I've given birth four times, and each experience was unique and added to my knowledge of the in's and out's of having a safe birth. I'm hoping this thread will help some of those who are facing this for the first time or who are dissatisfied with their previous birth(s). I really wish someone had told me all of this when I was pregnant with my first!

1. Hospitals exist to make money. It may not be obvious why this matters at first, until you realize that the facility you birth at handles you based on their business model, not on giving you the best possible care. They focus on getting rooms turned over and controlling liability. The moment you show up in labor at a hospital, they start the clock. They engage in multiple practices like continuous fetal monitoring that have been shown not to increase the positive outcomes for mother or baby while drastically increasing the odds of a cesarean. Hospitals and doctors love cesareans. The hospital makes more money, the woman is no longer taking up a room in L&D, doctor gets to go home sooner, and they covered their collective butt. The attitude is that when you did the cesarean, everything possible was done to save mother and baby.

2. Your doctor, midwife, nurses, etc will often make decisions based on THEIR OWN best interest, not yours. Medical professionals are generally attracted to their careers by a desire to help people, and many are truly altruistic, great people, but it is a mistake to assume that anyone will put your interests before their own, because these are people, not saints. These people will have a variety of influences on their actions, foremost a desire to cover their butts, followed by the need to eat, sleep, and see their families sometime this year. While we need to respect the expert advice of the professionals we've hired, it's paramount that you and your partner educate yourselves and remain in control of the situation so you are prepared to advocate for yourself.

3. Every interference with your body during labor and delivery has the potential to snowball into more and more invasive interventions. Being induced, having your water broken, pitocin, epidural, episiotomy, forceps, cesarean. Be very cautious of allowing any intervention without clear medical indications. Allowing myself to be induced without a good reason was a major mistake for my 2nd birth. It cascaded out of control and sabotaged the whole experience. I barely escaped without an emergency cesarean and it was very stressful and dangerous where it didn't need to be.

4. The pain of childbirth is not as bad as you think. Women are so terrified of the pain of birth we willingly submit to multiple unnecessary interventions in order to avoid it. During my first birth I got the epidural as soon as I was 4 cm when the contractions weren't even challenging. I was being induced because of preeclampsia, and I had decided early on in the pregnancy that I would get an epidural and basically hand the birth over to my OB. The result was that I lay there not feeling anything, not moving or helping my baby get in position and having to be constantly checked for "progress" and told when I was ready to push. I then pushed as they counted. And pushed. And pushed. But I couldn't push out my daughter because she was in a bad position and I was flat on my back not feeling anything. After over an hour I was completely exhausted. My OB came and took decisive action to wrap things up. She cut a large episiotomy, reached in and flipped baby facedown, then pulled out the forceps and pulled while I pushed. The damage to my body was extensive. My daughter's forehead was bruised and she was in respiratory distress from the long sojourn in the birth canal. The real wake-up call for me came two days later. Little did we realize at the time, but somewhere in all those cervical checks and forceps and catheters and baby flipping a dangerous bacteria was introduced into my body. The fevers raged for a week while the doctors tried combination after combination of increasingly exotic antibiotics. The infectious disease specialist who was called in to treat my post-partum infection after reviewing my latest labs 5 days after the birth told my family to prepare for the worst. He was trying one more combo of antibiotics, but if they didn't work he was afraid I would run out of time before he could try another. I couldn't believe I was dying at 23, all because I'd been afraid of the pain of childbirth. I'd just met my baby and now it looked like I'd be saying goodbye. Fortunately and miraculously, our last shot worked and I pulled through.

5. Not all midwives are created equal. After the horrors of my first birth I was determined to do things differently. I went to a practice of CNMs working with OBs thinking that midwife=natural birth friendly. Sadly that is not the case. Many midwives are trained to make the same decisions and provide the same (minimal) level of support that OBs do. The result was my 2nd birth where I was scared into accepting induction at 40 weeks 1 day simply because they didn't want to keep the close tabs on me that are required once you pass you due date in order to make sure baby remains ok. They said there was no benefit to waiting and the risks only increase. So I went in, still determined to avoid as many interventions as possible. Sadly my body reacted to the Cervadil they put in to "ripen my cervix" violently. The contractions were agonizing and right on top of each other. There was no down time between and I wasn't allowed to get up or move. I clung to the rail of the hospital bed shaking in utter agony. It was unreal. These were not normal contractions (I've given birth naturally twice since then and was never in as much pain as I was after the Cervadil). I didn't cave easy, but finally I literally begged for the anesthesiologist. Fast forward to the end of labor, the midwife is focused on the readout from the fetal monitor. So focused that as she tries to decide if we need an emergency cesarean for fetal distress, I'm trying to get her attention. "Hey, isn't this the baby's head coming out? Wanna come catch her?" No wonder the baby showed distress. She's waiting IN the birth canal. The midwife cuts an episiotomy (seriously?) and baby slides out with 1 little push. I call that CNM OB lite.

6. You can refuse anything. Nurses will tell you that you HAVE to be on the monitor. It's policy. You have to get an IV and you HAVE to not eat or drink. Lies. Hospital can make all the policies they want to, it's your body and you can refuse anything you don't want done to it. Now, it may be best to choose your battles wisely because you will make waves and you don't want it to be too adversarial, but if it's important to you, stick to your guns. They can't throw you out. I dislike birthing in a hospital, but for most US women it's the only option. If you are prepared you can protect and advocate for yourself.

These are the main things I really wish I'd known. There's a documentary by Ricki Lake called "The Business of Being Born" that is a must see. It has a bit of a granola bias, but it makes some very true points that really helped me make sense of what went wrong with my 1st births. If this helps just one woman be better informed and better prepared I will consider it time well spent.

EDIT: I am in NO WAY advocating or promoting unassisted birth!!! NO, NO, NO! Please, make sure you have the best qualified OB or CNM that you can find attending you, and if you can manage it, one whose childbirth approach matches yours.

Also, interventions are not evil- they can be life-saving when medically necessary. I am not anti-intervention. Just against unnecessary interventions and for evidence based care.