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Wednesday
Jul092008

When Dogma Trumps Common Sense

I stumbled onto this blog post from someone who 1) seems to work in a hospital 2) hears great stories from friends who work in a hospital. You decide.

A birth plan, but no immediate mothering skills highlights the image of a rabid natural birth fanatic (and I use the term purposefully) as she moved from her planned homebirth into the hospital after she had ruptured membranes for 7 days and no labor to speak of.

(Those that know, know I also had 7 days between ROM and the birth of a baby, but I was under the care of myself and a sneaky group of CNMs. Don't know how tolerant I would be of another woman acting like I did! It'd need to be on a case-by-case basis, that's for sure.)

N E Way....

So the blog poster illuminates how stupid... er, strike that... ignorant? (not good either)... crazy? (probably a better word) an immobile natural birth advocate can sound when confronted with a change in plans.

(Edited for typos and attractiveness, not substance.)

(Begin quote)

- Her water broke 7 days before she ended up in the hospital. She had gone into a small town hospital (after the planned home birth didn't happen) that was not equipped to handle sections so was transferred to ours.

- She refused a section even though her baby was in DISTRESS; she had a birth plan and a section was NOT in her birth plan.

- She continued to refuse the section even though her baby was in IMMEDIATE DISTRESS because she wanted a natural birth.

- The doctor eventually had her agree to the section, not quite having to "hit her over the head with a hammer" as my friend so elequently put it.

- The baby was covered in meconium when born and even though he had not yet taken a breath she insisted he be placed on her chest.

- Couldn't happen becuase a) the baby wasn't breathing and b) her chest was in the sterile zone.

- They did place the baby on her chest immediately after he started breathing and the nurse stayed with them as the mother could't technically hold him.

- She refused to let the baby go to the nursery to be checked over while she was in recovery and wanted him left with her. As she had no partner and she was still somewhat drugged the ICN nurse had to stay as well, meaning she couldn't see to the other babies under her care in the nursery.

- When she was transferred to the maternity ward she had the baby lying on her stomach and the nurse suggested she lift the baby higher if she was looking to feed him. "Oh no, he will crawl to the breast if he is hungry." The two nurses say that newborns don't actually crawl to the breast and she says "Yes, they do! I saw it in a video." Editing, ya know.

- She refused to have a crib in her room and wanted the baby with her. When the nurse came in to do some bloodwork on the baby, the mom was sleeping and baby was nowhere to be seen. The nurse lifted up the blanket to find the baby with his face down in between her armpit and breast. Baby grey, no heartbeat, not breathing. Nurse rushes him out of room, all the while trying to get a heartbeat and breath. When in crib in hall, heart rate measures 40 (normal newborn in 100-160). If nurse had been 30 seconds later, baby would have been dead.

(end quote)

Even if we looked at the story through squinted eyes, believing some of this is exaggeration, I know this story is true because I have read/heard enough accounts from the fanatics themselves!

When you buy the hospital ticket, you go for the hospital ride.

As I recently said, hospitals have a huge responsibility to normalize birth within their walls, but for crying in a bucket, when there are complications, birth plans should be shredded by the women themselves.

When I have clients that move from home to hospital during their births, anything relating to the reason we are going there for now rests solely in the medical personnels' hands. It's what they're there for!

For example, if mom is laboring and there is lack of progress that sends us into the hospital, a birth plan that says, "No pitocin," isn't going to cut it. The part that says, "No erythromycin (in the baby's eyes)" is easy to adhere to because it isn't related to the reason for the transport.

Make sense?

If you have to move to the hospital because the baby has low heart tones, asking for intermittent monitoring is not only foolish, but dangerous.

Hmm. thinking

My frustration... let's see... part of it is it's embarrassing to have women be so adamently against something when that something can possibly save their lives or their babies' lives... all in the name of "natural childbirth." I'm not talking about the routine crap that goes on in hospitals, but the stuff that is really necessary when birth deviates from the norm.

Just like the hospital treating everyone the same and demanding that they stop doing that, it behooves natural birth advocates to stop seeing every intervention in birth as dangerous and weigh the risks with the benefits. Sometimes technology is fantastic!

The issue, of course, is how can you tell when the interventions are really necessary? So much of it depends on trust and distrust definitely sets the stage when there's mutual antagonism.

Walking in/being wheeled in with an open mind and heart can help tremendously.

Having an advocate... your midwife or a doula... not your partner (who is laboring right along with you) who can explain things to you as they unfold... a person you implicitely trust... someone with the experience to understand the hospital language, the interventions and their necessities... where was the woman's midwife in the above scenario? Was she UCing? (Sadly, it sounds like it from her rigid attitude towards birth and the hospital. Sad because UCers have a reputation that precedes them.)

And finally, believing that whatever happened was supposed to - for whatever reason. Lessons. The baby's choice. Destiny. Fate. However you are able to explain it to your psyche, it's important to integrate the experience so you are able to be a mother and a woman in your life.

None of this means there can't be distress in the experience, that women might not be coping with birth trauma or recovering from birth abuse, but integrating can mean the difference between immobilization and functioning.

Some women have found my The Gray/Grey Messenger: Recovery helpful when overcoming birth trauma.

It's a precarious place... needing to trust the hospital yet knowing many women are bulldozed into interventions they don't want/need.

Even though the medical folks tend to play the Dead Baby Card too often, it really is more important to err on the side of safety for both mother and baby.

I hope the mom in the above post is able to obtain some balance in her reality.

It's all any of us can ask for.

Reader Comments (34)

NGM -- ouch. Shaking my head and cringing. Oh, I too do believe this happened more or less as the teller tells it, even though this particular case is especially egregious. A whole big bunch of irrational behavior and none of it is defensible: whatever this woman's history or reasoning is, is probably pretty sad. You present this as a matter of dogma v. common sense, which begs the question wherein lie the origins of this dogma. Who is responsible for this particular woman's dogmatic behavior? Is there blame to assign beyond the mother herself? Is anyone else culpable for her holding these beliefs? I bet the fingerpointing has already begun...

I propose that in the comments section we each examine ourselves for past and present inclinations for closed mindedness or boneheadedness. Here I go.

Insisting on bedsharing while on narcotics -- not me. I clearly recall Dr Sears does not recommend this.

Insisting on the 'neonatal crawl' -- I've seen the video, it wasn't just clever editing; but didn't they say explicitly that this may happen after a physiological birth with a baby born in good condition?!

Refusing cesarean for obvious distress -- Of course not. But might I disbelieve a doctor who said baby was in distress? I probably would ask to see the tracing or for other specific information. I would be open minded and respectful. Not to mention absolutely terrified.

Stay home with several days of prolonged ROM -- I don't know because I declined to find out. It was a very slow trickle of something. I didn't test for it. I took hygene precautions and the vit C regimen. In hindsight, my waters did break with a big gush before I started pushing, but I admit not checking out my trickle is questionable. Internet UC lore has it that a minor tear in the amniotic sac will seal by itself, so why worry. Maybe it wasn't so good to base decisions on internet UC lore.

Maybe that's the take home lesson, don't let internet lore be the ultimate word... unless you can trace it to a good midwifery blog ;-)

July 10, 2008 | Unregistered CommenterJudit

it really is more important to err on the side of safety for both mother and baby.


I get what you are saying and I think you have made some important points. However, this statement here I'm not sure is always true. I'd have to think about it. The reality is that if a c-seciton, for example, IS in err, it's NOT safer for anybody. So "better safe than sorry" doesn't really gel.

July 10, 2008 | Unregistered CommenterRebekah Costello

To Judit:

Interestingly, afaik, studies indicate that the risk of developing an infection with PROM, provided the mother does not have VE's and keeps everything out of her vagina, does not increase at all for four days. Then and only then does it begin to climb. That isn't just internet UC lore, that's a fact. Also, while it's true that the idea of small tears in the forewaters or hind-leaks resealing is one that is commonly discussed on the internet uc boards I frequent, I first learned of it in a midwifery textbook. So it's not, for me anyway, a choice I'd be making based on "internet uc lore". (not that I've ever had to make that choice, of course, I'm just saying :p)

That being said, I think you have a very good point. All information that comes in, no matter where we get it from, must be carefully weighed and cross-referenced, if you will.

July 10, 2008 | Unregistered CommenterRebekah Costello

I read your post about birthrape and the subsequent comments. Then I read this post.

How or why should we ever trust the members of the medical industry? I am sure some of them are good people, but how do you ever know if you and your baby are in good hands?

The whole tone of this story was sooo hostile to the birthing woman. Even if once in awhile a woman really was such a flake, how does this compare to the industry wide savaging of women regularly practiced by medical professionals, not just in birthing, but in uneeded hysterectomies and other procedures?

Let's think about it. Read articles such as the birthrape article, then be forced to transport to hospital and go in with an open mind. How?

Sincerely,
Beth

July 10, 2008 | Unregistered CommenterBeth

Hey mama,

Just wanted to chime in and comment about your Post Date post. I am a "post date" mama myself. I had my 2nd child at 42 weeks via c/s (home birth transport) (my first was a planned c/s at 39 weeks due to breech, blah, blah).

My 3rd baby was born at 43wkd 6dys and she was a successful VBA2C!!! I did absolutely NOTHING to interfere when my body was ready to birth my baby. And she and my placenta were in perfect health. It's a long story and I'm working on writing it out now. Just wanted to share from a "post date" VBA2C mama.

Ok, now I went back and read this post (sorry for the out of orderness! by the way...I like to make up words.) I totally see your point. I'm so in the middle. As one of those mamas that wants it to be natural and to be left alone, it's really hard to throw that to the wind. Ya know? With my daughter, I knew she was stuck and I actually had a beautiful c-section with a great doctor who signed off on my birth plans and made sure the nurses had copies. It really was my best birth, believe it or not. I did not have that kind of relationship w/a doc and due to different reasons ended up at the hospital with number 2 and 3. The were not great experiences, let me tell ya! I was humbled though. While I still tend to me "all natural", I was humbled in knowing that medicine does have it's place and it can save lives. However, it (being the entity of medicine) does not know it's place and also takes more lives. It's a hard, hard balance.

I think what is really sad is that we can't/don't trust our care providers. Planning for a VBAC, I feel like I have to have a degree in midwifery myself to defend against all the unnecessary interventions I may come up against. And when a provider suggests an intervention, how am I to know if it's a) policy, b) covering the cp's a$$, or c) truly necessary.

I'm very sad for the woman in this story. It's clear she had no one with her she trusted and the simple fact is that hospital/doctors/nurses no longer deserve our unilateral trust.

July 11, 2008 | Unregistered CommenterKEM

I agree that the tone of the whole post was too snippy. Instead of going back and editing... adding more balance... I am choosing to leave the snarkiness because it is simply how I really feel sometimes. It's frustrating (and I say that) and an outlet for me is writing. I don't want to alienate my audience, however, so I try to temper it most of the time. I wrote this post immediately after reading the other blog, so I know that is a huge part of my snarkiness.

I should allow more space between reading and writing. I'll do better with that.

July 11, 2008 | Unregistered CommenterNavelgazing Midwife

And...

You are right (*I* am right!) - how do we ever REALLY know the care provider (midwife/doctor/nurse/hospital) is really going to have our best interests at heart? We don't, but by trusting, I believe, we are at least starting out on the right foot.

When a laboring woman comes in "armed" with a rigid birth plan it's almost like the staff does everything in their power to unhinge and throw the plan away. However, I see when women go into even staunchly interventionist hospitals with an easy-going "let's see what happens" verbalization (even if her birth plan is kept to ourselves!), her wishes are much more readily accepted and adhered to. The defensiveness is gone on the hospital "side."

But, again, how do we know? We don't and it's a crap shoot, but aiming for the best possible situation can't be bad.

Birth abuse *is* still going to happen. I know that! But, I have seen the difference between the immobile and the lax and the lax get a WHOLE lot more of what they want than the immobile.

Does that make more sense?

July 11, 2008 | Unregistered CommenterNavelgazing Midwife

Lets not forget that the person who wrote the post heard it from someone who heard it from someone....no telling what REALLY happened. IF everything was true and not over-exaggerated (which I doubt), than I feel intensely sorry for the laboring mama in such a hostile environment with no one to gently help her through such a difficult time. I cant say that I blame her entirely for not trusting the doctors or their 'machines that go ping'. I for one have heard both doctors and nurses make some pretty large mountains out of some pretty innocuous molehills. Maybe she did make some mistakes in judgment, but I would venture to say that it was undoubtedly NOT because she just wanted to stick to her birth plan...I sure would like to hear her side of that story. Still....food for thought.

P.S. I love the PP's line that 'medicine does have it's place and it can save lives. However, it (being the entity of medicine) does not know it's place and also takes more lives'

July 11, 2008 | Unregistered CommenterCascade

I like your blog because of the very fact that you posted about birthrape AND a laboring mother's complete inflexibility. It's important that we remember both sides of the equation, because they are a complete cause & effect relationship. I firmly believe that if you go in without a birth plan (at least in your head, but written down is better), you run the risk of being left out of most decisions. But I also firmly believe that the more rigid the birth plan, the higher the chance of complications and forced intervention. Go in with a plan and tons of knowledge, and then be willing to weigh each decision carefully with an open mind.

I am also asking the question, where the HELL was this woman's support system? Maybe she had pushed them away too, who knows. But my heart breaks for her that she had to make all of these decisions completely alone in an environment she was terrified of.

July 11, 2008 | Unregistered CommenterKelly

What would help, tremendously, here is that instead of condemning a woman who makes the wrong decisions in pursuit of natural birth as a loon, is for medical personnel--nurses, OBs, midwives--to acknowledge that they bear much of the blame for a climate in which women feel they cannot trust them.

Women have never-NEVER--yet been treated by the medical profession as a whole as full human beings capable of making decisions and deserving of rights. We still mostly have to choose between being thought of as passive children or dangerous loons. The role of "Person Who Deserves Respect" is usually not on offer!

So far, the only response to UC and homebirth and all the rest has been threats and increased stories about Dead Babies--not an attempt to educate, not an attempt to understand the forces driving this movement, not an attempt to change *anything at all* that currently goes on in hospitals.

Want these kinds of cases to disappear? Stop making the risk of them the only alternative to being a piece of meat on a slab. Until hospitals change what they do and how, these things will happen, along with the deaths from over-intervention and unnecessary surgeries. Not because women want them to happen--they don't. But because, just as in abortion, when you refuse to give women good choices, they will suffer from bad ones.

July 11, 2008 | Unregistered Commenteremjaybee

Honestly, I find supporting families who are so connected to this dogma exhausting. I work in a hospital setting and I am very sensitive and conscious of the fragility of the psyche for some homebirth transfer women. For Pete's sake I am a homebirth and midwifery care advocate.

But my patient doesn't know this, and assumes that because I wear a white lab coat and work in a hospital....I am one of 'them'!

What I have experienced, is women receiving me with hostility, putting words and sentiments into my mouth that I would never consider expressing (nor do I feel such).

I once had a transfer homebirth woman who I was helping with breastfeeding and explained a relatively obvious mechanical issue (a tongue tied infant and a mother with completely retracting nipples, will on occasion benefit from intervention!) accuse me of stating her 'breasts don't work'.

I had to leave the room and take a break, she was so transfering her hostility at the medical community onto me. I would never say, nor imply such a thing. But apparantly because I choose to offer my skills within a hospital setting I am now open target for the client to misdirect their anger upon me for daring to work in a hospital.

This woman was so opposed to considering any intervention (even hand expression and spoon feeding), she was determined to simply starve her baby out until she would latch. It wasn't as if the baby didn't want to eat, it was a genuine mechanical issue, she couldn't without an intervention.

I realize there are side effects to breastfeeding interventions, that is why we should only utilize such when it is genuinely warranted. But guess what, there are risks to your baby in terms of not eating!

Anyhow this exhausting experience with this hostile mother opened my eyes to how some homebirth clients are groomed and supported by their midwives to resent the support of any hospital healthcare professional to the point that if the hospital services are considered warranted and beneficial, the client has already been set up to feel hostile toward virtually any and every caregiver who dares walk the halls.

I think this is a sincere disservice to new families.

Does Western OB care involve unnecessary interventions and is it offered in a less than woman centered approach, of course it is (sometimes, not always! there are lots of really great OB's out there!)......

But geez, if you find yourself in the role of supporting a woman as she travels the path of homebirth and midwifery support and care, why not focus on the value of the midwifery care, and the wonderful services these midwives offer and back off on grooming clients to despise every staff member who dares to walk the hospital hall lest you and your client have the misfortune of ending up needing their services!

Now what have you accomplished besides setting up an antagonistic situation?

July 11, 2008 | Unregistered CommenterAnonymous

I recently attended a birth which makes me feel that it CAN be done, and SHOULD be done, barb. A mama, on her first baby called me at 5 cms dilated. we went to the hospital and into a low risk birthing room, where she laboured with intermittent monitoring to full dilatation, and began pushing, in the pool. Then, it went tits up. The baby just DIDN'T come. He was there, and I could feel him, and she was pushing and fully and everything was as it should be: but he woudn't come. When I went out and asked the doc's for help, help was given. We had to have a section in the end, and by the time we got the baby out (who had been "fine" throughout, on both IA and eventually CTG), he had apgars of 3,6, 9. He needed medical help. And he needed it when he needed it. My pride in the womans ability to labour so strongly doubled at her ability to accept the change when it came, and embrace the asistance offered to her. she asked intelligent questions, got the info she needed and said, "right, then, lets do it" THAT is informed choice in childbirth. choosing what is RIGHT when it is actually happening. She chose a natural, non intervened with labour with no drugs and no noise and no drama: and then, when tht didn't work, she chose a timely CS and health for her child. Surely, the empowerment comes from the choices? And sometimes, the choices are ones that cannot be made in advance of a situation.

July 11, 2008 | Unregistered CommenterTrin RM

Tonight I had an EMS transport from home to hospital.

EMS says to dad (who's translating), "Is she going to refuse an IV?" in a not-so-nice tone.

I touched his arm, which was connecting mom to the gurney, and I said, "NO! She is going to have a cesarean. Start the IV immediately." He was rather taken aback, but I could tell they softened immediately.

The care my client got from EMS was phenomenal and she went from bed in the home to surgery in less than 6-7 minutes. I am extremely grateful for their using lights and sirens (they don't always when necessary) and treating my client with kindness and respect.

While I didn't get to go in the rig, her husband did.

For a really shocking situation, it went off without a hitch.

July 12, 2008 | Unregistered CommenterNavelgazing Midwife

Trin: Exactly! My client (actually I was overseeing another midwife) was as graceful as a willow branch in the wind when the emergency shifted the plans. It is why I knew I could tell them to start the IV - the family believes in fate... the baby's hand in things... and I find this attitude to be the healthiest/easiest during postpartum healing.

I know these women exist... the ones who can flow from one experience to another easily; I tend to have these women as my clients - and I don't believe it is any accident. I foster/nurture the attitude of doing what is necessary in the moment, no matter what is happening IN that moment.

My clients (so far) have had very little postpartum depression that I have seen in women who can't cope with the shift in plans mid-stream. Even when the hospital or staff are turds, my clients have been able to mourn their experiences without finding them devastating. I'm very proud of them and learn so much about human nature watching.

July 12, 2008 | Unregistered CommenterNavelgazing Midwife

Great post. Too bad you threw this, imo, bias into the mix:

"Was she UCing? (Sadly, it sounds like it from her rigid attitude towards birth and the hospital. Sad because UCers have a reputation that precedes them.)"

I am sure there are UC-ers like this, but I know many who will be flexible and accept a change of course and medical assistance/intervention if needed.

I also was going to add what Rebekah already added here as well about PROM. I love your other points too though, Judit.

To me a birth plan has always sounded a little silly, especially if my plan is to give birth at home and I write a hospital birth plan. My assumption would be that if I had to transfer, all bets are off and I need to face things I did not foresee. What good would a birth plan do in an abnormal and unexpected situation? Maybe I am not getting it, I don't know. I never had a birth plan.

And seriously, what hospital/nurse lets a drugged up mom co-sleep?? And even in non drugged births, not all babies will crawl up. I mean, I have seen the video, but I could barely stand it. Just pick that baby up already! is what I thought the whole time.

Anyway, there are stupid people all over the world, and you are entitled to your opinion about UC. I just can't read a good blog and not say anything about what is in my opinion, a bias :D UC does not necessarily mean brainless.

July 12, 2008 | Unregistered Commentermaria

Not brainless; rigid.

July 12, 2008 | Unregistered CommenterNavelgazing Midwife

i>To me a birth plan has always sounded a little silly, especially if my plan is to give birth at home and I write a hospital birth plan. My assumption would be that if I had to transfer, all bets are off and I need to face things I did not foresee. What good would a birth plan do in an abnormal and unexpected situation? Maybe I am not getting it, I don't know. I never had a birth plan./i>

Agreed. if i'm transferring, it's because i NEED help and a "birthplan" doesn't make sense. i still expect to be fully informed and i will still make careful choices, but i'm not going to be "rigid".

which brings me to my next point: NGM, you seem to have some rather narrow opinions about ucers as a whole. That's a real shame. They are as diverse and different as all women are, though they are *generally* better educated about birth (though not always). Like Mariah, the only rigidity that i have, when it comes to birthing, is who's in charge (me). Part of being "in charge" in an emergency situation is understanding that sometimes you have to make the choice to let someone else take over, give good council, and roll with the punches. i know this isn't all you, but i'm really getting tired of all ucers being painted as rigid, fanatical, idealistic and even dangerous idiots. That's not me, it's not Mariah...it isn't most of us.

July 12, 2008 | Unregistered CommenterRebekah Costello

I guess, even as a hospital birth provider, I feel that the answer to situation like the one described in the post is not "women need to be less rigid" but "healthcare providers need to be more trustable." Even the most rigid clients I've ever dealt with respond great to honest acknowledgement of their feelings and concerns and honest explanations of the situation and why I feel a particular course is needed. It's not so hard to acknowledge to a vulnerable, frightened person that things aren't going how they want, that you are sorry things are going this way, and then why you feel things need to go more medically. Maybe this lady was just nuts - or maybe she would have responded great to some actual compassionate care instead of sarcasm and disdain. If there wasn't so much to fight against, maybe women wouldn't fight so hard.
It's hard for me - even though I genuinely believe in the value of the kind of care I provide - to get on board with saying things like we just need to trust the medical providers/setting/method and do what they say.

July 14, 2008 | Unregistered Commenterdoctorjen

I feel it is very important for women to understand that there are midwives whose "skills" and decision to act/not act are as questionable and risky as many doctors/nurses/medical professionals.
This being said, how are women to achieve empowered birth with safe and successful outcomes when the path of a pregnant and laboring wommin resembles a minefield?
Can we arrive at a solution to our problems?

July 14, 2008 | Unregistered Commentermama

Anyone who's read my writings for any length of time knows I speak about midwives and their practices as well. Certainly, my own isn't perfect; if I didn't keep striving to grow, I might as well quit now.

UCers will never find satisfaction with how most others see them, so it's a moot point to even try and appease them/you. My experiences with UCers comes first hand in real life world and, augmenting my knowledge, is the on-line world via a long-term list I am on, reading on Mothering.com and in answering the multitudes of questions via my email.

I do not speak of UCers rigidity lightly; it is well-deserved. If that doesn't fit YOU, then don't own it. Trying to convince me UCers aren't rigid is a waste of time typing. Thanks for playing anyway. In fact, the more UCers protest they aren't rigid, the more rigid they appear!

I spoke at a conference a few years ago - sharing midwifery information with the audience of UCers. A woman in the audience used my information and her baby died during her UC. While she doesn't blame me, I can't help wondering if my "education" had a hand in her baby's death. The experience forever changed my viewpoint of UCers.

Even WITH education, not having someone (a SKILLED provider) there can kill your baby.

July 14, 2008 | Unregistered CommenterNavelgazing Midwife

This is so very true. So very sad.
How do we improve wommin's abilities to connect with SKILLED providers, the sort of caregivers we can trust in our most sacred moments?
Our sweet babies lose their lives, wommin lose our sanity and safety.

I just want to thank you and everyone for honestly addressing and openly discussing the topics covered here; dogma, uc-ers, birth, pain and joy, etc. I have been following for a few months now and find solace in your thoughts.
thanks.

July 14, 2008 | Unregistered Commentermama

I hear the regret in your voice and I'm so sorry that circumstances have led you to feel responsible in any way for another woman's choices. I can't imagine that if anything tragic happened for *any* care provider, whether they were there or not, it would be easy to deal with. I think it's a very positive reflection of your character that you care so deeply for the women you come in contact with, even if I can't always agree with your conclusions.


Even WITH education, not having someone (a SKILLED provider) there can kill your baby.

Even WITH education, with skilled care providers, with all the technology and interventions at our disposal, babies still die. In certain, not terribly common circumstances, not having a skilled care provider can loose you seconds that can, indeed, cost the baby or the mother's life. I have yet to meet a woman that doesn't know that. In other scenarios, having those same skilled providers can cause life-threatening complications. Some women feel it is safer to go without intervention of any kind. It's an individual thing and an individual choice and not something you should feel responsible for should another woman use it. If anything, you gave her a gift and that is the true freedom to make that choice in an informed fashion.

I know three women (in person) whose baby's have died while under the care of a skilled provider. Without giving you or anyone else any information, of course it looks like having a doctor/midwife increases the chance of death (though, in fact, afaik, only one was truly caused directly by the care she received. She very nearly died, too). So by that same logic, having a skilled attendant at your birth can kill your baby. Many people claim having a home birth, skilled attendant or no, can kill your baby. DEATH is a real risk in birth as it in any other aspect of life. When we say "Birth is as safe as life gets" that's with the inherent understanding that life comes fraught with the risk of death. That is reality.

I think all of us like to think that our way is the "safest" way. Nobody I know makes the choices they do for birthing (whether it be homebirth, hospital birth, birth center or uc) because they think it's the least safe! All of us have different priorities, different concerns but every single mother I know wants a healthy, live baby. Each of us must evaluate our options, listen to our hearts and choose based on what we feel is the safest. Saying "You're baby can die, that's a real risk" is kind of redundant. You're giving birth, the baby could die. YOU could die. Welcome to motherhood. I'm not trying to make light of it or to be nonchalant about it because of course it's a very serious thing. It's just that there is no way to eliminate all of that risk. What disturbs me is that if a uc-er's baby dies, the assumption is that it's the mother's fault for having a uc. It doesn't matter why the baby died, what went wrong, etc. If however, that same baby were to die after birth, even in the care of a midwife, chances are, it would be "just one of those things". Most of the time, for all of us, that would be the truth. And no matter where you birth, sometimes, it WILL be the fault of the caregiver, whether that person be an OB, a MW or the Mother herself.

All of the different "choice groups" when it comes to birth say that their rival choices come with the risk of a baby dying. And yet still, no matter which choice you look at, more than 95% of the births will end with healthy mothers and babies. Maybe we really should quite playing the dead baby card?

As far as trying to convince you that ucers aren't rigid, that's really not what I was trying to do. I think maybe my problem is how all of us have this tendency to just generalize everyone into oblivion. I have known many uc-ers, for example, to insist that midwives are all medwives and that none of them truly trust birth. A real shame, that, because while that is undoubtedly true for many medwives, it certainly doesn't describe them all. I wish there was some way we could stop doing that to each other and learn to view each person as a whole, unique individual, regardless of their "labels" and wait to apply preconceived notions until after we get to know them. Unfortunately, I think it's something we all do without thinking about it most of the time (I know I'm as guilty as the next person with it).

How are we to build a true community of women if we all insist on categorizing each other and making judgments on each other?

Thanks for playing? Apparently I hit a nerve without even trying to (or being aware one was there). Sorry.

July 15, 2008 | Unregistered CommenterRebekah Costello

"And seriously, what hospital/nurse lets a drugged up mom co-sleep?? "

It sounds like the nurses were barely able to get permission to stimulate the baby to breathe at birth, you think they are going to be able to get this mom not to cosleep? I work in a mother/baby unit and go to deliveries as a baby nurse...trust me, if a mom's going to cosleep in the hospital, nothing we say will stop her. We just have to keep repeating that its dangerous in a hospital bed, after you've had meds, etc, etc but what else can we do? Maybe my hospital is too "nice", we recently had a homebirth transfer (after delivery, too much bleeding and signs of infection) and the family enjoyed their stay and care so much they wrote us a beautiful letter after discharge. I didn't have an opportunity to interact with this family, but I'm proud of my hospital and coworkers who made such a great impression on them.

There are good OBs, nurses and hospitals out there who don't do c-sections because they are "easy"...who are they easy for? Not a single person...not the OB who has to scrub in, cut you open, sew you back together, see you for 3-4 days in the hospital, see you 2 weeks post-partum for an incision check...not the L&D nurse who spends 1.5-2 hours doing a 1-1 recovery with you, not the post-partum nurse who has to check on you at least every 1 hour for 4 hours, then every 2 hours (at least) for another 12-18 hours, we can't get you up for 18+ hours so all of your "peri-care" has to be done in bed...no one likes a c-section. No one.

I'm sorry this mom didn't have support with her, and even if you take this report with a grain of salt, there's truth to it, and its scary someone would be that neglectful of their baby. I understand the desire to room-in with your newborn, hold them immediately after birth, nurse as soon as possible, but I don't understand looking at your baby not breathing, while covered in meconium and the desire to try to insist you get to hold them...lets try to get the meconium out of the airway and then get the baby breathing before you hold them...shouldn't take too long and will be very helpful to your desire to take home a healthy baby. Just a thought.

July 15, 2008 | Unregistered CommenterAnonymous

Yeah, that wasn't very nice. I'm sorry.

Your writing about the choice of UC is one of the most cogent discussions I've ever heard on the topic. Your gentle demeanor is something not often seen in the UC department.

It's definitely a psychological game that's played regarding putting people in clumps so they are recognizable quickly. You are right, we all do it. It's part of human nature.

It certainly doesn't mean we shouldn't rise above our base instincts to see people as individuals, but there is certainly something to be said for generalizations, too. They come from many, if not the majority, of a group thinking or doing the same thing over and over as time passes.

- Doctors see birth as an accident waiting to happen.
- Midwives have to consider the law when making decisions about client care.
- UCers are anti-establishment.
- Extended breastfeeding moms are into Attachment Parenting.

I know we ALL know exceptions to these generalizations, but *generally* these are beliefs that come from a majority group-think.

I laughed when I read that it sounded like I played the dead-baby card! Lately, I'm sounding more and more like an OB! "You just haven't seen enough, yet." "Complications can happen in the blink of an eye." "Midwives need more education." It's just so funny how my pendulum has swung so far... from high hospital to UC to really hands-off midwife to midwife who utilizes her skill and knowledge when appropriate. I can't worry about how others see me; I am a midwife who strives to offer the safest (and most loving!) care I can. I know I'm not the right midwife for everyone. Thank goodness there are choices!

Yes, babies do die with providers present, but I think sometimes semantics is at play instead of grasping what was said.

If a baby's head is stuck outside the vagina and the mom can't get the baby out by herself (either she didn't think about changing positions, didn't realize something was wrong, didn't grasp the passage of time, etc.), having someone there who has dealt with shoulder dystocia *can* save the baby's life.

Yet, I *just* argued about homebirth versus hospital birth (in my response to the AMA/ACOG) when I said women *know* hospital birth tends to be PHYSICALLY safer than homebirth, but women choose, instead, to take the risk to not have continual monitoring, to avoid the hospital's protocols in order to have what they feel is a SAFER birth in their home.

Weighing the risks and benefits is crucial when deciding where and how to birth. I hear you saying UCers do this, but I have to shake my head thinking they (the generalization) *really* aren't clear what it all entails.

And hospitals/nurses/doctors/CNMs say the same thing about the clients who choose my care!

It does go 'round and 'round, doesn't it?

Thanks for talking. It's good.

July 15, 2008 | Unregistered CommenterNavelgazing Midwife

it is very upsetting to read about not "playing a dead baby card."
Perhaps we should stop playing the empowered birth/choices in birth card as well??!! I mean, what are you suggesting!?
It would be great if you could honor the dead and their mothers/families with more sensitive/compassionate wording and tone.

July 15, 2008 | Unregistered Commentermama

Thanks, Rebekah, so very well written.

I agree NGM, about not all UC-ers being educated and some being anti-establishment and rigid. But like Rebekah said not all are, and the same type of generalization could be applied to all groups, including midwives. It is just sad to me that there is such a divisive attitude most of the time. I don't think there has to be.

For me, the reason I came to UC was because of a very wonderful midwife (actually a few of them) who helped me with my births and who taught me a lot. There is no fighting against establishment, or against this or that, no bad experiences, just a deep conviction for something that was right for me, after prayer and research, knowing full well that there are no guarantees in life. I had nothing to prove nor to fight against.

I look to midwives like you for information and insight, I look at reports and studies, books, heck, I even peruse Dr. Amy's site so as to have the 'other side' loud and clear (not sure she really is the other side because I think the 'other side' is much more nuanced in its totality, just like 'we' are ;) I ask questions of various people, read articles by various people, listen to other women and their experiences, but in the end, I need to make my own choice for me and I feel I can do this without judging others.

I think people are only rigid when they feel misunderstood and cornered. Like someone here wrote, when faced with possible medical intervention, the right words and gestures become so important. Indeed, sometimes someone has been deeply hurt before or is too biased and nothing will soothe them, but these examples too are just that, examples. There are as many examples of when someone did not react like this as well, and there are many examples of women not being treated with kindness.

I would feel terrified to be mistreated because I dared to attempt a home birth, let alone UC. We all so want to preserve ourselves and fear makes us do and say things. There are so many situations in life (schooling, vaxing to name a few) where we retreat in opposite camps and are ready to fight. I believe this is only because we are afraid. And I believe there is room for letting each other live.

I really appreciate and enjoy this discussion. I am not out to convince people they should UC, nor I am out to get all midwives, or all OB's for that matter. Nor am I out to prove that UC is safer or better, I don't think it always is. It is just a choice I made, and knowing many other women who have made that choice and whom I respect, I feel compelled to speak up when I see a generalization.

Ah well, rambling I guess. I don't know, I guess I would just like to feel welcome here and I'd like discussions to get away from judgement.

NGM, I am not sure I understand what you mean with 'wondering if your education had anything to do with that baby's death'. Was yours the only information she gathered? If so, is that wise and how is that your responsibility? You give information, you still do. A baby could still die. How is your job as midwife now different? Would you end up not practicing midwifery if a baby died in your care now? Do you feel your knowledge is more accurate now and you would have educated her differently now? A woman still makes her own choice, it is her responsibility in the end. No one should ever listen to one other person alone. It is not your responsibility to make sure she knew all there was to know (if that would have changed the outcome).

Anonymous: yes, you are right, the nurses could not have forced that mom to not co-sleep. So sad. I think women get confused between normal life and intervened life if that makes sense. Rules change in different scenarios.

Anyway, thanks for letting me speak. Enough I guess.

July 16, 2008 | Unregistered Commentermaria

NGM and Rebekah: -- Rebekah you really are a gem, very thoughtful and courteous; but certainly no pushover!
Now, for the alleged rigidity of the UC birthing strawwoman. We tend to generalize the context as well. Not all women are choosing to forgo assistance in identical contexts. One mother facing a forced choice between either an undesirable hospital or staying home alone is not the same context as another mother who could pick her best match from among a handful of wonderful, compassionate, sliding scale charging midwives but instead insists that their mere presence is so detrimental to her birth process that it endangers her baby and herself. Could it be that in states like CA and OR, more of those who UC, do it on ideological grounds rather than as a practical decision? Is this the context in which you see the choice to UC as rigidity, Barb?

P.s. Membranes: some midwives are pretty aggressive about starting labor after ROM, so it still depends on whose advice you choose to follow, based on your inclinations... my PROM, if that's what it was, was a good week before onset of labor, which I didn't induce. One thing is for sure: I do not go online and tell other women to do as I did.

July 16, 2008 | Unregistered CommenterJudit

Weighing the risks and benefits is crucial when deciding where and how to birth. I hear you saying UCers do this, but I have to shake my head thinking they (the generalization) *really* aren't clear what it all entails.


See, I'm not sure, myself. Some of the most well-educated women I know are ucers and, as someone whose spent the last four years reading huge uc boards, I can say confidently that *most* of them are better educated about "birth basics" than your average lay-woman. That being said, my closest UC internet friends, if you will, also are birth professionals (doulas, retired and practicing mw's, l&d nurses) so it may very well be that my perspective of the UC community is a little scewed because of the women I'm closest to there.

I can only really speak for myself. It is my belief that if Mom (i.e me) is going to truly take responsibility for her own birth, that means truly being aware of ALL of the risks as well as the benefits. I've heard it said of ucers that they are more interested in "having a pretty experience" than the health and safety of their own babies (I've actually heard that tripe aimed at the homebirth community in general as well). I'm *sure* that's true for some uc/homebirthers but most of the women I know don't think that way. Myself, I take the responsibility very seriously. I know about dystocia, I spent a month reading everything I could get my hands on about how to minimize the risk (you can't eliminate it, no matter what size your baby is or you are) and how to recognize it, what all of the possible maneuvers are to correct it and of course, when to transfer. Because, in my situation, I was planning a uc from the get-go, this was something I grilled my dh and my "helpers" in for weeks (I think they may very well have been sick of me describing turtling). As it happens, we had other things to deal with and dystocia wasn't an issue for us. My point is that rather than going with "my body knows what it's doing" alone, we accepted that yes, Nature knows what it's doing...but sometimes shit happens. I think that's realistic no matter what your birthing choices are.

I think you are right, though, about many birthing women. I am a freelance doula and have had the privilege of assisting at a few births. I had a client recently that wanted to VBA2C. She was such a sweet-hearted women and I wanted to assist her in any way I could, honestly. She wanted to UBAC. Well...after speaking with her at great length, meeting her, spending a lot of time with her (we became friends in the interim because I moved to her area and she was the only person I knew) I realized that for her, that would be a dangerous and foolish choice. And I told her so. Flat out: you aren't prepared. I didn't want to be cruel or dash her hopes or any of that but reality of it was she just could not grasp what "taking responsibility" meant. She didn't do her research. She had this attitude of "well it will all work out if it's meant to be" and to me, that's naive. In the end, she would not "own" her birth and she ended up with a CBAC because she was so unbelievably rigid in her dependence on someone else to tell her how to think, what to do, etc . No ownage.

Maybe I'm going out on a limb, here, but lets set uc vs mw assisted hb aside for a minute and look at the birthing community as a whole. I don't care who you are, your statement above applies to most birthing women, doesn't it? We as a whole need to OWN our births. For some women, this will mean consciously choosing an ob's care and a hospital birth. For some, mw care and for a few, uc. But for each of us, we NEED to own it! I think what you are touching on is this rosey-eyed, glamorous, perfect birth ideal that women seem to want to believe. The truth is that birth is dirty, grunting, hard, messy work. And sometimes, complications arise no matter how carefully we've formulated our birth-plans. No matter what situation a woman chooses to birth in, she NEEDS to be responsible for her OWN care. That is double true for a woman planning a uc. This is admittedly not a popular perspective in the circles I run in as many women use their faith or their "acceptance of nature" as their crutch for making up for the gaps in their knowledge. And I whole-heartedly agree that this is irresponsible and taking u necessary risks! I just don't think the answer to this is to wipe it all away with "uc causes babies to die" or something like that. I think it far better for us to educate each other. Give each other the tools needed to make informed, conscientious decisions. This isn't just about *feeling* good. This isn't just about "having an empowering experience", ya know?

Thank you so much for sharing your thoughts with me. You've really given me a lot to think about! My nursling has usurped my lap so I'll have to end here, for now.

July 16, 2008 | Unregistered CommenterRebekah Costello

I'm annoyed at the one example given of how the staff tried to "explain" things. "The two nurses say that newborns don't actually crawl to the breast and she says "Yes, they do! I saw it in a video." Editing, ya know." Is BS. Newborns do crawl to the breast, it's just that, as judit said, these are babies in good condition. By lying to her they really aren't making a good case for other issues.

Like "the baby has to be in a crib". Well, mom's on narcotics, has just been lied to about the existence of a neonatal crawl in *any* newborn not just "your baby will need more help because of the stress of the birth", and now these same people who have proven themselves to be ignorant want to do something else? Um.. no. And I'd bet the nurses didn't bother to say something like "you're on narcotic medication, you're going to be sleeping very deeply"

Anyway, I'm soooo not going to a hospital without a support person. Because a translator would've helped this case a LOT. "Remember, safe bedsharing guidelines say not to share a bed when you're on medication that causes deep sleeping. I'll be right here and will wake you up and give you the baby if s/he so much as wiggles in his/her sleep."

July 25, 2008 | Unregistered CommenterElizabeth

I am a midwife and I haven't EVER seen a baby crawl up to the breast, even in unhindered births. Granted, I might not have seen that many, but even women who want to see a baby "crawl" haven't had their babies do it. I believe that *some* (few?) babies can make the natural stepping and grasping reflex look like crawling, but I believe that is so rare as to warrant a film about it.

But expecting a baby to remain uncovered in an Operating Room (which is flippin' freezing!) and to "crawl" on a belly that is sliced open was an absurd request... even amongst the most crunchy of women.

Yes, it is nearly required for ANYone in the hospital, not just OB women, to have a "doula" 24 hours a day. So many medical events happen in the night - and even the most capacitated of people can use an extra set of eyes.

July 26, 2008 | Unregistered CommenterNavelgazing Midwife

Barb,

I don't know if you're following this blog, but every time she posts a birth story I think of you.

This is the latest:
http://www.ruraldoctoring.com/2008/08/birth-story-380.html

Thanks!

August 7, 2008 | Unregistered CommenterAlison Cummins

There is no reason to mistrust a medical professional right of the start. My husband is an emergency room nurse (who in his own words likes his job because he makes people feel better, and sometimes saves families some pain.) my sister a nurse-midwife. Most of my close friends are also medical professionals. While there are doctors among my close friends that I wouldn't see due to a brusque bedside manner let alone dedication to their patients, there are professionals among them who go to work every day with nothing but a desire to help whoever crosses their paths.

In addition, please let me say that I have a birth plan that is a flexible list of preferences that is moot when the lives of my baby or myself are at risk. When a lady arrives with the attitude that she needs to be "armed" with a birth plan and have someone to defend you from "attacks" made by medical staff makes such a hostile environment from the start, the doctors and nurses wonder why you are there at all if you are expecting to be attacked and harmed. And for the record I have yet to meet a doctor who likes as was so eloquently put earlier, having to "cover their a$$."

Even with my family and friends the way they are I have had two children both over nine pounds without the need for intervention and one who would most certainly have died without. My fourth is due any day, tonight would be fine by me, and this time I will go straight to the hospital and be looked after by a friend who is a good man and a compassionate doctor.
After all of my rambling due to frustration that there are people saying you can't be stupid enough to trust medical professionals, I want to say, NO you can trust them, but as an adult you can also let them help you make informed decisions about your care.
Thank you.

Oh one more thing, NGMW I think you are fantastic. I may not agree with everything, but your attitude and attempts to educate are wonderful. A presence such as yours would have been most welcome at any of my children's births.

August 11, 2008 | Unregistered CommenterAnonymous

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