Ricki Lake - Your Best Birth: Know All Your Options, Discover the Natural Choices, and Take Back the Birth Experience

This book is not intended as a substitute for the medical advice of physicians. The reader should regularly consult a physician in all matters relating to his or her health, and particularly in respect of any symptoms that may require diagnosis or medical attention.

Copyright 2009 by Azzura Productions, Inc. and Barranca Productions

All rights reserved. Except as permitted under the U.S. Copyright Act of 1976, no part of this publication may be reproduced, distributed, or transmitted in any form or by any means, or stored in a database or retrieval system, without the prior written permission of the publisher.

Some material has been adapted or reprinted from the following sources and is used with permission:

The Labor Progress Handbook, by Penny Simpkin and Ruth Ancheta, 2005

Gayle Peterson, PhD, An Easier Childbirth, Shadow and Light Publications, 1993

Victoria Macioce-Stumpf, www.choicesinchildbirth.com

Marsden Wagner, Creating Your Birth Plan, 2006

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First eBook Edition: May 2009

ISBN: 978-0-446-55213-4

For our sons, Milo, Owen, and Matteo

Jacques Moritz, OB-GYN

Director of Gynecology at St. LukesRoosevelt Hospital and Assistant Clinical Professor of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons

On a recent, beautiful fall day in New York City, my family and I went for a walk around Gramercy Park. It was a walk we had taken a hundred times before, but this time, as we passed by a brownstone, we all noticed a National Parks Foundation sign that read The Birth Place of Theodore Roosevelt. My fourteen-year-old son asked if Theodore Roosevelt was actually born in this house or if it was just the place where he grew up. I thought it was a great question. Of course the year, 1858, meant that he was actually born in this house. My daughters response was cool! At that time, Mrs. Roosevelt didnt have a choice. Giving birth at home was her only option.

A lot has changed in the 150 years since Mrs. Roosevelt delivered. If you were to walk into the coincidentally named Roosevelt Hospitals labor and delivery floor, where Im the director of the gynecology division, the first thing you would see is two sixty-inch plasma monitors displaying an array of data such as fetal heart rate, intrauterine pressure readings, blood pressure, pulse oximetry readings, and the list goes on. In front of these monitors would be a group of well-minded physicians and nurses that are all managing the laboring women. It reminds me of air traffic controllers at JFK trying to get a 747 on the ground in one piece. And patients love it. They say, The care must be goodlook at all that high-tech equipment they are using. But is all this high tech a good thing? Have we now entered the day of high-tech, low-touch deliveries? And if we have, what are the risks and benefits? These are all questions that expecting mothers should ask themselves. These questions and more are answered in Your Best Birth.

In 2006, I was approached by Abby Epstein and Ricki Lake to be involved in a documentary for television that was initially titled, Manhattan Midwives. Im not a midwife but I am supportive of the midwifery model of care and have been the midwifery backup at Roosevelt Hospital for the past fifteen years. In fact, my own children were delivered by midwives. As Ricki and Abby began doing research for the film, they realized that they might have stumbled on a bigger question, How are babies born in the United States? What started as a film on midwives turned into The Business of Being Born, a film that became the childbirth equivalent of Al Gores environmental expos, An Inconvenient Truth. Birth, something that happens every day in America, was examined and questioned like never before.

Women and, especially, men have applauded at every screening, always saying the film opened their eyes to the many different ways you can have a baby. At the same time, after screenings at my hospital (where the film was actually shot) the film was being booed, with Abby and Ricki being called Nazi propaganda filmmakers. I remember going to Labor and Delivery just after the film was shown and a young OB running up to me in her full space suit (gown, booties up to knee, and a mask covering her entire face) looking like she had just come out of some biohazard, screaming, Youre not the only one that can deliver a baby naturally! I had to chuckle. The most recent form of criticism came from the American Medical Association, which came out with an article announcing their stance that all home births were unsafe. I had never been aware that a film could be so powerful.

The state of obstetrics in America is in a crisis mode. The word crisis is a strong one that is overused in this country, but the obstetrical crisis is real. Women must understand this crisis and how it will affect their birth options. Physicians and midwives are being squeezed between the dual constraints of rising malpractice premiums and increasing lawsuits. The record numbers of OB-GYNs who are voluntarily stopping obstetric practice and of midwives who are unable to find backup physicians or get malpractice insurance are signs of a major crisis. Even more importantly, there are increasing limitations imposed by insurance companies that introduce restrictions on how OBs can practice. In Oklahoma, for example, OBs are not covered by their malpractice provider for VBAC. Even if the doctor wants to provide a patient with the VBAC option, the hospital wont allow it because the hospital doesnt have the insurance coverage. Of course, in the classic Catch 22 the insurance providers tell doctors that they can still do VBACs (vaginal birth after cesarean)they just wont be covered. Obstetrics training itself is questionable, in my opinion. In my four years of residency at Columbia University, the only natural childbirth I ever saw was done by midwives.

The days of pregnant women interviewing their doctor (as seen in the film Knocked Up) may be a thing of the past. I know doctors who now interview patients to see if they will accept them in their practice, or fire patients if they have too many questions. The days of your health care providers being the person who attends your birth are also over. Most OBs and midwives now practice in groups. Not a bad idea in theory, since the last thing a woman wants is someone who hasnt slept in the past forty-eight hours delivering her child. However, when it comes to todays common mega groups of OBs where you have eight OBs covering each other in a group, it means you have a one in eight chance of getting your doctor for delivery. And this new trend goes one step further with the laborist, a physician who is now commonly hired by a hospital or large obstetrical group exclusively to deliver babies. Laborists often have twelve-hour shifts. You will never meet the laborist before you start labor and you wont see the laborist again after delivery, and if your labor is a long one, you may have more than one laborist taking care of you. Welcome to the new world of obstetrics.

When women find out they are pregnant, theyre often so excited that the only thing on their mind is maintaining a healthy pregnancy. I understand, but the next priority should be deciding what kind of birth they desire. The first step in the process is finding the right health care provider, but there is information you need to know up front as you make this decision, and there are many more decisions that will follow. Do you want an OB or a midwife? What services are available in your local community? Is there a birthing center in your local hospital? Are you a good candidate for a birthing center birth? These are all questions that should be answered early on.