# What Women Aren't Told About Childbirth



## pamamidwife (May 7, 2003)

http://www.alternet.org/story/65608/?page=entire

Quote:

The survey Listening to Mothers II (LM 2) was released in 2006 and reports on U.S. women's childbearing experiences. Conducted for Childbirth Connection by Harris Interactive in partnership with Lamaze International and Boston University School of Public Health, it is the first comprehensive survey of women's childbearing experiences. The survey population is representative of U.S. mothers 18 to 45 who gave birth to a single infant in a hospital, with 1,573 actual participants.

"The predominant picture that emerges from our data," the report states, "is of large segments of this population experiencing clearly inappropriate care."

The majority of women ended up attached to IVs, catheters and fetal monitors. They had their membranes artificially ruptured and were given epidurals. Most of these women had little understanding of the side effects of these interventions, including cesarean and medical inductions. The report also shows that though women understood that they had the right to refuse medical interventions, few did, and many received interventions, such as episiotomies, without their consent.

Just as troubling is what is not being done. A "very tiny minority" of women received all of the care practices that promote natural birth. "With 4 million U.S. births annually, a single percentage point represents about 40,000 mothers and babies per year," the report authors say. Despite the relative health of women in the United States, many women are not getting the uncomplicated births they might expect.


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## gcgirl (Apr 3, 2007)

I would like to see women, at their very first prenatal visit with their provider, receive a detailed handout on what to expect and what to prepare for. Like "Here's what we do at week X, and week Y, etc.," and "Here's what tests we normally do and why," and "Here are the things you should start thinking about so you can decide what kind of birth to have..." Kwim? At least get people thinking, and realizing that they DO have options. But I guess it's easier to have a compliant patient when they aren't educated and don't know what to expect.


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## jillmamma (Apr 11, 2005)

I'd also like to see doctors quit scheduling inductions because "you are just about 40 weeks anyway, and I will be out of town the week you are due, so that way I can be there instead of my backup".







:


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## AlpineMama (Aug 16, 2007)

I'm finding it hard to relate to any woman who DOESN'T try to learn all she can about pregnancy / birth etc when she finds out she's pregnant. It's just hard for me to wrap my mind around, or maybe I'm a nerd.







A lot of women just think about baby registries and maternity clothes and baby showers, instead of the marvelous process actually going on in their bodies.


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## LoveChild421 (Sep 10, 2004)

thank you for posting that Pam! I will definately be sharing it with all the women I know.


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## tammyswanson (Feb 19, 2007)

The Food and Drug Administration (FDA) has never approved Pitocin for the use of augmenting labor and it has been suggested now that mismanagement of Pitocin is the leading cause of liability suits and damage awards.

Continuous electronic fetal heart monitoring is another seemingly innocuous medical intervention that is linked to adverse outcomes. Even though it requires women to be strapped to a machine and therefore limits their mobility -- movement in labor is listed as one of the recommended comfort measures by Lamaze International -- it may seem that constant feedback on a baby's heart rate would reduce unnecessary interventions and surgical procedures. Yet, some studies have shown CEFM to be an ineffective indicator of fetal distress and one of the causes of the increase in cesareans.

"There is no scientific reason do to any of this stuff," says Eisenstein.

*EXCELLENT ARTICLE!!! THANKS FOR SHARING!*


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## laralee16 (Nov 12, 2005)

Quote:


Originally Posted by *tammyswanson* 
The Food and Drug Administration (FDA) has never approved Pitocin for the use of augmenting labor and it has been suggested now that mismanagement of Pitocin is the leading cause of liability suits and damage awards.
[/COLOR][/SIZE][/B]









Could you post a link for me where it says this? I tried looking on the fda website but I can not seem to find it. (Its not that I dont belive you, I just would like to learn more )


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## tammyswanson (Feb 19, 2007)

Quote:


Originally Posted by *laralee16* 
Could you post a link for me where it says this? I tried looking on the fda website but I can not seem to find it. (Its not that I dont belive you, I just would like to learn more )









It's in the article in the link that was posted here initially by PaMidwife, it's further down the page though.
http://www.alternet.org/story/65608/?page=entire


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## laralee16 (Nov 12, 2005)

Quote:


Originally Posted by *tammyswanson* 
It's in the article in the link that was posted here initially by PaMidwife, it's further down the page though.
http://www.alternet.org/story/65608/?page=entire

OHHHH, Ok, I feel like a dummy, lol. Im sorry!


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## rmzbm (Jul 8, 2005)

"The predominant picture that emerges from our data," the report states, "is of large segments of this population experiencing clearly inappropriate care."

Really??


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## Storm Bride (Mar 2, 2005)

Quote:


Originally Posted by *rmzbm* 
"The predominant picture that emerges from our data," the report states, "is of large segments of this population experiencing clearly inappropriate care."

Really??









Yeah...I'm shocked...really, really shocked...

*sigh*
I had the whole "I'm trying to avoid another section this time" conversation last night. The response..."Oh - so you _have_ to be in the hospital". Naturally - the best way to avoid a section is to be really, really close to an OR...


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## GISDiva (Jul 13, 2007)

Quote:


Originally Posted by *truemists* 
I'm finding it hard to relate to any woman who DOESN'T try to learn all she can about pregnancy / birth etc when she finds out she's pregnant. It's just hard for me to wrap my mind around, or maybe I'm a nerd.







A lot of women just think about baby registries and maternity clothes and baby showers, instead of the marvelous process actually going on in their bodies.









:

I find myself thinking about this all the time - if I never happened to find Mothering.com at a really key point in my life, would I have known that there's a whole other side to the coin? Or am I more inclined that way anyway? I can't remember a time when I didn't want a homebirth, so I'm not sure. Some of my not-as-close friends don't even seem to know that there are decisions to be made besides "breast or formula?"...and lots of them choose the latter anyway...another post...maybe if the same mainstream baby books would stop getting passed around from one woman to another...

I'm hoping I plant some seeds with my birth in other women's minds...because I certainly am not surprised by that study when I hear all the stories about inductions gone bad, pain medications making things worse, etc, etc...

On another message board that was formed for moms in my community someone asked everyone to share their birth stories and there was NOT ONE STORY that didn't contain some sort of intervention until a doula finally gave her great home birth stories. I personally wrote her and thanked her because all of the previous stories sounded so horrible to me and the women writing them weren't fazed by what had happened to them at all.

Sorry, that was long, apparently I needed to get something off my chest...


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## GreenRose (Jun 20, 2007)

Quote:


Originally Posted by *truemists* 
I'm finding it hard to relate to any woman who DOESN'T try to learn all she can about pregnancy / birth etc when she finds out she's pregnant. It's just hard for me to wrap my mind around, or maybe I'm a nerd.







A lot of women just think about baby registries and maternity clothes and baby showers, instead of the marvelous process actually going on in their bodies.









:
Although DH is wondering where to put the new bookshelf we need for all my natural birth books...


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## Storm Bride (Mar 2, 2005)

Quote:


Originally Posted by *truemists* 
I'm finding it hard to relate to any woman who DOESN'T try to learn all she can about pregnancy / birth etc when she finds out she's pregnant. It's just hard for me to wrap my mind around, or maybe I'm a nerd.







A lot of women just think about baby registries and maternity clothes and baby showers, instead of the marvelous process actually going on in their bodies.

Maybe so. But, a lot of women also believe that when their mothers, sisters, best friends, _and_ doctors are all saying the same thing (eg. "get the epi - no need to suffer" or "labour is hell, and that's all there is to it" or "thank God for my OB - my baby/I would have _died_"), they tend to believe it.If they do start looking for info, they read What to Expect when You're Expecting from cover to cover. Or, in my case, they pore over the "official" provincial pregnancy/newborn guide, which is called Baby's Best Chance.

I didn't try to learn a bunch of other stuff, because I thought I already knew it. I thought I _knew_ what to expect. I thought the doctors really wouldn't do a c-section unless it was absolutely necessary to save me or my baby.

I loved being pregnant. I was eagerly looking forward to labour. I didn't give a crap about maternity clothes (I've never owned any, except a pair of black pants for work), baby showers (mine was after the baby arrived, anyway) or registries! I was all about pregnancy/birth - I read the guide (I practically memorized it!), and talked to everyone I knew who had a baby about what it was really like. That was mostly women of my mom's generation, as I was one of the first in my entire circle to have a child. I didn't do a lot more research, because...honestly, it doesn't seem to me to be something that needs to be "researched"...it feels like something that should be intuitive. It actually _was_ intuitive - I paid no attention to anything I'd "learned" about labour when I was actually experiencing it.

I guess what I'm trying to say is that's it's possible to be less than totally interested in researching pregnancy/labour/childbirth without it being about a lack of concern with these things. I've done a ton of research over the last few years, but that's because I don't want to end up cut again...and that scar means that I need to be armed with info. I use it as ammo - but it doesn't really add anything to being pregnant.


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## Patchfire (Dec 11, 2001)

Quote:


Originally Posted by *Storm Bride* 
I guess what I'm trying to say is that's it's possible to be less than totally interested in researching pregnancy/labour/childbirth without it being about a lack of concern with these things. I've done a ton of research over the last few years, but that's because I don't want to end up cut again...and that scar means that I need to be armed with info. I use it as ammo - but it doesn't really add anything to being pregnant.

Yes! And honestly, some of us prefer to think about the 'marvelous process actually going on in [our] bodies' in less detailed ways. I purposely avoid descriptions of fetal development when I'm pregnant. I like the mysteries of it.


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## ~pi (May 4, 2005)

Quote:


Originally Posted by *Storm Bride* 
I guess what I'm trying to say is that's it's possible to be less than totally interested in researching pregnancy/labour/childbirth without it being about a lack of concern with these things.









:

Also:

1. I think it's ignorant to think that every woman has the time, ability, or know-how to do this research.

2. There is a huge range in the way people respond to information. Information empowers some people and overwhelms others.

3. Even if you do have all the right information and are a strong person, you can still get caught in the machine.

I think it's way too easy to suggest that the problem lies with individual women, when really, the issue is that we have a broken system.


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## courtenay_e (Sep 1, 2005)

yessss...but those individual women who put themselves into situations where they are statistically more likely to end up cut because of who is attending and where the birth will take place are PART of the broken system. It is evident in woman after woman after woman after WOMAN who is raised up believing that, as a doctor has had so many years of learning, they are infallible, that the doctor always knows what is best for an individual (over said individual, who lives in their own body) (and, when it is actually, in obstetrics, OFTEN protocol set by lawyers that "knows" how to "treat" a "patient"), and that the staff always has the patient's best interest in mind (or that they have even been educated as to the alternative treatments available to whatever treatment is being offered, so they can help a patient to CHOOSE what might be in their best interest with true informed consent...).

I, too, have a difficult time with "ignorance is bliss" attitudes. NOT that everybody has it, or that anybody should be "punished" with cesarean because they blindly trust a doctor. The doctor does, of course take an oath that includes that they will "FIRST DO NO HARM." However, when information IS readily available, and women choose to ignore it because, oh, they have a cute doctor, or even though they are young, healthy, and KNOW the stats, choose to birth at a hospital because it's the one with the good NICU...it simply helps to perpetuate the brokenness of the system. And that bugs me.

*shrug*









Lets see how long it takes doctors to glance at this report and completely disregard it, just like they do every other piece of literature that supports the midwifery model of care. Sorry ladies, I'm tired and cranky tonight.







: Maybe I'll feel better about it in the morning.


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## ~pi (May 4, 2005)

Quote:


Originally Posted by *courtenay_e* 
yessss...but those individual women who put themselves into situations where they are statistically more likely to end up cut because of who is attending and where the birth will take place are PART of the broken system.

This statement presumes a range of choices that many women may not actually have.

Consider:

- women whose choices are limited by geography.

- women whose choices are limited by financial realities.

- women whose choices are limited by illiteracy (which is way more common than you might think.)

- women whose choices are limited by the false dichotomy of risk categories (that would be me.)

- women whose choices are limited by lack of access to health care.

- etc. etc.

Blaming these women for their choices and feeling unable to "relate to" these women







for their lack of empowerment does not fix a misogynistic, paternalist system that sets women up to fail.

Quote:


Originally Posted by *courtenay_e* 
I, too, have a difficult time with "ignorance is bliss" attitudes.

How do you reconcile this with the fact that for some people (not just women) health information can be truly overwhelming?


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## GISDiva (Jul 13, 2007)

I know what you're saying Pi, there are some people that truly just don't have access (same goes for nutrition, finding good financial advice, etc), especially when the system is set up so strongly to point them down an unhealthy path.

I wonder more about the women I know though, who don't have any of those limitations, who are generally well-informed people. As a PP said, when your sister and your mother and your aunt are all telling you the same thing and those are people you trust, it's hard to ignore. *sigh* Not sure what the answer is...


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## Storm Bride (Mar 2, 2005)

I guess the whole "you have to do your research" thing strikes me on a personal level...

I had an unwanted c-section in 1993. By the standards of this board, I was very uneducated. I chose a doctor - we didn't have legal midwives and I certainly wouldn't have had a clue where to find an underground one, even if I'd known they existed.

But, you know...my baby was frank breech when I got to the hospital - 8cm dilated. He hadn't been frank breech 20 hours prior when I went into labour. I've been told by doctors, midwives, L&D nurses and other women that a baby _can't_ turn in a first-time mother, because things are too tight...that the breech was "missed". And, I frankly don't give a crap how much education, experience, etc. these people have...because I was there - I was the only one there (laboured alone for about 8-10 hours)...and that baby turned when I went into labour. If I'd been experienced with labour, or if I'd realized that a baby _could_ turn at that point, I'd have known it. But, he turned - the pressure in my lower pelvis disappeared, and a hard lump appeared beside my navel, where there hadn't previously been one.

The hospital where I was cut didn't do routine sections for breech in 1993.

So...I was fairly uneducated about birth by MDC standards...and looking back, I don't think it would have made a damned bit of difference if I'd been educated to the max. My education wouldn't have told me that "no - I don't want a c-section" would be ignored. My education wouldn't have told me that my baby could turn breech at the last minute. My education wouldn't have told me that a breech would mean I was cut.

Maybe this is why I hesitate to put too much importance on researching the issues. I could have researched until my hands were all paper cuts...and I'd still have ended up being doped with general anesthetic and cut open over my protests.


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## ~pi (May 4, 2005)

To GISDiva: That's true, and it's also true that demand can drive change. I.e. if more women demanded better care, change might be easier to achieve.

I just think that putting so much blame on other women (or even individual health care practitioners such as doctors, who are caught in the same machine) is way too easy, and ignores the real problem.

Quote:


Originally Posted by *GISDiva* 
I wonder more about the women I know though, *who don't have any of those limitations*, who are generally well-informed people.

Are you _sure_ that they don't have any limitations? Limitations are not always visible, you know. And cognitive and emotional limitations count, too.


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## ~pi (May 4, 2005)

Quote:


Originally Posted by *Storm Bride* 
I could have researched until my hands were all paper cuts...and I'd still have ended up being doped with general anesthetic and cut open over my protests.


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## michiganmidwife (May 26, 2005)

Quote:


Originally Posted by *~pi* 
To GISDiva: That's true, and it's also true that demand can drive change. I.e. if more women demanded better care, change might be easier to achieve.

I just think that putting so much blame on other women (or even individual health care practitioners such as doctors, who are caught in the same machine) is way too easy, and ignores the real problem.

Are you _sure_ that they don't have any limitations? Limitations are not always visible, you know. And cognitive and emotional limitations count, too.


Worth mentioning. Historically, women *have* demanded better care. They insisted that they did not want to birth alone in a "delivery room" without their husbands. They did not want shaves, enemas, legs in stirrups, betadine scrubs, episiotomies etc. They have prepared for natural childbirth by taking the appropriate classes and so on. The response has been met with pretty wall paper and a "home like" environment that is, IMO, misleading. It leads women to think that a healthy, normal attitude is prevalent in the medical setting. Well... it's not. All of these changes were forced as a result of consumer demand. Not because birth became more "normal" in the medical model. Despite these changes, the big business of medicine wins out. Birth is less normal in this country now than it has ever been. And I know it can be a hard pill to swallow, but the absolute fact is that what a woman wants for her "birth experience" is never a part of the equation when medical decisions are being made about her care. The all encompassing, holistic approach of looking at each individual WHOLE person, situation etc. does not exist in the medical model. Because (and we've heard it a million times) of the litigious society in which we live, where no one takes personal responsibility or even realizes that no one is to blame in many unperfect circumstances, the medical system has to practice defensive medicine regardless of whether the defensive choices are good or bad for a particular woman or situation. I think that single biggest thing that could drive significant change toward normalizing birth is a cultural understanding and acceptance of the tenative nature of pregnancy and birth. Until then we just have to accept that it is what it is and be grateful that MOST women do have options if they find themselves wanting a different model of care.

~Bridgett


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## michiganmidwife (May 26, 2005)

Quote:


Originally Posted by *~pi* 
To GISDiva: That's true, and it's also true that demand can drive change. I.e. if more women demanded better care, change might be easier to achieve.

I just think that putting so much blame on other women (or even individual health care practitioners such as doctors, who are caught in the same machine) is way too easy, and ignores the real problem.

Are you _sure_ that they don't have any limitations? Limitations are not always visible, you know. And cognitive and emotional limitations count, too.


Worth mentioning. Historically, women *have* demanded better care. They insisted that they did not want to birth alone in a "delivery room" without their husbands. They did not want shaves, enemas, legs in stirrups, betadine scrubs, episiotomies etc. They have prepared for natural childbirth by taking the appropriate classes and so on. The response has been met with pretty wall paper and a "home like" environment that is, IMO, misleading. It leads women to think that a healthy, normal attitude is prevalent in the medical setting. Well... it's not. All of these changes were forced as a result of consumer demand. Not because birth became more "normal" in the medical model. Despite these changes, the big business of medicine wins out. Birth is less normal in this country now than it has ever been. And I know it can be a hard pill to swallow, but the absolute fact is that what a woman wants for her "birth experience" is never a part of the equation when medical decisions are being made about her care. The all encompassing, holistic approach of looking at each individual WHOLE person, situation etc. does not exist in the medical model. Because (and we've heard it a million times) of the litigious society in which we live, where no one takes personal responsibility or even realizes that no one is to blame in many unperfect circumstances, the medical system has to practice defensive medicine regardless of whether the defensive choices are good or bad for a particular woman or situation. I think that single biggest thing that could drive significant change toward normalizing birth is a cultural understanding and acceptance of the tenative nature of pregnancy and birth. Until then we just have to accept that it is what it is and be grateful that MOST women do have options if they find themselves wanting a different model of care.

~Bridgett


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## neverdoingitagain (Mar 30, 2005)

Quote:


Originally Posted by *jillmamma* 
I'd also like to see doctors quit scheduling inductions because "you are just about 40 weeks anyway, and I will be out of town the week you are due, so that way I can be there instead of my backup".







:

Or at 35 weeks, since its your 6th baby and apparently it'll just slip out you body after 35 weeks.







:


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## mothercat (Mar 12, 2006)

~pi
I have to agree with you about the choices women make in pregnancy and childbirth being based on ignorance. This is like saying that a woman who needs food stamps could make better food choices if she just educated herself a bit more. The truth is that $84.00 per month per person doesn't go far no matter how educated you are or the choices you would like to make.

I think that the childbirth education and referral groups need to do everything they can to get the word out that some providers and facilities are better or worse than others.

There is a group near me that I hope is doing a better job of this now than they were. There was a provider that they received a lot of complaints about, but they never passed that info along to the women who inquired about her. Their response was that they provided the questions to ask and the responses to expect to indicate a mother/baby friendly provider. However, women needed to educate themselves and use their discretion. This is assuming that women had the interpersonal skills to make that happen. Providing the partial information they did (Q&A) w/o telling women the rest of what they knew is the same thing as telling her the benefits of any given intervention w/o telling the downside. It is not a truly informed and educated choice because she doesn't have all the info she needs.

If any one has been following the thread about disappointment in your midwife, there is a link to three articles from Midwifery Today describing and discussing midwives as bullies. The bullies know the answers that these women expect and tell them what they want to hear. The women think they have made an informed choice, but w/o knowing the really bad experiences some women have had with that provider, then their choice is not fully informed.

I like the NYC project where women go on-line and rate the provider and facilities. Then the information is there w/o the woman having to ferret out who knows what, so she gets the whole picture.


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## Anglyn (Oct 25, 2004)

I just had my fourth baby six months ago and I had a nurse literally struggle with me trying to pin me down to insert an IV that I said multiple times I did not want. I had to ask if there was pitocin in it and there WAS despite the fact that I went from one centimeter to pushing out baby in an hour and a half. WTF did I need pitocin for? To rupture my uterus? The hour and a half was spent with them telling me that I was not in labour, it was braxton hix and they tried to sedate me with a sleeping pill. The IV came when they finally checked me and realized I was fully dilated. They thought now would be a good time for an epidural. I told them it was too late, he was coming NOW and all they wanted to do was get that IV into me. My baby literally shot out and landed on the mattress with no one to catch him. ONly my mom and dh even bothered to look when I yelled "Is that the head?" Then the nursing staff claimed that they could not have known I was truly in labor, despite the fact that dh, my mohter and myself told them how fast it goes once it truly starts and that Ive had three other kids and I know when Im in labor. They were very condescending in explaining to me that every labor is diffren and bh really hurt (despite the docs assurance that they DONT). They wouldnt call my doc so she got there twenty min after the fact. At some point after the baby was born I quit struggling because I was focused on him, since he was born in the caul and a little blue. My cries of "is he ok?" were also ignored and by the time I heard him cry and relaxed, the IV was in. And don't you know I got a bill for those IV fluids as well as for "general labor and delivery". Hm. He delievered himself. DH looked at me afterwards and said, "we could have done this at home" and I wish to hell we had because the next two days were spent with someone waking me up every hour to check on me. Where was that concern when I needed it?

What does all that have to do with informed consent? Well, I still never consented to that IV that I finally yanked out on my own.


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## michiganmidwife (May 26, 2005)

Quote:


Originally Posted by *mothercat* 
~pi
I have to agree with you about the choices women make in pregnancy and childbirth being based on ignorance. This is like saying that a woman who needs food stamps could make better food choices if she just educated herself a bit more. The truth is that $84.00 per month per person doesn't go far no matter how educated you are or the choices you would like to make.

I think Women should educate themselves about choices in pregnancy despite their socioeconomic status. Staying ignorant is no help to an already oppressed population.
I also think a pound of apples goes further financially and nutritionally than a pound of pop-tarts. No matter what your grocery budget is, it makes more sense to eat healthy food.
I guess the point is that even women who who don't have the luxury of considering alternative care if they wanted to, should still feel that they can have some measure of security knowing how best to work within the confines or parameters of where they are receiving their care.

~Bridgett


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## ~pi (May 4, 2005)

Quote:


Originally Posted by *michiganmidwife* 
Staying ignorant is no help to an already oppressed population.

This is true ...

Quote:


Originally Posted by *michiganmidwife* 
I think Women should educate themselves about choices in pregnancy despite their socioeconomic status.

... but how do you propose actually achieving this?

Quote:


Originally Posted by *michiganmidwife* 
I also think a pound of apples goes further financially and nutritionally than a pound of pop-tarts. No matter what your grocery budget is, it makes more sense to eat healthy food.

I invite you to actually do a little digging into the economics of food supply. There is plenty of research to support the idea that it is significantly more difficult for many low income people to find decent (or any) produce, partly because grocery stores have moved out of low SES areas, leaving behind mainly convenience stores.

And sure, a pregnant, urban, single mom of two could make the trek out to the grocery store in the suburbs. On the bus. After her shift at her second job ends. Then she could bring home her pound of apples and feed that to her children while she educates herself about birth options.







:

Quote:


Originally Posted by *michiganmidwife* 
I guess the point is that even women who who don't have the luxury of considering alternative care if they wanted to, *should still feel that they can have some measure of security* knowing how best to work within the confines or parameters of where they are receiving their care.

What good does that feeling do when _it isn't actually true_? Have you read some of the posts made here by women who were well-educated and had interventions applied to them against their will?

Just out of curiosity, do you have any clinical criteria that would preclude a woman from being accepted as a potential client? How about financial criteria? Do you offer free classes?


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## applejuice (Oct 8, 2002)

I am sick and tired of reading on these forums that homebirths are for upper class women. That is a lie. My mom had me and my sibs at home and was asked if it was because she could not afford a hospital. When I had my four at home, everyone thought it was because I was a hippie (no, I am not). Now a days, everyone blames their insurance for limiting their choices.

Please stop letting other people and organizations make important decisions for you. Vote with your feet and stay home for your birth. Hire a midwife, a doula, and educate yourself and your Partner. Stop playing the victim. People spend more time planning a vacation or dinner out than they do planning a birth, an event that will decide their obstetrical health history for a lifetime and affect the healthy beginning of life of their baby. You are going to live the rest of your life with the decisions others make for you in labor, delivery, and recovery.

Harsh, but terribly true.


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## thismama (Mar 3, 2004)

Fruit does not fill you up. Carbs and protein fill you up. Fruit is a luxury item, yes even apples.

And yes, homebirth is much easier for upper class women. "Hire and midwife and a doula"... ummm... with money, yes? And even here, where midwifery is covered by the national health care plan (Woot! for universal health care), homebirth is still much more doable if you have money. I live in a shared house, and while I will homebirth, that choice is not as straightforward as it would be if I owned my own home. We also have neighbours very close by, on one side the windows of both houses line up perfectly because they are cheap and poorly constructed. Someone could call the police, which wouldn't be the end of the world, but which would interrupt my birthing and is a source of stress. And, if I lived in an apartment I would be even less comfortable.

Plus our bathtub is small and not so functional due to crappy landlord maintenance issues (ah! that seem to come with cheap rentals IME). Water is fabulous pain relief. So I need to find cash to rent a birthing tub, and figure out if our old floorboards can hold it. Oh yeah, and a doula, because I am a single mother and have literally NOBODY to be my birth partner. Poverty and single motherhood goes hand in hand, so where you find poverty, you will find higher numbers of single mothers.

For the record, I am not poor. I just have a limited income, and homebirth is less accessible for me than for upper class women. True poverty absolutely can impede homebirth. And we can sit around in our big houses with our 'pull up your bootstraps' mentality, but if the fact is poor women are hospital birthing in larger numbers, our armchair quarterbacking their decisions without having lived them doesn't really do much good, except perhaps for our own egos.


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## glendora (Jan 24, 2005)

Quote:


Originally Posted by *applejuice* 
I am sick and tired of reading on these forums that homebirths are for upper class women. That is a lie. My mom had me and my sibs at home and was asked if it was because she could not afford a hospital. When I had my four at home, everyone thought it was because I was a hippie (no, I am not). Now a days, everyone blames their insurance for limiting their choices.

Please stop letting other people and organizations make important decisions for you. Vote with your feet and stay home for your birth. Hire a midwife, a doula, and educate yourself and your Partner. Stop playing the victim. People spend more time planning a vacation or dinner out than they do planning a birth, an event that will decide their obstetrical health history for a lifetime and affect the healthy beginning of life of their baby. You are going to live the rest of your life with the decisions others make for you in labor, delivery, and recovery.

Harsh, but terribly true.

You may be sick and tired of it, but last time I checked women living at poverty level don't exactly have a couple of grand lying around--which is how much a homebirth would cost in my county. And, add another grand or so for a doula. Likewise, if you don't have that extra couple of thousand bucks lying around, you aren't hanging out planning vacations and fancy soirées, either.

Homebirth may have been cheap when your mama birthed, but it's not that way anymore.

Reality is pretty harsh, too. The difference between "free" and 2-5k is significant, whether you like it or not. Particularly when a third of all pregnancies in this country are "unplanned."


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## thismama (Mar 3, 2004)

Quote:


Originally Posted by *glendora* 
Reality is pretty harsh, too. The difference between "free" and 2-5k is significant, whether you like it or not. Particularly when a third of all pregnancies in this country are considered unplanned.

OMG yes! 5K kept me out of university from age 19 until I turned 30. When my grandfather died and left me that amount. More money than I had ever seen. And... I am not poor.

A few thousand dollars can make ALL the difference. And even if you have it, if it's all you have who could justify using it for a homebirth when you'd have to leave a newborn baby to go back to work fulltime? Yk? If I had 2-5K and no paid mat leave (which most poor women in the US do not have), I would be birthing at the hospie and staying home with my infant for as long as I could.


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## mothercat (Mar 12, 2006)

Quote:


Originally Posted by *~pi* 
I invite you to actually do a little digging into the economics of food supply. There is plenty of research to support the idea that it is significantly more difficult for many low income people to find decent (or any) produce, partly because grocery stores have moved out of low SES areas, leaving behind mainly convenience stores.

And sure, a pregnant, urban, single mom of two could make the trek out to the grocery store in the suburbs. On the bus. After her shift at her second job ends. Then she could bring home her pound of apples and feed that to her children while she educates herself about birth options.







:

What good does that feeling do when _it isn't actually true_? Have you read some of the posts made here by women who were well-educated and had interventions applied to them against their will?

Just out of curiosity, do you have any clinical criteria that would preclude a woman from being accepted as a potential client? How about financial criteria? Do you offer free classes?

oh ~pi, a woman after my own heart.
I didn't realize how bad the situation was until I read a booklet by a Detroit midwife, Melva Craft-Blackshear. She detailed precisely what you are talking about for inner city Detroit women. But what she researched and wrote applies to most rural areas and certainly to the urban areas.
However, it also has a trickle down effect to other things related to pregnancy and childbirth. The chronic stress of lack of money, lack of jobs, lack of reliable transportation. It begins to effect the immune system and then you start to see the great inflammations of pregnancy like PTL pPROM, short cervix, pre-e. All of these problems are pretty directly related to poor diet.
As midwives we tell women that they need "x" amount of protein and lots of fresh (organic, if possible) fruits and veggies. Most of them agree that this is what they should be doing, but do we ask the questions about whether this is financially possible? It is a very hard subject to discuss sometimes, but it is analogous to McDonald's situation. Telling women to eat this way w/o helping them to find the resources to be sure it happens is another story.

I always keep smoothies, juice and other healthy snacks available at my office. There are moms and kids that I know come in hungry for lack of resources. Everyone knows that this stuff is available and they make use of it.
Whenever I suggest protein powder or other supplements, I always ask if it will be financially feasible. If not, then we try to find other alternatives.


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## applejuice (Oct 8, 2002)

My family is pretty ordinary and middle to low class, yet we managed to have 8 of 9 babies at home; as a mother myself, I had 4 of 4 at home. People make decisions everyday and need to set priorities in life. That is it. What is important to you?

Class envy will get no one anywhere.

I never had health insurance on any continuous basis, and when I did have it, it never dictated to me the kind of care I received. I had maternity insurance with my first baby that only covered a caesarean or catastrophic occasions through my husband's work. I elected to pay out of pocket for a home birth. In 1980, that was $850.

Three years later it was $1,200, but I had insurance that covered 80/20, with $1,000 down. I had no insurance for the others. By 1992, I paid $5000 for a homebirth with the same midwife, plus lab expenses.

We make choices each day. I took a class at a community college in women's health; I asked alot of questions and was told to leave the class.

Interesting. Women are there to learn about their own health choices, but if someone asks questions that the teacher cannot answer, they are the problem, not the student who asks the question. Kill the messenger, and all of that rot...


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## ~pi (May 4, 2005)

Quote:


Originally Posted by *applejuice* 
Please stop letting other people and organizations make important decisions for you. Vote with your feet and stay home for your birth. Hire a midwife, a doula, and educate yourself and your Partner. Stop playing the victim.

First of all, I think you're fooling yourself if you think that finances never create any barriers for women in this respect.

Secondly, the limitations that I listed above include many issues besides finances. There are also limitations due to geography, education, psychosocial factors, accessibility of health care, and clinical characteristics.

Finances would not have made a lick of difference in my birth choices. I live in a place where midwifery (along with most other health care) is fully funded. However, I have type 1 diabetes, which means that I risk straight out of midwifery care, despite the fact that theoretically, midwives could liaise with my endocrinologist just as well as my OB did.

I'm genuinely curious: what would you suggest in my case?


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## applejuice (Oct 8, 2002)

Quote:

I'm genuinely curious: what would you suggest in my case?
I suggest you quit letting others make decisions for you. You are an adult, and with adulthood, comes the responsibility to make your own decisions and live with the consequences. Stop blaming others. Get a good midwife if it is so prevalent in your area, laison with a good dietician and endrocronologist, check your glucose each morning, track it, and do the best you can. I do not know how your diabetes affects your pregnancy, labor, recovery, lactation, but I do know that a good midwife can catch your baby under obstetrical supervision if there are so many in your area.

My mom and I gave birth at home in a state and at a time when that state had not certified any midwives for decades. This did not stop us. My mom has had blood sugar and other health issues also. I have two sisters who are diabetics. I am not.

I just love the way MDC members attack when personal responsibility and priorities are an issue.







You should ask questions of your HCPs the same way.


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## mamajama (Oct 12, 2002)

poverty does not occur in a vacuum. There are often a myriad of social factors at play in the life of a low income person, ie. health issues, lack of support, lack of stable housing, lack of self-confidence/feelings of self worth, lack of access to resources such as computers for informations and networking, lack of educational opportunities, high levels of stress etc. I can also guarantee that most women who do not homebirth due to lack of money, are not spending the money instead on vacations.

prioritise you say? I spent years prioritising on a subsistance level with no room to plan ahead or budget. It was hand to mouth all the way around here. That has changed now, but I would NEVER presume to tell a mother living in poverty to learn to prioritise. They are some of the most amazing budgeters and prioritisers around to be able to survive and even thrive under such constant incredible strain.


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## rixafreeze (Apr 30, 2006)

My home birth cost me next to nothing: just a few basic birth supplies and that was it. Having a UC helped: no midwife to pay!

To the person worried about the cost of birth pools: many women use those $20 inflatable fishy pools with great success. You don't need to rent a fancy Aquadoula to have a comfortable water birth. And as far as the floor support issue goes--if you'd be comfortable having a group of 5-6 people stand in the middle of the room, then you should be entirely fine filling a fishy pool. It's the same weight.


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## thismama (Mar 3, 2004)

UC is all well and good for *some* people, but it is not the solution for everyone.

I find it so ironic that in many countries a huge priority is attempting to provide qualified birth attendants for labouring mothers, in an effort to lower the infant and maternal mortality rates. And here we talk about giving up those attendants, especially when we are discussing poor women and affording the cost of medical support for birth!

I hardly think that is the solution, and further I think it is very dangerous territory to start advocating UC as a cost saving measure. Doesn't the US already have one of the highest infant mortality rates in the developed world, thanks in large part to the lack of universal health care?


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## mamajama (Oct 12, 2002)

I believe it's the second highest thismama. Disturbing. Actually infant mortality rates have to do with general health and quality of life of the population (including healthcare access of course!).
UC is a great option for some women, and a mark of privilege (in developed countries) as well. I agree with thismama, it should never be chosen for its perceived cost saving measures. It's actually incorrect, imo, to say it's 'cheaper' really because one must generally have a certain standard of living in order to have a healthy UC. The cost of reaching that level would be out of reach for many women living in poverty.


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## mothercat (Mar 12, 2006)

Quote:


Originally Posted by *mamajama* 
I believe it's the second highest thismama. Disturbing. Actually infant mortality rates have to do with general health and quality of life of the population (including healthcare access of course!).
UC is a great option for some women, and a mark of privilege (in developed countries) as well. I agree with thismama, it should never be chosen for its perceived cost saving measures. It's actually incorrect, imo, to say it's 'cheaper' really because one must generally have a certain standard of living in order to have a healthy UC. The cost of reaching that level would be out of reach for many women living in poverty.

The US is 29 th in infant mortality and 41 st in maternal mortality. Slovenia and Cuba rank better than we do for infant mortality. It's in the article that pamamidwife posted.


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## mamajama (Oct 12, 2002)

here's a list from wiki
http://en.wikipedia.org/wiki/List_of...mortality_rate


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## sea_joy (Aug 5, 2006)

I think the poster whol originaly said she "found it hard to relate to women who don't do a lot of reasearch" was just being honest. It's true that some people (myself included) like to read a lot and naturally excersise our curiosity that way. I also found so much empowering and enlightening information that I can't imagine living without it. Although I do not really identify with Women who don't do a lot of research, I can understand that everyone is different. Some women don't have the time, soem don't have the inclination, some don't have infomation even if they want it.

That being said, I wonder about this whole "women turning on women" thing. I just don't see this issue coming to any kind of solution, or even betterment, until we can accept that, although we will not ever be able to agree on what is best in pregnancy-labor-birth we can agree that we all have the right to choose what kind of care we want and to recieve it in a non-financially taxing manner.

I don't understand a woman who has an epidural, I honestly don't get it, but I would NEVER take steps to try to remove that right from her, just as much as I would be deeply offended by a woman taking steps to remove my right to a Homebirth.

The lack of information for so many women is deeply troubling, and the fault certainly lies at the feet of the providers. The only solution I can really think of is (in addition to lots of information from non-profit type groups) is for more women to accept that they were cheated by their providers, who did not act wih thier best interests in mind. Does that mean suing? I don't know, maybe it means mre communication between women.

How many women would be willing to come here and say "I went to my OB for my babies birth, got an IV, got drugs, got an epi, got an episiotomy, and got a C-section. I am so unhappy with the whole thing"? Not many. Why? Because someone will invariably tell them that they deserved it.

Until women accept each other, support each other, and encourage each other to make a stand, we won't even be able to conquer the medical industry.

Crystal


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## mamajama (Oct 12, 2002)

Awsome post Crystal







I especially loved this line

Quote:

although we will not ever be able to agree on what is best in pregnancy-labor-birth we can agree that we all have the right to choose what kind of care we want and to recieve it in a non-financially taxing manner.


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## Lizzie9984 (Sep 27, 2007)

I'm not meaning to attack any doulas or midwives here, but as far as the financial limitations go in regards to them, I think they themselves are just as much a part of the problem (inaccessability) as anyone else. Thousands and thousands of dollars out of pocket for something that is supposed to be an accessable alternative is quite a substantial/painful bite to the checkbook, no matter how much more a hospital birth costs in comparision.

Really, all I'm saying is wtf ever happened to helping moms for the sake of it? Is this really a lost, dead art now?? I realize a living has to be made, but....Is the sky-high price tag per client really justifiable? I could never afford 5, 6, 7 grand for a midwife/doula-attended homebirth, it would just not ever be financially viable for me, and I know the same goes for millions of other women out there.

I'm sorry ladies, but modern medicine isn't the only route for birthing that's been corrupted by money......"Dollar Fever" is highly contagious......


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## JustJamie (Apr 24, 2006)

I'll chime in...

I became unexpectedly pregnant at the end of 2004. I had my mom telling me the whole time that I was a high risk patient, due to a pre-existing metabolic issue. I had my (male) bosses telling me that I was fine, and that it was perfectly reasonable for them to expect me to work 18 hour days with no meal break, because one of them would buy me a (one) slice of pepperoni pizza and a can of Coke. I had doctors telling me that gaining 13 pounds over the course of 3 weeks in the beginning of the 2nd trimester was perfectly normal, but I needed to stop eating for 2.

I read the books I could find in the book store - What to Expect When You're Expecting, A Child Is Born - I read the magazines - Fit Pregnancy, Parents; I read random pregnancy-related websites that popped up on Google searches.

I thought I had done my research. I had no idea there was more information out there. I had no idea that I had _choices_ regarding my birth, but I thought I was prepared. I didn't know what I didn't know, until I was dealing with post partem depression and trying to figure out why the hell I was so miserable following my daughter's birth...why I felt so empty, so lost. I didn't find mothering.com until my daughter was 6 months old. I didn't hear about Dr. Sears until she was closer to a year.

I didn't know that there was so much I didn't know. I thought I had done the research. I went into the hospital, armed with a birth plan that I had discussed with the doctor. I didn't know that when I agreed to a pitocin-induced delivery for pre-eclampsia, I was also agreeing to any and all interventions he felt necessary. I didn't know. I didn't know that the epidural might not work, and that I would be literally held down in the bed even if it didn't.

I didn't know I was nothing more than a glorified incubator. I didn't know I could ask for more.

I know now, and I'm fighting for myself now - but it's too late...I will forever have the scar across my uterus, across my belly, and across my soul; I will never be able to remember my daughter's birth without crying at what I lost, what I gave up - because I didn't know it was something I wanted in the first place.

Blame the mothers for not doing the research all you want. It's not going to change the fact that most mothers turn to the medical establishment for answers, and most mothers are going to trust the scare tactics of doctors...because the doctors are the authorities. The medical establishment is the authority. If every professional you ask is telling you to read What to Expect When You're Expecting - that's the book you're going to read. Especially if your local bookstore and library don't even stock anything by Dr. Sears.


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## sweetpeasmom (Nov 20, 2003)

Quote:


Originally Posted by *truemists* 
I'm finding it hard to relate to any woman who DOESN'T try to learn all she can about pregnancy / birth etc when she finds out she's pregnant. It's just hard for me to wrap my mind around, or maybe I'm a nerd.







A lot of women just think about baby registries and maternity clothes and baby showers, instead of the marvelous process actually going on in their bodies.


For me it's not hard because I used to be one of these women. My first pregnancy I didn't want to know anything about anything about birth or pregnancy. I also didn't worry about all the other stuff like showers, and baby stuff either. I'd have to say, I was probably afraid and fearful of what I would find out, probably because of what childbirth is perceived in this society. I figured why should I bother, the doctors and nurses will tell me what to do. Of course I did end up with a pretty sucky birth and it took about a year afterwords till I finally clicked that something wasn't right about my birth. Then thats when I started reading and researching birth.

So I can understand why woman don't look into it more even if it is for different reasons than what I had.


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## applejuice (Oct 8, 2002)

Quote:


Originally Posted by *Lizzie9984* 
Really, all I'm saying is wtf ever happened to helping moms for the sake of it? Is this really a lost, dead art now??

As a second generation homebirther who has trained and worked as a childbirth educator, doula, CLC and mother's helper, I was chatised royally and harshly by colleagues who told me I was denegrating my training by doing it cheaply or for free. Working gratuitously is lost since the core organizations like it that way. How to charge fees and collect them is a large part of the programs. I know as I have taken all of them. A person does not have to be a mother nor do they have to be a female to train and work in these capacities. They do the job and collect. A person who is not paid is a slave, or so it goes.

The midwife who helped me deliver my four at home told me she used to do homebirths for free years before in her home state.


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## ~pi (May 4, 2005)

Quote:


Originally Posted by *applejuice* 
I do not know how your diabetes affects your pregnancy, labor, recovery, lactation,

Yes, I can see that. FYI, type 1 diabetes is almost certainly different from what your sisters have.

Quote:


Originally Posted by *applejuice* 
but I do know that a good midwife can catch your baby under obstetrical supervision if there are so many in your area.

You are mistaken. OBs do not "supervise" midwives in my area. Midwives are independent HCPs with a defined scope of practice. Despite being very healthy and very well-controlled, I fall outside that scope simply by having a somewhat rare chronic illness.

Like it or not, barriers to birth choices exist. Putting all the onus on women to make the "right" choices ignores the fact that sometimes, options are simply not available, and that even if women do make all the "right" choices, it can still end up being a profoundly disempowering experience for them.


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## applejuice (Oct 8, 2002)

Odd how you are in another country and already know all about my sisters and their health. You are bit presumptuous.

I cared for older relatives with diabetes in the 1970s. The definition of diabetes has changed in the last 30-40 years as has its management. For example, diabetes insipidus is no longer considered diabetes, a disease which I was privy to information and knew many participants in the studies that were done.


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## michiganmidwife (May 26, 2005)

Quote:


Originally Posted by *~pi* 
This is true ...

... but how do you propose actually achieving this?

In response to how low income women can have a better birth:
Educate themselves In whatever way they can with whatever resources they have. Poverty is a very complex issue. It is about so much more than a women having lack of $. The social problems that are associated with it are enormous! And YES, many of those social problems would exclude a woman from being a good candidate for midwifery care or OOH birth. However, not every impoverished woman or family is simply a victim with absolutely no resources whatsoever.

Quote:


Originally Posted by *~pi* 
I invite you to actually do a little digging into the economics of food supply. There is plenty of research to support the idea that it is significantly more difficult for many low income people to find decent (or any) produce, partly because grocery stores have moved out of low SES areas, leaving behind mainly convenience stores.

Going out on a limb here... I believe that most impoverished women have access to more than just the local convenience store for their food supply. There is a lot of fraud going on too, between inner city convenience stores and food stamp/bridge card holders. This MAY account for why so much of the state's $$ for food stamps is pumped through convenience stores.

Quote:


Originally Posted by *~pi* 
And sure, a pregnant, urban, single mom of two could make the trek out to the grocery store in the suburbs. On the bus. After her shift at her second job ends. Then she could bring home her pound of apples and feed that to her children while she educates herself about birth options.







:

It could just be me but I see a sarcastic nature to this comment. I don't understand its purpose. It makes me think that the message is that it would just be "too much work" for an urban mom to go out of her way pick up some apples and read a book. It also has the "victim" overtone to it. Enabling the poor and oppressed by keeping them victimized does not help a community of people build a better tomorrow for their children.

Quote:


Originally Posted by *~pi* 
What good does that feeling do when _it isn't actually true_? Have you read some of the posts made here by women who were well-educated and had interventions applied to them against their will?

Many women have had amazing births because of choices they have made after learning as much as they could.
Many woman of high socioeconomic status have been treated poorly in the hospital as well. When intervention and poor treatment happens in a hospital birth setting, I believe it is generally non-discriminatory.

Quote:


Originally Posted by *~pi* 
Just out of curiosity, do you have any clinical criteria that would preclude a woman from being accepted as a potential client? How about financial criteria? Do you offer free classes?

I'm not sure what your point is so I'm going to answer the best I can. Of course there is clinical criteria. Not everyone is a good candidate for midwifery care. This is non-discriminatory of economic status. And for those who do meet the clinical criteria, there is a fee to pay for service. I do not offer free classes. Firstly, I think it is very presumptuous for you to think that I would have the means to do so. And second, I am a midwife and I don't personally teach a series of childbirth classes. A local childbirth educator does that. And what do you mean by FREE? Do you mean do *I personally* PAY someone to teach a birth class to the underserved? And do I personally pick them up after getting off work from their second job and drop them off at home too?
No. I don't. But I do have a compassionate heart for the underserved.
I have helped plenty of underserved women by attending their births pro-bono. And yes... I've even driven a couple home, or attended prenatals in their homes in their impoverished neighborhoods of Detroit when they couldn't find a ride to my clinic. As much as we would love to do so, we don't have the funding or resources to do inner-city outreach. I'll also add that it has been my experience that many very low income women are the first to set up a payment plan and humbly make all payments on time. I can't apologize that we are not a free clinic. As you may or may not know, The Birth Place has been very blessed to have the opportunity to serve metro-Detroit for 10 years now. I have seen many birth centers across the country close their doors because they were *impoverished* businesses and could not afford to stay open. Now they serve no one. Birth centers are not big business. They are a work of heart and we've all done plenty of charitable work.

~Bridgett


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## applejuice (Oct 8, 2002)

Quote:

They are a work of heart and we've all done plenty of charitable work.
YES. My own midwife being one of them.

A better question would be how many OBs have done pro bono work. They are considered, in our culture, the standard of care and midwives are not for the most part.


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## michiganmidwife (May 26, 2005)

nevermind

~Bridgett


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## ~pi (May 4, 2005)

Quote:


Originally Posted by *applejuice* 
Odd how you are in another country and already know all about my sisters and their health. You are bit presumptuous.

No, I'm just being logical.

Type 1 diabetes is significantly less common than type 2, and while there is a weak genetic subgroup, typically, it does not run in families. So I'm making an educated guess that your sisters have type 2.

And you'll note I said "almost certainly," i.e. an acknowledgment that that guess could be wrong.


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## ~pi (May 4, 2005)

Quote:


Originally Posted by *michiganmidwife* 
In response to how low income women can have a better birth:
Educate themselves In whatever way they can with whatever resources they have.

Honestly, I think that is a lovely idea and a laudable goal, but don't you think it's kind of vague? How do you propose to raise awareness of the need for self-education, let alone its achievement?

Quote:


Originally Posted by *michiganmidwife* 
Poverty is a very complex issue. It is about so much more than a women having lack of $. The social problems that are associated with it are enormous!

Yes, you're right. And one of the major determinants of health that is associated with low SES is low education. Illiteracy is much higher in low income populations than high income populations. Can you see how that creates a barrier to self-education about birth choices?

Quote:


Originally Posted by *michiganmidwife* 
And YES, many of those social problems would exclude a woman from being a good candidate for midwifery care or OOH birth.

Thank you for acknowledging this.

Quote:


Originally Posted by *michiganmidwife* 
However, not every impoverished woman or family is simply a victim with absolutely no resources whatsoever.

I agree with you. But I really think that putting the onus all on individual women is a short-sighted and incomplete way to tackle the issue.

Quote:


Originally Posted by *michiganmidwife* 
Going out on a limb here... I believe that most impoverished women have access to more than just the local convenience store for their food supply. There is a lot of fraud going on too, between inner city convenience stores and food stamp/bridge card holders. This MAY account for why so much of the state's $$ for food stamps is pumped through convenience stores.









Admittedly, I'm not as up on this topic as I might be if it were my area of research, but I know of a researcher by the name of Shannon Zenk who has looked at this issue in your area, and found that, in fact, low income is a very real barrier to access to produce. Here are a couple of abstracts of her work:

From "Fruit and vegetable intake in African Americans income and store characteristics":

CONCLUSIONS: Previous studies have shown that few supermarkets are located in the city of Detroit, a symptom of economic divestment over the past several decades. Results of this study suggest this may have negative implications for dietary quality, particularly among lower-income women.

PubMed abtract PMID:15958245

From "Fruit and vegetable access differs by community racial composition and socioeconomic position in Detroit, Michigan":

RESULTS: Mean quality of fresh produce was significantly lower in the predominately African-American, low-SEP community than in the racially heterogeneous, middle-SEP community.

PubMed abstract PMID:16599383

Quote:


Originally Posted by *michiganmidwife* 
It could just be me but I see a sarcastic nature to this comment. I don't understand its purpose. It makes me think that the message is that it would just be "too much work" for an urban mom to go out of her way pick up some apples and read a book. It also has the "victim" overtone to it. Enabling the poor and oppressed by keeping them victimized does not help a community of people build a better tomorrow for their children.

Sorry, yes, there was sarcasm. It's just frustrating to me when people refuse to acknowledge that some women have very real barriers to self-education and/or choices.

Quote:


Originally Posted by *michiganmidwife* 
Many women have had amazing births because of choices they have made after learning as much as they could.

Which is *awesome*.









No one here is saying that self-education is bad, just that it cannot be the only answer, because it just doesn't get at enough of the problem.

Quote:


Originally Posted by *michiganmidwife* 
Many woman of high socioeconomic status have been treated poorly in the hospital as well. When intervention and poor treatment happens in a hospital birth setting, I believe it is generally non-discriminatory.

Clearly, there is way more to this issue than economics (and I listed a lot of non-economic factors in my early posts) but I think you're mistaken if you think that financial status does not impact on the likelihood of poor treatment in a hospital.

Quote:


Originally Posted by *michiganmidwife* 
I'm not sure what your point is so I'm going to answer the best I can. Of course there is clinical criteria. *Not everyone is a good candidate for midwifery care.* This is non-discriminatory of economic status.

My point was to highlight the bolded part. Midwives are not an option for everyone. Homebirth is not an option for everyone. Finances can be a barrier, but so can lots of other things.

I see a lot of opinions here at MDC that state or imply that if only everyone would hire a midwife and have a homebirth, all the issues within the current birth climate would be all fixed, and I just don't think that is the case.

Quote:


Originally Posted by *michiganmidwife* 
And for those who do meet the clinical criteria, there is a fee to pay for service. I do not offer free classes. Firstly, I think it is very presumptuous for you to think that I would have the means to do so. And second, I am a midwife and I don't personally teach a series of childbirth classes. A local childbirth educator does that. And what do you mean by FREE? Do you mean do *I personally* PAY someone to teach a birth class to the underserved? And do I personally pick them up after getting off work from their second job and drop them off at home too?
No. I don't. But I do have a compassionate heart for the underserved.
I have helped plenty of underserved women by attending their births pro-bono. And yes... I've even driven a couple home, or attended prenatals in their homes in their impoverished neighborhoods of Detroit when they couldn't find a ride to my clinic. As much as we would love to do so, we don't have the funding or resources to do inner-city outreach. I'll also add that it has been my experience that many very low income women are the first to set up a payment plan and humbly make all payments on time. I can't apologize that we are not a free clinic. As you may or may not know, The Birth Place has been very blessed to have the opportunity to serve metro-Detroit for 10 years now. I have seen many birth centers across the country close their doors because they were *impoverished* businesses and could not afford to stay open. Now they serve no one. Birth centers are not big business. They are a work of heart and we've all done plenty of charitable work.

~Bridgett

Look, I am in no way arguing that you should work for free. I totally respect birth centres doing what they have to do to stay open and at least provide alternatives for some women.

It was an honest question -- if you think everyone should educate herself and that would fix everything, does your business model support that, or is it just an academic belief?


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## thismama (Mar 3, 2004)

I do not think midwives should bear the burden of lowering birth costs - I think health care should cover midwifery. It does here in Canada (although there are issues that come with regulation, to be sure). Otherwise you have (usually male) OBs getting paid richly and midwives getting paid less than what they should, for superior quality care. That would suck.

On the issue of birth choices, ITA that every woman should have the right to make an educated choice about her birth. And I think this idea that women who choose intervention are less educated about options is an iffy one - I think it can be true, but I also have a friend who had two elective c-sections for 'no reason' other than that is what she wanted, and she is a trained nurse and a medical malpractice lawyer. I debated her a bit and she can talk circles around me.

She is definitely not making her choices out of ignorance, even though they are choices I would not personally make.


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## applejuice (Oct 8, 2002)

In Canada, (as I was told by American doctors) doctors are paid the same for a caesarean section as for a normal delivery because of the national healthcare system, yet their caesarean section rate is the same as the United States where doctors are paid more for doing a caesarean.

The infant mortality rate in Canada is lower than the U.S. yet the caesarean rate is the same. Does this extend to the maternal mortality and morbidity?

To me this means that doctors simply believe in what they do with no foundation in science. This makes their behavior and decision making regarding birth and interventions more of a religion than having any foundation in science.


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## thismama (Mar 3, 2004)

I don't believe docs are paid the same here for c/s, although I could be wrong about that. Do you have a link? Plus even if they are, you have to think, a c/s takes what, an hour? Letting a woman labour naturally takes hours and hours. So even if they get the same $, it's for an hour's work and occupation of a room, not like a whole day. So the compensation rate is still greater for c/s.

I also think docs do c/s to avoid lawsuits.


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## applejuice (Oct 8, 2002)

No link. I was told that by more than one American doctor, one of whom had family in Toronto near York University. He was trying to make the point that the drive to do caesarean sections is more than $ and science based, it is simply belief based, religiously and the fact that everything was done that possibly could be done to save the baby.

I would guess that the net compensation for an American doctor in doing surgerical births is more simply because they can and do charge more than a Canadian doctor. The extra cost in recovery and occupation of a hospital room and more personnel would go to the hospital than to the doctor who did the birth.

And of course the whole hospital staff benefits if the state is paying them more for the surgical births....mmmm


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## Storm Bride (Mar 2, 2005)

Quote:


Originally Posted by *applejuice* 
In Canada, (as I was told by American doctors) doctors are paid the same for a caesarean section as for a normal delivery because of the national healthcare system, yet their caesarean section rate is the same as the United States where doctors are paid more for doing a caesarean.

The infant mortality rate in Canada is lower than the U.S. yet the caesarean rate is the same. Does this extend to the maternal mortality and morbidity?

To me this means that doctors simply believe in what they do with no foundation in science. This makes their behavior and decision making regarding birth and interventions more of a religion than having any foundation in science.

I actually believe our c-section rate is _slightly_ lower than the US. However, my OB during my last pregnancy was discussing "guidelines" for postdate babies. He told me that the official guidelines in Canada are to induce (or schedule section) at 41w, 3d and in the US, the guideline is to induce (or schedule) at 41w even. The comment he made after that was...a little scary, imo. He said, "the US has a more conservative approach (ie. more interventions







: ) than we do, but we tend to follow their lead, so I expect our guideline on this will change in the next few years".

So...he was basically saying that we follow the US lead...even though you can find US OBs all over the place who state that they practice the way they do in order to protect themselves from lawsuits - a concern that doesn't apply to anywhere near the same extent in Canada. (I'd guess parents are less likely to sue for bad birth outcomes, because we do have universal health care, and they don't need a fat settlement to provide care to their special needs babies.)

To me, this is a scary state of affairs...our country is developing guidelines for obstetrical management based on the legal system in another country...







:

Of course, this is all assuming that the OB I spoke to had a clue what he was talking about. In light of several other things he told me over that pregnancy, I do have my doubts about that!


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## applejuice (Oct 8, 2002)

I agree with you, Storm Bride.

The thing that worries me about the US taking on a federal health care system is that our culture is so medical/patriarchal based that a national health care system would run all over any civil rights we have left to our bodily integrity, especially children and women in their childbearing years.


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## sea_joy (Aug 5, 2006)

For what it's worth, my healthcare in WA (my MW, all my prenatals, optical, regular doctors visits, medicine, dental, short visit to the hospital for a ultrasound and an external version) were completely covered by the state insurance for pregnant women









Women in other places don't have it as lucky, and although the northwest is a place where it is not uncommon to have a MW, some people still thought that I was totally incompetent for making such a decision.

There is also something to be said for finding informtion that suits your opinions. I had a friend who thought that a hospital birth was more responsible and safe than an out of hospital one. Although she did not do research on out of hospital safety, she did a lot on emergency situations that would require emergency care, possibly ceseareans. Oddly enough, she ended up with a cesearean. I don't know if her intuition just told her to be in the hospital, or that her constant focusing on c-section s set her up for one.

My point is, there is so much info out there that you can find something to suit what you want.









Crystal

Oh yeah, I went off the state insurance after my baby was born because it dictated that in an emergency situation my childs major health decisions would be up to the state. Since I don't Vax or give antibiotics (unless is really is necissary) this worried me a lot.


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## loraxc (Aug 14, 2003)

I'm surprised that no one has mentioned that sometimes midwife care is cheaper for the underinsured. I don't know if this is true if you are on Medicaid, but I think it's very true if you're in that segment of the US population that is not insured (or drastically underinsured) but does not qualify for Medicaid. The birth center I used for my first child served a lot of low-income clients for precisely that reason.

My birth center was also located in the "poor" part of town and their back-up OB was an African-American who served a lot of African-American women. I am pretty sure these were intentional decisions on their part to reach out to a lower-income community. ( I live in the deep South and the AA community here is disproportionately poor.)

Of course, that BC closed because they could not afford their malpractice insurance.









I've also heard of many midwives who use a sliding scale to determine their fees.

As for access to produce, while there is a real problem with this for some people, especially those in the inner city, it's not an issue everywhere. The nutrition/income issue is more complex than just access.


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## applejuice (Oct 8, 2002)

Doesn't WIC provide coupons for food and for local farmers' markets? This is a way to get good nutritious food for pregnant, lactating and young mothers and children, often organic.

Free baby stuff here


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