Debunking the Business of Being Born: Part 3

This part 3 of a series attempting to debunk claims made during the business of being born. The descriptions and quotes in the movie are in bold

 

dr jacques moritz (abby epstein’s OB) discusses how birth is 98% waiting and 2% sheer terror, and you never know when the scary stuff is going to happen. He says “It goes from being completely normal, to 2% terror. When you’re at a hospital- and I don’t like hospitals in general, The idea that theyre not healing places in general. But they are good for when you have that terror.”

Ricki Lake responds “My issue is for those women that have the normal, the 98% that have no complications, they come to the hospital, and they’re put through these, you know, its like this system where they’re flat on their backs. They want a natural birth. Or they want to have a vaginal birth, and all these things are stacked up against them.”

Ricki Lake understands the “2% sheer terror” comment to mean that only 2% of births have complications. It seems that on average about 16% of births involve complications. The physician was clearly stating his opinion of childbirth and not quoting an actual statistic, and probably meant that his estimate is that 2% of the time there is a threat to life of the mother or baby, or their functionality. 

 

Anyway, the other main concerns expressed are a lack of options for women who do not want interventions. These are valid concerns to have. I worked in a variety of hospitals and clinics for a number of years, and this portion of the film really resonated with me because of that. I did not work on the maternity care floor very much, but I saw these same problems in other areas of the hospital. People are more or less put on an assembly line, asking questions can get you branded a trouble maker by staff, many patients agreed to procedures or drugs that they did not fully understand, etc. These are things I am very concerned about. 

However, there isn’t much reason to think midwives are the answer.

The Business of Being Born constantly implies that midwifery and out-of-hospital birth is the solution to the problems with maternity care systems, but I beg to differ. I found out the hard way that midwives can be just as aggressive and uncaring as any physician. There is not much accountability for physicians on this front, but there is even less for midwives. Since I had my difficult experience with multiple midwives, I found that many other women have had experiences like mine, with midwives and OBGYNs. The setting of your birth has nothing to do with if your provider actually cares about you, or just pretended to. 

Tina Cassidy, journalist says “They’ve told women ‘Come to us, we’ll take care of everybody’s birth. Doesn’t matter what kind of birth you want. We’re open to anything. And then you get there, and you realize, No, the hospital system is really set up one way, to handle one kind of  birth, and you just get put through that system. And its a fight to try to not get put through that system.

next is a montage of physicians ordering pitocin for patients and nurses providing pitocin and other drugs on a maternity floor 

The ‘one kind of birth’ they are referring to is actually a complex set of recommended interventions based on the physician’s assessment of the situation and protocols that the hospital has created to deal with any complications in the (statistically) most successful way possible. I do know that treatment happens without patient agreement sometimes, and that is absolutely wrong, but again- that isn’t restricted to hospital birth experiences. The pitocin scenes are there to bolster their point that the hospital won’t respect your birth plan, but demonstrated that poorly. We are not given any opportunity to speak to women who agreed to the pitocin or shared what they thought of it- ditto for pain relief and induction. We are given the impression that these women are duped into something they don’t really need, but aren’t given any opportunity to investigate if that is true or not. The nurses state that most patients (she says 90%)  use some kind of augmentation during their labor- its just the word of one nurse, so its impossible to verify if it is true, or if it is true outside of this one hospital. The use of personal statements by medical professionals in lieu of actual data is problematic- individuals are prone to misunderstandings and sometimes they lie for whatever reason. This portion of the film leaves me wondering why they don’t present data instead of anecdotes. 

Patricia Burkhardt, an NYU midwifery professor says “Hospitals are a business. They want those beds filled, and emptied. They don’t want women hanging around in the labor room.”

 This is a criticism of capitalism, not hospital birth. This is especially true since midwifery is a business too! I also know for a fact that a lot of hospitals aren’t businesses. Not for profit hospitals are the opposite of a business- any surplus at the end of their fiscal year is used to improve the facilities. 

someone else says “you get this feeling in the hospital that theres like a limit to how long you can be in labor.Like ‘oh its been 12 hours, now you need pitocin’

ricki lake says “I did know the pressure was on, you know, as we got into like 20 hours, 21 hours, 

cut back to the other woman “at the hospital I had pitocin, which made me itchy. So they give you something else for your itching.”

A third woman says “I knew once they gave you that pitocin, you need the epidural.”

cut to a scene of a nurse asking “feel better now that you had the epidural?”

the patient replies “OH GOD YES.”

There are several different women talking about how they felt there was a ‘domino effect’ of interventions. 

The ‘limit’ on how long you can be in labor is there for a reason. Again, it is because statistically there are problems if you let labor go on for x amount of hours without any progress. Will you be in the minority of people who has no problems after a prolonged labor? There is only one way to find out- labor a long time and see if your baby is okay or not. Each patient needs to weigh that against the risk of augmentation, something that should ideally happen as an agreement between a patient and their doctor. I believe most women are uncomfortable waiting and seeing if things are going to go wrong or not, and that is a valid choice to make. I also believe most women get pain relief because labor is painful.It is inhumane to let women suffer when they ask for pain relief. 

I am aware that unethical things happen in the hospital (forced treatments, lies about the treatments from drs or nurses), but again, midwives do unethical things at home too. There hasn’t been any adequate study of what setting is more likely to respect patient autonomy. There has been adequate study of what setting is more likely to facilitate a better patient outcome. Hospitals have been shown to repeatedly have better patient outcomes. To pretend that the better outcomes have nothing to do with the interventions is hard for me to accept, especially when we all know that c-section is the treatment responsible for saving many babies from many different complications.  There is also a lot of objective evidence that you are less likely to find justice if your midwife does something unethical vs a hospital or doctor. 

A cartoon plays about the snowball/domino/cascade of interventions theory at a hospital. The first thing they say is that epidurals interfere with dilation if you get one early in labor.

There is conflicting information about if epidurals slow labor. There is not a consensus on this issue. If it does slow it down, then the effect seems to be small- the studies I found that reported a prolonging of the 1st or 2nd stage of labor both reported that it prolonged it 30 minutes or less. The main thing that seems to be associated with epidural anesthesia is instrumental delivery.

The cartoon shows an upset baby inside a woman while she is given pitocin. The narrator says the epidural has to be turned up to deal with the pain of pitocin contractions. She says the increase of medicine in the epidural slows labor down more so they add more pitocin, which in turn makes the baby go into distress and then a c-section is ordered.

if this were true, there would be an association between epidurals and c-sections, but there isn’t one. While the length of labor associated with epidurals is controversial, the rate of c-section in women using epidural anesthesia is not.  

In the middle of the cartoon/montage of people talking about the cascade of interventions theory, an obgyn says “there is clearly an association with induction of labor an cesarean delivery.”

This was not what the previous cartoon was arguing- they were arguing epidurals and pitocin cause c-sections. Induction of labor is a whole different ball of wax, but the doctor’s words are put in the middle of the repeated statements about *any* intervention leading to c-section to try and give credence to the unsupported claims made. 

examining the themes so far-

I can empathize with women who had a bad experience at birth in a hospital, completely. I had a pretty awful time in the hospital too, but there is a reason I am an ex natural childbirth advocate and not an ex hospital birth advocate.

It is horrible when you have an expectation that is shattered, when plans change because something might be going wrong. That does not mean that these women made the wrong choice or that the hospital was bad for recommending the interventions that they did. NCB leaves women constantly wondering what they did wrong to ’cause’ problems during the birth. The reality is they did nothing wrong, and if they did somehow cause a problem it doesn’t mean it was ‘wrong’. We do our best based on the information we have at the time, and there is no reason to beat yourself up about how things ended up if everyone is healthy and happy. 

There is nothing to ensure that you will be in control in your birth. Birth is a very vulnerable time for that exact reason. I think that people with a healthy faith in humanity are okay with a bit of unpredictability, they may even find it exciting.This is part of why I believe women with abuse, OCD, or eating disorder histories are drawn to natural child birth. NCB advocates prey on women with these vulnerabilities to sell home births and midwives. They sell a very alluring fantasy of control, of perfection, if you are just good enough or try hard enough. It is a cruelty to do this to women who cannot actually control things to such an extent. 

 

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