Tag Archives: birth trauma

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.

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if your baby dies, will the NCB community be there for you?

I read a lot of home birth loss stories before I chose a home birth. Most of them were explained away by saying that the baby would have died if born in the hospital. Sometimes though, its obvious that the baby never would have died in the hospital.

The recent death caused by Christy Collins (a las vegas, nevada CPM) is a good example of this. Her patient was weeks past her due date and had ZERO amniotic fluid. Christy posted on facebook to get advice on how to deal with that, and other midwives said to wait it out or try worthless remedies like stevia. This was an entirely preventable tragedy and should have never happened. How does the natural child birth community react when this happens?

This babycenter thread is a good example of what loss moms are up against when they lose the baby at the hands of a midwife outside of a hospital. 

Most NCBers tried to say this was a bad midwife instead of proof that lay midwives are NOT adequately trained to care for pregnant women. People who said this ignored the crowd-sourcing portion of the tragedy, because industry leaders and other long-time midwives advised waiting despite the obvious danger.

Those who realized that the majority of other lay midwives said to wait decided to blame the mother instead. Here are some choice quotes:

“Did the mother thoroughly check out this midwife? The other midwifes on that facebook page? Obviously that midwife lacked experience and the ladies on the page giving terrible advice did as well. That absolutely does not speak for the majority of midwives who strive for complete care centered around mother and baby trying to obtain the best and healthiest birth possible

This would have never happened to me because I would have been pro active.”

another person said:

“IMO, once you become pregnant you owe it to yourself and your child to *educate* yourself. It doesn’t matter what type of birth you want to have, learn about *all* of them. Unplanned home births happen. Emergency C sections happen. You need to be *educated* so you don’t fall prey to shitty health care “professionals”.

You get the sense they are trying to convince themselves more than anyone else. They are desperate to make up reasons that this could not have happened to them, but it could have. It could happen to anyone who uses a provider willing to do out of hospital births- specifically non-nurse midwives. They have nothing to lose if your baby dies, and they genuinely believe that there is not any elevated risk for out of hospital births.

Even if you manage to find the strength to fight a negligent midwife and tell everyone what happened after she causes your baby to die, she can just move and set up shop again. She can make up a story about what ‘really’ happened and other midwives can corroborate her story. None of these women on babycenter understand that this easily could have been them. It could have been me. I find myself being grateful every day that everyone was physically okay at the end of my horrible experience. I feel like I dodged a bullet, like I came out of a car accident without a scrape- in short, I feel that I was very lucky. It is baffling to me that these other women feel that they were somehow earned a safe birth for their baby.

Imagine having trusted your midwife and paid the price for it- you have to bury your child. Imagine having to see these comments about you. Strangers saying that you just must have been stupid or uneducated or not researched enough about that midwife. Why are these women focusing on the victim? What about the next woman who is duped by a dangerous midwife? Is it okay for that baby to die, as long as its not yours? Why should these women even have ACCESS to patients after demonstrating that they don’t know what the hell they are doing? 

 

If moms are to blame for not doing enough research (although there might not be information available on the midwife), or for not being ‘educated’ enough, then why the hell do they hire a midwife in the first place? Natural Child Birth advocates change their tune completely when an event does not fit the ideology of the group. You get this kind of blame even if your child is okay, but you’ve decided a lot of the things you were told about birth by the NCB movement was rubbish. That’s certainly been my experience.

 

NCB is there for you as long as you agree with it all the time. If your baby dies and you don’t blame the midwife (even if she was clearly at fault), if you still want your next birth at home, then they will be there for you. If you lose your uterus to a VBAC rupture and do not blame the people who convinced you it was safe to VBAC at home, only THEN will NCB be there for you. They will only be there for you if you don’t try to hold anyone in the movement accountable for their words or actions.

 

If you believe in Natural Child Birth and you disagree with my view, please prove me wrong. Advocate for mandatory licensing and midwives who are Certified Nurse Midwives instead of lay midwives. I would be delighted to be wrong about my view of the movement.

Debunking the Business of Being Born: Part 7

This is part 7 in my series on The Business of Being Born. The other parts can be found here. Descriptions or quotes from the movie will be in bold, and my commentary will be in normal text.

Bad Company’s “feel like makin’ love” plays

Footage of hippies dancing, presumably from the 1960s, is shown

Patricia Burkhardt, proffessor at NYU’s midwifery program says says “Historically, the home birth movement grew apace again after it was basically cut out from under the midwives at the turn of the century. During the hippie era, when there were communes, and the communes mimicked, in many ways, immigration communities. They mimic, you know, extended families, and so midwives were reborn, in a sense, during that era. “

I have always had a lot of interest in communes and other non-conventional communities. I’ve read about more than I could count. One thing I know for sure is that each commune I have read about was very different from others and it is difficult to generalize about them in any meaningful way. Some are religious, some are not. Some are vegan, others are not. Some are polyamarous, some are not.  Some are violent other not. Every difference you could imagine existed in these societies.

The movie shows a lot of happy hippies while the midwives speak in an attempt to (once again) associate the pro-midwife speakers with positive imagery. Once you recognize that technique in the movie it becomes quite grating to watch it, because you know exactly what to expect in terms of imagery based on if the person speaking is pro or anti home birth.

Ina May Gaskin says “We wanted the choices. We didn’t want somebody else making the rules. That didn’t understand us, that thought we were machines instead of people with feelings. ‘Cause we knew that feelings affected birth.

The last line here is something that the movie glosses over, which is curious because ‘feelings affect birth’ is a major part of Natural Child Birth and home birth philosophically.  A film maker with integrity would delve deeply into core tenants of NCB and explore if they have merit or not.

There is no real evidence that feelings affect birth- it is hard to measure feelings outside of self reporting.  I cannot find any research about feelings during labor and their impact on outcome. It is important to base childbirth choices on good information, for instance lets say that Ina May is right and feelings do affect child birth. How much of an affect is there? What outcomes do maternal feelings influence? Is it more or less than the affect on outcomes that birthing out of hospital is associated with? Again, critical questions are not asked in this movie, and it does a disservice to women who believe this film is educational.

More hippy footage and “feel like makin’ love” soundtrack

An anthropologist from earlier in the movie says “That was part of what sparked the natural childbirth movement, was a reaction against the abuses of the scopolamine era, the twilight sleep era, because some people realized the only way to get away from that was to get out of the hospital altogether.”

This is one theory about where NCB came from. Another is explained here, basically it explains that the origins of the natural childbirth movement can be found in stalinist russia. There was a lack of pain medication for laboring women so the government told women that there was merit to foregoing pain relief. The same dynamic can be found with midwives- they cannot provide pain relief that is as effective as hospitals, It is hard to say with any authority which one of these is the true origin of NCB (it may be a mix of the two theories, or neither). However the belief out necessity dynamic is absolutely present in home birth situations because midwives have very limited options for pain relief compared to OBGYNs in a hospital setting.

This portion of the film tries very hard to make it seem like the NCB movement, as a political movement, is about the rights of laboring women. From what I can tell, based on the political actions endorsed by midwives, it is a movement to let midwives operate without accountability or adequate training. Midwives and NCB advocates will fight hard to prevent a midwife from being held accountable for a death. They will fight hard to prevent any educational or licensing requirements for midwives. If anyone is aware of a political campaign by NCB or midwives that does not fall into one of those two categories, please let me know. I have literally never seen it. What a political movement represents is better understood through its own actions than its stated aims- virtually no one is willing to broadcast shocking aspects of a groups political ideology to the uninitiated.

She continues “Just as we were getting someplace, technology caught up to us again. The electronic fetal monitor got introduced into hospitals starting in 1970, and by the end of the 70s it was pervasive in hospital birth.”

creepy music and footage of 1970s hospital births are shown 

“And the cesarean rate in that decade went from 4% to 23%”

No word on what the perinatal mortality rate was at the beginning and end of the 70s. I decided to look into it myself. According to the CDC:

From 1970 to 1979, neonatal mortality plummeted 41%

If you look at the table the CDC provides, neonatal, perinatal, and infant mortality all fell significantly during that time period. It is completely irresponsible to fail to report this information while decrying the use of the technology that facilitated the drop in death rates, because its a totally obvious question that should have been asked and answered during the film.

Footage of a younger Ina May Gaskin is shown. She says 

“See, when I started, only 5% of women in the US had cesarean. Ten years passed, and it was up to about one woman in four. I couldn’t believe it. And we didn’t, in our group, didn’t need the first cesarean until birth number 187. So we were going the other way from the rest of the country. And we were doing that safely. So that told me something about the pelvis of the American woman, its just quite fine, thank you very much. And we didn’t have another c-section until birth 324.”

There is absolutely no word about the outcomes of these births except for c-section. Absolutely NONE. That is very difficult for me to understand, because there are many other outcomes to consider, such as birth injuries, debilitating tears, pelvic floor damage, disability (for either infants or mothers), PPH, and of course death. We are not given the numbers to examine if Ina May’s practices were producing an extremely low c-section result ‘safely’. Even if she had done it safely, three hundred or so births are not adequate as a sample size to determine if their practices at the farm were optimal or not.

Text appears on the screen that reads “since 1996 the cesarean section rate in the U.S. has risen 46%

In 2005 it was one out of every three births “

news footage of reporters discussing high c-section rates in America are spliced together

This is a pretty blatant argument from tradition- they are making it seem as though newer protocols are bad just because they differ from the past. The only other reason that the audience has been given to worry about the c-section rate so far is that it isn’t a vaginal birth. They have not demonstrated any benefit of one form of birth over the other yet, but we are supposed to be shocked about the rates.

Dr Marsden Wagner says “As we all know, The cesarean section rate in this country is going up, up, up. Why? What is really, really underneath this? Cesarean is extremely doctor-friendly, because of instead of having a woman in labor for an average of 12 hours, 7 days a week, It’s 20 minutes, and “I’ll be home for dinner”. 

Once again, we are made to believe that midwives never behave poorly because of the inconvenience of looking after a laboring woman. There is no evidence for that, and I do actually know of two cases that ended in death because midwives couldn’t be bothered to look after their patients. My midwives were eager to get me out of their birth center when I was in labor too.  Midwives are once again shown as the answer to a problem when they are equally as capable of being unethical. I am sure there are bad doctors out there that do this, but to claim that it is industry wide practice so that OBGYNs can go home earlier would require a lot more evidence than the film offers.

The difference, as far as I can tell, is that if you have an unethical OBGYN you can end up with procedures done against your will or without your permission, a c-section, and extremely rarely a preventable death.  Deaths or injuries caused by unethical OBGYNs can be reasonably sued for in a malpractice case. A doctor can lose his or her ability to practice based on their actions. If you have an unethical home birth midwife you can end up with procedures done againt your will or without your permission, birthing unassisted, preventable death or injury at a much higher rate than physicians. You can not readily sue them in malpractice court, and if you sue it is hard to collect. You cannot prevent them from simply moving to another state and setting up shop again.

These are big differences that women deserve to know about, but the film leaves them out because it does not fit the film maker’s beliefs about birth.

Stay tuned for part 8.

For first time mothers who want a Natural Child Birth

Dear first time mom who wants NCB,

I used to be one of you. I tried very, very hard to have a natural childbirth in a free standing birth center. I would have chosen home birth if my house did not have so many negative memories attached to it (although that is another post for another day). I tried.

I cannot overstate how much I felt like a failure rolling down the hall at the hospital in a wheelchair to the L&D unit. It was the place I desperately did not want to be. I had a great doula with me, but the midwives I trusted with my labor had abused me, and so I declined to have any of them accompany me to the hospital.  I knew I was going to have to give birth with strangers, and I dreaded a fight with them over what I would consent to or not.

I won’t lie to you- it was an awful experience. A procedure was done without my permission. My trust in any medical professional was shattered. I still haven’t gone to an OB or a midwife since my baby’s birth, despite the fact that I had surgery and was told to follow up with someone. Some nights I worry that I will have cervical or ovarian cancer and not find out until its too late. The fear of that is outweighed by the fear of being violated again.

I learned the hard way that people are not always what they say they are. I learned the hard way that it didn’t matter if it was a midwife or a doctor, I couldn’t control what anyone decided to do to me during my labor. I felt especially upset because I believed that I had avoided a lot of problems by picking midwives, that they would respect me and my wishes. I felt bad for having chose to have a baby, that I was too weak or stupid to properly care for my child. I felt that the way things went during my labor was proof that I shouldn’t have even tried in the first place, that my judgment must be terrible to have ended up like I did.

I had to make my decision about care providers without a lot of crucial information, because it there was so little data about first time mothers in home birth. Most women in the NCB movement had a traumatic or less than ideal birth in the hospital and decided to home birth after that. I searched endlessly for anecdotes from first time mothers who home birthed, and found very few reassuring stories. What I didn’t know was that in other countries first time mom status was enough to consider a patient high risk. There isn’t a way to know if some kind of issue inherent to an individual will arise in a mother until it happens. Most of the time the occurrence of a complication in the first birth is an indication of a problem in the subsequent births. I still want to know the rate of transfer for home birth midwives with first time mothers ONLY, I know it is usually about 10% over all, but I am willing to bet that first time mothers have a disproportionately high rate of transfer.

What I want first time mothers to know most of all is this: You can’t control your birth. You can roll the dice and choose a birth provider that brags a certain percentage for certain things, but there is no way to know if it will be you or not. Anyone who has played D&D or any other table top RPG knows that sometimes you strike out, even with a 90% skill. 10% happens, and its not because you did anything wrong. Its just life. If you had a c-section or an instrumental delivery or an epidural you did not fail at anything.  It literally means nothing about you as a human being if you had a c section vs a vaginal birth- you can force it to be meaningful, and therefore you also have the power to decide it isn’t worth worrying about.   Having a vaginal birth or a c-section isn’t inherent in anyones character- how much meaning could it really have outside of one constructed by culture?

I don’t think there is anything wrong with wanting a specific experience in childbirth. I don’t think there is anything wrong with being disappointed when it turns out differently. I am not someone who will complain that women who tried for NCB and ended up with something else are selfish or ungrateful, because I know that isn’t what its about.  No one needs permission for their feelings or their hopes- they just are, and should be accepted. What I do think is wrong is women blaming themselves for something that they don’t have the power to change.  I don’t think women blaming themselves are wrong, I think the people who perpetuate a culture that blames women are wrong.  This means that home birth midwives are wrong- they perpetuate a culture of sexism where mothers are at fault for virtually anything that happens during a birth, and where women who have the ‘right’ child birth experience get bragging rights and support for something that happened by luck instead of skill.  I remember ruminating over my c-section, wondering at what critical point I fucked up and made the small odds of having a primary c-section become a certainty. I’m reminded now of the aftermath of sexual abuse, where victims wonder what they did to “make” the other person hurt them, all of us search for absurd ways to make it our fault.  Women cannot control the outcome of giving birth any more than we can control the actions of other people. We can say “no” to people or interventions, but it guarantees nothing.  Women should not be made to blame themselves for any of it. Picking up the pieces, working through what happened and moving on takes a lot of strength. Energy should not be wasted on self hatred during something so difficult.

Take care!

-An ex home birther

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. 

 

Debunking The Business of Being Born: Part 1

This is a series on The Business of Being Born (TBBB), a powerful film that has influenced many women to give birth outside of a hospital. I’m going to do my best to point out the factual problems with different aspects of the film.  The descriptions of the film are in bold.

The film opens with a montage of a midwife, Cara Muhlhahn, packing various medical supplies at 3 in the morning (IV kits, oxygen, towels out of an oven, etc).  Scenes are spliced in where people describe their thoughts about midwives, most of them are from people who either dislike the idea of using midwives or who are ignorant of what midwives do.   

The midwife drives to a clients house. They fill up a birth tub. She says she will just stay out of the way and advises the client to pretend she isn’t there. We see a woman coping with a contraction, and the screen fades to white and says:

“Midwives attend of 70% of births in Europe and Japan

In The United States they attend less than 8%”

This is intended to make you question why the United States is so different than the rest of the world. What they left out is that most of the midwives featured in TBBB  are not considered actual midwives in places like Europe and Japan. Most of them are direct entry midwives or ‘lay’ midwives, they are not nurses and do not have anywhere near the training that a nurse does.  On page 8 of this document from a Japanese Midwives organization you can see that midwives in japan must either first become nurses, or be proficient enough in nursing to pass the national nursing exam, before being able to apply for a midwifery program.   The European union’s midwifery standards are very similar. Their document is pretty confusing, so I’ll just point out one part that makes it clear that European midwives are also either nurses, or equivalent to nurses in training and education. You can see on page 8 of this document that one condition of being a midwife in the European union is carrying out treatment prescribed by doctors, something direct entry midwives are not capable of doing (because they aren’t nurses).  The american equivalent of european and japanese midwives are Certified Nurse Midwives (CNM), advanced practice nurses who got midwifery education after being a registered nurse for a number of years.  In some states in the US you can simply claim to be a midwife and you are legally qualified to be one. It is that way in Utah, and the midwifery community here pats itself on the back for having “one of the best” midwifery laws in the country.  Since direct entry midwifery is legislated on the state level, a dangerous midwife can just pack up and move somewhere new if they cause an injury or a death, or if they do anything else unsavory that they would rather not take responsibility for.

There isn’t any mention of the radical difference between Japan, Europe, and America’s health care systems, either.  There are many differences between the care people receive in different countries, and it can sometimes be attributed to a public vs private health system. There could be many contributing factors to explain the difference in the % of births attended by midwives, but the only one they explore in The Business of Being Born is ignorance about midwives, discrimination against midwives, and greed from OBGYNs and hospitals.

The next scene is Dr. Marsden Wagner exclaiming that “maternity care in the united states is in crisis. It’s, in many ways, a disaster.”

A provocative statement like this should be supported with some kind of explanation, but its not. They are planting the seed that hospital birth is problematic without explaining why exactly. Its a technique used by advertisers and scam artists all the time- they appeal to some feeling, in this case, fear or curiosity, and then don’t provide enough information to examine it for validity. You are left with whatever gut feeling is evoked by the imagery.  It is good film making, but it is a very poor way to educate anyone.

Another person says “Medical decisions are being made for monetary and legal reasons, not because they are good for the mother and the baby.

“Monetary and legal reasons” meaning avoiding a lawsuit. The unexamined assumption is that preventing a lawsuit is different than preventing a bad outcome. In reality, bad outcomes cause lawsuits against hospitals and physicians. The film talks about how doctors are trying to prevent lawsuits, but did not feel it was important to discuss what patients go through when they have to sue for malpractice. It is a glaring omission.

A doctor says “Technology is technology, its not stopping. This is what life is all about. So if you’re gonna have good stuff you might as well use it to get the best outcome. ” with a grin. 

Someone else says “We should constantly be asking ourselves, ‘is this an improvement, or are we making things worse?’

This contrast implies that the doctor quoted beforehand has not thought about this, or that there is no one constantly asking if technology in birth is an improvement or a hindrance. In reality, scientists and doctors are asking these questions.  The protocols in hospitals aren’t developed out of preference, they are developed based off of hard data from physicians and researchers about outcomes. They are reviewed, based on the data, at regular intervals. Changes are made based on the reviews. It is not a perfect system, so there are things that aren’t needed or cause problems, but it is a system that constantly aims for improvement of outcomes. The same can not be said about natural child birth.

“if we don’t quickly take ahold of this, we’re gonna lose normal birth” exclaims a woman.

A doctor says “I call it feminist machosim, you know, when you’re pushing your baby in a stroller three months later to say ‘I did it naturally.’ Personally, I don’t think its important.”

Anyone who has worked with physicians knows that its really not hard to find a mean one to cast the profession in a bad light. It doesn’t really reflect on if the care protocols in a hospital are better or worse than at home with a midwife. Ideally, a system of maternity care would have a level of accountability that would ensure that even the most sociopathic practitioner would have to try and ensure the best outcome. Malpractice lawsuits and medical licensing accomplish this (to a certain degree), but midwives do not carry malpractice insurance so they are not subject to these rules. There are also states where licensing is not required, or penalties are small for illegally practicing midwifery.

A woman says “There is so little understanding, of how incredibly important this process is to women.

A man says “Theres something going on in the nature of care in the united states thats troublesome. Women, they’ve been told for years now, that they’re not responsible for their own birth process.”

“Basically what the medical profession has done over the last 40, 50 years, is convince the vast majority of women that they don’t know how to birth.”

These are all slight digs at women who needed interventions in their birth. What is wrong with women who don’t know how ‘incredibly important this process is’? Are women who choose a doctor or a c-section less ‘responsible for their own birth process’ than someone who doesn’t? If a woman has an intervention, is it because she has been convinced that she ‘doesn’t know how to birth’? What actual women would prefer and why is left out of the equation, there is a strong implication that natural childbirth is The Best Way to have a baby.

There is a discussion of new york women scheduling their births because they are so busy. The discussion takes place at a photo shoot with a pregnant model who is planning a home birth. There is obvious disapproval of scheduled birth, though it is not stated outright.

Cut to a pregnant woman discussing how she prefers midwives for well woman care. Her husband discussed his feelings about doctors and how they can change your birth plan with seemingly no medical reason.

I am not sure why we get to hear so much from people who prefer natural child birth and so little from women who do not.  The clips of women talking about preferring a c-section or an epidural are usually used to demonstrate that they are ignorant somehow, or that these methods aren’t preferred by most women.  This is such a crappy message for first time mothers, because they cannot know what type of birth they will prefer. You can guess what you would prefer, but you cannot know for sure until you’ve experienced it. Women who have had babies can’t prepare another woman either, because her labor will be different than yours This film attempts to make one type of birth seem ideal for everyone and all others inferior, regardless of what individual women have to say about their non natural births.

Cut to footage of Ricki Lake on her talk show while pregnant, and then an interview with her about her birth experience with her first child. She wanted NCB, and ended up having a lot of interventions that she felt were not needed.  She felt cheated, and decided to do things differently next time. She reccomends Ina May Gaskin books for educational purposes. She states the aim of the documentary- to explore the birth system in the US, and ask if they are benefitting mothers & babies or not.

Cut to a monty python sketch about birth. 

The monty python sketch represents how some patients feel in a hospital, but there is no way to know how commonly women feel like that during their hospital births. There are endless complaints in this movie about doctors and hospitals, but there is no data (not even surveys) presented about how common these problems are at the hospital vs at home.

An analysis of the themes so far-

There are a lot of feminist dog whistles in this movie- things that would seem innocuous to people not involved in womens rights movements, but very note worthy to feminists (like myself). I instantly became interested in hearing the NCB side of the story because of the use of feminist themes in the film. The way that the majority of pro-NCB people in the film were women also made me more willing to believe their side of the story- after all, women are the ones having babies, not men.  Feminist women who are interested in NCB need to be aware of the way that midwives treat women who have been wronged by other midwives. The will support the midwife instead of women who lost their children because of negligence, or women who were abused or mistreated by midwives. The line that they support women’s choices is a good way to sell the services, but is it actually true? In my case, a midwife with decades of experience testified in court that doing exams against a patients will is the ‘standard of care’ in midwifery.   Either she is willing to lie in court to help her colleagues, or she is willing to lie to patients when she tells them that the midwifery model of care is about dignity and respect.  This was after the one midwife did the exam against my will, and the owner of the birth center said it was my fault. I reached out to prominent members of the community for help, and there was none. That is when I started to find out that a lot of midwives won’t refund a fee or even apologize after they cause a death by negligence, and that the same lack of help existed for women who had suffered much more than I did at the hands of negligent midwives.  Midwives are not more or less likely to be feminists than anyone else, but they present themselves ambiguously to appeal to feminists.

Feminism has helped me immensely in dealing with misogyny (including internalized misogyny), I now find it very offensive that Natural Child Birth has hijacked something I care about so deeply in order to sell midwives. I was lied to. The regard for women and their choices that is sold by midwives is only practiced if your midwife feels it is important. You can’t tell if she actually believes it is important until its too late.

I should have seen their political appeals as a red flag- If natural child birth is better, even just psychologically, then data will reflect that clearly.  An Inconvenient Truth managed to be a data-heavy documentary that gained popularity because it was so educational and concise. The Business of Being Born is more geared towards playing on the emotions of women to convince them of the inherent merit of natural child birth. It is the only way that I can make sense of the content of the film, knowing what I do now, and knowing what Ricki Lake must have discovered when she did interviews and research for this film. I would love to know what interview footage ended up on the cutting room floor.

stay tuned for the rest of the series!

in defense of unnecessary c-sections

I found a wonderful piece about unnecessary c-sections, from a mom that (maybe) had one. I am in the same boat as she was, though I did not labor as long. Here are some of the bits I really appreciated:

You know why my c-section was traumatic? Because I felt like it was my fault. Because everything I read about c-sections treated them as something that happens to women who are uneducated and don’t advocate for themselves. Because I had bought into the idea that, if you don’t give birth vaginally, you did something wrong.

I don’t know if my c-section was necessary and I never will. Maybe if I had been somewhere without access to modern medicine, I would have been in labor for a few days, vomiting, in mind-warping pain, increasingly weaker and more exhausted, and eventually her head would have turned and I would have given birth vaginally.

Would that have been better?

Would that have been the way an educated person gives birth?

I identified with this so much. I can’t believe how I spent time wondering what I could have done differently to avoid a c-section. I know that self-blame for things that aren’t controllable is a sign of an unhealthy relationship (or unhealthy self esteem). To me it signifies the way Natural Child Birth causes an unhealthy relationship between women and their bodies.  They teach you that you can control your child birth destiny by being Good Enough. Strong, trusting of your body, positive, self assured, etc. It is a part of why NCB is so alluring to so many people- birth can be scary and feel very uncontrollable, if NCB were true we could all have much more control over our own birth experiences. This is an especially alluring thought for women who maybe haven’t always been in control, like the 1/4 of women who have experienced some kind of abuse in their life.

Another bit that resonated strongly with me:

There are some births where c-sections (and other interventions) are clearly unnecessary. There are other births where c-sections (and other interventions) are clearly necessary.
But an uncomfortable percentage of births fall in that gray area in between, where it is simply not possible to tell if the c-section is necessary or not. In that gray area, there are four possible outcomes:

1. True positive: A c-section is necessary and performed
2. True negative: A c-section is not necessary and not performed
3. False positive: A c-section is not necessary, but performed
4. False negative: A c-section is necessary, but not performed

Now, think about the consequences of 3 and 4:

So, obviously, we want to err on the side of more false positives than false negatives.
I wish I had thought about that before my pregnancy! This makes perfect sense.