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Monday, December 16, 2013

technology and it's appropriate use. when pitocin and an epidural might be the right choice.

it's monday and four hours to midnight. no birth yet, but was paged to evaluate a mother with a potential pulmonary embolism.

what i'm about to write about may piss a bunch of people off. but i think it's important.

technology and it's appropriate use. when pitocin and an epidural might be the right choice.

i've been thinking about this recently. it's an ongoing dialogue really, but now that i have the use of pitocin and pain relief in my bag of tools it's become more relevant.

there have been a number of first time mothers with long labours recently. some who have used the resources a hospital offers without reticence and those who have chosen not to.

perhaps it's not appropriate to compare any labour to another, but it's interesting.

what happens when a mother chooses to avoid intervention in her labour, striving for a natural birth without intervention, and ends up with a cesarean? what would have happened had she opted for augmentation earlier? would the benefits of an epidural relaxed her pelvis enough to open up and let the baby down?

is the mother happier, knowing she did everything she possibly could have within her body and soul to labour that baby down and bring it into this realm? if the result is a cesarean, is this still a more satisfying birth experience than had she used these other tools or "interventions" earlier?

these are the questions in my mind.

i'm not an experienced midwife. i'm an entry level midwife and damn proud of it. i know my limitations and i'm open to learning. i'm open to a multidisciplinary approach. i'm open to using modern technologies that we are so privileged to have access to in north america.

my job now as a midwife who has these tools within her scope of practice is to use them effectively.

i am experienced enough to recognize when labour has become abnormal. if i couldn't then, well, i'm not ready to be a midwife.

the conflict of interest arises when my clinical judgement may disagree with the desires of the labouring mother.

ultimately, this is her birth, her body, her baby, her decision.

i can offer, suggest, recommend what i see as the appropriate course of action or what the available options are. but the decision is not mine to hold.

reflecting on a birth, however, i can't help to wonder. if the mother had taken my recommendation and utilized these "interventions" would she have had a vaginal birth?

this leads me to evaluate the current culture of birth in which we live, in which women live and are educated.

childbirth education, the media, books teach women how to say no to intervention. however, are they teaching them when saying yes, might be appropriate?

have we completely desensitized ourselves and abused these advancements to the point that the only option is saying no, because either a) women do not trust their care providers to use these tools judiciously and as needed, or b) women are taught that if they say yes to any intervention, they have failed. that putting themselves through hell and back, fighting, being that warrior goddess, means that they must say no to the point that their only option is surgery?

i see every mother as that warrior goddess. no matter how her birth story is written.

carrying, growing, and birthing life is the utmost human feat.

how can we get to a point where women not only trust in their bodies, but also in their care providers and the technology that is available?

how can we get to a point where care providers trust women's bodies, and not rely on these technologies to manage birth?


  1. Tracy, yes! The highest point of your post being your final statement, "how can we get to a point where care providers trust women's bodies, and not rely on these technologies to manage birth?" Within the "natural birth" arena, reliance on staying the so called natural course is too high and makes the informed, or the conscientious so skeptical and against the possibility of the need to use interventional drugs against all odds simply because going the other route feels as though no one has got your back, no one is listening or offering another approach or option or simply that you have failed.

    However, when I had my hospital birth with epidural and IV, etc etc, it was totally unnecessary but no one supported me in my decision otherwise when I wish more than anything that they had. On the contrary, if cesarean or any other intervention would have been appropriate I would most certainly have wanted a kind and compassionate voice to guide me. Birth is natural, it should be treated as so. It should not be feared and anyone who is to assist or sit beside a birthing mother should know all the ins and outs of helping the mama to make the BEST decisions for her needs and the babies needs. AND doctors really need to get on the page of having these best interests in mind as well as mothers understanding that a lot of what they are told IS lip service...unfortunately.

    I like this post, its a thinker!

  2. Love this! Thinking about these same things myself. You hit the nail on the head in regards to the midwifes dilemma - safety and safety recommendations vs. upholding mamas autonomy in birth. I think it really has to come down to women trusting their care providers and care providers being completely transparent and honest with themselves and their clients about their motives. Past this, we all make the best decisions we can with the information we have in that moment and that is really all we can do both as mamas and providers. So much to think about with this post. Thanks for being courageous and writing about such an important subject.