Saturday, November 22, 2008

Update and more doula thoughts

Well, for those (one) of you who freaked out at my last post, everything is A-OK. Apparently, for this pregnancy (which is different from the last one, so you people who are on your first, don't think you know everything now....things can be verrrrry different) the end of the day is hard on my uterus. Or something. Didn't matter what I did yesterday, my insides were practicing for labor. Which should still be five weeks away.

Anyway. Lying down settled everything, mostly. Now, if anyone can give me a fool-proof way of getting this baby to turn, THAT would be helpful.

Ok, onto the doula controversy.

My doula says that the ban on doulas at Reston Hospital, referenced in my last post on the subject, has been in place for a few years now. However, in her experience (13 years), she has never heard of a situation in which a doula got "between" a doctor and a patient in a medical situation.

There are several tracks one could go on with this: 1) railing at the way the medical system treats birth as a disease to be managed rather than a normal process of life; 2) the condescending view of many physicians that a medical/surgical answer to anything is the quintessentially "right" answer; 3) the fact that the trial lawyers and massive litigation has made it impossible for doctors to exercise judgment and true patient care in any particular case; or 4) the insurance companies (both mal-practice insurance, which is a boondoggle to lay directly at the feet of the trial lawyers, and health insurance, which demands certain standards of care unrelated to specific patient needs) have made health care workers extremely twitchy.

I am sure there are more, but those are the four that come to mind.

It is much more fun to rant and rail on 'tracks' one and two. It is fun to pick on doctors. Just like it is fun to pick on lawyers. But since I grew up with the former, I sometimes feel compelled to defend them. And since I am one of the latter, I choose to pick on my own. Though frankly, I sometimes think it is not so much the lawyers' problem (massive lawsuits with big money, which drive up insurance rates, which cause insurance companies to require doctors to jump through stupid hoops, etc.) as it is the public. Lawyers are opportunists. And they are ethically required to represent their clients zealously (ok, fine, I know that there are many lawyers who go waaaay beyond zealous, but still). It is the juries, which are made up of ordinary people, just like you and me, who award these big huge verdicts in med-mal cases.

So, what is the real problem? Our sense of entitlement of a "good" outcome in any given situation. We can talk about tobacco (you smoke for 40 years, get lung cancer, sue the company that makes the ciggarette that you CHOSE to smoke for 40 years, even though EVERYONE knew that cigs were unhealthy....don't tell me they didn't. If my 86 year old grandmother who grew up on a farm in central Virgnia called them "coffin nails" when she was a teenager, EVERYONE knew they were bad for you....just like we all know that french fries are bad for you). We can talk about firearms (no, don't get me started on that one). We can talk about worker's compensation, etc. etc. etc.

And medicine is the same thing. Doctors practice medicine with one hand tied behind their back, because they are afraid that if they take any risks, or do anything that is creative, they will get their pants sued off. And they are right.

And birth is no exception. It used to be taken for granted that babies, and mothers, died in childbirth. And it was sad. With the advent of better hygeine and sanitation and pre-natal care, those numbers dropped drastically. And using surgery judiciously prevented women with placenta previa or transverse breech babies from bleeding out and dying. All those are good things. But still, with all of our technology today, reproduction is still a bit of a mystery.

Someone told me a long time ago that 30% of babies who are conceived are miscarried before the mother even knows she is pregnant. And another significant percentage are miscarried early in the pregnancy. All in all, I read that every woman who is sexually active and of childbearing age will have some sort of pregnancy loss in her lifetime, at least once. And THAT is WITH all of the good healthcare we have now.

Nevertheless, people believe that they deserve (are entitled to) a healthy baby. And if they can blame ANYONE other than themselves, for a result other than what they expect, they will. And somehow over the years (here I blame the lawyers), that "blame" has become associated with monetary damages. As if any amount of money can make up for a life lost, or damaged.

As I sit and write this, I am five weeks (plus or minus) away from giving birth to my second child. Doctors say he is a boy and apparently healthy. We pray that they are right.

And I am trying for a VBAC this time. And I have a doula to help me through some of my labor b/c while I have a great doctor, he only is going to be there for the last three minutes, not the rest, and I didn't go through labor the first time (breech baby that we knew about, scheduled C-section before I went into labor). She will be with me in labor, and at the hospital, until after the baby is born.

If something, heaven forbid, goes wrong, I know that I have a crack medical team standing by. And a husband and doula who have mine, and the baby's best interest at heart. And if the result of all of this is something other that what we expect, we will all want to blame someone. That is just human nature.

So, for now, not only do I have to trust God for the rest of this pregnancy, and this child, I will have to trust Him for the outcome. And we all know that doesn't stop with birth, eh? I have to trust God every minute of every day with my two year old (who is quickly learning to test the limits of his physical abilities). I need to learn, in the words of my obstetrician, to "stop trying to control everything." Because I will drive myself crazy otherwise.

Anyway, somehow this post morphed into a "Trusting God" post rather than a rant about the silly ban of doulas. Maybe that is shere it was supposed to go. Hmmm.


Anonymous said...

I am praying for you, dear Kimberly. My first child was born by C/S and my second child was a VBAC--the first VBAC at Arlington Hospital, actually! I know it can be done, so I just want to encourage you and tell you that you've got an intercessor in northern Virginia. xoxo Ymelda

Kristie said...

I have a good friend who did a VBAC with a doula--I'm happy to connect you two if you'd like...And your analysis of where we are with healthcare is refreshing. The blame attributable to the jury is an often overlooked factor. It's our legal system people. It needs to work like a legal system, not some kind of lottery.

Patty Ayers said...

I'm praying for you too, Kimberdoodles. Maybe this birth will surprise you and be not just smooth, but a beautiful thing. I'm really happy you have a doula. On another subject, you're a natural blogger, I think, because of your easy-chatty streak and your smartness. love, P.