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Excerpt from Homebirth in the Hospital Confidence and Trust The pregnant woman must trust her provider with her life, and with the life of her baby. You must have confidence that your provider will follow through on the agreements made during prenatal care. You should expect full communication, to be told the truth, and not to have to defend your preferences while you are in labor. Similarly, you need to be honest and communicative with your provider throughout your pregnancy. You need to know you can voice your concerns and be heard. During the birth, with all the added stressors of nervous family members, the busy hospital staff, and the realities of labor, this trust will be the cornerstone of an integrative childbirth. Trust is built over time and will happen naturally if you have honest and open communication with your provider. You will have made agreements about care with your provider before you go into labor. Ideally, procedures initiated during labor should be discussed and agreed upon at the time, though in the case of a sudden emergency, you must rely on your physician to act quickly and without negotiation. Whenever I think of the trust issue, I remember a particular birth early in my career. Riki and Christine lived in the mountains and drove for more than two hours to come in for their prenatal appointments. They felt the effort was worth it because they wanted to be able to birth their baby with minimal intervention and in the hospital where they felt safe and where their insurance would cover the costs. They were a fiercely independent couple; Christine stayed in shape throughout her pregnancy by hiking the mountains they called home. When her due date was near, they came down to stay in a hotel near the hospital to await labor. They spent her early labor in the hotel and came in to the hospital when she was almost six centimeters dilated. All went well until the second stage, when Chris started pushing. In spite of a powerful effort, this baby was not coming out. Two hours passed, then three. There was plenty of room in Christine’s pelvis. We did everything we could think of, short of medical intervention: changed pushing positions, made sure the people in attendance were not getting in the way, and kept Chris hydrated. She and Riki refused anything else, and because Chris and the baby were both doing well, I allowed her to continue pushing. Four hours passed, then five, then six. The room was feeling stale. The nurses had changed shifts, and the new energy did nothing to help Chris bring that baby further down the birth canal. Still, she and Riki refused intervention. More hours passed. The baby was doing fine, but Chris was exhausted. The nurses were starting to question my tactics. Finally I had to explain that whether she wanted it or not, Chris was going to need help getting her baby out. Even with my minimalist style of labor management, I knew that Mother Nature needed help with this one. I suggested starting some Pitocin to stimulate the uterus and produce stronger contractions. Chris was so tired she would have done anything I said, but Riki was protecting her by questioning my suggestions. After all, Chris had said very clearly, “Don’t let them give me any medicine if I can do it naturally!” As the doctor responsible for a safe birth, I saw Pitocin as a small intervention compared to the C-section most of my colleagues would have performed several hours ago. But Riki saw it as questionable. I explained the risks of continuing along the path we were on: more pushing, more disappointing fatigue, and possibly a C-section if the baby started showing signs of distress. Riki was obviously confused and torn about what to do. Finally, I stood up tall and looked this six-foot, four-inch man in the eyes and asked him point blank, “Are you going to trust me to do what it takes to give you a healthy baby?” He searched my eyes for deception, blinked, and said, “Of course I will. Go ahead and do what it is you do best.” I started a Pitocin IV drip and thirty minutes later Jacob was born—healthy and lusty—and handed to a very tired Christine. For nine months I had been building this relationship bit by bit. In the end, they had no regrets and neither did I. |
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