Does fear cause labor pain?

There haven’t been any conclusive studies about attitude affecting labor pain, but it is a central tenant of Natural Child Birth.

The following is an anecdote, but its a pretty powerful one. Two men agreed to undergo a labor simulation, where their abdominal muscles contracted with similar intensity to uterine contractions. These men thought they could handle it, they had no doubt going in, it was a way for them to prove how macho they are. They were likely more fearless than pregnant women, because as men they didn’t have ANY of the fear or anxiety that can accompany pregnancy (like worrying about tearing or dying or something being wrong with the baby).

They got hooked up to the machines…It still hurt like hell. It brought them to tears and made them cry out in pain.

According to natural child birth advocates, fear=pain. So if you are a woman and are in a ton of pain you just aren’t fearless enough. You just need an attitude adjustment. There is so much judgment heaped on women in natural child birth and home birth communities if they end up wanting pain relief. I think part of the reason why so many midwives seem calloused or cruel is because they have to watch people in pain for hours and hours, knowing that they could be getting relief if they simply went to a hospital. I don’t think someone who empathizes with people in severe pain could handle midwifery as a career.

Labor hurts. Its okay that it hurts. Its okay to ask for pain relief. Really.

UK midwives insult a father whose son died from negligence

I point out the difference in training between nurse midwives and lay midwives often, and there is a difference in that nurse midwives have more training and more accountability. I would say that on average there is a big difference in practices and attitude as well, but of course there are horror stories about CNMs just like any other profession. The common thread seems to be Natural Child Birth (NCB) advocacy.

Here is one such story from the UK, where there have been many problems because of midwives pushing vaginal birth no matter what, and otherwise discouraging any intervention during births. The father who lost his son to negligence is treated like an inconvenience, as an unimportant voice, in the natural birth debate. We should be listening to those who paid the price for ideology based decisions. That is the only way to learn from the past.

it wouldn’t happen to me

I did a lot of research before choosing an out of hospital birth, and unlike a lot of women I know who also did a lot of research, I looked at the anti-home birth side of things to try and get information about their position. I read hurt by home birth and skeptical ob mostly, because I thought those blogs were the only game in town (they aren’t, here is an alternative that is much less abrasive).

I read the stories of midwives doing unspeakable negligence on hurt by home birth. I came up with all kinds of reasons it wouldn’t happen to me.  I remember the things I told myself.

I thought garbage like “Those women should have researched their provider more. They should have discussed specific issues and wishes ahead of time. Its very sad that it happened but it doesn’t mean anything about home birth or midwives as a whole. They could have had a sadistic, horrible time in the hospital too”. Etc etc. Some of these justifications have a grain of truth in them.  You can be abused in the hospital, but at least you and your baby are more likely to live. You can be abused in the hospital, but at least you have a chance of actually collecting damages because providers are insured.

I felt that it was a small increase in absolute risk, which is true for some pregnancies and not so true for others. I was a first time mother so there were a lot of variables I couldn’t definitively answer for. I put my faith in midwives and the process of birth.

I remember taking walks and listening to hypnobabies, especially the birth affirmations tape. I remember being post dates and strutting around, repeating “babies are born when they are ready, not when doctors say they should be” to myself from the tape. Part of me knew it felt vaguely cult-like to have to repeat things to myself over and over again. I brushed it off. Part of the natural child birth mantra is to believe that your feelings affect labor. It functions the same way that cults do, they teach members to police their thoughts, they teach them that doubt is a sin. In natural child birth, fear is a sin. You aren’t allowed to be afraid. If something goes wrong, other cult members will blame your fear for what happened.

I had been a skeptic for so long that I hadn’t been scammed for many, many years. I thought I was on top of my game. I know now that people who think they are not able to be fooled are the easiest to fool. It keeps me humble and on my toes to know this now.

I am lucky enough that everyone got out of the birth physically healthy.  Every time I see a new home birth tragedy I feel my stomach churn. I look at my child- healthy and alive, and think “it could have been us”. It easily could have been.

I am grateful for the opportunity to see the error of my ways. If everything had worked out I would probably be in the ranks of other natural child birth advocates, insufferably gushing about my perfect birth as if it would make me better somehow than anyone else. I may have been permanently damaged by home birth midwives, but at least I’m trying to learn from my mistakes. Home birth midwives just try to cover up their mistakes or pretend they never happened. 

Dr Amy understands that deleting facebook questions is evidence of guilt…

Dr Amy understands that deleting facebook questions is evidence of guilt…

…But when she deletes the questions on her facebook group asking her to clarify her position on date rape its fine?

 

I emailed dr amy to ask why someone so anti-censorship deleted a post. Her response is that I am a  “huge jerk”, so that justifies censorship, apparently. Just keep that in mind every time Dr Amy claims that people who delete tough questions are cowards or guilty; she does the same exact thing when she makes a mistake, and if I am a ‘huge jerk’ for making a big deal about rape apologetics being endorsed then I guess she is the Hugest Jerk Ever for the things she writes. 

VBAC deaths are a terrible outcome of natural childbirth ideology. The outcome of blaming rape victims (which sometimes means suicide) is also a cause for moral concern. Important issues deserve thoughtful discussion and truthfulness, not misdirection and evasion. The Skeptical OB writes about a lot more than obstetrics and home birth, there are discussions of violence against women, racism, parenting, etc. There is no reason for this to go unanswered for so long. It reflects poorly on her personal integrity to throw so many women under the bus by failing to address concerns that many members of her own community brought to her attention. Step up already and just answer the question. You can ask dr amy about her position on rape by contacting her on facebook.

 

 

Debunking the Business of Being Born: part 8

This is part 8 in a series on debunking The Business of Being born, the popular documentary by Ricki Lake and Abbey Epstein. You can find the other parts of the series here. My descriptions of the movie are in bold. My commentary is in regular text.

Dr Michael Odent says that there are people that claim “that in the future most women will prefer to have an elective cesarean section. But when you talk about that with certain women, [they] still have some sort of intuitive knowledge of the importance of what’s happening when the baby is being born. They cannot accept that cesarean section is the future.” 

It is indeed true that certain women prefer some things and other ones do not. Its almost like we are individuals!

Rickie lake is talking with Abbey Epstein. Ricki Lake says  “I couldn’t get enough information. I was just blown away by what I didn’t know the first time around. I knew, even before I planned a second pregnancy, that I wanted it different. I wanted to do it on my terms. “

That’s fine. The unfortunate part about The Business of Being Born is that they pretend that unmedicated births are the only way to have a child on your own terms. Women who want c-sections, or who do not want assistance at all, are not represented. The contrast between the extremes would make for an interesting movie, but it becomes obvious that this is a movie intended to make home birth look good in the public eye, not to explore any issues surrounding womens preferences during child birth.

Abbey Epstein remarks that she thought it was just an eccentricity for Ricki to prefer home birth. Ricki replies that she loves pain medication and takes it when she has a headache. “But when it came to giving birth, it wasn’t an illness. It wasn’t something that needed to be numbed. It needed to be… experienced, you know?”

Ricki Lake filmed her home birth and footage of it is shown. She has multiple people trying to relieve her pain during contractions.

Rickis voice narrates over the footage “I remember I was in a LOT of pain. I was enduring just about the worst part, almost the worst part. I didn’t lose my sense of humor. I was naked and going ‘uhhh’ and we heard an ambulance go by, and I was like ‘That’s my ride, get me the fuck out of here! I want to go to the hospital, I want my epidural.’ “

Footage is shown of Ricki’s home birth where she is obviously in a lot of pain and says “I don’t think I can do this.” Ricki narrates over the footage saying “My midwife reminded me of all the reasons I was at home, and what I wanted to avoid, and the gift I was giving my baby.” and I thought “yes” and I got through that contraction, and I was one step closer.

This footage would be extremely disturbing if you hadn’t been prepped with natural child birth talk for 40 minutes beforehand. If you had seen the footage without being pummelled with the film’s conclusion (that vaginal unmedicated childbirth is optimal, is an amazing experience, etc) you would have thought it is cruel to deprive a woman of pain relief when she was in intense pain and requested relief. I also have a feeling that when women trust their midwives it is easier to go with their narrative of birth rather than to see their actions for what they are- cruelty. It is cruel to deprive someone of pain relief when they are desperate for it. After all, ricki isn’t experiencing the pain now, so it is easy to look back on it and make light of how horrendously painful it was.

More footage of ricki’s birth. She is in pain and her midwife wispers “this is you having a baby.” 

Ricki says “I feel like pushing.” her midwife responds encouragingly. 

Ricki’s narration over the footage says “At a certain point, I just gave in to the pain. I just let go and surrendered, and that’s when things went really quickly. “

Again, incredibly disturbing to someone who hasn’t been told repeatedly that doing things this way is optimal. It seems so needless to hurt that much. Ricki looks exhausted and dazed by having endured hours and hours of painful contractions. I remember that before I had my baby, I thought that midwives who acted like Ricki’s were acting like they believed in her, but after having been that patient, in tons of pain, with a midwife inadequately prepared to deal with my pain… it seems very cruel. I think that midwives witnessing pain so regularly without the means to solve it can harden them to the pain other women are enduring.

There is footage of ricki pushing her baby out in her bathtub, her midwives encourage her to pick up the baby.  Ricki is crying and saying “My baby” over and over.

This is the bread and butter of the business of being born: birth footage chopped into bits that emphasizes the baby being born and minimizes the labor and pain. I just wish that they would have been forced to show footage in proportion to the time spent on different portions of the actual labor. Women typically labor for hours, and the moment of birth is just that- a moment. There is a disproportionate amount of focus on the end of the birth.

Ricki remarks “That was just…everything to me. I mean, I could start sobbing right now. It was so empowering.”

Statements like this try to establish the objective supremacy of natural birth, when in reality it is just Ricki’s opinion of home vs hospital. Other women with different experiences are not represented.

A Doula is giving a couple lessons in their home on how to deal with contractions and talks about different techniques to provide relief. The woman’s husband is interviewed and talks about how he was on board with home birth from the start. Footage is shown of the midwife providing prenatal appointments in the couples home. 

Eugene Declerq, an MPH says “The research on home birth is pretty consisten in showing that in a supported environment, (he clarifies this to mean well trained attendants with quick hospital transfer), the outcomes of home births are very, very good. Generally better than they would be at a hospital birth.”

The outcome of home birth with nurse midwives with quick transfer are better than the outcomes of home births without those things, but the majority of home birth midwives have none of the things he listed. Regarding the numbers, its quite a stretch to call them “very, very good”, and its an outright lie to say the outcomes are better than hospitals. It is difficult to evaluate what studies he is referencing because they are never named, nor do they tell you what they believe to be a good outcome. I can bet that they care more about the c-section rate than the death rate.  The majority of studies show a decrease in interventions and an increase in perinatal death. MANA’s numbers, which came out this past year, demonstrate the same thing (if you look past their flowerly press release that tries to ignore the obvious conclusion that comes from looking at the numbers and then comparing it to hospital statistics).

The midwife talks about screening out patients for risk and other safe guards in place to protect moms (like preparing for transfer and making the call to do so in time). 

That’s nice and all, but those things only matter if the midwife actually decides to do them. There are so many cases of midwives taking high risk patients, of midwifery publications calling dangerous conditions “variations of normal”, etc. This seems like another attempt to make home birth midwives look like something they are not. Most of them are not nurses, most of them do not have adequate training, most do not have adequately quick transfer, and most of them do not have a good working relationship with hospitals.

OBGYNs express doubt that midwives could adequately manage complications without the equipment available in the hospital. One dr compares it to driving without seat belts using previous safe driving as a justification for the risk. Eugene comes back on the screen to dispel the myth that midwives are using archaic methods to manage labor or pain. He says they bring pitocin, oxygen, etc to births. Home birth midwives are shown packing up this gear.

Once again, this movie tries to make it seem like most midwives are nurse midwives (the only highly trained midwives in the usa), but most home birth midwives aren’t. Most home birth midwives are direct entry or “lay” midwives who do not have adequate training to deliver babies. Direct entry midwives are not allowed to carry medicine in all states, and some don’t do it because they think that complications should be managed by homeopathy or other techniques.

It is worth noting that midwifery is “traditional” or “ancient” when it suits natural child birth advocates, and its contemporary and evidence-based when it suits them.

Eugene continues “Home birth midwives are incredibly skilled at what they do.”

Then why is their death rate so high? Why is it that in many states I can become a home birth midwife simply by calling myself one? I have no skills or training outside of a doula class, but no one can prevent me from attending home births in my state because the standards are non-existent.

An OBGYN says “In a postpartum hemorrhage, you can lose your entire blood supply in about five minutes.” 

The midwife says “if you think a mother has a higher risk of bleeding you have the pitocin drawn up. You have the IV warmed here, right by her side.”

Anyone who has attended codes or traumas knows how hard it is to start an IV on someone who is bleeding heavily.  Having it ready doesn’t mean a lot if it isn’t physically inside the person’s vein. When they get really desperate for a line they jam a huge IV into your bone to provide fluids. Its not pretty. I doubt midwives have the equipment for that. Anyone who has watched the beginning of this movie knows home birth is all about NOT having IVs or other medical interventions, even “just in case”. They only bring it up when safety concerns are being addressed, to make it appear safer than it actually is.  They again they ignore the fact that the majority of american home birth midwives are not nurses and have no real medical training.

My patience for this is wearing thin. There is so, so much deception at this point that it is hard to conclude that it was not intentional. Either that or the film makers are in so deep that they are basically acting as cult members, who believe that it is okay to lie as long as you are serving the cause.  An entire portion of the film is dedicated to talking about how skilled and trained and prepared home birth midwives are, but they take absolutely no time to discuss the difference in training and preparation between the majority of home birth midwives (direct entry midwives) and the majority of hospital midwives (certified nurse midwives). Its a truly glaring omission.

“do nothing”- the official slogan of home birth

With a few exceptions (namely placenta previa) the home birth midwife’s theory of practice is to not do anything. Their strategy of not doing anything (often euphemistically called “trusting birth”) is what patients shell out thousands of dollars for. Home birth midwives seem to believe that active management of risk factors causes deaths, when there are plenty of statistics that evidence the safety of hospital birth when compared to home births. Here are the numbers from Oregon. The midwives have a theory, that doing nothing is better than doing something nearly all of the time, but they ignore all the available data to check and see if their theory is correct. They put peoples lives on the line and do not check ahead of time to see if their idea is true.

The way that midwives come to believe such nonsense is that the majority of the time no one dies when they decide to do nothing. The issue with doing nothing isn’t usually death, its usually brain injury caused by oxygen deprivation. There is not any accountability or tracking of brain injuries in babies by home birth midwives, but a paper by perinatal specialists found an 18 x higher rate of them. Sometimes it takes years before the effects show up.

I began thinking about this matter because of an article on the Thinking Midwife’s page about how nuchal cords (cords wrapped around baby’s neck) are a “scapegoat” for interventions. Heres her advice:

  • During birth DO NOTHING.
  • IF the cord is preventing the baby descending once the head is born (extremely rare) use the ‘somersault technique’ (Schorn & Blanco 1991) – see below.
  • Once the baby is born, unwrap the cord (the mother/family can do this).
  • If the baby is compromised at birth encourage the parents to talk to their baby whilst the placental circulation re-establishes the normal blood volume and oxygen for the baby. if the baby requires further resuscitation do it with the cord intact.

She emphasizes over and over again how rare it is to have to use the somersault technique, but to me that says that american home birth midwives specifically will be unlikely to actually learn this technique during a birth. Would you want to be the first patient a midwife has used this technique on? Would she even know if she were making a mistake? States that actually regulate direct entry midwives require that they fulfill educational criteria that is woefully inadequate, You can take the NARM exam and get certified after attending only 20 births- most non OBGYNs deliver more babies in med school than that.

The thinking midwife’s theory is that compressed cords are providing compromised, but not completely absent, blood and oxygen to the baby. That may or may not be true in any specific case, but there isn’t any electronic fetal monitoring to detect distress at her home births, so midwives are forced to form an opinion based on intermittent Doppler readings.

I sometimes wish I could get midwives together with malpractice attorneys sometime to talk birth injuries. Midwives who do home births attend to far fewer births than physicians, midwives get to pick their patients with more freedom than physicians, and lay midwives are less likely to actually recognize their mistakes. Home birth midwives are less likely to see the impact of their practice choices in any representative way, which probably makes it easy for them to pass around useless advice over and over. Malpractice attorneys deal exclusively in cases where someone died or was injured because critical decisions were made (or not made). They tend to have a much more common sense explanation of the problems caused by nuchal cords because they actually have to see the parents of the injured babies, and file the documents in court, and see the costs associated with the injuries, interview medical experts who explain what went wrong, etc. Malpractice attorneys have to face what these midwives would rather forget or blame on the parents. You will notice that it says in some cases the only way to treat is emergency c-section, and the only way to make sure its not an unduly delayed c-section is to use fetal monitoring. Home births have neither of these things at their disposal, so they have to push the lie that doing nothing is better than doing something that can only be done in a hospital. Admitting that it is more dangerous would lead them to having to obtain actual informed consent, and very few people would be willing to sign on for the risks of homebirth if they were honestly represented ahead of time.

 

…a space for people who left NCB

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