Routine Care VS Medically Justified Care

Managed care represents a very real loss of control over your person and your experience.

Going to the hospital literally means that you are placing control of your care and your baby’s care in the hands of others.

Managed or risk-based medical care typically relies on a lot of routine rather than medically necessary interventions. Let’s talk about what that actually means.

Interventions can work wonders when they are medically justified and/or you find yourself suffering rather than coping with your birth experience.

The routine administration of IV fluids will provide a good example as 62% of pregnant women routinely receive them upon admission to the hospital.

Staying hydrated is extremely important during your labor and delivery because Birth is very demanding on your body, so it is vital to keep liquids going in regularly.

According to the website Evidence Based Birth when laboring people are free to drink fluids, the use of routine IV fluids is not supported by evidence.

The simplest solution is keeping a beverage constantly at hand and a birth partner/doula who will stick the straw in your mouth in between every contraction. 

Dehydration can be a factor. It can make Labor more difficult than it needs to be. Your contractions will feel more painful and trying to insert an IV port into a dehydrated vein can be difficult for even a very talented nurse—these are just two of consequences.

But I digress.

Medically necessary means getting IV fluids administered when you arrive at the hospital and you are severely dehydrated, you are at risk and your baby is at risk. Downing a couple bottles of water will no longer do the trick.

Risk-based managed Maternity care means getting IV fluids routinely administered when you first arrive at the hospital regardless of necessity.

In this instance, IV fluids are administered “just in case”, the rationale being that because you are a pregnant woman who might be in active labor there is a possibility that you may become severely dehydrated during your labor, and hospital staff wants to prevent that by preemptively giving you fluids.

“Just in case.” You may also hear, I’m sure you want to do all that you can to keep your baby safe. It’s our policy.

Not because you ARE dehydrated but because you MIGHT BECOME dehydrated. Not because your life is currently at risk but because the POTENTIAL risk of dehydration exists. 

Medical help when you need it is a very good thing. Managed care may indeed work well when you are medically ill, when you have been in an accident, when your birth has met special circumstances.

But, and this is a BUT, instead you are pregnant and in labor—so more than likely you are healthy, not sick, you are whole, not broken—Just because something works well for the sick does not translate that it works well for the healthy.

And yes— that sentence requires a bit of further explanation, and a lot of common “routine” interventions just don’t make sense once you dig a little deeper.

Let’s think of it this way:

A cast works wonders if you break your arm, it allows your bones to set and your body to heal. A cast does nothing but get in the way when one is placed on a healthy arm, just in case it might get broken. Just saying—If it isn’t broke, don’t fix it.

And for our example:

IV fluids work wonders if you are severely dehydrated, they allow your body to receive vital fluids and lifesaving medicines. IV administration does nothing but get in the way when a needle is inserted into a healthy arm and hooked up to its bag on the pole, just in case, you might get dehydrated. Just saying—doesn’t it make a lot more sense to simply take your fluids by mouth?

The reality in Pittsburgh, PA, is that the majority of local hospitals will insist on some version of this intervention, the most likely compromise is to get a Heparin Lock. The needle is in place but no routine fluids are given—you will still have freedom of movement. The medical staff will have the ability to quickly administer drugs and fluids should they become medically necessary. 

Educating yourself on what is considered routine and what is really medically necessary is the key to mastery over your experience. Pick your battles wisely, the ones where you really want to stand your ground. Compromise on some things so that you can have other things, working in and around the system.

“Right knowledge” will enable you to know when and how to navigate the system so that you make the best decisions and the right choices for you and your baby.

Here again, like Yoga, the prescription is not the challenge, taking the medicine is the challenge.

You need to determine what choices and decisions are best for yourself and your baby so the “prescription” is to tease out the “right knowledge” surrounding Birth in America today and that means the “medicine” is deciding to wade through a lot of murky water.

The even tougher medicine is finding your voice and advocating for yourself and your baby. You will have to stand up for yourself and not just figuratively but quite literally.

If you want to utilize gravity and movement during labor and pushing, then YOU are the one who needs to stand up.  Your team can advocate and suggest but you are quite literally the only one that can stand your ground.

Present your case with the evidence to back it up. It pays to be prepared, finding a team, a doctor, a nurse that you can work with and not against.

You will need to search out and study, read up on a lot of topics.  There are “rules” about just about everything during pregnancy and birth.

And there is A LOT of information out there about these topics—unfortunately, it turns out that a lot of the recommendations, the interventions, and a lot of the do’s and don’ts— isn’t all good or even true.

What you find out there is often contradictory, it often doesn’t make good sense, and it varies in quality. Faulty studies, misinterpreted evidence, myths, apocryphal facts, and just plain old cover your ass tactics.

But help, is out there if you know where to look. It is my intention that “here” is one such place. But for now, please bear with me, as I write these words, this project is still very much a work in progress.

Yoga is very concerned with reality, because when you see things as they really are, then suffering diminishes. So let’s find some reality, dispel some myths, some misconceptions, and misperceptions.

I will focus on just a few, at this point, just to show the value, of getting the facts straight. 

If you plan on being an Outlier and swimming against what passes as normal in Birth nowadays, then you will need the evidence to back up your case.

Certainly share your evidence with your medical staff, it very well may help you get more optimal mother friendly care, but mostly find it for yourself as a means of looking clearly at birth with an uncluttered mind. When you know something to be true you can trust it.

Creating a calm positive mind is the path to a calm positive birth. If you know the truth you will no longer need to subject yourself to needless suffering.

Sutra I:7 Right perception arises from direct observation, inference, or the words of others.

Sutra I:8 Misperception is false knowledge, not based on what actually is.

Knowledge replaced my misunderstandings about birth and my mind stilled, my fear diminished.

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