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Serving the Greater Los Angeles area
Serving the Greater Los Angeles area

28th Year of Teaching Thoughts

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birthing-classes-in-Los-Angeles-teacher-tells-us-her-musings-about-the-induction-epidemic-and-childbirth-care-options

Someday I will write a book “Confessions of a Childbirth Educator.” 

I plan for it to be well-organized and based in accurate research combined with personal emotion.

In this blog, however, I give myself permission to describe random thoughts and observations of late.

Induction. Again. The past few years have really been bad (not mentioned here are the additional bad effects from the temporary ban on doulas during Covid, which is thankfully lifted). I am in the process of digitalizing my Supported Birth class albums, which hold several thousand reviews of students’ births since 1996. They are organized alphabetically and chronologically by hospital/birthplace (includes birth centers and home births), give the name of the doctor or attending caregiver, describe (in their words) the couples’ experience, and state the outcome of the birth (vaginal, c-section, epidural, Pitocin, induced, any other interventions), baby’s weight, as well as whether or not they had a doula or Labor Support person.

As I skim through the physical albums and transfer them to digital, I am reminded of the changes, ebbs, and flows I have seen over 27+ years of teaching childbirth classes in Los Angeles, doula-ing, and training doulas. Some hospitals have reviews that have changed from more positive to more negative (UCLA Westwood, with the loss of the original midwife group and the rise of residents being involved), more negative to ravingly positive (Kaiser WLA), improvements (Cedars postpartum; St. Johns in general, especially more liberal doctors). I’ve seen doctors come and go, birth trends come and go (I don’t even have to mention episiotomies in class anymore, in fact, some people fabulously don’t know what they are). But with the rise in routine induction (I can pretty much promise my students now that they will be expected to induce), there are so few unmedicalized births in hospitals than there used to be, at least for my students. Recently a French woman in a new class asked what induction was. She stared at me, trying to comprehend, when I explained that it was making your labor start in the hospital instead of waiting for it to start on its own. She hadn’t heard of this and was quite confounded. I often wonder why more women don’t feel more “insulted” by the implications that their body has become dangerous to the baby, doesn’t know how long to gestate, or will end up in a c-section if allowed to wait for labor to begin on its own. They are told they are too young, too old, too big, too small. But I do know the answer – fear. Women are scared into compliance.

Fears about childbirth. My whole career has been about trying to help people un-learn what they have learned. Basically, what you’ve been taught about birth throughout your life is probably WRONG. In utter simplification: the countries in the world that use the Midwifery Model for birth have better outcomes by far than those using the Obstetric/Medical Model. Fewer deaths, fewer damage, fewer c-sections. For a low-risk woman, birth with a midwife or at home or birth center (with a qualified midwife and the standard equipment for hemorrhage or resuscitation) is statistically safer than birth in the hospital. That means research-based, that means EVIDENCE-based. The Midwifery model is characterized by: a) Continuity of Care (she will be delivered by the same person she has seen and gotten to know throughout her pregnancy; not a stranger, a partner in a medical group, or a backup, who shows up for the delivery; b) She will be attended to throughout her labor; c) Acknowledgment of the wide variations in labor and a holistic approach; d) A hands-on approach to physiological complications that may arise (an imperfect position of a baby is not a life-threatening condition that should result in a c-section, but this often happens with the Obstetric care model. Baby’s position can be aided by mother’s positioning, manual assistance by caregiver, etc., when there is a qualified person present, skilled in normal labor variables; e) Awareness of the “Needs of the Laboring Woman”: privacy, darkness, quiet, freedom to move, minimal interruptions or disturbances, reassuring support team.

And yet. Women go to the hospital because they think it’s safer and because it is so challenging in our society to do the alternative. I NEVER try to talk anyone out of going to the hospital in my classes. It’s not about that. I wish they would look at birth outcomes in midwifery-care countries like Holland (about 30% home birth), I wish they would read the reviews of their chosen hospital and then read the reviews of the Home Births. I know it costs money in Los Angeles to have an out-of-hospital birth but I wish they would view it like they did their wedding day (and I believe the day of the birth will have a more dramatic impact on life). I wish I could tell them about a recent class with 4 women: the 40-year-old gave birth at home: 7-hour labor, candles, tub. The other three 28 year-olds gave birth in hospitals, with combined outcomes of induction (all of them), Pitocin, artificial rupture of membranes, epidural, antibiotics, morphine, foley balloon to dilate the cervix, intrauterine pressure catheter, internal fetal monitor, fever, fetal distress, c-section, hyperstimulation of uterus from the Misoprostil ripening gel, placenta needing to be manually removed. 

I don’t like being the bearer of this bad news.  All I really want is for women to have a positive experience, no matter whether the birth is natural or medicalized. Honestly. I want them to feel informed, have agency in the choices they make, be treated well. 

I have observed, over the past few years with the induction epidemic, this has become so much harder.

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