Women Speak Out About What's Gone Wrong with the United States Birthing System

T

thanka2

Registered User
I think this is a good summary.

It's really not much different in HK except minus the lawsuits.

But, to encourage women....it is possible to have a beautiful, intervention-free birth in the HK public system. You only need education, preparation, determination, confidence, a good partner by your side, a strong game plan and the strength to stand up for yourself.
 
I had my 3 children in the US, all natural (with pain meds). My story doesn't come near what the story is describing, but I know it's true, the statistics don't lie. I was lucky to be in one of the best hospitals in the country (top 20) and have a very good doctor. My oldest was born after 28 hours of labor, and because she was doing well, they only mentioned the word c-section once because I was completely stuck for hours at 6 cm thinking there was something wrong in the birth canal (or she was really big, which she kind of was). Even my twins were born naturally, one my baby B was even breech. The word c-section was never mentioned because I had a successful natural delivery before with a large child (these wouldn't be that big, but they were still very big) and as long as the first born A would be head down they would go ahead with a normal birth (in the OR, just in case). It was done in 4 1/2 hours, 4 pushes (and 1 push for B).

I've only met 2 women in Hong Kong who had their twins naturally (only in QMH). It's sad because although it's not possible for everybody it's definitely an option for a lot more women, both here and in the US (and other industrialized countries).
 
It's interesting how giving birth has evolved from a natural human process to a medical procedure. Then again, society & lifestyles have changed over the years and women are choosing to have a family later in life and with that comes more health complications or risks.

For my first baby, I was fortunate enough to have a very positive birthing experience in Sydney via waterbirth. There was no medical intervention whatsoever. Just a birthing pool with warm water. It was indeed empowering as I was open to this option & the midwives offered it. My husband said "something clicked in the middle of your labour, you were in charge as if you instinctively knew what to do, when to push etc"

So positive was the experience that in my second pregnancy (this time in Hong Kong) I was "looking forward" to the labour. Waterbirth isn't practiced here but at least I had a natural delivery. The midwives here referred to my birth plan - no stirrups, husband to be with me during active labour, baby to be placed on me immediately, husband to cut the cord, breastfeeding. When they couldn't accommodate it, they let me know.

In my experience at Prince of Wales, you can have a positive intervention free birth. I even think that in a public hospital, the more you take charge, the more grateful the midwives are so they can get on with their other duties.
 
Newbie_hk, I don't think the midwives were at all grateful for us taking charge in our case in the public hospital. We were, in their words "ho ma fan" (好麻煩) or "troublesome/pain in the a**". They were quite open about this with both their words and body language. I shared the story of my most recent birth here in case there happens to be someone reading this thread that hasn't read it already. But, honestly, it didn't matter to me how good or bad they felt about things--the important thing was I had the birth that I knew I wanted and knew I could have.

My first birth with my son in the US was 100% med-free, spontaneous and vaginal and the labor lasted 43 hours. It was tough. I was at home for part of it but it was a hospital birth. An experienced and pro-natural childbirth midwife attended our birth but there was a doctor on call who came in after I'd been in labor (without waters broken) for about 24 hours and told me that "you don't want to be like those women who labor in the desert in Africa for days and then die in childbirth, do you?" So, if he had had his way we would have had interventions but we stood up for ourselves then as well as in the hospital in HK. Knowledge is power and the more truly educated women are, the better equipped they will be to demand what they know they can have--but you have to know and believe that you can have what you want to begin with, I think.
 
thanka2, i just read your birth story! it was similar to mine in that i refused monitors and had to fight to be allowed to stand up for most of the labour instead of lying down. the nurse even said to me,'i don't know why you even came to this hospital if you are going to have such unreasonable demands!'. ha! its not like i wanted soft music and candle light, just to be able to labour in a comfortable position. i read that it has only ben the last 100 years or so that women have lay down to give birth, before it was always in a squat position. this is since male doctors started delivering babies, and they like it to be more organised and controlled.
 
marie313 said:
thanka2, i just read your birth story! it was similar to mine in that i refused monitors and had to fight to be allowed to stand up for most of the labour instead of lying down. the nurse even said to me,'i don't know why you even came to this hospital if you are going to have such unreasonable demands!'. ha! its not like i wanted soft music and candle light, just to be able to labour in a comfortable position. i read that it has only ben the last 100 years or so that women have lay down to give birth, before it was always in a squat position. this is since male doctors started delivering babies, and they like it to be more organised and controlled.
Click to expand...

Yep. Exactly. It's called birth rights--and is a part of a greater set of human rights. Have you ever seen the documentary "The Business of Being Born"--they talk about how they used to drug women up, bind them to the bed and leave them to "labor" in a semi-unconscious state in their own vomit, urine and feces--sometimes for days--it was called "twilight sleep"--that was in the 20th century.

About the lithotomy (lying flat on your back) position I wrote this thread awhile ago.
 
There seems to be a lot of concern about this - especially women being forced into certain labour positions, or medical choices at the whim of the doctor - but I wonder why we don't do anything about it. As in, for those passionate about this issue (which I must admit I'm kind of on the fence on), why not start a petition to the HA and then contact the press to get some pressure going? It may not work - the HA seems to have its own problems to contend with - but has it even been tried?
 
charade said:
There seems to be a lot of concern about this - especially women being forced into certain labour positions, or medical choices at the whim of the doctor - but I wonder why we don't do anything about it. As in, for those passionate about this issue (which I must admit I'm kind of on the fence on), why not start a petition to the HA and then contact the press to get some pressure going? It may not work - the HA seems to have its own problems to contend with - but has it even been tried?
Click to expand...

I don't know how big of a deal it is to most women in the system in Hong Kong, honestly. It seems that most women are honestly content to do what the doctor instructs them to do without questioning it. It's a very doctor/system-centered system here in HK so the stance is whatever is convenient and most efficient for doctors and the system. Also as the system that most women use is public it's kind of a mentality of "you can't expect too much if you're getting public care." In the private system, often the attitude is, "If you don't like how we do it here you can always go public" so it's a very circular argument.

I think the best challenge that the system can get is for women to simply insist on their rights. These rights don't exist just because they are legislated by the HA. These are basic human rights--such as not being restrained without your consent etc. Educate women on what they can do in labor and then prepare them to do it and see what happens. The doctors in HK are the ones that hold the power to educate but they choose not to. That's how I see it.

It starts with a fundamental difference in worldview when it comes to childbirth. Most doctors are educated that childbirth is risky and an emergency situation so that's how they are trained to deal with childbirth. We know that childbirth in itself is not an emergency situation and often what doctors do can turn it into one (unnecessary inductions, c-sections, vacuum extractions, epidurals etc.). But if doctors are only trained to view all childbirths as an emergency that needs to be dealt with and that takes a change in worldview.

So, basically, midwives should be delivering babies and not doctors in most cases. Because there is also a certain emotional/spiritual/mental/metaphysical element that plays a huge part in childbirth that most doctors aren't in touch with--they are in touch with and trained with the physical/biological/scientific elements of childbirth but mostly don't take into account the other huge elements that affect the outcomes of labor and birth. It takes a certain amount of confidence and mental toughness to go through labor naturally and also it takes letting go. I experienced this first-hand with a first labor that lasted 43 hours--likely because of my fear of letting go and then a labor that lasted 12 (felt like a very short 12 too!) because I learned how to let go. In the same way that I find the HA lacking in general bedside manner--this reflects their disconnection with the emotional/mental/psychological elements of providing physical care and simply put, HK isn't a city or system that slows down for those things.

Ideally, women in HK would have the safe option of having midwives attend their births in their homes or there would be birthing centres established so women could have more choice of their birth experience--it would actually save this city a lot of money because midwife-attended births are statistically less risky and require less interventions--same can be said for birthing center births and many women would be excellent candidates for this type of care in HK (where the obesity factor which causes a lot of the high-risk pregnancy cases in other countries) isn't so large.

So, I don't know if anyone has tried a letter writing campaign in HK but first women have to be convinced that it is actually their right to move about during labor and do what it physiologically and psychologically conducive to labor and that they should be standing up for these rights. Doesn't seem like even on a site like this we have much belief in this notion. Again, very circular. People in HK trust doctors and don't question them. Doctor says "Do it this way." Women don't question it. Study comes out saying "Better to do it this way." Women take study to doctor. Doctor says, "No. Do it this way." Women don't question it. The power lies with the doctors.
 
and what if a woman wants intervention ? as in what if it's an educated, well informed, thought through decision ? am a little perturbed by this generalization that women are "going through this" because they dont know their rights.
 
I come from a country where 30% has a home birth. I would never want that. I prefer a hospital birth with an OB instead of a midwife (had one for the first 30 weeks with my first pregnancy until I moved continents). I had an epidural both times and was constrained to the bed pretty much and it was my choice and I was fine with it. Again, I had doctors who were very much pro-natural birth so I had my 3 children natural including the twins, with one breech. I wouldn't opt for a c/s without a medical reason. But other than that, I made my choices, and accepted the circumstances that came with it. Everybody makes different choices, I was happy with mine, and would do it again.

I understand where thanka2 is coming from but also tend to agree with miran, that I did educate myself, but pretty much prefer certain ways of intervention. And that's fine too.
 
@Thanka2


You are right that a lot of women in HK would prefer a more medicalised birth than less. I think the reason the c-section rate is high here is because it?s a happy marriage between women who believe it will be less painful, less scary than labour and doctors who like the controllability and convenience of it. So the doctors might be pushing c-secs, it?s not a hard sell; they have a ready audience in women looking for a way to avoid labour.

C-secs are one thing but I don?t see why more women wouldn?t get behind more comfortable labour positions, for example. My perception is that just on this forums there are plenty of women who would support more flexibility in labour positions.

I?m not sure whether getting women to insist on their rights at the time of labour is the way to go. For first time mums, there?s so much else to contend with and if you?re not the confrontational type in the first place ? which a lot of women aren?t ? gearing up for that is going to stress you out in a way that?s not going to be beneficial to the whole process. That?s why I feel that maybe we should be insisting on the rights before we go into labour. And the only way for that to happen is for the HA to change its policies.

I also do see that the HA has its constraints. It may be easier to hook women up to a monitor and monitor them from elsewhere than to have someone come in and check on the woman every so often ? they are understaffed as it is. They also face liabilities if anything goes wrong and so they tend to play it safe, as the article you linked to shows. Will we waive our rights to sue if we insist on doing it our way?

Although slow to change, the HA has changed. I think not too long ago dads were not allowed into the delivery rooms. One of my friends who delivered at Kwong Wah said they had a birthing ball ? you could only use it if you had done their antenatal prep course though. They are also very pro-breastfeeding which I don?t think was always the case. I?d be interested to know how these changes came about. Was it just some bright spark in the HA who said lets institute this progressive change or was there pressure from the outside?

I?m not sure if we?d be able to drum up enough public pressure to influence any change with a signature campaign but I think it?s easier than expecting women to stand up for their rights at the time of labour because the number who will do that will be even less.

The obvious question would be why don?t I organise the campaign. The reason is I?m not sure where exactly I stand. I?m definitely all for more flexible positions during labour but not sold on home births. I?m also not very anti-medication and at the end of the day, I?d like to trust my doctor to make a good decision based on what I hope is more extensive study than my one year of reading up. But I am for better communication and answering the mother?s questions clearly. (The doctor on call when I delivered literally said not a single word to me except for a parting shot ? ?you aren?t in that much pain?. The problem is that even if I want to lodge a complaint against her I don?t know her name!) Bottomline ? I don?t think I?m passionate enough to organise something.

Anyway, even if we don?t get a campaign going, it would be good if each of us who delivers at the HA would write in to them about our experience, the positive and negative. Maybe if they get enough individual letters asking for a change, it might give someone in the HA sympathetic to the cause some ammo.
 
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