Hey, I guess people have known about that cutting entry in the index to an obstetrics text for a good long while. Here’s an article on the book and general ob-gyn attitudes, in which we learn that the indexer was … the author’s wife! I guess she’d know. But doctors know better now, right?
Recall that preeclampsia was once called toxemia because it was thought to be a build-up of toxins in the maternal blood that had not been secreted through the normal monthly purification of the menstrual cycle. Miscarriages must be caused by the woman doing something she shouldn’t have done, like picking up a bag of groceries. Bottle feeding was superior to breast feeding because men had used science to outsmart the female breast. In fact, for about half of the twentieth century, obstetrics consisted of rendering pregnant women unconscious, cutting a procto-episiotomy, and ripping the child out with forceps. Sounds very efficient and modern. [Yikes. That’s how I was born.]
But surely we don’t think this way today. Have you ever recommended that a woman be on bed rest for any condition in pregnancy? Have you ever mocked a woman with a birth plan? Have you ever told a woman to “take it easy”? Do you believe that a Cesarean delivery is an improvement over vaginal delivery? Do you believe that when women suffer from depression or anxiety it is related to abnormal hormone levels? Much of the worldview of modern obstetric practiced was formed with the belief that women were inept and incapable and that science needed to fix them. Think about that next time you integrate old myths into your practice.
I believe that c-sections are superior to vaginal delivery under certain circumstances, i.e. obstructed labor, placenta previa, and maternal request. I also note that most OBs are women and the author of this article appears to be male. Perhaps he believes that women who are doctors are inept and incapable and need “science” (men lecturing them) to fix them.
Thinking back to Lamaze classes about 16 years ago with our healthcare provider, it seemed like the instructor went over a lot of childbirth options, but really it would have required a lot of extra work to wind up anywhere other than our local hospital for a standard clinical delivery (not cesarian though). I am not sure if anyone else in our group did something different.
My view (and admittedly male perspective) is that the ideal delivery would be with an experienced midwife and a complete hospital staff at ready if something does go wrong.
My view (and admittedly male perspective) is that the ideal delivery would be with an experienced midwife and a complete hospital staff at ready if something does go wrong.
Why is that the ideal?
@dianne It may not be ideal. It is my view of ideal.
If not ideal, I believe it would be better than a delivery by an experienced midwife without a hospital staff. Because something definitely could go wrong. Or if you are objecting rom the other direction, it is certainly understandable that many women prefer just going the traditional hospital route. That was more or less my wife’s view, which is what counts anyway.
Maybe I should have hedged thus: presuming one wants a midwife or some other kind of delivery, my preference (if I had any involvement whatsoever) would be to have modern medical facilities at ready.
To make a more specific point, the Lamaze instructor went over several birthing positions and their potential advantages, none of which, to be clear, would have been available at the hospital we were being channeled into. It seemed a little odd to have instruction that goes “You can do this, this, or this, but once you get to the hospital it’ll basically be whatever they tell you to do.”
@dianne Or another way to say it. I felt at the time that it would have been nice to have our Lamaze instructor, who was also a midwife, do the delivery. On other hand, I would have been freaking out if I believed that this in any way reduced our access to modern medical facilities. My wife is more pragmatic and was fine with a hospital delivery.
@PaulBC: I may have been assuming, based on past experience that is in no way your fault but tempered my response, that you were saying that a midwife was the ideal way for all pregnant people to give birth. It’s not. An experienced nurse midwife in a hospital with 24/7 OB and anesthesiologist coverage, and NICU at the ready is the ideal way for a person who wants to try for a traditional drug free delivery*. That’s not what every person wants and shouldn’t be imposed on those who don’t want it. I do not want to accuse you of doing that, since you’ve made clear that you are not demanding this model be used universally, regardless of the desires of the pregnant person. However, at this point, there is strong pressure on pregnant people to have a “natural” birth, to blame them if anything goes wrong, and to coerce breast feeding even when it’s not working. That is as much paternalism as any 20th century pressure for twilight sleep or bottle feeding.
*It’s what I had. Fortunately, because after a pregnancy so normal as to be boring, I had obstructed labor and would have died outside the hospital and been permanently damaged with a dogmatic practitioner who refused to call for help in a timely manner.
@dianne Well, I think a midwife potentially humanizes an experience that should be human. The question of how that weighs against other factors is a matter of personal choice. I never wanted “natural” childbirth, but I did have a sense of false advertising comparing the choices presented in prenatal class and the ones actually available (though I am sure we have neighbors who spend a fortune on a midwife, doula, etc.).
Ordinary healthcare professionals can also provide a very human experience. Our local pediatric hospital, where I have spent way too much time with my daughter, has an incredible caring staff who are also rocket scientists at fixing things that had a 100% fatality rate half a century ago. So yeah, I am a big believer in modern medical care. I would have been anyway, but for me it is rather personal.
On the subject of breast feeding, my wife will never forgive me, and I’ll never forgive myself, for letting my son’s growth slip in the first few weeks while my wife and he got breast feeding to work. We eventually augmented with formula. I still think that it would have been a mistake to go all formula from the beginning. We did get breast feeding to work, and it does have value.
But I see pictures of this skinny baby (who looked normal to me at the time) and wonder if there is permanent damage. He seems OK now. I am also OK as far as I know, despite being formula-fed like all my other siblings. The main thing that could have made things better with my son would be to have more frequent followup. We had good advice, weighed diapers and all that, but at least two or three weeks slipped by when it was bad. Somewhere I have that weight chart, and in retrospect it’s a really short period before his growth finally got going.
I’m also sure we didn’t turn him enough and left his head lopsided, though I don’t think anyone really notices. He doesn’t.
My daughter, two years later, took to breastfeeding immediately and I am not sure if we ever fed her any formula. So I agree it is a mistake to handle these things dogmatically. It is partly I think a backlash to the medical dogma of my parents’ generation.
Sometimes? Postpartum depression is real, and changes in hormone levels are a contributor.
Natural birth without pain killers sounds like masochism to me. I’m a person who takes pain killers even for pain that is mild enough to be bearable. I think it is silly to make my experiences worse than they absolutely need to be in 21st century with the existing medical advances. I don’t care about “natural,” I just want my lived experiences to be as pleasant as possible without actually overdosing anything and harming my body as a result. Then again, I have chosen to remain childfree, so my own mindset clearly differs from women who do chose to have babies.
All dogmas are bad, because they ignore individual circumstances. I never got any breast milk simply because my mother didn’t have any. The lack of breast milk made my mother extremely worried, and stressed, and scared that I might experience health problems as a result. According to a doctor, my mother didn’t have any medical problems and she ought to have had breast milk, yet she didn’t have it. It’s possible that the reason why she didn’t have any milk was because of all the stress she experienced immediately after my birth. A dogma that makes individual outcomes worse is a bad thing (in my mother’s case, the false belief that a child must be fed with breast milk resulted in her experiencing plenty of stress and fear). By the way, my health was mostly fine back when I was a child, so no breast milk turned out to be a no big deal.
dianne @ 1
I assume you are saying so because you have seen numbers that show that it is true, so I won’t contradict you.
However, this must be a rather recent thing (at least in the US.) I’m sure in my mother’s day, there were few if any women OBs, since there were very few women doctors of any kind. In fact, a few decades ago, when my children were born, I had the impression that women OBs were (still) a minority, though I don’t have the numbers and could be wrong.
And an OB being a woman doesn’t at all mean that how she practices medicine will necessarily be better than your average MCP male doctor. In my experience, most doctors practice medicine the way they were taught, regardless of how sexist or racist or just plain brutal it might be.
Anyone who has looked back at their own family’s genealogy should be able to appreciate how common infant mortality used to be. I am sure some of that was due to women simply not producing enough milk. (But a lot more because of kids dying of disease they can now be vaccinated against.)
The problem with nature is that it deals in aggregates and couldn’t care less about individual outcomes. I am not sure why this point eludes so many people.
That said, I think there are reasons for preferring breastmilk when available. Nobody should be pushed either way, and I seem to have done fine as a formula-fed infant, even at a time when there was a lot less understanding of what goes into human milk.
That’s totally fair and a really good example of harmless individual differences. I’m on the opposite end and don’t like to take painkillers for any pain that I can bear unless I understand its source really well (e.g. routine menstrual cramps yes; sprained ankle no), because it wigs me out a little bit to not be able to feel how much something “should be” hurting in case I miss an important signal. But I don’t think either way is “better”; they just are good for different people.
To the broader point: I suspect it’s tempting for OBs to think that they’re the ones responsible for the delivery. Indeed, in most medical specialties the doctor is the one who does stuff and the patient accepts treatment. But in obstetrics that is not so much the case: the doctor is there to facilitate the patient doing something, except in the cases where it turns out the patient actually can’t quite do it and the doctor has to jump in and take over. It may just be a case of a mismatch between the conventional medical approach and the particular specialty of obstetrics.
@Allison There may be both good and bad reasons for that. I wonder if there are so many female pediatricians because these are less lucrative than other specialties. The idea of a male obgyn strikes me as strange and I doubt my wife would be happy with it (though I read an article somewhere about women who prefer male gynecologists).
When my daughter had to go to our children’s hospital for a very serious medical condition, I had the impression that all of the doctors treating her were women and half the nurses were male. So I think there is some progress. It has evened out significantly on subsequent visits. The doctors are about 50/50 and most nurses are women. I guess the first sample was not representative.
Allison @10: The trend started in the 1990s and has continued. At this point, 80% of US-American OB residents are women. Older doctors, of course, are more often men. I agree with you that most people learn what they are taught, but cis-women, trans-men, and non-binary people with uteruses all have at least potential need for an OB and so have at least a vested interest in making the care decent. (Of course, cis-men have a higher than average risk of heart disease and male cardiologists…)
PaulBC @#11
Sure, but the key words are “whenever available,” which is often not the case.
@#13
Personally, I couldn’t care less about the junk between my doctor’s legs. If the only difference between two doctors was “male” versus “female,” I’d make an appointment with whoever has a shorter waiting list.
When signing up for a gynecologist appointment, I always ask the receptionist for somebody who isn’t a homophobe, is trans friendly, and doesn’t try to tell me about God’s will regarding my body. So far my luck hasn’t been very good. The first gynecologist I ever visited told me that God wants me to make babies. The second literally kicked me out of her office when I told her that I want to sterilize myself. The third was polite but clearly confused about how to react to my announcement that I am a masculine-leaning queer person and want to surgically change some things about my body.
PaulBC @#11 – Speaking just about myself I probably could have breastfed my daughter, however I did not want to. As I live in a first world country with access to clean water and had the money to afford formula. I had to go back to work at 6 weeksand I Did Not Want To Breastfeed. I formula fed my kid from the beginning. It is also becoming clearer that some of the supposed benefits of breast milk over formula are actually the benefits of being able to breastfeed/exclusively breastfeed, in other words college educated parents who have time and space to pump at work or take a maternity leave/be a stay at home parent:
https://www.theguardian.com/lifeandstyle/2019/jun/20/is-breast-really-best-i-looked-at-all-the-data-to-find-out
Also, personally I would have preferred a C-section over the precipitous vaginal birth of a nine pound baby that I ended up with. Lets not talk about multiple tears and how many stitches I had…
The push for breast feeding has resulted in the Baby Friendly Hospital “rules” which in some hospitals means expecting exhausted, some times post C-section mothers being expected to room-in or bedshare with their newborns so they can breastfeed. This has resulted in some tragic accidents:
https://www.reuters.com/article/us-health-newborns-falls/newborn-falls-in-hospitals-while-rare-may-increase-with-rooming-in-idUSKCN1OX1WF
It has also resulted in more babies being readmitted to the hospital due to dehydration and jaundice due to undernourishment.
@embraceyourinnercrone I think the main issue is having the choice. As I said, I was exclusively formula-fed as was the norm in the US in the mid-60s. If it harmed me in any way, the effects are pretty marginal.
I think my preference for breastfeeding is again more of a vague idea of “humanizing” a process. But I respect your choice and your candor. My wife wanted to breastfeed and that is pretty much the beginning and end of it.
I know, I’m late to the party but…
The best delivery is the one that results in two (or more) people who were not seriously damaged by the event. This means that there should be expertise, equipment, and fundamental respect especially for the pregnant person. I think that the sufficient reason why somebody might get a C-section is “because I want one” because a vaginal delivery is an extreme event and I’m speaking as somebody who did it twice, without painkillers, not because I’m “masochistic” but because my labour was too fast for anything. You cannot be pro choice and accept women’s and other’s bodily autonomy when it comes to abortion, but not when it comes to delivery.
The best infant feeding is one that results in a well fed baby and happy caregivers. I breastfed. I bought into all all the bullshit nonsense when I had my first kid and I was absolutely heartbroken, feeling like a complete failure when breastfeeding didn’t take off and nothing in all those books and brochures had prepared me for the reality of the matter. I had just made a complete new human with my own body and delivered that human being through an opening that is usually small enough to please a dick and I still felt like the worst person in the world. We the supplemented with formula and look and behold, the baby thrived. Next kid we ran into a completely different set of problems only that this time I accepted that “this is hard and may require work” and was happy.
Post partum depression is one part hormonal changes, but also a big part individual circumstances.
@Andreas Avester – I’m sorry you have not been able to find a doctor willing to actually listen to you. I hope you find one. I am always a bit taken aback by doctors who think it’s OK to put their religious feelings/beliefs ahead of the patient. I find it depressing that many doctors still make it so difficult to get sterilization surgery…
@Giliell I think you got at the same point, but the “best” solution is the one that doesn’t leave anyone with lasting regret, not just about the health of the mother and child, but about missing an opportunity to carry out a once-in-a-lifetime event in their preferred manner. E.g., suppose you were pushed into a big wedding and wanted a small one with close friends, or vice versa. Or maybe you wanted to start a family without being married at all but succumbed to social pressure and/or tax incentives. None of these affects anybody’s health in an obvious way, but they’re still big choices and people care about them.
In the case of formula vs. breastfeeding, there’s nothing really edgy about promoting the use of formula (which you did not say there was, so pardon the straw man, but maybe some people think so). Along with whatever nudges our care providers gave towards breastfeeding, the first thing we got in the “baby care” package was a Similac sample and bottle of some kind. We had to supplement the first time around and had no trouble at all finding stacks of formula at Costco, two brand names and the Kirkland generic, both milk and non-milk-based–a startlingly robust set of choices for Costco.
Clearly, none of it really matters all that much in biological terms. I did well on a much more primitive generation of formula 50 years ago. I would still have been disappointed if my wife had just gone straight to bottles, but it really wasn’t a matter of discussion. This was probably an unusual instance where were we aligned with each other and our healthcare providers.
Sadly, it’s probably a class thing more than anything else. Like, some preschoolers get Suzuki violin lessons, and some get plopped down in front of the TV 12 hours a day. In that case, the difference is more significant to development (I think) but you can also grow to be a successful, happy adult without any instrument lessons at all (as I claim for myself with only mild regret).
I did feel that despite the claimed choices, there is a feeling of being railroaded into doing everything the way your healthcare provider prefers. It does take some assertiveness to break that cycle.
I’m going to reply in more detail, but, wtf, dude?
If your wife had decided not to engage in the time consuming act of breastfeeding (and thereby almost by default becoming the primary caregiver), continuing to limit her own choices and freedom for the overhyped benefits of breastfeeding you would have been disappointed? Because of what? Because, after all the sacrifices of pregnancy and childbirth, she chosr not to make more sacrifices? Sacrifices that you were never asked to make? You really need to reevaluate your ideas about cis women, pregnancy and babies because your current ones suck.
@Giliell
To be clear, I would abide by my wife’s decision either way. It’s obviously hers and hers alone. It wouldn’t affect our relationship at all and I’d understand. It’s not as if it’s the only time in my life that I accept the autonomy of other human beings. That’s basically how life works.
Do you further require that I fail to feel disappointment? How exactly am I to carry out that requirement?
Honestly, puzzled here.
In fact, under the circumstances, I probably make an effort not to express disappointment and be completely supportive (to the extent possible, because I’m kind of an open book). But I find it a little bizarre that my having feelings one way or another would elicit a response like you. Like, you don’t have any opinion at all about how other people do things whether it’s your business or not? Seriously? You seem to have a pretty strong feeling about whether I am entitled to feel disappointment.
“You really need to reevaluate your ideas about cis women, pregnancy and babies because your current ones suck.”
Finally, perhaps you’re correct. I was merely being honest about my less than optimal feelings on the matter.
Paul BC
Very easy: by not expecting her to do that in the first place. I feel zero disappointment because I’ve never gotten a valentine’s gift from my husband, but I expect him to remember my birthday and our wedding anniversary.
Because your feelings betray a some pretty fucked up attitudes about women and childcare. That’s the difference between your “disappointment” about a woman’s decision not to breastfeed and my reaction to your opinion.
How kind of you. Do you even read what you’re writing? The decision whether to breastfeed is a very personal one. Breastfeeding comes with heavy costs for the breastfeeding person:
-Continued limits as to what you can do with your own body (drinks, medication)
-Very time consuming
-Serious limits to your independence and ability to return to work
-Physical issues like sore nipples and possible infections of the breast
-Very likely becoming the primary caregiver of the infant
So you expected your wife to do all these things, you would have been disappointed if she had not done all these things (that conveniently left you free of most of that shit, you didn’t even need to boil out the silly bottles, how practical), and you would have made her feel it because sadly “you’re an open book” in a world that already heaps a lot of pressure on new mums and others who have recently given birth and you still want a cookie for being a good guy and then you are flabbergasted that women don’t appreciate you enough.
How about we stop treating childbirth as a lifestyle event and push “birth experience” and supposed supremacy of one kind of birth over another on women?
Birth is a radical act. There is pretty little you can plan. Things happen, and they can happen fast. This doesn’t negate personal autonomy, which should always be paramount, yet having a “preferred manner” is a recipe for disappointment. It also causes a lot of harm to people who could not get this supposed “experience”. I do know a fucking lot of women who felt inadequate, a failure and “not really a mum” because they needed c-sections. This harm was 100% caused by people pushing vaginal births as the “correct births” and not by the c-section.
@Giliell I find it interesting that you read “some pretty fucked up attitudes about women and childcare” into one throwaway phrase. I am not being snarky when I say that I thought my comment about Suzuki violin was a lot more insensitive and classist.
15 years is a long time for me to remember how I actually feel about anything. It is a fact that my wife wanted to breastfeed. This was a non-negotiable. I gave her whatever small assistance I could, obviously not capable of doing it myself. We went to all the same appointments together with doctors and nurses. I weighed diapers, recorded growth stats, helped track down where to find fenugreek, which I believe is entirely useless, and read a lot of advice, much of which I found dubious but tried to apply.
She was working full time as a software engineer at the time, as was I. If she had said, “let’s bottlefeed immediately” it’s entirely likely I would now have different post hoc memory of how relieved I was that she had made the decision and I would express it the opposite way “Well, it was her decision, but I’m sure glad we did it this other way.” We supplemented enough that I have experience and opinions on formula too (there was something I did not like about the Kirkland generic; either harder to mix or some digestive issues).
As it is, I think the way my wife nursed our babies was kind of nice and I have happy memories about this. If it offends you that I have a viewpoint on a matter that is no business of mine, then I acknowledge that, but nevertheless I have that viewpoint. I am no mind reader, but I believe my wife too has no regrets. We have enough regrets about educational choices, disciplinary approaches and everything else that goes into 15 years of taking care of kids together. And I really couldn’t care less what other people do.
I think that I have the right to reflect fondly on a part of parenting I participated in, even if I didn’t give myself physically. I have put a lot of time into other things over the years: being primary daycare/activity driver and primary point of contact with schools, equally sharing hospital time related to my daughter’s medical needs, long hours (thankfully mostly past) trying to tutor my son, including in piano and Chinese, neither of which I knew any better than he did. (And I no, I’m not pretending to be some kind of extra-involved dad; I kind of suck at it to be honest, but I think my kids are OK and the first year of their lives is a distant memory).
Sorry but, no I’m not sorry. I do have a right to have feelings about things I went through even if I was not a direct physical actor in it. Needless to say, your feelings also valid. I find it really interesting though, that you take one post where I said more about violin lessons and Costco than I really said about breastfeeding and are somehow able to infer so much about my beliefs and attitude.
@ Giliell “you still want a cookie for being a good guy and then you are flabbergasted that women don’t appreciate you enough.”
No I do not. Again, you are reading a hell of a lot into my reflections on childbirth and child care. I was there as a spectator, and it is kind of a big thing. I have been directly involved in other hard work as a parent in ensuing years. Not asking for a cookie, but just f— off if you think I have not done enough work as a father. It is truly none of your business.
I am not “flabbergasted” but I admit I had not anticipated that my use of a mild word “disappointed” was offensive, when I can only guess after so many years if it’s even true. How the hell should I know? I might have phrased it differently. I will say that I enjoyed taking care of babies in the house (happy I don’t now). I think my wife’s decision to breastfeed was valid and that it is valid for any potential parent, man or woman, to have a preference on the matter. It is up to the mother, clearly, whether to go through this much effort for a process that I think we both agree has zero-to-marginal physical benefit.
Based on your Valentine’s day example (my wife and I don’t celebrate it either) I think you and I have subtly different understandings of the term “disappointed”. I do not believe that to be disappointed in an outcome, you either need to expect a different one or feel entitled to a different one. I consider it merely to be the act of observing an instance in which reality does not conform to a preference, independent of expectation, and feeling something about that. But maybe you’re right about connotation and I should be more careful in word choice. I gave it very little thought.
Sorry for the triple post. I realize it makes me look like an asshole, but it’s just my writing method. I lack the discipline to compose my thoughts all at once. I promise this is my last comment on this thread.
I wrote: “I would still have been disappointed if my wife had just gone straight to bottles, but it really wasn’t a matter of discussion.”
I would revise this to “My wife wanted to breastfeed, so it really wasn’t a matter of discussion. If asked, purely hypothetically, I believe I would have expressed a preference for this as well, but even this is hard to be certain of 15 years later.”
And seriously, Giliell, if this revision is insufficient, please do f— off. I am not a mind reader, and don’t claim to know what is bothering you, but you are also not a mind reader and should not imagine yourself to be.
Paul, I’ve pretty clearly expressed what is bothering me, but it’s also pretty clear that you’re not getting it, as evidenced here:
Since it’s pretty clear by the second sentence that you’re talking in binary (There is exactly one kind of male parent who is the exception here and that is trans men who have given birth): No, it’s not OK for people who have not given birth to have a preference on the matter because it’s not their fucking body. Seriously, I don’t know how much more clearly I can express myself here
@Giliell Point taken and I disagree. I believe we are all entitled to have preferences on anything we like and have very limited control over our preferences. This could include, for instance, a racist “preferring” to live in an all-white neighborhood. How people act on these preferences is the primary matter of practical significance. Though, e.g. in the case of the racist, one may come to conclusions about whether this is a good person. I would conclude No in that case and would not associate with them. Likewise, you may come to conclusions about me and probably have.
Sure, you’re entitled to have preferences, and you’re entitled to expressing them.
You’re not entitled to me thinking you a decent human being or accepting your preferences. I get to analyse, deconstruct and judge them. I know, I know, hard thing for a guy to accept, especially when the judging is done by a woman, but that’s the way the cookie crumbles.
@Giliell “You’re not entitled to me thinking you a decent human being or accepting your preferences.”
And I never asked for such a thing. Sorry if my sloppy language led you to think otherwise. I initially thought that I misunderstood what you were getting at. Thanks for the discussion.