Tag Archives: Childbirth

More on childbirth

I have already writtenabout the Capital and Coast District Health Board (CCDHB) plan to give women who have just given birth $100 of grocery vouchers  if they leave hospital early, within six hours of giving birth.  The ludicrous plan was quickly abandoned, but as I said in my post, the pressure for women to leave hospital early would remain.

That pressure turns out to be real.  The CCDHB Clinical Director of Women’s Health Services, John Tait, said on Morning Report this morning that over the next two months, women would be encouraged to leave the delivery suites and maternity ward as soon as possible after giving birth, because there is a shortage of midwives. My understanding is that the shortage of midwives has led to some beds in the maternity ward being closed. There is literally no room at the hospital for women who have given birth.

The whole issue of women being sent home early has been highlighted by a very sad story in the news this morning, of a woman who gave birth to her first baby at Wellington Hospital, and was sent home just five hours after the birth. Her baby died within a few hours of their return home. It’s not clear that the baby died because the mother and child were sent home early – sometimes post-natal deaths just happen. However, as more details have emerged, it seems very, very odd that this new mother was sent home in the first place.

She was in labour for 20 hours, and had been awake for 10 hours before labour started, so she had not slept for 30 hours. She had an epidural. She had an episiotomy. Although she had a vaginal delivery, the delivery was not “normal”, according to John Tait (in the Morning Report interview).

I had a long, difficult labour with my first child. At about 24 hours in, there was a serious discussion about whether or not I should have a Caesarian. My husband and my mother stood beside me, and supported me through that discussion. Eventually, I didn’t have the C-section, and our baby was delivered using forceps, about 8 hours later. It wasn’t much fun.

Even at the 20 hour mark, I was in no state to make sensible decisions, despite all the careful thinking and planning surrounding the birth. By the time our baby was delivered, I was completely and utterly exhausted. I was quite surprised when, in accordance with my birth plan, the midwife suggested I tried feeding the baby. But I dutifully did what I was told to do, by my medical professionals. I am an intelligent, articulate, independent woman. I don’t usually get pushed around. But the overwhelming physical process of giving birth meant that I simply could not assess information and make decisions. I was totally reliant on the medical professionals. My husband and my mother were there for me, and supported me, but like me, they are not medical professionals. They gave me the emotional support I needed, but like, me, they were dependent on the medical professionals too.

The new parents whose baby died seem to have left the hospital at their independent midwife’s suggestion. They were not aware that they could stay in the maternity ward, and it seems that the option of staying in the maternity ward was not even presented to them. In addition, it seems that the hospital staff were not consulted, although given that there had been some low level interventions in the labour, the hospital staff must have at least been aware that there were some issues, even if they had not been formally invited to assume care for the mother and baby. So someone, somewhere, made some very bad decisions.

And these decisions would have been bad whether or not the baby died. It is just plain wrong to shoo new mothers out of hospital as though they were a nuisance within hours of a baby’s birth. A first time mother has so much to learn about caring for a baby, and even more to learn about breastfeeding. She needs to be able to access expertise and assistance. A second or third time mother just needs a rest before she goes home to deal with her other children, as well as her new born baby. It’s called labour for a reason – it’s hard, tiring work. And that’s with a normal, straightforward delivery. For all that midwives like to buy into the cant that birth is a natural process, and therefore a good process, many births are not good births. And in those cases, the default position needs to be that the woman stays in hospital, where she can access the care and assistance she needs. Of course, if a woman wants to go home, then that’s fine. But, no matter what, she should be entitled to stay, and that entitlement should be upfront.

My understanding is that lead maternity carers get an extra payment if a new mother leaves hospital early. I think that extra payment is starting to work as a perverse incentive.

I am also deeply worried for the women who are due to give birth at Wellington Hospital in the next couple of months. They will be under pressure to leave, simply because the hospital does not have the resources to care for them. Will we see more infant deaths, and maybe even maternal deaths, as a result of this pressure?

I am also concerned that part of what is going here is an on-going battle between midwives and doctors for control of birth. The midwife was seemingly reluctant to consult doctors before directing the woman to go home. That just seems to be plain stupid to me. When will midwives and doctors get over their power struggle, and have the decency to focus on the people at the heart of childbirth, that is, the woman giving birth and the baby, and along with them, the mother’s partner?

I have a suggestion for CCDHB. It seems that resources are very short, so perhaps they should be directed to where they are most needed. People who are having babies over the next couple of months made the decision to have a baby about six or seven months ago. They are in no position to rescind that decision; no matter what, they are committed to having a baby.

However, people who play sport make a decision about whether or not to do it every time they walk onto a playing field. They are entirely able to avoid playing sport. I suggest that CCDHB asks people to avoid playing sport, of any sort, over the next couple of months. This should eliminate sports injuries altogether, and so reduce the load on Wellington hospital. The free resources could be devoted to childbirth and maternity care instead.

This post is somewhat incoherent, I’m sorry. I am very angry about this whole situation. It seems to me that when the going gets tough, it’s women who get shortchanged, shunted aside, and treated as second class citizens, or in this case, not treated at all.

Out as quick as you can

Capital and Coast District Health Board has, thank goodness, backed down on its silly plan to bribe new mothers to leave hospital quickly. There is a critical shortage of beds in the maternity unit in Wellington Hospital, so in order to keep enough beds available, the hospital was going to give mothers a $100 voucher if they left within six hours of giving birth. The target group was second time mothers, people who already know a little bit about how to look after new born babies.

A moment’s reflection tells you why this was a silly plan. The risk is that people who still need trained care and assistance would choose to leave the maternity ward, even if they were not well. A very poor health outcome, for mothers, and for new born babies.

The bribe is gone now, but not the pressure for women to leave hospital early. If you read the article, you will see that lead maternity carers get an extra payment if women leave hospital early, and that hospital staff are still under pressure to keep women moving out.

This is anti-women, and anti-family. I have written before about the difficulties of sending new mothers home within hours of birth, in connection with establishing breastfeeding.

Rooming in looks very nice, but there’s a big problem with it. Although it is phrased as “allow”, in practice, it becomes, “mothers and babies must be kept together”. So a woman who has been through an exhausting delivery will nevertheless not be given any chance to sleep, because the nursing staff won’t help her to settle her baby, and won’t consider taking the baby into a nursery even just for a while, to allow the mother to sleep. The baby can always be brought back to the mother when it wakes, so there’s no lack of breastfeeding. However, it does take staff time to manage a nursery. So babies must stay with mothers, even at the cost of the mother’s exhaustion. This is a worse problem if the mother is heading home to other children. Unless she has a partner who has time off work, or family nearby, she will be required to look after those children too. So her brief time in hospital really is the last chance she will have to get a decent rest for weeks, if not months. And surely, that must have a bad effect on babies.

And I just don’t see how any hospital which encourages new mothers to leave after just two or three days could possibly be described as a “baby friendly” hospital. Breastfeeding is a learned skill. Some women and babies find it very, very easy, but others don’t, at all. They need help and support, especially in those early few days, when they are tired from the processes of giving birth and being born. By about day three, a new mother’s milk will be coming in, so she and her baby will be getting used to an entirely new process, but that’s almost exactly when hospitals kick mothers out the door. New mothers need to be able to stay in hospital, where they can rest, and where they can get help, for more than just a few days. To my mind, to deserve the title, “Baby Friendly”, a hospital needs to encourage women to stay for five or six or even more days after birth, if that’s what they need. And in order for that to happen, hospitals need to be properly funded.

The solution to funding pressures is not to refuse to treat patients. Let’s see if we can think of other ways that funding pressure could be reduced by not treating people. Maybe kids with broken bones could be sent home to see if they really need hospital treatment. Middle aged men with chest pains could be told to wait a few days, just to see if it really is a heart attack. Perhaps people could be discharged straight out of operating theatres, if they feel that they really have come through surgery quite well.

One of the difficult aspects of this whole episode is that any woman who is due to give birth at Wellington Hospital in the next few months must now be feeling quite nervous. This will affect my family – my brother and sister-in-law have a baby on the way, and they are due to give birth there sometime in January, all going well.

Please, if you have a partner, a friend, a sister, a daughter, a daughter-in-law, who is due to have her baby at Wellington Hospital sometime in the next few months, be there for her. Be there to fetch, run and carry, to sit by her bedside and look after her, to make sure that hospital staff don’t put pressure on her to leave too early.

Of course, that’s the sort of thing that families and friends do in third world hospital systems. We have always liked to think we are a bit better than that, but perhaps we are not. And that’s perhaps the most disturbing aspect of this whole story, that we simply can’t rely on our health system to provide a decent standard of care.

Childbirth, breastfeeding, power and hypocrisy

As I said earlier today (about 2.30am actually – insomnia is so much fun), I was particularly taken by three posts on the 46th Carnival of Feminists, which are all about childbirth and maternity. I have been musing about the ideas all today, in between cups of coffee.

When I was first pregnant, my older brother, an anaesthetist, said something fascinating. By then he had been studying and working in medicine for about 15 years. “In my time in medicine,” he said, “I have seen power in childbirth pass from doctors to midwives. But it is still not where it should be, which is with the mother giving birth.”

Having been through two labours and three deliveries (how does a twin birth get counted?), I know that when my body was involved in the intense and difficult work of seeing my babies into the world, all I could manage to do was survive from moment to moment, and push. (I had difficult deliveries – posterior presentations all of them.) I was completely dependent on my partner, and my obstetricians and midwives. So in some senses, it’s reasonable for power to remain with professionals – I was in no position to make sensible judgements.

However, I wonder if the midwifery inspired mythology around labour and childbirth can be a disservice to women. From being told that labour and childbirth was a problem to be managed medically, we seem to have swung the other way, into believing that labour and childbirth is a natural, and therefore good and easy process. Somehow, we have forgotten that women and babies used to die, routinely, in childbirth. And in many developing countries, they still do. When a midwife prattles on about natural processes, and control over bodies, what they are doing is setting an impossible standard for many Western women.

I found it very difficult to find a midwife who would listen to me when it came to my deliveries. For the most part, they had their heads filled with some sort of spiritual naturalistic claptrap, and they didn’t seem to want to believe that all I wanted was my babies. I didn’t need a life-changing experience.

So maybe my brother was right about power still not being where it belongs in childbirth.

Then there’s breastfeeding. Anyone who thinks a woman and baby should not breastfeed in public can just go away. That’s not what’s irking me today.

What I am more concerned about is the Baby Friendly Hospital initiative. The aim of the initiative is to encourage women to breastfeed their babies.

Here’s what it takes to be certified as a baby friendly hospital.

1 Have a written breastfeeding policy that is routinely communicated to all health care staff.
2 Train all health care staff in skills necessary to implement this policy.
3 Inform all pregnant women about the benefits and management of breastfeeding.
4 Help mothers initiate breastfeeding within one half-hour of birth.
5 Show mothers how to breastfeed and maintain lactation, even if they should be separated from their infants.
6 Give newborn infants no food or drink other than breastmilk, unless medically indicated.
7 Practice rooming in – that is, allow mothers and infants to remain together 24 hours a day.
8 Encourage breastfeeding on demand.
9 Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants.

Nice, isn’t it. The trouble is, I think it’s a women and family unfriendly initiative. It prioritises the baby, as all costs, even when that baby is going to be living in the social context of a family.

7 – Rooming in looks very nice, but there’s a big problem with it. Although it is phrased as “allow”, in practice, it becomes, “mothers and babies must be kept together”. So a woman who has been through an exhausting delivery will nevertheless not be given any chance to sleep, because the nursing staff won’t help her to settle her baby, and won’t consider taking the baby into a nursery even just for a while, to allow the mother to sleep. The baby can always be brought back to the mother when it wakes, so there’s no lack of breastfeeding. However, it does take staff time to manage a nursery. So babies must stay with mothers, even at the cost of the mother’s exhaustion. This is a worse problem if the mother is heading home to other children. Unless she has a partner who has time off work, or family nearby, she will be required to look after those children too. So her brief time in hospital really is the last chance she will have to get a decent rest for weeks, if not months. And surely, that must have a bad effect on babies.

And I just don’t see how any hospital which encourages new mothers to leave after just two or three days could possibly be described as a “baby friendly” hospital. Breastfeeding is a learned skill. Some women and babies find it very, very easy, but others don’t, at all. They need help and support, especially in those early few days, when they are tired from the processes of giving birth and being born. By about day three, a new mother’s milk will be coming in, so she and her baby will be getting used to an entirely new process, but that’s almost exactly when hospitals kick mothers out the door. New mothers need to be able to stay in hospital, where they can rest, and where they can get help, for more than just a few days. To my mind, to deserve the title, “Baby Friendly”, a hospital needs to encourage women to stay for five or six or even more days after birth, if that’s what they need. And in order for that to happen, hospitals need to be properly funded. Otherwise the Baby Friendly Hospital initiative is just so much hot air.