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Saturday
Jan072012

What a Doula Said

On my Facebook Page, I dropped a link to this piece, “Journal Article Review – Bipedalism and Parturition: An Evolutionary Imperative for Cesarean Delivery?”, an article about (just what it says) walking around on two legs and does that fact make it more likely that we’d eventually need to deliver our babies (at least more of them) by cesarean section. It’s an awesome piece and the comments have, for the most part, been great… Creationists aside. Well, their comments are interesting. Hard to believe people still think like this, but who am I to poo poo another person’s religion. 

Anyway. 

Along the thread comes this doula who says, and I quote verbatim: 

This is the most insidious article I have ever read and it figures that it was written by a man with a penis who will never experience childbirth. Fact: only 3% of women in the US actually need a Ceasarean due to try complications. In most cases they are performed out of laziness and impatience on the hospitals and docs part. And insurance companies, lest we not forget those bureaucratic jackasses.” 

I couldn’t help laughing outloud, but what I wrote was: 

Where did you come up with only 3% of women need a cesarean? I have NEVER seen that number in 30 years of birth work. Source, please.” 

And this was her answer, again quoted verbatim: 

I got the stat in an article I just read, I will find it and repost. In my experience with my clients he need for C/S deliveries is 0 with home births and about 2% for hospital deliveries. The procedure has skyrocketed unneccisarliy.” 

My short answer to that was: 

So, <Doula’s Name>, how many births have you been to? 4? Talk to me when you've been to the 900 or so I have, then we'll see what "your" cesarean rate is. 

You have a LOT to learn, young lady. Your arrogance is going to bite you in the ass and I hope you will then learn some humility. 

And quoting ONE FREAKIN' ARTICLE that said the c/s rate shouldn't be above 3% is the height of gullibility. Do you not know discernment? It scares me there are doulas like you out there.” 

What is this doula teaching her clients? What is she saying to women all around her? Spouting off her amazing statistics without so much as any qualification of how she got to that number. 

I started thinking, “How could I get a 0% c/s rate at home and a 2% for hospital births?” 

  • I could have only attended 5 births.
  • I could take only clients that have had babies born vaginally before and are truly low-risk in this pregnancy.
  • I could lie about my statistics. 

There are so many parts to her comments that annoy me, it’s hard to just pick out a couple. But, I’ll try. 

  • If we are to believe she’s been to at least 100-200 births to even get a somewhat valid number, “her” 2% hospital birth cesarean rate is incredible considering the cesarean rate in hospitals. Is she so magical that when she is there her clients miraculously avoid the operating room? If she is that magical, she should be teaching courses all over the world so the rest of us can know her secrets. 
  • If you throw out the word “Fact,” you better have a buttload more than one article to point to and, at the very least, one you can put your finger on at a second’s notice. That she even had to look for it stuns me. 

Note to doulas and other birth workers: Just because you want it so badly you can taste it, doesn’t make it so. If you repeat crap others say, even others who proclaim they are (or who are heralded as) experts in birth, you best be able to back up your beliefs. Sure, statistics can be skewed, but looking deeply into anything touted as real and true will probably give you a much clearer picture of what you’re talking about. 

No one… NO ONE… in this community has The Answer. If she did, it would be headline news.

Reader Comments (12)

I signed on to read your blog and facebook page some time ago and have read many of your posts and am always struck by your desire to breed contempt and confusion in a world that is already full of it. I could, and in other circumstances, would, say more but this is neither the time nor place. My only desire is that you would use your gifts and talents to do more than spur confusion and animosity in this community. You, your blog and your facebook page seemingly exist for one purpose, to stir the pot and I for one am tired of your approach.

January 7, 2012 | Unregistered CommenterVanessa

Thank you! I was WTFing over that comment myself, but I've seen a similar attitude from other doulas plenty of times, so I suppose I shouldn't have been surprised.

January 7, 2012 | Unregistered CommenterHeather

Vanessa: Blessedly, it doesn't take much to stop reading something you no longer enjoy. I wish you well.

If it's "pot-stirring" to discuss controversial subjects, to bring in topics that aren't shared in other arenas, to force people to stand behind their words, then I want to be the most humongous wooden spoon in the world.

January 7, 2012 | Registered CommenterNavelgazing Midwife

I always have to laugh at the "huge" number of deliveries homebirth midwives and/or doulas have assisted with. Any hospital-based CNM who works full time, in an institution that has about 350 deliveries a month [which is a mid-sized hospital] is involved in at least 50-60 a month [or more!], which is often the number a homebirth midwife has in a year. When I think that I have been in this situation since 1967...well, you do the math. Who has the greater range of experience?

The whole subject of "necessary" vs. "unnecessary" C/S is complicated by a number of factors, including repeat C/Ss. Not all women are VBAC candidates, even in the best situation. [Most women are not really homebirth candidates either, if proper criteria are used for vetting] Breech alone accounts for nearly 6% of presentations so that puts the 3% number out the window right away. Macrosomia and CPD, [real] fetal distress, prolapsed cord, genital herpes, multiple pregnancy, pre-eclampsia, [real] dystocia and failure to progress...

Moreover, are you going put your trust in, if you quoted the doula properly, can't even spell? "unneccisarliy", indeed!

January 7, 2012 | Unregistered CommenterAntigonos CNM

I'd love to hear what you have to say about Ina May's birth statistics at The Farm. I know there are some cases they do not accept, but in general... thinking about what at term is thought to be a low risk case. I understand asking someone to back such a low statistic. As doulas and educators we should never spout off statistics from just any publication. It is our job to determine accuracy and legitimacy of what we read.

About the article... I think that logic flys in the face of common sense. This is coming from a mother who has had 2 c-sections. One unnecessary and one necessary because of malposition and fetal size. It doesn't make sense that surgical birth or interventive birth should be our norm from an evolutionary standpoint. I'm not a scientist or anthropologist. I do also believe in Intelligent Design which brought forth evolution. But, it seems that if as a species we'd have to rely on surgery or similar sorts of interventions to allow birth to be safe, it would eventually bring about the destruction of the species. I believe I can birth vaginally. Without c-section for my last birth, I'd probably have died or my baby... maybe... maybe I just needed more time. I don't know. But, with those sorts of circumstances being non-repetitive and some of which I faced preventable somewhat. I think education on healthy pregnancy and birth, time, and more hands off is what most of us need to give birth safely.

January 8, 2012 | Unregistered CommenterKelli

I don't know for sure... probably could ask if others do... but, I suspect the criteria for delivering on The Farm is extremely tight and that they risk out many along the way. I also suspect the women, for the most part, are extremely healthy and work hard. I've been to The Farm (in 1987) and those folks *worked* the farm. Not sure if the visitors have to or not, but suspect they have to earn their keep/birth somehow. Everything was far from each other, walking a normal part of the day (like it should be and was for eons before cars) and I can imagine the incidence of GDM and IR is rather low because of that PLUS the vegan diet women adhere to while there.

In other words, I think it's an extremely tightly selected group of women who would begin labor there. I'd love to know how many they've risked out that other midwives would, quite easily, take on in a homebirth setting.

Last I knew, too, they had/have an ambulance either standing by or very close so stretching boundaries of safety is a tad easier if you know you can get a woman to help quickly.

I do, however, believe *some* of the low percentage is more patience and helping women/babies resolve malpresentations. Many midwives on The Farm, Ina May especially, have buttloads of experience that most homebirth midwives do not.

Plus, Ina May was trained by a doctor. I think that fact is often left out of her "But Ina May's a CPM!" exhortation. Yeah, well, training and skill is everything -and she got some good of both.

January 8, 2012 | Registered CommenterNavelgazing Midwife

Anecdotally, from friends who have birthed at the farm, they use - gasp - actual midwifery skills and interventions not too infrequently to avoid serious complications and transfers. There are so many midwives today who are awfully good at sitting on their hands, but not much else.

January 8, 2012 | Unregistered CommenterLinsey

I might get flamed for this, but I guess I just don't see what the big deal with c-sections is.
I had one, after a terrible, 36 hour labor. My baby couldn't get through my pelvis. , I pushed for 3.5 hours, and was trying everything to avoid a c-section.I walked, and stood, and swayed, and rolled around every possible way. I even let my doc ( who is very natural birth friendly, by the way) attempt vacuum and forceps. No luck. As her heart rate started plummeting, we had an emergency c-section and she was out in less than 6 minutes.
Guess what: It wasn't that bad. The pain was manageable, I was up on my feet within hours, showered 3 hours later, nursed my baby while being wheeled from OR to L and D.
Now, don't jump my case: If I had it to all over again, I would agree to section much earlier. In fact, I have no plans to attempt a v-bac. My c-section saved my baby, and did me no harm.
I know there is the possibility of complications, but there are complications that can happen with any procedure: even having a mole removed!

I guess my point is, why do people care soooo much how other women birth? Why is the process so much more important than the outcome?
I have a living, breathing, 10 week old beauty. I couldn't care less how she arrived, just that she did.

January 13, 2012 | Unregistered CommenterJulia

By the way Barb, I'm really glad you are posting again. I enjoy reading here, even though I don't always agree with you :)

January 15, 2012 | Unregistered CommenterJulia

As I recall, the World Health Organization considers a c-section rate of 10-15% to be appropriate.

February 3, 2012 | Unregistered CommenterNimue

I feel like you are wasting your time on someone who holds an extreme position in the world of doulas/birth assistants. She is obviously immature and totally inexperienced -- and you are right, once she has some more births under her belt, she will learn and grow. Having been involved in birth work for 10 years, I've met plenty of newbies along the way, and honestly have never met anyone quite this ridiculous. Yeah, she would have irked me too but why give air time to such a crazy?

I do wonder what you think is the right c/s rate? Approximately, obviously. Do you agree with the WHO's 10-15% estimate? I know a lot of midwives in my area claim a 3% rate (or thereabouts) but obviously they have strict criteria and risk many women out. I think it would be fascinating to see a world map with c/s rates, alongside infant/maternal mortality rates, all by country. How much of that info - worldwide - do we have?

March 13, 2012 | Unregistered CommenterElizabeth

I LOVE your blog, but I do think this is a little harsh to that doula….I'm a new doula too (16 births so far) and I get it. She was definitely over the top…but I think there's just so much we put up with as advocates for birthing women that she had a knee jerk reaction to the idea that women's bodies aren't able to birth babies very well. (I'm not saying I disagree with the bipedal = bad for vaginal birth idea, but it does make me sad.) New doulas like me and her are still learning and we're just trying to navigate this hyper political profession. I'm constantly learning new things and trying to keep an open mind. I'm sure you taught her something and that's great, and yes she shouldn't have been so vocal about her "fact" but give her a break. :)

April 13, 2012 | Unregistered Commenteranonymous

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