I absolutely agree with you that there can be, and should be a common ground between health care providers who embrace allopathic, naturopathic and holistic approaches to patient care. These philosophies do not necessarily need to be mutually exclusive.
I have personally experienced a moderate level of pregnancy and childbirth management, as well as a more hands-off approach to patient care. I have also been on the "giving" end of these two types of patient care approaches and have been the witness to these different approaches in numerous scenarios through labor support and through the stories of my students.
To me, a "managed pregnancy" is a pregnancy in which someone else (most likely a health care provider--doctor, midwife, nurse practitioner...) directs, or manages the progression of the pregnancy through ordering tests (regardless of proven efficacy), maintaining a very rigid schedule of prenatal exams, making recommendations to the pregnant woman based on protocols, rather than a very personalized approach--that might include taking into consideration social, personality/character, economic, medical and past history factors.
I absolutely agree that there are times when medical management during pregnancy and childbirth are important, if not crucial. When pregnant women are found to have conditions such as placenta previa (the placenta partially or completely lies over the cervical opening), placenta accreta, blood clotting disorders, pre-existing heart, lung or thyroid disorders, a higher level of "management" is definitely in order. And, in many cases, these women are not candidates for a home birth experience, and ought to be guided in a different direction.
However, there are many other scenarios in which women are told they are "high risk" and that level of risk is arbitrary, at best. For example, if a 36-year-old woman who is in excellent health, had a couple of previous healthy, no-complication pregnancy and deliveries becomes pregnant for a third time, she will still be told she is "high risk," and treated as such, simply because of her age. In reality, her present health status and past history ought to be equally considered.
I would like to clarify something about my position as this dialog goes on: I am a mother of three young children. I birthed all three of my children in the hospital. Two of those three births could have just as well occurred at home with no difference in safety outcome to me or the baby. I am not strictly a "home birth advocate" as Dr. Tuteur would like to pit me to be. I can see the potential value in both cases--hospital or home birth. What I am, is an advocate for the best possible treatment of mothers and babies--which includes applying medical technology when it is truly warranted, and holding off when studies, present circumstances, health history and intuition suggest otherwise.
Can all maternal deaths be avoided? No, absolutely not. Have we made great strides in reducing the number of maternal and neonatal deaths in the past 200 years? Yes. But, as I made the point earlier, the two main things that have helped us achieve these goals are prenatal care and antibiotics. (Both of which are still unequally distributed in our socitey.)
Technologies such as constant, or near-constant Electronic Fetal Monitoring, elective labor inductions, elective c-sections, and artificially breaking a woman's amniotic sac are all technologies and techniques that RAISE a woman's level of risk during childbirth...not prevent death or illness. And these are also tools that fall under the blanket of "heavily managed" childbirth.
Technology is great, when chosen wisely. I tell my Lamaze class students this every class session. But so is using a healthy dose of restraint. And as health care providers who are trained to utilize and apply technology, we sometimes have a difficult time doing that.
Kimmelin Hull, PA, LCCE
author of A Dozen Invisible Pieces and Other Confessions of Motherhood
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Allison,
I absolutely agree with you that there can be, and should be a common ground between health care providers who embrace allopathic, naturopathic and holistic approaches to patient care. These philosophies do not necessarily need to be mutually exclusive.
I have personally experienced a moderate level of pregnancy and childbirth management, as well as a more hands-off approach to patient care. I have also been on the "giving" end of these two types of patient care approaches and have been the witness to these different approaches in numerous scenarios through labor support and through the stories of my students.
To me, a "managed pregnancy" is a pregnancy in which someone else (most likely a health care provider--doctor, midwife, nurse practitioner...) directs, or manages the progression of the pregnancy through ordering tests (regardless of proven efficacy), maintaining a very rigid schedule of prenatal exams, making recommendations to the pregnant woman based on protocols, rather than a very personalized approach--that might include taking into consideration social, personality/character, economic, medical and past history factors.
I absolutely agree that there are times when medical management during pregnancy and childbirth are important, if not crucial. When pregnant women are found to have conditions such as placenta previa (the placenta partially or completely lies over the cervical opening), placenta accreta, blood clotting disorders, pre-existing heart, lung or thyroid disorders, a higher level of "management" is definitely in order. And, in many cases, these women are not candidates for a home birth experience, and ought to be guided in a different direction.
However, there are many other scenarios in which women are told they are "high risk" and that level of risk is arbitrary, at best. For example, if a 36-year-old woman who is in excellent health, had a couple of previous healthy, no-complication pregnancy and deliveries becomes pregnant for a third time, she will still be told she is "high risk," and treated as such, simply because of her age. In reality, her present health status and past history ought to be equally considered.
I would like to clarify something about my position as this dialog goes on: I am a mother of three young children. I birthed all three of my children in the hospital. Two of those three births could have just as well occurred at home with no difference in safety outcome to me or the baby. I am not strictly a "home birth advocate" as Dr. Tuteur would like to pit me to be. I can see the potential value in both cases--hospital or home birth. What I am, is an advocate for the best possible treatment of mothers and babies--which includes applying medical technology when it is truly warranted, and holding off when studies, present circumstances, health history and intuition suggest otherwise.
Can all maternal deaths be avoided? No, absolutely not. Have we made great strides in reducing the number of maternal and neonatal deaths in the past 200 years? Yes. But, as I made the point earlier, the two main things that have helped us achieve these goals are prenatal care and antibiotics. (Both of which are still unequally distributed in our socitey.)
Technologies such as constant, or near-constant Electronic Fetal Monitoring, elective labor inductions, elective c-sections, and artificially breaking a woman's amniotic sac are all technologies and techniques that RAISE a woman's level of risk during childbirth...not prevent death or illness. And these are also tools that fall under the blanket of "heavily managed" childbirth.
Technology is great, when chosen wisely. I tell my Lamaze class students this every class session. But so is using a healthy dose of restraint. And as health care providers who are trained to utilize and apply technology, we sometimes have a difficult time doing that.
Kimmelin Hull, PA, LCCE
July 17, 2008 - 7:50pmauthor of A Dozen Invisible Pieces and Other Confessions of Motherhood
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