Taking the Fear Out of Birth: Not Getting to the Hospital

My friend Kylie of Family Birth Support and I (Amy of AKFW Childbirth Services) have started a new column in one of our local papers called "Taking the Fear Out of Birth."  Since this particular paper is not online, I will also be posting our articles here to share with the the internet community.

The first article in this series is on "Not Getting to the Hospital."  Enjoy!

Taking the fear out of birth: Not getting to the hospital.

By Amy Wehner, childbirth educator (www.akfw.net)

It’s an exciting movie scenario isn’t it?  A very pregnant woman in labor rushing out of a public place or in a car wondering if she will make it to the hospital?  Turns out, many women (and men) are afraid of this; they just won’t make it to the hospital in time to have the baby.  Fortunately, this isn’t the worst scenario for childbirth, and the likelihood of it happening is pretty low.  In the US in 2009, only 0.9 percent of births (about 40,000) happened outside of the hospital, this includes planned and unplanned births. Of those, only 6% (2,400) didn’t occur at home or in a birth center or hospital[1], which means you have about a 1/2000 of finding yourself in an emergency situation.

However, since it is preferable to have your baby with a trained medical professional near by, let’s talk about what you should do to lower your risk of an emergency childbirth and what to do if it does happen.

First, prepare for situations like this by taking a childbirth education class.  Look for a class that teaches both you and your partner about normal, healthy pregnancy and labor and how to deal with the unexpected.  Practicing labor can help you both to talk about what you would do if the unexpected arises.  Understanding what normal labor looks like will help you judge better when it is time to get to the hospital.

Second, having an additional birth professional, like a doula, can give you extra peace of mind in an emergency.  A doula supports you through the entire labor and is available to you before you go to the hospital.  She helps support your partner in many ways so that he can attend to your needs.  She can also call 911 and help coach you through emergency labor.

Third, it’s unlikely you won’t know you are in labor in advance (more likely with your second or third child, but still not great).  The biggest problem here would be your distance from the hospital.  To plan for this, you can compensate by leaving a little earlier than recommended.  The most common recommendation for leaving for your birthing facility is the 4-1-1 rule, contractions 4 minutes apart, lasting for 1 minute for the duration of1 hour.  You can adjust this as needed to give you time to get to the hospital.  One caveat: if you are like me, your contractions may not be regular, varying in length and time.  In this case, call your doctor, earlier rather than later, to get their recommendation.

Now, if you do find yourself an emergency birth situation, here’s what to do [2]:

1.     Don’t Panic. Childbirth is completely normal and natural.

2.     Call 911 from the nearest available phone.

3.     Stop, in a safe place and prepare.  Find any blankets, sheets or t-shirts you can, place under mom and over baby when born.  Stay where you are and wait for the ambulance.

4.     Let nature be your guide, do not give mother any medications, or alter her state or the baby’s at any time.  Let baby and afterbirth come naturally without assistance.

5.     Catch! Dads, that’s it! Don’t pull, tug or turn the baby to help. Place your hands under the head and allow the baby to fall into your hands gently.  Be prepared for it to be a little slippery at first!

6.     Put baby skin-to-skin with mommy immediately. Have her try to breastfeed, which helps pass the placenta and reduces risk of hemorrhage.  It’s also the best way to keep baby warm. Put baby directly in contact with mom’s skin and cover both.

7.     Do NOT cut, tug, or pull the umbilical cord.  Let the placenta come naturally and gather it and umbilical cord in blanket with baby.

8.     Finally, cheer up!  If this does happen to you, now you know what to do and you will have had a great natural birth and a fun story to tell for years.

For more information contact Amy Wehner at amywehner30@gmail.com, or Kylie Saari at familybirthsupport@hotmail.com.

Next time: Taking the Fear Out of Birth: Loss of Privacy/Modesty

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[1] MacDorman, M., Matthews, T.J., Declerq, E. (2012). Home births in the United States, 1990-2009. NCHS Data Brief, (84), Center for Disease Control and Prevention. http://www.cdc.gov/nchs/data/databriefs/db84.pdf

[2] Adapted for non-medical professionals from the Federation of American Scientists bulletin, Emergency Childbirth. http://www.fas.org/irp/doddir/milmed/childbirth.pdf

Article Reference:

Wehner, A. (June 26, 2013). Taking the fear out of birth: Not getting to the hospital. The Fairmont PhotoPress, 50(7), 4.

48th in Maternal mortality....really US?

-->According to the CIA World Fact Book, the United States sits at 48^th in maternal mortality rates compared to the rest of the world.  Some sources (www.huffingtonpost.com) estimate that it is now 50^th as of 2012.  This puts the United States behind every other industrialized nation (and a couple developing nations).  Why is this?  How can a country with so much wealth and advances in technology be so far behind?  Many people in this country claim that it is the best in the world, well, this stat certainly doesn’t seem to prove that.  Here is the list of the 47 countries that have better maternal mortality rates than the US:

Table 1: Top 50 Countries Ranked by Maternal Mortality Rates and Showing Health Expenditure

Rank	Country	Deaths/100,000 births	Heath expenditure %/GDP & world rank
1	Estonia	2	6%, 85
2	Singapore	3	4%, 24
3	Greece	3	10.3%, 173
4	Italy	4	9.5%, 158
5	Austria	4	11%, 179
6	Sweden	4	9.6%, 161
7	Finland	5	9%, 149
8	Iceland	5	9.4%, 155
9	Poland	5	7.5%, 119
10	Czech Republic	5	7.9%, 130
11	Japan	5	9.5%, 157
12	Spain	6	9.5%, 159
13	Slovakia	6	8.8%, 145
14	Netherlands	6	11.9%, 193
15	Ireland	6	9.2%, 153
16	Norway	7	9.5%, 156
17	Qatar	7	1.8%, 1
18	Australia	7	8.7%, 144
19	Germany	7	11.6%, 189
20	Israel	7	7.6%, 123
21	Portugal	8	11%, 180
22	Montenegro	8	9.1%, 152
23	Lithuania	8	7%, 112
24	Switzerland	8	11.5%, 187
25	Malta	8	8.7%, 142
26	Belgium	8	10.7%. 177
27	France	8	11.9%, 182
28	Bosnia/Herzegovina	8	11.1%, 181
29	Kiribati	9	11.3%, 184
30	Cyprus	10	6%, 86
31	Macedonia	10	7.1%, 113
32	Bulgaria	11	6.9% 108
33	Denmark	12	11.4%, 186
34	Canada	12	11.3%, 185
35	Serbia	12	10.4%, 174
36	United Arab Emirates	12	3.7%, 20
37	Slovenia	12	9.4%, 154
38	United Kingdom	12	9.6%, 160
39	Kuwait	14	2.6%, 7
40	New Zealand	15	10.1%, 170
41	South Korea	16	6.9%, 107
42	Croatia	17	7.8%, 127
43	Luxembourg	20	7.8%, 126
44	Turkey	20	6.7%, 99
45	Bahrain	20	5%, 50
46	Puerto Rico	20	N/A
47	Hungary	21	7.3%, 117
48	United States	21	17.9%, 190
49	Iran	21	5.6%, 72

Additionally, the WHO Health Statistics Report shows that, since 1990, maternal mortality rates have nearly doubled going from 12/100,000 live births in 1990 to 21/100,000 live births in 2010.  This abysmal ranking is in spite of the fact that in 2010 the US spent a higher percentage of its GDP in health care (17.9%) than every other country in the entire world except for the Marshall Islands (18.1%, well at least we aren’t the worst right?).

While it does not appear that money spent = lower rates, the majority of the top 20 countries spend between 8-11% of their GDP on health care, with the exceptions of Estonia (6%), Singapore (4%) and Qatar (1.8%).  This seems to indicate that spending between 8-11% of GDP is the optimum amount to spend on health care.  Much more (like the US) and there seem to be issues with efficiency and overuse of expensive procedures, and much less (Somalia, Chad) and there are not enough services to help every woman.  Some countries, especially in the Middle East show low percentages due to very high GDPs and smaller populations (United Arab Emirates, Qatar)

According to an article done by Frontline ((http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/countries/models.html), there are basically four ways of paying for health care: The Beveridge Model, the Bismarck Model, The National Health Model and the Out-of-Pocket Model.  The majority of the countries in the top 46 have one of the Beveridge Model, the Bismarck Model or the National Health Model.  All three of these models require the involvement of government to either provide health care or provide regulation on health care so that prices stay low and affordable.  The Beveridge Model is government controlled health care where all health care professionals either work for the government or receive their payment directly from the government.  This model is used in countries like the UK, Scandinavia, Spain, and New Zealand.  The Bizmark model uses private insurance and health care providers funded by employers etc (similar to the US), but the government is responsible for regulating the industry to make sure that everyone is insured and prices stay low.  Countries like Germany, France, Belgium, Japan, the Netherlands, Switzerland and much of Latin America.  The National Health Model uses private health care providers, but bills are paid for by the government, which is funded through taxes.  In all three sections, health care providers and insurance companies are non-profit, which keeps prices low and ensures that the patient will get preference not the procedure.

So here is the thing, almost all of the countries that are doing better than us in maternal mortality rate use one of those three systems.  The United States has pieces of all four systems (including the out-of-pocket system, which means rich people get health care and the poor do not).  This makes our system completely disjointed, inefficient and means that the systems values practices that cost the most money rather than save the most lives. 

The US C-section rate is 33% and growing; that is worse than 175 other countries in the world and more than twice the WHO recommendation for 15%.  A C-section is a costly procedure that benefits both doctors and for-profit insurance companies.  Delivery of mediations (epidurals, spinals, Pitocin), running fetal monitors, these are all things that hospitals get to charge people for, which increase the bills and gets more money for them and the insurance companies.  C-sections and medications are necessary in some cases and o help some women, but these rates show that there is too much unnecessary intervention going on.

These “standard” procedures are also what cause most of the complications that women face during labor, which leads to higher death rates.  In countries that use one of the 3 primary health care models, the government is able to control the use of these procedures because they end up costing tax payers and people more money (which they do here too, even if you have health insurance, don’t kid yourself you are paying for these expensive procedures!).  For instance, in Canada, doctors are now trained to deliver breech babies vaginally in order to lower the rate of C-sections and keep rates and prices low for the people.

In many of these countries (Canada, Scandinavia, the UK, Germany, etc.), midwives are also an integral part of the health care systems.  Their services are less expensive and since they promote natural birth, the births themselves cost less.  For the majority of low-risk mothers, this is the best way to have a baby, and it is the cheapest.  The systems of doctors and midwives work together in these countries to insure that the majority of mothers who do not need interventions have healthy babies, but when the mothers come in that do need help to save their lives and those of their babies, doctors and hospitals are necessary as well.

While acceptance of midwives is growing in the US, there are still many states where the practice is illegal, or midwives are so strictly regulated that they can’t perform their duties to the best of their abilities and it actually causes problems. 

The US health care system is so disjointed that we cannot effectively treat women. Too much depends on expensive procedures, expensive medicines and not enough on the health of the woman (or anyone for that mater).  I’m not saying that there is a perfect system out there (because that isn’t possible, we are human after all and gloriously imperfect), however we need to streamline this system, pick one, and move forward.  Pick a system that promotes the health and wellness of the people and not the pocket books of the insurance companies and health care professionals. 

My birth story

Last night I sent in my application to register for the Bradley Method teacher training.  Becoming a Bradley instructor and Doula has been on my mind for sometime and last night I finally took the leap.  Since it was my own birth experience that was the impetus for doing this, I thought I would share with you my story.  Getting the word out about the actualities of natural childbirth has become very near and dear to my heart.  Women have spent too long being lied to about what birth is or should be like, when the truth of the matter is that everyone is different, so it is important that we share our stories.  

First, I want to preface this story by saying that I am a wimp!  I have no tolerance for pain and still have a terrible, uncontrollable fear of needles, yet I decided to do a drug free birth to give my daughter the best start I knew how.  I recommend for any one wanting to do an all natural birth 3 things: 1) Education:  read as much as you can about natural child birth and about you options, this where Bradley Method classes come in handy, because they give you very detailed information about the birthing process.  2) A supportive Doctor/Midwife and hospital who will encourage you to have the birth experience you want and 3) A good Coach.  Bradley classes helped me learn more about birth than I ever knew and taught Ryan to be a supportive coach so that when the time came he could be my greatest source of support and encouragement, which is a necessity.  A strong support system is crucial because inevitably you will cry out “I can’t do this anymore!” and you need someone to say, “YES YOU CAN!”

On May 6, 2011, we went to see Kim, our midwife.  Aurora was a week late and I was getting worried that she wouldn’t make it before Grandma Dawn had to leave.  Kim said it could be a couple more days before she arrived, but we were hoping it would be sooner.  That day I tried to relax a lot: we ate lunch at Chili’s (I had a lot of very spicy buffalo wings), we went for a walk around Ikea and watched some TV and then Ryan and I went for a walk at home.  We stayed up late that night, at 1 am on May 7, 2011, Ryan and I finally decided to go to sleep.  I had had some strange stomach pains while walking earlier and I was very tired. 

 However, while we were getting ready I went to the bathroom and noticed that there was some blood in my urine.  I had passed the mucous plug, one of the signs that Aurora would be coming soon.  Immediately after I went to the bathroom, I started having strong pains in my back and stomach.  We weren’t sure this was real labor because I had been having a lot of contractions the last couple of months of my pregnancy; but these were different.  We called Kim and she said to just go to bed and see what happened.  So we did.

The contractions continued fairly irregularly while I tried to sleep.  I would wake up when they came and then fall back asleep between them.  Finally, at about 4 am, I couldn’t handle the pain by myself any more, I needed some support.  I work up Ryan so he could help me.

     

 I had very bad back pain during my contractions and Ryan had to press very hard on my back to help me with the pain.  We still managed to sleep in between contractions for a couple more hours, but then finally at about 6 am the contractions were too strong and coming too frequently to sleep.

         

 We were timing the contractions, but they were very irregular and so we didn’t know when to call Kim for her to come.  The rule was 411, when the contractions were 4minutes apart, lasting for 1 minute and had been doing so for 1 hour.  My contractions were very irregular:  bouncing from 7 to 5 to 6 to 3 to 4 minutes and lasting for sometimes 2 minutes.  At one point my contractions went from 6 minutes to 3 minutes apart, so we decided to call Kim.  She arrived around 9 am as we went into full labor.  I continued laboring mostly in bed with occasional trips to the bathroom.  I didn’t want to get up and walk or eat or drink or do anything, my back hurt very bad and when I walked the contractions got more intense and closer together, good for making the baby come faster, but bad for the back pain.

      

Ryan, my husband, was AMAZING, he stayed by my side almost the whole time and helped me relax through each contraction.  He gave me encouraging words and made sure that I got the support I needed.  Grandma Dawn was there and she helped Ryan so he wouldn’t have to leave my side.  The only time he left me was to get me food, and once to try and fill the birthing tub. 

         

 My contractions were very irregular so I was a little afraid that I was going to be in labor forever, but things progressed nicely.  Our midwife, during 2 contractions helped stretch me a little more, which made things move a little faster. (This is not a comfortable procedure, but it helped!)

     

 Finally about 2:30 pm I had a contraction where I felt ready to push.  She was almost here!  I got in the birthing tub, and the water helped me relax and helped the pain go away instantly.  My water broke on my first contraction in the pool.  I wasn’t in the tub very long before I really wanted to push and knew she was coming.  Ryan got in the tub with me to support me.  He held me so I could float in the water and relax between the contractions.  It was awesome to be able to really relax every muscle in my body between pushes!

     

 Pushing was very hard, but she was very ready to be born because I didn’t have to do it for very long, only 45 minutes, which is very short.  After a couple of pushes I was very tired, but my body took over and did the work by itself so I didn’t have much time to think about it.  Our midwife helped me through the contractions, coaching me to do short, controlled pushes so that I would slowly rock her out; this prevented me from tearing (which I didn’t!).  Suddenly Kim and Grandma Dawn were saying that they could see her head.  After a couple more pushes she was out.  Aurora cried immediately and was very, very loud, but it was the best sound I had ever heard because it meant she was alive.

     

 They gave her to me and I held her in my arms as she cried.  She was so beautiful and alert.  Right away she opened her eyes, lifted her head (so strong!) and looked right at me.  Ryan kept saying how wonderful and beautiful she was.  It was the most wonderful moment of our lives.

Now, almost 2 years later, I want to say thank you again to Kim Verbarg of Sweet Child O'Mine, Charlie Rae Young and Dr. Alexa Valdez-Fagan of Totally Chiropractic for being there to support us during our birth.

If you would like to share your story about attempting natural childbirth (I say attempting because I know that isn't always the outcome), put it in a comment on this post so we can bring all of our stories together.  Share it with your friends and family and spread the word to help empower women so that we can take back control of our bodies and birth experiences.