Yesterday, I attended an all day perinatal conference. As an RN, continuing education is required for relicensure. I listened to information on retinopathy or prematurity, screening for cardiac conditions newborns, the variety of newborn screenings available in my state, genetic markers for certain cancers in women, and something called "Mindfulness Meditation", which managed to let me take a little cap nap.
However, there was one topic which elicited a wide array of responses as the presenter spoke: nods (a few), rolled eyes, whispered comments to a next seat neighbor, expressions of "really?" on faces, and so on.
In my seat, as the only childbirth educator in the room, I was nodding and inwardly saying "Yes!" Once or twice I gave a hidden fist and elbow jerk -- you know, the once athletes do when they score points, or what someone does when something good happens and they say "That's what I'm talking about".
As a childbirth educator, I am required to teach according to the evidence, a.k.a. "evidence based practice". As you know from earlier posts, and probably some personal experience or reading, this is not always the case in the medical profession, especially in maternity care.
What got me so excited?
The speaker was a certified nurse midwife who was the director of a department and practice at a large medical center in Richmond, Va. Their c-section rate is only 6%. Most women labor without medication. Most of the women who receive epidurals receive a very light dose of the medication so they can still assume some positions of comfort, and cooperate with their bodies to push out their babies.
Women can choose where they want to give birth (the bed, the shower, the toilet, the couch, etc.). They can choose the position in which they give birth. They can catch their own babies if they desire. Babies are not bulb suctioned, bathed (just wiped off while on mom's abdomen), or subjected to any newborn procedures until after completion of the first breastfeeding. Episiotomies are not done, preserving the integrity of the pelvis floor for the mother's lifespan.
When babies are born via C-section, they are handed to the mother via a "sterile pathway" so that she is the first contact the baby makes with an unsterile object. This allows baby to be innoculated with the organisms of her skin vs those in a hospital warmer, etc. They even swipe the fluids from the mom's vagina and perineum with a sterile gauze and then wipe the baby's mouth and body with it so the baby receives the organisms it would have picked up during normal vaginal birth. These last two practices help protect the establishment of a normal microbiome in the baby's gut and respiratory tract. An abnormal microbiome increases the chance of asthma, diabetes, and a weaker immune system, among other health issues.
When the speaker asked the group why they would do such a thing, this lone childbirth educator was the only one who raised her hand to answer. When the speaker asked if anyone knew what microbiome meant, no other hands went up.
This does not mean I am smarter than the average bear. It meant that in a room where most of the nurses worked in a hospital with a highly medicalized approach to birth, they had had little exposure to normal birth and the evidence, based on research, which supported the procedures (or lack thereof), the speaker was presenting.
One nurse suggested that this approach needed to start with the OBs. The speaker noted that at their medical center, the residents taking a rotation at the birth center so they could learn how normal (and optimal) birth was handled -- or in many cases, NOT handled. She told us that the hardest thing for the residents was learning to stand by and watch. They would want to do vaginal exams to check progress, but were told they were not necessary for most of labor and only increased the chance of infection or desire to speed labor up by mechanical or medicinal means.
The speaker also responded to the nurse's comment by pointing out that changes in maternity practice often starts with the mothers. When women wanted husbands to be present during the labor and birth back in the 1960's and 70's, they used the services of the doctors and hospitals which supported this. Loosing market share, others had to follow suite. The same thing is happening now. The speaker reported that women were coming to their practice from as far away as two to three hours drive, passing hospital after hospital, in order to have more control of how they give birth, yet doing so in an environment in which they feel safe.
At the end of the session, during Q and A, I asked the group if they had heard of "birth circles" where women get together and share birth stories -- and their opinions of care providers and hospitals in the area. None had. I explained there were more than one (actually three) in our area and then shared how this can impact a hospitals bottom line, plus employee's paychecks and job security. Many hospitals depend on government issued reimbursement checks for patients on Medicaid. Many hospitals have a high volume of patients enrolled in this program. But cuts in what the program will allow to be paid can affect a hospitals bottom line. If private pay, or private insurance pay (at least as long a private insurance is allowed to exist) customers go to places two and three hours away in order to have the birth experiences they want, and in order to avoid unnecessary interventions which carry risks and side effects the women don't want, hospitals will loose market share. At some point, like in the 1960's and '70s, the light bulb will come on and changes will be made.
Needless to say, I was thrilled that the nurses were exposed to this information. I know many of them and they are a passionate and caring and bright bunch of professionals. Still some will (and did) scoff at what they heard -- but a lot listened and accepted the evidence. The photos of the smiles on women's faces moments after giving birth said it all. Many were not in a bed, and were holding their newborns, cord/placenta connection still intact, against their chests. The incredible joy empowerment they felt was visible in their expressions.
I am looking forward to knowing that those I teach in class will be walking into a labor and delivery environment where the nurses are more familiar with what the mothers are wanting. I am sure many of them will be even more supportive of "the magical hour", mother's request that the baby NOT be suctioned at birth as a routine, and so on. They will more strongly advocate for the mothers' desires. They will have opportunity to share what they learned with the physicians as they explain why the mothers want what they want. Information will slowly, but surely, continue to "trickle up" because of the efforts of the patients and their nurses. One day, more hospitals in our area will be offering, as standard care, the type of approach to labor and birth offered by the Centering Pregnancy group in Richmond, VA.
http://www.obgyn.vcu.edu/pregnancy/index.html
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