# Is everything that goes wrong the fault of doctors?



## eilonwy (Apr 3, 2003)

It seems to me that everything anyone on these boards mentions about anything in labor and delivery going wrong is somehow directly the fault of doctors. Do you honestly believe that nothing at all goes wrong in labor or delivery if a doctor isn't at the bottom of it? I'm just curious here. I never thought I was a champion of the medical establishment, but I don't believe that doctors are responsible for every single thing that can go wrong. It doesn't seem logical to me and I want to know why most of you (all?) seem to think that way.


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## cottonwood (Nov 20, 2001)

"Do you honestly believe that nothing at all goes wrong in labor or delivery if a doctor isn't at the bottom of it?"

Of course not. It's just that there is so often evidence that the problem has to do with the management of labor or the hospital environment. Doctors (and other medical professionals) can't really help being blamed -- the system itself is flawed and not conducive to normal birth, and their job is to work within that system. It doesn't leave them a lot of room to do things _right_.


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## sadean (Nov 20, 2001)

I certainly cannot speak for anyone other than myself, but I will see if I can put into words my thoughts (it's late, i'm tired, but I will try). Do things happen during childbirth that are not the fault of doctors? Yes, of course. No one would say that birth is absolutely fool proof, and that adverse events cannot happen. And I believe that doctors have their place in the contiuum of prenatal and childbirth care. BUT (and this is a HUGE but), they do not belong in the realm of normal prenatal, childbirth and post natal care. Pregnancy is not a sickness, yet the vast majority of the medical establishment treat it as such. And if a condition is treated like an illness, than it is almost self prophisying that SOMETHING will happen, or that something minor and manageable may be interpreted as something major and treated as such. One little (seemingly harmless) intervention/test/procedure often becomes a full blown medical emergency (at least in their eyes, and often in reality) and situation dominos and suddenly someone is being operated on, is sick or sometimes is dead. Would that negative outcome have happened if there had not been a doctor there? Who is to say? CERTAINLY not them. If you can get a doctor to admit that BECAUSE of their care/intervention/interference into a normal biological event that there was a negative outcome, I will pay you a dollar (maybe even $10







). I have a general mistrust for the medical establishment because 1)they are egotistical and have God complexes, 2)always think they are right even if they are talking out their ass, 3)have interjected themselves into and corrupted the natural process of childbirth with widespread fear of the process, distaste for the events, and paranoia of "what if", and 4) are taught to treat patient symptoms and conditions in a ideopathic way (I hope that is the right term), and not as a holistic system.

And like I said, there are serious conditions that warrent medical care during pregnancy. If that care is absent, than a serious complication MAY occur. Any midwife worth her salt can tell pretty quickly who has/will have a normal pregnancy and who is a more complicated case that may require a referral... It isn't fool proof, but we must accept that there is ALWAYS risk involved in pregancy and childbirth and our general health is the best indicator of whether that risk is small or large. IMHO, the vast majority of times, doctors do not belong involved in pregancy and childbirth and often bring many of the problems we see in normal cases with them in their assumption that pregnancy and chilbirth are sicknesses and that SOMETHING must be wrong to justify their presence/existence...it is almost self-prophesy.

*edited to say: i should qualify my opinions with the fact that my father was a doctor, my cousin (who has had, count them, 4 C-sections and will be having a 5th in a couple of months) is married to a doctor, and my sister is a paramedic with the most screwed up sense of "normal" that I have ever seen. So I speak from my personal and professional interactions with the "medical establishment".


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## Greaseball (Feb 1, 2002)

Yep, almost always. They are taught to work against a woman's body, rather than with it. Some midwives, even home birth midwives, have the same mentality, which is why home birth does not work for some people.

We all know there are situations when obstetricians and medical interventions are truly needed, and I'm grateful they are available. But the vast majority of the time, they are useless. For a woman with a normal pregnancy, they are harmful.

Almost everything that can go wrong with a baby - such as decreased heart rate or other distress - is the result of some procedure the doctor did to make birth faster, more convenient, or more "like normal." Then they blame it on the woman's "defective female body."

I don't know many doctors who are willing to sit back and let a woman labor for three days (which, BTW, is not harmful to a baby) or do many of the other things she may need to do to get comfortable. Doctors who try to let everything happen naturally make less money for more time spent with the woman. Do you know of any obstetricians interested in a reduced income?

Even women who are told they are high risk by doctors are often told the exact opposite by midwives, who (aside from mothers) are the true professionals of birth.

I think a woman needs to give birth in a place that makes her feel comfortable if she is going to have a labor that feels normal for her. For some women this is the hospital. If a woman chooses to have interventions, she should be aware of the proper guidelines for their use. For example, when pitocin is administered, the woman is never supposed to be left alone. Yet many women are. This causes problems because the doctor is harder to reach when the baby goes into distress.

In countries with the lowest infant mortality rates, doctors practice the opposite of the way they do in the US. They stay with patients in the hospital for longer, and are personally responsible for their care instead of delegating tasks to residents or nurses. They receive the same fee for each birth, regardless of how many interventions are used, so there is no financial incentive to interfere. They actually attend only 5% of all births - the rest are attended by hospital or home birth midwives.


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## *Erin* (Mar 18, 2002)

what greaseball said.


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## KKmama (Dec 6, 2001)

Well... I'm not really happy with the state of malpractice insurance and how defensive it has made drs. about childbirth, but... my parents probably should have sued the pants off the dr. who delivered my brother (~35 yrs ago).

She was late, he did a totally botched induction/augmentation of labor, she probably should have had a cesarean at that point, and he had a birth injury that led to some pretty big developmental disabilities. It not only screwed up his life, but it put a huge burden on my parents' weak marriage...


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## eilonwy (Apr 3, 2003)

Quote:

_Originally posted by KKmama_
*Well... I'm not really happy with the state of malpractice insurance and how defensive it has made drs. about childbirth, but... my parents probably should have sued the pants off the dr. who delivered my brother (~35 yrs ago).

She was late, he did a totally botched induction/augmentation of labor, she probably should have had a cesarean at that point, and he had a birth injury that led to some pretty big developmental disabilities. It not only screwed up his life, but it put a huge burden on my parents' weak marriage...*
yes, but do you think that if she'd had a super crunchy homebirthing midwife or an UC that everything would have been fine? because that's the impression i get from most people on the boards, even though it's not entirely logical to me.. hence my op.


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## KKmama (Dec 6, 2001)

No, I don't think that the perfect cure for my mom would have been a midwife/homebirth/UC (especially if I consider what kind of person my mom is). I think a *competent dr.* would have been sufficient in her case. Eg, when she had me, she was with a different dr., an ob who had been delivering babies for over 30 years. I was 3 lbs bigger (10 lbs 2 oz







), and the whole birth was a much better, easier process for her. I don't think all of it was because I was the 2nd kid; she thinks a lot of it was just that she had a better dr. and he knew what he was doing.

For what it's worth, I haven't opted for the homebirth/UC route, either. With ds, I had a CNM and an emergency cesarean (which I think explains why he's with us today, happy and healthy). With this one, I'm going for a hospital VBAC with obs. (My only other option is direct entry midwives and homebirth, and it's just not for me.)


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## stafl (Jul 1, 2002)

All I really know is my own experience of childbirth. And I do know that what went wrong the first time was indeed because of things the doctor did. Now, it's true that there's no telling whether things would have been better or not without the interventions that snowballed into an emergency c-section.
And, the first thing that went wrong was, in fact, that I went to the hospital when I shouldn't have, and that was totally my mistake and not that of anyone else.

Anyway, you can read the stories of my births and that of others. Mine, at least, is a classic example of intervention upon intervention leading up to the dreaded c-section, when I should have been safe at home waiting for labor to start on its own.

Things do sometimes go wrong regardless. But there's a lot more trauma when things go wrong because of something done to you by a doctor. That's why it seems we are always blaming the doctors.


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## Greaseball (Feb 1, 2002)

Quote:

yes, but do you think that if she'd had a super crunchy homebirthing midwife or an UC that everything would have been fine?
In cases like these, the answer is usually yes. Inductions are one of the most dangerous interventions and they are less likely to be used in a home birth. Induction with pitocin or cytotec can cause uterine rupture, even in a woman who has never had a cesarean. (In fact, the rate of rupture is the same for women with and without a previous c/s when pitocin is used. When pit is not used, rupture hardly ever happens.)

Though a normal pregnancy is 37 to 43 weeks, many doctors won't even let a woman get to 40 weeks today. My midwife had a client go 48 weeks and says she is fine with that.

Birth injuries can cause lifelong problems, and they are present in hospital births more than at home. Every non-biased study has shown that homebirth is safer for most mothers and babies than hospital birth.

Doctors also give women advice that can cause life-threatening problems. Women who follow the doctor's advice of minimal weight gain, low-calorie and sodium restricted diets are more likely to develop eclampsia than those who are under the care of midwives and receive instruction in real nutrition and are "allowed" to gain as much weight as they need.

Homebirthing mothers report less pain with birth, if they have had previous hospital births. They tell me the pain they experienced in the hospital was abnormal and came from the interventions, while the pain at home was normal, natural and had a purpose. I'll let you know how I rate it when the time comes!


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## IdentityCrisisMama (May 12, 2003)

I am with you, OP. No, I don't think doctors should be or are always to blame with problems.

Personally, I had a fetal monitor for my planned homebirth and was transferred for a decreased fetal heart rate but the only interventions I had had were a midwife and the fetal monitor. I had a good experience at the hospital&#8230;well, I good would be stretching it a bit, I guess. In the end, I'm okay with the transfer and happy that they were there because I feel that I "needed" it. I do shutter to think about the outcome of my dautgher's birth if labor wasn't primarily at home. I'm sure I would have been medicated and probably had a c-section. I'm just happy that I chose home birth AND had doctors available for backup.

My mother, OTOH, had 5 hospital births with (male) doctors. She had 4 unmediated births and one long hard labor with Demerol.

I do think that "medicated" births or births that begin with the premise that birth is not normal are the bigger problem, and they do happen more with doctors.

OTOH, I am thankful that most (if not all) possible interventions exist if anyone were to need them. It's the incredible over use that is the problem, IMO.


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## eilonwy (Apr 3, 2003)

Quote:

_Originally posted by Greaseball_
*Doctors also give women advice that can cause life-threatening problems. Women who follow the doctor's advice of minimal weight gain, low-calorie and sodium restricted diets are more likely to develop eclampsia than those who are under the care of midwives and receive instruction in real nutrition and are "allowed" to gain as much weight as they need.*
Okay, I know that there are people here who have gotten this advice, but it's totally outdated. I've never had anyone tell me anything like this, and I'm a fat person. In fact, any doctor with any sense will tell you that you don't need to restrict sodium, or eat a low-calorie diet. This particular example is one of many things which homebirthing advocates assume that all doctors do. It certainly has not been my experience.

Quote:

*
Homebirthing mothers report less pain with birth, if they have had previous hospital births. They tell me the pain they experienced in the hospital was abnormal and came from the interventions, while the pain at home was normal, natural and had a purpose.*
It is my understanding that most women who've had prior births report less pain in subsequent births, regardless of where they happen and who is with them.


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## captain optimism (Jan 2, 2003)

Quote:

*
Do you honestly believe that nothing at all goes wrong in labor or delivery if a doctor isn't at the bottom of it?*

No. I wish I did believe that. I don't think everything that can go wrong with a birth is the fault of the birth practitioner. Bodies are mysterious. Birth isn't the only process that can go wrong.

I feel very lucky to have used a hospital in a period after a lot of homebirth and natural birth ideas had been incorporated into the medical model. I think I probably would have been pressured into a C-section if that hadn't been true. It was a doctor who told my midwife to go for it (with the vaginal birth) and not to give up (and do a c-section.)

I met a really great OB socially over the weekend. I kind of wish I hadn't met her socially. I would totally go to her for care on my next baby. I like it when people are really knowledgeable and can answer questions. In my ideal world, I'd have a doctor and a midwife attend me at home, like my great-grandmother had. The doctor was her 1st cousin and everyone in the family really trusted him and knew him well. That would be very cool.


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## citizenfong (Dec 24, 2002)

I have to add my opinion here. Doctors and other interventionists get blamed for doing so much wrong because so much of what they do is wrong. Whether or not something would have occurred if an intervening HCP was not there is something that is VERY difficult to determine. Why? Because what percentage of births fall in that category?

We no longer have ANY idea about what the range of normal in pregnancy and birth is, because almost NO ONE has unhindered pregnancy/birth. Since I started researching UC about a year ago I have met so many women who had perfectly healthy births with factors that would have NEVER been allowed to develop under the care of docs. Like the woman who labored, not just prodomal labor, for 11 days before giving birth. Or the woman who started off and on labor at 33 weeks. Her water broke at 36 weeks. 3 days later she gave birth to a 7 lb. baby who was obviously ready to be born. Just a few examples.

The thing is this: so much of what OBs do is superstition, voodoo, non-evidence-based malarky. Therefore, when you examine a birth story/situation and find X, Y, and Z that a doctor shouldn't have done, there is no way of really knowing how much ensuing damage is a result of malpractice-avoidance medicine and how much actually would have occurred otherwise. Am I making sense here? Although, the more research I've done, and the more birth stories I've read/heard, the more obvious it becomes that many, many complications are the result of obstetrical interferance, since they never seem to occur in UC (or many homebirth) situations.

So the bottom line is that if I blame OBs for everything I KNOW they are doing to muck up the birth process, and if every OB I've ever heard of is doing them, it's going to seem like a lot of blame.

For what's it's worth, I am happy to be living in a time when good nutrition is easy, information is extremely accessable, and emergency medicine that I AGREE to is available just down the street.


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## citizenfong (Dec 24, 2002)

Quote:

_Originally posted by eilonwy_
*Okay, I know that there are people here who have gotten this advice, but it's totally outdated. I've never had anyone tell me anything like this, and I'm a fat person. In fact, any doctor with any sense will tell you that you don't need to restrict sodium, or eat a low-calorie diet. This particular example is one of many things which homebirthing advocates assume that all doctors do. It certainly has not been my experience.*
This went up while I was typing and I wanted to address it. It's not that it is assumed that every OB does ALL the things I/other homebirth advocates disagree with. But I have yet to hear of a single OB who doesn't do at least one thing as standard practice that I think is at least unnecessary and at most extremely potentially harmful.


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## Anguschick1 (Jul 25, 2003)

Just fyi, I was told by my ob that she "strongly reccomended" not gaining more than 10lbs, 15 max. Yah, I was heavy, but weighed 175 at 5'4", not morbidly obese or anything. I was told not to add any salt to my diet (fine, I don't cook w/it anyway) and if my morning sickness kept me from eating, "good, maybe you can encourage that." I went on to have a medwife who had no problem w/my weight gain (plenty of other issues there though!)

And this was happening this time last year! So, unfortunately, it is still a problem. Do I think that my ob/medwife is to blame for all that went wrong, no, but I did look to them for guidance, advice and knowledge seeing as how I had never been pregnant before and that was their business. I should have educated myself more, but didn't quite realize that was an option, you know?

Born mainstream, bred mainstream, just recently changing streams....


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## Greaseball (Feb 1, 2002)

Quote:

It is my understanding that most women who've had prior births report less pain in subsequent births, regardless of where they happen and who is with them.
I'm talking about women who have had a few at home and a few in the hospital. They say all of the hospital births were more painful than all of the home births. This includes the hospital births that were medicated - medication does not "take" for some people.

About the diet, that advice is outdated (or should be) but some doctors today still follow it. They may "allow" 25 lbs instead of the previous 12, but they don't seem to realize that what's most important is not the amount of weight gained, but the quality of food eaten. I read of a mother on these boards who gained 90 lbs on the highest quality of food and the weight was all gone a week after the birth. "Eat for two" is common sense, yet many OBs prescribe diets that are not enough for one. Some still recommend fasting and diuretiucs, though thankfully (I think) they no longer prescribe amphetamines.

Even fat people need to gain a certain amount of weight. Most likely, if a woman eats high-quality food whenever she is hungry and does not deny herself any food for fear of gaining weight, she will gain the right amount of weight for her. I gained a very small amount of weight last time; this time I'm only halfway there and have already gained more than what I did last time. I know I'm doing it right this time, just as I was last time. Though I know several doctors who would disagree.

Obstetricians are trained as surgeons, and to handle high-risk pregnancy and birth. Most of them have never seen a normal birth, which makes them just as uneducated about birth as any lay person. If I were to have a high risk delivery, I'd want someone who specialized in that. If I had no risk factors, I'd want someone who specialized in normal birth.

There are very few things a MOTHER can do that are wrong and that will complicate her labor. Most of these things are listening to the doctor - believing him when he tells you walking in labor is harmful, that it's best if you don't eat or drink, that you need to be induced after x weeks or x hours in labor, etc. But what can a mother do wrong other than listen to the doctor? I think that's why people say it's the doctor's fault; he's the one giving the bad advice.

I hear a lot of stories about how everything was done right, and yet a c-section or other intervention was still needed. But in these stories, there is also mention of induction, medication, lithotomy position, vaginal exams, IVs, continuous fetal monitors...so how can someone say the baby couldn't have been affected by these interventions? People tell me "natural childbirth" doesn't work since it didn't work for them. I guess we all have different ideas of what natural childbirth is. For me, it doesn't include routine medical interventions. If no interventions or restrictions are used at my homebirth and the baby still goes into distress, I can go to the hospital knowing it's the right thing to do and that it was probably one of those rare cases that couldn't be prevented. I'm glad I have both choices, home and hospital, available to me.

It's common sense that one intervention leads to another. How many women come out of the hospital with only one intervention done to them? (I guess they would have to define what an intervention is for themselves.) Drugs lead to pitocin, monitors restrict movement (I am NOT impressed with the units that are supposedly portable, nor do I think it's OK to restrict movement "just for the strip"), IV solutions are no substitute for real food; you still have a good chance of becoming exhausted and requesting assisted delivery. Forceps and vacuums sometimes require an episiotomy, vaginal exams encourage reliance on arbitrary numbers and a diagnosis of FTP...the best way to avoid a cascade of interventions is to avoid the first one, which is more likely to happen at home.

I had 7 interventions in the hospital, which were all interrelated. I believe if I had been at home I wouldn't have needed any. I guess I'll see how I do next time around.


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## mountain mom (Nov 6, 2003)

I'm gonna jump in with my two cents and I hope that I don't offend anyone. I think that if you choose to have a hospital birth then you choose to birth within their timeline and protocol. If you choose an alternative route you may have a larger role in making desisions regarding your childs birth.

I birthed our dd in a hospital with a very progressive doctor who adovocated my alternative views throughout the entire pregnancy but when it came time to birth I fell into the hospitals 'guidelines for safe childbirth' even though I had a Doctor who understood my desires. After a relatively easy, unintervened labour with no drugs, iv or continual monitering, the time came to push. I pushed for 5 and a half hours and at that time the head of ob and delivery decided that it would be dangerous to continue and that I needed a section. If I had been at a birthing center with midwives or at home it may have been different. Was the Doctor at 'Fault'. I actually say no because the doctor was following the proctocol of the hospital that is definately influenced by malpractice suites and the 'bottom line'. I take responsiblity as well because I knew what I was 'getting into' by opting to birth in a hospital. I had a monitrice present as well who in the end became inpatient and felt the section was the way to go even though my dd was not in any danger and never was stressed. If we choose to have another child, we have the tools to make the appropriate birthing choices for ourselves.
I think that it is too black or white to say that Doctors are responsible all the time







:


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## doulamomvicki (Nov 4, 2003)

I hope nobody gets grossed out by this comparision. A friend of mine who is a LM gave this analogy. Birth is like having a bowel movement. It happens naturally and is not a medical condition. But sometimes for whatever reason help is needed.

Birth is a natural experience. But sometime things can go wrong, it is not the moms or the medical staffs fault.


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## IdentityCrisisMama (May 12, 2003)

Quote:

_Originally posted by citizenfong_
*...many complications are the result of obstetrical interferance, since they never seem to occur in UC (or many homebirth) situations.

*
What is the UC birth that you refer to?


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## eilonwy (Apr 3, 2003)

Quote:

_Originally posted by citizenfong_
*I have to add my opinion here. Doctors and other interventionists get blamed for doing so much wrong because so much of what they do is wrong.*
Could you give some concrete examples here? Something that doctors who've studied medicine within the past 30 years do, maybe?

Quote:

*We no longer have ANY idea about what the range of normal in pregnancy and birth is, because almost NO ONE has unhindered pregnancy/birth. Since I started researching UC about a year ago I have met so many women who had perfectly healthy births with factors that would have NEVER been allowed to develop under the care of docs. Like the woman who labored, not just prodomal labor, for 11 days before giving birth. Or the woman who started off and on labor at 33 weeks. Her water broke at 36 weeks. 3 days later she gave birth to a 7 lb. baby who was obviously ready to be born. Just a few examples.*
You found these extreme examples (and yes, they are extreme) because these are what you were looking for. Last week on Oprah, I saw a show about a doctor who has been doing surgeries on women in rural parts of Africa (Ethiopia, I think) who had a common complication of prolonged labors: they developed holes between their bladders or colons and their birth canal, thus rendering them unable to contain urine or feces. Most of their babies were born dead after labors of between 2 and 14 days. I disagree with the idea that we have no sense of what's normal in childbirth.

Quote:

*The thing is this: so much of what OBs do is superstition, voodoo, non-evidence-based malarky. Therefore, when you examine a birth story/situation and find X, Y, and Z that a doctor shouldn't have done, there is no way of really knowing how much ensuing damage is a result of malpractice-avoidance medicine and how much actually would have occurred otherwise. Am I making sense here?*
You are making sense, but I entirely disagree. First of all, most of what OBs do is, in fact, based on evidence. Just because it's evidence that you don't like doesn't mean it doesn't exist. Secondly, if you can't tell for a fact that a doctor caused X, Y, and Z and you don't know exactly what the consequences of X, Y, and Z are, how can you assume that the doctor was at fault?

Quote:

*Although, the more research I've done, and the more birth stories I've read/heard, the more obvious it becomes that many, many complications are the result of obstetrical interferance, since they never seem to occur in UC (or many homebirth) situations.*
That's ridiculous. What you mean is, they never have occured in any of the cases you've read about. Of course they haven't, because you're not doing open research. You're starting with the premise that UC is the safest way to go for everyone, and looking for proof that supports your premise. Of course you're finding exactly what you're looking for, because you're not looking for anything else.

Quote:

*So the bottom line is that if I blame OBs for everything I KNOW they are doing to muck up the birth process, and if every OB I've ever heard of is doing them, it's going to seem like a lot of blame.

For what's it's worth, I am happy to be living in a time when good nutrition is easy, information is extremely accessable, and emergency medicine that I AGREE to is available just down the street.*
It does seem like a lot of blame, and much of it seems unwarranted.

It's not that I think that homebirth or UC are bad things, even. I'm just mystified at the attitude that OBs are responsible for all the things that can go wrong. It's interesting to me that I feel this way, because my doctor was an idiot. I understand why people have homebirths and UC, especially women who've had births with complications that were definately caused by a doctors interventions and women who had easy births with no complications at all. I don't understand how anyone can say that it's the best choice for most women who've had complicated births, because I don't see doctors as being wholly responsible for complications.

I had a horrendously complicated birth, but that wasn't (entirely) my doctor's fault. The only thing I think she could (and should) have done differently was do a ceserian, and that's hardly less intervention. My birth was complicated by the fact that my water broke 4.5 days before my son was born, and it did not replenish itself (someone said on a thread that it always does, and there's no such thing as a dry birth-- they are very much mistaken). We developed an infection, and I labored for 3 days with no medication and no progress. If it hadn't been for medical intervention, there is no doubt in my mind that my son would not have survived his birth. It's doubtful that I would have survived his birth. It makes me sick when people talk about all the horrible things that "only go wrong in hospital births". Please! Do a little more research, and ask some more open-ended questions before you make these judgements. It doesn't make any sense. If medical intervention is such a horrible thing, and most women can give birth unassisted, why is it that at the turn of the century 1 in 4 women died in childbirth, while the rate today is miniscule? Why is it that the rate of stillbirth was ridiculously high, while today it is relatively rare?


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## Greaseball (Feb 1, 2002)

Quote:

I saw a show about a doctor who has been doing surgeries on women in rural parts of Africa (Ethiopia, I think) who had a common complication of prolonged labors: they developed holes between their bladders or colons and their birth canal, thus rendering them unable to contain urine or feces.
OK, here are my open-ended questions:

Homebirth does not mean unhindered birth. Even a UC can be complicated if a mother tries to use medical interventions on herself. I would say these births need to be looked at more in-depth, instead of saying "Everything went wrong because they were at home." What about mothers who are in hard labor for several days to a week at home and have healthy babies? How do we explain that? How do we explain c-section mothers who have incontinence?

Do you really know why women started dying in childbirth? They were doing fine until hospitals were invented. Doctors there refused to wash their hands after surgeries or after touching dead bodies. They attended births covered in blood and grime from previous operations. Women labored in beds from which corpses were recently moved. Hospital-acquired infections are still a leading cause of death in this country, and maternal death can be prevented. Mothers and babies who deliver in hospitals have higher rates of death.

Living conditions are responsible for a large number of fetal and maternal deaths. Sometimes it's not always poverty that is the cause - in the 19th century, rich women who gave birth at home had a lot of deformed or dead babies. The reason was that these women were corseted as soon as they hit puberty, and they wore their corsets through pregnancy. The babies did not have room to develop properly. (The women were also not allowed out in public when they were showing, and when they became "agitated" from being shut-ins, their husbands would call the doctor who would come over and dope the woman up with opium. Yum! This was all related to the restrictions of their social class.)

What OBs do is based on time and money, not evidence. It used to be that 9 and 10-lb babies were healthy and normal, now they are harmful. Did the "evidence" change from one decade to the next? What "evidence" says that in 1970 it was safe to vaginally deliver breech babies, but in 1990 it wasn't? Why was it once normal for a woman to carry over 42 weeks, and now it's abnormal? What about doctors in other countries - do they use evidence? If so, where is the evidence that Swedish women need cesareans 4% of the time but American women need them 26% of the time, and Brazilian women need them 95% of the time? Where is the evidence that says although a woman giving birth in a hospital in New York City can safely labor for 18 hours and push for 4 hours, women in Atlanta can only labor for 12 hours and push for 2 hours? Is it something in the air?

Evidence shows that almost all babies can be safely born at home with little or no intervention. It's easy to miss that when you don't want to see it. I'm sure all of us who are pregnant are informed consumers of birth, and are planning births that feel right to us. I think homebirth is a mistake for women who don't want to be there, and hospital birth is a mistake for women who want to be at home. I believe if you don't give birth at the place you would prefer, you will have complications.


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## captain optimism (Jan 2, 2003)

Though I agree with you in general, Eilonwy, I have to take issue with your citation of late 19th-early 20th century stillbirth and maternal mortality statistics. Women in that era died in childbirth in large measure because their doctors carried illnesses when they didn't wash their hands! This was called childbed fever. It was a tremendous example of the inferiority of doctors to midwives and an interesting case in the professionalization of medicine.

Of course, doctors today do wash their hands, as do midwives of every stripe.

I have been amazed, as I read here and listen to people's birth stories, that doctors do incredibly dumb things that screw up people's births. We make progress as a society but we don't make it uniformly.

The pushing example is a good one. I pushed for more like 8 hours. Then my baby came out. I didn't have a c-section. That was also in a hospital. Institutions vary.

I also want to add that homebirths here in the US are a skewed sample, because they are often moms who are healthy to start with and who think through their births carefully. (and obviously, I think that's good!)


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## candiland (Jan 27, 2002)

Eilonwy,
Please do some research. Obstetrics is NOT evidence-based. I highly recommend Henci Goer's "Obstetric Myths Vs. Research Realities". Most of what happens within the ob. establishment is only done because it has been done for such a loooong time now....
Some concrete examples of what I, as an experienced doula, have seen with my hospital clients:
1.) Insisting on a heplock or iv. An iv. is part of hospital protocol to help keep the woman from becoming dehydrated. But research shows us that iv.s actually dilute the hormones in the woman's bloodsteam that causes the uterus to contract. As you can imagine, this can easily lead to the use of labor-augmenting drugs. The iv. is also a huge pain in the butt...... a woman wishing for the safest kind of birth - a natural birth - has to be able to move about freely and completely uninhibited to go into a labor trance to help her deal with the pain. But when she has to wheel the iv. around, maneuver the line, be careful with her hands so she doesn't experience discomfort from the iv., etc., it also paves the way for the inability to enter that labor trance and can pave the way for medication.
2.) The external fetal monitor. See the need for uninhibited laboring, above. The monitor is not evidence-based, either. It has not been proven to save any mothers or babies or decrease the incidence of cerebral palsy, yet it drastically increases the number of cesareans performed.
3.) Not letting a woman eat and drink to taste. It used to be thought that anything taken by mouth could be vomited and choked upon if the woman needed emergency general anesthesia. Yet all the research shows that the majority of women who need an emergency section get an epidural. And - this is the real kicker - it is shown that if a woman DOESN'T have anything in her stomach when she's knocked out and then aspirates her stomach contents, it is MORE DANGEROUS to aspirate stomach acid than it is to aspirate stomach acid diluted by food and drink!:LOL
Women also get very weak and discouraged when they labor for hours and hours without nourishment. Labor is like running a marathon...... women need lots of high energy food and lots to drink to cope with the intensity of what their bodies are going through!
4.) Induction. Induction is verrrry rarely indicated, yet many women today are getting induced. Inductions have actually INCREASED the chances that these babies need to be sent to NICU because they are - SURPRISE! - not ready to come out yet, so many have serious breathing problems because the lungs are not fully formed until the VERY end of a pregnancy. Also, inductions often don't "take" because the mother's body and the baby know it isn't time to give birth yet. This leads to thousands of unnecessary cesareans every year. Cesareans are much more dangerous than a normal vaginal delivery.
I really could go on for several more paragraphs, but I'd like to take a nap now that the kids are asleep. Please do some research for yourself. You will be shocked with what you find. I know I was.
Edited to add: my midwife has a 5% transferral rate and a 4% cesarean rate. (She only does homebirths.) Yet her maternal and fetal outcomes far exceed even the local freestanding birth center! And she rarely risks women out, either. She's even done twins and breeches at home. She's also had drug addicts, low income women, you name it...... so it's not a demographic issue, either. Is it just luck? I'm sure that's what all of the, er, evidence-based obstetricians would say!:LOL


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## IdentityCrisisMama (May 12, 2003)

I just wanted to add that it is not just doctors doing stupid things that screw up births. I have suspected all along that the fetal heart monitor's diagnosis was the reason that I transferred to the hospital. Now, in the end I think the transfer was for the best (for me, not for baby Aya) but the fetal monitor was my choice and the choice of a very well respected homebirth midwife.

For me, I wish all interventions (including the very first ones&#8230;even a HPT) came on an "as need" basis.

If I have another birth I'll look for a midwife with a better fit to my personality and pass on the fetal monitor unless the need comes (I don't know when that will be).

Congrats on pushing for 8 hours! I thought 5 was a long time&#8230;

So, UC is "UnComplicated Birth"?


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## Greaseball (Feb 1, 2002)

UC is unassisted childbirth, meaning no professional assistance in the form of doctors or midwives. I was born this way in the late 70s, with just mom and dad there.

That's right, the EFM does not work well. I will be monitored intermittently during labor at home but with a Doppler.


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## kimberlylibby (Dec 28, 2003)

In response to the no salt thing.... good grief, I heard that every WEEK from my ob.

He'd say "Wow, you gained 4 lb this week" (I had pre-eclampsia) and then say "Make sure you have NO salt"


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## IdentityCrisisMama (May 12, 2003)

So why is unassisted birth UC? Is it for Unassisted Childbirth? I have always been a touch confused about the term unassisted birth because I have heard it being used for births with midwives in attendance.

Thanks, I always need to learn these new things. I even needed to learn what ICM was and it's my user name, IdentityCrisisMama, that people reduced down to ICM.


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## eilonwy (Apr 3, 2003)

Quote:

_Originally posted by Greaseball_
*OK, here are my open-ended questions:

Homebirth does not mean unhindered birth. Even a UC can be complicated if a mother tries to use medical interventions on herself. I would say these births need to be looked at more in-depth, instead of saying "Everything went wrong because they were at home." What about mothers who are in hard labor for several days to a week at home and have healthy babies? How do we explain that? How do we explain c-section mothers who have incontinence?
*
The women I refered to did not "use medical interventions on themselves". They were young women who had complications because they were alone, many of which could have easily been prevented by the presence of even a single knowledgeable person. These things went wrong not because they were at home, but because they were alone and uninformed, a deadly combination. Mothers who are in hard labor for several days to a week and have healthy babies _are the exception_, and that's all I said. You hear those stories because those are the ones you look for. Lots of women have had hard labor for several days and had dead babies at the end to show for all their work.

C-section mothers who have incontinence can certainly be explained, almost exclusively, by incompotent doctors, but that's a far cry from saying all doctors are incompotent.

Quote:

*Do you really know why women started dying in childbirth? They were doing fine until hospitals were invented. Doctors there refused to wash their hands after surgeries or after touching dead bodies. They attended births covered in blood and grime from previous operations. Women labored in beds from which corpses were recently moved.*
I knew that this was going to come up. Yes, I've heard of childbed fever and am well aware of the whole icky corpse aspect. So explain to me why the death in childbirth rate was the same for women living on farms as for women living in the cities? Women giving birth on the prarie also had a 1 in 4 chance of dying in childbirth.

Quote:

*Hospital-acquired infections are still a leading cause of death in this country, and maternal death can be prevented. Mothers and babies who deliver in hospitals have higher rates of death.*
Perhaps because the mothers who have hospital birth are more likely to have other complications? Yes, infection is a bigger concern in a hospital setting, but there are many other causes of maternal and perinatal death.

Quote:

*What OBs do is based on time and money, not evidence. It used to be that 9 and 10-lb babies were healthy and normal, now they are harmful. Did the "evidence" change from one decade to the next? What "evidence" says that in 1970 it was safe to vaginally deliver breech babies, but in 1990 it wasn't? Why was it once normal for a woman to carry over 42 weeks, and now it's abnormal?*
That has much more to do with lawsuits than it does to do with the incompotence of doctors. All it takes is two women who sue because they tried to deliver breach and ended up with a dead baby and there will be policy changes implemented. Many doctors are more than willing to attempt a breech delivery, especially with multiparous women. If the woman is informed and insists, and her doctor is a reasonable human being, she can certainly have a breech birth in a hospital. I don't know if I have encountered super-progressive doctors or not, but I think that you're talking about doctors who still live in the dark ages. Granted, they're out there practicing, but I find it hard to believe that they are the majority.

Quote:

*What about doctors in other countries - do they use evidence? If so, where is the evidence that Swedish women need cesareans 4% of the time but American women need them 26% of the time, and Brazilian women need them 95% of the time?*
In Sweeden, people are not nearly as lawsuit happy as they are in the US. In Brazil, women and OB's are currently much more concerned with convinience than anything else. Those facts have absolutely no bearing on this discussion.

If getting sued means that you will never again be able to do the thing you went to school for and have wanted to do for years, wouldn't it be prudent to avoid getting sued? How is that being motivated only by money? What about OBs who work in free clinics, are they motivated by money?

Quote:

*Where is the evidence that says although a woman giving birth in a hospital in New York City can safely labor for 18 hours and push for 4 hours, women in Atlanta can only labor for 12 hours and push for 2 hours? Is it something in the air?*
Again, it has to do much more with how lawsuit-happy the area is. I didn't say that every single thing that doctors, or anyone for that matter does is based soley on evidence, only that there is evidence out there to support certain actions. For example: a breech position with a first time (untested) pelvis is more likely to lead to complications then a vertex position. Babies are more likely to be stillborn if they go beyond 43 weeks gestation. And no, that doesn't explain why women are induced at 40 weeks sometimes. Again, I have never heard this from a practicing doctor itrw. In fact, I was given my due date and told to wrap my head around a date two weeks later because they wouldn't consider induction before that if nothing was seriously wrong.

Quote:

*
Evidence shows that almost all babies can be safely born at home with little or no intervention. It's easy to miss that when you don't want to see it.*
Quite to the contrary, I *do* want to see it. And I understand that for most people, pregnancy is a normal condition and birth is also a normal condition of being human. I don't believe that it's a pathology. I do, however, believe that things can go wrong during birth regardless of how ideal the conditions are. I've met lots of people who had hospital deliveries and should have given birth at home; my mother, for example. It was just a waste of time for them to go to the hospital at all. What I have a problem with is people saying that the reason my delivery, for example, was complicated was because it was in a hospital. It's not true. Homebirthing advocates live in a dream world where things only go wrong if they're in the hospital, and that doesn't seem remotely realistic to me. Just because you pass by the homebirth and UC stories that end in death for the mother or child, or in other serious complications, doesn't mean those stories aren't out there. It's not safe for everyone to attempt a home delivery, and it's not reasonable to expect everyone to want to, regardless of how well informed we are.


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## Defenestrator (Oct 10, 2002)

Quote:

_Originally posted by eilonwy_
*
First of all, most of what OBs do is, in fact, based on evidence. Just because it's evidence that you don't like doesn't mean it doesn't exist. Secondly, if you can't tell for a fact that a doctor caused X, Y, and Z and you don't know exactly what the consequences of X, Y, and Z are, how can you assume that the doctor was at fault?
*

I have to strongly disagree with the idea that what most OBs do is based on evidence. There is a great lack of scientific evidence available about pregnant and laboring women because of the numerous ethical problems that exist with doing a double-blind controlled study with pregnant women and their babies. Most Obstetrical practice, whether carried out by doctors or midwives, is instead based on habits passed down through the oral tradition and personal experience. The problem with this is that many severe complications occur at a rate of one in a thousand or one in ten thousand, so an OB can honestly say, "Well, I've used cytotec many times and never seen a uterine rupture, so I believe it is safe." If that same drug takes maternal mortality from a rate of 3 per 100,000 to 6 per 100,000, effectively doubling it, or if cesareans kill four times as many moms as vaginal births, most OBs will never notice because their own experience will never involve those kinds of numbers. I can give you example after example of OBs continuing to practice procedures which have specifically been proven in study after study to be ineffective, untrustworthy or harmful, from early cord clamping to withholding food and drink during labor to episiotomy (still practiced in more than 60% of births attended by private physicians) to third-trimester ultrasound for weight estimation to induction at less than 42 weeks for a healthy postdates pregnancy. Happily, many other out-of-date procedures, like shaving the pubic hair before birth (thought to prevent infection, actually made it worse) have fallen by the wayside, but change comes very, very slow in the medical community, unless inspired by litigation.

Litigation and other pressures have led to something more insidious than lack of evidence-based practice in my opinion. Many women are being over-aggressively treated for complications that arise in late pregnancy and during labor, resulting in live babies and mothers, but at the cost of additional maternal recovery time, physical trauma to mom and baby, and increased chances of separation. To get to the bottom of what I mean, I will show another example. If a woman is diagnosed with breast cancer, the best thing to do to maximize her chances of remission would be a double mastectomy, with possible removal of lymph nodes, aggressive chemotherapy and radiation, and some kind of continuing drug therapy. However, cancer specialists, using evidence, have come up with a number of other options and can present women with other choices, like perhaps a lumpectomy + radiation and no other treatment. Obviously the second choice, while marginally less successful than more radical treatment, has significant benefits in its lesser trauma and recovery time. A woman with breast cancer is given a whole spectrum of treatment options and is given evidence about the likely benefit of each.

Many pregnant women are being given the birth equivalent of a double mastectomy. If a baby is "too big," an induction or cesarean is ordered (sometimes by a court of law, as we have seen recently). Women who are post-dates are being told they will be "allowed" to go to a certain date. Women who have strep B are told that if they don't accept antibiotics in labor, their babies can be ordered to undergo spinal taps, NICU stays and their own antibiotic courses. Women are often not allowed to choose less aggressive interventions -- when they decline the advice of their Obstetricians and Pediatricians in the birth setting, they are often threatened with court orders.

Homebirth and hospital-based midwives are often guilty of their own practices which are not backed up by evidence. I love Spiritual Midwifery, but cringe when I read some of the things that they do in that book. More common are midwives who put their clients through an exhaustive regimen of supplements and teas and exercises, adding expense and bother to a healthy pregnancy that didn't really need the extra support. Midwives can be too slow to intervene in ways that might prove dangerous as well.

I think that some interventions are absolutely necessary -- some because of problems caused by previous decisions, others which would have been necessary regardless of birth setting. I attended a mom in labor as a doula last year who had a very necessary vacuum extraction, but her 26-hour labor would have been greatly minimized by better care, perhaps eliminating the need for a surgical birth. The thing about interventions, though, is that the community seems to want to take the evidence about when an intervention is warranted, and then write a protocol that is much, much more conservative. The OP gave an example of premature rupture of membranes -- the WHO recommends induction after 48 hours, the ACOG, 24, and most hospitals in my area, 6-12. There is a pretty huge range amongst those numbers. The ACOG has recommended that testing begin to determine placental health and fetal well-being after 42 weeks in a post-date pregnancy, but many doctors begin such testing immediately after 40 weeks, and induce at 41.

One thing that I have come to believe about birth is that if a practitioner has a tool, he or she will use it. In the homebirth practice I work in, we do not have easy access to ultrasound, so it is not a tool we use routinely. My favorite group of hospital-based midwives can't perform cesareans, vacuum extractions or use forceps, and so when they choose to use those tools, they must turn over care to an OB or resident. Consequently, they don't use those options unless they really, really have to. But the OBs, who know that they are likely to produce a relatively healthy baby if they order an immediate cesarean when there is meconium or a deceleration, vs. entering into the unknown by allowing a labor to continue, will often strongly advise a c-birth. There is huge pressure on them to make those recommendations, and I don't blame them, but I also would not choose them for my own care unless my health mandated it.

You are right, though, about the uncertainty of the impact of individual interventions in labor. Did the morphine given in labor cause lingering fetal distress or was it the exhaustion? Was the induction the cause of the meconium or the post-date baby? Did the epidural make it impossible to push out the baby or was it the weak contractions? Hard to know. What the evidence points at, though, is that low-intervention practitioners, like hospital and home-based midwives, achieve simliar if not superior results with matched populations to those achieved by OBs, with fewer interventions. If it is possible to intervene less and still and achieve healthy mom and baby, why not intervene less?


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## IdentityCrisisMama (May 12, 2003)

Quote:

_Originally posted by eilonwy_
*It's not safe for everyone to attempt a home delivery, and it's not reasonable to expect everyone to want to, regardless of how well informed we are.*
I think this quote and your OP are very different issues. This quote is totally understandable but it is a very different issue from doctors being blamed for all labor complications, which was the topic of our OP. No one is saying that *everyone* should be expected to attempt a homebirth. Are they?

Do you want to talk about people choosing homebirth OR do you want to talk about doctors being blamed for all labor complications?

BTW, I live in Germany and I just heard the C-Section rate here is 30%. Can anyone back that up


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## Alstrameria (Sep 8, 2002)

Great thread! I always wonder where the unfortunate woman gave birth who was ignored, bullied and who had her birth experience coopted by evil OBs. I feel for them.

I had a great labour and birth. I felt cared for and respected by my entire birth team, my doctor included. Never for a moment did I feel my voice was not heard, or that my needs were ignored. In fact, I felt empowerd and confident. I chose to give birth in our hospital because that's where I feel comfortable. I'll make the same choice this time. I had no interventions at all, no meds, no IV, no monitor. Because I said so.

Am I lucky? Sheltered? Fortunate to have a family physician who cares for me and a delivery doctor who shares my birth philosophy? I guess so, but why can't everybody? Surely I don't have the only doctor who can be trusted to care for me?

Jen


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## Greaseball (Feb 1, 2002)

Quote:

The women I refered to did not "use medical interventions on themselves".
I wasn't talking about forceps and epidurals...did they lie on their backs? Did they restrict food and drink? Did they perform cervical checks on themselves, as some UC women do today? If they were uninformed, why was that so? Too many women are uninformed today and it's very sad.

Quote:

So explain to me why the death in childbirth rate was the same for women living on farms as for women living in the cities?
Poverty can cause malnutrition, which can cause unhealthy fetuses and a deformed pelvis in the mother, which can lead to a true case of CPD.

Lawsuits brought on by women are given as the main reason for all the obstetrical problems in this country today. It's another way doctors have of blaming women. In reality, it's very hard to sue a doctor. If you can even find a lawyer who is willing to accept the case, you most likely will not win.

OBs who work in free clinics are paid out of tax dollars, and many of them resent the work they do, the clients, and the lower pay they receive. Medicaid will typically pay only 70% of a bill, and the doctor just goes without the extra 30%. To make up for this, some doctors do all they can to increase the cost of the patient's stay. Some use every intervention they can, and bill for that; others don't use the interventions but bill for them anyway. The patient never sees the bill, so no one knows. (I used to work in a hospital as a Medicaid billing person, and this is common practice.) There are some highly educated professionals who are happy to work for a reduced income to serve an underprivileged population, but they tend to be midwives and not OBs.

In Brazil, women are motivated by wanting to "keep their vaginas honeymoon fresh." These thoughts do not originate within the minds of women; men (and doctors) have a hand in this!

It is prudent to avoid getting sued, but there is no excuse for doing so at the expense of the patient. Some people don't realize that interventions come with risks.

Quote:

For example: a breech position with a first time (untested) pelvis is more likely to lead to complications then a vertex position.
In a hospital, yes. At home with a midwife experienced in breech delivery, no. OBs do not learn breech deliveries in medical school, so it would be risky for them to attend one.

Quote:

Babies are more likely to be stillborn if they go beyond 43 weeks gestation.
In an unhealthy mother with a poor diet, there is a slight increase in that risk. Not enough to make me induce at 43 weeks, though. I feel the risks of induction are much greater. If I were considering induction I'd try breast pumps and sex. I'm glad we have magazines like Mothering that can explain some of the ways to lower the risks of carrying beyond 43 weeks. There are some articles in the archives.

Quote:

What I have a problem with is people saying that the reason my delivery, for example, was complicated was because it was in a hospital.
That would be impossible to determine without knowing the nature of your pregnancy and birth. Most likely, you had some interventions that carry a degree of risk. Vaginal exams, for example, can cause infection if the water is broken. Very rarely can a woman give birth in a hospital without a vaginal exam. You often need it to be admitted at all. It could be if you were at home, you would have had exams as well. Exams are largely useless. No one "needs to know" how close you are; trust me, the babies all come out even if it's unknown how dilated a woman is.

If you really want to know what complicated your delivery, I'd run it by a midwife. Not any of us; hearing about something online isn't enough. The homebirth stories that end in death are so incredibly rare; that's why it's easy to overlook them. Many home births end in infant death because the baby had a fatal birth defect to begin with, as was the case with the most recent ACOG study. Women who choose home birth are less likely to abort a fetus with such a defect.


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## emmalala (Dec 3, 2001)

No, I have that doctor too! I'm on my 3rd pg with her and can honestly say that none of the nasty unhelpful things that get talked about on MDC have even been mentioned.

I guess I am a statistical fluke, but here I am, and here too is my great OB.


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## anothermama (Nov 11, 2003)

I haven't read the replies yet....

BUT! I think the what goes wrong in most normal, otherwise healthy women is USUALLY the fault of medical intervention.

Some women go into pregnancy unhealthy, and those are different circumstances.

But most women are normal, most women can birth just fine and end up with interventions anyways. I think it's not only the fault of the ob's but the fault of societ for keeping women in the dark about their health care in the first place.


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## cottonwood (Nov 20, 2001)

Whew, a lot to respond to here!

""If medical intervention is such a horrible thing, and most women can give birth unassisted, why is it that at the turn of the century 1 in 4 women died in childbirth,"

Medical intervention is *not* a horrible thing. _Unnecessary_ medical intervention is a horrible thing. And there is a lot of that in modern obstetrics. Someone mentioned Henci Goer's The Thinking Woman's Guide to a Better Birth, which is basically a report on the medical literature that exists about birth (mostly describing managed birth, because that is mostly what there is in the USA.) Have you had a chance to look at that book? Even more technical is her book Obstetrics Myths vs. Research Realities. I'd be interested to hear what you think of the stats she's compiled.

I think you mentioned that much unnecessary intervention is due to fear of litigation, and I agree. Is it still then the doctor's fault? As far as I'm concerned, yes. I understand that they have to protect themselves, but it should not be at the expense of those they claim to serve. Here is a relevant article by Marsden Wagner, M.D., former director of Women's and Children's Health for the World Health Organization:

http://www.midwiferytoday.com/articl...ogyinbirth.asp

"I knew that this was going to come up. Yes, I've heard of childbed fever and am well aware of the whole icky corpse aspect. So explain to me why the death in childbirth rate was the same for women living on farms as for women living in the cities? Women giving birth on the prarie also had a 1 in 4 chance of dying in childbirth."

What are your sources for this statistic? 1 in 4 for rural women seems awfully high to me. Even so, I would expect death rates throughout history to be much higher than they are now (heck they were higher for _everyone_, not just women in birth.) Women living on farms at that time did not have access to antibiotics, and were often living in unsanitary conditions, malnourished, overworked, and pregnant too often (since there was no birth control) putting more stress on already stressed bodies. Furthermore, they were often attended by country doctors and midwives who had their own ways of interfering. And they had no access to emergency medical care. (Which is what doctors generally do fairly well, and exactly what I am happy to have them for.)

"If the woman is informed and insists, and her doctor is a reasonable human being, she can certainly have a breech birth in a hospital."

Not so. Most doctors are not trained in medical school to do breech births, so they (rightly) refuse to do them.

"Homebirthing advocates live in a dream world where things only go wrong if they're in the hospital, and that doesn't seem remotely realistic to me."

Okay, forgive me, but this is kind of funny. Haven't you just been railing against making generalizations about doctors? Yet here you are generalizing about homebirthers. So I guess it's not _generalizations_ per se that you have a problem with? (By the way, I'm a homebirther, and it doesn't seem remotely realistic to me either. Who woulda thought? :LOL )

"Just because you pass by the homebirth and UC stories that end in death for the mother or child, or in other serious complications, doesn't mean those stories aren't out there."

Did some homebirther here actually claim that?









"It's not safe for everyone to attempt a home delivery, and it's not reasonable to expect everyone to want to, regardless of how well informed we are."

Uhhhh, no, it's not. Who on earth is saying these crazy things, anyway? [edited to clarify: I was *agreeing* that it's not safe for everyone to attempt a home delivery, and it's *not* reasonable to expect everyone to want to; and then asking, who are the crazy people that are saying that it *is* safe for everyone to attempt a home delivery and that it's reasonable to expect everyone to want to? Sorry about the confusion...]


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## cottonwood (Nov 20, 2001)

Someone wrote earlier about the fact that we (as a society) do not know what normal birth looks like anymore. I agree.

"By medicalizing birth, i.e. separating a woman from her own environment and surrounding her with strange people using strange machines to do strange things to her in an effort to assist her (and some of this may occasionally be necessary), the woman's state of mind and body is so altered that her ways of carrying through this intimate act must also be altered and the state of the baby born must equally be altered. The result is that it is no longer possible to know what births would have been like before these manipulations. Most health care providers no longer know what "non-medicalized" birth is. This is an overwhelmingly important issue." -- The World Health Organization


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## cottonwood (Nov 20, 2001)

Citizenfong wrote: "Doctors and other interventionists get blamed for doing so much wrong because so much of what they do is wrong."

Eilonwy replied: "Could you give some concrete examples here? Something that doctors who've studied medicine within the past 30 years do, maybe?"

I'll take a stab at that.

Many doctors, nurses, and midwives:

&#8230;rupture membranes "to get labor going", even when baby is not in danger, risking infection and cord prolapse.

&#8230;do internal exams after rupture of membranes, even though this greatly increases risk of infection.

&#8230;do cervical checks to determine dilation, even though dilation is not a good indicator of how close or far away the birth is, and therefore can easily lead to a wrong diagnosis of "failure to progress" and from there invasive and risky interventions or surgery. All because birth isn't on a certain _arbitrary_ time table.

&#8230;do cesarean section for "failure to progress" (which, as long as baby is not in distress, really just means failure to be patient.)

&#8230;do cesarean section for "big babies" (over nine lbs. by ultrasound, which is often wrong, resulting in babies being forced to be born prematurely; and if they are not early, the doctor has still subjected the mother to unnecessary surgery, which carries its own risks of course.)

&#8230;induce so that the baby "won't get too big." (See above)

&#8230;use induction drugs for VBAC (just "to get labor going," see above,) which increases risk of uterine rupture.

&#8230;use cytotec to induce labor, even though it puts the mother at higher risk of uterine rupture than other induction drugs. (It's used because it is much cheaper and "very effective"!

...induce with pitocin even when baby is not in danger (failure to be patient, see above) even though pitocin induction carries risks, not least of which is that it makes the labor harder so that it is much harder for the mother to refuse drugs, which also carry risks.

&#8230;advocate induction just because they or the mother is tired of waiting, even though induction greatly increases chance of other interventions that carry risks to maternal and infant health.

&#8230;advocate "purple pushing" also known as vasalva pushing; holding breath during labor decreased oxygen to baby, increasing risk of distress, increasing risk of perineal trauma, increasing risk of prolonging 2nd stage, because of swelling of tissues that are not yet meant to have pressure on them, tiring mother out so that she may not be able to complete labor without mechnical help (forceps, vacuum extractor, surgery, episiotomy) (and no, there is NO scientific evidence that this kind of pushing is effective or safe)

&#8230;insist that women labor for a certain amount of time in bed (which makes monitoring easier, despite the fact that it _is_ possible to monitor women when they are upright and moving around) even though being bed-ridden usually makes labor pains worse

&#8230;tell laboring women not to make so much noise

&#8230;tell laboring women not to eat or drink (there is no longer any medical reason for this, but the practice persists)

&#8230;tell women that epidurals are "completely safe" (well, okay, just _one_ doctor that I know of, I heard an OB say this on national television )

&#8230;do episiotomies (nearly all episiotomies are unnecessary, i.e., they are not done because baby is in distress and needs to be born immediately; one reason they are done is because doctors still believe that episiotomies reduce risk of tearing, which is completely scientifically false.)

&#8230;expect women to give birth in a reclining position. Marsden Wagner, M.D., writes: "For more than 25 years we have known scientifically that this is the worst of all possible positions for a woman giving birth."

Okay, I've gotta take a breather but I'll be back with more, don't you worry...


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## cottonwood (Nov 20, 2001)

Defenstrator wrote: "Did the morphine given in labor cause lingering fetal distress or was it the exhaustion? Was the induction the cause of the meconium or the post-date baby? Did the epidural make it impossible to push out the baby or was it the weak contractions?"

(Not arguing with you, just running with it...) And what in the management of the labor contributed to the exhaustion? And what in the management of labor or birth environment caused the contractions to be weak? The baby being post-dates is obviously not due to obstetrical intervention







however how many other things about the management of the labor could have caused the baby to go into distress and pass meconium? We can take it back and back and back, and eventually we might find a way to blame nature or the woman's body. But more likely way before we get there we will have found a whole host of things about the routine management of any labor, of which it is completely logical and scientific to conlude that they contributed to its dysfunction.

The fact is, we _don't_ know that in any of these cases there wouldn't have been fetal distress or dysfunctional labor even without interventions. But does anybody really believe that drugs will make the situation any better? I mean, so you have a baby who _naturally_ goes into fetal distress. What sense does it make to argue over whether the morphine had anything to do with it? _Of course_ morphine is going to make a distressed infant even more distressed. I mean, drugs in labor (and various other procedures) may not be the inital cause of distress or dysfunction, but are certainly likely to make it worse.


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## Greaseball (Feb 1, 2002)

One thing that goes wrong at hospitals (and occasionally at home, if a mother is not comfortable with the midwife) is a woman is so scared or agitated that her labor stops. She does not feel safe, so her body will not let the baby go. I've heard a lot of stories from women who were in transition at home and then their contractions stopped when they got to the hospital. Sometimes their cervix even closed back up.

I think it's a mistake to try and speed up something that was obviously meant to take a long time. The way hospitals are run, like factories, makes it so women don't get to take the time they need. The sooner a woman gets out of the birth room, the sooner another woman can get in, meaning more money for the hospital. If there is one thing I can be proud of in my life it's that I probably made my hospital lose money.









I think women need to be uninhibited when they give birth. Some say that chanting, primal screaming or masturbation helped a lot. But try doing any of these things in the hospital when you never know who is coming into your room to stick her arm in your vagina. Some women want a period of complete privacy; also not an option when you "have to" do another monitor strip. "Progressive" hospitals are letting mothers have non-husband family and friends there, but will still limit the number of people. And try getting your favorite pets in there! What if you want to order pizza? Play Trivial Pursuit without a bunch of meaningless interruptions? Take a walk by the river? (Most places think they are "progressive" because they allow mothers to walk down the hall for a certain period of time, as long as they are back in their rooms for, you know, all the stuff. They won't let you leave the labor ward, though.) Everything done to them is done against what their bodies are crying out for. Not an ideal situation.

Most likely, not letting a woman do exactly as she pleases in labor won't lead to a baby's death, but will probably lead to several interventions.


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## its_our_family (Sep 8, 2002)

I'm commenting as I go along but....

Quote:

_Originally posted by Greaseball_
*
Doctors also give women advice that can cause life-threatening problems. Women who follow the doctor's advice of minimal weight gain, low-calorie and sodium restricted diets are more likely to develop eclampsia than those who are under the care of midwives and receive instruction in real nutrition and are "allowed" to gain as much weight as they need.*

I recieved this advice 2 months ago from a midiwfe. Her direct quote was "You need to start limiting your caloric intake and the amount of protein you are taking in to insure that you have a small baby in order to make delivery easy"

So obs aren't the only ones shoveling hooey.....


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## its_our_family (Sep 8, 2002)

Ok, so I have no quotes from books or actual research or an expert opinion. I have had one c/b and am planning another for next week.

My first c/b was due to ftp. Was it my obs fault. Not entirely. I was induced at my own decision. I made my choice for induction without doing research. I knew I was tired of being pg and I wanted that kid out! And that is what I based my decision on. I didn't take my obs word on everything butfor the majority of thigns I let him do his own thing. I believe with patience and more knowledge things would have been different. Which is my point.

Yes, obs do things that don't make sense. At times they speak without really knowing (ie estimating fetal weight and predicting the day you will go into labor) in order to appear either more knowledgeable than they are or just to be annoying (not sure which







)

I do not believe that every women is "Cut out" for homebirth or for UC. I would have loved either one but i can't redo the past. Anyway, I think you have to look at just more than the ob and the overall medical profession. You have to look at us as a society. People aren't into the thing that is natural. They don't care how nature intended it to be. They want a baby at the easiest most conventient way possible. When women cease to be comfortbale the fun and cuteness of being pg is over.

When it comes down to it women are as much to blame as the ob themselves. Why? because most ppl do not research what they have gotten into. They have decided to take the word of the "professional" No one cares if you did it without drugs. If it hurts they don't want to do it.

Until the ideals ppl have change then nothing will change. Nothing will get better. No one will learn.

You can blame the ob for everything if you want. But at some point "we" gave them the power. I don't think it is right or fair and we weren't the ones who did it but we are paying the price for those who did. I just hope that things will be different for our childrens children.


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## Alstrameria (Sep 8, 2002)

And Greaseball, you can bet nobody is shoving their arm up there without me saying so. If my perspective is skewed because I'm in Ontario, CAN, then I will bow out now.

blueviolet, who is the woman who agrees to these things? Someone uninformed and scared. Dh and I made concious decisions about these things well before labour and discussed them with our provider.

Shouldn't I bear the responsibility for being informed? It's my birth. Sure I consult with professionals for various reasons, including my doctor, but ultimately the decision to (or not to) vaccinate, become vegetarian, give birth, etc, is mine. And, my choice is respected.

Jen


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## Greaseball (Feb 1, 2002)

Quote:

"You need to start limiting your caloric intake and the amount of protein you are taking in to insure that you have a small baby in order to make delivery easy"
What a bunch of crap. It's not only the size of the baby that makes delivery easier. Someone on this board said her 8-lb homebirth was easier than her 3-lb vaginal hospital birth.

Cigarette smoking and pill popping used to be recommended for controlling fetal size.


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## Quirky (Jun 18, 2002)

Quote:

_Originally posted by eilonwy_
You found these extreme examples (and yes, they are extreme) because these are what you were looking for. Last week on Oprah, I saw a show about a doctor who has been doing surgeries on women in rural parts of Africa (Ethiopia, I think) who had a common complication of prolonged labors: they developed holes between their bladders or colons and their birth canal, thus rendering them unable to contain urine or feces. Most of their babies were born dead after labors of between 2 and 14 days. I disagree with the idea that we have no sense of what's normal in childbirth.
Wow, I can't believe no one has responded to this. Don't tell me they didn't mention on Oprah that Ethiopia has one of the highest rates in Africa of female genital mutilation. Many in Ethiopia practice the most extreme form of female genital mutilation, the pharaonic form or infibulation. This is where a girl's external genitals (clitoris and labia) are cut off and the sides of the wound are sewn together, leaving only a tiny hole for the excretion of urine and menstrual fluid. Men often use a special knife to cut their brides open on their wedding night (or cut them over the course of several weeks) to be able to have sex. With all that scar tissue and no elasticity of the tissues, of course childbirth is extremely dangerous, and birth attendants often have to cut extensively to allow the baby's head out. Even the milder forms of FGM create a lot of scar tissue and inelasticity that contributes to birthing difficulties. Add chronic malnutrition to that, childbearing early and often, and the practice of infibulating a woman up again after childbirth, and you have a recipe for disaster.

Ethiopian women's experiences under these circumstances can in no way be considered a data set for normal childbirth.


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## newmainer (Dec 30, 2003)

Wow. fascinating thread...

Eilonwy, you mentioned a couple times about doctors in "this day and age" In my experience interviewing peds for my daughter, the "newer" docs who are out of med school in the past 10 years or less are so married to their med school education still, that they refused to think beyond anything mainstream and that recommended by Such and Such Board. We went with an older doc whose been around the block enough to make some intelligent, experienced based decisions. I had a homebirth with some ooooooold school midwives, so can't comment on whether this would hold for obs, but I'm sure examples abound.

And you might read Diary of a Midwife. Excellent book. Her first hand accounts of being a nurse in delivery in hospitals while getting her CNM prior to being a homebirth midwife are beyond scary. I was floored at the actions she witnessed from doctors ( manually ripping open a womans' cervix because it was taking "too long"- a female doctor, too!) This wasn't the 50s, or 60s, but mid 80s. I doubt all that much has changed. check it out; great book.

oh, and has anyone else ever wondered, amazed, that the majority of ob/gyns are men? This isn't to male bash, but they will NEVER, EVER experience pregnancy or birth... isn't it weird that they are presiding over it and making decisions about care based on something they can't even remotely imagine? Witnessing it is not the same as doing it. I know this is OT, but man this just boggles me. (Not to say that a female doc is always better, but at least if she has given birth herself there's some recognition there...) And the majority of midwives are women. hmmmmmm.....


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## cottonwood (Nov 20, 2001)

its our family wrote: "My first c/b was due to ftp. Was it my obs fault. Not entirely. I was induced at my own decision. I made my choice for induction without doing research. I knew I was tired of being pg and I wanted that kid out! [...] You can blame the ob for everything if you want. But at some point "we" gave them the power."

Very true! At the same time, doctors take an oath to "do no harm." If _any_ person is in the hospital for _anything_ and asks for a procedure that they do not understand the risks of, it is the doctor's responsibility to educate that person and even refuse to perform a medically unnecessary and risky procedure.


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## Greaseball (Feb 1, 2002)

Quote:

I was floored at the actions she witnessed from doctors ( manually ripping open a womans' cervix because it was taking "too long"- a female doctor, too!) This wasn't the 50s, or 60s, but mid 80s. I doubt all that much has changed.
No, it hasn't. Not long ago there was a story from a mother on this board whose cervix was ripped open. She was never told what was happening, either.

Most female OBs do not have children, and those who do often have them by cesarean. I also read that nurses have higher c/s rates than the rest of us. Doctors' wives have even more.







:


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## cottonwood (Nov 20, 2001)

Alstrameria, I think you misunderstood what I was trying to say. I wasn't very clear, so I went back and edited it.









Quirky, THANK YOU. I meant to comment on that and forgot. Really awful stuff. Eilonwy, was your point that birth practices here are normal compared to that?

Newmainer, another good book for taking an inside look at hospital birthing practices is "Hard Labor" by Susan Diamond, who is an L&D nurse.


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## KKmama (Dec 6, 2001)

I'm not sure if I believe that most OBs are men. It certainly isn't the case anywhere I've lived. And slightly more women go to med school these days than men...

Not sure if I believe that women OBs don't have kids, either. All the OBs at my clinic are women, all have kids or are pg. (Not a statistical sampling, I know...)

I don't know how they or RNs have had their kids, but I'm a little sceptical of that, too...

Not trying to be a weenie, but any references?


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## OnTheFence (Feb 15, 2003)

Quote:

_Originally posted by KKmama_
*I'm not sure if I believe that most OBs are men. It certainly isn't the case anywhere I've lived. And slightly more women go to med school these days than men...

Not sure if I believe that women OBs don't have kids, either. All the OBs at my clinic are women, all have kids or are pg. (Not a statistical sampling, I know...)

I don't know how they or RNs have had their kids, but I'm a little sceptical of that, too...

Not trying to be a weenie, but any references?*
Where I live about 1/3 of OBs are women. All but one I know have birthed children. I love my OB and sad I have to find a new one. She went along with everything during my pregnancy that I wanted, loaned me medical books, and tlalked to me a great deal about her own pregnancies (she was also pregnant at the time), breastfeeding, PPD, etc. What man could have done that? LOL The only think my OB and I disagreed about was breastfeeding. She advocated breastfeeding but pretty much thinks that after the first couple of months the baby really doesnt get much benefit from it. She knew I breastfed past a year. She breastfed her first child 4-5 months, her second child she breastfed longer.
My sister was a L&D nurse for 10 years. She would never have a homebirth, had two medicated births but she could have gone natural with her last one. She didnt get the epi until she was 9cm, the only reason she said she got it was because she was having a tubal after. @@ She did have a midwife doula for her last birth and she believes there are too many interventions in childbirth today. She isn't aginst homebirth, but she says she has seen to many things go wrong to really advocate for it.

Kim


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## Greaseball (Feb 1, 2002)

Quote:

Not trying to be a weenie, but any references?
I just make it up as I go along. Heh heh, not really. Here is my reading list:

Open Season, by Nancy Wainer Cohen
Birth as an American Rite of Passage, by Robbie Davis-Floyd
Mal(e) Practice, by Robert Mendelsohn
Mothering articles
Our Bodies, Our Selves

Lots of others that I don't use nearly as much...


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## pamamidwife (May 7, 2003)

I cannot possibly add any more to this thread (and I'm thinking that it's probably useless, since so much evidence-based info has been given and the OP is firm in her beliefs, which is fine), but I do have to think about the WHO's ratings of infant/maternal morbidity/mortality rate worldwide - and how there are 23-25 countries that have BETTER rates than the U.S.

Also, the arrogance of so many Obstetricians includes the belief that many of the problems with birth today are the fault of the woman and the imperfection of the female body. One only has to visit the www.obgyn.net forums to read the belief systems.

An acquaintance of mine is an OB (can you believe it!??) and he said that not only are they being pushed to do more cesareans, but they receive lower malpractice premium costs if they have higher rates. He also reminds me that the majority of OBs are in it for the surgical aspect. In addition, many practices are starting to induce women at 39 weeks routinely. This is very _against_ evidence and safety for both mother and baby. However, a managed labor is what the goal is - after all, our bodies are completely faulty and could kill us or our babies at any minute - even if we're apparently "healthy". "Birth is dangerous and risky".

While it's world-rocking to hear another side to commonly held beliefs (that birth is inherently dangerous and OBs have improved outcomes), some people are not ready for that sort of life change. I know I denied it forever. I actually *thanked* my OB the day after birth for cutting my vagina deep into my rectum.

The belief is deep. Evidence based, though, it is NOT.

The bottom line is there is a minority of women who need surgical intervention and hospital-level assistance in birth. I am grateful for the surgical expertise of OBs when I transport care. However, it has become less about evidence-based care (even getting full informed CHOICE from a provider - OB or CNM in the hospital - is a joke), and more about saving your ass from a lawsuit.

If I worked in the hospital, and saw the results of so many mindless interventions, not to mention the high-risk births on daily level, I probably would be scared of birth, too.


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## Greaseball (Feb 1, 2002)

Quote:

He also reminds me that the majority of OBs are in it for the surgical aspect.
That reminds me of another book on my reading list, A Woman In Residence by Michelle Harrison. She is a OB resident. She tells of one male resident who does not like obstetrics at all, but he tolerates it because he likes to do surgery.

American Rite of Passage gets into that too - when asked why they chose obgyn, doctors say "Because I like to operate" instead of "Because I have deep respect and awe for women and babies."


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## its_our_family (Sep 8, 2002)

Quote:

_Originally posted by pamamidwife_
*He also reminds me that the majority of OBs are in it for the surgical aspect.*
I have also heard that most mws are in it so they don't have to go to medical school. (Not saying I believe it at all...but it said but I do believe that there are mws out there that are as dangerous as some obs)


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## pamamidwife (May 7, 2003)

Quote:

_Originally posted by its_our_family_
*I have also heard that most mws are in it so they don't have to go to medical school. (Not saying I believe it at all...but it said but I do believe that there are mws out there that are as dangerous as some obs)*
Yeah, I responded to the ignorant comment above made by your chiropractor in another thread that you posted it on before.

Whatever.

I would NEVER make it through medical school. Not because I'm not smart enough or not because I don't want to invest the time, it's just that I don't always agree with western medicine's heroic savior attitiude. (I don't vaccinate my child, I don't believe in the liberal use of antibiotics, among other "radical" things that would never keep me paying money to attend a school that tried to teach me the exact opposite). CNMs, in essence, DO attend medical school. Through nursing and their clinicals, these all take place within the medical model.

That said, I'm sorry you got stuck with some egotistical CNMs. You live in a state that is hostile to homebirth midwives and I'm sure the CNMs are not willing to align themselves with anything but the medical model.

Still, hearing it from one outrageous, egotistical chiropractor (who sounds pretty full of himself from the way you have talked about him) does not make it so. Please remember that. I find the repeating of that - especially because you SAY you don't believe it - so offensive.

This thread is interesting, because nobody is saying that you cannot have a normal, beautiful birth with an OB. Nobody is saying that all homebirth midwives are peaceful and accurate with their information. We cannot - and should not - make blanket statements. However, "most" is a term that we need to look at - and see where the information is coming from.

I get most concerned about the consumers. With all the VBAC backlash (totally NOT evidence based, but all about CYA in lawsuits, nevermind not looking at what inductions like cytotec or prostaglandin gels do to ruptures!), the push for more cesareans, the push for inductions, etc., I'm wondering that women are getting exactly what they are demanding.

Your care provider in pregnancy is your partner, hired help. They are NOT Gods, nor are they the ones that should be making all the choices in your care. However, so many women do not want to take responsibility for their choices. It's a reason why our malpractice rates are SO HIGH - women turn over the power, the doctors gladly accept that power and then BOOM! Women are upset over the outcome. Granted, women are not given choices ("we're going to break your water now to speed things up"; "the epidural has very few risks to you and NONE of the medicine gets to the baby") about their care.

Whose "fault" is it? It's all of ours. That's why it's so heartening to see women educating themselves and learning about their choices - whether they choose a repeat cesarean, an epidural, or a homebirth. It's great to see women pointing out erroneous attitudes about birth and our bodies.

I'm not sure where this current train of thinking will lead, but I have no doubt that it will continue to get worse before getting better. I'm willing to stick it out and trust that all of us will have an easier time - including those OBs (and get back to practicing evidence-based medicine, rather than fear-based medicine) and women about to birth.


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## Greaseball (Feb 1, 2002)

Quote:

Your care provider in pregnancy is your partner, hired help.
Yes, why do we pay people to tell us what we can and cannot do? Why do we pay people who almost always do things to hurt us? There seems to be a real hierarchy in patient care, and the patient is always at the bottom, even though she is the one who pays for everything.

Some doctors claim they do all their stuff "because the patient requested it." That makes no sense. If doctors did everything patients requested, there wouldn't be so many people dying after being turned away from doctors. What about all those people with AIDS who request treatment and then don't get any? Most likely, what happens is doctors do everything they can to convince a patient that something like an episiotomy is a good idea and then of course she will ask for one, which they do. I think that is another way people blame women. "She asked for it." Well, what were the circumstances around it? Was she educated on alternatives? Had she been told all her life never to question or disobey a doctor (or men in general), as many women are? I think women need support if they are to overcome these attitudes.

Doctors also suggest things to women while they are at their most vulnerable. After I had been pushing for hours and the pain was a lot worse than I thought it would be, the OB came in and asked if I wanted a cesarean. Of course I did, then! I thought it would be great if I could just be put to sleep and wake up and the baby would be there. I think that's an inappropriate thing to suggest to a first-time mother who is havng a hard time, especially when the baby is not in any danger. No one asked if I would like to change positions, have something to drink, or take off the monitor. (I actually found the EFM to be painful.)








T
A friend of mine was a medical student planning to be a pediatrician. Then he had a nervous breakdown (as a lot of med students do) and decided it wasn't for him. He is now a nuclear engineer. One would think if his main interest was children, he would have then tried to become a child psychologist, teacher, or something else that helped children. Instead he went for something totally different. I don't think he wanted to go into pediatrics out of concern for children. Reminds me of people who become OBs when they have no respect for women.


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## Greaseball (Feb 1, 2002)

Heh heh, it's me again! I just had to post about one of those "extreme situations."

A 42-year-old woman had 2 cesareans for CPD/FTP, and wanted a home birth with her 3rd pregnancy. She was under 5'2, carrying twins, and the first twin was breech. She had to look out-of-state for a midwife who was willing to help her, and the midwife had to fly in. The woman was in active labor for three full days and nights, and each baby was about 7.5 lbs. And, of course, everything was fine. The ultrasound had also gotten the gender wrong. (This is all from Open Season.)

I actually don't think the situation is that extreme.


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## its_our_family (Sep 8, 2002)

Quote:

_Originally posted by pamamidwife_
*Yeah, I responded to the ignorant comment above made by your chiropractor in another thread that you posted it on before.

That said, I'm sorry you got stuck with some egotistical CNMs. You live in a state that is hostile to homebirth midwives and I'm sure the CNMs are not willing to align themselves with anything but the medical model.

Still, hearing it from one outrageous, egotistical chiropractor (who sounds pretty full of himself from the way you have talked about him) does not make it so. Please remember that. I find the repeating of that - especially because you SAY you don't believe it - so offensive.
*
Ok, I know my state isn't very homebirth friendly...obviously







But my chiro had 2 of them. and it was also the way he told me I should be going. I don't think it is an ignorant statement. I believe there are SOME who have done just what he said. I do not think it is the majoirty by far. In fact I think that majority are doing it becuse of the right reasons. So, I guess I can't say I don't believe it is true in every case but some cases, yes.

Is my chiropractor egotistical....yes,in some ways, but aren't most ppl in some ways?

It is very true around here that cnms are very medically minded. I got the brunt of it being vbac.

And I have not just heard the comment from ONE egotistical chiropractor. I've also heard it from a midwife or 2 and an ob or 2. I was just trying to show that the mud slinging goes both ways.


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## charmander (Dec 30, 2003)

I just wanted to say - what midwife would WANT to go to medical school? Doctors study pathology and how to treat diseases and abnormalities. They are trained to intervene.

Unless there are complications, birth is a normal, natural process and NOT a medical event. But you wouldn't know it if you gave birth in a hospital.

cmd
DS age 5
DD 13 weeks (home birth)


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## TurboClaudia (Nov 18, 2003)

Great post Hilary! And I don't think that's just a New Zealand perspective. Your experiences may be, but your citations of research and background are very appropriate.


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## pamamidwife (May 7, 2003)

Quote:

_Originally posted by cmd_
*I just wanted to say - what midwife would WANT to go to medical school?*

Yeah, why go to medical school? I make SO MUCH MONEY as a homebirth midwife!

And, my $2000/year license is great, too!

Oh, and let's not forget the fact that I'm as popular with mainstream America as Ralph Nader!

I appreciate the fact that any adverse outcome at home is well publicized and family and midwife are shamed, while mothers and babies die in the hospital all the time and nothing is said.

And no off-call time? My family loves that!

The 36 hour births that I'm there the whole time, rather than consulting by phone and waltzing in at the last minute? YEAH!

I just wanted to catch babies right away, that's why I never went to medical school. Nope, I didn't care about anything in regards to safety, hell, I'm one crazy wild lady that lives on the edge! I just wanted the fastest, easiest way to do it! That's me, selfish midwife! Oh, and many of the midwives out there are the same way! We're all reckless and dangerous!

/sarcasm

So, that may not sound like I love my work, but I do. Honestly.







I just envy one of my best girlfriends that is an MD and her office hours, her on call and off call time, a regular paycheck, paid vacation time, etc.

But, that's about as far as my envy goes.


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## georgia (Jan 12, 2003)

No, doctors aren't *always* to blame. I believe it's the entire medical model of care (and the accompanying technocratic view of birth) that is the main issue. Doctors are merely the most visible spoke of that horrendously broken wheel. If I remember correctly, the #s for women who need "obstetric" care during their pregancies is about 10%....so, for the other 90%, they're seeing a surgeon, hoping not to have surgery.

Amy
(whose mom--a registered nurse, just called to tell me my cousin had her baby today, "Emergency C/S!!!", in Manhattan, b/c "the baby was 9 lbs!!! She would have never made it. Thank goodness for modern medicine!!"


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## georgia (Jan 12, 2003)

Especially since she knows I had my second, 9 lbs (which IMO, is not very big!), at home......


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## fourgrtkidos (Jan 6, 2004)

I am an RN and worked labour and Delivery at a hospital that did 300+ births a month. There are always doctors who love and respect woman and know that birth is a natural process and that a woman knows instinctively what she needs to do to birth successfully...... and then there are always the jerks (male and female) doctors who don't feel that they really did their jobs unless THEY made that birth possible by intervening. I had a female MD tell me birth would be "perfect if the mother wasn't in the room". I had a male doctor tell me "I don't feel like I'm needed.... so to keep from being bored (and in my opinion to stroke his ego) he always did an episiotomy." The surgical procedure caused him to feel like he was part of the work that had been done and therefore could take some credit in the birth. I have also had another male MD say "look how wonderful women's bodies are..... they bring us into existance and you are all an expresion of the divine." He was in awe of our ability to create or be used by divinity to create. He loved women and believed he was only there to support, protect and preserve the mother's and baby's life. His gift to his patient's was this: he empowered them to do all the work and get all the credit for the birth and it's product! He only lent his medical expertise when it was needed. Only when the process of birthing did not go as mother nature intends it. He felt being allowed to attend birth was a priveledge not that his patients were priveledged to have him attend. It is no surprise that he had the lowest intervention rate, the lowest post-partum infection rate, lowest episiotomy rate, lowest c-section rate, lowest newborn neonatal admission rate and lowest postpartum depression rates.
He should've been a LM!!!!


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## Greaseball (Feb 1, 2002)

OBs are basically practicing midwifery without a license. They should be required to attend a certain number of home births with midwives before being allowed to deliver babies themselves.

If women are to be informed, someone needs to educate them. I think it should start whenever sex education starts. Teach kids and teens about normal birth, cesarean prevention, alternatives, etc.


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## its_our_family (Sep 8, 2002)

Quote:

_Originally posted by cmd_
*Unless there are complications, birth is a normal, natural process and NOT a medical event. But you wouldn't know it if you gave birth in a hospital.
*
Are you saying that by looking around you can't tell that birth is a natural thing?

Because otherwise may I







for giving birth in a hospital. Just because I did doesn't mean I see birth as an unnatural event. It sickens me that there are so many issues to deal with in order to have a baby! I would like nothing better than to have everyone leave me alone and jsut be able to give birth. But because of decisions I made without knowing the facts or being informed it isn't going to happen.

In today's world EVERYTHING is medical. Thats just how it is. Now some ppl choose to go the other way (which is great) but the majority of ppl don't. So, of course we can blame the drs. Where else does the MAJORITY of ppl go? To the ob. So, it only makes sense that they are involved in the majority of interventions and such. (does that make sense?)


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## cottonwood (Nov 20, 2001)

I totally agree. Many interventions wouldn't be able to take place without the consent of the patient. But it doesn't matter how strong and informed the patient is, there comes a point where the birthing woman (because her body is otherwise occupied) is vulnerable, and the medical staff can easily gain the upper hand. To keep that from happening takes a lot of strength that should be devoted to the labor, not to demanding your rights. That's stressful, and stress hinders the process, and it hurts the baby.

Oh well then the solution is easy, right? Just hire the "right" doctor at the "right" hospital in the first place. But there are no guarantees. If you have to give birth in a hospital (or even at home with a midwife) all you can do is make the best educated guess at which are the best people to hire. Past that, it's luck.

And what about women who just aren't so smart? Or so strong? Do they deserve it when they get unnecessary interventions at the hospital? Or should we instead expect medical professionals, who make the claim of being "healers", to get their heads out of their asses and start practicing scientifically and compassionately? And when they don't, to hold them accountable?


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## its_our_family (Sep 8, 2002)

Quote:

_Originally posted by blueviolet_
*But it doesn't matter how strong and informed the patient is, there comes a point where the birthing woman (because her body is otherwise occupied) is vulnerable, and the medical staff can easily gain the upper hand.*
Ain't that the truth!


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## Greaseball (Feb 1, 2002)

Quote:

And what about women who just aren't so smart? Or so strong? Do they deserve it when they get unnecessary interventions at the hospital? Or should we instead expect medical professionals, who make the claim of being "healers", to get their heads out of their asses and start practicing scientifically and compassionately? And when they don't, to hold them accountable?
I don't think "she deserved it" just for going to a hospital. I think if a woman with a normal pregnancy wants to deliver in a hospital, she should see a CNM. An ethical OB would say to this woman, "You are too healthy to be seeing me" and would refer her to someone who oversees normal birth.

Also, about lawsuits - could it be these women would not be suing their doctors unless the doctor had done something wrong in the first place? Why is it always the mother who is to blame? I practice a very simple program - I don't want to be taken to court, so I don't do things to hurt other people. Maybe if doctors followed that philosophy, they would not be sued. If you don't want to be sued for malpractice, stop malpracticing! It's so hard to sue a doctor anyway, so if they lost in court they probably were guilty.

If someone does something wrong to me - runs into my car, breaks my window, etc. - of course I will be taking them to court. I guess I'm just not very forgiving and compassionate. I'm sure these same doctors who complain about being sued would sue someone who harmed them as well.

Hilary - I don't know if they use pelvimetry in the U.S. anymore. It's unreliable even if the woman is squatting, since it doesn't measure how much the pelvic ligaments will stretch or how much the baby's head will mold. Do they still use this in NZ?


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## Alstrameria (Sep 8, 2002)

Thank you Hilary, for your previous posts.

In my area, we have seen a huge increase in the amount of doulas available. Dh and I had one with us at dd's birth. She was never compelled to "advocate" for us, but she could have, had something unexpected come up.

I like to think the rise in doulas is indicative of our community's progressiveness. At any rate, it's a good start to getting the information out there.

I do believe I am responsible for my decisions, this goes beyond birth.

Quote:

Oh well then the solution is easy, right? Just hire the "right" doctor at the "right" hospital in the first place. But there are no guarantees. If you have to give birth in a hospital (or even at home with a midwife) all you can do is make the best educated guess at which are the best people to hire. Past that, it's luck.
I love my doctor, truly he is like a member of the family. If I didn't have a doctor I trusted, I would see someone else. Same for a midwife. Same for a dentist.

Quote:

And what about women who just aren't so smart? Or so strong? Do they deserve it when they get unnecessary interventions at the hospital? Or should we instead expect medical professionals, who make the claim of being "healers", to get their heads out of their asses and start practicing scientifically and compassionately? And when they don't, to hold them accountable?
They deserve to be treated with respect! I think both things need to happen.

Jen


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