Tag Archives: hospital birth

Debunking the Business of Being Born: Part 9

This is part nine in a series on debunking the Business of Being Born. The other parts can be found here. The description of what is happening in the movie is in bold, while my commentary in in plain text.

A female OBGYN says “Fetal distress, cord prolapse, a fetal brachycardia that doesn’t come up… how are you going to get someone sectioned or emergently delivered from home? Its not so easy.” 

These comments being allowed in the movie provide a false sense of balance to the film. Noam Chomsky once pointed out that if you only allow two view points, and then allow vigorous debate between the two view points, you can achieve the appearance of democracy and free speech without ever actually having it. At this point in the film the arguments between the doctors and midwives boils down to hypotheticals, and only the midwives are allowed to discuss the research that they have reviewed. The film picked doctors unfamiliar with home birth rather than those who are well versed in it for a good reason- its much easier to control the debate and make it appear balanced.

Midwife Cara says “People think when you do birth at home, you’re not necessarily prepared for that eventuality, and that everything has to go great. But it doesn’t.”

No explanation given of how to resolve the conditions the OBGYN brought up earlier.

Marsden Wagner says “The netherlands loses fewer women than we do, the netherlands loses fewer babies than we do, and one third of their births are planned home births.”

The safety data Wagner cites simply is not true. Multiple studies exist to evidence the fact that planned home birth has horrible outcomes compared to hospital birth, regardless of what country it takes place in.

The scene shows Abbey Epstein and Ricki Lake discussing strollers. The scene changes to Abbey and her husband at an OBGYN office. They are discussing the baby’s position. They perform an ultrasound and say the growth is right on track. Abbey discusses home birth with the doctor. “We really are very, really considering the home birth with Cara.”

Abbey’s doctor replies “Go. I’ll be your back up.” He is very encouraging. They discuss the logistics of being a back up. He is concerned about his patient being treated poorly at the hospital if he is not their back up. 

Cara is talking to Abbey in her car now. Cara says “I’ve had (inaudable) back me many times. And, you know, I could go to saint vincents, or we could go there. It would depend on what the circumstances were. 

This exchange makes for a false continuity of care. There is none. A back up means the midwife dumps you there and may or may not come in, may or may not tell the truth to the staff. Having your doctor willing to be on call is a step up, but it might not matter depending on how emergent your transfer is. New York magazine has talked to former patients of Cara Muhlhahn and area hospitals- they say the same thing. 

Physicians that say they “back up” midwives never bet their insurance on it, and that’s because its a very bad bet.

Abbey mentions that she would love the possibility of transferring to a birth center. Cara points out that if they need transfer its going to be to a hospital because something is wrong. Abbey says she fears she would change her mind about home birth in the heat of labor. Cara replies that she personally begged for a cesarean during her home birth. Quirky music plays and footage from Cara Muhlhahn’s home birth is shown. It is obviously intended to be funny. 

I have taken a break from this series and haven’t been buttered up by the first half of the movie, so I feel absolutely terrible for a woman who desperately wants pain relief and denies herself. I know that Cara likely felt like she couldn’t get pain relief because of the business she works in and her ideological beliefs about child birth.

Cara says she felt like she was between a rock and a hard place, was trying to escape her labor. Footage shows her in obvious pain many times. She says “Every single woman that is having a natural birth feels that way at a certain point. The rock is ‘I’m not pushing because it hurts too much’, and the hard place is ‘Ok then, you are staying pregnant forever, and its going to hurt forever’. Its the most infuriating place to be.” Footage shows Cara crying and whimpering during labor. You can make out her saying “just awful” while she is crying in the labor footage.

This is terrible to watch. I personally would not have included this. It normalizes suffering that is needless. No one should hurt that bad and have a room full of people look on apathetically.

Cara discusses how mean she was to other people during her labor. She is shown in the bathtub crying. She narrates “I looked at the faucet and said thats me, I’m either dying or pushing the baby out.” She talks about having a difficult labor making her a better midwife because she knows how hard it can get. 

If you think about it, Cara was in an interesting position after her difficult labor. She was at an impasse, she knew she had aided other women that were obviously suffering like she had. In light of that she could have either chosen to stop promoting natural birth and worked in a hospital again. She could have stopped practicing altogether. She could have apologized to people she knew that she encouraged to suffer needlessly.
Instead it seems she took the easier option, which is to justify what happened. It is easy to forget pain when you aren’t feeling it right then, and it is easy to forget just how badly something hurt you.

We all have certain beliefs about ourselves or the world that are deeply painful to confront. I have a feeling that Cara’s self image as a helper, as a sacred journey keeper for women in labor, was more painful to betray than labor itself.

triumphant music plays. Cara is pushing. The baby emerges and is put on her knee. One of her arms is grasping someone elses with a white knuckle grip that she doesn’t release, even to hold her baby. Her other hand keeps the baby somewhat more secure on her lap. She looks down at the baby with a rather stoic expression.

Cara did not have the amazing moment that Ricki Lake did during her birth. There are editing tricks employed to imply that it happened, but from what I can see she was just terribly exhausted, to the point where it was difficult to enjoy her baby’s birth. The hand she haphazardly extends so her baby doesn’t fall on the floor seems to be all she could manage right then. The scene ends rather abruptly, making me wonder what else happened after that.

The fashion model patient is trying to hear something through a stethescope. Cara is examining her and helps her use it. The client talks about her insurance company being unsure about what to do with a non-hospital birth plan. She says its cheaper to have a baby at home. 

They cut to Carol Leonard, lay midwife and owner of Longmeadow Farm Birth center says that a spontaneous vaginal birth at a hospital costs about 13,000$. She exclaims “Hello! I’m charging 4000$ for everything!”

There are many factors as to why midwives charge less. These aren’t highlighted in a frank manner, so I will do so here:

1. They provide fewer services (no OR, anestesia, continuous fetal monitoring, emergent labs, blood bank, etc)

2. They do not have insurance (if they screw something up they won’t be able to pay, and if barred from practice in one state they can move to another one and set up shop again, unlike a physician that banks their whole career on retaining their license)

3. Their education costs next to nothing (a CPM can usually get their whole degree for about 3K)

The old addage that you get what you pay for is true here. So is the fact that insurance varies wildly in the US, you may pay less than 4K for a hospital birth depending on your insurance and its terms.

Fashion model patient wonders “what their agenda is” in pushing a far more expensive hospital birth on the insured.

I can tell you right now- it is making sure the insurance company doesn’t have to pay out for a costly NICU stay, or perhaps a lifetime of special education or disability related doctor visits from hypoxic brain damage. The bet of paying on a hospital birth pays off in the long run. The people who run insurance companies just crunch the numbers and charge based on the results. They do not have much of an agenda outside of trying their best not to screw over their stockholders by insuring things that will ultimately cost the company more than it makes.

Marsden Wagner says “The insurance companies, are part of the establishment, and so when the obstetricians who are giving the advice to the insurance companies say that home birth is dangerous or that midwives are not as safe as doctors and all of this nonsense, the establishment CEO in the insurance company believes them.”

Things really do not work that way, but that is beside the point. The assumption is that OBGYNs say home birth is dangerous because they have a bias instead of because they actually know what they are talking about. The questions brought up earlier about specific problems that require emergency c-sections are still hanging heavy in the air, and no one has answered them. I’ve been tracking home birth fatalities enough to answer the question- depending on the problem that occurs at a home birth, someone either dies, is injured, or disabled. There are far too many complications that cannot sustain life between home and the hospital, even if it is minutes away.

A woman says “I’ve interviewed many nurse midwives who noticed that once their practice reaches more than 30 percent of the patients in a hospital the doctors will start firing them, because that is too much competition.”

We are again inundated with gossip from the point of view of midwives with no opposing viewpoint given from the people who are (supposedly) firing nurse midwives. No one knows if this is actually happening or why. OBGYNs do much more than CNMs ever will. It isn’t as though every OB’s bread and butter is delivering babies. Here is a list of specialties that OBGYNs can branch into if delivering babies isn’t their preference. CNMs can do almost nothing that OBs can on that list.

A woman says “The AMA as the trade organization for physicians, has a very clear and public position that holds that they will not allow non-physicians to do anything that physicians do. You wanna talk big lobbies, big dollars, they can call a lot of shots.”

The name of the statement or any reference of it isn’t provided so that it can be verified.

The AMA has a lobby like every trade organization. They are infinitely more ethical than trade organizations like MANA, that had horrendous perinatal mortality rates on the books for several years before privileging the rest of us with them. The period of time between the collection of those numbers and the release of them was the period of time I was pregnant. I was not allowed to make an informed choice because MANA wanted to keep the data secret.

The biggest difference between MANA and the AMA is that the AMA changes its policies based on data. MANA does not. MANA only cares about protecting the legality of home birth instead of the safety of patients. They refuse of even define what constitutes a low-risk pregnancy, despite insisting left and right that home birth is only for low risk pregnancies.

The attempt to smear physicians and their organizations is pretty rich when its coming from midwives. They have very little room to speak.

stay tuned for part 10.

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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.

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.

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 5

This part 5 in a series debunking the Business of Being Born. Descriptions of the movie are in bold, my commentary is in normal text. The other parts of the series can be accessed by clicking here.

A woman says “Its very easy to convince a woman that they need this procedure or that procedure, because there is a huge power disparity.”

There is an inherent power disparity in any situation with patient care. Doctors are trained in how to deal ethically with the disparity, while I have noticed a tendency in midwives to ignore the problem or pretend that it can be overcome by force of will.  There is also the issue of accountability- doctors are not very accountable for unethical behavior that does not result in bodily harm, but they are still much more accountable than midwives. The film makes it seem as though midwives are the solution to patients being given misleading information and coerced/forced treatments, but midwives are equally as capable of doing this to pregnant women. I know because it happened to me, and have since found many stories of women who have been through it, too.

There is footage of a laboring woman in a hospital  asking “What is the risk to the baby?” and a doctor replying “minimal”. 

Combining this footage with the previous statements gives the impression that the doctor is lying to the patient. We are not given enough information about the procedure or the patient to judge if it is true or not.  This scene is emotional for me- I feel for the woman who may be uneasy about what her doctor has told her (or maybe she is feeling fine? We don’t get to speak with her again so we cannot know, her face is blurred so its impossible to know if she was even anxious or not). This movie expertly manipulates feelings of helplessness that women almost universally experience in patriarchal society.

A woman says “So if you’re in labor and the doctor says, ‘wow, I think we need to do x,’  you’re gonna say ‘yeah we need to do x’. The doctor may think he is giving you an option, but you hear the expert advising you to do something. ” The woman making the statement is revealed to be a part of citizens for midwifery, a political group whose aims are to increase the access of women to midwifery. 

I agree that patient consent violations are an enormous problem in medicine. It isn’t just a problem for pregnant women, and so using homebirth midwives as a solution leaves out a wealth of people who could benefit from a more universal solution. Almost dying in an accident, or surviving cancer, or any other situation that causes a person to face their mortality is a major life event and transformative in the same way that giving birth can be. People who actually care about solving a problem are always looking for possibilities to better deal with the problem, they ask meaningful questions about what strategy is best. They do not push a single solution and fail to discuss any others. That is a sign of pushing an ideology or a belief system instead of practical solutions for practical problems.

(more footage from monty python)

Ricki Lake and Abbey Epstein are on the phone with an indiana midwife talking about her interest in their project. They discuss that Ricki Lake is the driving force behind the movie because she had 2 babies, the 2nd one at home. Ricki discusses how it was important for her to experience everything, to feel everything, to have the memory of pregnancy and birth. She notes how a lot of women she knows don’t care about any of it, they just care about a healthy baby. She wanted to explore it because she feels that so many women are missing out on an amazing life altering experience of natural child birth. The midwife agrees that it is hugely transformative. 

(footage of a happy unmedicated birth)

Something I really resent now is that someone like Ricki Lake can use her class privilege to push whatever agenda she wants, simply because it was important to her personally.  I would personally love to make a documentary about the dark side of midwifery in america, but I am not rich or connected in the entertainment industry so its unlikely that I would ever get the opportunity. My message isn’t less important than Ricki’s, but only one of us will be heard on a national scale. People who wield that kind of privilege have a duty to others to act with integrity and avoid misleading others. This movie is grating in its emotional appeals and telling omissions. Shame on you, ricki lake.

Several other women discuss how powerful having a baby was for them and the reverence the occasion deserves. There is more footage of a different woman during her home birth labor.

“A woman doesn’t really need to be rescued. Its not a place for a knight in shining armor. Its the place for her to face her darkest moment and lay claim to her victory.” Says Cara Muhlhahn

At the time that I fell for this movie this line of thinking seemed empowering. In reality, none of us have any real control over if an unmedicated vaginal birth is possible for any individual woman. When I was in a doula training I remember the instructor saying “the baby will come out if she is in a coma. The uterus pushes the baby out.” I felt a little confused- how was it an achievement (or a ‘victory’) if it can just happen while you are unconscious? I ignored the cognitive dissonance involved with that. I admired how amazing our bodies are instead of questioning the premise of NCB- that you can control how your birth ends up. You can’t. All you can do is make a bet based on statistics and hope you are in the majority.

There is footage of cara assisting a laboring mom at home in a birth pool. 

Another midwife talks about how birth can be empowering and wonderful or traumatic and scarring. They show footage of a woman being wheeled off to an emergency c-section who is obviously in a lot of pain. 

The implication is that her birth by c-section was traumatic. We can’t know because we cannot speak to her. We are made to feel sad for her when really, the reality for women without access to c-sections is much more grim.

“We are completely lost. And we have even forgotten to raise the most simple questions. What are the basic needs of women in labor? And the fact that midwives have disappeared is a symptom of the lack of understanding of the basic needs of women in labor.” says dr michael odent. 

He continues “Like a traveler who suddenly can realize that, he took a wrong way. The best thing to do in this case, is to go back to square one. The point of departure. And to take another direction. 

This isn’t necessarily true. The best course of action may be to find out what is working and what isn’t, and make revisions to the things that are obviously not working. He doesn’t ever get specific about the ‘basic needs of women in labor’, but makes it the basis for his entire argument to return to home birth using midwives. Another claim that is impossible to actually examine for validity. Its boring at this point to type that out.

There is footage of Cara looking at a map and planning a route to a patient, and discussing her credentials as a CNM. She says that her reasons for preferring home births is that the client gets to have their baby at home. Her secord reason is that she would prefer to be on their turf instead of the other way around. She discusses the philosophical underpinnings of “giving the power back to the woman.”

This mindset isn’t restricted to midwives, there are OBGYNs who believe in giving power back to female patients. There are midwives who believe that they know better than patients. It is so easy to exploit the human tendency to stereotype groups of people, and this movie is absolutely shameless about it. They never ask if there are abusive midwives or feminist leaning physicians. Its an obvious question that the film makers failed to examine.

(footage of cara during prenatal visits. She is very nice to the patients and their families)

“I do believe that women who choose homebirth, they do share something. It could be just a feeling that she knows how she wants to do things. And then I think when she’s in labor, she can interact with her labor in a different way than if everyone is doing things to her and making decisions about her.” 

Examination of the themes so far:

I think women who choose home birth may or may not share things. I do know that most of them are white, middle or upper class, and college educated.  Something women of that demographic share more often than other groups is anorexia or bulimia. Until there is research about this I can only offer my opinion, but I do believe there is a connection. Natural Child Birth has a lot in common with the twisted thinking of an eating disorder. There is a lot of perfectionism, judgment, black and white thinking, and the belief that your body will perform a certain way if you are Good Enough. Your body will be proof that you are Good Enough. Your body, its pain, its resistance, is a thing to overcome to prove to yourself, and others, that you are acceptable. If you accomplish it you will finally feel amazing, whole, at peace. There is only one ideal birth to chase, just like there is only one ideal body.  Craving an unhealthy level of control over yourself or your life is a feature common to many women with eating disorders, it may be because there is such a large proportion of eating disordered women who have survived sexual abuse. Midwives are not helping these women, they are preying on them for income. This is such a horrible, dangerous idea to give women who cannot control if they need a c-section, or if natural child birth is a meritless agony to them in retrospect.

The movie deceptively pairs footage of doctors with negative statements and midwifery footage with positive ones. Where are the women like me, like so many others, who had awful midwives? Where are the vignettes of births that women considered ideal that were not NCB?  I have a hard time believing that the film makers could not access anyone with a contradictory opinion, they simply chose not to show anything damaging to the image of midwives.

Something that really made me dig in my heels and adhere more strictly to NCB ideology was the way that anti-home birth advocates ridiculed the idea that women highly value the experience of giving birth. It was extremely personal to me. I identified with this movie a lot because of the value it placed on women and their experiences.  I was at a positive place in my life after overcoming a lot of adversity, and after seeing this movie I thought “Hey, why not me? Maybe I can have the best experience and a healthy baby. Why not aim for the best life can offer?” When other women ridiculed chasing the ‘ideal’ experience of child birth I felt very sensitive about it. Who were they to tell me what I should or should not want?  They always framed it as an experience vs safety, but it seemed like a false dichotomy to me. Why not both? I had to fight for so long to feel like I was worth anything, or that things might turn out well for me in the next chapter of my life.  It also made me think that anti home birth advocates were sexist. The ridicule of a woman who wants ‘too much’ from life is rampant, and it seemed to me that this was yet another example. The worst thing a woman can be is someone who takes more than their share- of food, sex partners, of a conversation, of attention, of decision making, of authority. We are constantly told to be happy with our lot, even when it is woefully inadequate. It is unfortunate that anti-NCB groups are not sensitive to the hopes of women in NCB. I empathize completely with those wishes and do not see them as selfish or narcissistic.  I am hoping that this blog will be a place to show sensitivity to the valid concerns raised by NCB advocates while also being critical of their message about the proper solution to these problems. Stay tuned for more.

Debunking the Business of Being Born: part 4

This is part 4 in a series debunking the Business of Being Born. Descriptions of the movie are in bold.

A woman complains about the ‘intense interventions’ and claims that there is no medically justified reason for interventions in obstetrics.  She also says that there is no common sense reason for many things, such as the lithotomy position in labor.

Once again, no evidence is presented and the claims are so vague that they are impossible to investigate. Its an opinion, that is all. I cannot tell if she is saying that there is never a good reason for ‘intense’ interventions, or if there is never a good reason for any of the interventions OBGYNs use, or that there is not a medical reason the majority of the time.

There is a montage of hospital births and interventions that seem selected to make viewers feel uncomfortable. They cut to a home birth mother. She says “the more you can move with labor, the more you can move through your contractions, they don’t seem as intense.” There is footage of her moving during a contraction. “To lay still its like ‘who would want to do this? I just want to get up and move my hips!’ “

That was her experience during labor. I believed that it was the experience of women in general because of this movie and other NCB advocates. I believed it fully until I went into labor and tried it. I tried for hours to ‘move through’ my contractions. It didn’t do a god damn thing for the pain, it actually made it worse. I’m not saying the mom in the movie is full of shit, just that her experience isn’t shared by everyone. Even if every hospital pushed NCB on patients there would still be people like me who need something stronger than a butt-dance to deal with the pain.

The same woman as before claims “the lithotomy position is the most physiologically dysfunctional position ever invented for birth. Because putting a woman flat on her back literally makes the pelvis smaller. It makes it much more difficult for the woman to use her stomach muscles to push. And therefore makes it much more likely that an episiotomy will be cut or forceps will be used. Or the vaccuum extractor will be used. ” More creepy hospital footage and modern hospital deliveries are shown on screen. 

I could not find any real data about these claims, but (as I discussed in part 3) epidurals are the intervention most strongly correlated with instrumental deliveries. It makes absolute sense that moms who use epidural anesthesia would be positioned in a way that could facilitate interventions, because women with epidurals obviously cannot move around without assistance and any emergency interventions would be delayed by having to re-position her.

What is really strange is that I watched The MORE business of being born, and recall one of the super models talking about how being on her back was most comfortable for her during her unmedicated birth. If our bodies “know how to give birth” and all that I am not sure why her body would choose the most “physiologically dysfunctional position ever invented for birth”, which resulted in an uncomplicated vaginal delivery.

A man speaks a foreign language, he gestures towards a patient bed and references the lithotomy position. Subtitles read “this position here, it is easiest for the doctor. But its nearly impossible for the baby to come out alone in this position.

If its “nearly impossible” why does it happen so often? All the information I could find demonstrated that operative vaginal deliveries were 5% or less of all births in the U.S., and the vast majority of vaginal delivery patients were in the lithotomy position.

A woman uses a toy doll and a foam pelvis to demonstrate that babies need to turn after their heads engage in the pelvis in order to be born. She claims that shaking the pelvis and moving around helps. 

The same man as before (who we now know is an OBGYN) says Now if she was squatting I would have to be sitting on this little seat right here…

Footage of a birth where the mother is moving around on her own is shown, presumably not in a hospital. 

The dr continues: So the mother is active and thats very important, shes participating. As opposed to when shes laying down, the doctor is telling her “Push! Stronger now!”

Footage is shown on the screen of a hospital birth with a lot of people telling a mom to push. She is yelping in pain and there are hands all over her. Her face is blurred out.

This kind of footage freaked me out when I watched this movie. Peoples hands all over the mom while they barked orders at her really squicked me out as a person with an abuse history. Pretending that midwives are never grabby or never yell at women to push or that all doctors are aggressive in this manner is just nonsense. It is another attempt to put anecdotes in our minds instead of actual data. The degree a person obtains does not determine how much respect they will give you.

A doula/rn says: Women here have given up their autonomy about birth. Women are so afraid of birth. Because you do not have an image of what birth looks like. Women in america don’t know what’s normal about birth.

A CNM says “they watch A Baby Story and they watch Maternity Ward. They watch these programs. I think there is a lot of fear instilled in women around birth.”

The screen shows footage of terrified mothers in hospitals, presumably from the programs mentioned by the CNM.

A birth center owner says “Every birth that you see on television is women screaming and being rushed down the hallway and looking like an absolute dire emergency. So why should women feel confident about giving birth when the whole culture is telling them this is scary, this is dangerous? “

Those shows are the real stories of real women who really did have a terrifying experience. Why are women supposed to ignore the possibility of something terrifying happening? How are women supposed to make reasonable plans without contemplating what could go wrong? I am not advocating for anxiety or non-stop worry about complications, but the experiences of women who had emergencies in birth shouldn’t be ignored or buried in favor of the more positive experiences. I also know for a fact that they have shown unmedicated and home births on the shows mentioned. I remember being a teenager and watching a woman give birth in a kiddie pool in her home on the discovery health channel. I usually did not watch the birth shows, but she was screaming “CYOTEEEEEEEEEE” over and over again and I needed to know why she would yell “cyote” during birth so I tuned in. It was what she named her son.

Anyway.

Birth is what it is- why does it need to be portrayed a certain way?

NCBers know why- they believe, like many alt-med folks, that your attitude can determine your outcome. They believe that if you just aren’t afraid of birth it won’t hurt you. It sounds ridiculous when the theory is stated outright, so the movie does a good job of easing you into the idea that your attitude will determine the outcome of childbirth.  Several NCB icons like grantly dick reed and Ina May Gaskin state this theory in their books. They believe that giving birth while scared is like trying to pee with an audience- fear interrupts the process. It is a hypothesis, but it isn’t one that is testable. The hypothesis relies on the subjective inner experiences of women over a period of hours, it is something that can change dramatically in a matter of minutes. If a woman has even a moment of fear during childbirth any problem that occurred can be blamed on her. It is unspeakably cruel to blame women for something they have no control over. The movie accomplishes it very stealthily, and I believe that women are so used to accepting blame for things that it can be hard to even notice that its happening.

“Women expect to have traumatic experiences. Thats why women are having epidurals, they are all terrified of what this is.”

This is another subtle jab at women who chose interventions. She is implying that women chose epidurals because they are ninnies who were brainwashed by the media into believing they needed one. Women have epidurals because they are in pain.

A childbirth educator complains about the fear present in the depictions on television. She says that once the doctor plays the “your baby is in danger card” the battle is over. There is footage of a mom whose baby is having heart trouble during delivery, her OB is trying to avoid instrumental delivery but mentions it as a possibility. He tells her to push. 

“That’s one of the great manipulative techniques that are used, is when a woman starts to question, “wait, why do we need to do this? Wait, is there something else we can do? the first thing you turn to is ‘its for the good of the baby’.  Weather or not it is, you’ll do anything because if you go on to question it, well, then you’re a bad mom. 

There is more footage of a different OB recommending a vaccuum assisted delivery in a hospital.

As I stated before, there are very few instrumental deliveries. This part of the film gives the impression that it is much more likely to happen than it actually is, and they pretend that there is no danger in maternal exhaustion or pushing for a very long time.

Sometimes ‘its for the good of the baby’ is just the simple truth of the matter, or it is the truth to the best of the physician’s knowledge.  This film basically promotes paranoia about why your physician would recommend something. Why are midwives exempt from paranoia about non-intervention? The Business of Being Born very rarely questions the actions or recommendations of midwives, but constantly questions physicians. The physicians have the disadvantage of having many years of training based on a large amount of complicated data. Issues like that are hard to explain concisely. Midwives can usually explain themselves in a slogan. It is superficially more convincing to lay people. It is very much the same as creationism, where snappy lines are more compelling to people who do not know better.

Discussion of the themes so far:

Negligence is usually defined as doing something a reasonable person would not do, or failing to do something a reasonable person would do. Both can cause death or problems. The Business of Being Born makes it seem like only the first kind of negligence is dangerous, when in fact both are.  The movie, and NCB advocates, repeatedly suggests the second kind of negligence as desirable without explaining why. The fact of the matter is that many women find the risk of intervention preferable to the risk of not using an intervention, and its understandable. There is a certain percentage of the time that the intervention would not have been needed, but it is not possible to know until something bad has happened.

I got irritated with statements that I could not investigate in this portion of the movie. If you make a statement using dramatic, emotional language, but never get specific enough to actually have your statement investigated for validity then people will hear whatever they want to hear when they listen. Its something politicians are experts at. It is a red flag for dishonesty. I wish I had spotted it before I decided to use a midwife at an out of hospital birth.