Kelly (BellyBelly) might be interested in this...

We had our antenatal class reunion, and out of the 10 couples, only 2 of us had a spontaneous, natural labour. Actually, you probably wouldn't class mine as natural, as it was augmented with the drip. But I had no further intervention and had a vaginal birth.

The REST were inductions.. leading to c/s (I think.. there was actually one couple I didn't get to talk to) Oh wait.. actually one induction did result in a natural delivery.

The inductions were for varying reasons - blood pressure, 2 days late!!, 2 weeks late, gest. diabetes, .. and don't know the other reasons.

And all the time I was thinking about Kelly emphasising the risks of induction leading to further intervention! it's so true!

Anyway.. just wanted to share, as it really brought home to me the risks of not being fully informed and just following the hospital's lead.

Oh and btw.. only 3 of us are still breastfeeding. Many didn't make it much past the hospital stay :(

Sadly it doesn't surprise me and it is very common what you speak of.

Here's a few explainations of terms... I think what you meant was spontaneous labour which is where labour starts at it's own accord. Sometimes people confuse vaginal birth with natural birth. A natural birth is extremely rare, even where there have been no artificial oxytocin drips, pain relief, assisted delivery etc, they can be quick to jab you with synto at the third stage for the placenta unless someone puts a stop to it. So a natural birth is no outside interference in any way... very low percent that have this, but its the same very low percent that the WHO say would be a valid number to have interventions - we've got it completely around the wrong way.

I've seen Obstetricians sit there and argue black and blue that things like epidurals don't increase the rate of caesareans etc. But I have seen interventions cascade like you wouldn't believe... even mums see it - the last birth I was at, she said, 'Gee it's just one thing after the other isn't it?' She had so much fear and after a long labour (because of that fear) and bubs passing meconium, she was trapped in a network of cables and monitors. Sad really, when it was something so simple that caused all that. She had to have forceps as a result of an epidural leading to ineffective pushing. I sat there and thought, it's all so much that we are up against, and really questioned myself in many ways. But if it wasn't a very beautiful SMS from a student midwife I was speaking to, I think it would have effected me a great deal more. She said something along the lines of... 'You have to realise what an amazing thing it is that you are doing for this woman. If you weren't there I am sure she would have had a caesar the night before.'

Aah... ok. In that case.. 2 spontaneous labours with vaginal delivery? hehe. Mine was spontaneous, but then was augmented. Yup.. no doubt the jab was done for the other girl re the placenta.

But still.. it was more the point of almost all the inductions ending in c/s. I was quite shocked actually, coz my personal experience/impression of our hospital was that they leaned more towards (hmm.. can't say natural.. hehe..) normal vaginal births, with intervention as a last resort.. but encouraging so many to have inductions like that, leading to further intervention.. sheesh.. at least now I know to be prepared for a battle should #2 present any "problems".

ETA. and yes.. I'll be holding off on any augmentation next time too. I was a bit too quick to let them put me on the drip.. I was fortunate everything went smoothly from then on. But next time I'll be waiting longer if my waters break like that again.

First birth is always a learning curve ;) Second one too but first births are very different to the second. I asked not to have the drip put up with my waters being broken to augment, Ob said no, but I had no confidence to do anything about it...

Ah Kelly, just wait til number 3........I'm sure you will be a delightful "patient" :p
Lisaxxx
(Who is absolutely refusing to allow a Dr near me for this pregnancy...its midwives or nothing!!)

LOL home waterbirth here so no doctors I am afraid ;) I'll be having my own private midwife, a doula and some gorgeous women I know.

Hey we might be going to Perth early next year Lisa, would love to catch up and see your newest waterbaby ;) xx

Ivanababy that is really depressing!

I have a question about this:

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First birth is always a learning curve ;) Second one too but first births are very different to the second. I asked not to have the drip put up with my waters being broken to augment, Ob said no, but I had no confidence to do anything about it...

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I'm wondering about this sort of thing alot lately. What exactly would happen if you did say no? Could the OB have refused to continue treating you, or would they likely back down? The exact same thing happened to me in my first labour and it didn't occur to me to refuse the drip. Now it most definitely would, but I'm really unsure about how this would actually play out when "push came to shove", so to speak? I think alot of women are really unsure of their rights in this area, or don't realise they even have any rights?

Some important things to think about:

1. Hospitals have policies, but none of that is law. They have policies to control and manage birth - often something that isn't very birth friendly. You can even say no to monitoring - no stress, they will just write it on your notes. But they are so used to women presenting not knowing what on earth they are doing so they take the lead and manage the process for them. Not many of us question. Not many of us refuse. Not many of us demand. So they are just used to women wanting to be told what to do.
2. Midwives / Doctors / Obs can be sued if they do something you have not agreed to or consented to. This happened recently in the US where a woman sued her Ob for uninformed caesarean and she won a $3MIL lawsuit and all of a sudden a statement pops up from the US Ob/Gyn assoc discussing how interventions should be looking at being reduced due to litigation (nice, but how about how these interventions harm mums and babues too).
3. This is why I put such emphasis on informing and empowering yourself. If you read the right books, you will read that the machines they use to monitor you can give false positives, can be innacurate to the tune of 50% , and can lead to more caesareans, rightly or wrongly so. The Thinking Woman's Guide to a Better Birth is great. But the problem is, we go to HOSPITAL based pre-natal education, we read 'What to Expect When You Are Expecting and Up The Duff - but this will do nothing for your rights and empowerment.

I am sure many women think I am a raving lunatic but until they read the books, they see how desperately bad the system is - even midwives coming over from NZ are appalled by our system here which is completely different to a country so close to us, which offers by far better outcomes and women centred care. For one of the most affluent, thriving, 'lucky' countries, how come in the world area we rate so poorly for birth outcomes? Something has to be done and it starts with women informing themselves and making their voices heard. Are you really getting the 'service' and outcomes you wanted?

My experience with refusing a procedure was to have the ob in question "chuck a tanty". She took her gloves off, threw them to the floor, insisted that she "always" performs episiotomies (sp) and went to leave the room. It took DH threatening to throw her out a window if she did not put her gloves back and continue with her job before she would continue.

So whilst there may be a policy of right to refuse, I am not sure if the hospital actually knows how to cope when that happens.

OMG!!! That is completely unprofessional. Routine episiotomies are completely not appropriate - I hope you reported her completely unprofessional conduct???

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My experience with refusing a procedure was to have the ob in question "chuck a tanty". She took her gloves off, threw them to the floor, insisted that she "always" performs episiotomies (sp) and went to leave the room. It took DH threatening to throw her out a window if she did not put her gloves back and continue with her job before she would continue.

So whilst there may be a policy of right to refuse, I am not sure if the hospital actually knows how to cope when that happens.

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This is what bothers me.
I know I have the right to refuse - but in a practical sense what's that going to mean for me? That I'll have to deal with a po'd OB for the rest of the birth? That I'll have to deal with a big argument when I'm in labour? Or worse what happened to Astrid :eek:

I'm trying to feel out my OB at the moment on some of these things but you just don't know what they're going to be like until you get them in that situation...but by then it's too late I guess.

It also demonstates how much control she likes!! What a silly woman!!! I'm really pleased your husband reacted the way he did. The more women that refuse these "routine procedures" the better the hospital will have cope with it and find alternative solutions for the birthing women.
I've attended a lot of births, in the Uk I only ever saw one episiotomy..and here only one birth that I have attended DIDNT have an episiotomy....really shocking.
Kellys absoltely right...women really do need to be as informed as they can. A fantastic book is Your Birth Rights by Sally Inch..( I think, from Memory) I was fortunate enough to read it during my first pregnancy..and it stood me in very good ground, it changed everything for me.
Kelly....You know how much I would love you to get in touch when in Perth..xxxxxxx

A debrief was done with the head ob where we told her that she needs to send all her staff through the family birth centre so they learn about "bed side manner" and I did lodge a complaint with the appropriate department via phone. What I really needed to do was write a letter, but I still struggle now to write about the whole experience, I can only cope with writing parts of it. Considering I ended up with a c-section, I am so glad she did not end up cutting me.

Definitely be upfront with your OB. I've got a list of things I'll be talking to him about for the next one. Mind you, we did discuss these things during my pg, and he has quite a low intervention rate.. he did give me a %.. umm.. can't remember.. 6%? 3%? I really can't remember. He was great, explained all the different types of tears you can get, and how there are monstrously bad tears where it would be better to cut, but unless its looking really bad, he prefers not to. I had a lot of trust in my OB when it came to that kind of intervention. But I will be requesting more time before being augmented if it happens again next time :)

Astrid, if you have the strength to do this I would urge you to contact the maternity coalition, I can even have someone contact you if you like. They act on your behalf and all you need to do is give them the approval to do so. This is what the maternity coalition does, improve maternity services and they deal with this stuff all the time. This is why I am a member!!!

Options:

1. Get them to sign your birth preferences / plan BEFORE the birth
2. Find a new OB
3. Find a private midwife
4. Get a Doula
5. Have both the Doula & your partner advocate for you including if this situation comes up again, one of them to remain with you and one of them to go the the midwifery desk and request someone else to see to you. If you are public, ask for the consultant who is one up, or a registrar - ask for second opinions, they have to give this to you.

You have options, don't just sit there and take it!!! What messages are we giving to them, that it's okay for them to bully us and it wont matter? This is something you are going to remember your WHOLE life, to them, it's just another day's work - stand up for yourself hon!!!

Gee thanks girls for all this info - i am gaining soooooo much knowledge since joining bb! I know one book about our birthing rights was mentioned - thanx Lisa-jay - which i will definately look into. Are there any others u'd highly recommend. I wanna get reading and informed now as DH and i are going to begin TTC #2 (had emerg c/s due to placent abrupt) and are really desperate for a VBAC next time round :crossfingers: Thanks again :)

Wow, I too am a bit overwhelmed with all this info but well and truly wanting to know it ALL before our little one arrives. I have beeen reading Sarah Buckley's book - Gentle Birth, Gentle Mothering and found it a real eye opener.
I am a part of the medical profession - veterinary, not human but do have a lot of faith in modern medicine -with ILLNESS and PROBLEMS. Giving birth is not an illness and should be something that most woman can do as nature intended. Yes, I myself use oxytocin and do caesarians on birthing pets but it is certainly not the "norm".
If you leave well alone, most times, all will happen as it is meant to. However, there is a tendancy even with animals for vets and owners to search for intervention - usually because of time constraints. A "natural" labour can take a long time - oxytocin and caesarians speed the whole process so everyoone goes home quicker! I find it disturbing with animals, let alone how much more this is the case with us humans.
Even with my own medical knowledge, until doing all this reading on BB etc, I never realised how much harm our so called "helpers" can actually be doing. I truly believe that most of it is due to a) the "power" of modern medicine and feeling like they have to "control" things b) our general willingness as a society to just "accept" the authority of those with Dr in front of their name and belive that of course they would only be doing the "right" thing for mothers and babies ( I myself probably fall into this trap a bit!) c) Time, time time or lack therof - I really believe a lot of intervention is so things can just get "done" and over with. Midwives don't have the time to sit with labouring woman for hrs and hrs. OBs certainly don't want to hang around to see if natural labour will progress or not. Augmentation and c/s's are all "quick" and get the baby out so everyone can move onto the next one. I would have a suspicion that if you got a truly honest answer out of most OBs - they would all prefer to do elective c/s's - they are timed so no middle of the night etc and they are pretty quick compared to labour with vaginal delivery. I even admit, I myself have felt like this at times when sitting up with a whelping dog for hrs on end. There is definite temptation to just do a c/s and get it all over with.

Thankyou all for sharing experiences - I am on an incredible learning curve. I only hope i can have the strength to stand up for what i want because that is a defnite fear - just giving in to what hospital wants because i am naturally submissive and really don't like confrontation.

I am faced with the "should I refuse?" dilemma atm too. I have been told that because of my previous two hemorrhages after delivering the placenta that I will need to have a cannula put in my hand during labour in order for them to infuse synto after the birth in order to stop/reduce another PPH. I am ok with that. I would rather that than bleed and bleed and need a blood transfusion. My concern is that because the cannula will be in my hand prior to giving birth that it will be all too easy for them to suggest augmentation of labour. I am not ok with that, because I believe that my previous PPHs may have been due to that fact that i was augmented, and also because this is to be my last pregnancy and I would like to experience a normal labour, and not one that has been artificially started with drugs. I am going to discuss this with my midwife at my next appointment which is on Friday, just to reiterate that while I understand why I need the drug at the end, I do not want to be induced or augmented.

Bon - could you ask that they don't put the cannula in until you're ready to start pushing? That should leave plenty of time for what they want it for, yet it won't be in there for your whole labour.
I don't see why they couldn't do that?

Bon, artificial oxytocin (syntocinon) use in labour can increase the risk of PPH. This is from Sarah Buckley's article on the natural approach to third stage of labour, in the birth section:

"Other western practices that may contribute to PPH include the use of oxytocin for induction and augmentation (speeding up labour)28 29 episiotomy or perineal trauma, forceps delivery, caesarean and previous caesarean (because of placental problems- see Hemminki30).

Gilbert notes that PPH rates in her UK hospital more than doubled from 5% in 1969-70 to 11% in 1983-5, and concludes, 'The changes in labour ward practice over the last 20 years have resulted in the re-emergence of PPH as a significant problem.'31 In particular, she links an increased risk of bleeding with induction using oxytocin, forceps delivery, long first and second stages (but not prolonged pushing) and the use of epidurals, which increase the chance of forceps and of a long second stage."

ARGHGHGH sorry sorry sorry, the book is by Pat Thomas......... no idea where I got the name Sally Inch from!!!!! Its got lots of research that completely contradicts current practice, and it WILL give you confidence to question and/or refuse routine practice.

Just wanted to add a couple more points.
An episiotomy always involves muscle, where as a tear will only tear what needs to be torn, (if you know what I mean..) it can range from a graze, to a 3rd degree.... usually the bad tears are as a result of women pushing the baby out, and not working with contractions and nearly always if they are birthing on their backs. However, what a lot of women often dont realise, is that an episiotomy, can also tear...beyond what would ever have happened in nature. Its a barbaric practice and actually very rarely required. The only time I have seen it done when it needed to be done, was a baby being born with both hands by her ears...and she kept peeking out and going back in....(mum was on her back though:angry: ) all the others have been performed to hurry things along.
Bon, perhaps you might like to consider a completely natural 3rd stage. You have less chance of PPH and the back up of synto if you do.

Kelly I found that out about synto and PPH after I had Grace. My mum was actually told that by an OB at her hospital as she mentioned my case to him - she told him I had had two previous PPH and his response was "Did she have synto?".
If I had known that before I would not have agreed to be augmented with her. I actually didn't think that it would happen again after I had Harry - I put it down to the difficult birth I had with him so I didn't think it to be a concern the 2nd time around. I have been told that the cannula is a precaution so that if need be they can shoot me up quickly after giving birth. Both times I started hemorrhaging straight away pretty much, so I figure if I don't have synto during labour then after I give birth if I don't start to bleed profusely then they won't need to use the cannula. But I will need to clarify all this with the midwife on friday. Maybe a natural 3rd stage could be an option, although I know that the hospital would not be in favour of it.

The hospital will most likely quote you a British study that showed women were actually more likely to PPH after a natural 3rd stage. The study was very flawed, as "natural 3rd stage" actually meant no drugs but cord traction. Cord traction is a really bad practice the placenta can take over an hour to come away but hospitals like the birthing room cleared up and out asap, so they tend to "hurry things along" hence tugging on the cord, not allowing nature to take its course and interferring with a process that usually a body is perfectly capable of doing. Synto can be a great drug in teh case of PPH, but really shouldnt be used as routine.
If you do go for a natural 3rd stage, ensure that what you actually mean is...leave me alone, hands off my cord! If they tug, you are certainly more likely to end up with problems. Its really your decision, and if you request not to have synto routinely, they really have to respect it, whether they like it or not.