Sometimes doulas are scary as well

A doula calling herself “rosie posie” on facebook (which is obviously not her real name) got into some trouble in a birth worker’s group recently (the group has everyone who identifies as a birth worker, from photographers to nurses and possibly some OBGYNs). A birth worker was discussing a mother with risk factors and what she should do. Rosie Posie suggested Unassisted Childbirth, or Freebirth as it is sometimes called. Someone sarcastically replied “sure, and we could just start a donation website for their child’s brain damage!” Rosie’s response is below:

“Brain damage? I’ve attended over 20 successful unassisted home births as a home birth doula, and I had mine unassisted. She could esaily find an affordable and experienced doula whose able to recognize signs of distress if needed.”

This is, of course, rubbish. Even home birth midwives are notoriously poor at spotting fetal destress outside of brachycardia (low heart rate). All the other people in the group call her out on it. The next claim she makes it horrifying:

“I have experienced a stillborn death. You openly discuss with the client that you are not a midwife nor are u responsible for anything that happens. Homebirths are 100% on the parents and they also need to be aware of signs. The doula is there for extra support, help with the kids help with theh usband help around the house and gentle guidance. Its not illegal unless you are impersonating a midwife. Im surprised at the lack of faith in homebirth in this group”

So she says she has seen “over 20” unassisted childbirths and had her own. Let’s be charitable and say it was 29, and hers made a 30th. That would mean the death rate she has observed is 1 out of 31 babies born unassisted dying. That is *astronomical* in the world of perinatal mortality statistics, even more horrendous than the 1/200 breech home birth mortality rate that gave MANA pause. Of course that didn’t make MANA condemn home breech attempts or anything, but they at least knew it was a terrible statistic that they would have to say something about, even if it was just weasel words.

Rosie goes on to explain more about her theory about her responsibility for her clients (in light of the outlandish safety claims she makes about freebirth):

“Meh. I’ve heavily discussed with a lawyer. my contract is pretty solid and ive never ran into these issues. If youre firm about the amount of support you can and cannot provide and the families sign on the dotted line they dont really have a case. Theres no harm in encouraging anyone to learn how to recognize the signs in labor. Ill keep doing me and attending awesome homebirths. There are doulas offering home abortions for christs sake you dont see anyone suing them when something goes wrong (again something i have experienced)

Another poster calls her out on her craven indifference to the lives of women.

It was refreshing to see people being called out in an NCB space about a lack of safety and concern for clients. The thing is that Rosie’s past and future clients will likely never see this exchange, and since she used a fake name there is no way to let anyone know about it beforehand. How many doulas and midwives have said something equally outrageous online without their clients knowing?

Everyone is so eager to put the blame on parents and families that hire a doula or midwife, but almost no one in their ranks is willing to make a system to hold them accountable.

Rosie quit the group later because she thought it was too closed minded.

It was hard to tell if a post had been deleted, but there seemed to be multiple responses to Rosie about the specifics of a doula performing abortions, they all mentioned purchasing Cytotec off of the internet and administering it to moms who were miscarrying early. I assume Rosie deleted a post in order to absolve herself of being investigated for practicing medicine without a license because the responses I saw do not make sense without such a comment. Leave a comment if you have more information.

Rosie has the kind of attitude that I imagine Rowan Bailey did before they were arrested for the death of a child during a home birth. She too had no idea what she was doing but was confident enough to stay a fatal course anyway. That is what is so disarming about natural child birth types- the confidence. It is hard to think of someone being so confident about if a child will live or die without being on the right side of things, but they aren’t. They are too stupid to know they are too stupid to be delivering children. The dunning kruger effect is alive and well in NCB circles.

name changes for negligent midwives

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

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

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

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 8

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Not Buried Twice Video- please share!

Doula Dani has made an amazing video about home birth loss mothers and the #notburiedtwice campaign. Please view and share.

What makes a profession?

I’ve read before that calling non nurse midwives ‘lay’ midwives is offensive somehow, because of their ‘extensive’ training and standards. They would prefer to be called a Certified Professional Midwive, or CPM. The middle initial prompted me to ask- What exactly makes something a profession? I’ve identified a few characteristics which can be said to apply to virtually any recognized profession.

 

The first is a standard of practice- this applies to everyone from a HVAC repairmen to an automechanic to a registered nurse. Real professions require a clear and defined set of practices or protocols to deal with specific problems. Do CPMs follow this standard?

 

No, they don’t. NARM (which certifies midwives, which in itself is entirely optional depending on the state in which a midwife practices has this to say):

NARM recognizes that each midwife is an individual with specific practice protocols that reflect her own style and philosophy, level of experience, and legal status, and that practice guidelines may vary with each midwife. NARM does not set protocols for all CPMs to follow, but requires that they develop their own practice guidelines in written form.

 

Can you imagine if people who worked at pharmaceutical companies, or toy companies, or car manufacturers, or a blood bank could just *decide* what made for a safe product? Whenever this has been allowed to happen the results were deadly. In the past hemophiliacs who needed blood products to live normally did become victims of a lack of legislation and oversight in the blood products industry.  They were infected with hepatitis and HIV and given little compensation for it. There is a heartbreaking documentary on netflix about it called Bad Blood. The results of decisions made during childbirth are no less consequential than decisions made about consumer products and drugs.  One could argue that the variability in street drug content and potency is another good example of what happens when an industry effectively has no real standard of practice.

 

You may be wondering, how do midwives recommend that parents find a competent practitioner in light of the lack of regulation? They typically believe it is up to parents to ‘research’ their midwives credentials, all while they refuse to have any kind of central governing body to make it possible for parents to adequately check the credentials of any midwife. Which brings me to my next standard….

 

Central, authoritative leadership is the second quality I’ve identified in a professional line of work. Real professions have leadership in the state (and possibly national) level, leadership which can revoke them from working in their chosen profession. Any deviance from a standard of professional practice is seen to diminish the profession as a whole.  Real professionals don’t want people working under their official title without having obeyed the strict standards of practice and ethics.

Local midwives organizations are not able to revoke practice in most cases, and when a local occupational or medical board CAN prevent a midwife from practicing its only at the state level. She can simply move to a state with fewer regulations.

National groups include NARM, whose accountability department is a real joke. They dodge the complaints of mothers who lost their children in home birth deaths. Here is a story of the run around given to mothers who had to bury their own children because their midwife screwed up. If you don’t believe me, email them yourself with a subject line about a negligent or dangerous midwife, and watch them avoid giving a meaningful response. I waited months for mine, and it had a disclaimer about how every midwife decides her own practice standards.

MANA is another national midwives group, but they mostly lobby for the profession. They refuse to set practice guidelines like defining what constitutes a “low risk” patient, despite referencing the phrase repeatedly to prove the safety of home birth. There is no way to discipline a midwife via MANA.

Out of the main two qualities that make an actual profession, CPMs or lay midwifes do not seem to obey either of them. Why is anyone obligated to call them a professional?

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 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.

why aren’t you breastfeeding?

There is a lot of buzz about this ridiculous question sent to The Alpha Parent recently:

“I feel awkward around formula feeders. I don’t know where to look. Is it okay to look at their baby? Is it okay to ask them why they don’t breastfeed, or when they stopped? What’s the etiquette? Any chance you could help with these questions? I’m not being weird, I’m genuinely curious.”

I would have linked her to a wikipedia article on “social convention” or “manners” or something else equally obvious, but a real discussion ensued about if its cool to ask moms why they aren’t breastfeeding. Of course that isn’t anyones damn business, so I am trying to come up with good combacks for sanctimonious NCBers who do feel compelled to ask:

HUMOROUS:

1. Well…honestly?  I lost my nipples in the war *stare stoically into the distance*

2. My pediatrician said a double dose of vaccines is just as good as breastfeeding.

3. If you read your bible you would know its a sin (if they ask which part, say Leviticus).

4. We do usually, but our wet nurse doesn’t like to breastfeed in public, so…

5. I would, but making cheese out of my breastmilk is so profitable…

BITING

1. I formula feed so that you can keep feeling superior.

2. I wanted to ruin the bond I had with my baby, and this was by far the easiest way.

3. Well it is insanely easy for everyone, and never painful, so I guess I don’t have a good reason.

4. I hate my baby, obviously.

Counter with another inappropriate question:

1. I need to know if you are on your period before I tell you. (can sub any condition or disease here for period)

2.  How much money do you make?

3. When was your last bowel movement? How did it go?

 

Direct

1. How dare you question how I feed my child!

2. None of your business. Ever.

 

These are the best I could come up with. Add your own!

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.