Last night on The Office (one of my favorite TV shows), the two main characters, Jim and Pam, had a baby. I had been worried about how the birth would be depicted, considering that a few seasons ago, another character, Jan, had a baby, and I was disappointed with how that was portrayed. Jan, a character well known for being crazy and kind of a bitch, had an unmedicated water birth. The idea of a water birth was a big joke in the dialog, and it was portrayed as something that only someone as crazy as Jan would choose. I was highly offended.
So I figured that if the show depicted natural birth as crazy, then when a “normal” couple had a baby on the show, they would probably depict it as a highly medicalized birth, as if highly medicalized is the normal way to have a baby.
All in all, the birth was not as bad as I thought it would be. They didn’t show much of it, but they opened the show with the premise that since Jim and Pam’s insurance only allowed for two nights in the hospital, they wanted to wait until midnight to go to the hospital, in order to maximize the amount of time they could spend there. That seemed reasonable enough.
Pam had been experiencing irregular contractions, but they started becoming regular during the work day. When her contractions reached 7 minutes apart, Jim started freaking out saying they should go to the hospital right then. Pam wanted to wait. Had I been there, I probably would have told them this:
“If you go to the hospital now, when she’s contracting every seven minutes, they’re going to send you home. That’s best case scenario. Chances are, she’s not dilated more than 3 cm, and she probably has another 8 hours of labor left, at least. Did you guys take a childbirth education class? Surely you learned about the 4-1-1 rule there. The mainstream consensus is that you should use the 4-1-1 rule to determine when to go to the hospital. You go to the hospital when your contractions are 4 minutes apart, 1 minute long, and have been doing that for at least 1 hour. Many natural birth advocates say that for a first birth (which generally lasts longer and moves slower) you can even change it to 3-1-1.
“It is relatively rare for things to go wrong in labor, especially this early, so don’t worry about that. If you took a childbirth education class, you would have learned to recognize warning signs of things that could be wrong. There aren’t many. Don’t worry. You have so much time left to your labor, you don’t want to spend that in the hospital, its not a comfortable environment. That being said, you don’t want to spend that at work either. Go home.
“If you went into the hospital now, in fact, you actually increase your risk of something going wrong. If they allow you to stay instead of sending you home, you’re probably going to be subjected to a cascade of interventions you don’t want or need, and these will very likely lead to something going wrong. Chances are they’re going to want to get you on continuous monitoring (despite the fact that this has been shown in multiple studies to hinder labor and not to improve birth outcomes) so that they can watch you and your baby from the nurses station and not have to check on you as much. To do this properly, they’re going to want you to stay in one place and not move around (this is very likely why it hinders labor). They’ll probably strap you to a hospital bed. This will slow down your labor and increase your pain.
“Then they’re going to want to give you an epidural, so you will be less of a hassle and worry. You’ll be keen to do this, because being harpooned in one place while you’re laboring is miserable, and you’re going to want it to stop. The problem is, you’re probably not very far into labor yet. Epidurals are most effective when you wait until you are at least 5 cm dilated to get them. When you get them before that, they are highly likely to slow down your labor.
“When this happens, hospitals usually start augmenting your labor with a synthetic oxytocin called Pitocin. Pitocin has been shown in many, many studies to increase the risk of fetal distress and increase your pain. Pitocin causes your uterus to have stronger and longer contractions than is natural. This can decrease blood flow to your baby, thereby decreasing baby’s oxygen and increasing risk of brain damage. It can increase your risk of placental abruption (when the placenta breaks away from the uterine wall before the baby is born) a life threatening condition for mom and baby. It can increase your risk of a uterine rupture, a life threatening condition for mom and baby. On the small end of the scale, the baby is likely to suffer increased bruising on it’s head from being squeezed too hard by your uterus onto your cervix, which is not fully dilated yet.
“It dramatically increases the chances that you are going to get a c-section. If you wish to avoid a c-section, you should wait to go into the hospital.
“These things happen routinely in hospitals not because the staff are bad people, or because they are lazy, or because they are poorly trained. These things happen because the staff is over worked, and especially in the case of the nurses, underpaid. There is a shortage of every kind of child birth professional in this country. A shortage of OBs, a shortage of midwives, and a shortage of labor and delivery nurses. They all have a lot of patients, and often times don’t have a lot of time to devote to each one. They are always on a lookout for a way to cut their work load, for a way to speed up the natural process of labor so that they can move on to the next patient – there’s always a next patient.
“If you end up needing a c-section because they messed with your labor too much, no big deal. A c-section can be done in an hour, wham, bam, on to the next patient. Vaginal birth takes hours. On average, 12 hours for a first labor. And once you get one c-section, chances are that any other births you ever have will be done by c-section, so they’ve already saved themselves the time of watching you labor for even a minute the next time you get pregnant.
“Furthermore, vaginal birth is a lot less exciting than a c-section is, from a doctor’s or nurses perspective. These guys are trained thoroughly to respond to birth emergencies, to save lives in an instant, when seconds count. I’m sure its quite an adrenaline rush. The thing is, it’s actually pretty rare that those emergencies happen. Only about 10 – 15% of births actually require a c-section. Compare that to our 30%+ c-section rate in this country (where our birth statistics are shockingly low – we are 32nd in the world for positive birth outcomes, according to what I learned in my doula training). All of the 31 countries that have better birth statistics than we do have lower c-section rates.
“I hate to say anything negative about our hard working medical professionals, but it seems pretty likely to me that a lot of OBs might be subconsciously looking for excuses to give women c-sections they don’t need, because c-sections are quicker, more predictable, and more exciting than vaginal birth. All an OB needs to do in a normal vaginal birth is jump in during the last 20 minutes or so and catch, pretty much. But he has to do twelve hours of waiting around before that happens. I can see how that might get boring for a person who spent hundreds of thousands of dollars and years of their life going to med school to learn how to perform surgery.
Anyway, I digress. The point is that there is no reason to flip out and go to the hospital so soon. However, you really should not be here at Dunder Mifflin Paper Co. while you’re in the middle of labor. Go home, walk around, take a warm bath, eat while you still can (because they’re probably not going to let you once you get to the hospital), and try to enjoy your birth experience.”
In all, though, their birth experience wasn’t too bad. Pam’s water broke after labor had started (only about 30% of women’s water breaks before labor). They made it to the hospital with plenty of time to spare, even though she didn’t leave for the hospital until her contractions were 2 minutes apart and it was rush hour when they left. Her labor lasted 19 hours, and she had a vaginal birth (no mention as to whether or not she got pain meds). All in all, I think it was a pretty realistic depiction of a normal, hospital birth.
The hospital staff after the birth, however, was horrible! Especially that nurse! Don’t even get me started on that.