If I could change one thing about hospitals in the US today, it would be to create an attitude of respect and acceptance for a woman’s right to determine what happens to her body. While there are certainly many factors that influence the lack of respect for women’s rights in the hospital setting, there are hospitals that are managing to consider the legal implications and still support women’s autonomy.
Risa was pregnant with her fifth baby and overdue. She was not concerned, because with each baby she’d gone at least 10 days overdue.
My concern was not for Risa and her baby’s health–she had excellent nutrition, and had never had a complication from being overdue. However, since I had recently attained certification in my state, I was now held to certain standards of practice. One of these standards stated that I could not deliver a baby outside the hospital if the pregnancy had lasted longer than 42 weeks, and I was obligated to induce labor once the 42 week mark had been reached.
Risa was vehemently opposed to any intervention with her pregnancy. She relied on natural remedies and working with her body to attain optimal health. When I explained to her my dilemma, she was frustrated: “Shouldn’t it be MY decision how long to wait for labor to start? It’s my body!”
I agreed with Risa, but because of the state requirements, had to explain to her that I could not care for her if her pregnancy lasted past 42 weeks. Risa asked if I would call my backup obstetrician and get his OK to continue the pregnancy provided she would get twice weekly ultrasounds with a biophysical profile to confirm adequate placental functioning and sufficient amniotic fluid for the baby. She referred to her devout faith and belief that God was in control and would choose when her baby would be born.
I contacted my backup. He was quite opposed to out of hospital birth to begin with, but we lived in a small town with no other obstetricians, so he had become my backup by default. I explained the situation to him and informed him of Risa’s plan. He made an impatient sound, and demanded,
“Why on earth is she opposed to inducing the labor? Isn’t she sick of being pregnant? Why would any woman in her right mind want to be pregnant any longer than she had to?”
I explained that Risa believed that God would decide when her baby should be born.
The OB laughed and replied, “Yeah? Well you just tell her that maybe God wants her baby to DIE!” He adamantly refused to work with Risa in allowing her pregnancy to continue beyond 42 weeks. Risa would have to choose an unattended home birth in order to continue waiting for labor to start.
Reluctantly, she called me the next day, now at exactly 42 weeks, and asked me to strip her membranes. I was pleased when I checked her to find she was already 5 centimeters dilated without having any contractions, so was hopeful that stripping the membranes would give labor a nudge.
Risa went for a walk after we stripped the membranes. An hour later, she called me and said she was having regular, strong contractions. Exactly three hours after we stripped the membranes, she had her fifth baby boy.
In some ways, this is a story of empowerment–Risa did not give in to the OB’s desire that she be induced in the hospital. However, it’s also a story that shows the weakness of our medical system–that there is only one way to do things, and if you don’t cooperate with it, we won’t give you care.
Midwives’ and physicians’ hands are tied when it comes to being able to work with women to individualize their care. Why can’t we give women the best information we have available about the potential risks of a situation–for example, extending a pregnancy beyond 42 weeks–and work with the woman to come up with a plan that is acceptable to her? After all, it is her body, and she is the one who will have to live with the results of our rules. She should not be punished by being forced to choose between an unassisted home birth or unwanted interventions.
Well said. I just discovered your blog and love it already. Thanks so much for getting the word out about normal birth.
Thank you for your kind words!
Having had two 43 week pregnancies, one with a private Obstetrician resulting in an unnecessary c-Section & the next a wonderful homebirth, I am so happy for Risa that you were willing & confident to support her in her choice. We need more midwives like you.
One thing I know is that there are no garentees on anything when it comes to baring children. I know people who have lost babies at 39 weeks.
Myself and I speak only as a mother, I was induced for both babies I was never given any other option. I was on the drip for the first one it was horrid and almost killed my baby. The drugs required were extreme, forcepts were almost required by the end. Three days in Children’s hospital ICU Calgary following. 2nd labour, gel, easier, but even without use of any drugs not a “natural” birth. Painfull contractions every 30 seconds for 12 hours.