The concept of 'choice'

[onthefly]

Kateo, if there were no indications of problems, then how could you have known? (and with no continuity of care it's possible they missed things I suppose, but again, that's not your fault). I'm sure it's not helpful to tell you that though

I know it's completely different, but I also blame myself for my DS' birth. I guess I can never know what might have happened if I'd made different decisions, but I do know what happened as a consequence of the ones I did make.

[Arcadia]

I hope this thread hasn't triggered some of you too much...it is so hard being a mum and thinking of two peoples needs (or more) all the time.

Pixie I hear you on the nicu front. I know my mdwife is skilled at resuscitating babies, and I think that is the risk homebirthers take. I may have a different opinion if I had your experience, but we can only work with what we know. it sounds like it was scary for you.

I also agree women shouldn't have to birth at home to receve continuity of care. My mums experience in the hospital actually sounds a lot like mine at home...but she was birthing 30 years ago in a country town and is a doctors wife...

I am just sad women are so often disappointed in their birth...which makes me wonder if it would be more benefitial to word women up on hospital policies and procedures, rather than dreams of natural births? But that is so depressing to me...

The truth is, hospitals don't know what natural birth is. Two midwives have said as much to me...so really there isn't a choice is there?

The maternity reform was supposed to address these problems, but instead it has been bogged down in debate over the freedoms and powers of independent midwives...I think the AMA has a lot to answer for in this debate.

[thepixie]

Arcadia my love I this thread... Really enjoying the discussion. Obviously I would have preferred DD didn't need specialist care, but as she did, I was incredibly grateful to be there, and she was looked after beautifully.

BBL to post more shortly I'm on my phone and I can't express myself properly LOL

[onthefly]

I thought I'd accepted my choices (with regards to DS' birth) and made peace with things, but then I got pregnant again and realised that I hadnt'. Still trying to figure things out.
Anyway, I'd like to know too, when is a choice really a choice? Why do some things stay with us so long and do our heads in, when others we can just brush over.
We gave DS some formula when he was newborn based on dodgy advice from a midwife. But I never beat myself up over that.

[thepixie]

OK I'm back on my PC where I can think out loud....

Pixie I hear you on the nicu front. I know my mdwife is skilled at resuscitating babies, and I think that is the risk homebirthers take.

It puts all of us in a very difficult position. When everything goes well, our own care is compromised by being in hospital because of the lack of continuity, the hospital procedures and the high rates of intervention. But if something unexpectedly goes wrong at home, then baby can be at risk because facilities aren't immediately available. We stuck between choosing the best care for ourselves in the overwhelming majority of cases when things go well and the best care for our babies in the tiny minority of cases when things go wrong.

When my OB threatens stillbith if we don't induce, is it really my free choice when I go along with it?

Why was your OB threatening stillbirth - there is an increased risk of stillbirth after 41 weeks but I don't know the exact figure. Surely a professional can just say "look, there is an increased risk, based on studies it is x. The options are to wait, to induce, to do x, y and z. The risks of those options are etc. What choice do you feel most comfortable with", and then respect that? How hard is that? and the same applies to the ob you saw Kate.

But again, it was my choice to see an OB in the first place. I said I wanted a natural birth, but the truth is I chose a medical one.

Marcellus why is everything that happened after you chose an obstetric model of care your fault? I chose an obstetric model of care and in terms of the birth itself, yes there was intervention, but I did feel some semblance (and yes it was only a semblance) of control and I came out pretty unscathed.
I was lucky - and that is the only difference between you and me - luck.

Kate I hope the conference is really valuable for you. How could you have been invited accidentally? I would love to know how they respond to your questions and what they are looking at to reduce stillbirth and improve outcomes.

On that topic I was at a conference recently for work and there was someone from DoHA there trying to explain the maternity reforms. I asked her what was going to happen in 2012 when the insurance exemption for homebirth midwives expires. She said it hadn't been decided or even discussed at this stage! Not sure if that was the truth or just the party line.

It looks suspiciously like the whole maternity reform thing turned into an opportunity for the RANZCOG to completely neuter independent midwifery as a profession. Better outcomes for mothers and babies appear to have been well and truly lost in the whole shambles.

[onthefly]

It looks suspiciously like the whole thing turned into an opportunity for the RANZCOG to completely neuter independent midwifery as a profession. Better outcomes for mothers and babies appear to have been well and truly lost in the whole shambles.

That just makes me angry.

On your question Pixie, I think you're right. I suspect maybe that is why I am still not ok about it - it's confronting to think that I was effed around. Maybe I'd rather believe I made a silly choice.
And no, there was no choice offered to me really as far as the induction goes.

[Sagres]

Just reading through some of the themes of this thread - choices, birth plans, expectations, how realistic those expectations are etc. kicking off a thought that has gone around in my a few times.
Do you think the difficulty some (or many?) women have with the process of 'planning' the details of a birth is that to a certain extend it is an oxymoron - trying to control the uncontrollable? I read some posts that make me kind of feel of sad for the poster, when the language they use seems to say that they really believe they can make a certain type of birth happen if they hope hard enough and research broadly enough, when of course in reality every birth is different and has its own unique twists, turns and risks and we really can't control that roller coaster. To me saying 'I am going to have X birth' is a bit like looking out into the garden and saying 'I am going to make that bird land on that branch'. We can do things that make that bird landing on that branch more likely (cut off all the other branches, put seed out on the branch, keep the cats inside) but at the end of the day the bird does what it wants.

I think I am lucky (maybe? maybe not?) that I am some one who did not go into labour with an expectation that I could control the outcome and control how we got there. But I TOTALLY understand that not all everyone has this perspective - we can control where we live, what we do for work, what car we drive and who we breed with - so why shouldn't we be able to control how the baby greets the world? But it does make me wonder, is it easy for me to own my choices (which I totally do, no hesitations there) because of how I went into it - not trying to control the uncontrollable. Like Fleur says, I didn't choose to get pre-eclampsia and to be induced due to that condition, I didn't choose to have blood pressure so high I was close to passing out and being unconscious during labour, but I did choose to introduce interventions that changed the nature of the labour (which some would call cascade of intervention) and I am very happy with those decisions, I *think* largely because of my expectations of what I could and couldn't control.

[thepixie]

Hi Sagres.... to give you a bit of background on this discussion we were talking about this a few weeks ago in this thread
Again it is a situation where there is no single answer. Sometimes no doubt people feel that they can control the process, only to find it takes on a life of its own. In other cases, women make what seem to be reasonable requests only to find that the hospital/ care provider isn't willing or able to comply. And then, as discussed in the thread above, some people are subjected to treatment which would not be acceptable in any other area of medicine. I think it's very difficult to write a birth plan that will be respected when your institution doesn't reveal the parameters in which your birth will be managed. That information is not given out in ante-natal classes, and really it is some of the most important information you can have when trying to prepare yourself to give birth.
Like you my expectations were pretty fluid, but I still think that I was lucky to have an experience that was pretty good and to receive care that was respectful and competent. If you have a look at the other thread you will find that some of the stories go well beyond a simple mismatch of expectations with reality, they relate to medical treatment which is really not worthy of the name.
If you have time to have a read, please come back and share your thoughts.

[Sagres]

To be fair thepixie, I was responding to this thread in this thread, if I was trying to comment on the other thread I would have done so elsewhere. I am fully aware of the other thread I feel very uncomfortable trying to comment on that in a general sense because it talks about some very specific and individuals situations that I have absolutely no first hand knowledge of. I have no doubt that within those stories there are a variety of situations, ranging from 'totally unnecessary intervention' though to 'intervention which saved 1 or 2 lives'. As I said I feel very uncomfortable about trying to make some blanket statement about those stories when they are so individual and all so unknown to me.

What I will say that differentiates my comments in this thread to the terrible stories in that thread is that I was referring to situations where there are not exception circumstances that cast a doubt on choices. In the other thread there are situations where someone in the room though it was emergency enough that action had to be taken IMMEDIATELY. Whether that was true or not is another question, but it does represent those 'exception circumstances' which again I am not willing to comment on when I know very little about them.

I am also unwilling to comment on hospital parameters being unknown because in my situation I asked my ob/hospital about these parameters in the preparation stage and knew what I needed to know because I asked, but I understand that not all care arrangements allow for that, so I don't feel qualified to comment on how you can deal with the lack of that information.

[thepixie]

No worries Sagres, that thread was kind of what lead me to a lot of the thoughts I have put down here, that's the only reason I mentioned it.
Personally I didn't receive a lot of information about how the birth would be managed in the hospital and it wasn't until I was in the situation that I realised it was information that would have been very useful to me.

[Arcadia]

Thanks for the input Sagres...were you with a private obstetrician? It is great you were able to be fully informed about the kind of care you would receive. Unfortunately that is not always the case in our society at the moment and many, many women feel very upset by their treatment. Although just as many seem to take it as given, that they had to be treated a certain way...which is where we ome back to "ignorance" over birthing options...perhaps it is just better to assume the worst and be pleasantly surprised by the outcome.

For me, I am planning another homebirth. Yes I am worried about PPH, the health of the baby and all the other complications that could occur...but I have taught myself to trust that things will turn out the way they were supposed to...in a way, that I have no choice, and that I HAVE to birth at home and hope for the best. Perhaps THAT is ignorance?

[Sagres]

Yes I was with a private obstetrician. This is a reason why I haven't really commented on continuity of care, because I had excellent continuity, but I can totally 100% see how this would have a very big impact on how things go when you have a 'things need to happen RIGHT NOW' type of situation. The episiotomy example is an excellent example, I had a surprisingly brief conversation with my ob about her 'approach' to them, she said she only did them when it was clear you were going to tear real ugly. I was fine with that but if I hadn't have been I would have said what I wanted. The 5 minute conversation was very simple, but again I can totally 100% see the difference between having that 5 minute conversation with your care giver and having some one you have never met or briefly met making that call in the heat of the moment. And it is not to say that you wouldn't be able to have that 5 minute conversation with the care giver, but obviously the systems the way they are make it almost impossible to get that kind of exposure the the right person at the right time. Which I think is really not good enough.


It is interesting what you say about ignorance. I can see downsides with both extremes, the 'trusting medical staff explicitly and not asking questions approach', and the 'knowing absolutely everything which inherently makes me feel like I can influence it more' approach. I think that is what my first post was kind of saying - I think it is absolutely wonderful that we are all becoming much more informed about the whole birthing deal, but are we as humans with thoughts and feelings able to resist the urge to see it as something we can determine/influence/control? Again this is not in reference to any specific examples, but more under the guise of a post about choices and what that really means in a very general sense.

[thepixie]

I definitely think that it's human nature to believe we can control things, even the essentially uncontrollable.
Whether we believe that ignorance is bliss, or that being educated protects us from things going wrong, the reality is that birth is a natural force, and in some ways inherently unpredictable.

[My Three Sons]

I definitely think that it's human nature to believe we can control things, even the essentially uncontrollable.
Whether we believe that ignorance is bliss, or that being educated protects us from things going wrong, the reality is that birth is a natural force, and in some ways inherently unpredictable.

Couldn't agree more. I have been reading these threads and find them really interesting and thought provoking. It is great to hear the opinions of so many women on how they feel about these issues. I must say i have been very lucky with all my births, and lucky with the birthing programs that i was accepted into, as i think that they really helped me in the end with being so happy with my birthing outcomes, and thus are the models of care i would like to work in the future.
It wasn't just my choice though as to these options. It was the hospitals choice as to if i was accepted into the midwifery know your midwife program, and at my local hospital very few of the women who want this model are actually accepted into it. Again, it was my choice to see one of the lactation consultants there when i first had problems breastfeeding, but i was lucky in that i was able to get an appointment the next day due to a cancelation.
We can make choices, but ultimately many times they can be inhibited by the choices of OB's, Midwives, Our partners, Money, Hosptial staff, Traffic, Timing, any anything else! Life is unpredictable.
All we can do is try to make the best choices we can, and do the best we can to try to make our choices eventuate, but also accept that sometimes we can't be in control of some things, and try to change them when we next get the opportunity- if we do.

[onthefly]

Control to me is not about being able to determine exactly what happens (of course I can't do that), it's about being an effective agent on my own behalf.
If my wishes were respected, if I had a truly collaborative relationship with my OB in making decisions, i would feel I had control, even if things happened exactly the same way.

[kateo]

In my case I originally had a Pvt OB but due to being referred to the FMU I then had the public system "inflicted" on me. So not only did I not have continuity of care I was referred to the place they should have saved my baby and they failed dismally. Keep in mind there has been no specific cause of death and I was perfectly healthy except for being overweight.
The points Sagres made are very similar to those I outlined in my first post here.
My choices rapidly diminished as my care became public and I felt less and less connected with the "caregivers" as I underwent the process.
I knew making a birthplan was pointless as I was "trained" by the system to understand I had no choices. I was compliant and even this did not save my childs life. I was ignored when I tried to explain concerns I had. This was because of lack of continuity of care.
If you want to have your personal birth choices recognised you NEED continuity of care. There needs to be relationship building before, during and after birth for the best care for babies and birthing women. This does NOT happen in the public system.
I stand by my comments that birthplans should perhaps be more realistic if bothered with at all. There is little room for choice unless carers intrinsically understand the wishes of the birthing woman. A birthplan does not create intrinsic understanding of general wishes............

[onthefly]

If you want to have your personal birth choices recognised you NEED continuity of care. There needs to be relationship building before, during and after birth for the best care for babies and birthing women. This does NOT happen in the public system.
I stand by my comments that birthplans should perhaps be more realistic if bothered with at all. There is little room for choice unless carers intrinsically understand the wishes of the birthing woman. A birthplan does not create intrinsic understanding of general wishes............

Yes, this is so right

[Inanna]

What a great thread Arcadia thankyou for beginning it & thankyou for all of the thoughtful responses.

This is such a multi layered issue. Birthing plans are very often not read or adhered to & I have seen that time and again. Quite rightly I understand why Women hold the belief that they need to have some "control" over their birth - when in the current "system" there is so little control given to birthing Women.

I despair sometimes when I read the stories of women or look into the eyes of a Woman who just does not understand why her birth resembled nothing like she envisioned.

I hope I can offer some of my insights into this formed over the years I have experienced Women in birth & during my own births.

Firstly birth is an unknown & we cannot control it. Part of the wonder of birth is that we need to "give over" our bodies, part of our Being. It's what we do when we birth. Birth is a line between life & death - a "little death" is known to describe orgasm & as such it describes birth as well. I always say death sits in the corner of each room that birth is in. By that it can be the death of the mother or child I guess - a reality. But more part of us dies - & is born. This is the letting go. It is my honest, deep & experienced belief that until a Woman can accept this in part birth will be very very difficult for that Woman. Women get "stuck". We talk about our heads giving birth before our body does. Well in part this is why. We really have to accept this handing over of part of us to a higher self, to the birthing process or whatever it might be. But it's letting go.

I cringe saying that out loud as I know I get much flack for my thoughts on the sacredness of the birthing process here on BB. I know that those that do not share my belief find it hard to wrap their heads around. That's okay I gently and openly accept that it sounds out there to many.

However, this is what I believe is largely "wrong" with the system.

We do not honor the sacredness of the act of birthing a child. It is sacred. It is not just a physical act. It is this great honor that we have tried to stuff into a surgical steel autoclaved birthing kit called a labor ward. It doesn't work. Just like most of us can't make love under fluro lights in a shopping centre mall outside Crazy Clarks. It doesn't work for most of us. That's why birth doesn't work. Not because birth plans are wrong, or doctors are morons & midwives are overworked. It's because we are not honoring this amazing great act of birth!

It needs to be done our way. We Women need to learn how to go inside of our bodies, ask ourselves what we need. WE then need to seek it out. It IS out there for us. Yes, it's hard to access because of the crazy clarks scenario but it can be found. But the answer does first lie inside us. What do I need? Where do I feel safest? What does it feel like to make love to my partner? What do I need to do that well, sensually and beautifully? I need candles? Perhaps a nice aroma? Privacy? Music? Safety? spontaniety? What is it I need? This is what needs to be the basis for our plans. Then how do I get my needs met? Do I go to the nearest private hospital? Or do I have this experience at home? Do I invite my mother? Do I invite my children? My chooks (I attended a birth where the chooks came into the loungeroom and the laughter is what birthed that baby I"m sure!). This birth needs to be planned for normal. Because usually it's normal.

When it's not how do I best feel all of the above at crazy clarks? For me (& I experienced the ultimate crazy clarks birth!) I had chanting music, I smeared my oils under my nose, I had the curtains open so Icould see the trees andthe sky, I had dimmed lights, I prayed. I had plan Z because we all need plan Z.

I agree so very much that we have to very much be responsible for our choices. We DO have control over many of them. We also have control over blame, anger & bitterness at what we perceive was taken from us. HOWEVER I have come to learn that even that which is out of our control can be empowering if we aim to see it in the best light.

I get why some women don't feel safe at home. Then that's not the place for your most intimate birth! I fully understand. For some women it's not safe to birth their baby's through their vagina - they are too afraid because of loss or grief or rape or violence. That is not the place for their most intimate birth.

What is absolutely essential though is that women learn to listen to their voice. That one that speaks inside us all that many of us have not been programmed to listen to. That one that is always wise and right - FOR US! My voice will say different things to yours because my DNA is different. But essentially women will often feel ufulfilled about their births or discontent or uneasy if they do not touch the inner sacredness that birth awakens in a Woman.

I truly believe this.

I feel sad when I read derogatory referals to the wild woman births or goddess births or earth mother births. Not because I am offended but because I hope & believe one day that Woman will get back to the wildness of birth that once was. The instinctual drive to birth with great passion & intuition. It is such a gift that we are truly missing out on when we hand it over to stainless steel.