My thoughts of these two questions are two fold – my emotional response due to experience, and my intellectual response due to research.
First the emotional response - both my children and myself, needed medical interventions either during pregnancy, or immediately post-partum. With my first daughter I had a very uneventful pregnancy and had every hope to breastfeed and be the perfect natural mom. I first noticed something was off while trying to nurse in the hospital. My daughter did great latching on at first, but started to grow frustrated and fussy. I was reassured everything was fine and sent home on a Friday afternoon. By Saturday morning we knew something was wrong, she was screaming constantly. Calls to the nursing support hotline
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However, I think having other options for women is great, as long as there is a contingency plan for if things go wrong. I do believe that midwives and doulas need to be 100% open and honest about the “what ifs” that can happen during pregnancy, birth and post partum. During the stressful time with my first daughter, I felt the midwife was too worried about reassuring me and was dismissive about my concerns since I was a first time mom.
Complications do happen and both mom and baby’s lives can be at risk; not everything is picked up during prenatal checks. The difference between now and the past is that most areas have neonatal ICUs and NICU transport teams near by that can provide care to the baby if something goes wrong. Even in a hospital complications can happen, and the more parents are prepared for the chance that they have to alter their preferred birth plan the better. Unfortunately, baby doesn’t read the birth plan and can decide on his or her own to change things up at the last
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Many things can put the pregnancy in to the high risk category, including high blood pressure (6-8% of pregnant women), preeclampsia (3-5% of pregnant women), multiple births (steadily increases with increase in fertility treatments), gestational diabetes (2-10% of pregnant women and age (over 40) (nih.gov, 2017). While scare tactics should not be used, giving parents a false sense of safety shouldn’t be done either. An ethical midwife or physician should listen to parents concerns and wishes and advise accordingly. As parents we are responsible for the health and well being of our children and making the choice of where to give birth is one of the first decisions that we make. Personally, I chose to give birth in a hospital, as I was not comfortable with even a slight increase in risk to my daughters and myself. I only think that a decision should be forced if there is imminent danger to the life of the baby - similar to if a child is in imminent danger they are taken to the hospital. Hopefully, with proper prenatal care and modern diagnostics, most life threatening issues can be seen prior to birth, and the decision on where to give birth can be discussed and risks can be presented to parents so they can make an informed