Control

Why does it seem that so much about birth has to do with who controls what? When I went on my friend's hospital tour at Inova Fair Oaks Hospital last week, some of the most irritating things about the hospital environment had to do with control. The hospital staff seems to have this great need to control every aspect of the birth and hospital stay of the mother and baby. They have rules about just about everything!

• There are rules about the birth tub -- you can stay in it for labor, but not for the birth, and definitely not at all if your membranes have ruptured!
• There are rules about the hours that your loved ones can be with you -- partner 24/7, grandparents can stay until midnight, children until 8pm, etc.
• Rules about bathing your baby -- the baby is considered a biohazard, so it must be scrubbed with soap and water 3-4 hours after the birth.
• Rules about whether your baby can go home in the car seat you brought with you -- don't even get me started about the car seat test!
• Rules about whether you can even take your baby home from the hospital -- can't take the baby home if you don't have a car seat.
• Rules about doulas -- some hospitals don't even allow them!
• Rules about what you can eat and drink -- pretty much nothing, although your labor partner should eat and drink frequently to keep his strength up. Hmmm... who's the one laboring?
• Rules about the Vitamin K and Erythromycin ointment -- they look at you like you just grew a third eye if you even question it.
• Rules about how many people can be in the room -- no more than five plus the laboring woman. But, there can be as many hospital staff members as the hospital wants.
• Rules about having to have an IV -- must have it unless your doctor "allows" you to opt for a hep-lock instead.

Yeesh! All of those rules! How does the presence of these rules affect a laboring woman? My thought is that just having someone else calling the shots on things you may or may not care about, puts you in the position of having to answer to someone other than yourself. The woman gives up her power and her responsibility to think for herself because the institution has a rule for every decision she would normally have to make for herself. Giving up this power and responsibility puts her in a position of being under the control of the hospital and doctor for her birth. She's already accepted the hospital and doctor as the decision makers, so how could she have the gumption to question the decisions they make for her? Birth becomes something that is done to her, rather than by her.

When listening to women talk about their hospital births, how often do you hear something like this: "I'm not sure why, but they did ____ to me. I'm sure they had their reasons." Something like that would just not fly in midwifery care! In midwifery, the woman takes part in just about every decision made. She becomes informed about the options available, the risks vs. benefits of the tests she decides to do (or not do), and makes a decision based upon this informed choice. This, I feel, is the cornerstone of midwifery care.

Are there rules for homebirth? Sure, I suppose so. Some midwives don't do breech births or twin births at home. Of course, the woman has the option to seek out another midwife who would be willing to help her with a breech or twin birth. But, for the most part, midwives are pretty open to the mother doing whatever she feels is the right thing. Eat and drink in labor? Absolutely. In fact, most midwives insist upon it. Get in the water after membranes have ruptured? Sure, why not? Have your loved ones with you 24/7? Absolutely. Skip the bath? It's your baby, why not? If someone is worried about disease, they can wash themselves after they touch the baby! Car seat? Yes, but we're not going to do the car seat test! Ultrasounds? If you want them, you can get them, but that's up to you.

The point is that you have as much control in a homebirth as you want to have. If you want to catch your own baby, go for it, but if you want the midwife to do it, she will. You have choices in your birth. Your midwife might guide you, and she might point you to information to help you make decisions about your care, but you have the control to make the choices you want to make.