An official statement was made today that says Baby Blue is taking over a whole floor, but is in an executive suite, with their own security detail and that she was not born via c-section, scheduled or otherwise.

As you’ve probably heard by now, Beyonce Knowles and her husband, Jay-Z, welcomed their daughter, Blue Ivy, this past weekend. You might expect this post to be about the reports that Beyonce chose a scheduled c-section, but honestly no, I have a different bone to pick with the whole situation.

The NY Post is talking to a dad who was prevented from visiting his premature twins because of security for Beyonce and her entourage.  Apparently there have been several such shut downs at the hospital during her stay, which reportedly encompasses a whole floor, minus the NICU, and costs an estimated $1.3 million for her stay.  This is also sad, that families in their times of need can’t get to babies.  What about moms who needed to nurse babies?  What about families who may have only had a few hours left with a baby who was very ill?  This is ridiculous.

The public health person is me started churning this over in my mind last night as I tried to sleep.  My first thoughts were to the waste of money.  Shouldn’t all patients have privacy?  Be it Beyonce and Jay-Z or me or you or anyone?  Okay, so that’s annoying, they get to pay extra and have windows darkened and people restricted from being in the halls.  The average person can’t afford it and probably doesn’t want it or care.  But then I started wondering – what about all the women in labor who were registered to have babies at Lenox Hill around now.  Do they get shunted to other hospitals?  In labor?  At what cost and to whom?  Maybe they just get shuffled to another area of the hospital, one less convenient for them and the medical staff, an area that maybe isn’t set up to specifically care for obstetrical patients.  What about the fancy modular birthing beds and birth balls that Lenox Hill brags about on their online tour? Did those move too?

To open a hospital, you need to get a certificate of need (CON).  That says there is a need for these services in this community.  Who is meeting the needs of this community while the whole floor is taken up for one family? While I used to think that Brad Pitt and Angelina Jolie were crazy to have their first baby, Shiloh, in Namibia with their LA physician by their side for her scheduled c-section, at least I know that once they were out of the OR, there wasn’t all this craziness in the clinic where she gave birth.  Even Michael Jackson, known for his extremes, simply took the baby and immediately left the hospital, paying for care in his own home.

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There is no room at the proverbial inn these days.

This is because many doctors, midwives and women are jumping at the chance to have an induction of labor, not for medical reasons, but for a variety of seasonal reasons, including these holiday top 5:

1. I don’t want my baby born on Christmas.
2. I want to be home in time for Christmas.
3. My baby is my present this year.
4. I don’t want to be in the hospital for Christmas.
5. I want my doctor to be the one to deliver my baby.

Seriously, the hospitals are perfectly prepared if you have your baby on Christmas.  It won’t shut down.  There are a full complement of staff and services available.  In fact, if you’re planning for an epidural, you’re less likely to have to wait for it given the demand on hospital services this week.  One hospital here actually has had moms laboring in the halls waiting hours because their huge anesthesiology staff can’t really accommodate the laboring women as quickly as the women would like.  This is when a mom calls to get in for an induction and the nurses say, “Call back in four hours to see if there is an open bed…”

Are you hearing women talk about not being able to get into the hospital for an induction?  What’s your take?

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As a part of this class, we were assigned a hospital in the area to interview and find out their birth statistics. I had never thought of questioning the procedures being done because hospitals are a place that sick individuals go to, get treated, and feel better by the time they leave. These interventions are done to save individuals lives and are for the most part necessary. As I began researching the hospital, I found myself asking “Why are pregnant women, who are not sick, being treated the same way as people who have illnesses?” Doctors do not need to “save” women from their births, they should instead be supporting women and letting nature run its course.  This being said, I do understand that some women, and that percentage is a small one, need help in delivering a baby due to some complications. Many women however, have a body fit enough to deliver a healthy baby on their own and that right is being robbed away from them.

To further my research for this project, I decided to go on the hospital tour as a pregnant woman.  One of the first questions I had for the guide, who was also a nurse, was their c-section rate. With this, two women on the tour stated that they already had their c-sections planned and were so happy because they knew the definite day and time they would have their baby.  As I sat there stunned and feeling bad for these women, the rest of the group congratulated them and one woman was thinking of doing the same.  At this point I decided to ask about natural births and the tour guide stated that she sees plenty of vaginal births.  When I explained that I meant natural to be 100 percent intervention free, she looked at me like I was crazy. She said that when women first arrive they are hooked up to IV’s and fetal monitoring with an epidural not too far away.  My face must have said it all because she said that I didn’t understand how painful it was going to be and that many women need some kind of assistance. 

After my tour, I was very upset and amazed at how much these women and the tour guide didn’t know. And I do not think that the women are to blame.  Doctors should be spending some time helping to educate about birth and all its wonders. Instead, they are ordering everything from fetal monitors and pitocin to epidurals and c-sections when all of these are usually unnecessary.  As I said before, a hospital is a place for the sick to become healthy and not the healthy to be treated as if they are sick and need saving. 

This hospital experience has opened my eyes and made me realize that these hospital ways need to change. The only way that can happen is if women come together and fight against these unnecessary procedures that are being done to them before a completely natural birth is only a thing of the past.

(The following is a short summary of a clip from the show, found here, starting at 5:15.)

Rebecca tries to explain the concept to her mother, noting that the birthing center is one of the biggest on the east coast and that “they emphasize natural childbirth in a relaxed atmosphere with no painkillers.”  As expected, a number of jokes follow about the pain of childbirth and a comment by Sophia likening the birth center to a Disneyworld theme park.  Dorothy encourages Blanche to keep an open mind and at least visit the birthing center.  In the next segment, the women all tour the birth center.  Blanche and Sophia make disparaging remarks about the lack of “equipment” and even Dorothy, ever skeptical, takes a negative view.  The women are interrupted by a yell, and then another.  An unseen woman in another room is giving birth.  The women seem alarmed- especially Rebecca, who asks, “Why is she screaming?”  Sophia answers, “Because she’s conscious!” and the group heads for the door.

In the next clip, Rebecca has changed her mind about the birthing center and decides to have her baby in the hospital.  She mentions she has a Lamaze coach and says there’s no reason she can’t have a natural birth in a hospital.  When she wakes up in the middle of the night wondering if she’s in labor, Dorothy has her get into bed to start timing contractions.  When Blanche and Rose wake up, the group heads to the hospital, where Rebecca is put flat on her back on a gurney and the obstetrician who arrives makes a number of snide remarks.

The  final clip has just about every cringeworthy stereotype about birth shown in popular culture.  Rebecca is in the delivery room, covered in all sorts of gowns and drapes, while everyone in the room is in scrubs.  Blanche at least gets to forego the mask over her face.  Rebecca is supported with her knees up around her ears, holding her breath while Blanche and the doctors loudly exhort her to push as they count to 10.  Between pushes, she’s nearly flat on her back on the delivery table.  (She’s probably only tilted up because otherwise the camera wouldn’t be able to capture her face in the shot.)  After Rebecca births the baby, the doctor immediately cuts the cord and hands her a perfectly clean, blanketed baby, and then the credits roll.

Granted, the original airdate of this show was in 1990.  But how much has truly changed in the intervening 20 years, in real life and in the mainstream media?  In many hospitals, women are still delivering in drapes, still in the lithotomy position, still being directed to push by doctors, nurses, birth partners, and whoever else happens to be in the room.  Certainly this is how birth continues to be portrayed on television and in the movies.  (see: Knocked Up)

I think the result is that we are stuck in a vicious cycle of expectations.  The general populace expects birth to be a horror show of screaming and sweating and laying flat on one’s back because that’s what is portrayed in the media.  The obstetric system expects that women (and men) will just accept their status quo.  And everybody expects movies and tv to depict birth the way it happened to them, further cementing the status quo and beginning the cycle again.

The birthing community has done a lot of work to break the cycle, especially in the arena of changing the status quo for births, both in and out of the hospital.  But if we continually portray birth in the popular culture as something that “happens to you” on the doctor’s or hospital’s terms, what lessons are we imparting to children, teens, and young adults who consume this type of media?  What stereotypes have those of us who advocate for choices in birth had to confront?  And most importantly, what can be done to turn the media tide?

We live in a time and place where in the media violence is recreated with painstaking authenticity, where we can watch any number of surgeries and medical procedures on television, where “reality tv” is a killer app.  And yet birth is treated alarmingly unrealistically.  In order to re-normalize birth in hospitals, perhaps it must first be re-normalized in pop culture.

While conversing with a nurse during my shift on a maternity floor, I proposed the question of what” normal birth”  is to her. The nurse replied, “ It is a woman who comes into the hospital with no complications and gives birth vaginally to a healthy baby.” The point she was trying to make is that when a birth occurs within a hospital it is considered a normal birth. I pushed further and asked would a normal birth include interventions. She replied, “Yes, if a little aid is needed for comfort, she will be provided with the necessary intervention.” The nurse’s definition changed from a delivery within a hospital vaginally to using any medical means necessary for a vaginal birth with no complications for the mother and child.

I decided to look for another opinion of a normal birth from a fellow nursing student who has not been exposed to the lectures of the bio psych of birth class. The student stated a normal birth consisted of “…giving birth in a hospital with medication to control the pain, and if it takes too long a c-section.” I am somewhat ashamed to admit that this was almost my own verbatim definition prior to my exposure to the Bio Psych of Birth class.

The nurse and my fellow classmate described what is known as the norm within the United States. Contrary to popular belief, the norm is different from “normal birth.” A norm is what the trend, or what the majority of the population does. In 2009, 32.7% cesarean sections, 55.5% epidurals, 20.1% medical inductions, and 24.6% augmented labors occurred statewide in New York. These percentages are viewed as ‘the norm’ within the United States. The true definition of a normal birth is the woman’s ability to trust her own body to perform the birth process with no unnessary interventions.  A normal birth consists of a woman in the company of a support system relishing in the experience and excitement of childbirth on their own.

Today I would like to pose a question to you: why is it that normal, non-interventive birth, which has been achieved for centuries by women everywhere, is now considered abnormal within today’s society?

While taking everything that is going on into consideration, you also have to keep your eye on the time, because as time passes, all of the bricks begin to creep slowly down the screen toward your pod.  Once those bricks touch your pod, the game is over.  You either have to know what you are doing or you are most certainly going to lose.  And sadly, even when you think you know what you are doing the game might toss you a curve ball and you could still lose.  This game reminds me an awful lot of laboring women in hospitals.

 A woman laboring in a hospital is very similar to the pod you are trying to protect in Brick Breaker.  Getting through her contractions is like breaking those bricks.  Finally, giving birth to her baby is the equivalent to eliminating all of the bricks! However, before that can happen, the hospital, much like Brick Breaker, is going to make that a difficult venture.  They will offer her Pitocin, to speed up her labor.

Then they will offer her an epidural to ease the pain that accompanies Pitocin; but an epidural slows down labor.  She better keep her eye on the time, because the longer she takes, the closer a cesarean section comes to her precious pod, ultimately keeping her from winning the game.  What I would call winning, in this situation, is the woman being able to deliver vaginally and without medication or intervention – inherently, how she intended. 

If women have a choice, why would they choose to play this sort of ‘game’? If a woman wants to have a natural, un-intervened, vaginal birth she should be able to do it.  It is her game; she should be able to make her own rules. After all, birth should not be about avoiding impending doom, it should be about happily bringing a child into the world.

As part of our biopsychology of birth class, we were put into groups and sent out to different hospitals to collect information. Some of the information we received included Cesarean section rates, rates of intervention as well as standard practices in these facilities. We were disturbed with most of the information we found as well as the level of difficulty in collecting it.

The class went to hospitals and birth centers all over the Hudson Valley from St. Luke’s Hospital in Newburgh to Vassar Brothers Medical Center in Poughkeepsie. I was actually assigned to the Neugarten Family Birth Center in Rhinebeck and after hearing about all of the different hospitals I must say that this is THE place to give birth in the Hudson Valley.

            After visiting the birth center at Northern Dutchess Hospital I was blown away by how understanding they were to the birth process, seeing it as a beautiful experience in which the mother knows her body and being confident that she can deliver her baby without the use of interventions. Then we flip to other hospitals in the Hudson Valley where there is no faith in their patients. Women are confined to their beds and not allowed to move during labor, pain medication is thrown at every patient, inductions happen in most cases.

            When hearing about all of the services that the Neugarten birth center provides I was thrilled to know that there was somewhere that women could go and have a birth that wasn’t restricted by impatient hospital staff and these ridiculous ideas of “standard of care”. But it also highlighted how many problems there are in the United States system regarding birth. Being able to move freely during labor or eating when hungry isn’t something that I should be excited about. Women should not be worried about being overwhelmed by an enormous amount of interventions being thrown at them as soon as they walk into the hospital doors. Reforms are being made in the field of healthcare but what is being done about the problems with our birthing system???

            This class has truly opened my eyes to all of the issues that need to be addressed in the birth system in America. From the use of interventions to the rate of Cesarean sections, something needs to be changed. The first step is to make people aware of the problems and with this awareness comes change.

                My sister-in-law ended up having a cesarean, due to high blood pressure towards the end of her pregnancy. My nephew’s birth weight was 9lbs 6 oz. After the delivery when her OB came to see her the next day she said to my sister-in-law “There is no way you would have been able to push that baby out.” This is just so irritating to me. Doctors have no confidence in women and their bodies, and if they make statements like the one said to my sister-in-law, they are making women feel like they are not capable. They are taking away their confidence of themselves and their bodies. And for the most part the woman will believe their doctor, because they’re the doctor, not you.

                As a nursing student, I have seen two c-sections. The first one I saw, I had to walk out before the baby was “born” because I the smell of the skin being cauterized made me feel so sick to my stomach and like I was going to pass out.  The second one I saw I was able to stay in the OR the whole time. I could not believe how barbaric the procedure was. Cutting, cauterizing, pulling, shoving, it was really hard to watch. As the doctor prepares to reach in and grab the baby, he has the nurse or assistant use what looks like a big shoe horn to hold/pull back on the incision to make as much room as possible for the doctor to get inside and remove the baby.  No wonder the woman is in so much pain afterwards, they push and pull and shove her insides around and deliver a baby that apparently was in distress (which is, most of the time, actually healthy at birth). If doctors weren’t so busy looking at the printouts of the electronic fetal monitor there would not be so many c-sections. They see a few decelerations and get all panicky, well what do you think that baby has been doing in there for 40 weeks? It probably has decelerations every day of gestation, only now that it is visible on monitor the doctors can use it to back up their advice that the woman should have a cesarean.

                With my own experiences and in reading both Cassidy’s Birth and Goers A Thinking Woman’s Guide to a Better Birth, I don’t know how a woman could want or be okay with having an (unnessary) cesarean.

The cesarean section is a form of major surgery and like any other, it (usually) includes anesthesia and a warning of any associated risks (any potential complications during or after). While the medical community may provide people with information about the procedure and inform a woman about her options, a lot in the decision making will be affected by what an attendant thinks is necessary to keep a baby safe. These decisions are made based on factors like breach births or fetal distress, which may be, but are not always be an indication of alarm or an end-all for a vaginal delivery. I am not saying that high risk patients or emergency cesarean sections are unnecessary, but that the criteria for deciding on having a section are broadening and causing an increase in cesarean rates that should be cause for concern.

  I believe that this increase is due in part to the belief that cesarean sections are a quicker and safer alternative than natural birth. What I believe to be underemphasized by the medical community when educating patients, is the impact a C-section can have on the birth experience and the toll it may take on a woman and her family during recovery. Typically, a woman who undergoes the procedure of a cesarean section have their arms strapped down as a safety precaution, their face shielded from the sight of the surgery, and are medicated to block the pain of the incisions, extraction and stitching. After a baby is taken out of their uterus, it may be hours before the mother gets to hold or feed her baby for the first time. Even after leaving the hospital a mother will feel discomfort, she is not permitted to move around very much, and is given a weight limit for things she can pick up or carry. And lastly, despite the recent innovation of the “bikini-cut,” physical and/or emotional scars are something that may stay with them forever.

Lesser reasons for this increase in frequency of cesareans may be the result of fear of pain and trauma with a vaginal delivery or the notion that vaginal delivery is antiquated.  Although doctors do not always readily accept requests for cesareans from healthy pregnant women, it does still happen. I believe the most important take-away message from all of this is that vaginal delivery is a safe and natural experience for women who are not truly high-risk. Cesarean sections play an important role in helping those who are high-risk, but a completely unnecessary and potentially dangerous role for those who aren’t.

                Almost about two weeks ago today I took part in a tour of the mother/baby and Labor & Delivery rooms at Vassar hospital. As part of the total grade for a Birth class that I am attending one requirement was to get “informed” of statistics and birth cultures at local hospitals. I took the liberty of telling the hospital that I was pregnant (3 months) and wanted to view the hospital as a possible birth site, and my findings were infuriating to say the least!

                When I arrived at the hospital I met the other women and men who were taking the tour in the lobby. Our group was greeted by the tour guide whose first statement to the group went something like this: “I am here this morning to show you around the labor and delivery birthing center, and to answer any questions that you may have, but I am not a medical professional so I cannot answer any medical questions you may have”. That definitely set the tone for how this tour was going to proceed. As we moved through the tour the guide had pointed out the “lovely photographs on the walls” and “the great view of the Hudson river” that you get to enjoy when you deliver at the hospital. She also added in that the phone is completely free for the mother’s first night after having the baby and that if you have your baby on a Sunday you and your husband can watch football for free as well.

                Besides feeling like this tour guide was trying to sell me the hospital rather than a positive birth experience I also noticed something else that felt off to me: not one person on the tour asked a single question. I had many questions and going into the facility as a “pregnant woman” who was interested in delivering in their hospital I demanded some answers. At first the tour guide tried to answer some of the questions, for example I asked what percentage of people within the last year who labor there had received some type of augmentation of labor. The women seemed quiet confused and said that she would introduce me to someone better equipped to answer my questions.

                I was then introduced to the head nurse for labor and delivery, who at first was very warm and inviting of my questions, though she soon became defensive and hesitant in answering them. The answers that she gave me as a “consumer” of the “product of birth” were astonishingly different than those listed on their state mandated report of statistics. One example: I had asked the woman what percentage of women receive an unplanned epidural when then come in with a birth plan specifically stating that they do not want one. Her answer to this was “unfortunately around 20%-30% of then NEED it”, after researching public records actually statistic the actual statistic was closer to 60%!

                I do not mean to speak badly about this hospital or any other, I just wanted the truth, and this is what I got. It makes me angry to think that one of the women who holds a specialist position in the labor and delivery room did not answer my questions correctly. It infuriates me to think that she may have lied and makes me very disappointed to think she just may not have known!