Thursday, November 15, 2007

Practice Makes Perfect

I was watching The Practice last night. I watched it specifically because there were going to be three births on it (okay, I watch it anyway). I was pleasantly surprised. The show actually had 3 unmedicated births (I hesitate to use the word 'natural' since the situations were so surreal- for example, crazed gun-woman birthing in the midst of committing a felony). One was even a waterbirth. None of the 3 births took place in a hospital. It really made me think about the premise of this show- not the relationships among the characters- they're all neurotic- but where the hell is this practice? I don't mean the city, I mean the theoretical framework. Their practice appeared to be set up to do births in their office. I have never heard of such a thing- have any of you? I know their office is not inside a hospital- I don't know if they are supposed to be near a hospital or not, but they have rooms with beds inside their offices. Did I miss some important element of the plot about where they are located, because they seem to do things in their offices they I didn't think docs did in offices. Another thing- I love that their practice is multi-specialty. Wow- is this really happening somewhere? I think its a great idea. Who needs a practice with 13 OBs that all have the same philosophy? They just sort of cross-refer on the spot (although I can see where this can become a problem, even compromise confidentiality). Anyway, enough marveling, back to the births:
One waterbirth with a woman whose husband had recently died (she sorta relives her loss during labor). The pretty but repressed doctor complains that waterbirths are icky, but in the heat of the moment, she jumps into the pool fully dressed to give physical support to the distressed mother ( I was really proud of that character for that). I was also really proud of the birthing mom who was very authoritative and took control of her birth. She was actually directing everything (until she lost it during transition, calling for her dead husband)
One office birth for a woman having baby number 4- she is expecting a long awaited girl but instead gets another boy- and she's not pleased. The male nurse actually catches the baby when she labors very quickly and the doctors duck out of the room to develop secondary plots.
One young woman births while robbing a convenience store- and oh get this- the doc doesn't just happen to walk into the convenience store, he's answering a house call- a house call! Has anyone out there every had a doc do a housecall??? (Actually I have, but its been more than 10 years ago)
This show really had me thinking about how healthcare is delivered. (It also made me think about how friends shouldn't be having sex with one another- but that's another blog entry- in another blog!) I've complained for a long time about the lack of innovation in healthcare delivery, so imagine my surprise at getting inspiration from a somewhat lascivious TV show. Oh well, I'll take my inspiration wherever I can find it.
I actually caught myself daydreaming about turning one of my training rooms in my office into a birth space! (Let's see, shove those manikins to one side, suspend a rope from the ceiling, throw around some beanbags, install surround sound and voila!) I'd call it my 'birth observatory' since I'd employ a hands off approach. Just stop by, hang out, and birth a baby.
Birth can be so much more simplified. I always thought hospital birth was such a HUGE production. Such a simple process taken to an extreme of regimentation and regulation. I'd like to lead a movement to 'declutter' birth. I'll have t-shirts that say BIRTH SLOW : ) or 'Squat and Deliver' and go on cable access shows to demonstrate a step by step process for braiding your own birth rope or write a pamphlet on 101 uses for a placenta. Women everywhere will demand 'Uncluttered Births' that are void of hidden trays and cabinets of medicinals, or hordes of staff that appear at precisely the moment your perineum starts to bulge. In 'Uncluts' (as they will come to be known) there will be no hierarchy and everyone will be called by their first name- the only one who 'delivers' the baby is the mom. The birth plan will be the supreme document, not consent forms. In fact, the caregivers will have to sign the mother's consent form to be present at her birth.
See what one little episode of a TV show has started. I'll be dreaming this stuff all night...


Anonymous said...

I would love for you to jump in on this discussion on that MOM2MOM thing in the KCStar. The question now is about "natural" birth. The mom mentions that she's all about the health of her baby, so she wants to be right there in the hospital with NICU and all that jazz. Then she comments that she guesses not all people feel the same way. I tried to speak about how the interventions often are a risk to the baby's health when you have a low risk birth. I feel my case is a good example (and I might have been considered "high risk" due to AMA, and grand multiparity). I didn't have any problems until they put me flat on my back, did a cervical exam with the monitor running. Baby was born healthy and had an apgar of 9 at where was the decel causing distress and danger to my baby?

Pish said...

One young woman births while robbing a convenience store- and oh get this- the doc doesn't just happen to walk into the convenience store, he's answering a house call- a house call! Has anyone out there every had a doc do a housecall??? (Actually I have, but its been more than 10 years ago)

Check out

Anonymous said...

If we want changes in Kansas for any laws pertaining to birth, now's the time to introduce the ideas to our legislators. This is a quote from Mike Kiegerl...

"Once the session begins legislators have only 28 days to introduce new bills. To get bills through both House and Senate committee hearings, to the floor and passed is sometimes impossible to accomplish for lack of time. Therefore if you want some legislation changed, amended or new legislation proposed, NOW is the time to act."
Mike has pre-filed several bills. HB 2125 as amended will require health insurers to offer coverage for hearing aids. HB 2341, passed in the house 121-0 last session, gives parents of stillborn babies the right to proper burial (incredibly some hospitals were incinerating these little ones with the trash!) This bill will be guided through the Senate by Dr. Barnett.

Anything you want done? Insurance payment for midwives??? He might just try it.


Laborpayne said...

Thanks Pish,
interesting reading. Dawn, I'll pass your info on to some interested parties.

Housefairy said...

I love your uncluttering birth ideas!!!

kirsten said...

I've only watched one episode of The Practice, but are you sure the "male nurse" who caught the baby wasn't the student midwife? On the very first episode, the female OB turned to the male student midwife and said " that even a word?". I figured my BP couldn't take it, so that was my last episode.