Maternity Care in the Rio Grande Valley-From one Mother to Another
I am Nicole Hoff but I am better known as "Mommy", "The Birth Lady," or "The Boob Lady." I have my Bachelors in Maternal and Child Health, am a Certified Doula (a certified professional that assists mothers during pregnancy, childbirth, and the postpartum period), a Certified Childbirth Educator, an International Board Certified Lactation Consultant, and a Midwife Apprentice. As a mother and healthcare professional in private practice in Harlingen, I have helped families from all walks of life, from each end of the Valley, during a special time in their life.
Despite good-hearted intentions of many dedicated and educated health professionals, the maternity care system across the US, including the Rio Grande Valley of South Texas, has many shortcomings. A recent report by Childbirth Connection and The Milbank Memorial Fund, called “Evidence-Based Maternity Care: What It Is and What It Can Achieve,” explains why the state of maternity care in the U.S. is worrisome. The care practices that have been proven to make childbirth easier and safer are underused, and the many interventions that may increase risks to mothers and babies are routinely overused. The report points to the “perinatal paradox” of doing more, but accomplishing less. I have witnessed this first hand in the Valley and I am truly worried.
Every year Valley women are suffering in silence from birth trauma that results from their treatment during labor and delivery of their child. The feelings of their negative experiences are overwhelming, and sometimes so much so that they suffer from major depression afterwards. Some women consider it "birth rape", especially if they had instruments or hands placed inside them without their consent. Because of my education and experience, I feel that I know misinformation, maltreatment, and abuse in this field when I see it. I have had the honor of attending many amazingly beautiful births here, but I think some of my "birth stories" at local hospitals would surprise you and many would just sicken you. I wish I could forget each and every demoralizing abuse these mothers and babies faced, but some were just so shocking they will always linger in my memory.
I want to put these following phrases I have heard over the years out there in the open so our community can know what is taking place. I think everyone involved in birth needs to read these, so that they can be more attuned to what they are saying and what type of care they are providing. These are just a few phrases from the many well-intentioned nurses, doctors, staff, breastfeeding "helpers", and childbirth "educators" I have heard but I will never repeat. While some of these phrases could have the correct time and place to be said, and may really hold true for a mother, there have been more times that I have heard them said when it was inappropriate or not factual than when really necessary. Mothers have been mistreated, lied to, given incorrect information, coerced, manipulated or deceived so that one will be obedient and go along with treatments, and have had procedures done when there was no reason or consent to perform them. Dfferent locations, different staff, same ABUSE.
From their lips, to my ears, to my typing fingers:
Was this a planned baby or just a mistake?
I'm a rough doctor, but I know what I am doing.
You don't need labor support.
No one can birth naturally.
C-sections don't hurt.
Wow, you're huge, you need to get that baby out now!
You're too small for this big baby!
You're seriously pregnant again?
Be quiet. Hush. Shhh. You're too loud!
Our hospital is best- even with over 50% c-section rate.
Your spouse/mom/doula can't come in with you.
We throw away birth plans.
We laugh at birth plans.
You're too sick/weak/tired for birthing your baby.
OB: I only come to catch the baby.
Give up and go with the c-section.
You can't have a VBAC (vaginal birth after c-section).
That won't work!
Since you have medicaid...
I only speak English, this is America!
You're worrying me, stop that.
I have to do this to you because...
That's not important. Forget about it.
I don't have time. I've got other patients.
That's normal. I see that all the time.
You're wearing me out
I'm not here for you, it's just my job.
C-sections are safer and better for you and baby.
You're not strong enough.
That's in the past, move on.
I can't help it if you don't understand.
Hold your pee and poop!
You can't get up!
No time to explain this to you.
Sit still. Lay still. Be still.
Why would you want that?
Well that's a first!
You ask too many questions!
You have to do what I say.
I know your body better than you do.
Only 1 person allowed in room.
I'm cutting you open.
Push now even if not ready.
It doesn't matter what you need.
Your epidural didn't work because you....
Let's induce now at 37-38 weeks.
Start pitocin she's not progressing.
You have to be alone for 2 hrs.
I'm taking your baby away for 4 hrs.
You have no choice.
Even if you say no, I must...
Ob:Plan a c-section or induction for when I'm in town.
Ob:I know what's best, not you! Who is the doctor here?
You're here so I can't let you leave.
Just get pain meds already!
You can't do this anymore!
You're not pushing right!
Spread your legs! Wider!
Lay flat even if it hurts.
Did you pay your deductible yet?
I cut you even though you didn't want it.
You will hurt your baby unless...
Emergency c-section was you're fault.
I forgot to wear gloves.
Your baby needs a bath, it may have swine flu.
Your baby is dirty.
The doctor decides...
Your baby needs more than your breastmilk.
Your breasts won't work.
I have to hurt you.
I forgot and fed your baby for you.
Formula is better.
You need a catheter!
You need pain meds!
You need an IV!
You need pitocin!
You need monitoring!
You need to just chill out!
Your baby doesn't like that.
You can't go to the nursery.
You're not dilating fast enough.
I got you too drugged up to hold baby.
The baby needs the nursery more than he needs you.
Epidurals have no side effects.
You're not breathing right.
We can't do that for you.
We do this because it works for us.
Your doctor won't be here for you after all.
Follow our rules.
We have policies and protocols.
Now you know why videocameras are not allowed in labor rooms! They would be too embarrassed to let this get out, and honestly I am embarrassed for them. This list doesn't even include the sighing, eye rolling, storming out, finger pointing, paper waving, bribing, rough handling, withholding, lack of privacy, lack of respect, and other abuses. Because such practice and sayings have become routine, few maternity providers consider them abusive or inherently inappropriate.
It needs to stop... but I fear it won't.
Still, someone needs to speak up for these moms and babies and I hope someone out there cares. No local maternity professionals or hospitals have responded yet to my plea to contact me about ways to end this system of poor care. And no one has apologized to these mothers or babies-many who feel traumatized by past births. I would like to apologize for them and my apologies go out to the mothers that have had this abuse, and my hope for you is that you find healing and closure.
I will get some harsh feedback from this letter and some will deny the existence this abuse to mothers or believe that I am exaggerating, but this is because misconduct is rarely reported. I know that, sure, some births go "fine" and there are a handful of "good" staff out there, and hospitals are "working hard to accommodate mothers". I have seen that too, just not often enough to right a passionate letter about it. Maybe someone will respond wanting to know how to help make the birth experience better? The answer is easy! Birth professionals need to empower women to prevent birth trauma. Give her control through education, support, and your time. Don't make decisions for her, make them with her. Show her that she is valued and that you will give her your all to give her the best birth for her. Treat her with respect and give her privacy. Ask permission anytime you are performing an intervention, treatment, or even touching her. If she asks you to stop, do so immediately, and always explain what you are doing in detail. Above all, listen to her, and show her that you care about her AND her baby. No one deserves to be treated any differently than this, especially when in pain, when in need, and at a precious event in life.
Attention-RGV Families: You're not free from serious risks at Valley hospitals when giving birth. You will hear many of these phrases above, whether you believe it or not, it is a sad fact. The c-section rate is high in our area. You risk so many interventions that can lead to a c-section or a sick mom and baby. You face the risk of unnecessary induction, which can turn out to be too early or fail and lead to a c-section. It is a fact that you will receive care from some, if not all staff, that have amazing skills but lack natural/normal childbirth and breastfeeding education. I have seen this at about every Valley hospital location. You will probably be made to do what they say and not what you need or want. You become their property and your baby becomes their responsibility!
There is an alternative. Escape from this abuse. There are a number of different ways for you to have a safe, happy, and healthy birth. Here are the four most common:
* With an "enlightened" doctor at a hospital
* With an "enlightened" midwife at a hospital
* With a midwife at a birthing center. Locally: Holy Family Birth Center in Weslaco.
* With a midwife at home. Locally: Beth Overton, CPM who does all prenatal care and home birth.
Seek many options, weigh the risks and benefits, and choose the birth plan that works best for you. If you are considering a natural childbirth, you should definitely educate yourself, consider taking a childbirth class not associated with a hospital or similar natural childbirth class. You really can have a beautiful birth experience even if you have your baby in a hospital, but you need to find a doctor or midwife and doula who will support you in your point of view, and you need some training to help you prepare yourself.
Attention-Doctors, staff, hospitals: If you think this isn't happening in your birth facility or practice? Prove me wrong. Show me your true support of these women and babies. Hire me as a Doula to be on staff and respected at your birth facility or clinic for 1 month. Allow video cameras into your center and take evaluations from your patients. Not brave enough for that? Show me the information on how these phrases and this type of "care" you are providing helps mothers and babies. Are you that "enlightened" doctor or midwife out there that can help Valley families, then contact me and let me know and I would be happy to share that information.
For now I, as a Valley mother and maternal and child health professional, will continue to advocate and support Valley families, and I hope that I will no longer continue to see and hear mothers and babies being abused at what should be the most joyous time of their life.
Contact me for more information.
Nicole Hoff, BA, IBCLC, CD, CBE