My wife and I have three kids, and while that pregnancy and childbirth thing is way, way back in the past, we did have some strong opinions after our experience. Midwives were wonderful, we had only the best and most positive experiences with them, and they were the indispensable supporters we were glad to have there. The doctors…meh. They didn’t seem to be involved much, and it was rather strange when they’d come by after all the work was done and sign the birth certificate, as if they were taking credit. But my wife had relatively uneventful, uncomplicated deliveries (the second was a bit rough, and she had to stay overnight for observation afterwards; that kid was gigantic), and we knew that the doctors were essential if things went wrong, and we would have been horrified and greatly worried if they hadn’t been there. All our kids were born in clinics, with professionals all around us, because we weren’t going to take any risks. Childbirth is dangerous when things go wrong, and they really can go very, very wrong.
But now I’ve discovered The Skeptical OB, and it’s all about this crazy kooky weird world of homebirthers — people who, just like anti-vaxxers and HIV denialists, refuse to recognize that modern medicine is actually incredibly powerful and useful, and have these bizarre myths about what is “natural”. So they insist on having their babies at home, away from those horrible doctors, and they end up with dead mothers and dead babies.
That last case is particularly eye-opening. A woman writes into a forum dispensing this quackery, and complains about ditching her OBGYN and going with an unlicensed midwife, and proceeded to go into labor for eight days and delivered a dead baby.
Or this case, where a homebirther is irate because doctors recommend against her desired natural childbirthing experience, because she’s “high risk”. She thinks she isn’t, because her first delivery was easy. But then she mentions that her second delivery had a minor problem: the kid got “stuck” and required resuscitation (!) after delivery, and her third child was born unresponsive and died two days later. And then she wonders why doctors are so worried!
It’s all very disturbing and new to me, but I guess I shouldn’t be surprised. There are all these strange people around who, for some unfathomable reason, worship pre-18th century medicine and make a fetish of “natural”. Heart attacks are also entirely “natural”, but you won’t catch me suggesting that we skip the doctor if I have one.
(Also on Sb)
This is where I’m glad I’m a misanthrope. I can’t get all that upset about dead babies. It’s when real people get hurt through no fault of their own – as in the case of antivax and war – I get angry.
Students of The Kids in the Hall know that a truly natural childbirth requires a caring cabbie—instead of dealing with medical personnel who treat pregnancy “like a disease!”
hoooooooooooooooo boy. I expect this thread to fill up with woosters.
My wife and I have had many healthy kids and all were smooth births (well, at least for me), so we could probably deliver kids at home with a high probability of success, but there is no way I’d risk it unless absolutely necessary.
Way too many things to go wrong with the mother and baby before, during, and after birth.
All these new movements to ‘all natural’ will put us back into the dark ages. Might as well start eating poisonous mushrooms too… They’re all natural.
My sister’s friends had a home birth. Except it turned out to be a home death. Had they been in a hospital the baby would have survived. Their next delivery was in a hospital. Home birth is great – if everything goes without a hitch. Otherwise, it is a disaster.
Odd. I could have sworn that you were the one that originally posted the link that led me to the Skeptical OB. Maybe it was Brayton? Anyway, I love her! I had my second baby just 19 months ago and visited her site regularly to research questions I had regarding childbirth.
I am glad my wife had no interest in that kind of nonsense, especially because she had a high risk pregnancy (an autoimmune issue that has a high fetal mortality rate). She felt happy and safe when she was around the doctors and nurses and machines that went ping all through her pregnancy and even now, 7 years later will point to our son and rave about modern science and fetal medicine and how they enabled the little guy to be with us today.
It was probably the beards that caused your confusion, Celeste. So, which one should shave theirs off, PZ or Brayton?
Know what pisses me off the most about these “natural” birthing advocates? Their absolute disdain for anyone who disagrees with them or tells them how dangerous it is to have a child without a doctor. Midwives are great support but THEY ARE NOT DOCTORS.
And they despise anyone who had an epidural or needed pitocin to be induced.
Yes. And I’ll be waiting.
As I see it, this is part of a backlash in which the baby is thrown out with the bathwater – in a more literal sense than usual. The mistrust of the medical establishment goes back to a genuine history of abuses. Or at best, patronising and dehumanising treatment. From Tuskegee to a history of “shut up, dear silly hysterical female, doctor knows best”. (This was not usually seen by the more privileged.)
The practice of medicine has greatly improved – but in part that’s been due to feminist pressures to do better. A huge increase in the number of women doctors, and comfortable birthing centres attached to hospitals are good outcomes; these “homebirth at all costs” campaigns are a very dangerous over-reaction.
Dead mothers and babies in childbirth are why god™ invented polygamy.
I look forward to having doctors around me if/when I give birth. I wouldn’t even mind a c-section because the thought of pushing a baby out of a tiny canal scares me!
Oh– and give me pain meds!! LOTS AND LOTS OF PAIN MEDS!!! There is absolutely no need to go without.
I was raised in Christian Science—wasn’t vaccinated, was excused from health classes in elementary school (except sex ed & drug awareness), and my younger brother (I’m the middle of three) was born at home. Even though I don’t recall ever believing in any higher power, or any of the very abstract nonsense I was told, and in spite of a fairly successful life long study (obsession) of science (B.Sc. in Math-Physics), it’s still dawning on me just how on the fringe it all is.
::sigh:: I’ve got a friend whose partner is a midwife and into all this stuff and I…well, mostly keep my mouth shut. I’ve tried to educate her on things like vaccines where I think I have a chance of making a positive difference. I don’t think I’ve succeeded, though :(
As someone who would most likely have had two dead babies (instead of two live troublemakers) without major medical intervention, I’m skeptical, to say the least.
That’s not to say that there aren’t big problems with the way doctors and hospitals do childbirth. (Don’t get me started. No really, don’t get me started.) There are some huge honking problems that need to be addressed, but they’re not going to be solved by removing the mother and child from the medical environment entirely.
I wish everybody didn’t feel the need to polarize these things. Problems with OBs? Have a home birth! Well, what about, have a doula or midwife in the room to help ease the problems? Or delivering at one of the licensed midwifery centers where they can transport you immediately if necessary?
Same problem with breastfeeding. If you’re not 100% breastfeeding then OMG YOU’RE KILLING YOUR BABY. Dude. Chill out. Get as much breastmilk into your kid as you can, but don’t kill yourself to do it.
(No, that’s not the rant I was trying to avoid giving. Really, you don’t want to know unless you love TMI.)
#9 Squigit
My sister was asked if she wanted to have an epidural (or go “natural”), she replied “hell yeah, knock me out, wake me up when it’s potty trained!”
They didn’t find it as funny as I did.
Counting down to the moment when some earnest god-botherer points out that it says in Genesis that women are supposed to experience pain in childbirth…
Easy answer: We don’t care what an alleged god allegedly told his simple-minded followers.
What’s the difference between babies, tapeworms and botflies?
I encouraged a friend of a friend who I hardly knew to have her baby with doctors rather than midwives.
She called me a lackey of the system and claimed that natural was better.
The six weeks she spent in ICU away from her newborn son, who didn’t even get to experience the genuinely beneficial natural act of breastfeeding, really didn’t make me happy. Actually, it really hurt to watch.
I like the idea of natural birth(though the extent of my authority is to politely recommend the mother of my future children look into the idea), but yeah. Does it have advantages when all goes well? It appears to from what my natural birther friends have sent me and some other research I’ve done.
But things don’t always go well. One of my nephews would probably have died if doctors were not right there. My sister, the nephews mother in fact, would have died if doctors were not right there.
A friend of mine, apparently out of guilt that her first son couldn’t get a natural birth due to complications, gave birth to the second without a midwife or even her untrained husband there to help. Thankfully things went well, but the extent of her “what if things go wrong” prep was making sure the phone was in arms reach. She’s otherwise fairly rational about medical issues(god help you if you tell her vaccines cause autism).
Oh, my sister is a believer in natural birth. Just also a believer in doing it at a hospital just in case things go wrong. Her daughter who neared 12 pounds was natural(except for it happening at a hospital, which some of the radicals would say doesn’t count as natural).
Dr. Amy, not a practicing doctor, is a dogmatist. I’ve seen her in discussion after discussion refuse to back her claims with research studies and refuse to address studies people use to support opposing viewpoints. It’s a huge mistake for skeptics to support people just because they’re targeting similar groups. It’s sloppy thinking and intellectually dishonest.
Rather than supporting and argument with Dr. Amy, appeal to self-proclaimed authority, and anecdotes, I think a far more enlightening discussion could be had by beginning with Henci Goer’s older but thoroughly documented “Obstetric Myths Versus Research Realities: A Guide to the Medical Literature.” http://www.amazon.com/dp/0897894278/
An unvaccinated midwife? How could that possibly go wrong?
Well, the slightly more difficult answer would be to ask if he toils painfully to eat food from the ground by the sweat of his brow.
And just in case he’s a farmer, we can ask if it isn’t as sinful to remove thorns and thistles with Roundup as it is to remove pain with epidurals.
Had to come out of lurking for this one. I’ve had five deliveries and only the first one was “textbook normal”. Had wonderful midwives, OB’s that were terrific, and deliveries that were pretty crazy. Kids who flew out in under 45 minutes start to finish(he was over 10 pounds on top of it) and ones who came out face up and arm out. All but the last caused immense bleeding and issues immediately following delivery. Luckily I was in the hospital, we had plans for all extremes (since after #2 we realized this was going to reoccur), all the professionals were on board with what needed to happen and after the initial childbirth/delivery was out of the way, I recovered beautifully.
However, I have been criticized, abused, talked-down to, called a child abuser and more because I chose (and yes it was a choice) to give birth in a hospital because it was not as safe for me any other way. In fact, one of our friends’ wives went on a tirade on Facebook about how horrible I (and others) were because we had babies in hospital and she would never do that (she was pregnant at the time). To the point that she was calling us child abusers and we should have our kids taken away.
Obviously there isn’t a friendship there anymore. My husband called her bluff and asked her if she would rather that he had a dead wife and baby at home, or a wife and baby that survived in the hospital. Her response? Home is always better, and the problems with my deliveries wouldn’t have happened if I had given birth at home. So yes, home would always be better, even if something bad happened because it was meant to be at that point.
I can’t even count the times homebirthers have given me a hard time for my birth choice. Which is ironic considering they’re all about “choice”. But the only choice for them is homebirth.
But I had five happy, healthy babies, a safe delivery (if wacky and crazy at times) and a perfect recovery thanks to medical science and doctors and midwives and nurses and good healthcare. I’ll keep that choice thanks!
People often fantasize about a more innocent, simpler life not unlike the Shire in the Fellowship of the Ring. Then they actually go to the countryside and realize cows poo and they have to clean the shit off.
A simple documentary about how life was before modern medicine (or maybe just a graphic showing the yearly percentage of minors dead of disease in the last two centuries) would separate the simply well-meaning uninformed people from the crazies. I think this is important since information can help sane uninformed people but not crazies, and it has worked before in the context of vaccines.
I’d like to point out that home birthing is not all new age nonsense.
In the Netherlands it’s actually very prevalent. About a third of all births occur at home, and studies [1] show the risk to mother or child is not higher than for hospital births. But that’s because there is a very good infrastructure. Midwives are well prepared and educated and hospitals are always on standby so that if complications arise help can be given quickly.
There’s something to be said for giving birth in a familiar and comfortable environment. You can rent special baths to give birth in, both my sister in law and a friend of mine recently gave birth at home using one, and they both say it was comfortable (as far as possible of course), and a beautiful experience.
[1] http://www.washingtonmidwives.org/netherlands-study.shtml
My parents were all into that stuff, enough so that I was born at home. My children, however, will be born at a hospital, with qualified medical personnel standing by in case of any problems.
I’m all for science, but a lot of medicine in this country is not science based. C sections are now at almost 35% which is just stupid. They are not harmless and they are far riskier for the mother and the child and they are being forced on mothers against their wishes, women have been jailed for refusing c-sections and threatened with having their children taken away. Its no surprise when they start totally avoiding hospitals and doctors when it comes to pregnancy.
Ah, I forgot to add that there’s a difference (at least in the Netherlands) between home birthing and “natural childbirth”. Even though many births occur at home in the Netherlands, they usually occur with all the benefits of modern medicine, although there also exists a tendency in the Netherlands to not want to use anaesthetics. I think that’s independent of where the birth is taking place though.
Apparently the natural-birthers don’t know how to look up just how many women used to die of pregnancy and childbirth. My OB prof in medical school started the semester out with the statement – “Pregnancy is a pathological condition.” I know that docs are responsible for no small number of complications, but they are beaten, hands down, by the condition itself. For a healthy woman with an uncomplicated pregnancy a competent, licensed midwife is just fine – as long as she practices at the same standard of care as an obstetrician. The trick is having enough experience to know as early as possible when something is wrong. Things can go bad so quickly in a seemingly normal birth. Why risk doing it at home? (No, I am not an OB and I cringed every time one of them called me to consult on a pregnant woman because it was always a disaster.)
Never a good way to start a post.
gworroll:
I’m not so sure that a natural birth is better than an…unnatural one? at least in part because “natural” is not well-defined. At any rate, you can have a medication-free childbirth in the hospital: the woman’s body has to go into labor on its own and she just doesn’t give consent to be given pain meds and everything goes well–tada. So you can have both a completely “natural” birth (if that’s your definition) and have the lowest risk of anything going wrong possible, with all the interventions right there for the using if indicated but not required. I don’t really know why people think doing the same thing but further away from the OR/forceps/well-trained assistance is a better idea.
I don’t understand why someone wouldn’t want anesthetics for a painful experience. Is it only for giving birth or do they have, say, their teeth removed that way too?
Zeno @16 reminded me of an excellent essay by Julia Neuberger, a Jewish UK rabbi, who dismissed the link between pain in childbirth and and Genesis with a resounding ‘it’s bollocks’ (in a slightly more erudite way). The essay is in Neusner’s ‘Judaic Perspectives on the Old Testament, 1990. My partner had a difficult birth, and our obstetrician had the personality of my left shoe, so we were very happy that he was dealing with an emergency somewhere at the time of my partner’s labour, and we had two truly excellent midwives for the birth. Way before, early on in the pregnancy, one of them had said to us, ‘Feel free to have a birth plan. Then ignore it, because it probably won’t happen that way.’
gworroll: Gah, we cross-posted and you apparently knew everything I had to say. Sorry about that.
Know what happens at most hospitals when things are going well? Natural labour.
We had a midwife, she was very attentive, regular long meetings with mom to be, detailed answers to questions, she stayed with us throughout the day of delivery, gave us all kinds of help with the complications that did arise, and had us in for a c-section faster than the obgyn on duty thought necessary. She did this because she knew our case and could make a decision informed by our status as well as by her past experience and training. That’s something that we valued, having a medical person who was siding for us in a personal fashion took the sting out of a lot of the stress we encountered.
My wife also encountered a lot of the natural birth pressure and thought going in that an epi was a failure despite my best efforts to argue otherwise. It’s sad that these people are preying on others who are already vulnerable and stressed out and that their agenda causes problems. We had a baby firmly wedged in the pelvis cavity, it would not have delivered naturally based on our doctor and our midwife’s understandings and had we been at home who knows how things would have played out. Yay midwives who are interested in providing the best care possible. Boo and hiss at those who thing that childbirth is a cookie cutter enterprise.
I think my mother had a wonderful compromise for the births of my brother and sister: a comfortable, home-like environment, in a birthing center that was actually part of the home of her fully trained OB-GYN. I was even able witness the birth of my sister – which seems particularly poignant now that she’s a mother herself. Of a child whose plummeting heart rate precipitated a medically necessary C-section.
My two births were both awful, with the one exception of the nice anesthesiologist who had gotten a bachelor’s degree in geology and talked rocks and fossils with me to get my mind off the pain until the meds kicked in. They were also both births that were going nowhere and required surprise c-sections. So yeah, the hospital was uncomfortable, and having different seemingly random people come and feel up my privates every hour was the pits (nothing will get rid of any personal modesty you might have like giving birth in a hospital), but without it we would have probably, you know, died. So I’m more on the side of making hospitals better places to be than eschewing them altogether.
THIS. I spent months after my children were born being depressed that I had “failed” at childbirth, rather than being happy that it all worked out with us all alive at the end.
Carlie,
We had feeding issues which of course she had been primed to think were caused by the lack of proper birth canal transit, but the shit really hit the fan for us when our child was diagnosed with CP. Of course it was her fault he had a stroke, vile shitty hateful creatures dressing up their lies as natural and best for the child. I hates them.
I just have to post on this thread. I am very much committed to the midwifery model of care and to home birth **under the right circumstances**.
I had a c-section in 1991 due to my daughter getting stuck sideways, which might have been preventable had I been given midwifery care… such as being allowed to move around in labor and NOT having had my water broken “to speed things up.”
In the defense of the hospital, they did try to turn her head so she wouldn’t have to be a c-section, but it just didn’t work. I was also exhausted after 18 hours of labor (including 4 hours of pushing).
My son was born in 1995 at home with a competent nurse midwife, via a birth center that was 5 minutes away from a large university medical center with whom the medical director of the birth center had admitting privileges. Additionally, whenever the birth center had a birth in progress, the neonatal resuscitation team & ambulance were on stand-by should they be needed. My midwife carried oxygen and other emergency medications for postpartum hemorrhage and all medical staff were trained in neonatal resuscitation. In the 10 years that birth center was open, only 2-3 babies were lost due to incompatibilities with life and a fetal demise in the 3rd trimester. Their transfer rate was approximately 10% usually for prolonged labors.
There are hospital interventions and practices that do not serve mothers and babies well, as well as a little bit too much faith that the strict homebirthers have in nature taking its course. I have seen both sides of that, having also been the secretary of my state’s midwifery association long ago.
Birthing families need a wider variety of choices. Of course, high risk women should not be out there having home births… nor should women having breech births… etc. However there is a great deal that the hospitals and OBs can learn from the midwives too. Home birth should be for the low risk crowd. But why can’t we have REAL intermediate birthing centers for those that want to be closer to the technology but not hooked up to every machine that goes *ping*, not allowed to move around, not allowed to eat or drink at will.
I should state that though I had hospital births, they were more what would be considered “birthing centre” births. I was off monitor, allowed to move freely, labour where it was comfortable, push in the best position for ME etc. So though it was in the trappings of a hospital, it was a much different experience than some mothers experience in hospital.
There was no part of me that ever wanted a home birth. It was an emergency backup option for #4 but she luckily held off an extra few minutes so we could get to the hospital. It was never something I felt comfortable with. Not for an ick/gross factor either; I just didn’t want it. But that made me a child abuser *sigh*
I was going to link to Hathor the Cow Goddess because I hate you all and want you to suffer, but apparently the comic was taken down or something.
Oh well. It’s
probablydefinitely for the better.One of my children was born after a 12 hour labour with gas and air and (IIRC) an epidural, the other after about an hour with nothing. Although both births seemed to be rather violent and frightening, the second was a “natural” birth and was less traumatic for my partner because there was no unnecessary medical intervention. Giving birth is a natural process, and shouldn’t be medicalised unless it is necessary to do so.
If a woman is entitled to the right to choose whether she should have a baby (and I believe she is), why is it so difficult to accept that, when she has chosen to have a baby, she has a right to choose how that child is born – whether by a “natural” childbirth or by caesarian section (which is the method of choice for many women in the UK,
Of course, the best possible medical support should be available if something goes wrong (two cheers as usual for the good old NHS), and mothers who need such support shouldn’t be stigmatised.
I just have to post on this thread. I am very much committed to the midwifery model of care and to home birth **under the right circumstances**.
I had a c-section in 1991 due to my daughter getting stuck sideways, which might have been preventable had I been given midwifery care… such as being allowed to move around in labor and NOT having had my water broken “to speed things up.”
In the defense of the hospital, they did try to turn her head so she wouldn’t have to be a c-section, but it just didn’t work. I was also exhausted after 18 hours of labor (including 4 hours of pushing).
My son was born in 1995 at home with a competent nurse midwife, via a birth center that was 5 minutes away from a large university medical center with whom the medical director of the birth center had admitting privileges. Additionally, whenever the birth center had a birth in progress, the neonatal resuscitation team & ambulance were on stand-by should they be needed. My midwife carried oxygen and other emergency medications for postpartum hemorrhage and all medical staff were trained in neonatal resuscitation. In the 10 years that birth center was open, only 2-3 babies were lost due to incompatibilities with life and a fetal demise in the 3rd trimester. Their transfer rate was approximately 10% usually for prolonged labors.
There are hospital interventions and practices that do not serve mothers and babies well, as does letting nature take its course. I have seen both sides of that, having also been the secretary of my state’s midwifery association long ago.
Birthing families need a wider variety of choices. Of course, high risk women should not be out there having home births… nor should women having breech births… etc. However there is a great deal that the hospitals and OBs can learn from the midwives too. Home birth should be for the low risk crowd. But why can’t we have REAL intermediate birthing centers for those that want to be closer to the technology but not hooked up to every machine that goes *ping*, not allowed to move around, not allowed to eat or drink at will. And for those that are choosing homebirth, we need smooth transfer from home to hospital without the animosity that currently exists in many places in this country between OBs and midwives.
Legalizing and standardizing midwifery training to a recognized national standard would also be a benefit to those most closely involved, namely birthing families. There will always be incompetent practitioners, maybe this would allow better policing of those who shouldn’t be practicing.
We need more evidence-based maternity care. There are studies that suggest that intermittent auscultation is as effective as continuous fetal monitoring in keeping track of the safety of the baby. There is also a known correlation between induction of labor and increased chance of cesarean section. I am personally gratified to see that research showing the increased risks of delivery before 39 weeks to the baby’s wellbeing is being used to govern OB practices nationwide, with the March of Dimes leading the charge.
A balanced approach, rather than an “all babies have to be born in hospitals” approach is really what we need.
Oh course she has and should have the right to choose. But just because there are various choices does not mean that some of them aren’t stupid.
Things are a bit different here in NZ from the sounds of it. Low risk mothers give birth in Maternity Hospitals (a bit like birthing centres I think), attended by a govt funded & trained midwife & with an OB on call. Higher risk mothers give birth in an ordinary hospital.
I’m all for natural birth, but natural birth in a place where doctors are on hand. I think hospitals in NZ are more focused on giving the mother a good birth experience than what I’ve heard about the US though.
(Personally, I had both my children in hospital (not a maternity one) as Son needed to be induced, & Daughter was breech & I had a c-section (was NOT happy about it, but knew it was for the best). But both births were very much focused on giving me freedom of choice, making me feel comfortable, & the staff were incredible.)
Anyway, the risk of something going wrong is too high in home births. I’d rather have an awful experience & a healthy baby, than put my child at risk just so I can try to have the birth experience I want. I don’t get how mothers think ANY amount of extra risk is acceptable.
This thread has so far contained a string of anecdotes. Where’s the proper evidence showing rates of morbidity and mortality for home versus hospital births?
Not all pro-homebirthers simplistically equate “natural” with “better” – when I looked some years back there seemed to be evidence that for women (not at particular risk, and for those who want to) delivering in the relaxed setting of their own homes and much more under their own control required less pain meds and produced fewer complications than in hospitals.
To drag in yet another anecdote (well if others can do it why can’t I? :-)) there’s a woman I know who already had an aversion to hospitals before her first child’s birth, which in the event was a ghastly affair with her being rushed to hospital in an ambulance with the blue+2s going, stirrups, forceps, cutting …. basically because her labour came on very quickly (both her children were delivered in about 4 hours). So when the second one was due she was adamant she wanted a water birth at home, which she got. Long story short she popped the baby out in about 4 hours again, with no meds, and was so happy with the experience she said she wished she could do it all again!
Point being? The birth was not only pleasant rather than traumatic for the mother, but probably less likely to have encountered complications. However if there had been complications they could have been more serious because they were at home rather than in hospital. Worst case the child and/or mother could have died – or had a greater probability of doing so than they would have in hospital.
Now the child has grown and gone on to climb trees, play in water, ride bikes and other activities which, life-enhancing that they are, carry a risk of injury and even death. So I think that slightly greater risk of the homebirth fits the pattern that life does have risks but there comes a point where trying to avert them all through some sterile utilitarian risk-minimisation-at-all-costs approach leads to a life not worth leading.
Which – to reiterate the point I made earlier about ‘not at particular risk’ and ‘who want to’ – is not to suggest that homebirth is a particularly sensible or even sane option for anyone and everyone. Just trying to try to counter a knee-jerk reaction that because some woos endorse it, it must therefore be inherently woo-ey. I think it can be a well-informed rational choice.
The problem is that things can go so very, very wrong, so very very quickly. You can have a birth plan all you want but things will never go how you want or expect them to go.
Correlation is NOT causation. Most often, the circumstances that prompted the doctor is induce labor (in an effort to avoid a c-section) are the same circumstances that prompted a c-section.
@Joses, with my first I had no pain relief, & strangely enough it was great. Adrenaline flowing, feeling rather like the cliche of “I am woman, hear me roar!”. I have extremely fond memories of that birth. It may seem silly, but conquering the pain really did empower me – I felt incredible & sooo awesome. But that’s just me, & I have been told by the husband I am a wee bit of a masochist :D
OK, PZ,
I usually agree with you guys, but here I must strongly disagree.
First of all, PREGNANCY IS NOT A PATHOLOGY. It is normal and natural and if docs were not given this horrible definition, it would help mothers a lot.
I had my first baby in a hospital, and my husband and I had to fight with everyone that we encountered to keep it natural.
It was the worst experience of my life and I swore that I would never have another child in a hospital.
We found an OBGYN who did homebirths for our second child.
It was everything that we wanted it to be, and my baby and I were in perfectly safe hands.
For our third child, we were in a different city, and we found an excellent Midwife/RN, who was married to our family doc. He was her back-up. Again, we had a beautiful, safe and healthy birth.
We lived in another state when our last two were born, and they were delivered by an excellent midwife. Again, we chose one who had lots of experience and good back-up in place. Our last two births were again the beautiful experiences that we wanted.
I worked for that midwife, and I assisted on 35 homebirths, including three water births. We always screened our Moms carefully, and my midwife did not hesitate to send a Mom to the hospital if she saw ANYTHING going wrong. She is still practicing, and has been practicing for over 30 years now. I don’t think that she has ever had a dead baby or a dead mother.
We respect science – my husband and one of my daughters are scientists. We simply did not want medical interference in our normal, natural births unless something occurred that would make it necessary. That is the way it should be. That is the way it is in other countries, as someone mentioned about Norway. Unfortunately, that is not the way childbirth is handled in most of the US.
magistramarla
Did you even read PZ’s post?
Noted for future reference.
—
magistramarla, I take it your first child turned out horrid, and the rest are angels?
I know how this is going to sound, but idiots having dead babies and/or dying in childbirth when they don’t have to is just natural selection at work.
I got into this with a whack job “Freebirther” when the mommy-blogging juggernaut Dooce was pregnant with her second child. Dooce announced that she was going to keep on her depression medication throughout her pregnancy and this person chastised her for that choice, claiming inevitable harm would come to the baby via those meds. I looked the stats up and found that the rate of complications due to the medication was half that of the chances of umbilical cord prolapse, a condition that is fatal to the baby if immediate medical intervention isn’t undertaken.
Freebirthers are a radical fringe of the homebirth movement, this particular one claimed that birth was a sexual act and as such needed to be done in private. She also called the act of giving birth a Birthgasm. I shit you not. So no cookies for those of you who guessed that pointing out that her practice was far more dangerous than Dooce’s had no effect whatsoever. In the end her experience of birth was far more important to her than the safety of her child-to-be and nothing was going to change that fucked up priority.
I think it’s important to make the distinction between reasonable homebirth, where a trained professional is in attendance and prior risks have been properly assessed and the quasi-religious freebirther movement where ideology is more important than the safety of the participants.
My own child was born via C-section and it was a miserable experience for my wife. She spent the whole time crying and I spent the whole time trying to console her.* But here’s the thing: as amazing as birth can be for a parent, it’s only the tiniest fraction of your life with your child. How she or he enters the world is just not that important in light of the years of joys, and pains, that parenthood will bring.
*The only thing that made a dent in her misery was when I pointed out that this was nothing, just wait until she brings home a boy, or girl, with a tattoo! My wife gave a half hearted laugh and said “You have a tattoo.” To which I responded “See, see, my point exactly!” That got a real laugh from her and from the surgeon whom I told to stop listening and get back to his stitching.
And as miserable as our birth experience was, it wasn’t completely awful. When they handed our daughter to my wife her tears of grief and fear turned instantly to tears of joy. I’ve seen plenty of abrupt shifts from moods to sad through stubbed toes and the like, but never one that went the other way so suddenly and completely.
David #27
“women have been jailed for refusing c-sections and threatened with having their children taken away.”
citation please.
I’m surprised nobody’s brought up the fact that the whole natural childbirth movement was started by a fiercely misogynist (and racist) fundie, Dirk Grantly-Read.
Interesting thoughtful piece in SciAm
“Why do those who advocate home birth feel the way they do?”
http://blogs.scientificamerican.com/context-and-variation/2011/08/24/why-do-those-who-advocate-home-birth-feel-the-way-they-do/
on more levels than you think
And yet you still said it.
janice:
http://www.feministe.us/blog/archives/2009/07/28/baby-taken-away-after-mom-refuses-c-section/
Normal? Natural? My best understanding of the human birth process is that it is one of the limits on what makes us human. Specifically, big-brained humans.
Evolutionarily speaking, we are trying to squish out the biggest-brained babies possible, so as to shorten our child-rearing time. The size of a baby’s head is right up at the limits of possibility. Childbirth is perhaps the biggest factor in natural selection for women.
I don’t know how else to say it. Women aren’t naturally selected as human by running from tigers, they are selected by living through the childbirth of big-brained babies.
I’m all for trying to make childbirth as relaxed and calm as possible, but claiming that it is as natural for humans as it is for other animals is bizarre. We’ve got sore feet, bad backs and knee troubles, even though we’ve been walking upright for quite a while. Big-headed babies are a lot more recent a development.
Look at what you’re saying, magistramarla. “natural”, “natural”, “natural”. Yeah, birth is natural, it is not a pathology, but that is NOT synonymous with it being safe and healthy. Pregnancy puts huge stresses on the body, and childbirth is a trauma. A natural trauma, but so what? Mosquito bites, measles, high blood pressure, arthritis, Amanita mushrooms…they’re all natural, too.
Pain is natural, too. But if we’ve got a way to reduce it, you’re crazy not to take advantage of it…especially when your rationale is that it’s “natural”. It’s a meaningless term.
kennypo65
I know how this is going to sound, but idiots having dead babies and/or dying in childbirth when they don’t have to is just natural selection at work.
When you can show that the predilection for avoiding modern hospital-care has a genetic component, then I might agree you have half a point. Until then…
You’re an idiot.
Damn, blockquote fail. The first paragraph in mine at #62 was a quote of kennypo65 at #53
Another worthwhile (IMHO) read:
http://daisymayfattypants.blogspot.com/2010/08/in-defense-of-reproductive-choice.html
http://blogs.scientificamerican.com/context-and-variation/2011/08/24/why-do-those-who-advocate-home-birth-feel-the-way-they-do/
I thought that this was an AWESOME article, and I really thank you for pointing this out. I think that labeling everyone that chooses homebirth as a preferred option as a quack is pretty bullheaded. I won’t give my personal anecdote, but as a scientist and a mother of a small child, I made sure to discuss in detail with my midwife a) her infant and maternal morbidity and mortality statistics and b) her protocols and opinions regarding hospital transfer. I think that for the most part, midwives are fairly quick to advocate a transfer to the hospital (it’s always good to make sure that the midwife has a good working relationship with the closest hospital- mine was allowed to be in the operating room as well as my husband when I had my c-section, which is pretty phenomenal), and that so long as a hospital is close (I am utterly surrounded by first-rate hospitals where I live), and those things can lead to decent outcomes with a homebirth assisted by a trained nurse-midwife. I also think that Dr. Amy Tuteur has provided AN ABUNDANCE of arguments from authority, which I find utterly pathetic. You will (almost) never find a nurse-midwife who will demand that you see things her/his way simply because she/he knows what is best for you. It’s disgusting.
Great article, PZ. I’m not a huge fan of the idea of homebirthing, and the main reason against home birthing, what if something goes wrong, hits close to home. If my mother decided to have me via homebirthing, I probably would have died. My birth was one of the births where things did go wrong, and I am grateful that modern medicine came in to save the day.
I consider homebirthing dangerous quackery.
Seriously — there is risk in childbirth, and it’s a risk to the most important people in my life. I want the machines that monitor everything hooked up. If something goes wrong, I want to be able to whistle and have a doctor come running down the hall…not wait for an ambulance. If my wife is in pain, I want her to be able to snap her fingers and get an injection on the spot. When the kid pops out, I want any problems treated, not in half an hour, but in half a minute.
There is a reason the U.S. neonatal mortality rate is higher than that of Croatia and the Czech Republic, and it’s not because of home births. http://en.wikipedia.org/wiki/List_of_countries_by_infant_mortality_rate
I am pro-science and definitely not a fan of woo, but after 2 bad experiences with hospital births I opted for midwives with my next 3 births. I will not go into anecdotal narrative, but there are reasons that rational pro-science women like me have home births with experienced, sensible midwives. The American health care system is not all good.
And yeah, as I said up top, sometimes doctors have lousy bedside manner or are distracted by too many other things going on. I also want the midwife who is there to help and be nice and keep a professional eye on everything. But if things go wrong, I don’t care if the attending physician has the personality of House MD…I want her there, right away.
I guess this is the issue, as well. I don’t think that women in hospitals even get that kind of treatment. I know this is another anecdote, but I have a friend who was in a really first-rate hospital who hemorrhaged ALL NIGHT after she gave birth even though she alerted staff to her condition, they just didn’t care enough to really pay attention. She needed 3 blood transfusions the next day. I mean, I definitely realize the benefits of hospital birth and doctors, but I think that there is still some gray area. And I don’t think that you will find many people who can argue with WHO statistics showing that the US is pretty low on the list of industrialized countries with maternal and infant mortality rates.
Weee more anecdotes!
I would have died without an emergency c-section which had to be performed immediately. I was hemorrhaging but because my water was being blocked by the baby’s head they didn’t notice the bleeding until they further popped it. The baby didn’t show signs of fetal distress which usually happens when the mother is hemorrhaging so she might have survived my death since we were at a hospital. Perhaps a midwife would have been more observant and attentive to the other symptoms, but I had been deemed a normal risk pregnancy because I was healthy and young. Baby was 4 weeks early and just over 5 lbs but completely healthy (probably because she was stealing all my blood lol).
So I tend to get angry when people judge me for giving birth in a hospital and having a c-section. And after a second baby – “natural” in a hospital VBAC, I honestly prefer the c-section. I was in labor for about 36 hours and that is typical. C-section took 30 minutes. Plus it honestly wasn’t too terribly painful compared to the tearing I had from the second. And this baby was only 6 and a half pounds.
Pregnancy and childbirth are certainly traumas and though I respect women who want to do it caveman style, they need to be ready for complications. Or face the dire consequences of giving birth to dead babies
Oh boy, was any post ever going to bring out more crackpots and misguided fools than this one?
So sad – though not really surprised – to see many people wheeling out their anecdata on this one, when this site does a terrific job of laughing at such behavior on other issues.
I want to see the anti-MRA wolfpack in here ASAP, snapping at the heels of these lunatics who want women to give birth in pools, beds of oak leaves, or whatever the fuck else their latest mystical idea is.
I know that the homebirthing movement was full of quackery, but this takes it to a new level.
Well trained midwives, i.e. CNMs, can be excellent health care providers as long as they understand their scope of practice and have good backup. And giving birth at home is really not the safest option. Plus you have to clean up the blood and meconium yourself. Find a nice modern hospital with a birthing room complete with jacuzzi, birthing ball, and ocean sounds cued up on the iPod-and a complete surgical suite with 24 hour staffing down the hall-and have the best of both worlds.
I’ve seen more than one of those. Says it all.
Dolphins.
Oh gee, another serial killer. Why should we pay attention to you much less let you near a houseplant much less live humans?
You had better hope there is no strawperson god or you will find yourself in the afterlife made of straw and torched over and over by smiling morons and kooks.
BTW, no one is forcing women to go to hospitals or have c sections. Home births happen all the time. Things sometimes go wrong and a baby ends up dead or sometimes a woman. I’ve seen it more than once myself.
When I got pregnant earlier this year, I found it really unsettling how hard it was to find good information. If you’re not careful, trying to research childbirth on the internet will turn up all kinds of scary stuff about those evil doctors just itching to cut you open so they can run off to their golf game or whatever, and you’ll end up thinking that a homebirth with a midwife is the best and safest option.
The Skeptical OB has been a huge source of comfort to me since I discovered it a few months ago, and I’m glad it’s getting more publicity — it seems like pregnancy and childbirth have been pretty underrepresented topics in the circle of science and skeptic blogs I like to visit.
Polio, the Black Plague, measles, ergotism, and hepatitis are natural.
So is an average life span of 47, what it was in the USA a century ago.
The fact that many of us are still alive is “unnatural”. Probably half of us would be dead by now of something…natural.
I think empirical studies have shown that natural with backup is the safest way to go, so it’s really sad to see that midwifry is descending so far into woo. Could turn an otherwise positive thing into more scheduled induction with their higher rate of complications or even scheduled c-sections. Even so, I think a woman should have final authority over her birth, even if risks are high. To suppose otherwise opens a huge can of worms.
One cool thing about natural birthing is that it promotes resistance to genital mutilations like circumcision and episiotomy. I think most of us here understand that circ is totally fucked up, but why did I include episiotomy? Well, episiotomy first developed to facilitate forceps delivery in anesthetized mothers and to make the “twilight sleep” births go a little easier.
Studies have shown that episiotomy reduces the risk of a first degree tear, but that episiotomy discomfort is the same as 1st degree tear. So by doing the epi you are taking a 100% risk for something that may not happen. Furthermore, the episiotomy makes it easier for higher degree tears to happen. Seems lose/lose to me, but they still do it, just like they still do circs.
Doctors are pretty fucked up about this stuff, and it’s a shame that midwives who could work against it are descending into the woo that may make them less credible.
To Dhorvath (#35)
Whether unmedicated labor in a hospital environment would produce the same experience as unmedicated labor at home (for a low risk pregnancy) depends on the practices of the specific hospital. There is more to laboring than enduring the pain. For instance, labor often progresses faster if the woman is free to move and walk about. Not all hospitals allow such freedom, and among those that do, sometimes the routine practices are such that place limits on the movement of the laboring woman in ways that may interfere with labor progression. (Of course insufficient progression calls for further interventions. But at least in some cases, the whole cascade of interventions could have been avoided by letting the woman keep moving as much as she was comfortable.)
Last time I read about the Dutch system (as described by captainchaos in posts #25 and #28) my impression was it results in low rates of interventions. I recall reading about doctors there being concerned about too many women opting for hospital births (one possible reason suggested was increased immigration bringing women unfamiliar with the midwifery system).
I would have loved to have such a system available to me. As it happened, I gave birth in a country where hospitals were the only option (well, there is always ‘oops, I didn’t make it to the hospital in time’ but I would never choose that on purpose). There was the ‘not so friendly’ hospital in my city and the ‘much friendlier’ hospital an hour away. Waters broke while I was at work, so I opted for less friendly but nearer hospital. While there was still a chance I’d check out and try the nicer hospital I was told I was progressing really fast. A few hours later I was told I was too slow and the labor should be augmented. I wanted to avoid that because augmented labor is not only more painful but also involves higher risk of fetal distress due to hypoxia (and further interventions to resolve it, up to C-section). It took no little assertiveness on my and my husband’s part, but we convinced the doctors to delay the decision to augment the labor for a while. Worked fine. I even had the fortune that the hospital midwife who happened to be present at the time of the birth itself was the one with the lowest episiotomy rates in that hospital – I managed to avoid that bit too. My experience is that it is possible to reduce to some degree the number of interventions in a hospital birth, but it isn’t easy. I would have preferred going through labor and delivery in a system that assumed low intervention as default for women in my state of general and pregnancy-related health (but had the means to intervene quickly if necessary).
This. I think people really need to understand more that our success as a species of intelligent apes has put an enormous strain on human females’ physiology. With our enormous brains, deciding to reproduce is a much riskier proposition for a woman than it is for, say, a female gorilla. Humanity really owes women a debt of gratitude for our evolutionary success, since we have born the brunt of the costs imposed.
In addition, the maternal mortality rate in the USA is shamefully high for a western industrialized country, and has been rising rather than declining for the past two decades. As another commenter pointed out, this is not because of the prevalence of quack midwives urging ill-advised home births for women with high risk pregnancies, but rather from obstacles to medical care, disparities in insurance access, and other problems typical to the American health care “system,” if you can call it that, most especially disparities between childbirth outcomes for women of different races. For example, women of color are FOUR TIMES more likely to die in childbirth than are white women. According to the Amnesty International study from which I’m drawing these figures, “near misses,” pregnancy complications in which the mother barely escapes death, have actually increased 25% from the 1980s to 2006. Since reporting of pregnancy-related deaths is mandatory in only 6 states, it’s likely that the actual maternal mortality/near-miss rate is much higher.
The cause of these disparities is not anti-medical bias from people obsessed with “natural” home births, but typically neglect and discrimination from doctors and the medical bureacracy. I appreciate PZ’s concern, but if we’re going to triage the causes of maternal mortality in the USA, quackery from midwives will be pretty far down the list.
It’s interesting that any discussion on quackery quickly turns into a discussion about rights. It’s a pernicious red herring, sidestepping the epistemic concern and going straight to the justification of the practice. Whether or not the practice should be the right of self-determination for adults to choose doesn’t stop the practice from being harmful nonsense, but shifting the conversation to rights is a great way to not have to defend any epistemic problems that would otherwise be cause for alarm.
To jose (#32)
There are reasons to seek to seek to avoid specific pain medications during childbirth. Some women don’t want opiates because they want to be mentally present to meet their child for the first time. There is also the issue of opiates crossing the placenta.
With epidurals there is the matter of losing sensation in the lower body interfering with movement during labor, high risk of hypotension (which can risk fetal distress) and many other risks and side effects.
It’s all a matter of risk vs benefit. People don’t all agree on where the balance is.
Our son was delivered by midwives at a birth center in 1977, and our daughter was delivered by midwives at home in 1980. No drugs whatsoever either time. Wonderful experience, and I have no regrets whatsoever. Hospitals are for sick people.
Home-birth is not the only area in which women are conned by pseudo-medical gobbledygook. My wife sees a “Dr” who badges himself as an “integrated therapist”. His office is in an up-market building in the city and is far more opulent than the typical GP’s office. His waiting room has cabinets well stocked with alternative “natural” remedies. He is an advocate of medicinal honey and an anti fever medication called Androtec, (a derivative of a relative of the Neem tree). His office is well furnished but the only medical items visible are his white coat, his stethoscope and device for measuring blood pressure. I have never seen him use any of these except for the white coat which does lend him an air of credibliity to the more gullible.
My wife is an asthmatic with some severe allergies. His recommendation take a sip of coconut oil, (expensive “medicinal grade” of course every night, together with medicinal honey when the allergy or inflammation is bad. He has told her not to use her preventer or reliever sprays prescribed when I took her to a real doctor or to use over the counter anti-histamine for the allergies. His reason: It keeps the inflammation in the body!!!.
Further evidence of his quackery: I suffer from an extremely rare immune system disease. So rare the most GPs have to look it up in their medical dictionary. Mine is the first and only case my regular GP has seen in his practice of around 5000 patients.
His diagnosis? It is due to my western diet. His basis for this insight is that his local patients contract it when they live in the west and it clears up when they resume their normal Asian diet. (I am presently living in an Asian country which has quite a good health care system which runs alongside numerous quacks offering all sorts of bizarre treatments for what ails you.)
WRONG!!! It is even rarer in Asians than in Anglo-celtic people like me. It is worse in African-Americans and there is evidence of a gene based racial predisposition to the disease. In all probability he has ever seen the disease or even knows what it is. In fact I now have 12 papers written by a total of 26 researchers from peer-reviewed medical journals. These include a good case-controlled study which shows a link between a chemical I was exposed to in my job of 30 years and the illness.
Further evidence of his quackery: For his cancer patients including breast cancer patients he counsels against surgery and chemotherapy. Instead he prescribes herbal tea, hot spas and aromatherapy and massage.
Does my science trump his conmanship? Not in my wife’s eyes because of his amazing success with treating the common cold which amazingly fades away after 4 to 5 days thanks to his herbal potions. OR more likely our brilliant NATURAL immune system.
Gazza, your wife is not all women. Please stop implying that her susceptibility to being conned is somehow due to her having a vagina.
Also, got to love the argument that can be recast as following:
You know, I’ve driven while drunk several times without even being close to having a problem. No accidents, no near misses, no attracting any police attention. Drunk driving might be a problem for others but not for me. Don’t. Know why your making such a big fuss about it, really.
Red herring indeed.
It’s legal for anyone over 18 to refuse any and all medical treatment and die. It happens a lot for various reasons; religious sacrifices to the gods (faith healing), anti-vax, HIV denialists, alt med and so on.
Whether it is a good idea is the question.
I don’t usually read Isis the Scientist, but she also blogged on this recently. From her post:
Wow,normaly on this site you talk about science. On this post you seem content to just make shit up. Do you have any evidence at all that says home birth with a trained midwife is more dangerous than hospital births? Just ‘sayin it’ makes you sound just like a creationist to me.
#55 & #59 — Good news! The woman who refused to sign a consent form for a ceasarian that she actually didn’t need MAY regain custody of her child, and the process of getting the CHANCE to do so only took FIVE YEARS! I would note that Dad, who apparently was more cooperative with the tyrants at St. Barnabas, has been allowed visitations with his daughter starting in 2009.
http://www.dailymail.co.uk/news/article-1366791/Baby-girl-kept-away-mother-5-years-refusing-sign-C-section-form.html
Information is available here on Amber Marlow, whose doctor got a court order allowing him to FORCE a ceasarian on her, and on the case of Melissa Rowland, who was charged with first degree murder because one of her twins was a stillbirth after she delaying giving permission for a caesarian, and convicted of a lesser charge.
http://www.advocatesforpregnantwomen.org/main/publications/articles_and_reports/could_you_be_forced_to_have_a_csection_1.php
But if you really want to be outraged, the story of Angela Carder is can’t-miss. There the nervous hospital administration risk managers went to court and asked for instruction on what the hospital was required to do “on behalf of” a 25 week fetus not expected by the physicians to be viable. Rejecting the testimony of her husband, her parents, her doctors and everyone concerned in the case, and giving undue weight to the opinion of a neonatologist who had never even examined Angela, the Judge ordered a caesarian to be performed.
Since her own team of doctors refused to do it, they brought in a pinch hitter, who couldn’t convince her to give him permission. In the face of her explicit refusal to agree, a three judge panel decided during a telephone conference the hospital could operate anyway. The fetus died within two hours. Angela lasted two days. Her parents sued and won, for what that was worth, having lost their daughter and their grandchild.
http://www.advocatesforpregnantwomen.org/articles/angela.htm
There are lots and lots more cases I can resurrect for those who are sure that doctors don’t try to over control pregnant women or who say ‘that never happens’. LOTS.
The concept of people rejecting modern medical science and insisting on doing childbirth the “natural” way makes a lot more sense when you realize their stance is not actually about birthing a baby. It is instead about *performing the sacrament of reproduction*, and if the ceremony isn’t done perfectly and according to the ancient formula, then the woman can’t be inducted into *the mystical order of sacred motherhood initiates*.
Interesting debate. Home birth is definitely a choice, and one that hopefully involves intelligent review of the costs and benefits. Some people treat this like a religious decision (for either case), with the usual lack of reasoning involved. If someone is rational they can minimize the risks of home birth (serious backup plans, midwives with great track records, etc.).
Hospitals are not without risks either. The thing of it is, medicine is a business. The more interventions that occur with a patient, the more money the hospital makes. Contrast the C-section rates between hospitals that have well off, insured patients and the hospitals that support a poorer population. There’s also MRSA, plus a host of other nasty, antibiotic resistant bugs found in most hospitals. If the hospital has a problem with MRSA, they’re not going to announce it to their potential paying customers. This is especially sensitive if the problem is in the NICU.
So, not everyone who has home births is a wackaloon. Intelligently prepared for, home birth can be a viable option.
The ideological natural/home birth crowd is really just phoning it in. Try squatting in a field, forest or beach, or you’re just a poser.
freakyfoodcdn #23
Oh, yes. Because that would be so much more natural, wouldn’t it?
I’m sorry you’ve suffered abuse from these maniacs for not dying in labor and taking your baby with you. Those people are idiots.
captainchaos #25
I’ll just point out that no one said that it was.
David #27
Both doctors and mothers can sometimes make bad decisions for elective c-sections, no doubt.
Lord Shplanington #42
The landing page is bad, for whatever reason. Start anywhere else and have at it. http://www.thecowgoddess.com/birthsmart-first-visit/
MelissaF #46
Sounds like the best bits of all options rolled into one. Women do need better choices and better care.
John Stumbles #47
I wasn’t seeing this knee-jerk reaction. I see a reaction to extremely bad advice: That all women should be doing the “natural” thing. And listen to Squigit #48:
FossilFishy #54
Oh jesus h. christ in a bucket wit a hat on.
R_Till #65
QFT and sensibility. I’d hope more for a birthing-center/maternity hospital sort of option though. Unfortunately, a lot of bad things that happen in the world are surprises. Glad it worked for you, though.
PaulG #72
And did it, really?
Personal anecdotes != anecdata. I don’t see anyone trying to support a position with their stories as evidence as if it were data or a data analysis.
When the lunatics show up, I’m sure things will get interesting very quickly. Squigit is waiting, among others, I’m sure.
I have a close friend who went the homebirth route but the company that helped were medical professionals and there was a standby to rush to the hospital if needed. Guess I thought all homebirth was that way. It saved thousands of dollars.
Man, women used to die all the damn time in childbirth (or from complications in the hours/weeks following) before modern medicine. Reading history, it crops up continually. And since there was no birth control, wives were continually at risk. It’s one of those weird things like half the population having crap vision (imagine a society without corrective lenses – there’d be no cars for one) and people hobbled from torn knee ligaments, and everyone walking around with rotted/missing teeth. Life was unbelievable challenging until the last century.
The kook never bothered to read the thread.
Since you’ve shown yourself to be a nearly illiterate idiot, why should we care what you think?
OT @ crowepps:
Was that you I read being all rational and stuff in comments on a blog post somewhere (I lost the link) about the blog author’s decision not to have children?
If I’m wrong, I’ll just continue watching you be all rational and stuff here. Cheers.
I had my first baby in a hospital, and my husband and I had to fight with everyone
I’m in a really tough spot with this issue. The extremely comfortable life I’d know for most of my teens was 100% thanks to my mother’s career in obstetrics. And knowing that the person who was most upset for how my son and I were treated before, during and after his birth is one of the professionals who knows what she’s doing and gives a damn makes it hard for me to hate on hospital births.
But getting treated like garbage, and my son nearly killed, thanks to an incompetent staff who didn’t seem eager to demonstrate the “miracles of modern medicine”, really shook my support for them. My son and I got the absolute worst treatment any woman and child could have gotten, so I understand why other women are reluctant to risk that for themselves and their children. I might as well have been at home for all the good they did us.
It can be very, very bad out there. Not all hospitals give a damn. And if they’re all but free of being held accountable for their incompetence, neglect, or outright malice, as military hospitals are, then they can be worse than any of you ever imagined.
A lot of the modern crop of woo-soaked midwives are also anti-vaxxers. I worry about the children that they help into the world, when they midwives have so much seeming authority, and then these babies wind up not getting vaccinated.
A few other natural things:
Black mambas.
Brown recluse
Lions
Grizzly bears.
Hurricanes
Tornados
Earthquakes
Cyanide
Arsenic
And I can do without them all in my home. Nature can keep them.
No.
You didn’t.
Sorry to disappoint you, but it doesn’t.
Midwifery in Germany is a qualified, highly trained and licensed medical profession. Actually only midwives are licensed to “conduct” a childbirth.
But I’ll tell you what my first experiences with midwives was: My second cousin’s partner, who works in an “anthroposophic birth-centre”, who has almost fully unvaccinated children (only the gran wouldn’t take them on a holiday without a tetanus shot), who lets her child suffer for 6 (!) weeks from scarlet fever, treating him with homeopathy because she doesn’t believe in antibiotics and who also, of course, had her children at home.
Yuck.
When I was pregnant I was thinking of her and was afraid of midwives. I didn’t want to fall into the hands of a quack. Then I met the good sort of midwives and was in the care of wonderful, compassionate, sciency (except for accupunture) people, who worked well with my gyn and really helped me with my feeding problems afterwards.
When I met my midwife during my second pregnancy, it was because she was seeing the gyn for her own pregnancy. You probably can’t show more competence in somebody you work with on a daily basis in this area than trusting them with your own child.
Now, both of those midwives have the same license, the same education.
I kind of agree with you. Women must be able to make good choices. But the first step towards good choices is good information.
Forcing C-sections on women is not only misogynistic, but also chases women away from science based medicine into the arms of quacks. Treating women as an unnecessary inconvenience during birth does the same.
But we’re not talking about a balanced approach, when does medical intervention do more harm than good, but about people with an ideology that’s anti-science and, despite it’s apparent women-centred approach, anti-woman.
For the record, I had both kids in hospital, delivered “naturally”, without anaesthetics.
Why? Too fast. When I arrived there for my first-born, my gyn asked me whether I’d like an epidural and I said “yes, please”, thinking that I wouldn’t make it too the usual 10-12 hours of labour. My midwife took a look and said: “save the phone-call, no use to call the anaesthesist, the baby will be out before the epidural is in. Right she was, that’s experience and expertise.
In Denmark birthing women are serviced by midwifes. Midwifery is a govenment sponsored education (like most education in Denmark), so they are highly trained health practicioners.
Typically there are a number of birthing rooms in the hospital, setrviced by midwifes, and at least one OB is on call.
If there are no complications then the midwife takes care of everything, thast is, during the actuakl birth a socialworker i present, I am not quite sure why, but I gues that person also signs of on something official.
In case of risky births such as twins or triplets, OB’s are present, and in high risk there will be one pediatrician pr expected child, an one doctor present for the mother, besides the midwife who helps the delivery.
We had to births in hospitals. In the first birth, started early because of gestational diabetes, the baby was monitored, and the midwife had the OB in twice to evaluate the curves. Afterwards there was a little trouble stopping the bleeding, so he was called in again, but by then the midwife had found and closed the tear (our son came out with his arm over his head, bruising his arm and tearing up his mom).
When our daughter was born, it was with a spanking new midwife, just out of school, doing one of her first unassisted births. When our daughter came out blue, she pushed the button and in seconds we had two experienced midwifes (one of whom delivers the royal breed), checking that nothing was amiss, apgar at 10 after 5 minutes.
Though Danish midwifes are a little to fond of woo woo such as acupuncture, and a little to happy for “natural” births with a minimum of sedatives an c-sections, I feel it is a good balance between treating pregnancy as a disease and just everything running according to plan.
I was born at home with a doctor and a midwife present. I guess home births took some wild tangent since the 80s with this anti-doctor thing (I guess because the research shows now how much better hospitals are). The apartment was also about 2 minutes away from the hospital, so maybe it was cheating anyways.
@Soren well that system makes sense to me. We do have advance practice midwives in the US (RNs with a graduate degree, like Nurse Practitioners) but in many states it probably takes more education to cut hair then to call yourself a midwife, the credentialing is rather hap-hazard.
John Stumbles:
Sorry to disappoint the wonderful home-birth myth (mind, I’m not 100% against them) and there is good evidence that women feel better in water births, but the second birth is quite often faster and smoother than the first one because the birth canal is already widened.
I tore and needed to be cut with my first one, but only tore a little with the second one despite both kids being the same size and the second one being even faster.
Do you mean that there should be no intervention unless necessary ot that there should be no “unnecessary” intervention because you didn’t want them? Because one of them is OK, the other one is bullshit
Forced C-section: http://advocatesforpregnantwomen.org/articles/forced_c-section.htm
There are anumber of such cases throughout the USA.
PZ: Well, that’s my sentiment exactly, but I also think there’s room for personal risk-evaluation. We do this with everything in our lives and those of our loved ones.
Yup, JAMA agrees: Episiotomy is a total wash:
http://jama.ama-assn.org/content/293/17/2141.short
They’ll cut your vagina and make bullshit excues to cut your kid’s dick.
What is up with these creeps?
Two babies at home. My wife was low-risk, both babies were healthy, we live literally 10 minutes walk from the nearest hospital. In both cases we had two trained certified midwives in attendance (well the second one we had a trainee, but she had attended 40 births already so I think she was pretty much certified; the ‘real’ midwife didn’t make it in time!)
All that said, if there was *any* risk to mother or either baby, we would have been into the hospital in a flash. Not doing so is just stupid – if it’s not needed, fine, but not accepting risk is not just sign of someone who’s stupid but someone who just doesn’t understand risk analysis
I think some commenters here need to consider what the people who are actually posting in the thread are saying, and not what their fantasy-pro-homebirthers are saying.
It’s sad that this has become so polarized; woo-ers are of course really bad, but so are the people who won’t recognise that it’s not a good situation when a lot of women giving birth think hospitals fucking suck.
Like many of the people above say, it is possible to approach this in a balanced manner – improve hospital environments, create birth centres and make them more available, and make sure midwives have a decent medical education and only provide home births in safe situations (low-risk, close to hospital etc).
And there’s no such thing as preventative medicine.
If I ever decide to get pregnant, I think I’ll just try to find a women-friendly hospital (as in, one where pregnant women are treated as more than breathing incubators) and get as drugged as possible while giving birth. I’m sure that in cases when everything seems to be doing well, home birth may sound like a better option – if everything really goes as expected. But if not, I don’t think that even having a hospital 10 minutes away would be much of a comfort when one could have been in the hospital to begin with. I’m not completely against home birth, but with all the precautions I would want to take, it would probably be much less trouble to just go to a medical facility (these birthing centers don’t sound so bad, having both the professionals available and a more comfortable atmosphere than hospitals).
If “homebirthers” want to have it natural, why not. Then they would just have to accept the normal, natural child mortality of roundabout 30% (as in medieval Europe).
I’d guess that would be the moment for Darwinian selection to kick in?
Raven, you do overreact a bit, don’t you? Calling me a serial killer is foolish, and makes you look like an extremist prat, to be honest.
I live in a civilised country where medical support is available free at the point of delivery. I agree that if such help is necessary during birth, it should be given without question. But that doesn’t mean that medical intervention should be anyone’s first choice, any more that we should automatically take antibiotics for minor infections unless we have compromised immune systems. Home births work for loads of women, and experienced and skilled NHS doctors and midwives support them for that reason. I have yet to see any evidence that properly supervied home births are any riskier than hospital births.
Of course that may be different in the USA, where health services are driven by the need to make profits.
There is a good argument to be made for home birth in cases where the risk of complications is low and the benefits of a less stressful, familiar environment outweigh those risks. This is only the case where trained, professional midwives are in attendance and are prepared to move to a hospital at the earliest indication of trouble. There’s a distinct difference between this sort of rational risk-benefit based decision making and the quasi-religious “natural” birth movement.
That said, my wife and I are in total agreement over our wishes for when our first child arrives in December. Our first preference is to have a home birth with a consultant ob/gyn and a consultant paediatrician along with their teams and equipment in the same building as us in case anything goes wrong. Since the NHS is unlikely to fund that, we’ll probably have to go with our second choice of going to the building they’re already in…
PZ,
I am disappointed in you. Where did your scientist’s brain go? Why are you willing to condemn the rest of the planet to no choice at all just because you ran into a crowd of extremists somewhere.
Let’s put it this way. In the fully developed countries – UK, NZ, Netherlands etc – the highly trained midwife will know more than the junior doctor attending a routine birth, will have experience and confidence way beyond the doctor’s. Thus the youngish doctor is much more likely to intervene, not because he needs to but because he is scared of being told off because he did not.
The fact that some people, even people as admirable as Mary, can get better because they are able to pay doesn’t make an indefensible death rate go away.
With a hospital you have more and nastier bugs about so that if bio-security breaks down when there is pressure or understaffing there are additional risks. That same understaffing, often the work of accountants, can leave the woman in labour alone – bad psychologically and much more of a risk that some warning sign may be missed. There are, too, all the problems of an institution getting set in its ways or wasting its enegry on internal politics – taking its eye off the ball. You need a reason to expose a woman to those additional risks. Sometimes there is a good medical reason and most of us would accept it.
Do you remember Ignaz Semmelweis? We only have the benefit of his work because he was bright enough to spot that the maternal mortality rate in the doctors’ ward was three times that in the midwives’ and, boy, did he suffer because doctors then as now find it difficult to be told anything. I mean, come on, how long did they insist on a routine episiotomy before we even start for everyone (and the cat) long after there was proof that a natural tear, even if it needed a stitch or two, would heal more quickly and with less pain? Decades, PZ, decades.
I am fully committed to modern medicine, the sort of modern medicine practiced very well in our fully developed countries by highly trained midwives – in hospital, in birthing centres and at home – with full back-up from from any other persons and bits of kit which may be required.
This is the first study which popped up when I searched Google Scholar. http://www.ecmaj.ca/content/166/3/315.short – there is plenty more.
PS: I can do anecdotes too but apparently some god-like figure has decreed that the experience of individual women in labour has no relevance in a discussion on the provision of service to them.So I’m off to have a delayed breakfast while I try to work out how we could do it by numbers – like a parade ground drill, a thousand of us at a time and with a statistician at hand.
Truly natural childbirth: you carry on working in the field until you start pressing. Then you squat down in the dirt and suffer alone till it’s over. Then you bury the kid if it’s dead or bind it to your back and carry on working. In 25% of cases you both die; so your work mates bury you when they finish working, or leave you for wild animals to dispose of naturally. In this case your other kids starve. But hey, it’s natural.
This raises a whole new point. For a truly safe and (almost) risk-free home birth, one would probably have to invest quite a lot of money. Sort of like a healthy vegan organic natural I-promise-not-one-single-bee-was-exploited diet, it’s for the wealthy. Those who can’t afford it can have a less safe home birth and hope they don’t unexpectedly start bleeding or that no other unexpected complication happens. Those who see so many faults on the hospitals’ side (which definitely exist) would do much better to put all those efforts they exert to promote home birth into fighting for better hospital conditions for pregnant women.
Oh dear, I never knew I was genitally mutilated.
Get your nonsense out of here.
Let me see, I started tearing. With every contraction I tore a bit more while birth was slowed down because of the obvious lack of room. So my midwife “mutilated” me by cutting so the baby would have enough space to get out instead of having to literally tear her way out of my womb.
Yes, seems to me like my totally natural childbirth (oh wait, I don’t qualify, I was lying on my back. If I’d only hung from a tree while my vagina was in a pool this wouldn’t have happened) put a lot of resistance to episiotomy….
Left Handed Atheist:
So why aren’t you there?
I think the problem here starts with hospitals and doctors often being fucked up the way they are. Treating women as incubators, not respecting their wishes and opinions, scaring them.
That’s the problem with the “least risk possible” scenario: It’s used to shame and intimidate women.
I had this experience once with my second child. She lacks a kidney and therefore I was in the care of the university hospital. The OB/gyn would make rgular ultrasounds, see if there was enough water (an indicator for working kidneys) and consult an urologist.
One of them was an asshole who tried to bully me into giving birth at the university hospital.
Here’s a hint: even though there was still the risk that the one kidney might not work propperly, that’s not something that’s going to case complications during birth and can only be detected some time after delivery because up to then the mother’s kidneys do the job.
University hospital would have meant giving birth in the presence of total strangers instead of my midwife and my OB/gyn (who never made it in time, actually).
It would also have meant induced labour to make sure I don’t give birth on the Autobahn because I tend to pop them out quickly.
Benefit even in the worst case scenario of not-working kidney: zero.
Well, I am an educated woman with self-esteem. My family, my OB/gyn, my midwife, the OB/gyn at the university hospital, they all agreed with me and supported me in my decission.
But not all women are that lucky, so a lot of them are frightened and scared and have a horrible experience* and are looking for alternatives and then the quacks come in.
*Personally, although it was a very intense experience and one I’m glad I made, I never made it to the “magical moment”. “Wonderful” is not an adjective that comes to mind. No idea what women are talking about when they talk about their wonderful childbirth. Holding them for the first time, that was wonderful. Poping them out was painful.
Sorry, correction, of course it’s not 25% – it’s 1 in 25 for third world conditions, so 4% death of mother and child in unattended births. There are plenty of statistical data (this from WHO), it is horrifying actually.
I don’t know the final figures for civilised countries. The best I can find is about 0.9% for mother and 4.5% for baby.
In the novel Titus Groan by by Mervyn Peake, the Countess has a baby, Titus. When Titus is presented to her, she says, “Take it away and bring it back when it is six.”
Infant mortality rates by country – remember, that’s up to one year – based on UN and CIA figures.
http://en.wikipedia.org/wiki/List_of_countries_by_infant_mortality_rate
Have a look at 33 and 34 in the first table. If anyone needs proof that you get better care for less money under “socialism” then there it is!
This is such a narrow view into the practice of birthing at home. Yes, there are stupid parents and stupid midwives that make poor choices that result in the death of the baby (and/or mother).
Birthing at home is much more common in countries outside of the U.S., and really, if you have a good midwife and you yourself are willing to accept that the home birth may not be possible (i.e. transfer to hospital may be necessary), there’s no harm in going this route.
I obviously speak from experience, so perhaps my view is a bit narrow as well. Regardless, it goes without saying that a few crazies needn’t ruin it for everyone.
I think a lot of people here are missing a very important point, and I guess I will be the feminist that brings it up. As I see it the ‘natural birthers’ are reactionary to a culture in modern medicine where women are seen as the weak spot in the process of propogating the species. Women have been evolving for millions of years to be mothers to give birth, and if it were on the whole too dangerous then we would have been extinct long ago. ‘Natural birth’ does have advantages for both mother and infant (physically and mentally for both), but so does the miracle of modern medicine if both can be kept alive despite what could have otherwise occurred naturally. So with medicine we can net a better outcome than what is natural. The problem, and hence the reactionary extreme of some home birth fanatics, is that treating birth as a disease has led to the idea that women cannot handle birth without epidurals and scheduled c-sections and this effectively dis-empowers women greatly. The fact that the rate of c-sections increase because the doctor wants to go home is frankly alarming.
“Hospitals are for sick people.
So why aren’t you there?”
Giliell:
Seriously? I’m ‘sick’ because my husband and I wanted to have a peaceful birth outside of a hospital and without risking some gawd-awful infection? Fuck you.
Yet you fail to cite or link to any of those studies.
And
Link or citation.
I will say it again (in my post around #48ish): Things can go so very, very wrong, so very very quickly. An at-home birth, without the medical equipment of a modern hospital or birthing center, is not a safe.
My birthing story is rather gory, so I’ll refrain from sharing it. :) However, I begged for a c-section, but my insurance said I couldn’t have one unless I was dying (ob/gyn later told me that the day I walked into his office, he was certain I was going to need one and had it not been for the insurance, I would have gotten one; it also turns out, that had I had the c-section, I would still have the ability to have children because what did happen would not have.)
Fuck off.
A little anecdata re the Netherlands: a friend of mine’s daughter lives in the Netherlands. Her child’s delivery was attended by a midwife, I’m not sure if at home or in hospital. The midwife kept her pushing too long rather than calling in an OB for a surgical extraction and the child has a learning disability because of hypoxia at birth. She (the child) receives excellent services for the disability and is doing very well, but doesn’t make up for the damage at birth.
For those who prefer a more statistically valid approach, this paper on high versus low risk cases in the Netherlands may be of interest.
I wanted to have a peaceful birth outside of a hospital and without risking some gawd-awful infection?
If you wanted to avoid infection, an out of hospital birth may not have been your best option. If the numbers here are correct, the risk of infection for a low risk woman delivering out of hospital is more than twice that of any woman delivering in hospital (which is going to include a number of women with extremely compromised immune systems, preexisting infections, every surgical screw up possible, etc.)
Not if you’re in the civilised world. Although I put things in a facetious way to explain that for us the immediate presence of help in case something happens is important, having a safe(r) home birth is just as free as any other method for people who choose one. The staff (well trained and experienced midwives) and equipment will come to you and the nearest hospital will be aware that you might have to come in should complications arise, all free. The only thing I’m aware of people having to pay for is if they opt for a water birth at home, in which case they pay for the purchase or hire of the pool.
Since I obviously don’t live in the civilized world, could someone besides Marcus Hill who does, tell me if having a bunch of medical staff at your beck and call for home birth is actually covered by some kind of basic health insurance in your civilized countries?
I suppose I might have been killed in a traffic accident on the way to the hospital instead of delivering at home. Stuff happens, and there is no cocoon that is going to keep you perfectly safe no matter where you decide to give birth. Sheesh, this is not a black and white issue. For a healthy woman with no undue risk factors, home birth can be a perfectly reasonable decision. If complications arise, get to a hospital, certainly – wow, that’s hard! If you don’t want to have a home birth, then don’t have one, but don’t vilify those of us who decided otherwise.
The anecdotal “evidence” and unsupported opinion in some of these comments leaves me disheartened.
Sure, having a child is perceived as a touchy-feely personal gift. So you want to have warm-fuzzies about it. You also should want a healthy child (and mother). And you should want to know ALL of the facts, not just the simple “gee! wimmen have been giving birth for eons! hospitals are for sick people!!” bullshit.
I only know a tiny aspect of this on a first-hand basis, and it’s enough to convince that the hospital is right place to deliver. My spouse is an orthopaedic surgeon who has a subspecialty of brachial plexus injuries resulting from difficult births. These injuries happen when the kid is part of the way out, something happens (gets stuck, stops breathing – whatever), and whoever is delivering has to get the kid out ASAP (for safety of mother and kid). They grab the arm, and pull. All of the nerves from that arm are ripped out of the brachial plexus, leaving the arm permanently damaged – anywhere from totally useless, to mildy compromised.
Surgical repair (my spouse’s job) has varying success rates, based on how badly ripped out the nerves actually are.
It obviously tends to happen more with large babies (anything over 9 pounds).
The *data* reveal that, while this avulsion can happen to anyone in a traumatic birth situation, it happens substantially more with non-medical professionals handling the delivery. End of story.
And to promote home-births that are away from medical facilities – and especially in lower-income populations where diabetes is rampant (blacks in the states, First Nations in Canada, etc) and, due to obesity issues, children can be really huge – is bordering on the criminal.
We don’t live in caves anymore. We shouldn’t be giving birth there. If you don’t know all the risks, you cannot properly analyze the situation.
…having a bunch of medical staff at your beck and call for home birth is actually covered by some kind of basic health insurance in your civilized countries?
A bunch of medical staff, no. A midwife and an assistant or maybe a student, yes. It’s actually cheaper for insurance companies than a properly monitored birth with nurses, respiratory techs, lab techs, etc. Unless something goes wrong, of course, and there is a need for a sudden, messy transport (a bit more than 1/3 of the time). A full term child in the NICU with hypoxic brain damage is an expensive proposition. But, hey, you can always sue the hospital, right? Home birth midwives rarely carry malpractice insurance so suing them is good for nothing except aggravation.
Don’t vilify those that don’t; not saying you in particular have, but a lot of the militant homebirthers/”natural” birthers do, vehemently and with no compromise. The healthiest, low-risk pregnancy can have complications that don’t arise until post-delivery (immediately after or otherwise) and at that point time can be of the essence. You can’t plan for every variable but the chances are greater that those will be considered in a medical facility and immediate help is there. For all the talk of having medical assistance on standby or being able to call an ambulance if something goes wrong, it still means you are not in a position where that medical assistance is available right there.
I’m not dismissing midwives or “natural” birth methods (I’ve used both), but when the safety of mother and child is at more risk by choosing to give birth at home, that where the issue is. Why would you want to put mother and child at higher potential risk?
I know the arguments that come with that statement, that hospital birth isn’t safe either. Childbirth isn’t safe just in and of itself. But it makes more sense to do it in the safest possible location. Why not take advantage of the resources available?
For a healthy woman with no undue risk factors, home birth can be a perfectly reasonable decision.
Caution, anecdata, but…During pregnancy, I was “perfectly healthy”. My diet was good, if a bit limited by pregnancy induced nausea (arguably, it was better than usual because the PIN left me eating mostly fruits, vegetables, and grains and avoiding fats). I swam every day up to the day before labor started. Which it did at just over 40 weeks. The baby was estimated at 7-8 pounds-large enough, but not overly large and was head down. I didn’t have a hint of gestational diabetes, hypertension, or edema. Everything should go smoothly, right?
No. Skipping a bunch of pain, screaming, and meconium, it turned out that the baby’s head was stuck in just the wrong position so that it could not pass through the birth canal. Just a tiny, flukey error in positioning and the birth changed from routine to deadly. Without a c-section at least one, probably both of us would have died. If I’d tried a home birth…I probably would have known to go to the hospital and made it in time. But maybe not. A woman in labor is easily influenced and a midwife telling me to be a “birth warrior” and work through the pain might have convinced me to stay at home until it was too late. (And given that my temp suddenly spiked to 104, possibly 105-there’s some controversy as my partner and I remember different numbers-too late might have been coming very quickly indeed.)
If complications arise, get to a hospital, certainly –
Right. When you drive, do you wear a seat belt or do you assume that there will be time to put on a seat belt if a crash looks likely? There are a number of complications of birth that need to be treated RIGHT NOW, not in 30 minutes or an hour. Uterine rupture, sudden hemorrhage, air, amniotic fluid, or thrombus embolization, shoulder dystocia that can’t be resolved with external maneuvers, cord prolapse, etc. are likely to cause death before you can get to the hospital.
Many times home birthers say that there’s no problem, the hospital is “five minutes away”. That’s 5 minutes drive time, under the best of circumstances. By the time you get the laboring woman dressed and out to the car-it’s hard to walk when you’re in extreme pain, negotiate the rush hour traffic or train at the usually unused rail road crossing you didn’t expect, arrive at the hospital with no notice and no one prepared to deal with you, etc, a lot more time will have passed than you ever thought possible. And that time may be the difference between life and death.
It appears to me (and I am willing to be corrected) that there are many Americans (three years late, as we know) who agree with PZ, and a number of Europeans who don’t. Perhaps there is a difference in our experiences that explains that.
In Britain, in my experience, women are seen by their GPs and by obstetric services as a matter of course. Many potential problems will be picked up early on, and many women choose to give birth in hospital because they are aware of these problems. So the group that chose to give birth at home are screened anyway – there may be a few people who chose a home birth in spite of advice, but they are a small minority.
There’s some research reported here: http://en.wikipedia.org/wiki/Home_birth#Research_on_safety. There are, as we might expect, some conflicting findings, and my reading of the results recorded is that there isn’t a conclusive argument either for or against home birth.
Beatrice,
Anecdote time! I had a home birth under the NHS and it didn’t cost me a penny. Nor would it now.
My daughter was born in a council flat, still with its 1930s fittings – including bath in the kitchen – and without a phone The midwife was a member of the team which had overseen my considerable amounts of ante natal care, who was called when we got to the agreed point as regards contractions – can’t remember exactly, long time ago – and arrived about 20 minutes later.
The hospital was by then on standby, knowing that I was in labour and having a copy of all my notes to hand. After a while one of the local GPs – not my own but this one by prior agreement – popped in for a double check on pulse, temperature, whatever and then popped out again. After a fairly standard birth during which I felt free to swear as much as I wished, the doctor popped back again for five minutes, pronounced us both alive and went away never to be seen again.
Later the midwife did a handover to the health visitor and I can’t remember which one of them did the check a few days later on my episiotomy but basically that was it. If something had gone wrong then there would have been an obstetrician at my place or me in the hospital within minutes.
End result of all that non-fuss is still looking good after 41 years! http://www.battleofideas.org.uk/index.php/2011/speaker_detail/279/
Dianne,
I am reluctant to argue with you but do your people not do a constantly updated risk assessment throughout the pregnancy?
In 1970 I, at 27, was regarded as an “elderly primagravida” – how times change – and was told that basically I would have to prove to them that I was fit enough to have the baby at home. So although that was the plan all along and the preparations were made with that in mind I was only finally signed off for the home birth about 2 weeks before my due date.
It was a healthy relationship between patient and physician – “I’ll take your advice if anything goes even slightly wrong but while things are going well I’m in the driving seat.”
I am reluctant to argue with you
I don’t know why. What else are blogs for? If you feel you’re mistreating me in some way by arguing, please don’t! If you simply don’t like the argument or are feeling uncomfortable, I am willing to drop it at any time.
but do your people not do a constantly updated risk assessment throughout the pregnancy?
Yes. The day before I went into labor the assessment was, “You look great, no problems identified on any parameters. If no labor for another week [at that point 40 weeks 3-4 days] then we ought to get a non-stress test.” Then I left the office, went swimming for 45 minutes, and came out feeling fine. All was well except for the position of the head, which wasn’t obvious until labor.
Even then, until the fever hit (which it did very late in the game-actually after the decision to go to c-section had been made), there were no signs of a problem what would have been obvious at home. There were concerning decelerations on fetal monitor, but home birth midwives don’t routinely use EFM. I was in a lot more pain than was normal for that stage of labor, but that would be easy enough to blow off as just a primagravida being dramatic about labor*. There was some meconium but it could have been written off as insignificant…In short, without fetal monitoring and fairly frequent “intrusive” vital signs, it would have been easy to miss that there was a problem.
*I think that’s what everyone except my mother believed was going on, initially. I’m not the world’s most macho person with respect to pain but I’ve had a couple of experiences to compare and can say that for me labor-early labor-was worse than second degree burns and having my fingernail ripped off. I’m pretty sure that’s not normal. But how does the provider know what my “9/10 pain” means if she has no idea about my baseline response to pain?
Just FWIW, I kind of gave up on Dr. Amy after about the fifth time I encountered something she’d written where the “shorter” (as they say over at Sadly, No!) was essentially “Now are you anti-abortion?!”
The answer is no. No, Dr. Amy, I’m not anti-abortion. Not in the case of sex-selection, not in any case. And if you actually cared about women as much as you claim to, you wouldn’t be, either. (Also, you wouldn’t talk shit about “feminists,” either, considering who made it possible for you to actually have a career…)
I personally have no dog in the birth fight, since I’m a committed nullipara and really don’t give a damn what you breedin’ folks do with your sprogs, as long as you don’t inflict them on me.
Now you are comparing giving birth to a car crash. I’m seriously sorry for you that you had such a bad experience. Meh, I’m gonna make myself a cuppa. I think I can “risk” it.
I think some people are confused about midwives, and that’s because the practice of midwifery differs from country to country.
Here in Ontario, Canada, we have a situation like in most of Europe: midwives here are licensed, trained medical professionals who give primary prenatal care and can deliver babies in hospitals. They are not an “alternative” to western medicine–they are part of the system.
I’m not being cared for by a midwife for my pregnancy, but if I had been, my birth experience would be similar to the one I have now: I’d be sent for all the usual ultrasounds and prenatal tests, then I’d show up at the hospital when in labour and give birth. There are a few midwives, a nurse, and an OB on call in the labour and delivery wing at our hospital at all times.
I realize that in some other parts of the world, midwives aren’t or can’t be licensed, can’t legally deliver without a doctor present, and are billed more as a sort of “alternative medicine” deal.
When you read other people’s posts, make sure you know what kind of “midwife” they’re talking about.
Now you are comparing giving birth to a car crash.
Actually, I’m comparing giving birth to driving and complications to a car crash. Driving is a “normal” activity, for 21st century people at least, and most of the time everything’s fine, no problems. But that doesn’t mean that you shouldn’t take sensible precautions.
I’m seriously sorry for you that you had such a bad experience.
Thank you for your sympathy, but I really don’t feel I had a bad experience. A hundred or two hundred years ago, it would have been a terrible experience. The best I could have hoped for would have been having someone pull a dead baby out of me after days of painful labor. But in the early 21st century, I had an epidural which relieved the pain completely, but left me able to move and feel light touch and pressure (i.e. I knew when a contraction occurred, but it didn’t hurt). My c-section was hurried, but painless and I got to see my not dead, not brain damaged, healthy baby within 10 minutes of the birth. Ok, so the transition from light epidural for vaginal birth to heavy for c-section didn’t go perfectly…they were in a hurry to get the baby out so didn’t wait for it to take well enough for proprioception to be completely gone, but if I hadn’t been scared of what was going on with the baby, I would have thought feeling someone moving my muscles and uterus around was kind of cool. We all went home 3 days later. I had no significant post-op pain and never even filled the T3 script. I’d rather have had a normal birth in the attached birthing suite after an uncomplicated 15 hour labor with 1.5 hours of pushing, but as outcomes go, I’m pretty pleased overall.
I read something by her fairly recently on a completely different subject (which I shall not name), and was distinctly unimpressed, with both the original piece and her responses to the comments.
I think one thing that has not yet been discussed is the possibility of regional differences in access to adequate hospital care. Many of the individuals here that oppose home birth keep referring to birth centers and women-friendly hospitals. Rather mystical things where I live. I would have had to drive HOURS to find either. However, there are many local certified midwives. The one we chose had attended over 500 births, and had never had a fatality. We all (both parents and midwife) firmly believe that the health and safety of mom and baby come first – we had a back-up OB-GYN with whom we met at least once a month during the entire pregnancy, and would have transferred complete care if at any point there was any hint of a future problem.
Also, an note on the statistics. There is a very logical reason why the statistics used by people who support well thought out, informed home births vary so drastically from those used by people who oppose home birth. The former often only includes individuals who planned their home birth and were attended by a trained medical professional midwife. The latter often include all babies born at home, including but not limited to quacks who chose to do it alone, people who are using midwives without certification, women who were hiding unwanted pregnancies, people who unexpectedly go into birth and can’t get to the hospital on time, etc. This is one topic in which the data are often manipulated.
Risk assessment for something like birth should be done on an individual basis. It doesn’t really matter what type of facilities are available to MOST women – what should matter is what is the best possible medical care available to the woman making the decision. I believe it would have been irresponsible to have had my children in my local hospital.
Thanks for your answers, Dianne and maureen.brian.
@59 … it’s more complex than that:
http://www.salon.com/life/broadsheet/feature/2009/07/23/c_section_neglect/index.html
PZ:
I’m sorry, but no. Just no.
Bedside manner is not an afterthought to medicine. It is integral to the art of medicine.
People see doctors at some of their most vulnerable moments, Western society is right now very atomized and stressed, and in the U.S. we pay for the privilege of having some privileged douche in a white coat smack us down. Stress and perceived lack of control elevate cortisol and adrenaline. To claim that a doctor’s attitude toward patients shouldn’t affect the patients at all is dualism — and, so damn often, it’s expressed in misogynist terms, with the typical condescension toward “weakness” and “emotionality.”
I’m childfree. But I’ve dealt with my share of asshole doctors (this shrink’s M.D. patients can cry me a fucking river). Let’s just say that I travel out of my way to patronize a certain medical practice which I’ve been going to for decades, because I trust them to listen to me and not mistreat me.
So my rage button gets pushed when I read about some of the shit that goes on in L&D wards. And I have to be in a certain mood to read Amy Tuteur, because she reminds me of certain physicians I never want to encounter again. (Although, going by what Interrobang is reporting at #142, I don’t think I need to ever go back to Skeptical OB again, either.)
Are awful doctors a reason to give oneself over to woo, or to insist that “being a mommy” makes you more credentialed than an M.D.? Of course not. Also, I loathe with the fire of a thousand suns the attitude that if a birth wasn’t a perfect homage to “the mystical order of sacred motherhood,” as Crowepps puts it, the woman is a bad mother. (Or if she didn’t breastfeed or doesn’t co-sleep or what have you.)
All that said, the medical profession could make major inroads against woo if it placed more of an emphasis on treating patients as people, not simply as obstacles to diseases that need to be cured. It’d be cheaper and more effective in the long run than trying to win people back by folding “complementary medicine” into their practices…but I guess it’s easier to spend money than to change one’s attitude.
By the way, Greg House breaks all sorts of rules of ethics, too. Another trait I don’t want in a doctor.
I’ve had two children – one born in hospital, one born at home. The hospital birth wasn’t horrible by hospital standards. The home birth was a lot better in many respects, from my point of view.
For the hospital birth I was bullied into an induction at 7 days overdue (although our dates weren’t certain, so I might not have been overdue, and the standard was changed to 14 days overdue a month after she was born anyway), and was roundly blasted by an OB when I asked how this was calculated and what the parameters were and why. I wasn’t questioning the judgment so much as just wanting to be informed and fully understand what they were planning to do to *my* body and why. I had an unmedicated birth because I wanted one, and there are some benefits to not having an epidural – I wanted to be in as much control of my body as possible, to be able to move around and it wasn’t really painful enough for me to feel I genuinely needed it (I have a pretty high pain threshold anyway).
Our decision to have a home birth took into account that midwives don’t have hospital priveleges here and there is no such animal as a “birthing centre”. That would have been my first choice. Since that was unavailable, we looked into the risks, benefits and my particular situation. We are only a few minutes from the hospital, the midwife was extremely experienced and made it clear that at the first sign of any difficulty we were hospital bound, I was in spectacular shape and was about as low risk as you can get. We continued follow up with my family doctor and discussed everything with him openly, listened carefully to his concerns and made sure he was in the loop. We were comfortable with the level of risk we were taking on.
I always wonder about the admonition that “things can go so quickly so fast, best be at the hospital”. For my hospital birth, I’m not sure how exactly they would have known something was up since I was mainly left to my own and my husband’s devices. Other than a few minutes (most agonizing part of the labour due to lack of movement) on the machine that goes ping, the nurse would pop in to see if I’d changed my mind about the epidural yet, ask me how I was doing and then leave. I expect I got very little attention because I’m pretty low maintenance My midwife and the nurse attending us at home were certainly a whole lot more attentive than the hospital staff and were a lot less distracted. So I have to wonder if you really are better off in hospital if you’re a low risk-er who doesn’t care to take advantage of anaesthesia.
That said, there are wackos out there who do stupid things, refuse to acknowledge what risk factors there are, go with untrained or inexperienced practitioners and just generally embrace the fluff-bunny ideal of natural without understanding it fully. I’d appreciate – as would many others – if you wouldn’t lump us in with the wingnuts. It’s not the same thing at all.
Anat,
Unwarranted medical intervention is not a good thing and should certainly be fought, the practices of any medical facility should be based on what works best for the patient. I get that there are OBs who choose what is best for themselves and I agree that is a problem, but I don’t see how the answer is avoiding hospitals.
Our experience involved a birthing suite with a variety of comfort assisting devices, but by the time we were at the hospital walking was played out. That was the advantage of having a midwife which I hope you also noted from my comments. Had our birth not turned into the complications that it did, there would have been no epi, no NO2, no c-section, and would have occurred between us and our midwife. Being at the hospital didn’t necessitate any extra involvement, it just allowed for it when it became necessary. Giving birth is stressful and dangerous, if hospitals are contributing to that stress without reducing the danger, yeah, I can see avoiding them, but the facts support a hospital birth as being safer.
Modern medical knowledge is great, less women die in childbirth because of it. That’s not something I would see thrown aside. So when people start campaigning for homebirth as the best option, or the natural option as seems to be the favoured lingo, I cringe. If someone has been exposed to the statistics and subsequently decides that the extra security isn’t worth the extra stress they have the knowledge and have made a decision within it. That’s not what I was talking about, I’ll say again: Yay midwives who are interested in providing the best care possible. Boo and hiss at those who think that childbirth is a cookie cutter enterprise.
This. A thousand times this.
I found the medical care I received during pregnancy and childbirth to be astonishingly traumatic, such that 16 years later, I can barely discuss it without crying. I left every single OB visit in tears because they’d spent the entire visit harping on yet another hideous risk. NONE of which materialized, and the one time I asked the MD for research about the risk du jour, he informed me that he had no peer-reviewed research, just “anecdotal evidence” for why he should scare me to death/put me on a draconian diet/send me to a new specialist etc. Despite research showing that women with PTSD find much standard obstetric care (including routine non-invasive prenatal care) retraumatizing, my OB never asked about PTSD, social support, why my partner never came with me to appointments, or almost anything else that wasn’t related to my uterus. I have never felt so irrelevant to my own medical care.
I dislike the quiverfull unattended childbirth people, the woo-peddlers, and the “if you had [insert intervention here], you’re not a real mother” social judgments. Just don’t think that because I disapprove of these, I approve of physicians who treat me as an irrelevant reproductive container. It’s my body, and my fetus, and until we’re two separate people, I have the right to make the decisions for how the separation is going to be accomplished. Even if that means one or both of us might die in the process.
Heh, I looked at the hospital staff as pretty much equivalent to the staff at, say, a grocery store. Nurse to check my and Dropkid’s vitals, anesthesiologist to give me the epi when bowling ball head turned sunny side up, and the doc to play catcher. If something more was needed of them, they had the skillset and training to handle it, if not, why bother me? I don’t like strangers touching me at the best of times, having touchy feely people rubbing on me would have enraged me during labor (and did, one nurse was touchy feely and thought i’d like it if she rubbed my back without asking. Once I spit her head out and gave it back, she got the idea).
I had a perfectly pleasant hospital experience, no complaints. I even told the doc “If students want to come observe, no problem. They’ve gotta learn somehow.” No shame in my game.
A home birth is the last thing I’d ever want. There are enough messes to come with a baby, I’d greatly prefer to have people who are required to clean it up deal with it on their turf. I DON’T want to start walking around my house and maybe find a bit of stray placenta somewhere. And the laundry? FUCK THAT, I hate doing laundry when it’s Dropkid’s soccer gear, I do not want to think about birthing laundry. Ew.
@153 – Mattir-ritated
You were traumatized because your doc spent most of his/her time “harping on yet another hideous risk”?!!
Um…
Perhaps his/her bedside manner could have been better, and I don’t know where you live to comment on your social supports, but your OB is there to make you aware of the “hideous risks” so that if the shit hits the fan, you have a gameplan in place.
How can you be responsible for yourself (and child) if you don’t analyse the risks? How can you “make the decisions for how the separation is going to be accomplished….even if [either of you] might die in the process” if you are too busy being traumatized?
Are you *really* going to make those life and death decisions without listening to the risk analysis?!!
Egad.
scriabin, you will notice from mattir’s post that “the one time I asked the MD for research about the risk du jour, he informed me that he had no peer-reviewed research”
Sounds like the risk analysis left something to be desired …
opposable pouces – I agree. Sounds, frankly, like the MD blew her off. There’s lots of peer-reviewed research out there (and, one must acknowledge, lots more yet to be studied).
But the fundamental point is the same: better to know the hideous risks – as we understand them – than not. And the medical world should be the access point for that information.
Also, think on the other side of the fence, too: the first people to cry, complain, and SUE (esp. doctors) when things go wrong are the ones who say “but I didn’t know the risks…”
Left Handed Atheist:
No, you’re sick because you judge everybody who doesn’t share your whoopie-poopie-home-birth-ideology.
Because with obviously having neither experience with nor data about hospital birth and care, you decleare them useless in childbirth.
It’s called “yourself” and I will follow your advice.
No, it’s not free, it’s paid for by the community. Which is where another can of worms is opened, but that’s not the topic here.
Midwives in Germany have to carry insurance. It’s actually a problem because the premium is so high it doesn’t pay off for midwives anymore. Even though there are really few cases, the amount of money needed in such cases is enormous.
Michelle ZB:
As I mentioned before, that doesn’t necessarily mean anything. My cousin’s partner is a trained, licensed midwife and she’s so full of woo I’m surprised she doesn’t pee homeopathic “remedies” and shits shakra.
24fps
Well, since that was what happened at my births, yes, in a propper setting and system, you get “24/7” care. With number 1, the doctor showed up once in a while, with #2 he was too late, but my midwife was there all the time.
Mattir: {{{hugs}}} if you want them.
Dropkickpa: You aren’t everybody. Everybody isn’t you.
Scriabin: As Opposablethumbs makes clear, you obviously didn’t read all of Mattir’s post and are harping on one phrase in it.
you will notice from mattir’s post that “the one time I asked the MD for research about the risk du jour, he informed me that he had no peer-reviewed research”…Sounds like the risk analysis left something to be desired …
It does. This is partly because it’s virtually impossible to do research on pregnant women. If you’ve ever read the PDR (and doesn’t everyone read the PDR for fun?) you may have noticed that there are next to no drugs which are “class A” (proven by rigorous trial to be safe in pregnancy.) This is because no drug company wants to risk doing a trial and having their drug be proven to be dangerous and have every woman in the trial who had a bad outcome, related or not, sue them. So there’s not a lot of good research to be had. I know there’s a horrific history of abuse of patients in clinical trials, but right now we’re being protected out of any chance of getting real data that might allow us to sort out what anecdotes are meaningful. Until this changes, anecdote may be all that’s available.
scriabin, stop ‘splaining at Mattir. Mattir is not some random idiot who doesn’t know what risk-assessment is. Please read the entire post. This was not reasonable risk-assessment because it was not based on data, and it was not based on the patient’s needs, because the MD made no effort to understand what those needs were.
Ms. Daisy Cutter: I am well aware that I am not everybody, which is why I used the word “I” when speaking of my experience. I did not generalize in any way, so why the snark?
scriabin I completely agree with what you said – “better to know the hideous risks – as we understand them – than not. And the medical world should be the access point for that information.” – it’s just that the problem was precisely that the medical practitioner in this case was failing to do this. Getting skewed and misleading information about risks encourages us to vastly over- (or under-)estimate them, leaving us no better off (and probably more stressed, which is only worth it if you actually gained some real info).
I am very appreciative indeed of modern medicine (especially compared with the alternatives of a hundred years ago), just not so appreciative of the circs that sometimes force physicians to work on a production-line.
Midwives in Germany have to carry insurance. It’s actually a problem because the premium is so high it doesn’t pay off for midwives anymore.
Exactly the problem OBs have in the US. I’m not sure how midwives (by which I mean the less extensively trained CPMs or DEMs rather than CNMs who do carry insurance and have outcomes similar to OB’s) do it, but often they seem to be working in marginally legal situations anyway.
dropkickpa:
That’s the problem: information: yes, scaring people out of their wits: no.
I wrote about the doctor who wanted to get me as “customer” for their hospital and who tried to scare me with no actual risk. He still handed me the “bad irresponsible mother” card.
Properly licensed and trained midwives ARE medical professionals, PZ.
In my state, there are two kinds of midwives: CNMs and Licensed Midwives. A Licensed Midwife has to go through training that includes observing more births than an OB has to observe in medical school.
I gave birth at home with two medical professionals attending and observing me every minute of the time: the same two medical professionals the entire birth, the same two medical professionals who had attended me my entire pregnancy and knew my history. That’s a better standard of care than the hospital offered me.
I was put at risk by hospital nursing staff who didn’t give enough of a damn to listen to me when I reported symptoms of what turned out to be my epidural aspirating into a vein. I was lied to by hospital staff about drug and intervention risks. I was given a drug specifically not recommended and known to be dangerous to pregnant women.
Which was why I decided the second time around that homebirth would be safer. As it was. When a minor complication arose after birth, my midwives competently handled it before it could become a major situation.
That’s the problem: information: yes, scaring people out of their wits: no.
There are situations where you can’t do one without the other. OBs have been successfully sued for things like telling a woman that treatment X was recommended for situation Y (which she had) because babies in situation Y were at increased risk of death without treatment X but failed to tell her that HER baby might die without treatment X.
Lawsuits aside, doctors want their patients to take risks seriously. Especially when there is a high risk of death or serious disability if the risk is not taken seriously. To give a vague example, a patient who is recovering from a life threatening illness. Patient has some very early signs of possible recurrence, which probably represent something else altogether. The recommended course is to recheck the relevant labs and either restart treatment in the worst case scenario or tell pt not to worry, all is well in the best case. So, probably everything is good, but if it’s not then a disaster is coming. Is telling the pt, “We need to recheck this and we need to be able to get in touch with you tonight so that if it is bad you can get started on treatment as soon as possible. If you have X and we don’t treat you could die” scaring him/her or providing necessary information? I would think it is doing both.
scriabin:
My OB was not going on about risks of complications. He was going on about how I needed to see a fetal nephrologist immediately because ONE measurement of Baby B’s amniotic fluid was in the low normal range. And how I needed to be on a diabetic diet NOW (before doing a longer test) because my one-hour glucose test came back marginal. And when I asked what percentage of women with those test results developed gestational diabetes, he DID NOT KNOW (I looked it up on my own and it was very very few). He did not give me a referral to a professional nutrition person, he gave me a badly xeroxed sheet recommending that I eat (no kidding) hot dogs and canned tuna and cut out fruit.
Amazingly enough, I’m fine with being given enough information to assess risks. It’s just that MD was not giving me information, and he was busily hunting for unicorns and zebras instead of (gasp) paying attention to the signs of horses in the neighborhood. I had plenty of risk factors with my pregnancy. It’s just that they weren’t what he thought they were, because they weren’t easily addressed by mimeographed diet sheets, referrals to other MDs, or additional tests. I wish I could have developed care plans for the risk factors I DID have, instead of listening to him free-associating about risk factors he’d heard about. (Seriously, when he tried the “anecdotal evidence” thing, I referred to this as “medicine by gossip.”)
The number of times I’ve caught MDs making pronouncements about test results without noticing what the normal range is, or using the normal range for the test result above or below it on the list of lab results, or using their “clinical experience” when it is contradicted by actual studies… This happens with good physicians too, but those are the ones who listen attentively when you point out their error and thank you politely.
Dianne, you are completely correct about the appalling lack of research on pregnancy and medications. Same thing with lactation – when I needed to go on a medication while I was nursing, the general consensus was that I should simply stop nursing. I was lucky enough to have a physician who did a bit more digging for research reports, and we concluded that the benefits of nursing outweighed the risks of medication. I familiarized myself with the potential side effects on the Spawn and paid attention.
This would probably be a happy medium for a lot of birthing women, but it simply isn’t the case in many places. For me, giving birth in a hospital would have meant accepting that whoever happened to be on duty at the time would come along and stick their hand in my vagina once an hour.
I had trouble accepting that this kind of intrusiveness and lack of privacy would have done anything at all good for my labor process, and while having someone stick their hand in my vagina periodically was in fact necessary to a well-monitored birth, I opted to have it done by caregivers I had known throughout my pregnancy and trusted.
Dianne:
Your example is providing necessary information. It scares the patient. When I got the diagnosis for my second child I was scared, I was sad, I was devastated. Sometimes it can’t be helped.
But handing women the “irresponsible mother card” for even asking for more information, telling all-horror stories without an actual refference to the situation, that’s scaring people.
Another example is prenatal diagnosis, an area where a lot of harm is done.
A Licensed Midwife has to go through training that includes observing more births than an OB has to observe in medical school.
Medical school is not the end of training for physicians. OBs go through a 4 or 5 year residency (sorry: don’t remember which) after medical school, during which they observe and participate in dozens to hundreds of births each week. This gives them a wide experience not only with normal but also with problems so that when they encounter problems in the future, they will recognize them and know what to do-or who to consult. According to NARM, to become a CPM, one must participate “actively” in 20 births and attend an additional 20 as primary under supervision. That’s not going to teach you what to do when a 1 in 500 complication comes up. (Actually, I easily participated in 20 births during medical school, despite having zero interest in OB. An interested student could easily log twice that number third year and another 50 or so fourth. So I’m not sure your original statement holds either.)
Also, scriabin, I was traumatized because the physician treated me like a piece of meat and did not assess what my actual risk factors were. PTSD is as risk factor, same as diabetes or autoimmune disease. I deserved to have it taken into consideration, but the message I got was that it was all in my head and I should be able to deal with it on my own.
Fuck you.
I agree with you that this is inadequate. WA state licensing laws for Licensed Midwives are stricter and don’t recognize CPMs.
Mattir, one of the things I appreciated so much about my midwives was that they assessed for things like rape and sexual abuse history — and that unlike all the doctors I have ever seen in my entire life, the relationship they established with me had enough trust that I could be open about that history and give them the information they needed.
But handing women the “irresponsible mother card” for even asking for more information, telling all-horror stories without an actual reference to the situation, that’s scaring people.
Now that’s just stupid (er, the OB, not you.) How can asking for more information be irresponsible?
Because you’re screwing up the physician’s schedule with your desire to understand stuff? Because you want to understand stuff in the first place?
I’ll never forget when a somewhat intoxicated medical student told me that he’d discovered that having his hands in the abdominal cavity of an attractive young woman who’d come to the ER with appendicitis was “actually pretty sexy.” Made me very leery of surgeons…
Because it means you’re not believing them straight away and might doubt their word.
A friend of mine was told, as soon as they could see two little blobs on the ultrasound, that she needed a C-section. When she asked if that really was necessary the doctors attacked her viciously.
Slightly off topic, but is it true that most women still give birth on their backs in the US, as movies/tv would have me believe? Because if the way things are portrayed as happening in hospitals are at all like real life, I totally understand why women are seeking other options.
Also, I think several people may have mentioned being cared for by multiple randoms in hospital. Wtf? Over here if we have to go to an ordinary hospital (rather than maternity) we have 1 or 2 midwives (depending on how long the labour is) throughout labour. How do they expect you to relax and get on with things if you don’t have one consistent carer to support you?
There have been a lot of negative anecdotes about treatment by hospitals in this thread. Do hospitals not give a fuck about women as people? Is it a result of hospitals being private (they are private in the US, right)? ‘Cause in NZ its all free & the majority of women get treated with respect & dignity. Although I would have thought you’d treat paying customers better? *confused*
Cool, not only have I been mutilated, I’ve also probably been mistreated because I made use of the bed people kindly offered me.
For everybody to memorize:
There’s nothing wrong with giving birth on your back as long as this is how you feel comfortable
PZ, you might want to consult with Dr Gorski regarding Dr Tuteur’s short-lived tenure on SBM a couple of years ago. The circumstances of the break-up were not discussed, but (IMO) Dr Tuteur’s writing there demonstrated something far short of rational dialogue.
In one instance, on a thread regarding circumcision, Dr Tuteur insisted that a male child born to a Jewish mother did not have a choice about being Jewish himself; he simply was, by definition.
So, yeah, if the definitions in a bronze-age book still hold true in the light of modern genetics, then, sure, she’s an expert.
You’re not alone. Most doctors who aren’t surgeons feel the same way.
Giliell – sorry ’bout that, its not at all what I meant. It obviously didn’t come out the way I intended, I should have been clearer. What I meant to ask is, is it true that women are pressured into giving birth on their backs *when they don’t want to*?
Having just had a family member give birth, I think there’s nothing inherently wrong with homebirth – I mean it happens, as does taxicab-birth, hospital-elevator-birth, grocery-store-birth, and whatever else. BUT I have a real problem with ideological natural birth stuff. On the one hand, I don’t disagree with them that historically there has been a lot of mistreatment by medical doctors of birthing women. On the other, I really have a problem with the overly-sunny view of childbirth promoted by the natural birth crowd. I mean yes, you don’t want to scare the crap out of parents for nothing, but the fact of the matter is, giving birth to human babies is dangerous for women, and dangerous for babies, and you can’t just ignore that.
Otherwise the worst case scenario is you wind up with dead babies and dead moms. Less-worst in my family, a mom who feels like both a victim and a failure for having had a C section, because she was undereducated about the risks and scared into paranoia and mistrust of doctors during her pregnancy, and then when she developed serious complications that could have killed both her and her baby, felt railroaded into having interventions because she’d been primed to disbelieve the doctors, and there wasn’t always time to explain as much as she may have needed, and anyway when you’re in labour isn’t really the right time to be learning whole new medical concepts, and since she and baby are fine now, obviously there never was much danger.
TL/DR: Low-intervention childbirth is great as long as interventions aren’t needed, but the misinformation that comes along with natural birth ideology does more harm than good.
Sorry, but this has to be challenged. The number of cases of death/brain damage that were utterly preventable, many of which are (and have been) making their way through the courts in NZ is terrifying.
Didn’t you see that article in North and South back in July?
Cant’t find a link to the article but this seems to be the most substantive reply the midwives managed (as opposed to discussing the actual piece): http://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=10738247
Tielserrath – huh, well I feel stupid now. I knew there had been a few issues but I didn’t know it was that bad. I retract my earlier statements saying how wonderful the NZ way of doing things is. I still think it’s not a *bad* system, but it obviously needs to be a lot better.
either #166 or 266:
Invalid comparison.
To become an OB you spend three years doing general training after med school, and five years of specialist training in solely obstetrics and gynaecology.
A midwife here has to do around 40 births – all or almost all of which will be normal deliveries. There is no requirement to be involved in high-risk care so they don’t get to see the bad stuff. They also don’t actually do any neonatal resuscitation – just train with a dummy. This is not the person I want managing an unbreathing, flat neonate.
Your crappy attempt at scare tactics is noted.
The only type of midwife I would consider seeing is a certified nurse-midwife, which requires a Bachelor’s Degree in Nursing, and then a graduate program in midwifery and appropriate clinical training. This is not an “observe 20 births” type training, it’s a “work as an OB nurse and then go back to graduate school and do some focused clinical training after that” program. CNMs provide a lot of well-woman care and deliver babies in hospitals and birthing centers as well as at home.
The commentary on this topic is unbelievable. All of it is ancedata. Disappointing from a group that usually is looking for the sound science.
COME ON PEOPLE> let’s investigate this a bit
I have seen a few papers with numbers for home births. When comparing *low risk* deliveries, they typically show that outcomes for home births are about the same as outcomes for hospital births.
I would have to do more reading to reach conclusions on how these studies were done, but how about actually looking at some research???? A good study would compare low risk to low risk in hospital to home births.
Here are three I just found. I am admitting here to only reading the abstracts.
-Olsen. Meta-analysis of the Safety of Home Birth, Birth. Volume 24, Issue 1, pages 4–13, March 1997 (I know nothing about this journal)
http://onlinelibrary.wiley.com/doi/10.1111/j.1523-536X.1997.00004.pp.x/citedby
-The safety of home birth: the farm study. American Journal of Public Health, Vol. 82, Issue 3 450-453
-Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician CMAJ September 15, 2009 vol. 181 no. 6-7 August 31, 2009.
http://www.cmaj.ca/content/181/6-7/377.short
not sure if this one is really comparing low risk to low risk Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician
and here is one that seems to have caused a stink
http://www.sciencedirect.com/science/article/pii/S000293781000671X
Mattir – just a quick note that your first post indicated that you were traumatized and crying specifically because your OB kept harping on hideous risks. My spouse has a subspecialty trying to surgically repair these torn-apart babies whose parents mainly ignored hearing about those hideous risks. Never, ever, ask a doc to minimize description of those risks.
Two hours later you posted that the traumatization was really a result of the lack of acknowledgement of your PTSD as a risk factor. That’s fair enough. PTSD *is* “all in your head”. That doesn’t make it less real. But it was probably way *over* the OB’s head. Hope you were (or are) getting proper MD help with it. Your “fuck you” was a little quick, even for Pharyngula.
And to those who want all the facts: a) Dianne has done a great job in this thread – listen to her; and b) you really don’t want all the facts unless you have an MD and have then gone on to take advanced epidemiology and bio-stats in order to actually know how to interpret them (eeesh). Find a good OB, and trust their risk assessment. If you don’t trust them, find a different one. But stay in the damn medical system.
The biggest problem with the licensing of lay midwives is that the licensure requirements are vastly inconsistent from state to state. In Florida, CPMs can be licensed, but they must carry malpractice insurance and have a strict set of mandatory transfer requirements (and they still practice outside of what’s been shown to be safe resulting in the deaths of women and their babies). In Oregon, ANYONE can call themselves a midwife and can practice without a license. But, here again, CPM is one of the paths to licensure. And that’s just the beginning.
There is a growing movement to improve patient care in hospitals and improve our licensing standards (generally restricting midwifery care to truly competent providers–CNMs) and care restrictions like transfer requirements, back up physicians, and malpractice insurance. Women deserve to know that states will only license quality providers. They deserve to have a choice in care, but they do not have a right to have whomever they want be licensed. The argument commonly given in response–that women will choose unassisted birth if they can’t have whoever they want–is bankrupt. They choose it anyways. And they certainly may. That is no more a reason to create a state licensure for substandard midwives than it is to create a state license for direct entry heart surgeons.
New study out: http://medicalxpress.com/news/2011-08-doctors-nurses-hospital-uniforms-dangerous.html
Researchers took cultures from the uniforms of doctors and nurses in a hospital. They found that “exactly half of all the cultures taken, representing 65 percent of the RN uniforms and 60 percent of the MD uniforms, harbored pathogens. Of those, 21 cultures from RN uniforms and six cultures from MD uniforms contained multi-drug resistant pathogens, including eight cultures that grew methicillin-resistant Staphylococcus aureus (MRSA).”
So, hospitals are not necessarily safer.
Dhorvath (#152),
I think our views are close enough. The difference is mostly attributable to differences in medical practice in our respective areas at the relevant times. :)
Wow, that’s crazy, are you saying there’s bacteria EVERYWHERE? I don’t believe it.
Score another point for press-release science. Here is the actual report if someone has access. Would love to know how many of those swabs were done in a busy ER versus the outpatient clinic.
Also, was that done in Israel? I don’t think JCAHO extends that far.
MaryF #180:
Please excuse me for asking, but why are you holding an open bottle of potassium cyanide above our well? That stuff is poisonous, y’know =/
Melissa:
OK, seems like a classical internet missunderstanding ;)
I must also admit that this “triggers” a harsh response from me.
I totally agree that “making” women to lie on their backs is wrong. But people don’t get to redefine my experience afterwards.
I could have had the full Monty: tub, ball, special chair, you name it, they had it. If things take longer you often see the women walking around the hospital, climbing stairs, carrying a portable monitor. What I wanted was to rest this massive walruss on a bed, push my feet against the railing, try to break my husbands hand into tiny little pieces and get that thing out of there. Worked well for me.
Scriabin:
Bullshit. Nobody is asking for doctors to lie to patients in minimizing the risks. What we ask for is an adequate risk analysis on basis of the individual patient backed up by science.
I’ll give you an example how it is done right:
I put on a lot of weight during my first pregnancy. I never lost it. So when my second one started I was already obese.
Yep, that’s a risk-factor. Obese pregnant women have a much higher risk of high blood pressure and diabetes, all things that can lead to dead mothers and babies.
Wrong way: Tell this to the woman all the time because she’s obese, which is not something that’s going to change now anyway, regardless of her actual situation.
Right way (as done by my OB): meassure my blood pressure, look for sugar in my urine, measure my blood sugar once, see that everything is about as normal as it can be, gently remind that I should not put on 60 lbs again.
More bullshit. You admit yourself that PTSD is real and a risk factor. Just like maternal age, blood pressure, diabetes, whatever. If the OB hadn’t bothered to check for those, would you still defend him by saying “oh, it was probably way over his head”?
It doesn’t matter if the risk factor is physiological or psychological, they are real, ignoring them and instead going on about other factors that don’t apply is malpractice
Has it ever occured to you that people ignoring risks might also be a case of “the boy who cried wolf”? If, as a patient, I’m under the impression that a doctor (or doctors in general) exaggerate risks, don’t take me serious, don’t treat me like a sensible person who’s able to understand, I’m not going to believe that person anymore.
My daughter is still in care of the urologists who looked after us during the pregnancy.
If the one who tried to bully me recommended an invasive treatment for something, I’d be doubtfull. That person does not have my trust. If the other one of who I’ve experienced nothing but calm, dedicated and competent care recommended it, I’d go for it.
Others upthread have been very clear about the best combination of care.
.
With regard to the downsides of the worst (and using two grossly caricatured strawpeople for the sake of brevity), the mystic-woo-yurt-under-the-stars brigade and the hyper-interventionist-feet-in-stirrups-timing-to-suit-my-golf-game cohort really have a lot in common (however much they may despise each other).
.
They both think one-size-fits-all, they both know with all the certainty of omniscience that they know best, they both reject/ignore any and all questioning, they both steamroller majestically over individual women, they both fail to attach any importance to – let alone focus on – women’s needs and wishes, and making the whole event go as well as it possibly can for individual women and their imminent offspring.
.
Shorter: neither camp gives a shit about what you want or need; what they know in their omniscience to be best is what’s important.
.
Chapeau to all the skilled, experienced, highly trained professional midwives, and to obs doctors who are happy to provide backup if and when actually needed (without feeling they have to treat it like some kind of turf war and show how important they are by taking over even when they’re not needed)
Giliell: No probs :) I’m all triggery over c sections after having to have one last time I had me a baby, so I fully get why you pulled me up. And I appreciate it – its one of the things I love about Pharyngula – people haul others up for shit that’s wrong/comes off wrong.
If things in the hospital are soooo terrible that you just have to birth at home instead, why not do something to make some changes? I read so many hospital horror stories from the NCB ideologists but really, most of the changes needed are small and are already happening in most hospitals.
As for midwives, why on earth can’t the US get in step with the rest of the Western world? Go ahead and have midwives, well trained ones like CNMs, and make practicing without a lisence illegal.Require reporting of deaths and require insurance. At the very least, require statistics to be available to all women who are considering home birth, and make them valid statistics looking at every attempted home birth.
I once bought into the whole Natural childbirth thing. I agreed to have my first in a hospital only to please my husband, with agreement that I could have the second at home. I knew I would have this fantastic birth experience and being at home was best. Then I met with reality. I was lucky, because my brush with reality didn’t cause any lasting damage to me or my baby. We discovered he was a footling breech when I was in labour, after my water broke, at the hospital. I was sensible enough to go for the c-section and you know what? It wasn’t that terrible and I had a beautiful, healthy boy to take home for my trouble. By the time I had my next child, I fully realised how badly things could have gone and chose a VBAC at the hospital. It was all “natural” except for a little gass and air once I was at 10 cm and a lot when the danged local didn’t kick in for some stitches. Neither type of birth affected the way I feel about the child involved. Neither made me feel all powerful or like less of a woman once I ditched the NCB ideology. Both gave me a healthy baby and were safe for both me and the child.
Home birth may be absolutely amazing, right up until the point that there is a problem and help cannot get there in time. I would much rather be safe than sorry when it concerns the life of my child and possibly myself.
scriabin – apparently you missed the bit about how the risks the OB identified weren’t based remotely on reality, or even robust clinical findings, but more on what he was free-associating to that day? There wasn’t even any continuity from visit to visit as to what he thought the risks were. And if PTSD from sexual violence is over the head of someone who specializes in reproductive health care, then we are all well and truly doomed.
DaughterSpawn did a wonderful impression last night about what it would be like if urologists behaved like OBs: Your penis is behaving oddly and I’ve heard stories about something like that. We may have to amputate. BED REST NOW!
Don’t think that “fuck you” was too fast for Pharyngula – I think you’re a ‘splaining fool.
What I like best about scriabin is that scriabin knows what my physician was thinking, saying, and doing even though, as far as I know, scriabin was not in the room and knows nothing about me except what I wrote above. (And given the demonstrated selective reading skills, doesn’t even know much of that.)
The wonders of Pharyngula – want to ‘splain some more at me?
Mattir – meh. There are great doctors and crappy doctors. Good thing, though, you know exactly what your physician was thinking when he interacted with you. And what he put in your chart. And what for you, based on your years of medical experience and knowledge of the literature, are actually reality-based risks.
Sarcasm aside (despite your apparent Mattirritation) maybe your doc was an incompetent asshole who should be reported because, amongst other things, he was scaring you with risks that weren’t remotely based in reality and didn’t acknowledge your PTSD.
Or maybe he was just an insensitive professional who may have come to his own conclusions about what you needed (or were equipped) to hear.
You don’t know either: you only know how he made you feel (and there’s no doubt, when using that metric, that he failed).
Whatever – I wasn’t there, and I can only react to your words and tone in this thread. You’re writing as if my comments somehow invalidate or deny your subjective experience. Obviously they don’t.
In a doc/patient relationship it takes two to connect. Is it too obvious to note that victims of sexual violence (or any kind of violence) should also try to connect with physicians with whom they have a real trust and rapport? Depending on where you live, it’s always your full right to go get a second opinion. Or third.
Oh you’re such a role-model for an actual compassionate human being capable not only of understanding but also empathy, telling a victim of abuse suffering from PTSD that it’s probably her fault the patient doctor relationship and that it’s also her fault she let such little things come in the way and didn’t just go on and look for a different MD, taking more chances to be retraumatize. After all, maybe a third MD would be nice…
See the pile of decaying porcupines over there? Feel free to grab one on your way out.
Hi, Giliell.
Suggesting that she stay with a doctor who traumatizes her for fear of seeing a second (or third) doc who might “retraumatize” her ain’t very good advice.
Nicely emphathetic, yourself.
MelissaF and Giliell:
Yes, the whole on your back thing really stirs people up. I had a terrible experience with my first birth where I had moved into a squatting position without really thinking about it only to have two nurses forcibly shove me back down on the bed and hold me there for the final 15 minutes of labor. It really intensified the pain of the contractions and make me feel super violated. THEN, with my second labor, I completely surprised myself by feeling more comfortable with that very position for much of the labor. I agree that the problem with hospitals is not so much the position, but the lack of respect or choice given to the laboring mother.
See, the great thing about the OB experience was that I had just moved to a new city, had no idea what I was supposed to expect, and was far less cranky and demanding than I am now. I would never stay with Dr. Risk-Factor-of-the-Day now, and I’ll keep complaining so as to let other pregnant women know that they do not need to stay with such physicians and point out to physicians who might read this that “in your head” issues like PTSD and social support are important, assuming that the goal of pregnancy is to end up with a healthy child, a healthy mother, and a healthy relationship between the two.
Accurate communication of risk is important. Bad communication of risk and ignoring of socio-emotional factors can make it a lot harder to end up with that healthy relationship in the early stages of parenthood.
Seriously, scriabin – have a porcupine. You’ve earned it.
Nice complete and utter fail, cupcake.
Or come up with one quote from me that somewhat suggests that this is what I claimed.
Thanks, Mattir.
And apart from your gratuitous porcupine comment, your @205 comment is wholeheartedly one I can agree with.
Glad I could provoke it out of you (I’m kidding!! Had to keep up the “asshole” persona a bit, no?).
Good luck with partner and DaughterSpawn.
Give it a rest, Giliell (sorry, “Cupcake” – am I doing it right?). “Taking more chances to be retraumatized” (your quote) is not a reason to not insist on changing docs. It’s not a stretch to empower patients to to “shop” for docs.
As Mattir nicely put, BE cranky and demanding and find a freaking physician that is compatible with you (but who isn’t going to mask the risks). Don’t “blame the victim” for staying with one doc: show them that they can take responsibility for themselves (that THEY have the power) and help them move to a second doc (or third, etc).
Scriabin, maybe you’re too invested in defending yourself for this to sink in, but really, stop it. You stepped way out of bounds criticizing Mattir for things she didn’t say, then ignoring things she did say, then lecturing her on how her feelings aren’t relevant. Stop it. You misread her and you were wrong. It doesn’t make you a horrible person, but there’s a reason people are treating you like an asshole. You’re acting like one today.
“But now I’ve discovered The Skeptical OB, and it’s all about this crazy kooky weird world of homebirthers — people who, just like anti-vaxxers and HIV denialists, refuse to recognize that modern medicine is actually incredibly powerful and useful, and have these bizarre myths about what is “natural”. So they insist on having their babies at home, away from those horrible doctors, and they end up with dead mothers and dead babies.”
Ugh. Homebirthing, or being in favour of a woman’s right to homebirth doesn’t mean you “refuse to recogise that modern medicine is actually incredibly powerful and useful” at all. I plan to birth my second baby at home if I can, with a midwife. I would, however, be prepared to change plans if for some reason during my pregnancy or labour it turns out it is medically necessary to do so. I’m all for modern medicine when it’s nececessary, but it’s for the sick, and birth is not an illness. I can’t speak for all homebirthers but that’s the attitude every one I’ve actually met has taken. And just FYI qualified homebirth midwives carry oxygen and syntocin and are trained in resus etc. so it’s not exactly the rejection of medicine you seem to imagine.
No doubt there will be someone out there who does think all women should give birth alone under a tree or something, just like there are some women out there who think every woman should have a ceasarian for the convenience, some people are just weird. Please don’t make such sweeping assumptions about all homebirthers, and all proponents of natural childbirth based on just a couple of nutters.
There are sound, logical reasons behind wanting a natural birth which you don’t seem to be aware of. In a healthy pregnancy medical interventions themselves create new risks (unnecessary surgery, the risks associated with various drugs for both mother and baby etc.) and natural birth avoids these. If you look you will find plenty of stories of dead mothers and dead babies that resulted directly from medical mistakes (like the two women who were paralysed after having disinfectant mistakenly injected into their spinal columns instead of anaesthetic), not to mention women traumatised by physical abuse at the hands of their doctors. Many women are told they are ‘high risk’ for stupid, mistaken reasons, like for example having a baby that the ultrasound shows is “too big” when ultrasound is a highly innacurate way of determining a baby’s size. So while ignoring all medical advice is dumb, on the flipside it is not necessarily a good idea to take something as gospel simply because it is said by a doctor.
And yet more anecdotes:
Both my parents are scientists. My mom had an awful hospital experience with my older brother (including Mom’s suspicions that the hospital “care” actually caused long-term negative affects on my brother). When I came along Mom and Dad agonized long and hard but eventually went with a midwife and home birth. They decided that a home birth was in fact the better option than the horrible doctors who were giving improper care. The midwife they chose was extremely experienced, and definitive on that if she even suspected problems with delivery that Mom go to the hospital asap.
I was born in 1971. At the time there were no birthing centers attached to hospitals in our major metro area. After my birth (at home, simple delivery with no complications except that my brother was frustrated that Mom wasn’t focusing on reading him Dr Seuss) Mom was part of a group that were instrumental in eventually getting birthing centers at the local major hospitals.
She told me one of the reasons she did it was to ensure that should I ever have children that *I* would not have to face the same difficult decision my parents had to make. And if the birthing center option had been available to her then she would have taken it in a heartbeat. My parents did what they thought was best for *me* – which included not putting me into what they deemed a more hazardous environment – the hospital.
Oh, and re. anaesthetic, choosing not to have anaesthetic during labour doesn’t make you a masochist or an idiot and doesn’t have to be for religious reasons. The drugs used carry serious health risks for both mother and baby and can make breastfeeding and bonding more difficult. Some women just don’t consider those risks worthwhile.
Jenny #210:
This
is a marked contrast from your last paragraph. Let’s see why:
[citation needed]
[citation needed]
Oh fuck off. You call this logical? Okay, then I say we should abolish government because you will find plenty of stories of dead people that resulted directly from governmental mistakes.
OH COME ON. HOW FUCKING GULLIBLE DO YOU TAKE US ALL FOR? Or do you not realize how insulting it is to come onto a blog devoted to skepticism and make extraordinary uncited claims, expecting regular readers to take them at face value?
…please. Don’t just say it, show it. Or do you really expect us to just trust that you know absolutely everything?
You know what else is dumb? People like you, who pay lip service to medicine and then turn around and spew bullshit like “there’s medical mistakes so medicine is worse!”. Because it’s not like there’s any complications that can happen on nearly no notice during birth that require medical attention. Or do you seriously (and stupidly) think that all houses are conveniently close to the hospital and there’s no way a woman going through labor could possibly lose enough time to turn a fixable complication into a fatal one?
Jenny:
And this is where you show your true anti-science, anti-modern-medicine colours, despite your previous assertions.
You’re either ignorant of the many areas where modern medicine makes our lives safer and healthier by prevention and early detection, or you’re one of the quacks who also refuse vaccines, check-ups, cancer screenings and toothpaste.
Yes, that’s why all those women in countries with a high level of totally natural birth are such happy campers. Ye-es, avoiding modern medicine avoids the risks of modern medicine. Nobody said there were none. It’s always a risk-benefit evaluation. And the data is not much in favour of home-birth.
Here’s a hint for you: modern medicine makes sure that a lot of pregnancies stay healthy by supplying folic accid at the most basic level, hormones and insulin for others, finding out what things you should probably avoid and so on.
So, do you want a medal for it? Or do you want to scare women a bit more by implying “serious risks” (data, please), making them feel like a failure if they go for it?
Choosing not to have anaesthetics is your right, you shouldn’t be bullied into having any and I fully support your right to take all the pain you want. But drop that “better than thou” bullshit or come up with some sound data.
Michelle: Yes, I think that’s the clue to the problem. Making or forcing women to go for X. Just because a lot of women have wonderful experiences with water-birth, forcing every woman in a tub would be just as wrong as requiring all of them to lie on their back.
Meegan:
I think you also have a point here which is something a lot of women have told (and despite my good experiences, I also know from a lot of women who nowadays have horrible experiences): Bad MDs and hospitals make women evaluate the risk-benefit ratio and decide that homebirth is safer, when it is inferior to good hospital care but superior to bad hospital care.
Lordestar,
I had thought better of you – that’s an opinion, doesn’t need a link.
Anyway, I see you are another willing to shout a woman down because it’s easier than thinking – than thinking why Jenny expressed things that way. It rang many bells with me and I’m sure it will with Mattir when she wakes up – that decades long struggle to be heard, the one which often explodes as, “Fucking listen to me, man!”
You would prefer such ideas either not expressed at all or expressed in a way you can have a dry-as-dust doesn’t-apply-to-me conversation about in the college library. We’ve had quite a bit of that style above. What you got was, yes, a certain amount of confusion but fear and anger, too. Now, where is that coming from?
I have two facts for you, neither of which requires a little linky.
First, women do not lose the right to make medical decisions once they become pregnant, to accept or refuse treatment and to be give full, accurate information on their choices. Not all doctors have grasped that last little bit, even now, and patients have bad experiences because of it.
Second, medical negligence, medical error and the use of outdated / disproved techniques and medicines occur in all branches of medicine. Except in perinatal medicine, you say? Bollocks.
And now, if you’re still reading, you may have your heart’s desire – a link to a piece of research. Note especially the final sentence of paragraph 2.
http://www.jstor.org/pss/3560318
New Childbirth Technology: A Clash of Values
Margaret O’Brien Steinfels
The Hastings Center Report
Vol. 8, No. 1 (Feb., 1978), pp. 9-12
Hardly qualifies as new anymore.
Defective newborns? Really? Did you not read past paragraph two?
Are you serious? Since over 99% of the time I drive in a car I don’t crash it, should I bother with a seat belt? Get real.
Giliell
This.
Let’s encourage effort into improving the bad hospitals; it’ll save more lives and improve the lot of more mothers and their children than encouraging mothers to revert to primitive, dangerous birthing methods.
More anecdotes:
My mother had myself and my three siblings at home. Apart from the youngest, the midwife failed to turn up in time for any of the deliveries and my father, with no medical training whatsoever, had to muck in. Mind you, delivering in hopital during the ‘fifties, ‘sixties & ‘seventies was probably not a lot safer either but I feel that we were all fortunate.
I had my children in the ‘eighties and ‘nineties, at three different hospitals, and the level of medical interventions available had risen enormously. And my grandchildren, born in the 21st century, have had even better medical facilities; but the general hygiene standards at the hospital where my daughter had her first child ten years ago were appalling, far below those when I had her. I hope they have improved.
Without hospital care and modern medicine I would have probably lost all my children to Rhesus disease and/or prematurity and/or pregnancy/birth complications; certainly I would not have survived either of my twin pregnancies. in any case, home birth, when I was living in a rural area far away from the hospital and with very quick labours (longest four and a half hours, shortest under two hours) was unacceptably risky.
I feel that, while it is up to the individual woman to decide risks and benefits, she should be supplied with accurate and fair information relevant to her particular situation to enable her to do so, not scare-mongering and propaganda from either side.
P.S. Taking advantage of modern aids is not somehow ‘cheating’.
maureen.brian #215:
And I stopped reading right there, because you failed to read my post at all other than noting what my post was responding to.
Never mind that they were using inane anti-science arguments that we see all the time in an attempt to support all forms of ‘alternative’ medicine, I was doing it to someone who is supporting home birth, therefore I’m simply shouting a woman down, right? It can’t be that I take objection to their claiming to respect medical science and then turning around and spouting off the same bullshit that anti-vaxers and naturopaths and chiropractors and homeopaths and reiki masters and all other forms of cranks do, no no, I’m against home birth so I must just be shouting them down.
I guess I should just give deference to women who spout such bullshit in all cases relating to women’s health, because apparently to not do so is to attempt to ‘shout them down’.
Jesus fuck, sometimes I really understand where MRAs are coming from when they claim marginalization…
Um, if the pregnancy is healthy, there are no unexpected emergencies and you have a competent doctor, there shouldn’t be any medical interventions that you don’t agree to. So, you can easily do a natural birth in the hospital. Some doctors having a bad bedside manner or being downright neglectful towards pregnant women is something else and needs to be examined separately. I understand it’s a woman’s choice where she wants to give birth, but putting forward such incomplete information and opinions stated as facts is not a very nice thing to do if you want someone to make an informed decision. You are also putting an emphasis on things that can possibly go badly in a hospital, while completely ignoring all that can go badly at home.
Did I say I agreed with Jenny? No.
Did I suggest that we might usefully wonder why she thinks that way? Yes.
I’ll add another question. If Jenny is getting only bad information then does that prove she’s at fault or that the system for providing good information is failing?
I remember the fights we had in the 1960s and 1970s – to get our legs out of those damn stirrups, to retain the right to make our own medical decisions, to be allowed to move around during labour, to break the production-line mentality which had somehow come in with the NHS in 1948, to persuade the medical professionals to read their own research, dammit.
The cases which finally put an end to obstetricians automatically running off to the High court saying “this woman is refusing a C-section, therefore she is mad, therefore give me a magic paper to over-ride her wishes” were very recent. The last two cases were from St George’s Hospital long after it moved to Tooting and both children were born healthy without the surgery.
Nothing in the above paragraphs is extreme but some of the rubbish we had thrown back at us by medical professionals and hospital managers at that time would put any woo-miester to shame. I seem to remember that the argument about whether the calculated due date was a rough estimate or a decree from the almighty ran for years.
Maureen
And a lot of those things have already changed. And they didn’t change because of new age bs, but because of brave women fighting to get good medical care in hospitals, fighting for birth centres (A birth centre with access to a hospital would have been my first choice, but there isn’t any here.)
When I was born, women had to stay in hospital from their due date onwards. I went for a routine check-up on my due day and then had to come in every other day to see if we were both doing fine. Kid came 5 days late, healthy and, oh “naturally”.
When I was born, the woman would be alone in the labour ward with the midwife. My mum was lucky that her friend was a nurse there and could hold her hand. Fathers were not allowed.
My hisband was there for both births, and for the last one so was his aunt who had asked if she could witness a birth. The “limit” was “we need space to move and will throw people out if it gets too crowded.
When I was born, women had to stay in hospital for 10 days, 3 weeks for a C-section. Spent 2 nights there and then left with my bundle of joy.
When I was born, women were told to stay in bed for weeks, because they were “too weak” to stand on their own feet. By the time they were allowed to get up again, they realy were. I was helped to get up about an hour after birth when they were confident I wasn’t hemorrhaging.
When I was born, breast-feeding was practically child-abuse. Now you get help and support to breast-feed your child (and still lots of crappy information)
I’m totally with you, Giliell. We got those changes which made the whole process better by rational argument – no quibble about that, not from me.
But in the mid-1960s in the UK we were being reacted to by influential sections of the medical profession as if we were mad – for instance when we argued that speeding up of labour was only justified if either foetus or mother were showing signs of harm and not because “the book says a normal labour takes x hours.”
We were dealing with doctors who had not been trained to recognise either the impact of their own, sometimes callous, behaviour or how very broad a range the fairly useless term “normal” covers when dealing with healthy women having babies!
We had to retrain ’em and some resisted – resisted to the point of accusing rational but articulate women of trying to bring down the whole of civilisation.
_________
It’s a pathetic little anecdote to set against my successful home birth at 138 but this is what happened two years earlier. I was just about sure that I was pregnant when I started to bleed. Partner phones doctor, I am told to lie flat on the floor and move as little as possible. This means I watched the famous Manchester United vs. Benfica match of 1968 upside down. The idea was that the bleeding might stop but it didn’t.
The next thing I knew it was the morning, I was incredibly woozy having been given enough knock-out drops to flatten several of Hannibal’s elephants. So I asked what had happened, was I still pregnant, had they done the D&C.
No-one would tell me! I had been home for 24 hours before I could convince partner and mother that I really did not know. Eventually they believed me and told me I’d lost pregnancy, had a D&C but who signed the consent form ‘cos it wasn’t me.
I came to no permanent harm but that is bad care in a hospital. We in Europe have come a long way but seems that huge parts of the USA are way behind.
Lordsetar, while I don’t particularly like the “medical care is for the sick and pregnancy’s not a disease,” philosophy, it’s a statement that’s really grounded in how physicians often treat women, and pregnant women in particular. Many physicians really do treat pregnancy like a disease. It is profoundly disturbing to have one’s pretty much normal pregnancy treated as if it’s just a bundle of pathology waiting to happen, or even pathology just hiding until it leaps out. I’m all for reasonable discussion of risks. What I am not for is assumption that a pathology exists on scanty (or even no) evidence, as was the case in my pregnancy. Spending all one’s clinical visits discussing risks, with no “things are looking good, how are you doing, now here are some things we should talk about” is not a good thing.
Women do die from medical errors in pregnancy and childbirth, and these errors happen in hospitals as well as in homebirths supervised by competent medical professionals. Also, medication errors are incredibly common in all settings. You should know this, but here and here are some citations.
Pain relief during labor does affect neonatal nursing (citation). This is not necessarily a reason NOT to have pain relief during childbirth, but it’s something to be aware of so that you can take appropriate steps to develop healthy nursing habits afterwards.
And this:
is not an irrational statement. Drugs, surgery, even monitoring equipment are associated with risks. They may be risks one wishes to take, but they are risks nevertheless, and a pregnant woman has the right to decide whether to take them or not. For me, the risk of a c-section was worth avoiding the pain and complications of a twin delivery in which the second twin was transverse and would have to be either manually repositioned or c-sectioned after first twin was delivered. I know women who decided against the preemptive c-section because they weighed the risks differently.
Shorter response: just because someone doesn’t provide citations does not mean they don’t exist and they’re just trumpeting woo. And just because someone does something you wouldn’t does not mean that they’re ignoring medical science. We should be thinking about WHY there’s such a market for childbirth woo (or anti-vax woo, etc.) at least as much as we think about HOW a particular practice is woo.
Hello again
I am not a regular reader of this blog, and I did not think people would expect citations in a comment on a blog post. That’s just not something I thought people would bother with. I’m not really part of the sceptic community, I was just directed to this blog post by a friend who is a regular reader of this blog. It’s not a particularly welcoming community just going on first impressions. I’m not familiar with the term ‘woo’, though I think I can gather what you mean from the context.
For the record, no, I’m not anti-medicine. I vaccinate my kid and myself and go to the doctor when I’m sick etc. Some people seem to assume that it has to be all or nothing- accept all medicine all the time or none of it. That seems silly to me.
Gilhiel
“So, do you want a medal for it? Or do you want to scare women a bit more by implying “serious risks” (data, please), making them feel like a failure if they go for it?
Choosing not to have anaesthetics is your right, you shouldn’t be bullied into having any and I fully support your right to take all the pain you want. But drop that “better than thou” bullshit or come up with some sound data.”
I had an epidural during my first labour actually. I don’t look down on other women for using drugs during labour at all and did not say anything to that effect. It’s up to each individual woman to weigh up the risks and decide what’s best for her. I have often heard people off-handedly comment that they don’t understand why anyone would refuse drugs during such a painful experience (as someone did in this thread), and they’re not really asking, just assuming that there can’t possibly be a sensible reason for this. In fact there is a perfectly sensible reason, and that’s all I was hoping to clear up.
The risks of pain meds used in labour are well known (so much so that I am suprised you would question their existance), and here in Australia at least you get told about them before you agree to anything. I particularly remember being given the list of side effects for epidurals, ranging from the unlikely but horrifying, like permanent paralysis, to the just painful and annoying like headaches (which thankfully is the worst I experienced). But if you want citations, have a look at this from the hospital where I birthed:
http://www.health.qld.gov.au/consent/documents/anaesthetic_05.pdf
It was not so much the side effects I wanted to avoid as not being able to move around during labour, and the other interventions that tend to follow from using an epidural which brought other disadvantages and risks of their own. But I weighed it up and in the end it is what I chose that time around and I certainly wouldn’t judge another woman for having an epidural, or for not having one if she didn’t want to.
The case I referred to where a woman was mistakenly injected with antiseptic was this:
http://news.ninemsn.com.au/national/7948729/mother-giving-birth-injected-with-poison
@Jenny – this is actually a great community. I came to Pharyngula via one of PZ’s anti-homeschooling posts and ended up staying – I’m even still a homeschooler. We like citations, and it helps to have a thick skin. Lurk for a bit and figure out who the people you don’t want to get into arguments with are and join the fun.
Really, I cannot overstate how wonderful I’ve found this community – I’ve met plenty of commenters in real life and liked all of them. Mr. Mattir thinks it’s plenty odd, but the Spawn and I really enjoy the relationships we’ve formed here.
Jenny:
You know, I had two births without pain-relief.
I’m a lucky fast birther, so there was never time to even consider them. So I got the full load. I sure could have gone a different road with my second kid, but I didn’t think it worth the trouble.
If, as a pregnant woman you bother to follow the recommended routine in Germany, you get the information in advance. I got an explenation from my midwife, watched a video about epidural and had an appointment with the anaesthesist about 2 weeks before my due date so he could explain everything to me again, risks and benefits, get to know me, get to know about my personal risks and medical history so we would not have to do this while I was in labour or when things went wahoonie-shaped.
I think that’s a pretty sensible way to go.
What I object to is the word “serious” in “serious risks”, because we just seem all to agree that pregnancy shouldn’t be treated as a disease, but as something that is a pretty normal thing. We all object to the notion that it’s something that consists mainly of “serious risks”, even though they surely exist and they exist in much greater numbers than the risk of death or paralysis via an epidural.
Yes, they carry risks, they have side-effects, they have disadvantages. And I’m all for giving women the necessary information and letting them make the decissions then.
But that’s exactly where I see the place of medicine in a healthy pregnancy. I never saw the a
…anaesthsist during birth, but I’m very glad I saw him before and could talk to him and discuss options. That’s where good medicine actually gave me a choice.
Regular check-ups with a good OB/gyn meant that I could be confident, not only that we were doing well at the moment, but also that we would pick up things when they went wrong. It wasn’t like he treated me as a sick person, or somebody who couldn’t understand things. (sorry for the two-poster, accidentially hit submit)
Yes, as I said, my experiences were rather good.
That’s what I want for all pregnant women. I don’t want “either side” to scare them into something.
Gilhiel, It wasn’t my intention to scare anybody into anything. Like I said, I just wanted to answer the question “why would anyone want to go without drugs?”.
I’m glad your experiences were so positive. Mine were more…mixed. It would be nice if birth centre care were more readily available to women in Australia, but in the city where I live there is only one public birth centre which takes on so few women each year that there is literally a lottery to decide who gets to go there. For most women here it’s either hospital or home birth. While it is theoretically possible to have a natural, unmedicated birth in hospital here it is often really, really difficult. No, I can’t give you citations for this one, just my own experiences and what I’ve heard from other women who have been through it. Even if you go into it wanting things that way, there is a lot of pressure to change your mind once you are there, and support people (eg. the bithing woman’s partner) can be taken aside and scared with horror stories then used to try and get the woman to do what she’s told, which often seems to have more to do with getting women through the system as fast as possible than it does with the health of mother and baby. Then there’s the lack of consistancy in care, with the midwives often going off shift halfway through and a new person coming in you’ve never met who doesn’t know where you’re at, and a doctor(s) you didn’t get to choose and may also have never met until the day. This being said, I do know a couple of women who were perfectly happy with their experiences of hospital birth. I just think it’s a great pity that there aren’t more genuine options available to women in labour and that labouring women aren’t universally treated as human beings, not just baby makers.
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