Monday, June 17, 2013

Standard of {Your} Care

The Stir on  cafemom came out with this article you can read below and I desperately wanted to leave a comment but what I had to say was too long. I felt this warranted a blog post! 

There is a term often used in our society that I have come to question. That term is "Standard of Care"
Initially, I think of my care provider taking this approach to care for me in the best way s/he knows how for my situation. What this term really means is, 'this is the problem, this is the solution' across the board.
 Pregnancy and birth are such intimate times and each woman and baby so unique; is this really the kind of care you want to receive. Standard not being what's best for you and yours but what's most commonly used (not necessarily evidence based or the best) throughout America.
I urge you, don't accept merely the "standard of care" but strive to discover what is best for you, as an individual, in your personal life and circumstance, creating the standard for your care.
Be empowered with informed choice and refusal

I have two overused and unnecessary pregnancy procedures to add to this list by Michelle Zipp- vaginal exams and IV fluids. 

Most importantly vaginal exams. They are not necessary in pregnancy or labor and can lead to the overused, and often inappropriate, diagnosis of "failure to progress" in labor. In pregnancy, many women think they need to know if "they're getting close" by vaginal exams as they near their due date. Getting a vaginal exam does not predict when you'll go in to labor. As a birth doula, I've had clients be at 2cm for weeks before labor starts and clients who weren't "showing any progress" go into labor the next day. I put "showing progress" in parenthesis because there is so much more going on in labor than a cervix is telling and the cervix dilation is the last thing to happen. In labor, not only is your body preparing to open and birth your baby, but the baby is preparing as well; it's an delicate dance, best left undisturbed. Maryn Lyster describes birth as "being, not doing."

Now along those lines of the position of baby- I've read a lot of comments in the original article of fetal monitoring and fear!!! We don't have to have the electronic fetal monitors and not having them should not create fear.  A hand help doppler or fetoscope works just as well. For years and into this day and age, women safely deliver babies at home without these efm's. Not only can electronic fetal monitors can be read wrong but they also restrict your mobility. Did you know that your position can also affect baby's heart rate? For example, if you're lying on your back, which you are doing quite often when on the monitors, you can be compressing the baby's cord which can cause a dip in the heart rate. Too often, unnecessary panic and cesareans are caused by these monitors. Before panicking, try changing positions. Also consider and internal monitor if you're being faced with a cesarean. Also consider, are you being directed to push and doing so on your back? 

This brings me back to the vaginal exams. Pushing should be left to the experts- the laboring mother. If you have the urge to push, you're care provider or nurse may want to make sure you're fully dilated- whether you allow this or not is up to you, but if you have the urge, you have the urge and if you don't, you don't! Quite often while attending births as a doula, I see [too] frequent vaginal exams during labor and then mother reaches 10cm and she's given "permission" or sometimes directed to push before she has the urge. As I said earlier, there is so much more going on than cervical dilation, including the position of the baby. Perhaps, though mom may be fully dilated, the baby is not in the most optimal positioning for pushing or perhaps she's lucky enough that her body is allowing a break before the 2nd stage. Going ahead and pushing on command could have a negative affect on baby and make it harder for mom, when she could be enjoying this nice break or using this time to re-position herself or work with her doula or partner, trying rebozo sifting or other methods of encouraging the baby to get into position.

IV's - when and why?

IV fluids are needed if you plan on or need an epidural. The hospital will administer fluids, via and IV, to help reduce the likelihood of your blood pressure dropping too low upon administration of the epidural or spinal block. IV's are also used to administer medications such as pitocin or narcotics.

If you don't plan on any of these interventions and are low risk, you don't need the IV. The hospital will encourage you to have a heplock, "just in case" but think about it- Getting the heplock is not going to administer the fluids, that you probably don't want any way, it's just there. So, it doesn't have a head start on much "just in case" and if you're trusting the hospital to be a safe place for the birth of your baby, I hope you trust the skill of the personnel enough to place an IV should the medical need arise.

Use your best judgement; do what's right for your body and your baby, know your options, be prepared for your birth- don't skimp on the childbirth education. The conclusion of all of this is to trust birth and to trust your body. Too often these "standard of care" medical procedures cause the very problem you'd like to avoid. If you are low risk, a low intervention birth is probably in your best interest. 

How will you be empowered on this Journey of Life?

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Jennifer Valencia | Labor & Postpartum Doula | 928.300.1337


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