Advocacy & Evidence-based Practice
11 Sep
Right to Information & Ability to Make Choices in Childbirth

I have been on an unintended hiatus for the past few weeks…. Reviewing the comments in response to my posts, I am surprised that almost all questions have been in the area of Cervical Insufficiency. Why is that? Granted this experience may not be statistically significant, it got me thinking as to why so many questions…

It is a fact that many women, by nature, have a hard time in asserting themselves. This is even more evident when they are vulnerable and stressed during the time of their pregnancy. Many expectant mothers often do not have much idea about how their body changes and the reason for and management of issues such as Cervical Insufficiency, low-lying placenta etc. Many a time, their doctor does not either have or take the time to explain fully all the implications of the issues.

I would think that giving more information is a good thing because women can have a better understanding of their body during pregnancy and will become more confident in their bodies’ ability to give birth. In our Healthy Mother program, we teach our would-be moms and dads how mother-nature has endowed a mother’s body with natural abilities to give birth and how to use this endowment with diligence and minimal external medication. While we are all for medical intervention during an emergency, we find that many would-be mothers and their families do not have the information that they have a right to, and are being subject to more-than-required levels of medical intervention.

The other day I met with a friend of mine, who is a well-known anesthesiologist. He specializes in “labor analgesia”, the sanitized term for epidural. While we were talking about his work, he said that there is an increasing trend among Indian women to prefer epidural during the early stages of labor. This surprised and troubled me – as the Indian economy expands and as people are exposed more to western cultures and practices, my guess is that some of the Indian traditions that deal with natural ways of pain relief and management during labor are being brushed aside. Studies have proven the long-term risks of epidural for the mother and have also proven the fact that the process of labor is actually good for both the mother and the baby. We are proponents of natural and healthy ways for pain relief, those that have been followed by women in many cultures through many generations – breathing, relaxation, rhythms, rituals. We follow the philosophies of Lamaze International and WHO to promote, support and protect normal birth, and so advise our participants to consent to epidural only as a last resort. Let me close by asking my readers their opinion about whether they would choose epidural if they were pregnant. How many of you actually chose epidural during your labor, and how many were actually informed of natural ways of pain relief by your medical team?

Keep those comments coming; and feel free to ask questions.

Dr. Vijaya Krishnan

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  • The midwives were at the time working for a new manager who prior to that had worked in a hospital for 14 years, and might I just say was not too competent, and didn't like me at all. In fact she did break a few laws during my pregnancy, and both midwives attending my birth resigned or got fired, which was tragic as they were founders of the program, so they went back to working independently. Before everything went wrong, my mind was firmly made up, but as I panicked and all the wrong hormones kicked in, my brain turned to mush. I completely forgot that you shouldn't even get an epidural early on in labour and no-body reminded me. Not even the anesthetist. As I said, I was only 3cm dilated, and as I had been in hard labour for 6 hours, to this day I have the feeling that in terms of hours, I was almost there. After that I bought a book, and in the birthing stories there were a few cases where that happened, that after a slow start their cervix's just kind of sprung open. And my mother got invited, and she told them to don't bother keeping me at home, because she had morphine births and since then has held this idea that epidurals are the safest and best way, and she never really wants to hear of the dangers of them, or the ineffectiveness. My story actually does get worse - my epidural was failing on one side and I beat a c-section by minutes. So it could have been a LOT worse. I went to an aneasthetists site, and found that although that's really common, they don't really know exactly what to do, because everything they've done seems to lead to danger, and either dicing with death or pain. In the event it's for a vaginal birth, they'll just apologise and say to try other methods. But for C-section, they're in a conundrum. They try one thing, and it leads to bradycardia. Severely. etc. so they're still trying to work out what to do, and what's a correct dose of the drugs and what's an OD. So although it's very, very common (about 1 in 32 C-sections where an epidural was used in labour), they don't really know what to do. In short, I lost control, and my midwives hands were tied, so as they're working independently, they've lost their insurance. So the tragedy wasn't limited to my daughter and I. It's just really, really strange, but I get the same feelings people say you get from c-section. That you're still waiting for birth, that you can't connect your baby with the one you were carrying, that it wasn't me who gave birth etc. But I haven't ever heard that from epidural births. My second baby was an underwater home birth, and so will any other children I have be, but it seems cruel that they/he had such a gentle start to life and hers was cruel and marked with pain, because she spent nearly 2 weeks in special care after she was born because she had lactose intolerance and they didn't diagnose it or care for it ie spend an hour burping her after feeds and let her feed slowly. So every time I left, she had a dusky episode. 4 all up and a lot of heel-prick tests, anti-biotics, canulas etc. And she made it very clear she hated being there, and for a while was a bit upset that she had been born and wasn't in-utero. She's nearly 3 now, and doesn't remember any of it, but it did affect her for a long time, and I know I remember it.
  • vsakotai
    I am sorry to hear about your experience. Unfortunately, it need not have been so. I was very surprised to hear that your home birth with midwives turned out to be the way it did. Who was directing the midwives? Were these midwives not committed to the cause of natural childbirth? Why else would you have opted for a home birth in the first place?

    Unfortunately, you are not alone in bearing the consequences of these kinds of artificially created deadlines on labor and birth. So many times, in the course of my work, I will overhear an OB say, "let's rupture her membranes, and within an hour we will know one way or another" OR "let's put in prostaglandin gel, we can wait for 12 hours and decide" OR "let's push oxytocin, and see if she progresses". My point is, I do not want to know "one way or another"! If the body is taking time to work itself through the process of labor, how can we assume that by doing certain procedures, it will do any differently? More often than not, it doesn't - and by adding unnecessary interventions, time limits get imposed. Along with this, in a vast majority of cases, these interventions eventually lead to fetal distress, which then leads the mother into a Cesarean Section.

    Obviously, there are times when even though everything is tried, there may not be enough progress, or there may be fetal distress during the progress of a natural labor. However, these times are few and far between. In such cases, medical interventions and even a C-Section may be required. But, this would be the last option - not the first one. And, I firmly believe that the period of labor is good for mother and baby - both physically, and psychologically!

    Thank you for your comment - I do hope that your experience is better the next time around.

    Good luck -
    Dr. Vijaya
  • I was having a home-birth, and at the first panic, my midwives were told (not by me - I had asked that they worked through it and tried to keep me at home) to take me to hospital for an epidural. I was only 3cm dilated. Everything went downhill, and after a while I was given 4 hours to become completely dilated or it would be a cesarean whether I consented or not. Because after the epidural my daughter became a bit distressed and passed meconium. Which would mean she could get sick and need antibiotics after she was born. I was never encouraged by a doctor to continue using natural methods at least until labour was more progressed. I know in China they're a bit ashamed of their culture of natural medicines, and over 40% of births are c-sections. This has been going on for a while now, and now these children are more grown up, China has the worlds highest suicide rate with an even spread of males and females. It's like they are trying to be more Western and thinking that they need to make an effort to detach from their children. Brazil now has a lot of c-sections, but large families mean that if a child is detached from their parents they have their siblings. Also, it seems that Chinese people are becoming more detached from people in general in their lives. I hope this doesn't happen in India. I've just been reading about the biology of bonding, and we are the same as animals. Intervention and inhibition of following your instincts in childbirth to biologically affect mother-baby bonding. After my daughter was born, I was heartbroken. She was in agony, and I wasn't. I had let go of her hand and left her to go through the pain on her own, and I was supposed to be her mother. For the birth of my second child I had resolved never to express ANY fear or negativity during the labour and birth. That in itself is unnatural, but worth it. For that to be put on a first-time mother-to-be is a terrible crime. I look at hospital births, and I don't see birth. I see torture, on levels seen as unacceptable by military interrogators. I see confused women handed their baby, holding and feeding their babies, while having a look on their face like they're wondering "What was that?" That's not birth
  • vsakotai
    Hi Linda,

    Unfortunately, most every mom who goes to the hospital in India gets offered an epidural or Entanox for pain relief, and they land up taking it because they are not fully aware of the side-effects or the cascade of further medical interventions that it sets them up for.

    To answer your question, yes I do teach moms a variety of exercises, based on which month they enter our program in. In the early months, the exercises are primarily aimed at keeping moms fit throughout their pregnancy - which translates into better health for both mom and baby. It aims to teach them that pregnancy is not a disease, and remaining active will let them go into labor and childbirth with best possible endurance levels.

    Later in pregnancy, I teach moms specific exercises which aim at providing flexibility to their pelvis, so that their baby's descent is facilitated as they approach labor. Most of these exercises and positions also help moms' relieve their back discomforts. In addition, as they practice these exercises, they are more likely to adopt them during labor. I tell them to choose the positions that feel most comfortable to them as they move along the labor time-line, starting with the more upright positions, and also walk for as long as possible to facilitate their babies' descent down their birth canal.

    I do go through deep breathing and relaxation techniques a lot. I also give them coping tools with other kinds of patterned breathing. However, I tell them that ultimately it is whatever feels good to them in labor - breathing patterns, rhythms and relaxation techniques - they should adopt. Many of my moms have gone through their entire labor using just one kind of breathing. There is nothing written in stone .. if something feels good to them intuitively they are probably better off using it.

    At the end of the day, I feel the sessions are ABSOLUTELY about building confidence in moms, which I do with a lot of birth stories, hands-on activities and visuals. Without doing this, I could be teaching moms all kinds of exercises and breathing patterns, but it would be of limited use to facilitate a natural birth in our "ready to epidural" hospital surroundings. To this extent we at Healthy Mother provide our moms with a constant source of support all through their pregnancy, labor and post-partum period.

    Thank you for your comments. Please feel free to e-mail me at vsakotai [at] yahoo.com in case you would like to have more details.

    I would also like to know more about your practice setting. I have practiced in both Medicare and Medicaid settings when I was in the US. It looks like you have your share of challenges, as do all of us who are working towards making childbirth a natural, rewarding experience for our moms.

    Regards

    Dr. Vijaya
  • I work with mom's (prenatal education, Lactation and am a doula) Currently working on a hospital based program with medicaid moms. Unfortunately, the majority of these mom's in the past have elected (or been"offered" without choice an epidural. I am incorporating a lot of education and I hope empowerment to the moms to allow their body to work with nature.

    I Would like to know what some of the excersises and breathing work you do with your mom's? What help do you give them in learning to trust their bodies in birth. You may email me at Verodoula@yahoo.com. Looking forward to your response! looks like you do very valuable work!
  • vsakotai
    Kathy,

    How wonderful that you were able to give birth in the warmth and comfort of your own surroundings, and at your own pace! Did you have a doula and/or midwife with you during the births?

    You are absolutely right ..good labor support is perhaps one of the most important factors to the laboring mom. To this end, we at Healthy Mother have trained all the nurses and support personnel at one of the hospitals where we conduct the programs to be a source of knowledge and support the the laboring mom. This is of course in addition to the physical and emotional support that dad (or any other labor support person from the family) provides.

    My own two births were at a hospital based birthing center. The first time, it was an emergency C-Section. The second time around I was determined to labor naturally, and my OB and staff were wonderfully supportive of me. 18 hours of labor later, I had a natural birth .. just an amazing experience. And the recovery was so remarkable. You can see what gave me the impetus to empower women and their families to do things the way nature intended! :)

    I would love to be a part of a home birth .. may be sometime in the future :)

    Thanks for your comments..

    Dr. Vijaya
  • vsakotai
    Dear Rati,

    It is wonderful that you believe in the natural birthing process. We at Healthy Mother empower you with all the information and techniques to help you get through your labor and childbirth in as natural a way as possible.

    Our next set of classes are going to be held at J.J. Hospital in Kalyan Nagar. This is will be a series of 6 sessions held every Sunday starting from Sept 28th. I would be happy to meet with you before the classes if you so wish, or you could e-mail me at vsakotai@yahoo.com for further information and details.

    Best wishes,

    Dr. Vijaya
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