Wednesday, March 19, 2008

Pre-Natal Class: Medical Options

Last night's public health pre-natal class was on Medical Options, or as we midwife-hiring, Birthing-From-Within-class-taking, cloth-diaper-using earth-mamas would refer to them, "interventions". It was actually a really interesting class to me for two reasons. First of all, the nurse running the class had a big box full of all kinds of medical supplies that she passed around to us. So last night for the first time I got to hold in my hands many of the things I've been reading about for months: forceps, a vial of Pitocin, a urinary catheter, the doohickey they use for internal fetal monitoring, and so on. That was pretty neat.

The other reason the class interested me is that it was fun to watch the nurse delicately walk the line between encouraging moms to avoid interventions if possible (as that is now the party line, at least at NRGH) and yet subtly implanting in our heads the notion that if an intervention is suggested by the staff (referred to throughout the session as "they" to cover up the fact that it will be nurses, not your doctor, who suggest these things) then we should probably go along with it.

As such, there were no statistics presented in class: no numbers on the hospital's intervention rates (even the rate of cesarean, which is listed on every earth-mama's list of What To Ask When Looking For a Hospital). Whenever the nurse was asked a question about how often a certain procedure was done, she'd think for a moment, then respond with something like "Really not that often," or "it's fairly common". All that was missing was a pat on the hand and an admonition not to worry our pretty little heads about such details.

There was also very little information about the downsides of various interventions. Even the biggie, C-sections, were discussed without any mention of the fact that if you have one, you will spend the next 6 weeks recovering from major abdominal surgery in addition to the usual upheaval and challenges of assimilating a newborn into your life, dealing with your new role as mother, struggling to keep up with laundry and housework, and the spectre of post-partum depression. The attitude presented was very much "we don't want to have to do any of these things (though we won't tell you why) but if we do, here's some cheery info on them so you won't be frightened."

I ended up asking a couple of questions I already knew the answers to, just to force the nurse to present some information I felt other people in the class might not know. For example, I asked about the effects on a baby of an epidural. I was told that the baby might be a bit sluggish and not take to feeding as easily, but the sluggishness would wear off in about a day. "Any breathing problems?" I asked. The nurse reported that no, they'd never seen any breathing problems after an epidural. (The very first site I found on Google mentions respiratory problems, waaaay down on the page but it is there. This site also mentions many other scary and LONG-TERM effects.)

Another strange moment came when one mom talked about wanting to have a C-Section (she is afraid her baby might be too big to deliver vaginally). The nurse couldn't tell her about the potential risks to her and her child of a C-Section, since that might scare other moms who may in future be advised they genuinely need the procedure. Yet she also couldn't agree definitively that an OB would perform a C-Section based purely on the mom's desire to do so. Her best suggestion was to discuss it at length with her caregiver. While on the surface I agree with this idea, the mom had already mentioned that her doctor had brushed her off and refused to discuss the subject. Further, as I reminded Chris when I reflected on my worries for this mom, a woman seeing a doctor for pre-natal care gets 10-15 minute appointments. Not the one-hour sessions we get with Lillian where we typically discuss subjects as far-ranging as british humour, the sterilization of Japanese weapons for use in cutting the umbilical cord, the politics at play in pre-natal care, and family dramas - not to mention, you know, our actual pregnancy- and birth-related conversations.

Anyway, the class didn't really present a lot of groundwork for "informed consent", as angled as it was. And that's a shame, because although caregivers may present the benefits and risks fairly and honestly at the time they suggest an intervention, many of the decisions are going to be made ahead of time based on what people learn when they're in a calm and rational state of mind (thus, the concept of birth plans). But I guess ultimately I need to be grateful that Chris and I have done the "extra-credit" reading and are not relying on a public health nurse to give us an unbiased point of view. Everyone else's birth, I suppose, is their own business to look after.

1 comment:

Anonymous said...

That's interesting, I found that our class (hosted by Women's Hospital in Vancouver and largely being populated by 40-something professionals, and therefore "high risk" pregnancies), interventions were discussed quite a bit of emphasis on percentages and numbers. We also had researchers from UBC as the hosts of our class, so while they were still friendly public-health-nurse types, they had a bit of the lecturing professor in them too.

They put the hospital statistic for c-sections at 30% for Women's, but I don't know if that's an accurate reflection of province-wide stats, since Women's gets most of the complicated and high-risk pregnancies referred to them in the first place.

I don't know that I picked up on a "if your doctor says it, better do it" undertone, but that's something I'll pay attention to at the next session. I know that we brought up a few questions about that as well in our class, since they tend to gloss over whether or not you have a choice once the doctor recommends a certain course of action.


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