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Wednesday
Mar252009

"Freebirthing"

I finally watched the “Freebirthing” show on Discovery Health. It was enlightening.  

I’ve read many of the blog posts and comments around the Blogosphere regarding this show, including when women who were in the show clarified their experiences. I have to say, what I saw wasn’t the same piece UCers (Unassisted Birthers) did – even though the content was exactly the same. As I read their comments, it seemed as if they were squinting, using kaleidoscopes and selectively watching the show about birthing without any care provider present.

Claire, a woman in the United Kingdom, tells us that she is choosing to birth alone because of a negative experience with a midwife the first time. I found it interesting, the language she chooses to use to describe her previous experience. She says the nurse was “intervening” and always looking at the monitor instead of at her. She describes the nurse leaving during the end stages of her labor, only returning when she heard Claire about to give birth. Claire said she still only looked at the monitor and then rang the emergency bell and she describes chaos that included whisking the baby to the isolette even though the baby was screaming. She says she kept telling them, “Give me my baby. Give me my baby,” but they continued ignoring her. 

You see, from this vantage point, there are parts of the story missing, parts that are pretty easy to fill in, although without the chart (or accurate eyewitness accounts) the whole story won’t be known. When the nurse left Claire earlier in labor, isn’t that what Claire would have wanted? Why was she so concerned about the nurse leaving when she, the next time, didn’t have anyone present? Then, when the nurse returned, she heard the baby’s low heart beat, went to look at the monitor strip to see how long it had been low and she called for help. Perhaps there was meconium and that is why the baby was whisked away to the isolette (not that I agree that this should have happened, but I am hypothetically filling in the gaping holes). 

During the pregnancy being filmed, Claire was getting prenatal care at the local hospital, but (I’m assuming) once she tried to bring the film crew in it came out that she was planning a UC. (Otherwise, why would she have told them?) She was released from the hospital’s care, including not being given the free “birthing kit” (that I assume comes along for the homebirth midwife). As Claire tells the audience about the distasteful visit saying at one point, “It’s kind of all or nothing.” Um... by your CHOICE! Question for Claire: If the hospital care was good enough to help you discover problems during the pregnancy, how did they become totally inept once you are birthing? (A question I will ask several times...) Was the “experience” of the birth more important than the health and safety of you and your child? For you, it seems it was. Does the idea of telling a good story, strutting around in on-line groups or shocking the family weigh more than death? 

Does it sound like I am playing the Dead Baby card? I am. And also the Dead Mother card. If a UCer doesn’t take these issues into account, she isn’t making an informed and complete decision.

Much is said about the crappy care women get in the hospital system. Having witnessed horrendous “care”, I understand the issue. I understand and sympathize with women who have experienced birth trauma, been birthraped or have been birth abused. I do believe hospitals, doctors and nurses are not the most wonderful places to birth when someone is having a normal pregnancy and birth. I believe a huge overhaul of The System must be done lest more and more women turn their backs on some of the very people who might save their lives. I believe the Internet is changing the ratio of women birthing at home and birthing unassisted. While the percentage of women birthing at home hasn’t changed in nearly 40 years, I believe that with the Net and with extremely popular movies like “The Business of Being Born,” more women are exploring a different way to birth. While “the experience” shouldn’t be THE reason women choose to birth outside of the hospital, it IS vitally important in helping a woman feel safe as she births her children.

As a midwife, I have also witnessed terrible midwives at work – disrespectful, manipulative and liars. But, happily, these are but a few in the (not-enough) bounty of midwives. 

As such, I can understand the drive for some women to birth unassisted. I am a pro-choice woman who can empathize with the pro-lifers. I understand when women do everything in their power to remain safe and healthy with a homebirth care provider and yet feel betrayed, assaulted and terrified. I also understand women hearing these horror stories don’t want to go there, so choose an unassisted first birth. 

I know the myriad of reasons women choose to UC: “No one will allow me to have a VBAmC”; “I can’t find a midwife that will do a VBAC at home”; “No one does breeches around here”; “I want my twins to be born vaginally”; etc. 

All of these issues are definitely distressing for women who find themselves in these predicaments. They must really struggle with what to do and where to birth. I wish I had wonderful answers to the questions, but I do not. 

But, how could every UC-wanna-be have no access to quality, respectful care? I don’t believe that is the case. 

Once Claire is “fired” from going to the hospital, she heads over to the local medical supply store to buy “sterile scissors.” The woman behind the counter tells her you can’t buy sterile scissors, you have to do the sterilizing yourself. This is one of many instances typifying the glaring ignorance of NORMAL, ROUTINE midwifery skills/knowledge. In fact, some of the ignorance/ineptness was so painful to watch, I covered my mouth and eyes at the same time. If these women were the cream of the crop of UCers, I shudder knowing the amount of luck UCers must require to keep themselves and their babies safe. It certainly isn’t the Internet or book learning that fills in the gaps. 

Claire goes for a visit with her grandmother and on the way she says she doesn’t want the risks “shouted” at her; she knows the risks. I am of the school that believes UCers should have to answer the questions posited to them. They should have to answer every question from “Why are you doing this?” to “How will you handle the baby’s death if that happens?” 

Once Claire is at Grandma’s, she tells her she is going to birth unassisted. Grandma is appropriately concerned and Claire says off-handedly, “If you think about women across the world, more women have unassisted births than probably any other kind of birth.” She chuckles as she says this, implying how ridiculous it is to be worried about a UC. 

Let’s see what the statistics show.

“According to the United Nations, Sierra Leone has the highest rate of maternal mortality worldwide, and a woman living in the country has a one in eight chance of dying in childbirth. Ireland has the lowest rate, with a one in 48,000 chance of a woman dying in childbirth, while the U.S. has a rate of one in 4,800. High rates of maternal mortality in developing countries often are due to a lack of skilled health care providers, inadequately equipped hospitals and widespread poverty that prevents many families from affording medications.” 

“In most instances, women who die in childbirth experienced at least one of the following three delays: 

- The First Delay is the delay in deciding to seek care for an obstetric complication. This may occur for several reasons, including late recognition that there is a problem, fear of the hospital or the costs that will be incurred there, or the lack of an available decision maker. 

- The Second Delay occurs after the decision to seek care has been made. This delay in actually reaching the care facility and is usually caused by difficulty in transport. Many villages have very limited transportation and poor roads. Some communities have developed innovative ways to address this problem, including pre-payment schemes, community transportation funds and a strengthening of links between community practitioners and the formal health system. 

-The Third Delay is the delay in obtaining care at the facility. This is one of the most tragic issues in maternal mortality. Often women will wait for many hours at the referral centre because of poor staffing, pre-payment policies, or difficulties in obtaining blood supplies, equipment or an operating theatre.”

“(Experts believe) Maternal deaths occurred because of lack of access and non-availability of good reproductive health services and approximately 75 per cent of maternal deaths are preventable, according to officials at the United Nations Population Fund (UNFPA) in Yemen.

UNFPA says that 84 per cent of all births in Yemen take place at home and only 20 per cent of these births have trained attendants present.”

These statistics demonstrate that, for the mother, the risk of dying is extremely elevated when no midwife or doctor is present. None of the above stats even begin to talk about infant mortality that could have been prevented if a trained birth attendant was there. 

The number one requirement, according to the CDC and other highly respected organizations, for lowering infant and maternal mortality and morbidity is providing quality prenatal care to all women. It is the women who fall through the cracks (or who purposefully remove themselves from The System?) that have the worst statistics of all.

We can know our country’s maternal mortality rate should be much lower (and work continues trying to make it so), but a segment of our women, African-Americans, have a far worse death rate than Anglo women; their maternal mortality rate is three times that as for white women! Absolutely atrocious. Experts say the lack of prenatal care, poverty, obesity and the propensity for hypertension and diabetes are the main causes for this increase. Number one is lack of prenatal care. 

Am I making you think? Pissing you off? Good.

Claire has a new partner, a girlfriend named Yasmin. Snarkily I say, “Oh, honey, I know we’ve only been together for 6 weeks, but will you be the assistant at my unassisted birth? It’ll be a great third date.” That Claire brings in 1) a total stranger who would blindly go along with something she probably never heard of 2) someone who gets a mere few weeks of information about what to do in an emergency 3) a woman she can all of a sudden lean on – tells us of Claire’s mental state: not healthy! 

Continuing, Claire and Yasmin are seen at a Red Cross CPR class where the man is giving them a private lesson. He forgets they're birthing alone for a moment and then stresses how vital the first few minutes are. Yasmin is seen standing off to the side looking like a deer in the headlights. 

Once labor begins, it is only a couple of hours long. No fetoscope or doppler is seen and Yasmin’s job seems to be videotaping. When Claire is birthing the baby, she is on hands and knees with Yasmin behind her holding a towel. You can see Yasmin grab a blanket and wipe down, getting the poop off of Claire’s rectum. (Wiping should always be up so the baby doesn’t get the bowel movement on him/her. Basic knowledge.) As the baby is being born, Yasmin tries to touch the baby, but Claire tells her to stop and at the same time begins hollering, “I’m scared! I’m scared!” Yasmin does nothing to reassure her. In fact, Yasmin looks totally out of her element, uncoordinated in her actions and superfluous to the whole affair. 

The birthing of the placenta isn’t shown or talked about. 

In the piece at one point, Claire discloses that she knows she will be “in a limited capacity” during the labor and birth. Was she depending on Yasmin to be her midwife?

And so we meet Heather, a twenty-two year old American woman, when she is a couple of weeks away from birthing. As her story unfolds, we see she is also UPing (getting no prenatal care). She listens to her baby with a fetoscope and checks her blood pressure at the local pharmacy. A concern of hers is there might be a low-lying placenta; she can hear it with the fetoscope. 

Now, I have to tell you how incredibly amazed I am that this woman who has never heard a heartbeat, a cord pulsating or a placenta through the uterus can tell she has a low-lying placenta (possible placenta previa or a partial placenta previa). It can take midwives years to be able to tell the difference between the cord and the placenta’s woosh. 

At a gathering of Freebirthers that Laura Shanley brings together, Heather tells us that she’s choosing to UC because her first birth was so awful... that her pushing stage was only ten minutes long, yet they were hollering at her to push with all her might. When hospital people implore a woman to push like that, it is because the baby is in serious trouble. In fact, she says they told her if she didn’t push the baby out immediately, she was going to have a cesarean. Proof to me, without even seeing her chart, that the baby was having a very hard time. Why doesn’t Heather talk about that aspect of the birth? Why does she demonize the hospital people instead of offering a balanced view of the previous birth? I don’t believe most UCers are able to do that. I wish for all of them a course in re-framing (there isn’t one; I should do one) so they can comprehend and accept why their births were the way they were. Again, I know birth abuse happens, but listening to two of the three stories, the medical people had horns growing out of their skull according to the women telling them. 

Even though Heather thinks she has a low-lying placenta, she does not go get an ultrasound. Instead, she brings in Karen Strange, CPM, to teach her a crash course in Neonatal Resuscitation. Interestingly, Heather is alone as she learns. Is she the one who will perform the rescue on the baby? If she does, indeed, have the placenta previa, who will do NRP on the baby as mom hemorrhages to death? 

As Heather is talking to Karen, she inquires, “How long, um, would the baby have to go without oxygen for it to....” (uncomfortable moment) (Karen states) “Die?” (Heather) “Yeah... like you don’t really know... is it like twenty minutes?” (?!?!?!?!?!?!) Karen tells her she doesn’t have twenty minutes. “Ten minutes?” “No, you don’t have ten minutes.” 

HEY HEATHER, YOU HAVE ABOUT FOUR MINUTES BEFORE BRAIN DAMAGE OCCURS AND ABOUT SIX MINUTES BEFORE DEATH.

Relieved, Heather says the ambulance is only five minutes away. Really, there is no way for Heather to know how long it will take an ambulance to get to her. They could be across town after another call as they drive the six or seven minutes to her house. They will come in and assess. Time is ticking all the while. 

Heather learned a lot of her information from the Internet. 

Do women who learn about birth on the Internet consider newsgroups and on-line support groups as their education process an adequate midwifery substitute? Why/How is it okay to take advice from on-line women no one has met in real life, yet turn their backs on real life licensed midwives who have much more information than those on-line friends? Even real-life midwives do not have the information needed to offer advice over the Internet and any of the people offering advice carry the weight of the outcome of the unseen women and babies. It disgusts me to watch as women tell pregnant women to do such and such or thus and so... everything from not showing up for inductions, dismissing NSTs, believing any number of ills are because of a) seeking medical/midwifery care b) not believing in the normalcy of labor and birth c) still being brainwashed and disbelieving of natural remedies and the ability to self-heal any complication. 

Watching the UCers, I see that they try to gather information they will need for their births, almost literally becoming their own midwives (or having someone else fulfill the role). What is baffling is they think the information is really important, yet won’t bring the person who’s really great at retaining it into their circle during birth! 

Just because one can learn the information, does that mean she has to learn it? Do we know how the engineer builds our cars? Do we care how the telephone works? Do we make (all of) our own clothes? Grow (all of) our own food? Do we stand next to the car mechanic and ask “Why are you doing that?” when they are fixing our brakes? Don’t we know why? Don’t we accept that some people are better at some things than others? Heck, I am terrible at math, but writing comes fairly easily to me. You wouldn’t want me doing your taxes, but I’d be okay creating a brochure. Shouldn’t we be able to tap into the variety of skills around us without becoming an expert at everything? If we aren’t very good at something, could we ever even BE an expert at it? 

Laura Shanley, a woman who says she just wants women to be “empowered” no matter where they give birth, is the guru of the Freebirthing movement. Her information and support are partially/muchly responsible for any negative outcomes that occur because of her advice. If women take the advice of those strangers over the Internet, those strangers also carry the burden of the brain damaged and dead babies that have happened with Freebirthing. We have learned of several on Mothering.com; what happens to the women who vanish, the ones who are humiliated they listened to such bullshit advice that their babies are dead? 

Just yesterday, Mothering.com (finally!) put a disclaimer up. It reads: 

“The opinions offered at Mothering.com, MotheringDotCommunity and the UC forum are for informational purposes only and are not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your midwife, physician or other qualified healthcare provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking care because of something you have read here.” 

The moderators at MDC typically edit dissenting comments, many times removing them from the boards. Did something make them come to their senses? Did something happen (again) in the UC boards? This statement is a good beginning, but allowing balanced commentary would be a much better avenue for them to follow.

During Heather’s pregnancy, she says, “I haven’t really thought a whole lot about if I lost the baby or if I died. And that’s the one thing that I don’t think much on, but when I do think on them, those are the really scary things.” 

How can any sane person say this woman should give birth alone? She won’t even confront the most basic issues of possible tragedy. She says she doesn't want to “make a big thing out of little things.” She does say that if something goes wrong, “I only have myself to blame.” 

During the birth, she is seen pushing in a couple of locations; she ends up on the bed, on her back (I thought that was pretty interesting). As the baby is born, she’s giving directions to her husband, to pull on the baby so he will be born. As he pulls, she says to stop, but you can see him pulling on the baby’s head to get him out. I shuddered. If she’d have had a midwife, she would have allowed the baby to be born much more gently, not pulling on the head, stretching the neck and possibly causing harm. When she gets the baby in her arms, she apologizes to him, saying she knows he doesn’t feel good. Not after that entrance into the world! 

The family decides to do a makeshift newborn exam, yet they have words about how to work the scale. Dad wins. When they are shown getting ready to cut the cord, Heather asks, “You don’t think it hurts, does it? Does it hurt the baby to do this?” I am serious. Wouldn’t you think someone who has deemed herself a midwife would know the answer to this? Dad’s answer? “I’m sure it doesn’t because they do it in the hospital.” Priceless! 

So, the baby is doing well and the next scene we see is Heather sitting on the couch, leaning forward saying it is “several hours later” and the placenta has yet to be born. She feels pressure, but it just won’t come. They decide to transfer to the hospital. 

Now, this is my favorite part of the whole show, so sit up in your chairs. 

Heather is in the hospital bed, on her cell phone and telling the nurse she doesn’t want an IV. “Do I have to have an IV?” and then “Do I have to have an IV for a D&C?” The nurse says they don’t even know if she needs a D&C. I am telling you now... if there wasn’t enough ignorance already showing in this girl child, these scenes in the hospital demonstrate it delightfully. A D&C?! How about getting the placenta out. A D&C?! C’mon. Basic knowledge. BASIC knowledge that is missing from Heather. If this is missing, how much else is? 

rubbing hands together and smiling 

Now the doctor is in the room, in a chair leaning back. He says, “What will you allow me to do?” and Heather hems and haws about his getting the placenta out, what will that take? She is alternately directing and meekly questioning, all one right after the other. The doctor again asks what she will let him do and she asks what does he want to do. He says he wants to examine her and she lights up and says okay. 

The doctor said exactly the right thing: What will you allow me to do? Listen UCers, if you go into the hospital for a problem, ALL BETS ARE OFF! You buy the hospital ticket, you go for the hospital ride. Don’t be asses and try to direct things in the hospital. YOU WENT THERE FOR HELP; LET THEM HELP. Sheesh. Interestingly, the baby was examined in the isolette. That is something I would probably have not allowed because the baby isn’t the patient. 

The placenta, it turns out, was right there, in the vaginal vault (they didn’t say that, but the pressure she was feeling demonstrated that) and came out quickly and easily. It was just sitting there, for goodness sake. A midwife would have helped the placenta out nicely and the trip to the hospital would have been avoided altogether. 

In a comment on a UC blog somewhere, Laura Shanley wrote: Heather is now sorry she went into the hospital, as many women that give birth at home deliver the placenta hours (and occasionally days) after the birth with no problems. There really was no reason for concern. Hey Laura! How about not giving out midwifery or medical advice, eh? Some women DO have problems, with bleeding, with an accreta or it could be sitting in the vault like Heather’s and lovely germs can crawl up the cord into the vagina causing sepsis and kill the mom. How about that information along with your flippant pieces of advice? 

(During a scene of Laura Shanley delivering one of her babies, she was also on her back and there were several men in the room. Is this unhindered? Hmmm... some debate about that.) 

Throughout the show, the women continually talk about “the experience” of birth, how they wanted things peaceful. A woman in Wales has her UC so she can have a painless birth (her experience, not the baby’s). When does “the experience” over-shadow the health of the mother and baby? Can’t the experience walk hand-in-hand with the health of both mother and baby? Heather says there are “dangers for my children” if someone was there to help. In fact, she would have avoided that trip out of the house if she'd have had qualified help! 

One of the midwives at the end says these women are “disenfranchised” and she is absolutely correct. Somehow we have to find a way to civilize birth in the hospital and make sure midwives are offering loving care in the home. Experience with safety must be the goal; there must be a way to do this. 

I really loved this piece by a mom who was trying to birth at home, but transferred to the hospital. 

“During my pregnancy, I had dreaded this showdown: The Medical Establishment vs. Sweaty, Agonized Me at the Not-O.K. Corral. But when the moment arrived, it wasn’t a showdown at all. My ob-gyn, a stately woman, entered the room. She wore an unsteady look. I could hear her laying out the reasons why we needed to do an emergency C-section, but I was only half listening. It was her face I watched. It pleaded, Please don’t make me risk your life.

That’s when I got it. That I could die here today. That I could leave my baby without a mother. Or worse, I could take my baby with me and leave my husband mired in grief.”

Somewhere I read: “Unassisted Childbirth was and is the answer for any couple that honestly wants to have a peak experience welcoming their own children into their lives.”

This is exactly the sentiment that must be dispelled. Birth isn’t just about obtaining a peak experience. The experience must be combined with the health and safety of mother and baby. Now THAT translates into a peak experience!

References (7)

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Reader Comments (56)

Hey there,

I was asked to be an "Ambassador" at MDC, a role to help the mods identify questionable threads, and help to mediate conflicts, etc.

I resigned because I just can't go there and see the crap that flies back and forth. MDC takes more effort in making sure that posts are in the right folders than they do in making sure that the environment is safe- not safe for people who need safety in which to express themselve, but safe as in *not a replacement for their providers*.

I just can't go there anymore, it makes me sick to my stomach.

The mods asked me why I quit and I told them exactly my reasons. This was just a few weeks ago. I'm glad to hear there is a disclaimer but I hope that it's a change in culture and not just a pretty bandage on a festering wound.

LOVE this piece. :)

March 25, 2009 | Unregistered CommenterKristina

Hey there
Whew. I was suppose to be working! i was reading instead! ;)

What a great article. As time has gone on I have become more and more against UC. I just cant imagine doing with just my husband and I at home. I think its crazy. Even midwives who know "everything" still have an attending midwife because they know things happen. Youre not super woman. And you wont be able to save yourself and your baby if sometthing were to go horribly wrong.

I am so glad you wrote it. MDC isnt all bad ;) I love that forum...I just dont pay attention to the UC threads. :D

March 25, 2009 | Unregistered CommenterRandine

Oh, Barb! I could feel my blood a'boiling as I read your words! I should probably write my own blogpost! I can't even stand to go on MDC anymore, because of the crazy, half-informed, idealistic, and foolish advice handed out on there like it's fact! And some of this "advice" is coming from women who are MIDWIVES!

Holy shit!

I read things like, "It's NEVER necessary to check for a cord!" from women who are supposed to have years of experience as a birth attendant, but obviously have never seen a baby hung up on a cord, eggplant purple head; white, floppy body, or had to rescuss said baby.

My other favourite? "It's NEVER necessary for the midwife's hands to touch your perineum!"

Or the all time classic; "VE's don't provide ANY useful information, decline them! Any midwife who wants to do a VE is obviously a MEDwife!"
Other MDC gems;
"Your body won't grow a baby too large for your pelvis!'
"GDM is a diagnosis looking for a disease!"
"Why swab for GBS? Watch for signs in the baby!" (Did anyone tell them that a baby with GBS disease is very likely to die?)

ARGH!


Truthfully, and frighteningly, most births, even unattended births, will progress just fine. The odds are stacked in their favour that the baby and mom will survive birth. But, lord have mercy, when things do go wrong, they go wrong, for realz.

I'll have to organize my thoughts and come back, I got a lot more to say on the subject!

March 25, 2009 | Unregistered CommenterColleen

Yes!! Yes!! Yes!! Best post I've seen in a while! I thought many of your same thoughts when I saw the show. I am so relieved everything went okay, but those women were lucky. I was offended by how Heather and Claire treated anyone with any real medical knowledge. To be ignorant as well as patronizing is about as bad as it gets.

March 25, 2009 | Unregistered CommenterAndalusians of Grandeur

What you wrote was brilliant.
I know there are women who have wanted to have a very private and peaceful birth. But they still had a midwife present, just in another room.

This was very well thought and written out. You are very very right.

March 25, 2009 | Unregistered CommenterCri

I have to agree with you. I cringed when I watch freebirthing. I felt.. well.. not to be smug...but, smarter than the women they showed.

I had once entertained the idea of UC'ing. In between having both my boys. But my first thought was, "well hrm... if something did happen, I don't trust myself or my husband to be able to handle it properly. I DO trust my midwife." I think I have my paramedic father floating around in my head. I'd rather have a professional there to guard my back and let me know of any red flags so we can get more help. Than have no one and know nothing.

March 25, 2009 | Unregistered Commentermommy michael

I'm SO glad you wrote something about that awful show, I wanted to jump into the TV and knock some sense into those girls. I've read dozens of stories written by moms who birthed essentially alone, with the midwife watching from afar.

What they failed to understand is that one bad birth experience does not ruin all future birth experiences. It just means you have to work harder to find a care provider who will offer the exact type of care you desire.

March 25, 2009 | Unregistered CommenterRenee

Hi NGM,

I appreciate your comments on UC'ing. It's unfortunate how many people follow trends that "suit" them without taking into account the consequences or even being aware of the possible risks. It reminds me of the argument a child has with his mom when he wants to justify his desire to do something less than smart and she replies, "If your friends wanted to jump off a cliff, would you?"

As a RN I have worked in the medical field and so I know the benefits but I don't agree with MANY of the interventions that are commonplace in a hospital birth setting. So when I became pregnant with my first and so far only child I chose to use a CPM even though it meant I would have to travel about 100 miles (each way) for every prenatal appointment and for the birth at the midwives birth center. There are no CPM's closer.

It's a long story but suffice it to say our child ended up going past the EDC by more than two weeks and even though I insisted that it was entirely possible that the EDC could be wrong I had to be turned over to a MD/NP group (100 miles away), take my chances locally (hospital within 5 miles) or take my chances with a UC. I chose to go with MD/NP group since my CPM could act as doula and it was not a happy experience... empowering when I successfully and prayerfully followed my instincts (with some medical input -- did two or three NST's that week and one biophys all WNL) and gave birth at 43 weeks by the EDC to a very healthy 10lb 1oz baby. I, however, felt completely unsupported by the NP who caught, she had a scowl on her face the entire time and didn't even say congrats when she left the room without stitching me up afterward; said I didn't need stitches... it later (2-3 hours later) took the MD 2+ hours to stitch me up. That's the short version but I've seen the charts and even though our child was LGA (off the charts 22" long, 14.5" head), tested 41.5 weeks on the Dubowitz/Ballard and the placenta showed no signs of detioration which was always the looming threat the MD/NP's pushed when arguing that I be induced.

So now as I consider my options of having another child. I wonder what you recommend? I don't want to end up in the same situation and don't feel connected to the midwife I used before because of what happened. I've honestly considered a UC but I don't feel comfortable even having medical knowledge or maybe because of having medical knowledge. I'd love to even correspond with you to give further details, if you wish, so you can have a more complete picture both medically and personally.

Obviously I am among the disenfranchised. So, what do you suggest to those of us who feel we've exhausted our options short of relocating to another city/state? How can we collaborate on a solution? I would love to be a part of that... just as you mentioned going back to school in a previous post... I myself have considered going to CPM school but at this point in my life it isn't feasible. I have read your blog for sometime now and am very interested to read your perspective/reply to my question. Thanks, Cindy

March 25, 2009 | Unregistered CommenterQ

Thanks for this review. I've been pondering seeing the film for curiosities sake (pretty sure I share all your sentiments on the issue, although it's not one I've looked into extensively as it's NOT for me) and I find it interesting that they don't even seem to present UC that well. LOL.

My face went into my hands when you mentioned the confused couple debating the pain of the cord-cut. Oy vey.

March 26, 2009 | Unregistered CommenterStassja

A beautifully, well written post. I have not seen the show, but am not rushing out to see it now! It will probably just make me angry. I just had a lovely homebirth with 3 excellent midwives. I would have it no other way. I am an engineer and would not expect someone to learn how to build a bridge from the internet! You are absolutely correct in saying that the skills midwives and OB have are important for healthy outcomes.

March 26, 2009 | Unregistered Commenterstephl

Renee said:

"What they failed to understand is that one bad birth experience does not ruin all future birth experiences. It just means you have to work harder to find a care provider who will offer the exact type of care you desire."

I know this statement is well meaning, however, it is insulting. It insinuates that people who had a bad birth experience did not work hard enough the first time to find a good care provider. Most care providers do not tell you that they will not follow informed consent standards at the birth when you go to them prenatally. Most women don't assume that their providers will be abusive towards them at the birth. Also, by saying that one bad birth experience doesn't ruin future experiences, yes, you are right, it may not. However, it will severely impact several aspects of any future birth experience, including whether or not there will be a future birth. When a bad birth experience has occurred, you will see women desiring their future birth experience to be on one side of an extreme, either an elective cesarean, or a UC. These extremes are both about reclaiming control. Perhaps over time, when everything stops appearing so black and white and she can start seeing the gray, she will pull away slightly from the extreme and settle for a birth with a hands-off midwife (which is much harder to find then the commentors here think), or she will settle for a 'check into the hospital, get the epidural right away, etc.' type birth. From what I have observed, most women who have been traumatized by their births choose the UC extreme for their subsequent birth. I think this is because most women who are traumatized by their births went into it more "educated" and more naturally minded in the first place - this actually seems to be a risk factor for birth trauma as women are going against a well established system and are punished for it.

Barb,

I liked your post and I agree with your viewpoints. I think that many women who have been traumatized by their first birth can not reframe it for quite some time. However, I also feel that sometimes they leave out the reasons why things were done at their births because it's easier to express that way so that others will understand how it affected them. What I mean is that it is hard to make people understand that the way something was done was traumatizing, even if the thing that was done was necessary. Also, in reality, informed consent should be upheld even in the case of an emergency. A mother should be given the opportunity to consent to all procedures, and when she is suddenly left out of the loop or is saying no to something and it is being done anyway, she wont always understand what is happening and why. She may understand it, but disagree with how it is being handled, yet is not allowed any say over it. The true issue is that a trusting relationship with the provider was never established, or if it was, it was taken advantage of at the time of the actual birth - which is the hardest for women to deal with because they didn't expect the drastic change in treatment or loss of control.

Also, I think avoiding future birth trauma is what some of these women are solely focused on. I think some women, and I did for a time as well, see avoiding this as weighing just as highly as avoiding a death. If you have to take a greater chance of a death, but it increases your chance of avoiding birth trauma again, this can make sense to those women. It makes sense to me right now as I write this, because birth trauma is life threatening as well. The risks of suicide and infanticide will be greatly increased if you experience a birth trauma, and the thought of being retraumatized a second time is enough to drive one to thoughts of suicide. How does a (hypothetical) woman who has thought of suicide or infanticide daily for a year or more, weigh these risks? They balance out more evenly if you have been through this. I'm not saying all UCers have experienced birth trauma, but I can understand it a lot more in the ones who have.

Personally, I considered UC for quite some time and I followed the community on MDC for about 2 years. I noticed a great deal of preventable still births, much greater a number then generally across the board. Also, what was very frightening was the mothers who would post while in labor and then drop off the board never to be heard from again. Also, I noticed a massive amount of hospital transfers. And many of these were transfers that turned out to be unnecessary. It seemed ironic to me that for women who were very much trying to prevent birth trauma, they were putting themselves at greater risk of getting it by voluntarily walking into a hospital for no reason - just to be mistreated and abused. Something that would have been entirely avoidable if only a midwife was there. That is when I decided not to UC. However, I wonder if I would have gotten pregnant at that time if I would have done it. I think there was a time where I was just in that mindset and I hadn't observed enough or realized enough that there were true increased risks, not only of death, but of being retraumatized. I also realized that I wanted support at my last birth, that I missed that and I want it for a future birth. I want to develop a trusting relationship with a midwife, and I want to be supported in a new way through another birth. I think it would go a long way in healing something that was so damaged in the past that I almost UCed to avoid it again.

March 26, 2009 | Unregistered CommenterJennifer (mama blogess)

Balanced commentary at MDC? BWAHAHAHAHA. Surely you jest, Barb. ;) I had to stop posting there because I couldn't tell whose "side" I should pretend to be on. Nothing disparaging about the medical establishment is allowed...but nothing disparaging about those who shun it is allowed either. So confusing! No chance for open dialogue THERE.

I feel your frustration. I really do. I am a little exhausted after reading thispost because I have thought many of these things myself. I am not against women who UC. If they are educated - REALLY educated - and prepared enough, then it can be the right choice for them. But you're right, it is not about an experience. And yes, some of the stuff I've seen thrown around on the internet makes me shudder. It really paints all of us who seek "alternative" births in a bad light. We're not all hippy-dippy moonrats who bite off the umbilical cord with our own teeth. But shows like this don't help that image whatsoever.

March 26, 2009 | Unregistered CommenterJill

Oh, I also wanted to add that the rising rates of UC in my own state are one of the reasons home midwifery was finally made legal a few years ago. Want to talk about having no choice...women here LITERALLY had no choice. It was either go to the hospital and likely get a Cesarean, or birth at home alone, unless you knew one of the very few underground midwives. Now, they have the SAFER option of a licensed attendee. Much better!

March 26, 2009 | Unregistered CommenterJill

Jennifer, Thank you for a VERY well-written and explanatory piece about the "why's" of UC. I am sure that eventually I'll get some hateful comments, but I hope they are able to look at YOUR comment and see that you *do* understand in a way that many of us cannot.

Everyone reading also needs to remember I *had* a UC for a variety of reasons. My daughter was 10 lbs 6 oz and a nasty shoulder dystocia that needed resuscitation that we didn't have there. I learned in that birth how valuable a TRAINED provider is at birth. While Meghann's birth transformed me, it also terrified me, much more than ANY hospital birth trauma could have.

March 26, 2009 | Registered CommenterNavelgazing Midwife

Barb,
I haven't seen the documentary so I can't comment on that specifically. As you know of course, I had a UC but unlike the women on the show, I didn't come to it from a place of fear, mistrust, or previous negative experiences with midwives or doctors or hospitals. I do have a lot of complex and sometimes conflicting thoughts about UC. For me, it wasn't about rejecting midwives or hospitals as it was about really needing privacy. For that particular labor, I don't know how I would have been able to give birth with one of the two midwives in my area (and there really only were 2 homebirth midwives, one CNM and one DEM, and they were still both 90 miles away). I worked with the CNM so I knew her practice style personally and I was definitely not at all comfortable with having her at my birth. Both she and the DEM were out of town for the same week when I expected my baby would likely arrive, so frankly I knew that my options were limited. I really isn't that easy to find a respectful midwife, especially in the many illegal states I have lived in over the past several years.

But anyway, back to my commentary...I do agree that there is an element (trend?) within online UC communities that is veering away from education and preparation and thorough research, and frankly that does worry me quite a bit. I actually addressed that towards the end of my dissertation chapter on intuition. I've also corresponded with several midwives/physicians who are involved with/supportive of UC about this, and they agreed with me about this rather worrisome trend (some of these comments also included in the diss if you're interested in reading them). I came from a strong midwifery background myself and if anything, doing my own prenatal care and birth was a spur for more knowledge. I used the internet a lot for social support and friendship, as I was preparing for my own UC, but not necessarily for solid knowledge about childbirth--that's what really good textbooks, articles, etc are for. And of course, first-hand experience attending births, which I had been getting as a doula & midwife's apprentice.

I do feel that your use of statistics from Sierra Leone or other poverty-stricken, war-ridden countries is disingenuous and logically unsound. There are so many other factors in these countries that contribute to maternal or infant mortality; you can't simply use evidence that to prove that UC in first-world countries--where women do have access to medical services, where women are healthy and well-fed, where they have good sanitation, where women aren't living under extreme stress and/or trauma--is unsafe. Now, I'm not making any kind of argument for or against the safety of UC--we really can't since we have no good numbers on it--but I do feel that the "3rd world arguments" are not very sound when discussing UC in the context of developed countries.

Talking about things like "safety" and "the experience" gets tricky because I can see these exact same arguments being used to show how women who home birth (with midwives) are just doing it for the experience, etc. I'm not entirely disagreeing with you, but it really gets sticky because these terms are so highly charged and malleable depending on the person's POV and core assumptions.

This second pregnancy has been interesting as I've felt more drawn towards having a midwife, but also worried at times how I'm going to be able to give birth with an outsider present. Laboring takes all of my focus, and even having my husband in the room was a distraction from that. So there's that unknown element that I hope will not be an issue for this labor. I have enjoyed the midwifery care from this pregnancy, especially once I had a thorough and very frank talk with my midwife about these concerns. I feel that each birth has its own individual needs and I am trying hard to honor that this time, like I did with my first pregnancy, in which I felt strongly drawn to doing it unassisted.

Anyway I have a lot more thoughts but really should go and work on my book proposal...there's nothing like a lively discussion to make me want to procrastinate!

March 26, 2009 | Unregistered CommenterRixa

Wow, lots of thoughts flying through the air here.

I think that in general most of the world is mostly ignorant, they just are. Or, as my mother likes to re-iterate, they remain convinced of their own rightness even when presented with facts to the contrary (she got it from somewhere and finds it to be true). I think a great deal of this is that facts are hard to come by, that libraries, real and electronic, are sometimes hard to access and there are no good guides in person in navigating the slew of information that is out there - someone to say "this is good, this is, well, fictional". I know which things to pay attention to only because of grad school, and even then I take it with a grain of salt as we all know that studies can be flawed and conclusions tossed out in 10 years with new evidence, and even then it's easy to listen to emotion more then good logic.

And perhaps you can address what Q was writing about, it has become increasingly an interest to me about how the window of full term has been decreased by a week arbitrarily due to increased preterm birth. Specifically, I know that humans occur in a continuum, full term should reasonably occur within the 90% range bell curve, 40 weeks +/- 2 weeks, but what about the outliers that really are okay at 37 weeks or 43 weeks? How common are there practitioners willing to allow the pregnancy to continue or does one need to advocate for that to happen?

I guess this entry to your blog just brings up some points I am wrestling with myself, that as a VBAC mom who is built as tall and heavy as a linebacker (ideal weight for me is 220lbs,and I'm 6') and no signs of dystocia (no turtling, normal delivery and normal labor times for him with no fetal distress) with my 10lb 5 oz 2nd born I have the clinic putting in my charts - yes I was reading it upside down when checking in last time - that there was cephalopelvic disproportion and shoulder dystocia, right... Perhaps if I were built like the average petite (to me) woman, but for my family that's full of Amazons that's normal. How do you as a midwife decide for yourself to go ahead helping a birth when the signs of a macrosomatic fetus and late birth is pending without feeling great doubts?

Sigh, I don't feel disenfranchised - I feel like the way we determine course of action is limited and doesn't really always fit properly. That for moms like myself who don't want a repeat c-section but know the medical community is creating evidence to support a c-section and also know that perhaps for her and her future babies that trying even for a homebirth with midwife attendance is pushing the line of okay and not okay, there are no clear answers and no good way to find them. I am pretty sure if I advocate for myself with my clinic doctors they will allow me a trail of labor next time, but that I can only advocate now since I am 36 years old - if it had been 10 years ago (prime fertility age) I would not have had the gonads to do so.

Maybe what it comes down to is women not being treated like women, girls not being taught to become women (and not stay girls), that we aren't taught how to talk to authorities and authority isn't taught or doesn't know how to help women become adults. It's not an either or, it's a continuum, and it needs to start before women become pregnant. Perhaps we need doulas before we get pregnant too.

March 26, 2009 | Unregistered CommenterEthel

Hi Barb,
I've been reading your blog for a long while now, but this is my first comment. I agree with every single thing you wrote, and while I haven't seen the show myself (our 20 month old disappeared our cable card!), I'm sure I would have watched it with as much fear, skeptacism, and as many snarky comments as you did. My only point of contention is the... I don't know - tone? that suffuses this post. I totally get your frustration and anger at the lack of experience and knowledge in the UC population, but many of the comments reminded me exactly of the tone that many midwife assisted homebirthing moms have to endure from in-hosp care staff, unsupportive family members, etc. who think that WE are completely ignorant and irreverent about the risks associated with birth. And that didn't sit well with me. I think that the broken system has so much to do with women pitting themselves against each other and treating each other with disrespect and a dismissive, us/them attitude. But, at the same time I have no idea how to combat UC with out discrediting the women who practice it except to do exactly what Ethel (previous commentor) suggests:

It's not an either or, it's a continuum, and it needs to start before women become pregnant. Perhaps we need doulas before we get pregnant too.

I can not agree more whole heartedly! To this end I have started teaching a course for undergraduate students at the liberal arts college where I am a faculty member (in psychology) called the Biopsychology of Birth where we explore (as I'm sure you can imagine from the title) the biological, psychological, & societal issues surrounding pregnancy & birth at a time of life when these issues are typically not steeped in emotion and controversy for women (and men). While I've only taught it once so far, and only had eight students (all of them women), I have to say the class was a huge success: the women who left that class are now completely aware and critical of the culture of fear that surrounds birth in the US, the major issues with our healthcare system that create such poor experiences and outcomes, they now know that midwives EXIST(!) and what superior care providers they are; they know the benefits of doulas (4 of the eight are investigating becoming douals themselves, one is planning to become a homebirth midwife); in short, they know that birth is normal and can bve a life-altering, empowering experience.
I'm happy to email anyone who is interested the syllabus.

March 27, 2009 | Unregistered CommenterSarah

Rixa: Thanks SO much for sharing your thoughts. I really appreciate them and hadn't thought about the UC women leaving education and heading for (only) intuition, but you are right... and that is disconcerting. Good observation.

The statistics I shared *were* relevant not in the numbers, but in the percentages. Over and over, organizations say if women had qualified providers, their mortality rate would be much less. That was what I was illustrating. Not that our rate is so fabulous because of better nutrition, but that we have more care for the women here... and is the rate of maternal death going to skyrocket in the UC community? Anecdotally, we know that the infant mortality rate is horrid. Sad, sad and more sad.

Ethel, the window of "full term" has lowered for a number of reasons, social as well as medical. Docs see statistics that say that after 41 weeks, the infant mortality rate goes up and after 42 weeks, it skyrockets. That certainly drives them to induce more often. Even I have issues with a woman over 42 weeks and will only take/keep her if she agrees to every other day testing and induction by 42 weeks and 6 days. It is just my limit of safety and comfort. (There are a LOT more conditions that determine whether we even go past 42 weeks... cervical changes, kick counting, etc.)

I really appreciate your post. Very thought provoking.

Sarah, yeah, I am frustrated and that came across in the post. It took 5 months to write it that coherent!! So it was a LOT worse as the months go backwards! This was the best editing I could do at the moment and if I wait another 5 months, I might be able to write a less emotional piece. For now, this is what you get. Sorry. (Well, not *sorry*, but sorry you read my frustrations and didn't like them.)

We can always take arguments and turn them on homebirth midwifery. I know that and hear it all the time. Nothing new here. But it doesn't mean sometimes it is TRUE! Whether it is for UCing *or* homebirthing. That's just the way it is.

Thanks for reading and commenting... everyone!

March 27, 2009 | Registered CommenterNavelgazing Midwife

Great article. I'm not very keen on unassisted childbirth, although I love the idea of JUST BEING ALONE, I do understand the dangers.

I just wanted to comment on one thing- You ask why the woman whose story you opened with was complaining that the nurse left her alone. I don't think that she wanted to be alone- I think that she wanted to feel supported. And that if someone was only going to be there to check monitors here and there, she might as well just be alone.

Me- I was thrilled when everyone LEFT ME ALONE in the room. When they were there, they were constantly doing stuff. Trying to get me to lay down on the bed, trying to put an impossibly tight contraction monitoring belt on me, putting my gown back on, trying to take my blood pressure, trying to talk to me about pain management. I wanted to slug them in the schnoz.

I got the "dead baby" card played- and saw that look of concern, and it snapped me into being perfectly willing to cooperate with anything that they asked of me--EVEN THOUGH I knew why the monitor was showing a "poor" heartbeat. They had placed it over my anterior placenta and were picking up my heartbeat- it had happened a few times with the non-stress tests that I had been getting for the 11 days before labor. I had told the nurse that if they put the monitor there, they were going to end up picking up my heartbeat at some point and asked if they could put it someplace else. The nurse didn't even try to find a better spot for the monitor. And so I got the "dead baby" card.

Could you tell me why MY son was pulled out, cord clamped and cut and why he was whisked away to the isolette? There was no meconium (he pooped for the first time on the isolette) it was obvious that it was my heart rate that they had picked up (because the "dead baby" card made the heart beat go quite crazy, and because they used a portable ultrasound to locate my son's heartbeat and verify it was just fine and dandy), and they called out the 9 APGAR pretty much upon seeing him. Yet, I didn't get to hold him for the first 10 minutes of his life. When pressured on it, the nurse basically dismissed me by saying it was "because his heart beat had been behaving oddly"... BUT THEY TOLD ME THAT WAS A MISTAKE AND IT WAS MY HEARTBEAT.

Not that I'd let the experience drive me to birth unassisted.. But it does agitate me that I had such a limited range of choices. That hospital was my only choice for birth because the other hospitals said upfront that they take the baby to the nursery for newborn procedures immediately after birth. A homebirth was not an option because my insurance doesn't cover homebirth midwives, and none of the insurance plans that I could buy into as a freelancer in this state/town pay for home birth midwives. The entry level cost for a HB Midwife was $5,000, not including supplies. And no one had availability because I had to switch so late in the game because my first hospital and provider LIED to me about the hospital policy, saying I could opt out of it. (I was told at 38 weeks that was a pilot program)

The frustration isn't enough to make me want to freebirth.. But it is enough to make me feel very disheartened about my chances of ever having a normal birth without interventions and panic.

March 27, 2009 | Unregistered CommenterSara

Sara, it is standard procedure to put the baby in the isolette after birth, but nowadays they almost always birth the baby onto the mom's belly first, but can imagine there are places where they don't. It is sad the nurse felt compelled to make a lame excuse about why your baby was taken across the room; they must have done the Vit K and eye ointment fast (assumption) because they kept the baby over there for 10 minutes.

Above, Jennifer stated that she believes many women leave out portions of their birth stories possibly to validate their traumatized perception of the birth. I hadn't ever thought of that, but I did the same thing, but the mirror opposite. With Meghann's UC, I told the fabulous parts for *years*, leaving out the terror, minimizing the call for an ambulance, the possible brain damage I could have caused; maybe this selective story telling is a trait in most labors? Hence the horror stories often told at baby showers?

It is sad your nurse didn't believe/listen to you. Anterior placentas can scare a provider to death! But, we always put our fingers on mom's wrist to see if the pulse is the same as the "heartbeat." That she didn't do that is, to me, a serious lack of quality care. And strange. But, we all know strange things happen all the time in the hospital.

It would take some doing, but finding a provider that is kinder and more respectful of your wishes would be the best idea I can offer. Call LLL, ask Bradley instructors... they will often tell you the Dr. Wonderful of the area. They might not be perfect, but they sure might be better than what you had.

Much good luck.

March 27, 2009 | Registered CommenterNavelgazing Midwife

"Experts say the lack of prenatal care, poverty, obesity and the propensity for hypertension and diabetes are the main causes for this increase. Number one is lack of prenatal care. "

I want to make two points. Poverty, the main cause, is often lumped in a listing of the consequences of poverty. "Prenatal Care" in this case and how it is widely used in these arguements needs to be defined.

"Prenatal care" most often refers to going to the doctor once a month and heeding their advice to do tests, with little understanding, awareness, or guidance about the woman's real life, and her quality of life -- emotionally, physically, spiritually.. Four children, I have, spanning 3 decades, 1975, 1977, 1983, and 1994, and I have been working in the pre and perinatal psychology and trauma healing since 1999.

In my personal experience and what I observe today "prenatal care" involved going to the doctor once a month where I was weighed, my BP taken, my ankles checked, and later vaginal exams. The number of tests (my hips were xrayed in 8th month during first birth and I was songrammed in last pregnancy) gradually increased with little input from or impact to my lifestyle and health and my approach to caring for myself during pregnancy. Women in poverty are not going to be impacted in a healthy, positive way by more medical observation and testing. Prenatal care has to do with lifestyle, emotional and physical well being of the mother -- it begins months and years before the pregnancy. The implication is always that women who don't go to the doctor for prenatal visits are not healthy and are high risk. My prenatal visits did next to nothing for the outcome of my births. We do know now that ONE single high BP in the office, at a prenatal visit, will be used to justify induction when the doctor needs to manage his/her schedule, even though we know that everyone's BP goes up after sitting in a medical office waiting room. True story. Mother's second birth she knew better, and we owe to her, and all mothers, to listen to THEIR story, their experience, and why it is that she is so against medical intervention. In midwifery, we tout that we should "trust women's bodies and wisdom."

I know two women who gave birth Unassisted -- I interviewed their husbands who were immersed in every aspect of preparing for the births, and caught their babies. They and a third woman whose birth I attended had "no prenatal care" with doctors or midwives. I know this woman's health and preparedness excelled beyond many because that is her lifestyle. Her Amish midwife arrived five minutes after me, and one minute before the baby. She basically caught the baby, handed her to the father and mother, and backed off to leave them alone. It could have been UC no problem. And, yeah, it could have been a disaster ... but it wasn't, and according to what the common belief is it is because she was healthy and nourished -- not in poverty, not in a toxic environment, not in a violent environment, not in an education deprived environment, not a subject for a government funded hospital resident to learn on, as are many African American women.

Poverty, true disenfranchisement (lack of ability to vote) is the cause of the disparity. (Disenfranchised is not the most accurate word to use in discussing women in situation of birth). When talking about poor maternal and infant outcomes in the African American community, POVERTY is not truly addressed. Poverty (poor education, violence, apathy, and poor health it creates) is not mentioned with the reference to better "prenatal care" (aka MORE medical care). It's not mentioned that many African American women give birth in inner city hospitals that are teaching hospitals because the hospital receives huge funds from the government to serve the uninsured. Residency programs in IL in mid 90's received federal money, $100,000 per resident per year, and had to treat the uninsured. Residents learn in clinics where poor, uninsured, malnourished predominately African American, and now Hispanic, women get "health care." Who are the big welfare recipients?

One of the UC families/fathers I interviewed is African American -- not in poverty. One is a nuclear engineer. Both of this men studied and prepared to support their partner and baby. He and his wife did 3 of their 4 children's births unattended.

I haven't seen the show and I don't know how it was presented, but I doI know Heather personally. She was required by the show to do the Neonatal resuscitation class. Karen Strange didn't have a class scheduled where Heather could attend, and both lived in CO, so the show paid for private class with Karen.

I'd like to say that it is routine in hospitals to pull on the baby's head while the mother is on her back ... and, I would really wonder about the difference between a father's pull and the medical caregivers. Family just don't use the same force on their loved one as strangers, medically trained people doing their job.

I wish Freebirth had shown something like the UC births I know. I wish in the US that we could have a collective will to support birth from conception through early childhood with evidence-based care, funding to assist women to be healthy, and to create healthy humans. I wish our funding went to that rather than to the myriad of social and psychological sources to fix the consequences of not doing it.

Janel
www.theothersideoftheglass.com

March 27, 2009 | Unregistered Commenterjanel

During my second pregnancy I was briefly enamoured by the UC movement. I thought that being well-read in midwifery and taking good care of myself would ensure a good outcome.Accordingly, I assumed that hours of evenly spaced (3-4 min) contractions were a variation of normal at 25 weeks, even though some were painful. It never occured to me that I was having preterm labour, that my cervix was effacing and dilating. Lucklily my midwife asked point blank if I was having contractions during the 27 week visit - it had never occured to me to mention it. I'm so grateful that I had prenantal care, that I was able to carry my son to term, though I had to be hospitalized and put on bedrest.

I was so naive and judgemental going into my second pregnancy - that complications only happened to others because of poor choices...Since then, I've stopped mentally re-writting the outcomes of other women's birth stories, how things "could have gone" if only they had made "better" choices.

Conception, pregnancy and birth are critical life events where natural selection acts powerfully. This is true for every living organism, humans included. Obviously most babies are born fine - our bodies have been selected (or created) for this purpose. But each baby is a slightly new experiment in evolution with no guarantee of success. Our big brains, which sometimes make births hazardous have also allowed us to develop many strategies for enhancing reproductive success (e.g. midwives, doctors).

As a former born-again Christian, I'm extremely leery of ideology, where ideas become more important than people. The UC movement is ideologically driven with its own set of cultural myths.

March 27, 2009 | Unregistered CommenterElisabeth

Janel, You can try to change the situations to what you believe, but that doesn't mean that is the way they really are. By women going to prenatal care (what you call going to the doctor regularly), problems ARE found and managed... women with PIH, GDM, PTL and a huge variety of other issues, VALID issues are found and treated/helped. So, whether YOU changed your behavior during prenatal care is not necessarily what other (or MOST) women do. I have served women in poverty, as a care provider, and I have seen the precious desires to do whatever they needed to do to have healthy babies. I think it is INSULTING to presume women in poverty wouldn't change their behaviors if they needed to for their babies.

I *have* seen doctors pull on babies' heads and this man pulled on his baby's head as hard as that; you could see the tendons in his wrist bulging. I watched it several times to see if I was seeing correctly. And I have seen MANY fathers do sloppy, terrible things to their babies during birth including one father who, at the last second, grossed out and pulled his hands back, his baby hitting the floor so hard she had bruises on her. So, just because they are biologically connected doesn't graceful -or knowlegable- make.

You can tell me in 10,000 words all the UCs you know that were poetic and dreamy. And I will have just as many words to tell you about babies that died (and fwiw, that trumps yours any day), mothers who are now traumatized beyond life and fathers who feel horridly guilty about what they either permitted to occur or that they were an actual part of willingly. Oh yeah, and the breasts leaking without a child to suckle. Did I say that already? And this doesn't even speak about the babies who DO survive with brain damage so profound the children will always be toddlers no matter how old they get.

Elisabeth is absolutey correct when she says that UC has become an idealogy... a religion... and discussing it clearly and without emotion just isn't going to happen. Making UC sound idylic does such a disservice to babies, I really hope you will THINK before saying how great UC is one more time.

(Hope all is well!)

March 27, 2009 | Registered CommenterNavelgazing Midwife

When I read the MDC boards about UC (voyeurism perhaps), what bothers me and saddens me most is when the discussion turns to 'what if something goes wrong'. When I hear women saying that if the baby dies, then at least it died at home or at least they (the parents) were the ones responsible, all I can think is why do they treat this as an acceptable outcome? Don't they realize that with a care provider, whether a midwife or a doctor, maybe their baby wouldn't have to die or be horribly damaged? Why is there an assumption that outcomes can't be altered when under the care of a qualified care provider?

It's so sad to me that in the process of chasing an experience or an ideal that some of these women have started to accept a dead baby as a possibly outcome.

And the women who don't educate themselves at all because they believe their body will take care of everything naturally or that God will take care of it? Frightening.

March 27, 2009 | Unregistered CommenterJen

The whole show did not sit well with me either, nor does MDC, and I can appreciate your words, NM.

For me, choosing a UC for my 4th birth had nothing to do with bad experiences or not trusting my midwife (I have had no hospital experience). In fact my midwife was very supportive in educating me and I consulted her with questions. I feel my choice was a very educated one, a choice that, like Rixa touched upon in her response, I needed to make for this particular birth.

I too get upset when women only want to rely on their intuition and admonish or encourage other women to do the same. It has never been an either/or scenario for me. Yes, my intuition and inner guidance are important, but I also know that it has failed me. Yes, I believe that how I approach life will have an influence on the outcome, but things happen that are beyond my control. I educated myself and I did consider myself educated enough for me about my birth.

"Just because one can learn the information, does that mean she has to learn it?"
Why not if that is what she chooses? The saying 'If you want the job done right, do it yourself' is as old as civilization itself. Why not help women educate themselves, nourish their autonomy, and be there when needed if wanted, instead of expecting to be the only one to know what needs to be known, the same way I use other experts in my life when I have a need for them? Why would I hand over all the responsibility I feel I need to take for myself to someone else? Why would someone even want that? Why would I have someone at my birth who does not trust me? There are many reasons to not want to bring in someone from the outside during the birth, this is only one of them.

Having said this, I think that maybe the reaction from women who only want to trust their intuition comes from the experience that many of them have had with professionals disregarding them completely. When this happens, trust is breached, especially during pregnancy and birth. I think there is a very delicate relationship between attendant and client, one that is not always treated with the care that is necessary. I have experienced this only once, with a hospital based CNM whom I was thinking about seeing for pre-natals for my 4th pregnancy, and the experience was very unsettling. Minor perhaps, but unsettling, and I wondered how that type of interaction would develop during the pregnancy and affect my labor. i found that I did not trust her, and I knew she did not put any value in what I what I knew and felt and thought. Not that she was mean, it was an attitude that she has become accustomed to taking over her years of experience I am sure. I did not appreciate it however, and not being very eloquent, the idea to address the issues I had head on, was not something I was looking forward to with a growing belly. I did not need the patronizing, this was my 6th pregnancy and my home birth midwife had always done a fabulous job with my prenatals. I was in the fortunate situation that I could pay my former midwife out of pocket if I needed to, so I was not stuck, but many women are and have not much recourse to a better attendant. A point already made previously as well.

Also, I think that one reason women may feel strongly about their autonomy with regards to labor and birth, is perhaps that 1 in 3 women have been abused. This is something that has to play a role in how women respond to care and the way they feel they are treated. I know I am sensitive to this. If going to the dentist is something most abused women have to come to terms with, birth can only be much more difficult. Again, I was very fortunate that I had a midwife who asked my at my very first pre-natal with her if past abuse could be playing a role in giving birth and if I needed help growing in that area. I don't think there are many midwives who even ask this (maybe I am wrong though, I have just never heard it).

Forgive me for rambling, I think I have one more thought to share, and this concerns how women educate themselves for a UC. I think that many women just read about the safety of home birth in general, and about how to handle common complications, because those are the questions they feel they have to defend themselves about. Most of these complications were also the things that were presented, often wrongly so as they find out upon educating themselves after the fact, by their previous attendants as a reason they needed a c-section. It is hard to come to grips with and trust professional advice when you are told you are 'too small' for a vaginal delivery, to then go on to have a vbac to a much bigger baby. Women fee betrayed by this. utterly so, and I don't blame them for rather taking responsibility themselves than risk betrayal again. These things run deep.

Perhaps the more normal aspects of birth are often overlooked because of the above. It never occurred perhaps. A basic midwifery course and book list would be a good thing to do as preparation. So often, I see women pointing out research after research, stuff that is hard to understand to begin with, while at the same time advising that cutting the cord with a pair of scissors rinsed under tap water is just fine. At least, I don't trust my tap water, let's just say that. Not saying overlooking basics is good, but I don't think that the apprehension a woman feels when she has to go to the hospital, is an indication about her intelligence either. It is so easy to get words and names of procedures confused.

Anyway, inasmuch as I can disagree about some things you write on your blog, I do appreciate the mirror you are holding up for women to look at themselves, and in this case for UC-ers to take their choice seriously. It is very serious business. I do feel that many UC-ers I know are able to discuss this topic without emotions. I, for one, am comfortable with my choice, though I would never suggest UC as a safe option to other women flippantly. I feel from this blog though, that you are the one who is using a condescending tone that makes it hard to engage productively. I think most UC-ers I know would gladly discuss UC with you if there was a real discussion to be held. There is no point if the mind of the other person is made up, like yours seem to be. This is fine with me, but don't blame 'us' for not being able to discuss the topic without emotion.

I also don't get the feeling that UC is some ultimate utopic ideology for the sane and healthy uber woman to achieve. UC is simply a path some women choose for themselves for various reasons, and some of those reasons will prove to be wrong one as well I am sure. But I cannot control that. I can only do my share when a woman seeks a UC. I can question her motives and challenge her to learn more. And I do that.

By the way, you can buy sterile scissors.

maria.

March 27, 2009 | Unregistered Commentermaria

Oh my gosh, yes, Jen. Those ones really horrify me. They are the same ones who look down on anyone who wants an attendant at their births, because they "don't trust their bodies or birth itself." I beg your pardon. I do trust my body, and I do trust birth, and I also know damn well that either or both of them can go rogue at any moment.

And don't get me started on the religious freaks. Isn't there a cutesy sentiment that "Jesus was born UC so it must be perfect?" UGH. That's almost as bad as "well, look at all the babies that are born in cars on the way to the hospital. They're all fine so why not just have the baby at home anyway??" *headdesk*

I admit that I fantasized about UC during my second pregnancy. It just sounded so nice to birth alone, at night, in my pool, just me and the baby. Yeah, it would have been really cool, in a perfect world. But unfortunately this is reality. I'm able to deal with that.

I am probably sounding like I'm painting all women who UC as idiots. I don't mean to. I'll say it again, I am not against UC if a woman is completely prepared and educated. I know women who UC and they are some of the smartest, most respectable women I know. But they are becoming few and far between as UC grows into the "gold standard" for the ultimate birth. It should NEVER have become that!

March 27, 2009 | Unregistered CommenterJill

I am sorry if the tone is so... strong? adament? skewed? I agree I should have edited more, but I had already hung out with it for 4 months and she felt ready to birth. Now I know maybe she was a tad premature. I am still figuring out how I feel about educated UC because I can totally understand the "pro-choice" aspect (being pro-choice myself re: abortion) and I also *do* understand the autonomy aspect, the inability to find a proper/kind/respectful/any care provider and even the romantic aspect, but the new crop of UCers is as Rixa says, nearly shunning the education of pregnancy and birth for relying on intuition and Net advice. It's frustrating! A blog reader shared a private story unfolding on MDC and it wiggles me in deeper and deeper, this need to speak out about UC.

But, you all are right. As I say to the women who don't want anyone to even say the word "cesarean" around them lest they bring in negative energy, I explain how vital it is to leave a teeny tiny window open wayyyyyyy at the tippity top of a verrrrry tall building. If I can't do more, I at least need to do this re: UC.

I'm listening and do understand it does my (opinionated) writing no good if no one reads or buys what I have to say. If I write black & white, those will be the only readers I attract.

Thank you all for your words and your patience with me.

March 28, 2009 | Registered CommenterNavelgazing Midwife

Hi Barb,
That's what blogs are for... to express your opinions... yours does some double duty since you are qualified to educate, and that's where in some minds you run into trouble. If you have a strong opinion and you also have the respect of people due to your own background/education/experience then it carries more weight with those who read. For those who disagree it rubs... well, even though I agree with you on this point, I don't always agree with you... my questions still remain on what can we do... how do we resolve this issue? I look forward to your thoughts on my previous post and also on what you mentioned on educated UC... perhaps that would be too risky a thing to try to share... but who am I kidding... that doesn't typically stop you. =o)

Incidentally, Ethel, thank you for responding to what I said... and subsequently, Barb, for responding to what she said. I wonder about the statistics, too, for postterm birth if they're skewed due to the fact that so very few people are allowed to go past and many of those that do have not been receiving proper prenatal care... which is what I've observed while working in the hospital setting. I wonder what the stats would be like if the parameters excluded women with no prenatal care or other unresolved issues?

Thanks again for sharing your thoughts.

March 28, 2009 | Unregistered CommenterQ

Love this post, NM! I was right there with you, frustrated and furious watching Freebirthing...

I have been a doula and perinatal educator for more than 10 years (since my youngest child was about 2), and now train doulas as well. UC comes up at each and every training, and I never miss the opportunity to stress how important it is for women to have competent care and how risky UC really can be. I point out that doulas are in a unique position to help clients seek out care that is compatible with their values and their medical needs, and to help women avoid trauma. UC is no place for a doula, either!

I have five children, my last two born at home with midwives in quiet attendance. And I was so thankful to have them. With my youngest, my husband and I spent most of my labor alone. Occasionally I would look up and realize that one of the midwives was very quietly listening to heart tones and then would slip out of the room again. At the moment of birth, my water broke and there was thick meconium. The midwife directed me to breathe while she made sure my son had not aspirated any, and I remember being SO thankful to have her skill and experience in that moment! What if we'd been alone? Would we have known what to do, how to do it, what to watch for? Not likely. We had a very private, intimate, memorable, and SAFE birth because my midwives were watchful without being unnecessarily intrusive, and were spot-on when their skill was needed.

March 29, 2009 | Unregistered CommenterRocky Mountain Doula

I'm curious where you draw the line on competent assistance. I'm about to move to a state where I cannot have a legally attended homebirth due to a cesarean for iatrogenic fetal distress (midwife induced!) with my first. Since I was 41w5d with no end in sight last time, I have to assume that should I become pregnant again, my options could rapidly dwindle to scheduled cesarean vs. "unassisted" (with or without unlicensed CPM) labor and/or delivery.

March 30, 2009 | Unregistered CommenterJudy

The placenta was not low-lying. The placental noises were low, and it troubled me. I knew the risks I was taking, so I was on the lookout for anything that could possibly signal trouble. Low placental noises are not a sign of placenta previa, and thus I had no indicators that there was anything abnormal about my pregnancy. This is called sensationalizing a story for television.

As to my first birth, it wasn't "awful." They weren't hollaring at me to push with all of my might. My oldest, Corbin, was never in any danger. It was a straight forward delivery. I've seen his medical records. I was there. My husband was there. The doctor was sitting there, looking completely disinterested and bored; had it been an emergency, I doubt he would have been so complacent. His heartrate was normal throughout the entire labor; it never dropped. The nurse was in my face screaming that I wasn't doing it right, threatening me with a C-section ten minutes into the pushing phase. Let's see, I have been in labor for a normal amount of time for a first time labor. I have been pushing for only seven minutes. The monitors are fine. The doctor is not alarmed. And the nurse is threatening me with a C-section already? Three minutes later, out comes Corbin with a 9 Apgar and a 10 Apgar five minutes later. A negative hospital experience was only part of my very complex decision to UC. Most of my true reasons were not even addressed in the film because so much footage was cut for time and to meet the needs of the network.

Don't judge a person by what you see on TV; you're likely to be incredibly wrong. Plenty of people have a hard time talking about death, or struggling to find a more appropriate word that would encompass both death and serious injury. That doesn't mean they don't accept either as a reality and definite possibility. I won't be wasting my time debating this any further. Both of my sons are healthy with normal, straight forward pregnancies and deliveries, and we are all happy and healthy. Had anything been truly amiss, we would have gone to the doctor--just as we did when the placenta failed to emerge after several hours of abdominal massage, cord traction, and various other attempts to dislodge it at home.

March 30, 2009 | Unregistered CommenterHeather B.

Also, I am not sorry that I went to the hospital. That's hearsay.

I might have waited longer to go, but I'm not sorry that I went. As far as the placenta cord cutting goes, we were interested in the concept of lotus birthing. Some people believe the baby feels the cut in some ways. I was curious as to Karen Strange's opinion. I'm not the first pregnant woman to ask that, and I won't be the last...and wondering about something trivial like that doesn't mean I'm incapable of knowing when to get my ass to the hospital.

As for the ambulance...in that area, it's rare for an ambulance to take longer than a few minutes to arrive. Colorado Springs has an abundance of hospitals. It is considered one of the safer cities to birth in.

The reason I didn't spend mass quantities of time thinking about death during my pregnancy is simple. I realize the baby can die, and I am mortal as well. Thinking about it won't prevent it. It won't help us handle it if it happens. Worrying yourself needlessly is not half as useful as preparing yourself as best you can.

There are times when a D&C is needed for retained placenta, such as when part has come out. As I was unable to examine my own uterus, I wanted the doctor's opinion. Before askiing me what I'd allow...he could have told me what he wanted. Usually they hand you a gown when you get in...not after demanding "Well, what can I do to you?"

And no, I did not get most of my information from the internet. I read countless books. I learned from midwives that I know online and in person. I learned from others who had BTDT, both online and in person. I didn't just spend nine months studying. I had been learning as much as I could since I made the decision to UC, long before we even began TTC little man.

Thanks for your concern though. You certainly are entitled to your opinion. Some advice for you: if you don't agree with UC...don't have one. :)

March 30, 2009 | Unregistered CommenterHeather B.

But see, I *did* have one... that went terribly wrong. And I personally know two women who had UCs that ended in babies that died because they didn't have help. The only babies I know that have died in the hospital were for anomalies, so in *my* experience, UCs have some serious issues going on.

That said, thanks for writing to clarify. It is always good to hear it from the source. I appreciate your writing very much.

I *do* understand tv because I know Mindy's UC of Psalm and Zoya and what Discovery Health did to *her* video - I saw both the real video and then the tv version and the tv version was horrid! They looked like two totally different births. I have also been on tv and the stories are definitely skewed towards entertainment, so I can imagine what they did to y'all's story. But, what we saw was all we had to go on, so commenting on it as is was, in my mind, appropriate.

March 31, 2009 | Registered CommenterNavelgazing Midwife

The only experience I have with an Unassisted Childbirth community is the one on Live Journal, from which I was totally alienated before I even became pregnant, from expressing relief that another member had chosen to go to the doctor; the moderators immediately chided me for even mentioning a doctor, which I found appalling, because I thought it was a forum for intelligent discussion, which, in my opinion, should include viewpoints that differ from one's own!

I was fortunate to have a wonderful, hospital birth with a midwife and I don't plan to birth alone in the future, although I may try to have a home birth with a midwife. My only complaint with the hospital was that they would not allow me to eat at all, so I had to subsist on broth and grape juice, but otherwise the entire Touro Labor and Delivery staff was wonderful (attentive, deferred to my midwife, and unintrusive), both during labor and post-partum. I should add that I understand the reasoning behind their ban on solid food, but that I was at very low risk for caesarean delivery, let alone under general anesthesia, so it was frustrating when I was in labor and hungry.

Thanks for posting this, because I was beginning to feel like I was the only woman who was made to feel like the interloper, the ignorant one, or the weak one for wanting to explore all the birth options available to me, rather than decide that birth is *always* safe and "interference" is *always* a problem.

March 31, 2009 | Unregistered CommenterJackie

Thankyou for this discussion. It is timely in Australia, where there have been several adverse outcomes and near misses recently in UC.
I have added a link to my blog http://villagemidwife.blogspot.com/.

April 1, 2009 | Unregistered CommenterJoy Johnston

Re: Does cutting the cord hurt?

I don't think this is about ignorance. Honestly there are many cases documented where the babies grow up and never get along with the grandma, dad, etc, only to find out that it was the trauma from the cord-cutting. I ran into several cases of this when doing NAET work.

That is why many of us choose to do a Lotus Birth.

You know, maybe it isn't outwardly and physically painful, but it is psychologically damaging according to many studies. I don't think anyone can rule out these things completely and just say "nope, painless" when really we don't know enough yet.

A lot of this is about manifestation and the Law of Attraction. As a Hypnobirther, I see that Heather was worried about her placenta from the middle of her pregnancy b/c of the possibility of placenta previa. Therefore she manifested placenta problems (well, there weren't any, but in her mind there were).

UCing is about having faith in a woman's body. I see that doctors don't have that and think they need to interfere and I see now too that midwives are becoming much like doctors.

Prenatal care in my two pregnancies has been about weight gain, and peeing on a stick to check for protein. Blood pressure. These are all things any of us could do at home. Nutrition info is available in books and online. We do NOT need a midwife to do this testing for us. I think if you're going to say that UCing is dangerous, it should be about the birth and not the prenatals.

April 6, 2009 | Unregistered CommenterRaene

I really appreciate this post. I am kind of undecided on UC at the moment. I feel like an educated women should be able to choose to have a UC without being told that she is irresponsible, and trying to kill her baby (not that I think that is what anyone here is saying). I personally would not UC, because my husband is not supportive and I just don't want to UC. Reading all of the posts have really got me thinking about UC as a whole. Thank you very much for writing!

April 6, 2009 | Unregistered CommenterAmy T.

I considered a UC with my last birth. My hospital birth for DD1 had been awful leaving me with physical and mental health issues. My homebirth for DD1 was good, but the MWs could not leave me alone, there was nothing wrong with either baby or me, they just needed to interfere and I ended up with a total of 5 MWs because they were all so excited about a homebirth going on (I am in the UK).

With both births, I felt pushed about, my DH felt pushed out of the situation completely. It wasn't about the experience, it was just about me wanting some privacy (I have issues and NEED privacy, not saying I want to birth alone, I just don't want x number of people poking me and staring at my genitals unnecessarily because it does affect the way I birth).

Both those births were intensely painful, both were about 12 hours long, second birth I had a 3 hour pushing stage, I could not relax at all and with DD1, everyone got impatient and I ended up with a ventouse.

So, birth number 3, I considered UC but decided against, I just went for a MW attended home birth, that is what I felt most comfortable with, I like to have company in labour (just not a party). I specified that I only wanted 2 MWs at most at the birth (obviously, if things went wrong the birth plan was changeable).

I went into labour, all was good, I called for a MW, but no one turned up in time, I couldn't get DH (he was busy and couldn't hear me upstairs). My third baby was born in 6 hours with half hour pushing stage. Completely unattended. MW arrived about 10 mins after baby was born and DH not long before.

I loved that birth, it was the best, the easiest by far. I regret DH missing it.

However, despite the whole thing being fantastic, it left me shaken, to the core, and I can't put my finger on it. It was lonely, I needed someone there with me.

I don't disagree with UC necessarily, but I don't necessarily agree with it either. I don't know, different strokes for different people.

The free birth documentary also left me rolling my eyes,the people they chose just didn't seem right, ya know?

April 7, 2009 | Unregistered CommenterKazia

you reference the mortallity rates going up after 41 weeks...have you not done research yourself on this? Maybe you should take some time to read up on what Gail Hart has written and compiled regarding post date pregnancies.

April 7, 2009 | Unregistered Commenterdisappointed...

I actually had to stop reading when you said, with 100 percent certainty, that Heather's baby was distressed because they were shouting at her to push?! What ignorance, coming from someone so *educated* on birth and who admits that the maternity care system in this country is flawed. You sit there and say it's flawed, that birth trauma and birth rape happens, yet you DEFEND a hospitals actions during Heather's birth and you NEVER SAW THE CHART!

My first birth was similar, I was being yelled at to push, told I was a failure when I didn't push the way the nurse/ob would have liked.. I was rushed and yelled at and had a perfect baby: no distress, no menconium, nothing of concern. Why was I being yelled at to push? Because nurses, and OB's are ignorant to the fact that a woman's body KNOWS how to push on it's own. The thought that purple/coached pushing can be very ineffective baffles them.

Your ideas of UC are false, and you base these opinions on what? A documentary that is edited? Have you actually seen a UC, talked with a woman in depth about her choices? Do you know that not all UCers, UP (unassisted pregnancy) and they still receive prenatal care (based on your *statistics* the main cause of death isn't ucing itself, but lack of maternity care. You make it sound like all UCers make the decision without fully educating themselves on the risks, etc.

Deaths occur in a hospital too, and when that happens it isn't the hospitals fault, yet in a home birth: it automatically becomes the fault of the birthplace. Quite sad if you ask me.

For a low risk pregnancy, you risk the life of yourself and child by birthing in a hospital.

April 8, 2009 | Unregistered CommenterShanna

Barb,

I hadn't been on your blog in well over a year, and I ended up finding this article on one of the UC groups I belong to. Reading this was actually what helped me decide to leave the groups...I had been contemplating it for a while and really frustrated by the lack of basic knowledge reflected therein, there were many times I've had to "bite my tongue" because I realize that not only will those posts be attacked, but the mother in question really needs to talk, in person, to someone knowledgeable, and the fact she's choosing to ask her questions on the net seems preposterous. This happens over and over, whether about birth or breastfeeding. It does no good to tell an inexperienced mother who's never seen someone successfully breastfeed to just "nurse on demand" when she's concerned baby might not be eating enough. That baby may end up dehydrated or worse. The same goes for ladies in who are in on and off labour for days....hmmm do you know what position baby is in? Could an experienced midwife or doc help you to improve baby's position? Are you really in labour, or are you just so worked up about it that you need some reassurance?

With this, my third baby, I am going the route of UC after much thought and preparation. While I feel comfortable in that decision, I am also happy to have back up plans and much time and learning behind me. I'm happy to say that after a good hospital birth with my first and an okay homebirth (which you helped me put into perspective a couple of years ago, do you remember?), I'm not doing this to "make it right" or to get over a previous experience. I am also not 100% committed to UC, by which I mean I have no qualms about seeking medical assistance and feel I have good backup in the medical community. Oh how I wish there was a great midwife in my area!

I feel this post does nothing but ask good questions. If we aren't equipped to deal with them, then frankly, how can we say we are making an informed and responsible decision? Thanks for a thought-provoking piece!

Cheers,

Amy

April 8, 2009 | Unregistered CommenterAmy

Shanna, instead of just going by what a group says, you might want to learn a bit about the writer. I *had* a UC. I used to speak on behalf of UCers, until death occurred and I came to my senses.

You all can holler all you want, but unless you are making INFORMED choices - and that includes sucking it up and hearing the scary parts - then you are not claiming and accepting the FULL responsibility. If you are *truly* committed to UC, nothing anyone says is going to ruin your experience. If something I say upsets someone and scares them, ALL THE BETTER! Making people THINK is my goal. So THINK, eh? Don't be a sheeple in a cultish ideology.

April 8, 2009 | Registered CommenterNavelgazing Midwife

Can’t the experience walk hand-in-hand with the health of both mother and baby?

That's the question, isn't it? When a population that has been powerless (women in birth) starts to seize power back, they will overcompensate--even more so if their seizure of power is threatened, as is the case with VBAC bans and AMA and ACOG bloviating about homebirth.

Doesn't excuse taking risks they shouldn't in UC, I don't argue that, but I think it's untirely unsurprising that things have gone the way they have. In a way, it's like the situation women often had before reliable birth control and safe abortion; the deep-seated desire to have control over what was happening to your body made you willing to run dangerous risks. And rape victims, you may recall, tend to act out too...have dangerous sex, develop other problems, in an attempt to regain the control that was taken from them.

So I guess I'm less concerned with addressing your logical and reasoned arguments and more concerned with how we bring women back from this brink; the first and most obvious way is to stop abusing them. The next is to address abuses that have already harmed them. And the third is to make any future abuse something subject to actual consequences for hospital and staff.

April 11, 2009 | Unregistered Commenteremjaybee

I am interested in your stats on post-date babies as well.

As for UCs, I am sorry that yours did not go well, but I don't think it's fair to classify all UCs by yours - or by the stories that have made the news recently. My husband and I made the informed, educated decision to UC with our daughter. Yes, the hospital birth of my son was horrendous and he still - eight years later - suffers from complications induced by the professionals there to help. That was not a major reason for the UC, however.

We are currently planning our third child and have not decided whether we will UC again. Now that we are where midwives can support mothers at home, we may go with a (very hands off) midwife. However, the attitude above is what makes me think twice about that. Yes, midwives are professionals and appreciate their knowledge. But *I* am responsible for my body and my decisions, and I am very uncomfortable with the idea of being "allowed" to do anything. The purpose of medical professionals in my life - in all aspects - is to advise me of issues, of solutions for them, and allow me to pick, of course while giving their educated opinion as well. Anything less is doing me a disservice. I understand that medical professionals are just that, but the fact that I am a UCer does not mean that I am any less intelligent or prepared to deal with the consequences of my actions.

When I am given choices in the hospital, when I am not told that I am killing my baby by not allowing ___ procedure (which is totally elective), when my other children are allowed to view the birth of their siblings if THEY desire (instead of being reported to CPS as abused children), when I'm not poked and prodded and cajoled and yelled at, then I will consider a hospital birth. Until then, for me, UC is a valid and appropriate option for a healthy mother and child.

April 19, 2009 | Unregistered CommenterTara

Statistics on post-dates mortality are easy to find. If you haven't looked into it yourselves, you aren't informing yourselves properly.

You, Tara, tell me I shouldn't judge based on my own experience or experiences I know or hear about. What then is judgement based on? Can I use the information re: the babies that die on MDC? Do those count? If we don't go by what we know, what DO we go by? If you go by YOUR experience, why can't I go by mine?

April 19, 2009 | Registered CommenterNavelgazing Midwife

This post was absolutely awesome. I just watched this short film about a week ago and had to call my husband in the room several times, cringing, so he could commiserate with me.

I felt like it sadly gave the UC "movement" a really pathetic representation, but so it goes. This post was so spot-on, and I just loooove how your write. I'm fairly new to your blog and just began catching up on OLD posts over the past few weeks.

Keep on writing, and rockin' the birthing world!

April 24, 2009 | Unregistered CommenterRachel Clear

Amen and amen!

I'd never dream of unassisted birth. Safety has always been #1 for me. It seems all these women want is a great story to write in the baby book. Well any birth, in which a child arrives safely, is a great birth story in my opinion.

These women should be ashamed of themselves! I hate how they use flowery words to cover their actions without statistics or proof that what they're doing is even safe.

April 28, 2009 | Unregistered CommenterJoy

Can I just say AMEN!!sister midwife! I jumped out of my rockin chair,ripping my milky breast from my toddler, yelling at the TV at Heather. The placenta was just sitting there! If I had been her midwife I would have said " Heather, honey get into a squat and take YOUR cord in YOUR hand and just guide it out while you push some". WOW what a bossy midwife I am. I got ripped apart on MDC for trying to let a mom know there is a difference between cord traction and a midwife gently helping it out. Than I realised the experts responding not only weren't health care providers at all, many of the most vocal had not even given birth! I gave up!
Wholistic Midwife Sam Evans LM CPM

May 22, 2009 | Unregistered CommenterWholistic Midwife

If I had been at her birth(im a midwife) I would have just said " honey that placenta is just stuck inside your cervix and vagina. If you just help it through you will be done with pregnancy!" But Im just a stupid midwife who doesnt trust woman and their bodies! I dont understand the distrust of midwives. I am trying to understand though could somebody enlighten me?

June 7, 2009 | Unregistered CommenterWholistic Midwife

From one midwife to another, I highly encourage you to not disparage yourself, even as a joke or sarcastically. That energy floats around and people can cling to it and think you are exactly what you said you were.

It is a distrust of any care provider... either they have been hurt by a provider they trusted or they knew of someone who has. There are certainly freebirthers that trust themselves first and foremost, even during something as specialized as birth, and distrust doesn't really have a place in the equation. It's that they see birth as normal, not needing anyone, hindrance or otherwise.

Does that help explain things a little?

June 7, 2009 | Registered CommenterNavelgazing Midwife

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