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Thursday
Feb072008

11 Myths About...

... Top 10 Childbirth Myths.

(The Owner of the above site initially made her blog private after I posted this. She has since opened it back up to the public without an iota of an acknowledgement that she re-considered anything the others or I have said to her. I encourage going there and commenting if you have something to say to her.)

1. When citing research, anything that is in print or on the web is true and I can use them as citations.

FALSE! Citing magazines such as Compleat Mother or websites such as Mothering.com and Pregnancy.about.com is not only inappropriate, it makes you look foolish. Compleat Mother is a magazine for the fringes (and I have been published in there more than once, so I can say that lovingly) and most of the content is written by mothers, not researchers.

You write:

“And before a single person comes and says "but but"...don't comment unless you have medical evidence, as in published research, to back it up. Period. All other comments can and will be deleted.”

Yet your own “citations” are anecdotal and un-researched.

Just because it is in print or on a website doesn’t make it true. Even if I write it.

2. Before Cesareans, women only died of diseases.

Can I just say, “HOW THE HELL CAN YOU SAY THAT?!?” You, Christy, need to read some midwifery texts from the 1600-1900’s. You only need look at our world today to know that this is so absurd it leaves me blinking at your ignorance.

From UNICEF's site (since we are using websites as a source):

”The complications of pregnancy and childbirth are a leading cause of death and disability among women of reproductive age in developing countries; more than 500,000 women die each year from maternal causes. And for every woman who dies, approximately 20 more suffer injuries, infection and disabilities in pregnancy or childbirth.

"The most common fatal complication is post-partum haemorrhage. Sepsis, complications of unsafe abortion, prolonged or obstructed labour, and the hypertensive disorders of pregnancy, especially eclampsia, claim further lives."

Making sweeping assumptions is extremely dangerous to the women reading your post.

3. “Again, unless you've been wearing a corset since puberty, or unless you have some bone deformation that effected (sic) your pelvis, or you were in an accident that effected (sic) your pelvis...this is not going to happen. Period. Less than 2% of women truly cannot birth their babies, and it has nothing to do with weight...it has to do with one of the reasons mentioned above.”

Sitting dumbfounded

You have got to be kidding, right?

This site discusses the rates of death and damage to babies born via planned breech birth compared to planned cesarean births. Mal-presentation is a serious and not unusual reason for a baby to die in utero around the world.

There are babies that don’t fit! Women eat enormous amounts of calories in this and other “developed” countries. Our meat and dairy supply harbors growth hormones that can affect a baby’s final weight. Women in our country are FAT (myself included) and they can grow some really big babies that can – and do – get stuck. Ask the multitudes of mothers who have experienced a shoulder dystocia... even women who did not have epidurals and were not on their backs.

(And of course I know the reasons for most shoulder dystocias don’t occur in the home – vacuum, forceps, immobility – but that doesn’t mean they don’t happen in homebirths. Personally, I’ve had 4 serious shoulder dystocia babies in appropriately-nourished mothers who grew huge babies – and one of my own [I was over-nourished]. We aren’t debating that there can be precipitating causes for a woman’s inability to push a baby out, but discussing that sometimes there are causes that can’t be prevented!)

What about women birthing babies who are persistent oblique lies? Transverse? Babies with spina bifida? Babies with hydrocephalus? Triplets? Babies with a really short cord? Babies with cords wrapped incredibly tight around their necks? Moms with a placenta previa? Moms whose babies are so post-dates the head no longer molds? Babies with a posterior face presentation? Some babies in a military position? Plenty of posterior babies find themselves in a too-tight place and need to be birthed via surgery.

Your thoughts do a great deal of damage to women who had valid reasons for having a cesarean. If I were a potential client reading your blog, I would stay far, far away from you because of your inflexible and unrealistic attitude towards the real-world possibilities in birth. You certainly don’t have to be paranoid when working in birth, but an understanding of the potential is crucial. How else can you be an appropriate lifeguard if you don’t recognize a drowning swimmer?

4. It’s okay that the baby’s cord is around the neck, you can always deliver your baby vaginally. “Babies will have cords long enough to facilitate a vaginal delivery. It's extremely rare that a baby will have a cord too short to do so. And really, there is NO way of knowing before you've gone through NATURAL labor.”

This quote illuminates one of the main issues in your entire post. You sound so sure of yourself, speaking in absolutes. “Babies will have cords long enough....” Yet, in the next sentence you say, “It’s extremely rare that a baby will have a cord too short to do so.” What is it? The cord is always long enough? Or rarely the baby won’t.

You say, “... there is NO way of knowing before you’ve gone through NATURAL labor.” How can you look a mother who’s lost her baby from a cord accident in the eye after thinking this? While you may not know anyone who’s had a baby die from a cord accident, you will one day. You’ll know several.

This myth you harbour is so wrong, so damaging to the truth about cords, it’s hard to understand what kind of midwifery you are studying. Are you reading midwifery texts?

From this Yale Medical School site :

“IUFD due to umbilical cord complications. The most common cause of IUFD in the third trimester is due to umbilical cord accidents. Carey and Rayburn reported that over a five year period in their institution a single nuchal cord was observed in 23.6 percent of all deliveries, both live and stillborn, and multiple nuchal cords were found in 3.7 percent of the stillborns. In another study Sornes determined an incidence of umbilical cord knots to be 1 percent, and a knot associated mortality rate of 2.7 percent. This was in contrast to the 0.48 percent rate of mortality in unknotted population. However, mere presence of a knot does not predict death. If the knot is loose and fetal circulation is maintained the fetus can survive, but if the knot is tightened, then there can be constriction of the blood vessels and fetal circulation can not be maintained. Furthermore, decreased Wharton’s jelly in certain areas of the cord, most notably the fetal and placental insertions, can result in occlusion of fetal blood flow if the vessels are twisted sufficiently.”

5. It’s okay that your water has been broken for days – and even weeks – if you keep everything out of the vagina, nothing bad will happen. Oh, and if you do mysteriously get an infection, you’ll get a fever to let you know.

FALSE. Reminding you, I went 7 days with my membranes ruptured with my third, but I had a doppler, went in to be checked by CNMs and had an NST and was meticulous with my vaginal care, but a woman in my care would not, in almost any circumstance I can think of, be encouraged to sit idly by waiting for labor to begin. Even I didn’t just sit there. I was nursing a toddler, did castor oil twice... even tried the cohoshes (with my German midwife there listening to the baby), all to no avail. I did eventually go into labor on my own, helped by my nursing daughter.

If a client of mine had ROM (release/rupture of membranes), not only would she be doing the infection precautions (nothing in the vagina, no baths [in general, these are fine with ROM in labor, but sitting in one’s dirty water, as far as I’m concerned, isn’t optimal for the baby], no tampons, taking her temperature every 4 hours, plenty of Vitamin C), but I would be at her house every few hours to listen to the baby, doing make-shift NSTs to see how the baby was doing. I might send her in for an NST/BPP. I’d have her do kick counts twice (or more) a day. I’d have her drinking a gallon of water a day. She'd be taking a goodly dose of Vitamin C. She’d also be pro-active getting things moving after 12 hours of ROM with no contractions. I’d offer her IV antibiotics after 18 hours, so would be there every 4-6 hours after that to give the antibiotics. I’d be hard pressed to go past 24 hours without considering Plan B.

Too much? The atmosphere isn’t one of drama or fear, but a healthy dose of considering the baby’s health and welfare. The visits are pleasant and light-hearted; my blending in with the family and gentle nudges to move into labor.

It is not true that infection is always heralded by a fever.

From The Green Journal:

“Among 6294 women who delivered in 1996, 189 (3%) had hospital discharge diagnoses of maternal chorioamnionitis. Fever was identified in 86, tender uterus in seven of 133, maternal tachycardia in 63, fetal tachycardia in 67 of 133, and foul-smelling AF in 10 of 136. Among 53 cases without fever, 30 had at least one clinical finding consistent with chorioamnionitis, and 72 of 86 cases with fever had at least one additional clinical finding consistent with chorioamnionitis. A total of 19 cases had no recorded objective evidence for clinical chorioamnionitis, and 11 of those had histologic (diagnosed via pathology) chorioamnionitis.”

Read here for even more information.

And one more note about prolonged ROM without labor. If a woman is GBS positive, has a herpes outbreak while waiting, has another sort of infection that hasn’t been diagnosed, she may have NO symptoms whatsoever, yet be infecting her baby as she waits for labor to begin.

From EMedicine:

“Because only 0.5-1% of mothers who carry GBS develop signs and symptoms of disease, clinical diagnosis of GBS infection can be problematic.

"In pregnant women, GBS is a cause of cystitis, amnionitis, endometritis, and stillbirth. Occasionally, GBS has caused endocarditis and meningitis in pregnant women, while, in postpartum women, GBS has been identified as a cause of urinary tract infections (UTIs) and pelvic abscesses.”

And while the majority of my clients choose not to be tested and plenty of homebirthing women also choose not to be tested, it is a consideration when awaiting labor with ROM. GBS infection can have no symptoms in the mother while infecting the baby. Something to remember.

6. ACOG encourages VBACs and women shouldn’t worry about the risk of uterine rupture.

ACOG says:

“Most women with one previous cesarean delivery with a low-transverse incision are candidates for VBAC and should be counseled about VBAC and offered a trial of labor.”

and

“Because uterine rupture may be catastrophic, VBAC should be attempted in institutions equipped to respond to emergencies with physicians immediately available to provide emergency care.”

and

“After thorough counseling that weighs the individual benefits and risks of VBAC, the ultimate decision to attempt this procedure or undergo a repeat cesarean delivery should be made by the patient and her physician. This discussion should be documented in the medical record.”

I’d hardly call that “encouragement.” In fact, it sounds incredibly discouraging to me and it is because of the second paragraph that too many hospitals aren’t even permitting VBACs anymore.

Christy says, “So then why do women believe that the *LESS THAN 1%* risk is too high?”

Perhaps because – for them – that risk is too high! Women are permitted to make their own conclusions and while it is true that enough OBs discourage/ban VBACs that it’s annoying as hell, it is also true that many women choosing a repeat cesarean have made that choice with their own research and thought process. Discounting women’s choices and saying that they shouldn’t concern themselves about a rupture is irresponsible and dangerous.

An important reminder: When that “less than 1%” is YOU, it is 100% for you. That the number exists means it happens.

7. “When you induce at 38 weeks, you're essentially inducing a 36 week baby. Period. And let's not forget that the BABY is the one that initiates labor. The baby's lungs release a hormone called Surfactant, and this hormone begins the labor process. When you induce, you're trying to induce a baby who's not ready to be born.”

I highly suggest you go back and learn how to determine gestational age. I don’t know where you learned that a 38 week pregnancy makes for a 36 week baby, but whoever gave you that information is WRONG. For crying out loud, Christy, this is BASIC birthing information. Your emphasis (“Period.”) doesn’t make it true.

Period.

The baby MAY initiate labor... or at least be one of the factors in starting it. There are still so many unknowns that it would be complete arrogance to state that one variable is the trigger.

As others pointed out, if surfactant were THE domino that started labor, why are babies born prematurely without it? How come some full-term babies are born without it?

Here it says:

“In full-term babies with unexplained progressive respiratory distress from birth and progress of radiological changes, both AD and SPBD should be considered. (Acinar Dysplasia and Surfactant Protein B Deficiency)

“Pulmonary surfactant dysfunction (inactivation, deficiency) has been implicated in term neonates with respiratory failure.”

8. When a woman has an epidural, she is completely immobile and has to lay on her back the entire rest of her labor.

Hmm. Have you not seen women be able to sit on birth balls, in rocking chairs or kneel in bed with (walking) epidurals? Did you know that sitting isn’t laying on the vena cava? Have you not seen women with epidurals have to rotate from side to side to get the medication to the unaffected side? Do you not see women bend their knees?

If you are being emphatic, be truthful and clear. Don’t make sweeping generalizations that aren’t true. You make it sound like a woman is all but in a coma with an epidural. Not so at all.

There are many other exaggerations in your number 7 (epidurals causing BP issues that cause cesareans [typically, they slam fluids and it’s resolved many more times than a cesarean is necessary], epidural births often end in the need for a vacuum extraction or the use of forceps [untrue! SOMETIMES, not often]) - , too, but this is long enough already.

9. Amniotic Fluid is the baby’s urine.

No, it’s not!

"Where does amniotic fluid come from?

"Early in the pregnancy, the placenta produces amniotic fluid. Later on, about the fourth month or so, the baby's kidneys start to work, and then the amniotic fluid is made there. Although the kidneys ultimately are responsible for filtering waste products out of the blood and making urine, amniotic fluid is not urine as we think of it. The majority of the baby's waste products actually are transported through the placenta to the mother's circulation and are then filtered by her kidneys. This cycle repeats on a regular basis as the baby swallows fluid and releases it through her urinary system, and so on."

From GYNOB.com:

"By the beginning of the second trimester there are 50 cc of fluid in the amniotic sac, and this fluid isn't much different from the baby's plasma, indicating an origin from secretions through the umbilical cord, membrane coverings of the placenta, and even the baby's skin. By the 36th week there is usually around a liter of amniotic fluid, but by this time it is made up for the most part from fetal urine. The turnover of fluid is fairly rapid, with a build up from urine and a reabsorption from fetal swallowing being important dynamics in the amniotic fluid picture from hour to hour. Since the baby's kidneys mature over the gestation, the amniotic fluid is more fetal urine-like later than it is when the kidneys are less mature. "

You also speak about low fluid volume and that in 98% of cases, drinking a gallon of water will remedy the issue. Only the misunderstanding of the placenta’s role in amniotic fluid could bring someone to say that.

Amniotic fluid is NOT only a mother’s fluid intake! Mind you, I have women hydrate before ever doing an AFI or BPP because it can make a difference (and research does say it can significantly elevate fluid levels), but if a placenta is deteriorating, gallons of water ain’t goin’ to make a hootie bit of difference. Where did you pull “98% of cases” from? Where did you obtain the protocols for low amniotic fluid from?

Here read what the Journal of Family Practice considers appropriate protocols.

While hydrating is one of the recommendations, it also states the repeat ultrasound should be within 4-6 hours, not 24 hours as you stated.

And if a woman has a(true)n amniotic fluid volume under 5, she best be discussing what she’s going to do immediately, not going home to research and deciding what to do. INFORMED CONSENT (as you holler) includes knowing about cord compression, placental insufficiency, fetal wasting, possible fetal distress in labor as well as the risks that come with induction, including the risk of cesarean being doubled. All of these things should be a part of the discussion. Not just the scary stuff about induction; not just the scary stuff about not inducing.

You also mention non-medical induction as an option for induction if it’s called for, but only speak about a Foley Catheter insertion. Foley’s don’t always fit/work. What then? What other non-medicinal ways do you mean? Castor oil? Nipple stimulation? Each of those has their own risks associated with them, too… you know that, right? Even the Foley isn’t without its own set of risks including infection, possible ROM, maternal discomfort, etc. No method of induction, natural or artificial, is without risks. This is yet another aspect of informed consent that’s crucial in a midwifery practice.

Lastly on this Myth, you asked what the woman was doing having an ultrasound for in the first place. Perhaps the baby has slowed down and she wants to know how s/he is fairing in there. Perhaps she is measuring small or large for dates and more information is needed/wanted. Perhaps, if you would excuse me for saying so, but perhaps it isn’t all horrors when a woman goes beyond (insert your arbitrary point of comfort here) weeks and taking a peek at the baby can offer a lot of reassurance that things are clicking along fine and dandy.

Perhaps acknowledging statistical evidence might be in order, preparing a woman for the BPP with proper counseling before she goes in (as I do and have shared here on this site before), coaching her on the typical remarks she might hear, and being available to her should they tell her it is crucial to be induced now. Perhaps not demonizing ultrasounds is a dandy idea considering the vast amounts of information one can learn from them – when they are used judiciously and professionally.

One of my favorite lines: The judicious use of technology is fantastic. It’s the indiscriminate use that is abhorrent. (“Can we all say, ‘Amen!’”)

10. “Does anyone actually know what HAPPENS when membranes are stripped? The care provider inserts his/her fingers INTO the cervix, hooks the finger in between the cervix and the amniotic sac (if even possible...most women that request this aren't [sic] barely a fingertip dilated)”

Yes, many, if not most, women know what happens when the membranes are stripped/swept – IF their provider gives them that information or IF the woman is told the truth when she asks what it is.

I’m not sure where you heard that “most” women are “barely a fingertip dilated,” but in my 25 years and in all the places from hospitals, birth centers and home, care providers simply wouldn’t even try to strip someone without the cervix being at least 2-3 cm. And, while we are on that sentence, I have rarely heard a woman ask to be stripped. It is almost always something that is brought up by the provider because of a post-dates pregnancy and concerns about a medical induction are looming. You also say “it is not uncommon” for the membranes to rupture with stripping. Not true! It happens, yes. But, common? No, it isn’t.

I should insert another Myth here, but you’ve blithely included it in this one, so I’ll call it…

  • Myth 10.5 The baby will come out when s/he is ready.

Not always. Some babies will cook inside until they die. It isn’t uncommon for women who need help getting pregnant to need help getting un-pregnant. Women with insulin resistance issues, seriously obese women, women with PCOS/Syndrome X or women with infertility issues that are hormonal in origin all can need help with starting their labors. Of course, it isn’t every woman, but enough to raise the eyebrows of any care provider when a pregnancy is plodding on and on. And on.

For some, it’s far better to strip membranes, use EPO, do nipple stimulation, herbs, sex, castor oil, herbs, etc. instead of pitocin. Other women just want to cut to the chase and induce with pit right out. Again, informed consent is vital.

MOST babies do perfectly fine at or after 42 weeks, but it is a statistical fact that babies born after 42 weeks have a higher mortality rate.

From this midwifery site:

It is undeniable that the rate of stillbirths and neonatal deaths does rise as pregnancy becomes more and more prolonged. However, many of these deaths are due to congenital abnormalities, or occur in babies with intra-uterine growth restriction.”

I would note that it wouldn’t be unheard of for a woman wanting to out-wait a post-dates pregnancy that she might not have had an ultrasound in the first place or, if she has, it might have been so early she wouldn’t know if there were anomalies. And, truly post-term babies don’t keep gaining weight; they actually start losing fat and weight, possibly putting them in the IUGR classification.

What’s nice in this culture is it doesn’t have to be an all-or-nothing proposition. It doesn’t have to be, “I’m just going to sit here and wait until the baby comes out even if hell freezes over first,” nor does it have to be, “Give me a failed induction with a hefty serving of a cesarean on top.” We can actually utilize the technology we have in a positive way, use it to our benefit, to gather information that aids in our own informed consent. We canNOT always depend on others to tell us everything we need to know. Nor can we just “know everything’s alright because I know it is.” We have a real responsibility to our own care and our baby’s lives to find the truth in the matter. Use whatever means are available to come to the conclusion that works for you. Have your midwife do a makeshift NST. Make sure you are doing meticulous kick counts every day. Pay attention if the baby slows down. (Term babies do NOT slow down. The movements get “tighter,” but the baby does not stop moving. If your baby stops moving, GET HELP!) Whatever you choose to do, don’t just stick your head in the sand.

Whew. One more. Well, one and a half.

11. Women who “claim” they pushed for hours really weren’t completely dilated and were forced to push before they were ready. Or they were in bed. Or had an epidural. Or were induced (which I have zero idea why this even matters).

Uh, nope. Some women, even when not medicated, are upright, even squatting, still push for hours and need a cesarean in order to get the baby out healthy and alive. In the last two years, one in the last 6 weeks! I’ve had two women who pushed for several hours. One had forceps to help the baby out (because there wasn’t an operating room available) and the other had a cesarean for a baby in the military position. The babies did well, but they don’t stay well with endless hours of pushing.

True, many women in the hospital are medicated and in bed. True, pushing in that position sucks for rotating a baby out of the pelvis. I don’t dispute that at all. What I take umbrage with is the word “claim” more than anything else. Like a woman is lying to you or everyone else. What do you know? Do you have her records in your hand? Were you there? Were you the provider who was in charge of making the decision to deliver a happy baby or keep pushing needlessly until the baby wigs out and needs to come out really fast?

If nothing changes, then nothing changes.

If the woman has an epidural and is in bed and has been pushing for a long time (use your own judgment about what a “long time” is) and there’s no forward movement, what good will more pushing do if she still has an epidural and is still in bed?

Something needs to change, yes? Let the epidural wear off if she’s game for that. Get her in different positions. (Hospitals won’t feed her, but in a homebirth we would.) Even let her rest some as long as the baby is being watched closely and all is well. But, as we know from countries without care like us, babies die impacted in their mothers’ bodies and ours can, too... if we just wait and wait and wait.

You say, “Your body WILL labor the baby down. Sometimes women are at 10cm for a few hours before feeling that urge. THAT'S OKAY!”

I’ve been doing this a long time and I haven’t ever seen, or heard of anyone in real life world, at 10cm for “a few hours” before the urge to push came along. Awhile, yes, but a few hours? Why would the body work that way? Unless there wasn’t appropriate pressure on the cervix, the normal course is dilation, then pushing. And, if someone is waiting a few hours, I’m hoping someone is listening to the baby to make sure s/he is doing well with the lull. Labors can peter out from maternal exhaustion and when mom is exhausted, babies can be (and eventually are) affected.

I agree that pushing immediately upon announcing a woman is 10cm is not the way to go – unless the baby needs to come out sooner than later (there are always caveats!). In fact, if people keep their hands out of the vagina and off the cervix, the mom will begin pushing when she is ready. But, if there is a long lull after wonderful strong contractions, someone might want to check and see what is happening... is the baby in a good position to put pressure on the cervix? Is there a hand there? Or is the lull just the normal course of events. This lull is different than one where a labor just seems to wind down – runs out of steam. That is the more ominous labor... exhaustion, malpresentation are two major reasons. And a posterior baby. Another common reason.

Some women need to push harder than others – when the baby is having a hard time and needs to get out or when the baby is a goodly size – these women in particular might need to do some of that Val Salva pushing to get a baby through the pelvis sooner or easier.

But the truth is, the body will not always labor the baby down. And midwives and doctors have skills in assessment for a reason and that it to use them – when appropriate!

  • 11.5 Women just don’t know that they didn’t need that cesarean. It’s my duty to make them feel like crap about their birth experience, not allow them to discover on their own if a cesarean was warranted. It’s important to discount a woman’s birth story even if I wasn’t there, don’t have her records, don’t know HER truth.

I think of all the things in this post that irks me the most, it is this belief.

Recently, I made judgments on another woman’s birth story and was quickly slapped hard to remind me to allow her to have her experience... keep it tender inside. I pulled the post (and want to thank the commenter that spanked me hard over it, too!) and shook my head to clear the fog so I could remind myself that women see what they need to see in their own time. Yes, women reading your blog were certainly led there, but hearing the snide implication that they were stupid for not changing their own births is just mean.

I encourage you to watch your tone when speaking about choices other women make. Intonation is hard to interpret in writing oftentimes. Some women agonize over their need for a cesarean (in fact, I’d say most women are deeply affected by the experience) and it’s vital for a midwife to BE where a woman is so she feels safe discussing the issue with you. She needs to know she won’t be judged, but that you (her midwife) will be empathetic and available should she need to know more information. Making a woman feel stupid is cruel.

Cases in point (emphasis mine):

“So, my previous posting on "Another Post-Cesarean Maternal Death" brought women out of the woodwork, trying to disprove the *fact* that cesareans are dangerous ( not just according to me - but according to every health organization that's weighed in on it so far ) with their personal stories and anecdotes. Most of them included elements that *led up to* the "need" for a cesarean. So that got me thinking about how many women out there truly believe all of the myths surrounding childbirth. This journal is to have a bit of fun while dispelling the aforementioned myths. : ) And before a single person comes and says "but but"...don't comment unless you have medical evidence, as in published research, to back it up. Period. All other comments can and will be deleted. : ) Have fun!”

(Fun? Have fun? How?)

“Oh, and for those of you who are genuinely wanting to learn....”

“Hmmm...maybe women should start asking their doctors for evidence based research when they tell them that the have to do _____ or _____. ; )

(How is that worth a wink?)

Women, go google (sic)....”

“I fail to see how this argument is even relevant if the person posing this argument would actually take 5 minutes to really think about it.”

“...unless you've been wearing a corset since puberty, or unless you have some bone deformation that effected sic) your pelvis, or you were in an accident that effected (sic) your pelvis...this is not going to happen. Period.”

Women don't understand that the things that you allow into your labor can - and will - often seal the outcome of the delivery.”

If you don't consider trying to force your baby out before he's ready, and possibly causing breathing complications in him...then sure, no big deal.”

“...saying that either their baby was too big, their pelvis was too small, or their body just didn't dilate. When an induction fails, your body does exactly what it's design to do - protect the baby. It didn't end up in a cesarean because the baby was too big, your pelvis was too small, or your body just didn't dilate....it ended in a cesarean because your body was protecting the baby inside who wasn't ready to come out. And then what happened? (you, stupid woman) Baby was cut out of you instead.”

Why do women believe that anesthesia going into their spinal column, integrating into their spinal fluid and through their system will not affect the baby? I really don't get it....”

Does anyone actually know...?”

“The first questions I ask women who claim this....”

So many women believe what they are told, instead of doing the research for themselves. If you'd TRULY like to learn more....”

The information you were trying to impart could have been kindly said. The belittling tone is offensive. I hope, if nothing else, you will take a moment and see if you might, from now on, speak in a gentler tone of voice to the women who might not understand your point of view, but that you want to hear you.

One last point about your number 10.

I find it offensive that you speak about bowel movements when talking about a baby coming out. In fact, many women find it offensive as I have learned over the years. It is a baby coming out, not poop. The sensation is sometimes like a BM, but not always. But thinking about pooping when one’s newborn baby is coming through the pelvis and vagina can cause enormous distress to many women. In fact, it’s a common question from women... wondering if they will have a BM during pushing and their embarrassment in advance about it. It takes some time to help women not be so concerned lest poop come out during pushing. Not every woman loses her concern and embarrassment, either, so mentioning it really isn’t very helpful.

Alllllll this said, I’m sure it looks like I am Ms. Medwife by now, but I say these things, Christy, so you understand the value of debating issues. In order to defend your own information, you must be able to speak from the other side’s viewpoint! If you don’t know ALL the information, how can you give informed consent? (The question always is, “How informed IS informed consent anyway?”)

In your comments section, being snippy about people’s questioning your words is an immature way to react. Folks’ comments are valuable moments in time to think, re-think and re-think again your thoughts and beliefs. It’s a time when you re-group and speak eloquently about what you believe is true.

It’s obvious you care about women, but it’s really important to care, too, about their feelings. And that they get the right information. I hope you’ll look deeply inside and be able to expand your views from narrow to wide open. It’s better for that to happen sooner than later because women you come in contact with in your life can make it a painful growing process.

While this post was directed towards another singular post, the sentiments resonate through too many women’s attitudes about other women’s choices. I’m hoping that those of us who work in birth can sit for a moment and remember that we are speaking to human beings who try hard to do the best they can for their babies (even when we think they are making selfish choices). No one sets out to hurt their child. We can, through our example and anecdotal stories (because really, statistics can be manipulated in a myriad of ways and interpreted differently by different people), illustrate varying ways to think, act, and be.

Be the example you want others to follow. My mantra... and my constant challenge.

Reader Comments (47)

EXCELLENT post. Just Excellent.

(I never minded the poop thing though. Helped me know I was using the right muscles. :) ) But that's me.

February 7, 2008 | Unregistered Commenterthordora

Thank you for this.

So often, as a natural birth advocate, it's assumed by others that I don't think epidurals should be an option, or that c-sections should never be performed, or that I don't think there was a chance of complications from having a baby born with the cord around his neck (didn't know this until delivery).

I believe natural birth is best in *most* cases, but of course interventions are sometimes necessary, and I believe the key is *informed* choice.

I'll be sending this link along to pg friends as need be!

February 7, 2008 | Unregistered CommenterJudy

BRAVO!

February 7, 2008 | Unregistered CommenterAnonymous

Brava for such a factually complete rebuttal, Navelgazing Midwife.

Regardless of where we fall on the homebirth question, I think all of us, including Apprentice Midwife, care about the safety of mothers and babies. However, you've got to have all the facts, including the ones that you don't like, in order to make informed decisions about your own care or for your clients/patients.

February 7, 2008 | Unregistered CommenterEmma B.

I think one thing people forget is what percentages really mean. You can see at least 100 mothers (of varying ages) just by walking around in any decently sized downtown area. Picture 1 of them losing a baby to this cause, and 2 to that cause, and a few dying of some rare complication or another, and the numbers start to look different.

February 7, 2008 | Unregistered CommenterJessica

OMG, who is this idiot???

i tried to comment on her site, but had to have a blog identity. here's what i wrote, barbwife. could you forward it? feel free to add any details i missed.
--------------------
my first baby was an unnecessary c-section because the MEDwife didn't recognize the classic signs of malpositioning.

second baby was VBAC, and proof that what you assert about cord length and pushing is NOT true.

my baby's cord was too short for her to descend properly on her own, period. and it wasn't even wrapped around anything!

it took a lot of work with MIDforceps to get her down into position for her birth. during that time she started deceling into dangerous territory.

i labored all but the last 1.5 ours with my baby AT HOME. NO DRUGS. with a midwife. free moving. i pushed for SIX hours. never once on my back. only when *i* felt the urge. no prompting from anyone. fully dilated. because of baby's short cord, she would descend, then rise back up.

my situation may be rare, but not impossible.

i am blessed that i wasn't cut when i finally transferred to the hospital. i know with any other ob i would have been cut. but DON'T blame me, implying that i could have done it "right" but just didn't. don't imply that i wussed out or naively followed medico bs. my baby was one of those rare examples of NEEDING medical intervention. the possibility of her dying without it was VERY real.

February 7, 2008 | Unregistered Commenternolabarb

Oh that was some much needed tough love, dear Navelgazing. I hope Christy can take it the way it was intended. If she made it to the very end, she will hopefully come to see you for a far more experienced and wiser incarnation of herself. She is not the first novice whose passion of her convictions leads her to think, and present her ideas, in terms of very dangerous absolutes. It's really human, a typical beginner's mistake. You're right, she certainly seems to care about women and babies, and if that's the case there is plenty of hope for her yet!

February 7, 2008 | Unregistered CommenterJudit

This is a great post, I hope she reads it and takes it to heart. I just wrote this post a while ago that sort of ties into this same issue; http://www.birthactivist.com/node/211

February 7, 2008 | Unregistered CommenterJennifer

I love you Barb...I really do. You are spot on. Thank you for posting this post. I think so many times "birth junkies" forget, sometimes things do not go perfect. Babies & Mothers do die. Please keep educating them. From the bottom of my heart, Thank You. Your posts like this keep the memory of my daughter Alexa, alive.

February 7, 2008 | Unregistered CommenterDebstmomy

Thanks for posting this!! It is very refreshing.
Nynke (birth doula and Birthing From Within mentor in Pennsylvania)

February 7, 2008 | Unregistered CommenterNynke

Barb,

I got teary-eyed reading your post. I'm not a reader of Christy's site, but I did go back and look at the original post for context. I was moved by what you wrote because as the mom of one baby (born by Caesarean) I have only one birth experience, and it's clouded and complicated and painful and beautiful all at the same time. I wanted a drug-free vaginal birth SO MUCH and did so much to pave the way for it. But it didn't happen. I continue to simultaneously beat myself up about it, try to learn from it, and come to some kind of peace with it. It really hurts when natural birth advocates make sweeping generalizations of the kind that Christy is making--especially when they are birth care providers. I knew all the stats going in. There was no way in hell my baby was coming out any way but lucid and through my vagina. However, he was posterior, and I labored for 40 hours. Maybe my Caesarean was necessary; maybe it wasn't. In the moment, I felt I was doing the right things, the best I could. It's only after the fact, faced with the arrogance of my own expectations, my profound sense of loss about the kind of birth I so wanted to experience, and the narrow-minded, uncompassionate attitudes of people who didn't experience what I experienced, that I have had such a hard time with it. YOUR words were like balm on that wound. I know that no one will ever be able to really tell me what SHOULD have happened. There is only what did happen. I thank you for standing up for those of us who have had to navigate those difficult waters.

February 7, 2008 | Unregistered CommenterErin

I really liked your comments about malposition. I think that a lot of cesareans result from malposition and most of those moms probably don't even know that the baby was malpositioned at all. If more women were aware of fetal positioning before and during labor, and what they can do to encourage optimal positioning, we'd see less cesareans.

I do have to say that your comments on VBAC make it sound almost as scary as the doctors make it sound. Less than 1% is a very low risk of rupture and there are other equally dangerous things that are just as likely (cord prolapse for one) but that shouldn't scare women into a repeat cesarean. The risks of ERCS are real too. Even with a true uterine rupture or dehisence it is not always a bad outcome. So not all of those in that less than 1% statistic are going to experience a hysterectomy or maternal or fetal death. VBAC is like normal, natural birth... you have a small chance for things to go wrong but you do everything you can to give yourself the best odds of things going right. I just hate to see the fear surrounding VBAC being perpetuated...

February 7, 2008 | Unregistered Commenterheather

Thank you!

I have followed my own personal journey to becoming a birth advocate...and am planning my 3rd birth (1st HB) in about 6 weeks.

This idea that EVERY WOMAN, ANY WOMAN can birth ANY BABY really bothers me. I feel that it's dangerous to both moms and babies, and at best makes women feel like crap.

I don't have the resources to dispel the myths and I thank you for doing so.

And I AM a birth advocate and believe in the power of natural birth. I also believe in the power of choice. It royally pisses me off when women are berated for making the choices that are right for THEM, but which are more medically inclined. So NB advocates want the right to birth however they want. With that comes the right of everyone else to birth however THEY want too. There needs to be a balance here and extreme NB advocacy misses the boat!

February 7, 2008 | Unregistered CommenterNicole

Thank you so much for taking the time to post this. I birthed at home but am sometimes frustrated when the "trust birth" sentiment is taken too far. It makes us all look uninformed and irresponsible.

And for the record, my baby had shoulder dystocia. It does happen at home even when you're changing positions and not medicated. And he wasn't ridiculously big (8 lb 14 oz), but he came down the birth canal with his arm kind of behind him. Scary.

February 7, 2008 | Unregistered Commentercognosco

I applaud you.

February 7, 2008 | Unregistered Commenterchris

Loved this post. Thank you.

February 7, 2008 | Unregistered CommenterRebecca

This is a very useful post! I know that as a newcomer to the birthing community I myself need to keep my own fervor in check -- so I'm bookmarking this for sure. Thank you for once again keeping everything honest and evidence-based!

February 7, 2008 | Unregistered CommenterKaren

Great post. I'm glad I read it. I did have one small comment though from my own personal experience. When my midwife did my stretch and sweep, my cervix was completely closed and I was only 3 days past my due date. When she finished the procedure she said I was 4 cms. I ended up having my daughter 3 days later at home in an excellent birth (some pp hemorrhaging 80cc but still great). Anyway, I didn't know that it is a problem to do this procedure early? I was also taking homeopathic medicine for induction too.

February 7, 2008 | Unregistered CommenterUmmZahra

I really appreciate the time you took to go over that point by point.

I think because you are another midwife, Christy perhaps might listen to your very good points and not dismiss them out of hand as she seems to when they come from people who are not advocates of homebirth.

My first thought when I read her post is there was so much misinformation there that the issues went well beyond hospital and homebirth. I am so glad you saw that too.

You addressed it very well and I applaud you and hope it does some good.

I wonder if your post was why she went "private"?

Anyway, we may not agree on everything but I think you did an excellent job with this post and it is a service to mothers who could be misled by this sort of information.

Thank you.

February 7, 2008 | Unregistered CommenterSusan

This blog which you discuss, in which the Apprentice Midwife makes it obvious that she's learning only from the midwife who's tutoring her, shows clearly why such training can be downright dangerous, and such "midwives" should not be allowed to practice.

I wonder if she will even read your excellent post.

February 8, 2008 | Unregistered CommenterAntigonos

I don't think there is a hormone called Surfactant. Surfactant is short for 'surface active agent' and means detergent. In this case it's a mild detergent secreted into the baby's lungs to prepare them for breathing. (We all have surfactant in our lungs to enable us to breathe properly.)

As the surfactant naturally mixes into the amniotic fluid, it breaks down to release precursors to the prostaglandins secreted by amnion cells that stimulate birth.

http://tinyurl.com/2xtrpo

February 8, 2008 | Unregistered CommenterAlison Cummins

The original OP was serious? Not satire or tongue-in-cheek? If so, it is frightening. So much misinformation being touted as fact. It's just ignorant, damaging and in parts downright cruel.
It's people like this that make me advise women interviewing homebirth attendants to do their homework. Just because someone is a homebirth/natural birth advocate doesn't equate to an adequate skill set or knowledge. No more than having an MD after ones name makes them all-knowing either.

Not that I have much to add other than "good post!" but, well: good post!

(why do you moderate comments?)

February 8, 2008 | Unregistered Commentersailorman

I love it that this forum allows (and more senior midwives are ready to give of themselves) gentle (or not so gentle) correction.

I've discovered myself that it's easy to overcompensate in whatever direction, when the status quo is so desperately unfriendly to mothers and babies. I'm learning though that there are times when every intervention in the book is 100% necessary.

Just last week for the first time I had a client with a baby who simply wouldn't come out, no matter what we or she or the docs when we transferred did. Babe was simply posterior and was well stuck.

It was a necessary cesarean, but absolutely non-emergent. It was the first time I have seen vaginal birth just not work. It broke my baby midwife heart, but I am grateful for that lesson.

Humility is **so** important. That would be my advice to Christy: (who's blog I have not seen), trust the wisdom of many midwives who have seen hundreds more births and complications and yes, even deaths.
As much as we all know that there's more to the whole process than "healthy mom, healthy babe". A dead or damaged mom or baby is the ultimate reality check. One you will never, ever again be able to overlook as you practice. Be humble and always know that there is always more to learn. You have to at least be open to new evidence, new knowledge, even if it flies in the face of something you (or your preceptor) have always known.

Cheers Barb, for stepping in. I'm grateful for your perspective.
Morag

February 8, 2008 | Unregistered CommenterMorag

I just want to say, thank you so much for this post.

I had a heavily intervened birth with my son. I unfortunately experienced first hand doctors' misusing technology (from the 5th week of my pregnancy), and scientific "knowledge" (when I was induced at 39.4 weeks because of a migraine, with no other symptoms of hypertension after 24 hours of observation, leading to a traumatic labor and birth experience), and I vowed to never let that happen again.

From being painfully stuck with a catheter I was told I would "get used" to, to having nurses talk about what they were going to order for lunch over my spread eagle legs as I pushed, to having yet another nurse exclaim how "swollen" my vagina was during the second placement of the catheter, I realized I was not a human being to these people.

I was mistreated by the recovery nurses, stuck in a room outside of the overflowing maternity ward, where my door was left open continuously in the middle of the night, where it was so noisy I couldn't sleep, where a nurse told me I wasn't doing a good job breastfeeding, and where I had to ring the nurse bell for a half hour before someone came to bring me some water. It took me months to get over the trauma that was my first birth experience.

On my journey to find a midwife and have a natural, drug free birth with my next pregnancy, I have encountered difficulty choosing a provider (my insurance has been boycotted by midwives in my area), difficulty finding a birth center (none in NYC, only the Brooklyn Birthing Center which has boycotted my insurance also), and difficulty finding a balance between my determination to have a natural birth and my fear that my or my baby's health will be compromised because of that determination.

I'm not at a point where I would want to attempt a homebirth--I like the comfort of knowing that help is there if I need it, and quickly. But I am petrified that I will have a good solid birth plan in my mind and on paper, and that once I get to the hospital it will all be thrown out the window for the hospital protocol and the doctor's agenda.

As much as I have argued back and forth with people, I believe that interventions for the sake of interventions don't work, can hinder labor, and should only be administered when medically necessary. And I don't mean when I consider it medically necessary, I mean when it really IS medically necessary, ie, if there is a pre-existing pregnancy condition, or if there is an emergency. Other than that, I feel that the laboring woman should be left alone (again, with well-trained help nearby).

It's difficult to convey my feelings on this to people who are very medically minded, and to people who are used to dealing with HB fanatics.

There are many good doctors, but there are many, many bad ones. Hearing hospital horror stories one after the other (even those attended by CNMs) makes me want to run and give birth in my backyard, by myself. What worse time can there be for me to have to fight and assert myself than when I am in labor?

I obviously know that there are situations and emergencies in birth that require interventions, I just don't trust that the doctors will ONLY intervene when necessary.

It's so very difficult to find the facts, especially when looking at statistical studies, because I believe wholeheartedly that they can be manipulated to report whatever one wants them to, whether it be pro or against the issue at hand (hope that part makes sense!). It's difficult to weed through the HB fanatics who have UCs with no safety considerations and the medical fanatics who claim that IVs and epidurals and pitocin and laying in bed for 15 hours have NO effect on labor.

Out of the 10 or so women in my family, only myself and one other woman have had vaginal births (she at home, in her tub!). The stories are similar--a few weeks past their due date, the baby was measuring big (over 9 lbs or so), so they were induced, were in labor for at least 24 hours, and then were given sections for fetal distress/failure to progress. The average weight of the newborns? 8 lbs.

Certainly this is anecdotal evidence, but how much anecdotal evidence can gather before it becomes a real statistic?

The scarier thing is, just when I think I have found a community of women that know what they are talking about, that support and encourage women in their pregnancies, labors, and births, it turns out that at least a few of them have no idea what on earth they are talking about, and that they are just as rigid, as unforgiving, as doctors, only in the other direction. That's discouraging, disheartening, and deflating.

Where do I look for information? How do I trust that the midwife I choose will be my advocate and not her own or the hospital's, when so many women in my circles have experienced otherwise? How do I trust that the information I am getting on natural birth is real and true and not fanaticism?

I want to thank you for your writing, not just for this particular post, but in general. Your words give me the balance I need to make an informed decision. Your writing is unbiased, well researched, and well-rounded. Thank you.

February 8, 2008 | Unregistered CommenterMommy Dearest

Wow, she's a bit arrogant, isn't she??

In fact, I had a hard time believing she wrote all these things with a straight face, because they sound so much like the kind of things that the medical community loves to believe that we say all the time.

She has a good heart, I can see that. But she is going about this the wrong way. Birth is something that can't ever be understood with a closed mind, and that goes for people on either side of the fence. (Shoot, even with the most open mind in the world, you could probably NEVER understand EVERYTHING about it!)

I'm glad the homebirth community has you as a voice of reason, Barb. Reading this reminded me of your "birth plan" post, where a couple wrote a long, ridiculous, flowery birth plan and you carefully wrote an appropriate rebuttal to it. I enjoyed that post and I enjoyed this one, too!

February 8, 2008 | Unregistered CommenterJill

I really appreciate the kind words. I worked on this hard and long! In fact, when I read the OP, I made a comment that I would be refuting it. It took 3 more days to get my post written and up. It was almost immediately afterwards that Christy pulled her site from public view.

If she's ready this, and I hope she is (or someone will tell her what I'm going to say), I really don't want her to just disappear or to get stuck in her beliefs that everything she's read is perfect or right. I *so* want her - and ALL apprentices (my own included!) - to *always* question... writings, what someone says, what women say, what doctors, nurses, midwives, doulas, etc. say.

EVERYONE has a point of view. Everyone. Being able to "see" from everyone's points of view is a vital skill as a midwife because that is how informed consent occurs.

We *have* to be able to get in the skin of a doctor and *really* understand why he or she despises homebirth. We *have* to be able to "get" it or we can never have a decent dialogue with him or her. And dialogue is one of the ways we will ever get ahead - for our clients as much as for ourselves.

Empathy with folks that are different (sometimes VERY different) is crucial in midwifery. Not every client will be lovable. Not every spouse of a client would be who we'd choose. Even kids sometimes can get on your nerves, but having an understanding of where someone is coming from, knowing that they have motivations, beliefs, desires and wishes that aren't yours, but are just as valid, is really, really important in this tight and stressed society.

Antigonos and I don't agree on much at all, but I nodded my head when she said it is because of beliefs that were expressed in Christy's post that midwives have such a rotten reputation in more learned circles.

And I agree that tunnel vision is a huge reason for insisting that any apprentice have more than one midwife to work with, talk with, learn from. I love that my apprentice finally began school. She now gets to hear a plethora of other viewpoints and I am so glad of that! I can share what I know, read the books again with her, but experience is a wonderful educator and she needs more than just me.

And so, thanks to everyone for the kind words. I have to thank Christy for the springboard, though. If she hadn't said those things, this post wouldn't have happened when it did.

I just hope that Christy, one day, if not now, knows how much she is teaching others.

We all teach each other, don't we?

February 8, 2008 | Unregistered CommenterNavelgazing Midwife

I have been reading your blog over th last week or so as someone recommended it as I begin my journey to UC.
I do appreciate the facts; however, the post feels like an attack. Maybe you didn't mean it to come across like that, but I feel badly for Christi.

February 8, 2008 | Unregistered CommenterRach

Mommy dearest I birthed in Brooklyn too...and had a similar experience...slightly less than half my natural hippie-granola childbirth class was c/sectioned. One woman homebirthed "illegally", and was fine...and yeah, it could have been different, and how can we know in this fucked up birth climate? Was she stupid to try, or was I stupid to trust?

I know Christy on ICAN, she's never struck me as a fanatic; her take is that she was not writing for general consumption, though other writers there were quick to point out that online=public. They also pointed out that those of us on the list are *not* ICAN...we are just women on a message board.

ICAN is very strict about the research it will promote on its site..I have been one of many people involved in creating new white papers lately, and there's some highly-educated scary smart researchers on there.

But I haven't seen the original post, so I won't take a side;...I love Navelgazer's site and I love my sisters at ICAN, who literally saved my life after my horrible birth experience.

I think what Navelgazer and what ICAN and others worry about is that homebirthing is gaining a lot more attention, and subsequent criticism; we're going mainstream, and that means we're going to be under scrutiny. ACOG continually threatens to try to shut CPMs and others down who threaten their business. Every midwife who says something foolish is likely to be seen as the representative of a bunch of silly woman seeking "experiences." We do need to toughen up, because the fight is coming.

February 8, 2008 | Unregistered Commenteremjaybee

you.just.ROCK.

February 8, 2008 | Unregistered Commenteruumomma

sailorman: I moderate comments for a couple of reasons.

1. Women write to me privately there (even though my email address is on the site) and I don't publish those "emails" because I answer them in my own email (per their request).

2. People will correct information or spelling and it isn't necessary to publish this, either, because I will go and correct things in the post.

3. I've written some pretty controversial things over the years and sometimes the response can be cruel and irrelevant to the topic at hand. I certainly don't edit for content and keep the controversial stuff out of here, but when someone just writes, "You're an idiot!" I am not going to publish that.

(I'm not an idiot. I just have strong opinions and voice them! You don't have to agree with me, either. In fact, if you don't agree, WRITE ABOUT IT!)

rach - I can see how you would think I was "attacking" Christy, but mostly I was attacking the misinformation she was spreading. It *had* to be addressed... and *sharply*... to make sure she and others knew to pay attention and quit spreading un-truths (they weren't even half-truths!).

I find it interesting that anyone in the UC World would recommend my site. Curious. Glad you're here, though.

emjaybee: Even if Christy's post was only meant for ICAN women, there are women there that don't know any different than what they read on sister-sites - and they believe those things, embrace those things said. And that can be downright dangerous!

Would/Did anyone in the ICAN list correct her misinformation? Or did they all say, "You go, girl!" Seeing how she reacted to "outsider's" comments, I find it hard to believe she was being corrected on the inside of her peer group.

I find it odd that ICAN even got into this discussion. I *adore* ICAN, support them, go to their meetings here and refer women to them all the time. Yet, when I read that Christy is an active part of ICAN and she's writing these things and isn't open to correction, it makes me wonder what else is going on in list conversations. I sure hope some strong personalities snap to attention and correct misinformation.

You are absolutely right. We *are* being scrutinized. It's imperative to be meticulous with our words and deeds.

February 9, 2008 | Unregistered CommenterNavelgazing Midwife

I appreciate your post. I did not read Christy's original post, but I can tell by the pieces that you copied that she is very passionate about women, birth and informed choice. I have to say that I was once like Christy. When I was walking down my path to homebirth I had some very strong opinions and spoke in absolutes about how "stupid women follow even stupidier drs". I had the gall to post some of these opinions on a message board (childbirth choices on Babycenter.com) and the smart smart women picked me apart and rightly handed my ass to me after they chewed it up!
Now I see the bigger picture and I can see the important role the medical field plays in keeping Moms and babies safe as well as the role MW play in doing the same.

But I did not get to this place without SOMEONE calling me on my misinformation and my tone of absolutes towards women. I thank the ladies on the childbirth choices board and I am sure that Christy will one day look back and thank you.

And if you didn't reach her you reached alot of other ladies by your post. Thank you for fighting the good fight......
Kalico24

February 9, 2008 | Unregistered CommenterAnonymous

When you say that most babies are just fine at or after 42 weeks...

Does this 42 week date mean 42 weeks after actual conception? Does it mean 42 weeks according to LMP?

With my second child (1st vbac), according to the little wheel chart and my LMP, baby was born at almost 44 weeks. Since I have long and irregular cycles though (and knew around when conception took place because I was charting my cycles), I knew that gestational age was closer to 41 1/2-42 weeks.

BTW, posterior baby, cord around neck, "short-ish" cord. Baby healthy at birth :)

February 9, 2008 | Unregistered Commentervbacwarrior

Hi,

I have found my way here from another list. I know you want to give out accurate information, and I guess that is why I am asking this question. On your Myth 10.5, you say that some women, and list some conditions can cause them to need help to become un-pregnant. Would you mind fleshing that one out for me? I had multiple miscarriages before being told a sketchy diagnosis of PCOS by an RE. (since that time I have had two endocrinologists, OB's and another RE tell me I do not have PCOS, but cannot find anything wrong with me to explain the recurrent mc's.). So, first RE gave me clomid, metformin, baby aspirin. I concieved and was able to keep baby to term. At the end, I had a questionable GD diagnosis (failed 1 hour by one point, and failed one timepoint by five points) and OB's monitored me as GD. My baby was guestimated at 39 weeks to be 11 lbs and my OB team did everything to scare me into scheduling a c/s. In the end I did everything natural to bring on labor, but gave in to the daily pressure from the OB's to schedue, at 40 weeks 3 days, an 8lb 14oz perfectly healthy (no sugar issues, no jaundice, nothing to say she was post dates) girl.

I am now trying for a second child after working through everything that happened the first time. So far, only miscarriages again. But your comment worried me, and I would like to investigate further the link between the conditions you mentioned and women never going into labor. Last time I was 75% effaced, and 2cm, so I was doing something to birth my child.

Thank you

February 9, 2008 | Unregistered CommenterNHMomma

Barb, again, a brilliantly edifying and honest and factual response. I did read Christi's post and found it offensive to my very core. There is no benefit to name calling and nastiness when dealing with women's choices. I applaud your effort's to give Christi some insight into the "real" worl obstacles that we face.

I had a classmate when I was training, who worked with only one midwife, a radical homebirth only, no medical intervention is acceptable, all women can birth midwife who refused to accompany women who needed to transfer into hospital (even though here in NZ we can work in home and hospital equally). My classmate idolised this midwife, hung on heer every word, made comments similar to Christi's about womens choices and how uncommitted they were to birthing naturally.

Then, a baby died. Unnecessarily.
Then, three charges of negligence in waterbirth rose up out of the woodwork, with one morer deadd baby, and two profoundly disabled ones. My classmate was forced to reevaluate and question her learning. And discovered that things the rest of us KNEW about waterbirth, about FH monitoring and about signs of infection and distress, she had never heard of.

My classmate switched midwives, learned more and qualified. She nearly lost her heart for midwifery when she discovered just how badly she had been led down the garden path by a midwife who used her "activism" to mask her lack of appropriate skills. I hope for Christi's future midwifery career that she learn's those same lessons from your words, and not by having to discover just how dangerous and inapprpriate her sweeping generalisations actually are.

last I heard, my classmate was training to be an obstetrician: she now believes that her best chance of changing the birth world lies in working from the insid out, instead of the outside in.

February 10, 2008 | Unregistered CommenterTrin RM

I didn't read the original post, but it sounds like the author has a fundamental misunderstanding regarding the role of the midwife. Of course an important part of midwifery is to protect and preserve pregnancy and birth as a normal natural process that is a part of life. But the midwife's role is also to be alert for, and carefully monitor for, problems that can arise. These two things are not exclusive.

It is pretty immature to suggest that because a particular condition is rare, that we don't need to worry about it/watch for it. Even rare conditions (short cord or true CPD for examples) happen so *someone*.

I have a very rare hormonal disorder that affects my fertility. It was very frustrating to me when I began trying to figure out what was going on and healthcare professionals would say to me "Oh, that can't be what's happening to you, that is very rare." Well guess what? It *is* very very very rare, and that's what I have.

This experience has changed my attitued about how to approach rare problems in midwifery. I used to think if something is rare, let's just not worry about it - but this is quite dangerous.

February 10, 2008 | Unregistered CommenterJoanne

NM, yes, some ladies on the ICAN list did back up your points to her, very strongly. I think someone's comment referring to ICAN was one you deleted...I don't see it now.

February 10, 2008 | Unregistered Commenteremjaybee

emjaybee: I was asked to remove it because it wasn't necessary to the topic, so I did. That's why it was removed.

Thanks for the clarification.

February 10, 2008 | Unregistered CommenterNavelgazing Midwife

Forgive me as I have not read the referenced post from "Christy. Although I certainly agree that there is a time and place for intervention, that medicine can be as much a gift as it is a curse, and not all research-based "evidence" is created equal, this post certainly left me with a bad taste in my mouth and smacked of the OB-trying-to-be-your-friend experience that I've been bitten with in the past.

The time for being nice is over. Unfortunately for many women (and hey, humans in general) playing the understanding, sympathetic pal in the face of a birth-gone-wrong isn't doing anyone any favors. It's nice for people to come to their own realizations when they've fallen victim to a ridiculous system, but the fact is that not all people are capable of reaching that realization on their own.

Should we stand idly by, information in hand, waiting for those people to bite? Or should we stop playing nice and start forcing them to question their own ideas, their own experiences, despite a few hurt feelings? If they come through that fire believing their experience was justified, so be it. But perhaps pointing out the obvious in a harsh and often extremely biased way will force them to think deeper on the issues. Many women in abusive relationships insist there is nothing wrong - should we stand there and wait for them to come to the realization that they're being mistreated, or should we make as good an attempt as possible to force them to consider the possibility that they deserve more respect than what they're getting?

If you feel truly confident in your birth experience, you won't get up-in-arms when women try to poke holes in the story. Confidence by its nature means you have no reason to feel defensive. If you do, that's something that needs to be examined on a deeper level. It's time for all women to get some guts, do some soul-searching and stand up for what they think is right. One woman's poor treatment by the system affects the treatment of all women by the system. We must be blunt (though of equal importance is to be able to filter out the "facts" that have no true proof) if we hope to change it for everyone.

The heart of all of these issues is the nature of life and death - yes, things can truly go wrong in birth. Yes, there are times when being in the hospital during one of those mishaps will make the difference between living and dying. But should we rule our lives with fear of being the minority statistic? Or should we accept that death is a natural part of life, that someone always has to be the minority statistic, and we cannot possibly hope to live a full life by making choices based on those small possibilities.

I had my beautiful, perfect Unassisted birth at home ... despite the usual prenatal diagnostics/ultrasounds, my son was born with Down Syndrome. An approx 1 in 1400 chance. I was that 1. So what? Life goes on and with a new perspective - live your life like you'll be the other 1399 because if you spend your entire life trying desperately to prevent becoming that 1, you will never have truly lived. You waste so much time trying to protect your eyes from the sun, you miss out on how beautiful things look in the daylight. If it takes some hurt feelings to reach that understanding, it's such a small price to pay!

February 11, 2008 | Unregistered CommenterChristina

Ye Gods. Brilliant post Barb, but frightening that Christy truly believed in what she was writing.

February 15, 2008 | Unregistered CommenterAgatha

I believe the original post is no longer set to private and has been *revisited*.

February 16, 2008 | Unregistered CommenterGenevieve

You're right! The site IS back open. I encourage everyone to head on over and comment about her post which she did not change very much (if at all). She apparently didn't listen very well. *sigh*

February 16, 2008 | Unregistered CommenterNavelgazing Midwife

I am only beginning to seriously educate myself about birth, as I am newly pregnant. However, even I was shocked at some of the claims Christy made, because they were so obviously one-sided and, sometimes, just seemed immediately like an outright lie! She struck me as someone who was trying to use scare tactics and her comment about how it was her responsibility to make women feel bad about getting a cesarean was just downright hateful - there's no other way for me to put it.

Thanks for posting your response to Christy's unbelievably biased post. It's important for women to be educated with facts, rather than be kept in the dark by the people who are supposed to be caring for them.

February 19, 2008 | Unregistered CommenterJackie

So I have read your posts a few months ago, and came back, and I have been thinking about what you have written. Commenting on someones blog is something that I do sometimes, but do so reluctantly - in that unless I think I have something to offer I type and close without submitting.

"Folks’ comments are valuable moments in time to think, re-think and re-think again your thoughts and beliefs." Well, it seems to me that you have an unduly large fear of large babies. Truly. I understand that the average woman is not ready or able to deliver large babies, but I would like you to consider the gals who are built and meant to have have large babies. As in my mother who at 5'10" who had only one baby less then 10lbs 44 years ago (11lb 6 oz, 23", 9lbs 5oz, 10lbs 6 oz, 10lbs 14oz). All vaginal, all late, but presumably becuase of doctor's assumption about gestational size and fetal age. As in myself who at 6' has had a 9lb 6oz (before being diagnosed with celiac disease, which implies he was the product of malnutrition) and 10lbs 5 oz as a VBAC.

I am not saying that my oldest brother was delivered at the best size, he was overdue for sure, overly large, and mom needed forceps - but I believe that had a lot to do with her desire not to be pregnant and not have that child. No, I am just saying that sometimes tall women with large bone structure are meant to have large babies, that its normal for them and please don't assume it can't happen or that you should be scared about them birthing such large babies.

That being said, you will rarely encounter women such as those in my family, that is tall and robust. Even women who are tall can often be quite slender and gracile, so this is not relevant to them. I just write this not because I want to scold you, but that in review of what I have read from you there seems to be an underlying fear that will interfere with the care of a few of your patients, and that can translate into an unwanted outcome. Be careful to step back and look at her body and her in general, she might be able to have that big baby vaginally after all (I am not saying encourage overeating, just letting go of the fear for some moms).

February 21, 2008 | Unregistered CommenterEthel

Your post is very spot on. When I had my first child was SUCH a natural childbirth advocate--TOO much so. I thought that since I had been able to labor and birth unmedicated with a posterior baby that EVERY woman could--"if she were just educated."

As a doula and childbirth educator, I mellowed. I encountered women who were "educated," and still had difficult labors--some that ended in cesarean. Some that benefited from the use of epidurals.

I will say though...I know someone who went 3 hrs between transition and starting to push. She had contractions every 45 minutes during that time. That was with her 3rd baby. She'd had breaks of 20 minutes and 1 hr with her previous labors. Nothing wrong in any case.

And yet I'm sure that sometimes still I use language by which I inadvertantly offend or belittle other women. I need to watch that. One thing in particular that you hit on is the word "claimed."

I remember in my first pregnancy (which was unplanned), getting a chance to briefly look at my chart when a nurse accidentally left it in the room. How I felt I was doing something I shouldn't do! And the nurse--who later caught me looking at it--confirmed that feeling. Yeah, as if I didn't have a right to see my own chart! But anyway...I remember reading with disbelief the letter my GYN had written to my primary care Dr. following my most recent annual exam. I was pregnant at the time of the exam, but did not know it. I just thought my cycles were being really wacky (the past few had been erratic), and told my GYN about it. He prescribed a hormone to start taking once I got my cycle to regulate things. He wrote to my PCP "patient claims not to have had intercourse."

I was SO angry and embarrassed, because my immediate belief (probably rightly so) was that he knew from doing the cervical exam that I was pregnant, and so he thought I was lying. I wasn't lying. My boyfriend and I were doing "everything but..." And yes, I got pregnant. Sigh... ("boyfriend" is now "husband." we've gotten pregnant without planning to 4 times since then, resulting in 2 babies, one miscarriage, and one in utero--you'd think we'd learn, huh? ;-)

March 27, 2008 | Unregistered CommenterAnonymous

wow, i just totally was amening like a church congregation through all of your comments. Well defended. I for one was on a birth ball, squatting, sitting, doing nipple stimulation with my husband and totally an active participant in my labor...after my epidural. Sit there in bed...pffff...only if you want to or don't have the support to do anything else. I also pushed for 3 hours, and although medicated, was dilated to 10 for quite some time before starting to push...at least an hour or so...she was, and still is, just not ready to be apart from her momma...:)

August 29, 2008 | Unregistered CommenterRachael

I think in #7 that her point was that at 38 weeks post-LMP, the baby is actually ~36 weeks post-conception.

March 18, 2011 | Unregistered CommenterD. Lane

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