Changes in Hospitals
Meaningful or just window dressing?
For a brief period in the late 1970′s, rigid hospital policies across the United States started to break down. In direct response to a growing vocal minority of birthing women and their families who desired truly natural birth in the hospital setting, nurses and physicians began to simply turn their back on such rules as “only one family member may be with a woman in labor.” Others got their hospitals to change the rules to permit two or even more family members and friends.
Women were refusing to sit in a wheelchair upon admission, insisted upon walking to Labor and Delivery, and walked out of the unit carrying their baby instead of being pushed in a wheelchair. Women were refusing to be moved from labor bed to gurney when it came time to go to the delivery room and were walking the halls with family members during labor. They wanted more than ice chips for nourishment and were bringing picnic baskets of food into the hospital, to feed themselves and their doctor and nurses. They brought candles and flowers, some brought their own sheets, a poster to focus on during contractions, tape recorders and music.
Labor and delivery
For the first time in the history of hospital birth, the labor and delivery unit became a lively place. Children were snuck into labor and into postpartum rooms, where a growing number of mothers were insisting on “rooming-in” with their babies and refusing to allow their babies to be taken to the nursery at night or given sugar water or silver nitrate in their eyes. And almost overnight a growing number of hospitals across the country changed their long-standing policies to allow children to be present at birth and with the new baby.
In many communities women banded together, formed organized groups with names like The Tri-City Mothers, did literature searches and produced volumes of scientific material proving that things they wanted were safe. These individuals and groups confronted chairmen of obstetric departments and heads of nursing with findings that ran directly counter to standard hospital policies that had never been successfully challenged by doctors and nurses in the system. These included scientific proof that:
- Putting an IV in woman’s arm and administering glucose water was an inadequate and inappropriate way (not to mention inconvenient and uncomfortable) to keep a laboring woman well-hydrated.
- It was safer and more effective for women to eat and drink at will during labor.
- Drugs given to women in labor did get to their babies, had a negative effect on labor, and were hazardous to the babies as well.
- That cutting an episiotomy was not necessary or beneficial in most births and that a good midwife could prevent more than superficial tearing. Healing from an episiotomy was, in fact, more troublesome than healing from a naturally caused tear (and that episiotomies tended to extend, whereas natural tears tended to be minimal).
- That a baby can be kept warmer lying skin-to-skin on its mother’s body than under warming lights on a warming table.
- The routine practice of taking every baby to the nursery for “observation”, and the bottle-feeding the baby sugar water undermined breastfeeding.
Home Birth Resurgence
Home birth and “lay” midwifery practices were producing changes in the practices of some nurses and doctors (even some hospital nurses and doctors began to have home births with these “lay” midwives!). Home birth midwives and couples explored various non-invasive, non-medical practices to keep labor on course, get contractions going or going stronger, to cope with pain, to prevent tears, and to stop excessive bleeding after birth.
Many self-trained midwives became skilled in handling complications without resorting to taking the birthing woman to the hospital. An entire body of wisdom regarding how to keep birth normal and resolve problems safely coalesced. Much of it came from indigenous practices of granny midwives, verterinarians, and others familiar with animal births. Books were published and knowledge was shared at conferences.
Because of the control that hospitals, doctors and medical management practices now had on birth, they sought out and talked to rural “granny” midwives and midwives from other countries who had been unable to practice legally in the U.S. so were working as labor and delivery nurses. They learned, for example, that with a big baby, having a woman lying on her side for delivery or being on her hands and knees brought the baby out without a tear. They researched and experimented with herbal and homeopathic remedies. They read Dr. Gregory White’s “Emergency Childbirth” manual and a manual for Mexican midwives.
A growing percentage of American women and men became knowledgeable and skillful in birth and dared to stay home. When some of these same couples did go to the hospital for one reason or another, they brought their bag of skills and knowledge with them. Today in many hospitals, one or two labor and delivery nurses and physicians might use these practices, which they never got in training but learned from home birth couples and lay midwives of the 1970′s.
As a result, in some communities in the U.S., Canada, Mexico and some other countries, women can sometimes find nurses and doctors who will use warm compresses or oil on the vulva to keep a woman’s perineum from tearing or being cut as the baby is born. They might find doctors who will place a newborn that is stressed directly skin-to-skin on the mother’s abdomen or chest to help it stabilize rather than whisk it across the room or down the hall for medical intervention.
“Change” in Hospitals
From the late 1970′s into the early 1990′s in the U.S., approximately 5% of women birthing in the hospital labored, gave birth and recovered in the same room, where policies included the allowance of siblings, family and friends to be present. In the 1990′s, a growing number of hospitals, responding to consumer demand, converted their separate labor and delivery rooms to single “LDR” rooms, where women could labor, birth and recover in the same room. Birth centers in hospitals, some complete with Jacuzzi tubs and kitchenettes and double beds are no longer as rare.
However, such humane environments for birth are few and still underutilized by physicians who resist doing a delivery anywhere except in a sterile delivery room, on a metal table with the woman on her back in stirrups.
Fancy wallpaper and high-tech equipment like electronic fetal monitors hidden behind drapes or in cupboards do not signal fundamental changes in attitude of staff. It’s still a rare hospital in North America that “permits” woman-directed birth, that keeps all healthy newborns with their mothers and works actively to keep babies out of neonatal intensive care.
Too many “sick” babies?
Today the newborn ICU (NICU) usually has the highest occupancy rate in the hospital. And high occupancy, especially in expensive ICU rooms spells big profit. That, plus the standard policy of paying physicians more money for doing medical interventions and cesareans than for doing natural births keeps natural birth to a bare minimum in the hospital.
And a small number of nurses and physicians today are as frustrated and angry about hospital birth practices as the parents who want alternatives are. As for the rest, it’s birth as usual. What that means is complications where there should be none. It means high-tech and hazardous invasive procedures where low-tech and hands-on human care would work better or at least equally well. And, it means women entering and leaving the hospital certain that what goes on inside those walls is good for them and their babies. Birth trauma is seldom acknowledged, especially from iatrogenic (physician/nurse caused) complications.