More equations that don't add up
Having a day off, I took myself out with the kids to do some shopping and have my coffee fix and found myself thinking about what I wrote earlier. Talk about living and breathing birth! Following on from my last post...
I made the statement that most primips, if left to gestate, will go beyond their due date. I am not yet entirely sure of all the reasons as to why this happens but I have read in places that it may have something to do with their body not ever having done it before. Obviously there is controversy as to whether or not this is true as there are many multips that go above and beyond their due date too, me being one of them. But it got me thinking anyways...
If the current trend continues, primips who reach their due date will be offered induction of labour. With or without an ideal bishop score, ripe cervix, a baby ready, the cascade will be begin. Time constraints will then impose, that is 'by this time, this will happen and if that doesn't happen then we will do this and if that fails, then we will attempt this for x amount of hours'... in the meantime, baby gets upset, distressed or completely pissed off - answer is caesarean section. If baby is happy, we continue until such time as there is some issue such as 'obstructed labour' , 'cephalopelvic disproportion' or 'failure to progress' and find our way to theatre anyways.
Or maybe its a high head, OP position or deflexed vertex, and maybe the use of forceps or a ventouse will result most likely with an episiotomy. The incline of induction rates means a greater likelihood of deviations from the norm which is inevitably going to lead to either assisted births or sections, increasing the section rate even further.
So then these primips end up with a section and when their next pregnancy comes about, they have minimal options, elective section or (cough, cough) VBAC. VBAC is certainly an option but in a system that has 'ifs' and 'buts' attached to everything, whether it remains an option will be down to whoever the woman sees on the day.
Unfortunately this is becoming the reality and women, although having an option as to what they want to do, by majority, do not realise it or believe it. And more, most place their decisions in the hands of those that do not really care about the well being or future of the particular individual but rather the convenience of booking an induction or section. It has become too difficult to give the power back to the woman and if the woman does have the power, somehow the are tainted and labelled uncooperative or radical.
Looking at it from this angle it makes sense that things are heading the way they are. What I do not understand is why women are giving into it. I know that every individual is different and varies in ideals and preferences but why is it that so few really question or seek clarification and understanding?
So here I am wanting to give the power back to women. I am confronted with a woman who by her dates is only just 40 weeks, a scan at 20 weeks suggests her dates are wrong despite her certainty. Her EDD is adjusted to suit the scan because baby is 'BIG'. On assessment, she has a bishop score of 3, head still high but nevertheless, head down, but induction is commenced regardless. What do you know, nothing happens! Discussion is had, a decision is made - C-section. Reasoning - unfavourable cervix, failed IOL, high-head, post dates (despite her only being due today based on her dates) oh and dont forget the massive baby onboard (even though she is over 6 foot and appears to have decent pelvic space). She agrees without a second thought.
Given my situation and my current role, I debate as to whether I should speak up. I realise that if there was ever time to step in and advocate for a woman it is now and I go in with the attitude that I am informing her of all her options, not just the escape route. Despite what I know, I put myself in her position and know that if someone was hanging outside of my door with choice and options, Id want them to make it known.
And so I go to her and I open her up to the options and I feel like I have fulfilled my purpose as a midwife and everything that a midwife entails...
I get shot down and feel like I am an imposition, stepping on toes and completely out of place. I walk out feeling uncomfortable not because I feel like I have said the wrong thing but because I am lost as to the reasons why anyone would not want options and choice and rather leave it in the hands of those that ''know whats best!"
I did what I felt was right and despite it not having an impact at the time, I can only hope that one day she looks back and remembers that someone was willing to stand strong and uphold her rights and autonomy. I once thought that given the opportunity to do what I did and receive the response I got, Id feel lousy, yet I feel good knowing that at least she was aware that there was a choice regardless of whether she grabbed ahold of it or not.
And so I ponder the reasons why we have become mute as humans and lack the authority and the power to make decisions based on our own choices and beliefs allowing others to abuse us and decide what is ultimately our decision.
Any comments you have in response would be thankfully accepted.
I made the statement that most primips, if left to gestate, will go beyond their due date. I am not yet entirely sure of all the reasons as to why this happens but I have read in places that it may have something to do with their body not ever having done it before. Obviously there is controversy as to whether or not this is true as there are many multips that go above and beyond their due date too, me being one of them. But it got me thinking anyways...
If the current trend continues, primips who reach their due date will be offered induction of labour. With or without an ideal bishop score, ripe cervix, a baby ready, the cascade will be begin. Time constraints will then impose, that is 'by this time, this will happen and if that doesn't happen then we will do this and if that fails, then we will attempt this for x amount of hours'... in the meantime, baby gets upset, distressed or completely pissed off - answer is caesarean section. If baby is happy, we continue until such time as there is some issue such as 'obstructed labour' , 'cephalopelvic disproportion' or 'failure to progress' and find our way to theatre anyways.
Or maybe its a high head, OP position or deflexed vertex, and maybe the use of forceps or a ventouse will result most likely with an episiotomy. The incline of induction rates means a greater likelihood of deviations from the norm which is inevitably going to lead to either assisted births or sections, increasing the section rate even further.
So then these primips end up with a section and when their next pregnancy comes about, they have minimal options, elective section or (cough, cough) VBAC. VBAC is certainly an option but in a system that has 'ifs' and 'buts' attached to everything, whether it remains an option will be down to whoever the woman sees on the day.
Unfortunately this is becoming the reality and women, although having an option as to what they want to do, by majority, do not realise it or believe it. And more, most place their decisions in the hands of those that do not really care about the well being or future of the particular individual but rather the convenience of booking an induction or section. It has become too difficult to give the power back to the woman and if the woman does have the power, somehow the are tainted and labelled uncooperative or radical.
Looking at it from this angle it makes sense that things are heading the way they are. What I do not understand is why women are giving into it. I know that every individual is different and varies in ideals and preferences but why is it that so few really question or seek clarification and understanding?
So here I am wanting to give the power back to women. I am confronted with a woman who by her dates is only just 40 weeks, a scan at 20 weeks suggests her dates are wrong despite her certainty. Her EDD is adjusted to suit the scan because baby is 'BIG'. On assessment, she has a bishop score of 3, head still high but nevertheless, head down, but induction is commenced regardless. What do you know, nothing happens! Discussion is had, a decision is made - C-section. Reasoning - unfavourable cervix, failed IOL, high-head, post dates (despite her only being due today based on her dates) oh and dont forget the massive baby onboard (even though she is over 6 foot and appears to have decent pelvic space). She agrees without a second thought.
Given my situation and my current role, I debate as to whether I should speak up. I realise that if there was ever time to step in and advocate for a woman it is now and I go in with the attitude that I am informing her of all her options, not just the escape route. Despite what I know, I put myself in her position and know that if someone was hanging outside of my door with choice and options, Id want them to make it known.
And so I go to her and I open her up to the options and I feel like I have fulfilled my purpose as a midwife and everything that a midwife entails...
I get shot down and feel like I am an imposition, stepping on toes and completely out of place. I walk out feeling uncomfortable not because I feel like I have said the wrong thing but because I am lost as to the reasons why anyone would not want options and choice and rather leave it in the hands of those that ''know whats best!"
I did what I felt was right and despite it not having an impact at the time, I can only hope that one day she looks back and remembers that someone was willing to stand strong and uphold her rights and autonomy. I once thought that given the opportunity to do what I did and receive the response I got, Id feel lousy, yet I feel good knowing that at least she was aware that there was a choice regardless of whether she grabbed ahold of it or not.
And so I ponder the reasons why we have become mute as humans and lack the authority and the power to make decisions based on our own choices and beliefs allowing others to abuse us and decide what is ultimately our decision.
Any comments you have in response would be thankfully accepted.
Labels: Caesarean Section, Random Thoughts, Troubling Tales of the System
posted by lovebubs at
10:26 AM
2 Comments:
We know term is 37 to 42 completed weeks. due date or estimated date of arrival is just the exact middle date of those 6 weeks. We are term every one of those day's but we all have an individual gestative period. first babies on average gestate longer than subsequent births. Average for first baby it term plus9 so why we give them a 40 week due date is beyond me.
June 25, 2008 2:26 AM
Viewing pregnancy and childbirth as a medical procedure means that you put the same trust in a doctor as you would if you were having heart surgery. OBs abuse this trust and exploit a woman's normal fears and excitement about childbirth by telling them they can't do it without medical assistance.
But you know that. What seems to confuse us is how so few women worldwide even question this. It's mindboggling.
January 18, 2009 1:54 AM
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