Category Archives: birth trauma

Never Good Enough

I found an article today that made my eye go a bit twitchy. It is called “A family centered cesarean is not a substitute for a fully supported natural birth or VBAC“.

I have no idea why the author thinks they are the authority on what is or isn’t a substitute for a natural birth, I would think that the woman giving birth would have to decide that on her own. I am sure there are mothers that have had a vbac and then a c-section for a later pregnancy. A poll of them would be more useful than just making a blanket statement.

The article is intended to demonize c-sections, as usual. What struck me is that physicians who do not feel comfortable with a “natural” vbac (see: almost none) are still considered bad for offering what is called a family-centered c-section.

And mothers, if when you are discussing your desires for your natural birth with your provider, they immediately start talking about the “family centered cesareans” they offer for mothers like you, please please please recognize this as a red flag, and consider transferring care to a more supportive provider….one whose immediate response is what they can do to facilitate your natural birth and then, only if all other options are exhausted, will perform the most family centered cesarean possible

No matter how much OBGYNs pander to natural child birth advocates, its just never good enough. I think I would do the same thing if I were in the OBGYN’s shoes, just to try and prevent anyone from having a dangerous birth at home.

The reason that most providers require close monitoring and epidural anesthesia for VBAC in the hospital is that the risk of a catastrophic uterine rupture is best managed under those conditions. A life saving c-section can be performed quickly under those conditions. An unmedicated VBAC makes it impossible to catch the problem early, which can result in death for the infant. It can cost the mother her uterus, or her life.

I just wish people like the author of the Birth Blissfully article  had to explain how superior a natural vbac is to women who have suffered a uterine rupture during a vbac. Here is one from baby center:

The room filled with people, they threw the sheet curtain on me, didn’t even have time to hang it up before I heard the doctor say “cutting!”  Thank goodess I had the epidural so there was no time wasted there.  She had my baby out so fast, literally within a minute or so.  DD’s arm and shoulder had went through my rupture into my abdominal cavity.  She was breathing but a little limp – it’s so scary to think that minutes later would’ve been a different story.  They rushed her to the NICU, right by DH who had no idea that she had even been born yet.

It seems that she came pretty close to death, too. She lost 2 pints of blood, had multiple transfusions, and had to stay in the ICU for monitoring. One of the big things people dislike about c-sections is that you may have to spend time away from the baby while getting stitched up, but this mom ended up going days without seeing her daughter because they were both in their respective ICUs and couldn’t visit each other. Here is what she has to say about her decision to vbac:

I spent more time thinking, praying, and researching this vbac decision than any other in my life.  Ironically, it was the worst decision of my life.

I feel the exact same way about my choice to birth out of hospital with direct entry midwives (though luckily I did not have this type of health outcome). I looked into it so much, but sometimes doing research is just assuring yourself that what you want is really what you need. It takes a lot of humility to realize when you are reinforcing your previously held beliefs vs when you are actually trying to get to the truth.

A fully supported VBAC, for this mom, would have meant death or serious injury to mom, baby, or both. A c/section is a fine substitute for that risk, that is probably why the vast majority of moms choose repeat c-section over VBAC when presented with information about risks. It isn’t because women are stupid or uneducated, they just have different priorities than NCB advocates. There is nothing wrong with that.

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No, OBs are not accountable

I was reading this post from the skeptical OB today

as you may or may not know, I was banned from the skeptical OB for calling Dr Amy out on being a fence sitter on the issue of date rape. Remember that any time she complains about being “silenced” by home birth bloggers for asking uncomfortable questions. She does the same thing to people who think there isn’t a neutral zone when it comes to rape.

IN this specific post Dr Amy says a survivor of sexual abuse who had several cuts to her perineum done to her body against her will during labor, by an OBGYN isn’t experiencing violence. She doesn’t even condemn the behavior of the OB at any point. She laments a series of home birth deaths in australia, one of the summaries she quotes points out that the mom chose home birth because she had been treated so poorly in the hospital. The only violence in birth is when the baby is injured? Here is as close as she gets to saying anything condemning that horrible physician:

Don’t get me wrong. I’m not claiming that hospital care is perfect. Although there is rarely any violence, there is a great deal of poor and disrespectful treatment.

Beforehand she literally says that the baby being inside the woman fundamentally changes the interaction. She talks as though women are simply vessels for children, and that being such a vessel fundamentally changes the way that a woman would experience having her gentials repeatedly cut against her will. The lack of empathy is very telling. The woman who was cut against her will, over and over, well before crowning, should be comfortable going back to the hospital because Dr Amy is apparently the ultimate authority on what constitutes violence or not. Its laughable, especially from a woman who insists that one must be an expert on a topic in order to have an opinion. Dr Amy goes on and on about the inability of midwives to call out their fellow midwives for negligence and damage done to patients, but here Dr Amy does the same thing and ignores deplorable conduct on the part of a gynecologist.  She goes on to say:

However, the chief victims aren’t Western, white, well off women; the chief victims are the elderly, people of color and those of lower socio-economic status.

For a skeptic she sure has an aversion to actually linking to evidence. Being white and college educated are one axis of privilege, but it doesn’t erase being female. It doesn’t erase the fact that women, regardless of any of their other characteristics, are targets for sexual abuse and violence by virtue of being female. Why anyone would believe that this problem vanishes in the hospital is beyond me. One kind of oppression does not erase the other. Dr Amy’s total ignorance of contemporary feminism and social justice movements is showing once again.

ANYWAY, I wish i could comment so I could let everyone know that NO, you don’t have many avenues for redress if your OBGYN decides to do all kinds of shit to you without your consent. You need a ton of money (enough to pay a lawyer for a lengthy and probably fruitless lawsuit). Medical boards don’t give a damn about this, and the doctor and hospitals have better lawyers than 99% of the population.

Women have many legit reasons for choosing home birth, and this is one of them. A lot of the people in the comments section of the Skeptical OB, who claim there are Very Serious Consequences for physicians who do things against your will, are living in a dream world. In the real world, your word doesn’t matter at all. I know from first hand experience. The issue at hand here is that midwives and home birth do not solve the problem. Horrible attitudes from other people about abuses of women during hospital childbirth (including disbelieving the women, rebranding their experiences as “disrespect” instead of abuse or violence, insisting that they will be compensated despite all evidence, etc) makes a vulnerable population easy pickings for midwives. I know that seeing unauthorized procedures done to patients during my time working in hospitals was instrumental in my decision to have an out of hospital birth. I knew that these doctors were not accountable because they did it all the time. There isn’t anything that holds them accountable for these issues. A suit for battery is unlikely to succeed and is hard to pull off. Ignoring the problems won’t make them go away, and will in fact drive more women to seek care from midwives, who at least pay lip service to how damaging abuse during childbirth can be to patients.

name changes for negligent midwives

The skeptical OB has an article up about negligent midwives changing their names as to deceive their customers.

It happened to me, too. Ester Werbach now goes by “Nueve Lunas Maternity” on the internet. The Utah Midwive’s Association is well aware of it, and my complaints of sexual misconduct, and continue to support my abuser. They don’t care.

These types of actions also make it impossible for women to research their care provider. If you have a health care provider that has killed negligently, had their license suspended, or otherwise been reprimanded their patients have a right to know. Midwives rob women of the opportunity to know what they are getting into.

The uneasy relationship between pro-life and anti-home birth rhetoric

There is an umbrella term for issues of abortion, birth control, and maternity care. “Reproductive rights”. Lumping these three topics together can make it very hard to have a meaningful conversation about the ethics of any specific obstetric or gynecological practice.

The way that home birth communities superficially appeal to feminism is something that contributed to my choosing an out of hospital birth provider. Con artists are skilled at  figuring out what selling point will work on any particular mark.

There were a lot of things that turned me off about anti-home birth web pages when I was doing initial research on maternity care. Certain phrases or arguments served as a  dog whistle to pro-choice feminists like myself. An abortion and a home birth are very different situations, but its hard not to have a knee jerk reaction to phrases like “The baby didn’t get to choose.”

An abortion is usually performed at 8 weeks (medicinally induced abortions can be initiated earlier). A fetus that was aborted was either not wanted or could not be adequately cared for if carried to term.

A home birth baby is very much wanted.

These are obvious differences that everyone knows. It is very difficult to let go of the dehumanization that women face when confronted with anti-choice rhetoric. The message is clear, over and over again: the woman matters less than the contents of her uterus. Its unfair, extremely unfair, especially in the case of elective abortion. Anything that even sounds like that makes me cringe, and that tendency caused a blind spot for me while researching home birth.

The mothers of home birth babies generally want them to arrive safely. They are overwhelmingly white, middle to upper class, and college educated. Outside of domestic violence and other outliers it would be hard to say that home birth mothers are forced into their pregnancies.

Talking about the rights of the baby to arrive safely means talking about what their mother is choosing as well.  There are some women who seem to think that having a home birth is more important than having a live baby, and it is a disturbing reminder of how disparate these issues are from abortion rights.  Virtually no one could condone the conduct of women who loved their home birth experience when their baby didn’t make it.

I am absolutely not arguing for revoking a pregnant woman’s right to refuse treatment or tests. That is a human right that everyone has.  That is not usually what is at stake in home births. Most home birthers are convinced that it is inherently better to have a natural birth at home, or that it is actually as safe (perhaps safer) than having a baby at a hospital. Most women choose home birth because they want a positive outcome, and have been lead to believe that home birth is the best way to accomplish it. Speaking about the babies that pay the price for misinformation is not at all at odds with what most pregnant women desire from birth. These women are being lied to. Just as crisis pregnancy centers twist facts about abortion to try to convince women of taking one specific path, midwives will twist information to make a home birth seem safer. By pushing for legislation to reign in home birth midwifery we are protecting a vulnerable population from predators.

 

My original blog is back up

It has the story of my experience at a birth center with lay midwives. There was a CNM at one of the checks and she was professional.

There is also a lot of information about how little the natural child birth community did in response to my complaints. I literally complained of sexual misconduct and no one who could do something about this felt the need to do anything. They want to sweep my story under the rug instead of dealing with it. They don’t want people to know what they will tolerate from other midwives. I thought that what I went through was the worst thing, but then I began to read about how women who lost their babies to negligence go through the same thing. Midwives support each other so much more than the people who get hurt by their natural childbirth ideology.

The blog was down because of an attempt at mediation with better birth of utah, but it looks like its not going to happen. 

What happened to me has made me stronger. It has made me an advocate for change. I know for a fact that my shame on better birth blog and my safer midwifery utah blog are making midwives fear that their scam will be exposed to the public. I have emboldened public officials to take a stand against unlicensed midwifery, and for that I will likely be taken to court for defamation. I’m willing to fight in order to tell my story.

Thank you to everyone who has shown me support.

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 Tuteur: hypocrite and rape apologist (UPDATED 4-28-15 corrections made)

UPDATE: I have been looking at the Fed Up With Natural Child Birth group and have seen Dr Tutuer tell off a male rape apologist in the group, which makes the standard of commenting different than what I previously asserted. I have also been unbanned from commenting on skeptical OB after asking nicely. I think this is just what happens when two stubborn people fight- neither one wants to budge. Below is a record from the time of the actual fight happening when tensions were high.

There has been a controversy started on Dr Amy Tuteur’s (the skeptical OB) facebook group “Fed Up with Natural Child Birth”.

It all started in a thread where a poster (lets call her Miss Ogynist) with a perpetual need to derail conversations blamed loss mothers directly for having chosen a midwife to attend their birth. This suggestion was made on a thread about a recent home birth death- an especially insensitive place to share such an opinion.

Other posters were appalled, and asked “would you blame a rape victim if they were raped while intoxicated?”

Miss Ogynist made it clear that she would blame rape victims who were intoxicated.

She said that if someone gets too drunk to fight off a rapist it is their fault. She says that if someone is drugged it is their fault because they did not keep their eye on their drink. Etc etc. Horrible victim blaming nonsense. Most people were totally appalled.

I made a reply or two pointing out that predatory rapists are at fault for rape, then promptly blocked the Miss Ogynist. I figured that was the end of that.

But then I saw some comments from the group administrator, Dr Amy Tuteur, that seemed to agree with Miss Ogynist’s opinion that women who drink are at fault if they get raped. The comments did not outright state her position one way or the other, but she failed to register any disgust with Miss Ogynist’s comments. Here is what Dr Tuteur had to say:

Image Dr Tuteur seems to think that the degree of fault that rape victims have if they are intoxicated is something “reasonable people can disagree about”. She compares being drunk and being raped (which she refers to as “disclaiming responsibility for having sex”) to a man refusing to pay child support because a baby was conceived while he had drunken sex. To me this is absolutely disgusting. Rape is an act done to a person, consensual sex is by definition not, rape and consensual sex should not be compared in this manner. This is like comparing theft to charity donation, or boxing matches to assault. The nature of consent radically changes the meaning of our actions, hence having completely different words for rape and sex.

She is repeating the sexist trope of women regretting sex and deciding that they were raped later on. All the available data on sexual predators says that this is not how rape typically works. Usually men who rape intoxicated women are serial rapists, and pick women who are intoxicated specifically because it is easy to get away with it. The reason it is easy to get away with it is because society decides that these women are at fault for being raped. Dr Tuteur’s attitude is right in line with Miss Ogynist’s tirade against victims who are raped while intoxicated. I was shocked. ACOG and other gynecological associations have newsletters, CEUs, and position statements about victims of sexual violence, and they are evidence based and sympathetic to victims. This was the opposite of what I expected from someone who had a lot of experience as a gynecologist.

There was also a lot of commentary from Dr Amy Tuteur that kept downplaying the seriousness of the problem of victim blaming rhetoric. She persistently implied that this issue is not important enough to talk about.

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Several of us came forward in that thread as victims of sexual assault. More than one person talked about how they felt physically ill or felt unsafe due to PTSD symptoms stemming from rape. These kinds of comments are not innocuous, they are not some lofty philosophical exercise- they are our lives. PTSD is a daily reminder of trauma that can only be managed, not escaped. It is our lives and she made it seem as though these comments simply caused “offense” instead of real problems. I would hate to see what Dr Tuteur’s opinions are on online bullying and teen suicide.

Anyway, I made it clear that I couldn’t stay in a group where this kind of conduct was not only tolerated, but endorsed. I made a goodbye post in case anyone was wondering where I went- I was an active poster who contributed to the group often (making blog posts, graphics, and other projects to try and further awareness of the problems with CPMs and natural child birth). What did doctor Amy say?

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I didn’t even bring up Miss Ogynist, other posters talked about her a lot, but I didn’t. My issue was that Dr Amy seemed to be in agreement with Miss Ogynist and was minimizing the impact of victim blaming in a predominantly female space. She even put “controversy” in scarce quotes, and instead of calling a rape apologist distasteful, she called me (and others who left) distasteful for “flouncing”.

She also had the nerve to imply we were all behaving like juveniles, shortly after having published an insulting limerick in response to criticism from a different skepticism blog.

Anyway, her claim to not censor is especially hilarious because she ultimately deleted this thread (and the one with the offensive comments) the next day, and then said that any comments made about Miss Ogynist would be deleted! She goes on and on about how home birth advocates simply delete tough comments, and how weak their position must be to resort to such measures, and then she did it herself.

She lost roughly 300 followers in a single day because of how she handled this problem, and the reason I am blogging and posting screen shots is that it is not fair to let unsuspecting women wander into the group without knowing that this kind of talk is encouraged by the group administrator. If I had known that Dr Tuteur thinks that blaming rape victims for being raped was something “reasonable people can disagree about” then I would have never joined in the first place, and neither would other members who ultimately left. Dr Tuteur ultimately ended up lecturing us all about how mean we are for picking on poor Miss Ogynist.

mean girls

 My ire was aimed entirely at dr tuteur for failing to disavow the comments, and seeming to support victim blaming in the Fed Up With Natural Childbirth group. She absolutely refused to clarify her position to anyone (several people tried via PM).

refuses to clarify

All I wanted to hear was that it wasn’t a woman’s fault. That’s it. I would have rejoined the fed up group if I had known that it wasn’t tolerated, but Dr Amy was determined to be a fence sitter on the topic of rape.

wont disavow rape

No one gets to be a fence sitter when it comes to rape. If you are not for victims then you put yourself squarely on the side of perpetrators and their supporters. Rape victims have virtually no chance at obtaining justice, and are left to pick up the pieces for the rest of their lives. Its devastating. That is why there is no neutral zone when it comes to rape. Support for victims is severely lacking in our society and is desperately needed to ensure victims feel safe in any community. There is no reason to tolerate victim blaming rhetoric any more than there is a reason to tolerate racism or inciting violence.

Several people have mentioned how bad this would look for ‘the cause’ and hoped that it wouldn’t be publicized, but I feel that trying to cover up the problems with leaders in any group is much worse than simply dealing with what they have done and calling them out for it. The truth comes out no matter how hard some people try to cover it up, and it is unlikely that Dr Tuteur’s rape apologetics would never surface again. The solution to the problem is obvious, Dr Tuteur could clarify her position, apologize, or otherwise try to remedy it. Instead she has chosen to try and cover it up and pretend like it never happened. I won’t forget the betrayal I felt learning that Dr Amy, an OBGYN, does not understand who is at fault for rape. I won’t forget the realization that all her mocking of “birth rape” was perfectly in line with all this- after all, she did not take rape seriously to begin with, so it was easy to mock forced medical procedures and their impact upon women during childbirth. It explained perfectly why she thought trigger warnings were insulting, that they called women weak somehow to give them warning beforehand that there may be discussions of rape or infant death or other distressing topics. Frankly, its hard to know how she could hold all those views and not be a rape apologists. Those other beliefs are the scaffolding of rape apologetics, they are necessary underlying beliefs that must exist for one to be a rape apologist.

It is only fair to let anyone contemplating joining the Fed Up With Natural Childbirth group know that this happened, and since dr tuteur has deleted all the relevant threads I am forced to publish her comments here so that they can be found by anyone. I wish I had known so I didn’t waste my time.

One of the people who left the group started their own group where rape apologia will not be tolerated. It is called Fed Up With Birth Zealotry. 

UPDATE- banned from commenting at Skeptical OB for linking to this article. Remember to bring it up whenever dr amy claims to not censor comments or allow debate. Her friend’s feelings are more important than silly things like principles or letting rape victims know that her website isn’t a safe space for them to comment.

Edited to add- I accidentally put the name of a group on facebook that was supposed to be kept private. I regret the error and have since removed the name and link.