Would you enroll your toddler at a daycare that provides hands-on care to your child for only 13% of the day? Would you feel you have provided your child the very best because in this theoretical daycare your child sits alone hooked up to a machine while an employee watches your child on a remote monitor?
Pretend you live in a country where fewer than one-third of people driving on the road have actually received driving lessons. Given this, you might consider it reasonable to take your driving test after having perhaps read a book or two and maybe watching a video.
But is it safe to assume that you can improve your odds of passing the driving test because you asked your partner to sit in the back seat during your test? (Important note: in this example, your partner knows less about driving than you do.)
Your car needs an oil change and you randomly choose a shop that you know nothing about. Some time goes by as you wait for your car and then the mechanic comes to you with the information that your car’s brakes are in such bad shape an emergency repair must be done immediately. You know nothing about car maintenance, but because you believe that all auto mechanics have your best interest at heart, you agree to this expensive job.
Later, you realize that because this mechanic has advanced training in brake jobs, it seems a bit suspicious that fully one-third of cars leaving the shop have all had “emergency” brake jobs. In fact, an independent audit shows that this rate is at least twice as much as comparable shops and if you had researched this before taking your car in, you could have avoided this pricey and unnecessary work.
I meet pregnant women[i] all the time who chose their maternity care based on almost no solid information. A friend or a co-worker may have told her that XYZ Hospital is “the best” so she then decides to use this hospital for birth. That is like asking a random stranger what car is the best one to buy…and this stranger knows nothing about cars other than having once been a passenger inside one.
We know that one-half of caesarean surgeries in Canada are unnecessary. Do you know the C-section rate of your healthcare provider’s (HCP) hospital? Probably not, because in my research as an Evidence Based Birth® Instructor, it is clear that this information is actually well-hidden from Ontario consumers. In my 30+ years as a birth professional, I never knew the statistics of the hospitals my clients used. I know slightly more now, but that is only after hundreds of hours of online hunting. When I requested information from publicly-funded institutions that have this available, I was informed that no consumers are not allowed access to this data.
You almost have to choose randomly, and even though your tax dollars fund these facilities, hospitals are not transparent with the public.[ii] You can find out about your local auto mechanic’s shop more easily than you can about your government-funded facilities.
In a world where corporations expect consumers to do their work for them (we pump our own gas, cash out our groceries, book our travel), it makes sense that expecting parents tend to think they can do this themselves. But, like a driving test with no practice, you do not improve your odds of success by having your partner in the car with you…a partner, by the way, who not only has no clue about driving, but has actually read fewer books on the topic than you did.
Most birthing women have a partner with them at birth, but as a large survey of childbearing women in Canada shows, only 32.7% reported attending childbirth education classes.[iii] This means that the majority of birthing women and their partners are not only unprepared for birth, they expect the labour and delivery nurse will do everything for them.[iv] In fact, when pregnant women are asked what their L&D nurses will provide, they report that they expect their nurses to:
- keep them comfortable,
- calm them down,
- provide a calming effect to the partner,
- and give reassurance and help with breathing and relaxation techniques.[v]
The sad reality is that not only does this not happen, the opposite is actually the case. In fact, most people do not realize that even if nurses had this training (the majority don’t), and wanted to provide this support, there is no time in our busy health care system. Nurses are so busy, they consider themselves lucky if they get bathroom breaks during a twelve hour shift.
It is also unfair to expect partners (who don’t know anything about “driving,” aka birth) to provide support in birth. Partners can be amazing at birth, but most are intimidated and overwhelmed by the health care system. In fact, research shows that partners actually need support themselves: one study found that partners “usually have little experience in providing labour support and are themselves in need of support when with a loved one during labour and birth.”[vi]
I am fairly certain that the daycare that uses machines to look after children would not be the place you would spend your childcare dollars. But this is what hospital birth units do. Women are admitted in labour and immediately hooked up to a machine to monitor the baby’s heart rate. Then the nurse leaves the room. Very few people realize that L&D nurses spend, on average, 69% of their time outside of the patient’s room and while in the room, very little of time (13%) was spent actually providing supportive care.[vii]
As a reminder, even though electronic fetal monitoring in birth is not evidence based care, the majority of birthing women are confined to bed, connected to these machines (with its constant ultrasound emitted into her body) not because it is needed, but because this is what all hospitals do. Even if a hospital wanted to stop the non-evidence based continuous fetal monitoring, they couldn’t because all the other hospitals in the area utilize it and the hospital has no defence in the event of litigation. It is more about protection against lawsuits than it is about medical care.
The field of obstetrics is well-known in medicine as being severely behind the times when it comes to evidence based medicine. Dr. Neel Shah, an obstetrician at Beth Deaconess Medical Center in Boston and Assistant Professor of Obstetrics at Harvard Medical School has reported that U.S. caesarean rates vary from 7% to 70% depending on the hospital, with the variation being even more extreme among low-risk women. No other area of medicine has this extreme a variation.[viii]
And most women do not know that the obstetrician (OB) she sees in the pregnancy will most likely not be at the birth. Most OBs are in large on-call groups and physically spend more time outside of the birth unit than they do inside. Unlike the U.S., individual OBs are not on-call for patients.
And most OBs practice “crowning obstetrics,” meaning that they are at the birth for about five minutes prior to the baby being born. They spend more time (approximately ten minutes) after the birth to deliver the placenta and suture the vaginal area. The medical model also includes other doctors (residents and fellows) that are in-and-out-of the birth room, none of whom are known to the woman before the birth.
More expecting parents are choosing midwifery because research shows that the continuity of care provided by midwives results in better outcome for mother and baby. Many midwifery practices have a one week on-call, one week off-call schedule, and while you generally will meet all the midwives in this on-call group, the unpredictable nature of birth means that you may not have the midwife you have grown to know attend your birth.
What, then, to do?
Hire a birth doula.
While doulas cannot provide a 100% guarantee of being present at your birth, this option allows you to have a professional you know (and like) at your birth.
I recommend a birth doula regardless of your pregnancy risk status and planned place of birth. Some women think that if they have a midwife they don’t need a doula.
Think again. There are greater demands on midwives these days and they have many medical tasks to attend to in hospitals as compared to planned home or birth centre births. Even though midwives are specialists in natural birth, they are required to monitor, chart, maintain good relations with staff in the birth unit, train midwifery students, keep the second midwife informed, and more.
And did you know that it is common for the early part of birth (when contractions are every five minutes) to last 24 hours or more? Even though women are told to go to the hospital with 5-1-1 (contractions every 5 minutes, lasting a minute for one hour), hospital birth units do not admit women in early labour.[ix] In fact, women are sent home. And that’s a good thing, but are you prepared with strategies on how to handle a long early labour by yourself?
This is where a birth doula is invaluable.
As a society, we spend considerable attention to the things that are important to us: planning a wedding, purchasing a home, choosing a career, where to vacation, and more. We don’t tend to allow the vendor/store/restaurant/resort make our decisions for us. Why would anyone choose a hospital randomly and allow the staff to make all the decisions. I’ve heard too many women say they will “go with the flow” in birth. That’s the same as walking into a car dealership and letting the salesperson decide what make, model, and price of car for you to purchase. You wouldn’t allow this in other areas of your life, so why abdicate responsibility for yourself and your baby at birth?
The birth of your baby is a very important event―make sure you are prepared early in your pregnancy: become informed about the differences between the medical model and midwifery models of care as well as the options for home, hospital and birth centre birth. I am not saying what choices you should make, I am just saying become informed.
Even more important, enroll in a good quality prenatal series and hire a birth doula: research shows that both choices result in better outcome for both you and your baby.
For more about Birth Doulas go to: https://evidencebasedbirth.com/the-evidence-for-doulas/
For more information on prenatal classes, go to http://www.childbirthjoy.com/prenatal_Toronto.html
- do a online search in your area for Naturopathic Doulas
- do an online search in your area for Registered Massage Therapists and doula
“It wasn’t until the middle of the last century that really people starting coming to hospitals in droves. And then what that hospital environment looked like has changed dramatically. And now we deliver 99% of our babies in these environments that basically look like ICUs. That’s part of what’s different. If we think about it, you take a healthy mom, you put them in the ICU, and you surround them by surgeons, you’ll get a lot of surgery.” ~ Dr. Neel Shah
“C-sections have skyrocketed in the U.S. [and Canada] since the mid-1970s. In just one generation, this country’s C-section rate has increased 500%.” ~ Dr. Neel Shah
“Studies of the relationships among fear and anxiety, the stress response and pregnancy complications have shown that anxiety during labour is associated with high levels of the stress hormone epinephrine in the blood, which may in turn lead to abnormal fetal heart rate patterns in labour, decreased uterine contractility, a longer active labour phase with regular well-established contractions and low Apgar scores (Lederman 1978; Lederman 1981). Emotional support, information and advice, comfort measures and advocacy may reduce anxiety and fear associated adverse effects during labour.” ~ Continuous support for women during childbirth, Hodnett et al.
[i] The majority of pregnant persons are women-use of the female gender is not meant to exclude pregnant males.
[ii] At over $61 billion annually, health care spending in Ontario is the biggest bite of your tax dollar at 38.7% https://www.macleans.ca/economy/economicanalysis/the-2018-ontario-budget-in-charts-and-numbers/
[iii] Stoll, K and W. Hall. (2012 Fall) Childbirth Education and Obstetric Interventions Among Low-Risk Canadian Women: Is There a Connection? J Perinat Educ, 21(4), 229-237 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3489119/
[iv] Only 10% of births in Canada are attended by a Midwife. https://canadianmidwives.org/2017/01/09/midwifery-assisted-births/
[v] Bowers, B. (2002) Mother’s Experiences of Labor Support: Exploration of Qualitative Research. JOGNN, 31(6), 511-521.
[vi] Hodnett, E. et al. Continuous support for women during childbirth. Cochrane Database of Systematic Reviews 2007, Issue 2. Art. No.: CD003766
[vii] Barnett, G. (2008) A New Way To Measure Nursing: Computer Timing of Nursing Time and Support of Laboring Patients. CIN: Computers, Informatics, Nursing, 26(4), 199-206.
[ix] If you have a midwife, you are expected to handle this part of the birth on your own.