone's permission and you don't need to worry about interruptions when you're trying to close your eyes for a minute. You are also more likely to feel calmer in a familiar environment where everything looks, feels and smells the way you like it. You won't have to deal with anyone in your space who's not welcome - everyone in your home will be there because you've invited them.
I've noticed one thing that makes this sense of comfort and safety really clear: at every home birth I've ever attended, the woman is naked by the time she's ready to push. In the hospital I rarely see a naked woman. Women will take their gowns off after the birth in order to nurse, but they'll have sheets pulled over them at that point. Feeling free enough to walk around naked comes with being comfortable in your environment. And when you feel comfortable and safe, you experience less pain.
When you do experience pain, it can be easier to roll with it when you can move, make noise and complain or celebrate freely. If you trust the people around you and you can feel their loving support, it's easier to believe that you're okay, that you will be okay, and that you can do the work ahead of you. Your midwife/partner/doula will remind you drink, to pee, to try the shower or bath, to try dancing, to try whatever makes you feel good and gives you strength. They will not tell you that you're too tired, too loud, too demanding, too out of control and that you need to take the drugs now. They will not take away your power. And if you try to hand it to them, they will lovingly help you to take it back, or carry it for you awhile until you're ready.
You'll make it.
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