Saturday, November 26, 2011

Women's Right to Choose

            I'm happy to say that I have completed my last day as a labor and delivery nurse...or so I hope.  As I have spent the last six months working as a labor and delivery nurse while sorting out my future work as a Nurse Midwife, I've come to view the hospital setting with new eyes.  Midwifery school has changed me and in ways I never dreamed it would.  No longer do I enjoy the many tasks nurses do on a daily bases, while getting little thanks for the hard work.  I long for the complete attention I can give to women during their time of change.  However, I feel comforted in knowing that I gave 100% to the few women under my care in the hospital.  While the word "hospital" may give you a feeling of nausea justing saying it, it really is an alternate universe.  A building filled with it's own ethics and personalities to boot.  There is a certain art and finesse about navigating these complex systems in a hospital.
             I've never really realized how much hospital policies dictate how women will be cared for, or even how physicians will practice.  I recently encountered a woman who wished to have a VBAC and because the hospital policies did not support this practice, she had to hold out to the last minute to come in to delivery her baby.  Boy..did this rough up the feathers of the nurses and physicians....Nothing pisses off a doctor or nurse more then a woman who actually has a say in her own care.  It's the illusion that you will get the birth of your dreams...that is...if you do what we tell you...really?..In this particular case, she was an excellent candidate for a VBAC (Vaginal Birth After C-section), but because of the American College of Obstetrics & Gynecology's statement about VBACs a couple years back, hospitals have also changed their policies.  As well as insurance liability coverage for those few physicians still holding out.  So the big question is are VBAC's safe?  I would encourage you to make up your own mind on this...meaning read some literature on the topic.  So what is really behind all this hoopla?  Well..I'm not surprised to learn its money.  Hospitals make more money with c-sections.
             This is where I don't want to confuse you, yes there are some situations where a woman is not a good candidate for a VBAC...please also look up those reasons too.  I'm telling you to look up the information for yourself, because its important you educate yourself on the matter.  If you don't know about your options, it is to easy to be persuaded in one direction.  I'm happy to report this gal got what she wanted, much to everyone else's dislike for her deception.  When I sat down and visited with our manager about this situation, she said she supported VBACs, but didn't like how this gal deceived everyone.  I replied with..what choice did she have?  The hospital makes it's policies and women are forced with guilt and scare tactics to abide by them...and for what?...for control and to make money. It is situations like this one that I am reminded of everyone's motives in the baby biz.  I"m not saying all hospitals are bad and are out to get you, but in certain situations, hospitals are necessary for the safe delivery of babies.  However, the words safe, money, access, and ethics have all been used interchangeable enough that confusion has set in. I say this with the experience of seeing what goes on in a hospital from a nursing perspective and with the knowledge of doing my homework on the matter, and as an advocate for a woman's right to choose where she will give birth, how she will give birth, and what is deemed safe to her.
              I think when it comes to deception, hospitals can be the biggest deceivers in this matter.  You will get what you want only if these conditions are met (A thru Z). The skill of the she comfortable with you having no IV, is she comfortable with you walking around, is she comfortable with what she is seeing on the fetal heart monitor?  (Yes, machines are not 100% accurate).  Does the hospital have enough blood products to replace lost blood in a post-partum hemorrhage?  How skilled is your physician with forceps? Do you have a history of post-partum hemorrhage?  How busy is the labor and delivery unit?  Do the nurses have multiple duties other then to care for you?  This will all play into what kind of care you will get?  Your provider will also be thinking of these things when discussing your delivery.  Like I said....alternate universe.
               So what is my angle?...It is this..I will continue to support a woman's right to choose and educate those unknowing individuals working in this alternate universe of complex systems.

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