Nov 172012
 

“Most women say they want to go natural, but don’t actually do it.” – OB to mother while discussing birth plans.

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 November 17, 2012  Birth Plan, epidural, OB  Add comments

  34 Responses to ““Most Women Say They Want To Go Natural, But Don’t Actually Do It.””

  1. Option One: Women don’t actually know what they want, so they require a fine doctor like you to inform them of their actual wishes.

    Option Two: Women under your care do know what they want but are en-masse unable to achieve it because of some situation or circumstance common to all of them.

    Shall we start listing what those commonalities are? Let’s start with *your* birth plan, the one you have on file with the hospital and that gets applied universally to all your patients, regardless of what they want. That would be a good place to start looking for a reason these women are mostly unable to achieve what they want.

    And if women don’t get what they want under your care, how does that make you feel? How do you feel when woman after woman after woman goes to you for what she wants and instead gets something else?

    Just some thoughts, Doc.

    • Option 3: Women have no clue what labor is really like until they actually go into labor.

      Many women, myself included, are shocked by how painful it can get. The OB is being honest. Most women say they want to go natural, but there’s no shame or dishonor in deciding late that you want an epidural or other pain medication.

      • Absolutely correct.

        I have had two births so far: one [traumatic due to interventions] with an epidural and one without an epidural. Personally, I preferred the no-epidural route, but nearly all my friends fall into the category of wanting a vaginal birth with an epidural. If that’s what they want, then great!

        • This isn’t about the women who want epidurals. This is about all of the women who want to go natural and are undermined from the minute they leave their house. I do realize that a lot of women don’t really understand how intense birth can be, and that every birth is different, but I don’t think that most births should be so catastrophic that a whole birth plan needs to be ignored. I have had two med-free births, and I don’t think I’m a superhero or a freak. I was just well-informed and well-supported by my companions. My births hurt. My first one caused extreme injury. I’m still very glad that I was able to get as close to my ideal experience as I did. I also feel the need to point out that while my births were both painful and intense, my homebirth without all of the ridiculous hospital interventions was much calmer and easier to manage. I like to say, most people don’t need an epidural for birth. You might need it for the hospital.

      • This is what I told the midwife at one of the first prenatals: my goal is a non medicated birth but I’ve never experienced labour before and I truly have no idea what contractions feel like. So if I decide I really need an epidural I would like to have that option. She said she actually recommended an epidural to a woman recently because she really needed it (very long intense labour). I love my midwife! Turned out I had a pretty easy 18ish hour labor and the thought of pain relief didn’t even enter my mind, not even during transition.

      • While that’s true, I believe if most women want something, many of those should be achieving it. If the doctor’s experience is that an overwhelming majority of women aren’t able to achieve something they want, then there’s an extra problem involved.

        Also, there are routines the hospital implements which do increase the pain level and decrease the woman’s ability to self-comfort. (For example, putting a woman on a monitor will confine her to bed for the duration of the monitoring; if a baby is in a bad position for delivery, being in bed will decrease the baby’s ability to change positions, thus keeping contractions painful for far longer than they would be if the mom were moving around and enabling the baby to move.) I’m sure that does in some cases make the difference between a woman achieving what she has stated she wants versus opting for pain management during labor.

        To be clear: I have no issues with women opting for pain management during labor. They can and should feel free to do so without any fear of judgment. It’s not a contest and (as they point out all the time) you don’t get a medal for a drug-free birth or an epidural birth or whatever.

        But I do believe the majority of women should be able to have something they want.

        • Friday night, we went out to dinner at a new restaurant. Both my husband and I decided to order the lamb. But right while we were ordering, he said, “Why don’t we get one lamb and one chicken?”

          “Okay,” I said.

          Now, going into the restaurant, we both wanted lamb. We’d discussed lamb. I wanted lamb. But, he changed his mind and wanted to try the chicken. He ordered chicken, I ordered lamb.

          Our food came and I tried his chicken and I liked it better than the lamb, so we switched.

          Should the waiter have tried harder to get me to eat the lamb? After all, prior to ever eating at this restaurant (an entirely new experience!)I said I wanted lamb.

          Should I complain about my husband who allowed me to have chicken (his!) when I changed my mind after experiencing the lamb?

          You can think you know what you want, but until you’ve actually been in labor, you’re just guessing. And it’s all right to change your mind.

          And what I see, over and over again, is women feeling like failures because they gave in and got pain relief, when in reality they should be grateful pain relief is available and happy they were able to have it if they wanted.

          Sure, doctors and nurses should be supportive, but that doesn’t mean saying, “You said you wanted to go natural, so no pain relief for you!”

        • But why should doctors and nurses help a woman achieve something that she’s changed her mind on?

          If I walk into an obstetricians office and say, “Hey, I want to go natural! I’ve done the research, that’s what I want!”

          And then 10, 15, 25 hours into labor say, “Hey, this stinks. Give me the good drugs,” why on earth shouldn’t my obstetrician believe me?

          • Well, first off, we don’t know for sure why all these women are changing their minds. Obviously they have the right to change their minds and the women should get the medication at that point.

            But BEFORE she’s changed her mind, she deserves all the help she can get to ensure she doesn’t change her mind and can achieve the birth she envisioned having. That means nurses who don’t walk in every hour and say, “Are you still being stubborn about not having a glorious, pain-free birth?” That means not confining a woman to bed unnecessarily. That means nurses who know how to support a natural labor rather than thwart it.

            I just find it hard to believe that the majority of women are physically unable to do something they would have had no choice about doing two hundred years ago. Every single woman who changes her mind and opts for an epidural (which is her prerogative!) would have had to go through labor without an epidural if she were delivering out on the Oregon trail, right? So what’s drastically different about labor now and then that renders women who previously said “No, I prefer not to have drugs” to “I can’t go on without it”?

            It’s the unnatural hospital environment. It’s the sabotage from nurses and doctors who snort and say, “Yeah, MOST women are naive like you, but then they don’t actually do it.”

            It’s also the subtle traps we set up that make labor harder than it has to be. “Oh, gee, let’s just break your water and speed things up,” when no woman on Earth has ever said, “You know what I really want now? I want labor to be much, much harder.”

            If you walk into the obstetrician’s office and say, “Hey, I want to go natural!” then you should have the right to be helped to that end. If you change your mind later, that should be respected, but the goal should be to help you not change your mind because you’ve got all the support necessary.

          • of course not. but the woman is not at this stage yet, she is discussing a birth plan and *her birth*. what reason does doc have not to take whatever her stated wishes are seriously?
            they don’t say, when you join a gym, ‘most customers who join our programmes want to get fit and healthy but most of them don’t.’ they help you achieve your goal and are encouraging both in word and action.
            please note i’m not comparing pain relief in birth to poor health, just talking about people’s goals and desires for themselves.

          • The point is not to make it so hard for the woman that she’s forced to change her mind.

            once her mind is changed, of course you support her decision. Let her own her decisions.

            But until that point in time, why should the hospital system undermine her decisions? Why should the doctor undermine THIS woman’s decisions?

            If most women who decide to do something don’t end up doing it, and women are not as a general rule weak, then I suspect sabotage or that the hospital is setting the hurdles impossibly high. Much higher than the work of labor itself.

          • The point is not to make it so hard for the woman that she’s forced to change her mind.

            once her mind is changed, of course you support her decision. Let her own her decisions.

            But until that point in time, why should the hospital system undermine her decisions? Why should the doctor undermine THIS woman’s decisions?

          • But why is telling her that most women change their minds undermining her? It’s giving her facts. It’s preparing her for the possibility that she may change her mind and that is okay.

            It’s not undermining, it’s educating, something people around here advocate for, right?

          • Because I dispute it’s a fact that most women are incapable of giving birth without pain-relieving drugs.

            Let’s say I’m your high school guidance counselor who’s in charge of helping students get into college. If you told me you wanted to go to college, and I snorted and said, “Well, you can fill out the application. Most people say they want to go to college, but they don’t actually do it,” you would feel undermined.

            You would begin to have doubts that you could get into college, since I’m supposedly an authority on getting kids into college.

            In fact, because as an authority I’m telling you college is nearly impossible to achieve and even if you get in, you’ll probably change your mind once you see the courseload.

            It may be true that this particular doctor is incapable of helping women birth vaginally. That doesn’t mean the majority of women cannot birth vaginally without pain meds any more than it means the students of an incompetent high school guidance counselor are incapbable of getting into college.

          • Giving her facts would be, “So you’re telling me you would like to avoid pain relieving drugs during labor. I’m writing that down, but I want you to understand that if you change your mind, we can still offer you whatever pain relief you need. Some women do find the contractions are a bit more than they can handle alone, and we can work together to take the edge off.”

            This “Most women say X but most women don’t actually do it” is derogatory of women in general and designed to make the woman feel naive and weak.

          • Thousands of years of history tells me that women are perfectly capable of giving birth without pain relief.

            It’s not “can” you do it, but why should you do it if you don’t have to. Our ancestors had no choice. Once you were pregnant, the baby had to come out and it was going to hurt.

            We now have a choice. And it does not make you a better mother or woman if you go drug free. It does not mean you love your baby less if you get an epidural. It means you had a choice.

            One is not morally superior to another.

          • I have never said one way is morally superior to the other. If you scroll back up the screen, I said women should feel free to have pain-relieving medication without fear of judgment.

            Any woman who wants to birth drug-free should be supported in her decision until that is no longer her decision. But we don’t need doctors telling women, in effect, “You’re going to give up eventually, so give up now.” That’s not supporting her decision to birth drug-free.

          • Thousands of years of history tells me that women are perfectly capable of giving birth without pain relief.

            It’s not “can” you do it, but why should you do it if you don’t have to. Our ancestors had no choice. Once you were pregnant, the baby had to come out and it was going to hurt.

            We now have a choice. And it does not make you a better mother or woman if you go drug free. It does not mean you love your baby less if you get an epidural. It means you had a choice.

            One is not morally superior to another.

            Telling a woman that most women choose drugs isn’t undermining. It’s letting her know that it’s okay to make that choice.

            They are morally equal choices.

          • Telling a woman that most women choose drugs isn’t undermining. It’s letting her know that it’s okay to make that choice.

            I think this is where we’re talking past one another.

            Telling a woman that most birthing women choose drugs = giving her information

            Telling a woman who has just told you she wants no drugs that most women who say what she has just said will actually not get what they want = undermining

            If the doctor said this to a woman who said, “What’s your experience about women who want to birth drug-free?” and the doctor answered this, it’s factual.

            If the doctor said this to a woman who said, “I’m really excited to have this baby drug-free,” then it’s undermining.

          • Well, I had a home birth and when I hit transition the contractions were the worst yet. I couldn’t do anything but moan through them. The pain in those moments was overwhelming. At one point I looked at my husband and doula and said “I can’t do this. I don’t want to do this anymore.” I wasn’t REALLY saying I wanted to go to the hospital, I was really looking for comfort and confirmation that I *could* do it. It was easier to voice my fears that way then to say “Tell me I can do this.”
            Does that make sense?

      • Agree. I had an epidural with my first. While it was a great experience overall, I didn’t like some things about it and thought it could be better without an epidural for my second, so I decided to try med-free with my second.

        I labored 8 hours med-free. The pain was getting more and more intense and nothing was alleviating it. My body was tensing up because I was so in distress from the pain and, though I was fully dilated, the baby was not dropping no matter what I did. After an hour of this, I discussed things with my MW and we decided together than an epidural was a good option for me.

        Ended up, it was exactly what I needed. The pain subsided, I finally relaxed and my 10 lb baby came out in 2 pushes (literally) about 20 minutes after the epidural was put in.

        Point of my story is, labor isn’t one size fits all. Going into that L&D room, the plan was to go med-free. My care providers were on board with that and didn’t really weigh in one way or the other. I was my decision and what I wanted. On the same token, when I decided that med-free wasn’t working for me, my MW got me the care I needed. The end result was an excellent birth experience, a healthy mother and a healthy baby.

        I never felt like the decisions weren’t mine or that I was being put down or judged for what I wanted to do for my birth. That’s the way it should be…

  2. “It’s SO WEIRD…..I pump them full of pitocin, tell them to lay quietly in bed so they won’t move the monitors, and don’t allow them to eat. I have no idea why they end up wanting an epidural!”

  3. Maybe because so many OBs like this one are unsupportive.

  4. Maybe his/her patients actually are having near natural births, but because they had a little bit of this drug or had very serious back labor and needed the epidural that he/she is mentally labeling them failures. I don’t think it is an all or nothing thing. I think the goal should be to keep the drugs and interference to a minimum in order to avoid problems. Much like I believe a home birth transfer is usually a responsible response to difficult circumstances and not a reason to declare people incompetent and irresponsible. If a woman says she doesn’t want drugs, but is faced with something that warrents them that doesn’t give this doctor the right to declare her a failure. There is such a thing as setting the bar too high.

    • Love this. Virtually all interventions are needed under certain circumstances, but they should be used judiciously and through consent of the woman working in partnership with her care provider. Planning an unmedicated birth but then choosing, for instance, to get an epidural so an over-tired mother can rest a bit, relax her muscles enough to finish dilating completely, and then push her baby out — this is not a failure! Similarly, planning an unmedicated bith but then opting for a c-section in a circumstance where one is warranted (for whatever reason) and likely life-saving does NOT make mom a failure!

  5. define natural in this context. I did not receive any pain meds in either of 2 births, but i DID have my water broken both times, does that kind of interference count as not natural anymore? you have to be more specific. and how many of those who want to go natural have a serious complication that actually warrants a c-section and now you are counting them out too because they didnt even get the chance to go natural?

    how many say they want an epidural and somehow go natural?

  6. Oh, Mr. Doctor, do you hear from all women who are giving birth? So you can say that “most women” want but don’t achieve natural birth? I think what you meant was “most women under my care” (since those are the women whose wishes you are hearing and whose births you are witnessing). So, as said above, maybe you are part of the problem?

  7. hmm i did! BUT saying that doc, what most women want is firstly not really a care of this particular woman.
    and secondly most women do not want a natural birth, most women want a vaginal birth, a percentage of those do want a natural birth but another percentage go in fully intending to get the epidural for one reason or another and theres the rest who want something in between natural and epidural, and some women choose a c section. all are valid ways to have a baby and all those women deserve the same respect and your job should be to ensure that these women get the birth that THEY desire

  8. A couple questions-
    Are you looking at numbers or relying on your memory, because you’re most likely to remember the cases that took up the most of your time- so not likely the ones that were low-intervention.
    Second, what are you doing to support your patients who want a natural birth (by their definition, not yours?

  9. I know a lot of women that were pursuing a natural (meaning unmedicated) birth without having experienced birth before. It was more intense than they thought it would be and they opted for medication. That’s their choice!

    BUT… the standard of care in a hospital birth goes against a woman’s natural instincts. Going against those instincts exhaust a woman and the combination of going against her instincts and exhaustion almost always leads to interventions. That’s where the problem lies with this doctor’s statement. As a general rule, doctors and hospital staff treat birth as a one size fits all situation and don’t bother to take the individual’s needs and desires into account.

    (Please note that I said as a general rule! I know it doesn’t happen everywhere.)

  10. Ach, site ate my comment again! This is the main reason I don’t post here everyday anymore! Let’s try this again!

    I know a lot of women that have wanted a natural (meaning unmedicated) birth and while in labor, realize that they have underestimated the intensity of it and change their mind. That’s their choice!

    That having been said… I firmly believe a lot more women would succeed in having the natural birth they are aiming for if they were better supported. Oftentimes, doctors and hospital staff treat birth as a one size fits all situation and fail to take individual needs and desires into account. They require a woman to do things that go against her natural instincts. That leads to exhaustion. More often than not, the combination of going against her natural instincts and exhaustion lead to interventions. (I know this isn’t true for every single doctor and every single hospital staff member. I’m speaking in generalities to try and get my point across here.)

    If women were provided with individualized support and encouragement, they would have a much better shot at succeeding in a natural birth! Plain and simple!

    • Yes. I felt pretty cocky about choosing med-free until I learned that when they say “you can have a natural birth,” what they mean is “we won’t force you to get an epidural, but we’ll proceed as if you have one anyway.” Which means you’ll probably want the epidural because being numb is how you endure the hospital ticket. My unmedicated hospital birth was excruciating and I would not fault anyone for wanting relief from that. I’m having the next one at home in a few weeks because I can’t go through that again.

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