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Monday, 04 November 2013 19:58

Experience vs Information: Your Choice

This post started out as a piece on optimal cord clamping, but has become a whole new beast. (Optimal, or delayed cord clamping is the process whereby the umbilical cord is left to cease pulsating before cutting). I read and I researched, after which time, this article changed tracks. I don’t need to tell you the pros and cons of delayed cord clamping. You can read all about it on the websites listed below. After which time you can make your own mind up. 

Could this be my shortest ever blog post? No, what all this lead me towards is the fact that in so many cases, women are not given factual evidence-based information to make a choice. Often it is the experience of others that leads us toward making our decisions, when it should be the combination of experience and information. 

It is in our nature to want others to have the benefit of our own experiences. Informed choice happens when we consider the experience of others and combine it with scientifically proven, evidence-based information. Sharing experience is a vital way to keep ideas flowing. Experience, or the stories that we tell, should serve as a motivation to gather more information on a particular topic; people usually make choices based on what is best for them. Being that individuals are unique, this will vary from person to person. I have made different choices in all four of my births. Many of them ill informed, but all of them mine. I hope to share my experience, tell you a story, then give you some information so that you can make your choice. First, a non-birth related example:

My husband is the sort of person who falls in love with a new product, and immediately wants others to experience the same revolution that he has. If something makes his life easier, cheaper or gives him pleasure, he shares his experience with all around him. When we were first married, we bought an “upside down” fridge. He would show all his friends the said upside down fridge, spout the benefits on not having to bend down to get vegetables, and marvel at the convenience of the mighty upside down design. Despite his enthusiastic sales attempts, I don't think any of the afore mentioned friends jumped aboard the upside down fridge revolution. I am sure that they looked at them, but made their choice based on what suited them and their family and not solely on the eloquent ramblings on my husband. Simply put, they listened to his experience, did their own research and make the choice that was right for them. 

So often advice is based on the experience of others, and not the evidence and information available. Many women that I speak to don’t know that they have a choice in regards to management of the umbilical cord after birth. The World Health Organization (WHO) recommends an actively managed third stage of labor, (another choice here, as you can request natural or physiological third stage) but recommends that after the birth of most infants, regardless of gestational age or weight, the cord should be left for 1 to 3 minutes before clamping.  

When I discussed my preference for a natural third stage with my fourth child, my caregiver refused. She told me that there are too many risks of postnatal hemorrhage, and that she would “not allow it.” We went back and forward over the issue of delayed cord clamping and a natural third stage. Eventually she “allowed” me to have optimal cord clamping if I would agree to an actively managed third stage. Interestingly, I have learnt while researching optimal cord clamping, that what I fought my caregiver for is exactly what the WHO recommends should be standard practice. It was her experience that women having their fourth + baby were are greater risk for hemorrhage. I accepted her expertise and experience as my sole source of information. 

I don’t want to underplay the importance of closely monitoring the third stage of labor. I understand in many cases, administration of an oxytocin based drugs has saved lives. In my circumstance, had I done my own research, and searched for evidence-based information, I would have refused active management. I was very low risk, regardless of the fact it was my fourth birth. I am left wondering how many birth related choices are influenced by experience instead of evidence. I was educated, informed and proactive, but still managed to be persuaded to do things differently based on the words that were spoken to me, and the manner in which they were delivered.

You always have choices. Don't let anyone take them away. You wouldn't go out and buy an upside down fridge simply because my husband, or even a well versed fridge expert told you they are the bomb. You might use his experience to motivate you go out and learn more about them; hey, you might even go out and buy one. Choice is always there, beware of advice and experience that disguises itself as information, and it truly becomes yours. 

Over to you now- make your choice. Here is some evidence-based information on optimal cord clamping and different options for the management of the third stage of labour. 

Midwife thinking - the placenta the essential resuscitation equipment

Dr Sarah Buckley on the third stage of labour

Published in Birthing Facts

Once you have established and met with your selected care provider, it is time to start thinking about what kinds of tests, screenings, and procedures you do and don’t want. In all likelihood, when you met with your care provider, he or she outlined the general schedule of checkups and tests that are part of procedure. These can include blood panels, ultrasounds, glucose screenings, and many more. Despite what your care provider may have told you, most if not all of the screenings are in fact voluntary. Per the Patient’s Bill of Rights, you may refuse any and all tests and procedures, you may allow some, or you may allow all. What you must now do, is investigate the reasons for these tests and determine if you feel that these tests are necessary to your health and the health of your baby. 

Now I know what you’re thinking; “Why wouldn’t I do what they tell me?” Ask yourself this; “Do I need to be screened for gestational diabetes even though I truly eat healthy, exercise daily, was at a healthy pre-pregnancy weight, and have no history of high blood pressure or diabetes?” 

Food for thought: American medicine is based around fixing health problems. While I’m not here to bash American culture or medicine, I want to point this out because many OB practices follow the guidelines of the ACOG for prenatal testing. This is not necessarily a wrong; however, it is a procedure that has been set up in an effort to streamline care and try to avoid mistakes in the world of drive-thru care. By testing all patients for gestational diabetes, an OB has one less thing to inquire about when seeing a patient and can focus on other things such as weight gain, blood pressure or urinalysis. The lesson? Ask yourself if the testing is necessary to ensure the health of you and your baby. Ask yourself if you feel that doing this testing will ease your mind about your pregnancy and allow you to continue your healthy lifestyle. I don’t want to discourage you from tests, I want to encourage you to educate yourself and make the best decision for you and your baby. Nothing beats an informed mother’s intuition and judgment when it comes to the best interest of her kids.

The most common tests that are considered “standard” for prenatal testing are outlined below. Some of the links are directly to the ACOG website in an effort to help you understand their perspective. Other links are to outside sources, since ACOG didn’t have a direct FAQ sheet available.

Some of these tests have low risks like urinalysis. In reality, peeing in a small cup only poses a risk to a woman in her third trimester that is having trouble getting the cup underneath her and may topple over. Others such as amniocentesis and CVS pose the risk of loss of pregnancy. STD’s can cause birth defects and risks to pregnancy, so if you are at high risk or do not know your STD status, this can be important because it may be in the best interest of your health and the health of your baby to get treated appropriately. 

It is important to remember, that there is tons of information out there for you to use to make an informed decision about these tests. I have provided some links to information about these tests within this article, but there is tons of great info available. I would encourage you to talk to your care provider about the tests they want you to have and why. Be prepared before you have this talk with them to ask questions; don’t accept an answer of “because it’s necessary” as fact. The more informed you are before engaging this conversation, the more informative answers you will receive from your care provider. If the conversation goes well, he or she will hopefully be glad that you are invested in a healthy and informed pregnancy and provide you with information that will help you come to a decision. If you find that your provider is defensive or argumentative, it may be a warning sign that your choices will not be respected when it comes time for labor and delivery. Another resource for information is other like-minded mamas. There are a bunch of great blogs and Facebook pages (including but not limited to Birth Without Fear, Mamas and Babies, Mama Birth) for moms and moms-to-be to get information and talk to other mothers who have made informed decisions about selecting tests. Sometimes it helps to hear the point of view from another person who has been in the same situation, though keep in mind the differences between personal opinion and advice from a medical or birth professional.

I know I sound like a broken record when I constantly say that you need to educate yourself and make the right choices for you, but I also know that our society continues to send a message to pregnant women that pregnancy is a risky endeavor that should be closely managed. If pregnancy was so risky, how is it that we have been doing this for thousands of years without the help of medical interventions? We wouldn’t be here if pregnancy was risky all the time. Are there times where women are at a higher risk of complications? Sure, but we don’t need to approach pregnancy as inherently risky. Trust that pregnancy, the natural process of procreation that has brought the world to a population of 7 billion and counting, is inherently safe. Besides, that glucose drink for gestational diabetes is nasty!

Go back to: Step #2: Establishing Support

Go ahead to: Step #4: Developing a Birth Plan

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