Will informed consent become extinct???

Recently I attended a birth where the doctor told my client that studies have proven that women and babies have better outcomes when we "manage" labor. He cited "the Ireland Study" which at the time I had never heard of. There was a good reason for that. It was done before I was born. I am 38. That's been a while. I can't think of many studies that were done that many years ago that still hold water today.

Here is what we do know. Our cesarean rate as a nation is at an all time high - curently 31.8% as of 2007. This was a 48% rise from 1996. In 1970, the national cesarean rate was 6%. See date from fellow blogger:


With stats like that, how dare a doctor reference an outdated study to try to convince my client that she needs pitocin so that she will have her baby faster. Those statistics are a frightening look at what managing labor can do.

Most women never question what their doctor suggests. Many women go their entire lives thinking that they would have never gone into labor if they hadn't been induced because they were induced with all of their children at 41 weeks. One thing that statistically we do know....no one stays pregnant forever. Many women believe that it's a good thing that they had that cesarean for failure to progress because when the baby was born, he/she had a cord wrapped around their neck (maybe even twice). Cords are gently unwrapped from around baby's necks(during homebirths)the majority of the time, I would say. It is not an uncommon occurence.

Women are believing a lie that they are powerless in their birth process. They are being taught by providers that listening to their instincts is reckless and instead, they should completely trust the information from their doctor. Little do they know that it is the insurance companies that have more control over a doctors decisions and protocols. Dr's are threatened on a daily basis with unseen increase in their malpractice insurance if they don't follow the game plan. As long as no harm is done right?? Well, no visible harm. Sometimes, the harm of a interventive labor is to the woman's psychological well being. But hey, most lawsuits for that aren't successful, so it's as good of a risk as any. The doctor's malpractice insurance remains affordable.....and women everwhere don't understand why they feel they lost control of their whole experience? Informing and empowering????? I think not.

Enlightenment continues......

My current reading for my midwifery study unit is Easing Labor Pain by Adrienne Leiberman. I must say, the first few chapters were dry as a bone. Granted, I do have an older edition and some of the information is dated, but still dry nonetheless. However, as you get past the 4th or 5th chapter, I found the book to be very informative. Here are some excerpts I found important:

In Chapter 6, titled "You are what you eat", I found wonderful nutritional advice. For instance, Adelle Davis, a respected nutritionist, recommends calcium supplementation at the beginning of labor. The premise is that calcium eases muscle cramps....thereby making uterine contractions less painful, but not less effective. This is not studied and documented, but I find it to be logical. And besides, what can it hurt to take a little extra calcium when your contractions get going. So have a tall glass of whole milk and take a nice cal-mag supplement at the get go and see what happens!

In chapter 17, "Hospital Routines: Is the pain worth the gain?", Lieberman writes,
"Each form of intervention carries with it certain risks, which are worth accepting in high risk situations where the benefits may outweigh the drawbacks. However, in low-risk situations, advantages of intervention frequently do not exist. Then these interventions only add risk and discomfort wihtout providing any compensatory benefits."

I wish I could help every woman embrace this concept. All of the things that you are subjected to at the hospital - for the good of you and your baby - have not been proven to make your outcome better. Unless your risk level during pregnancy warrants constant monitoring, routine IV fluids or other things, they really aren't necessary. And my next point explains why this is.

Quote from the same chapter: "By 1985, indeed two thirds of this country's obstetricians had been sued for malpractice at least once. This medicolegal climate makes an obstetrician much more likely to intervene in the birth process. As one obstetrician said, 'I've never heard of a doctor being sued for doing a cesarean, but lots of doctors have been sued for not doing one.'"

This is the crux of the matter. Many of the things that women believe are just part of a safe and healthy pregnancy are simply tools to put on paper to thwart a lawsuit. We don't want to believe that. Birth is beautiful....babies are cute....doctors who deliver them are pro woman and baby, right? Doctors must practice defensively in a country that allows them to be put out of a career over one lawsuit. How do they know that you aren't the one who will end their career? It's better to strap you with the fetal monitor and make you uncomfortable enough to scream for the epidural rather than not have it on and take that 2% chance that something will happen to your baby unknowingly.

Women must educate themselves on the true facts and figures regarding all of these interventions. Know what really makes you safe. The safest thing for you and your baby during labor(as long as you have no major medical complications) is to be up and walking around - moving. Do this at home. The longer you are at the hospital, the more likely you are to become uncomfortable enough to need the epidural. As soon as you get that first intervention and become immobile, then the baby runs the risk of struggling to adapt. If that happens, you will find yourself in the operating room.

Easing Labor Pain is worth the read for the mom who wants to be informed. THe book is not anti-hospital or anti-doctor. It is not going to tell you that you should just have a homebirth(but I might...LOL). It is very conservative, yet factual. There is also some wonderful information on methods of relaxation and labor coping strategies.

Want an empowering hopspital birth? Know your stuff. Find a provider you can trust. Hire a doula. Trust in your body. Keep moving. Push in a position that feels natural. Make your wishes clear. Make sure anyone present at your birth is completely onboard with your philosophies. Don't run through the doors after your first contraction. And finally.....remember that your body and your baby know the drill. Just relax and respond.