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Thread: What would a more realistic prenatal class look like?

  1. #11
    TJ TeresaJ's Avatar
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    Quote Originally Posted by oxyjen View Post
    I also have some unpopular opinions about what I perceive as the overidealization of natural birth. Also I think 'breast is best' but in my own experience, this is pushed to a degree where a small selection struggling babies are being denied helpful supplementation because of generalized ideas of how breastfeeding works for all women. Granted, that was my experience as being a medical exception--also the crunchy AP style is mostly white middle class and less of the demographic that is low-income or high risk.
    That is totally valid. There's a lot of virtue signalling around natural birth and breastfeeding that can get very unsavory. Also, as natural as birth is, human women already give birth at the edge of what nature can tolerate. Our babies are born relatively premature precisely because our bodies struggle to give birth to our freakishly large-headed species. We as a species do not generally go off into a den by ourselves and squirt out a few pups. Our typical model for labor - pre-dating modern science - involves assistance and a real risk of death.

    Anyway I actually really like the Ricki Lake documentaries on childbirth and breastfeeding for exploring these questions in an investigative and down to earth way. Have you seen the breastmilk documentary? The mom at the end is great. "...It's just milk."
    Too bad, Lady Une. You were far too lenient.
    As a soldier, yes. But as a civilian I lived an austere life.

  2. #12
    malarkey oxyjen's Avatar
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    Quote Originally Posted by starla View Post
    I agree that inductions for the sake of convenience are stupid. Literally nothing about having a kid is convenient, but you expect it to pop out on demand? I get especially annoyed when I hear of obstetricians inducing because they're going on vacation. WTF? I don't know how difficult of a childbirth you had, but I think c-sections are better than trying to force out a baby that doesn't want to come out and wrecking your body in the process. That can also cause permanent damage. I personally wouldn't want to be wearing depends at 60 because some doctor or midwife was overly committed to natural childbirth and thought I should be too. Are women educated about the long-term effects of natural childbirth compared to the long-term effects of c-section? Is this information tailored for their age, health, and other personal details? I haven't ever been pregnant so I don't know, but I'm not just going to go along with what my doctor thinks is best. We all have different priorities in life and to assume that someone is choosing a c-section for convenience or laziness is more presumptuous than I think a medical professional should be.

    I think breastfeeding is great for women who are able to do it. It's cheap, convenient, and it helps you lose weight. But given how strong the correlation is between family income and outcomes, I think encouraging women to stay home so they can breast feed and spend more time with their kids is likely to be counterproductive unless the father's income is so high that the mother's income is superfluous.
    I wonder how many inductions are for convenience, and how many are for medical reasons.

    I'm going to stop at 2, but for both of my kids my water breaks and then....nothing happens. I'm not sure if this counts as inducing but I go to the hospital and get pumped full of drugs because to have my membranes ruptured for so long increases risk of infection. Also if someone starts showing signs of pre-eclampsia, etc., they are going to induce and yeah, perhaps the baby isn't in position, the labor goes wrong and there's signs of distress and a c-section is had.

    ok, so induction/c-section is correlated, but do we know for sure that induction causes c-sections or are there other variables that would contribute to a higher likelihood of both those practices?

  3. #13
    TJ TeresaJ's Avatar
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    Quote Originally Posted by oxyjen View Post
    I wonder how many inductions are for convenience, and how many are for medical reasons.

    I'm going to stop at 2, but for both of my kids my water breaks and then....nothing happens. I'm not sure if this counts as inducing but I go to the hospital and get pumped full of drugs because to have my membranes ruptured for so long increases risk of infection. Also if someone starts showing signs of pre-eclampsia, etc., they are going to induce and yeah, perhaps the baby isn't in position, the labor goes wrong and there's signs of distress and a c-section is had.

    ok, so induction/c-section is correlated, but do we know for sure that induction causes c-sections or are there other variables that would contribute to a higher likelihood of both those practices?
    There are a host of valid medical reasons to induce or augment labor, including but not limited to:

    -maternal hypertension
    -maternal diabetes
    -prolonged rupture of membranes
    -any likely medical condition of the fetus that would make it safer for it to be receiving medical care outside the womb rather than to continue to be in the womb

    the following two are also valid reasons but are more subjective/prone to obstetric abuse
    -the fetus is too big for mom's pelvis (how accurate are the measurements of fetal growth and pelvic size? depends on the provider)
    -the pregnancy is "post-dates" (how accurate were the dates to begin with? is there any reason to suspect that the placenta is actually beginning to fail?)

    also, it is still perfectly legal for a provider to induce a woman for no damn reason whatsoever, provided that she is not technically pre-term. At my hospital we call these "social" inductions. In some regions, cities, these are rare. In my area they are not.
    Too bad, Lady Une. You were far too lenient.
    As a soldier, yes. But as a civilian I lived an austere life.

  4. #14
    TJ TeresaJ's Avatar
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    The Association of Women's Health, Obstetric and Neonatal Nurses has a position paper strongly recommending that labor not be induced, except for medical reasons.

    https://www.jognn.org/article/S0884-...rce=awhonn.org

    The American College of Obstetricians and Gynecologists takes a milder stance: "Labor can be induced via medications or other methods that stimulate uterine contractions so that a woman may attempt a vaginal birth. The ob-gyn may recommend induction if the pregnancy is postterm or if the health of the mother or fetus is at risk. Labor might also be induced for elective (nonmedical) reasons, such as living far away from the hospital. Ob-gyns, physicians whose primary responsibility is women’s health, play a leading role in helping women decide if and when to induce labor."

    But the implication is still that there should be an actual reason other than simple convenience.

    They offer tools to assess whether or not an induction is likely to be successful, but there is no mechanism for compelling an obstetrician to use those tools. It depends entirely on the OB's own practice, whether or not they want to assess likelihood of success or not. So you often get a situation where a woman is induced, labors for hours, winds up getting cut... When instead she either could have gone into labor spontaneously and delivered vaginally or should have gone straight for a c-section if there were something like a true pelvic dystocia (baby doesn't fit).

    //Sorry, I didn't mean to turn this whole thread into a rant about non-medical inductions. But at least in my hospital they happen all the damn time, they often go south, and as an OB nurse it's frustrating as hell.
    Too bad, Lady Une. You were far too lenient.
    As a soldier, yes. But as a civilian I lived an austere life.

  5. #15
    malarkey oxyjen's Avatar
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    Quote Originally Posted by TeresaJ View Post
    That is totally valid. There's a lot of virtue signalling around natural birth and breastfeeding that can get very unsavory. Also, as natural as birth is, human women already give birth at the edge of what nature can tolerate. Our babies are born relatively premature precisely because our bodies struggle to give birth to our freakishly large-headed species. We as a species do not generally go off into a den by ourselves and squirt out a few pups. Our typical model for labor - pre-dating modern science - involves assistance and a real risk of death.

    Anyway I actually really like the Ricki Lake documentaries on childbirth and breastfeeding for exploring these questions in an investigative and down to earth way. Have you seen the breastmilk documentary? The mom at the end is great. "...It's just milk."
    I have regularly pondered how things would have turned out for me if I would be like those crazy people who go out in the woods and try to give birth. Would my uterus eventually contract or would I just have this baby chilling out with no amniotic fluid? I hemorrhaged after both births, so I'd be dead. Also thank Jesus for epidurals because my first doctor gave me a shot, more pitocin, and then punched me in the uterus internally. Mr oxy said later, "that doctor had her whole arm inside you, up to her elbow."

    I spent time reading on a mommy forum and there was this unspoken culture that unmedicated vaginal delivery was the 'best,' and if you caved and got medication then you 'failed' to follow through with your birth plan. If a person needed to have a c-section for whatever reason (but a healthy baby was had), condolences and sympathy was given. I found that odd. It was like a healthy baby wasn't the goal, it was to prove you could do it a certain way was an achievement. I never understood that mentality.

    I really enjoyed breastfeeding, even though I had very low supply and needed to supplement with both kids. It's very annoying to be a zebra when everyone is trained to think of hoofbeats as horses. I'll spare the long story, but I actually had lactation consultants apologizing to me profusely and throwing formula at me when leaving their office. With both kids, I bucked medical professional's advice and supplemented after I could see signs that they were not getting enough to eat (with my first we were already at home and it had gotten bad, like urate stains in diaper and losing voice bad). They were both getting follow-up labs for medical issues (1st--bilirubin levels, 2nd--monitoring after diagnosis of transient tachypnea), and both times doctors commented about how their numbers improved dramatically. No shit, they're actually getting nutrition now.

    I will probably not watch a documentary about breastfeeding, as those days are behind me and it would remind me of my many complaints of how my situation was handled.
    Last edited by oxyjen; 11-07-2018 at 10:17 PM.

  6. #16
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    Well my sister opted for induction because her OB was going out of town. She preferred that to having to deliver with a different OB. It turned out fine, but I can't see the logic there. Induction sounds like a really hard way to have a baby.

    I think women tend to think their feelings surrounding their own birthing and breastfeeding experience should apply to everybody. Your feelings about things should not inform your advice to your patients unless they ask. Stick to facts, let the patient weigh them against their priorities, and let the patient make their own informed decision. If they ask your opinion, then you can offer it up.

  7. #17
    Now we know... Asteroids Champion ACow's Avatar
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    Obviously a number of things are going to already differ by country/health system. My impression here is that non-medical inductions aren't a thing, or at the very least they certainly aren't philosophically supported by the hospital, but then i don't know if people are demanding them or trying to access them through the private system.

    I've actually found the education component useful in the prenatal class, but I did hear another critique from someone at work, and I can see their point.

    The critique was basically: they spend X days teaching us about the actual medical/physical procedure of labour, but its generally something that's ideally going to be over in 24 hours. And frankly, lets be honest, whether it is or isn't, we're all pretty much going to be running on the algorithm "call hospital, do what the hospital tells us". Its not like I'm going to be all "stand aside doctor, i'll deliver this baby!".

    What everyone is really lacking information on is all the practical information that is entailed after the baby comes that first time fathers/mothers are entirely clueless about and basically doing all their research online or through family/friends. What are your employment rights? When to go back to work? What support, financial or otherwise, exists and how do I access it? What are some budgets for families of various structures and means and how do you prioritise things? How to swaddle (this is covered here), how to breast pump, how to change nappies (guessing this is coming up in ours). What products are wastes of money and what's really needed? How to raise a child in various atypical (which might be approaching typical depending on your context) family and social situations? What are the practicalities of child care, school enrollment? How to get rest, how to get sleep, how to get a break, coping mechanisms. What's the law say about parental rights, access rights and the communities general attitude towards children? Breast feeding in public? What to do if support person isn't available? Just as some examples...

  8. #18
    TJ TeresaJ's Avatar
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    When I was pregnant, I actually did not want to learn much about labor. I also had the mentality that the actual event of labor was much less significant to me than what the hell I would do taking care of a baby once it was feeding and pooping and crying.

    Now that I'm a nurse, I can see how obstetric nurses would focus more on labor - because that's literally our job - but it is honestly not the primary concern of most parents, nor should it be. Perhaps a fundamental problem with many of these programs is that they're designed from a nursing perspective moreso than from an actual parental perspective.
    Too bad, Lady Une. You were far too lenient.
    As a soldier, yes. But as a civilian I lived an austere life.

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