During the birth of my son in late-June, I discovered incredible tension during labor. No, it was not my wife regretting having ever married me. It was instead between the nurses and doctors and our doula. We hired a doula to help my wife through her first pregnancy and labor, and boy did the nurses hate her. Meanwhile, the traditional medical establishment completely ignored our every request. It was a real eye-opener.
Read all about it here.
I’d be interested to hear if anybody else has had similar experiences during labor.
Our sixth child was born here in Michigan. The rest were born in Utah. Our Utah OB was great. After an amazingly fast first delivery, he had me take an emergency childbirth class and promise to call him at home before leaving for the hospital. There were almost always conflicts between the doctor and nurses. The nurses did not believe the doctor when he said that my wife delivered quickly. He wanted them to hustle for the impending delivery and they thought that they had plenty of time. With one delivery, we called the doctor at home to tell him that the contractions were regular (not close, just regular). We got to the hospital first and I was trying to convince the nurses that my wife was ready to deliver. I got chewed out when the nurses found out that I’d already called the doctor. As it was he walked in barely in time to catch the baby (no time for gloves). My wife has always been last in and first out of the delivery room.
When we got to Michigan, our doctor would not believe that Mrs. Wonderdog delivers quickly. The doctor was paged just as soon as we got to the hospital. The head nurse checked my wife and started the other nurses to prep for delivery. The ever-lovely Mrs. Wonderdog laid out her list of birthing demands (don’t cut the cord right away, let the placenta detach without pulling, etc.). The head nurse followed all of them. The doctor was paged three times. He came in five minutes after the delivery and began to chew out the nurses. He claimed that he was at home and only received one page. I intervened and told him that I had seen the nurses page him three times and that he had sufficient time to get to the hospital. I further informed him that because he was not present at the delivery, he would have to split his fee with the head nurse. Seemed only fair. I had to contact a hospital administrator to ensure that the nurse received her fee.
Mrs. Wonderdog says that the stress caused by the nurses and doctor disagreeing is greater than that caused by the birth.
Geoff,
I am not an anesthesiologist, but my wife is. Maybe I can convince her to post here later.
That said, it is common practice to ask others to leave the room during a spinal or epidural. This is because all too often the observer faints. Another reason is that it makes some doctors (residents mostly) nervous to have someone looking over thier shoulder while doing a delicate procedure.
The reason for the spinal might be that it gives instant relief, while and epidural alone can take some time to take effect.
Do you have any references on studies that show ill effects of anesthesia during childbirth? My layman’s understanding is that they are all highly flawed.
Finally, I can pretty much assure you that while bringing a doula into the situtation will help in many ways, it will also create conflicts that wouldn’t be there otherwise. Did you consider a home birth or a birthing center run by midwives?
I am sorry your family didn’t have the experience that you sought. My experience has been that delivery wards are filled with petty squabbles and politics that those of us don’t work there couldn’t begin to understand. Unfortunately it is the families celebrating a birth that get caught in the crossfire.
It seems to me that bringing a doula into a hospital (perhaps any hospital, but certainly those with a ‘very medical’ model of childbirth) is a recipe for conflict. I’m seeing a French chef accompanying you to McDonald’s and insisting on inspecting the fries, providing his own sauce, etc.
Well I have to admit that my births have been wonderful, because they were at home and I was able to follow my own instincts and no one was yammering at me, ignoring my wishes or telling me what to do.
I am sorry about your experiences and as a childbirth educator I have heard many similar stories. Many hospital staff do have problems with birth plans, mainly because they have their procedures and policies to follow. But I still say that it is important to insist that your wishes are met. And, in the event that they are ignored, you need to be vocal about that.
You have rights and responsibilities, and your rights are that you deserve to have the birth you desire. It is important to be very educated and aware. It’s good you had a doula, but too bad that she and you both were ignored. Very bad that this happened. Either a different hospital or another venue might be better next time.
A few interesting reads are Immaculate Deception II by Suzanne Arms and Obstetric Myths versus Research Realities by Henci Goer. You want eye openers about the childbirth industry, read those.
Luckily, the hospitals where our children have been born all accepted the presence of our certified nurse-midwife (CNM). Then again, we didn’t even have an OB, just the CNM, so no doctors were in the room to contend with.
But I have certainly heard horror stories from our friends who use CNMs and doulas.
We had our first kid in the hospital and the second at home with a midwife. The midwife was much more pleasent and trouble free. The doctor mad cow jokes in the delivery room, couldn’t recall my wife’s name and was there for all of 5 minutes. The Midwife was much more involved (she was a Nurse midwife with a Nursing degree and Master’s degrees in Midwifery and also Biology, so we figured she was qualified – we avoid direct entry midwives). We plan on using qualified midwives for future kids and hope to avoid doctors.
One minor quibble. Don’t always believe the hype. You said this: “Doula†comes from a Greek term for the most important house servant who helped women through their birthing process.
I hate to say it – but that’s false. False false false. Doula merely means, in Classical and Koine Greek “female slave.” Birthing was done by female slaves, but so was a lot of other work. Doula was not the most important slave (not servant – that’s a relic of mistranslations in the KJV) – it was pretty much any female slave.
But I’m a big fan of Nurse-Midwives.
Great comments all. As you may be able to tell, this whole situation is new to me. I’m learning an incredible amount from the people posting here.
Random John, I don’t have any studies on the effects of anesthesia, but common sense would say you don’t want to pump yourself and then perhaps eventually your baby full of drugs right when they are coming into the world. But I don’t have any science to back that up — perhaps you and your wife have conclusive proof there is absolutely no damage from anesthesia? Why do so many women try to have natural births then? I’m truly curious. Your wife may also have some insights as to why the anesthesiologist didn’t back off once he saw that my wife had already transitioned. It seems to me that would have been a good time to say: “whoa, this labor is almost over, no reason to give her any drugs.” Again, I am not being contentious — I am not a doctor and am honestly interested. (The hospital could give me no good reasons — it was simply “necessary.”)
I agree with you and Julie and Mary and others that doulas and traditional hospitals don’t mix. Next time we’ll go to a more doula-friendly hospital or a birthing center.
Ivan, I apologize for my lack of knowledge of Greek. Just going on what I was told by the doulas.
My wife did natural childbirth simply because she wanted to experience it and every little feeling entailed. That may seem masochistic, but for her it was a very sweet (although painful) experience. Also, she wanted to prove that she could handle the pain- it was kind of like a rite of passage to her.
I vehemently objected to her plan not to have an epidural almost the entire pregnancy- it seemed too “anti-establishment.” But then I realized that it was her body, so I was just kicking against the pricks. Instead of causing more conflict, I took child-birthing classes with her to learn how to help her. I have now sat by her side three times (and soon will a fourth) during the experience and have become a fan of her decision, although I am still not against using epidurals and the like.
With the second child, my wife was just about to cave and get an epidural because of the pain. But the CNM, unlike your doctor, Geoff, gently took her hand and said, “but sweetie, you are *almost* done!” That was so encouraging that my wife was able to push a few more times and our sweet daughter appeared in short order, and nursed for the first time within minutes.
Beautiful experience.
Geoff,
I think that charaterizing either a spinal or an epidural as pumping someone full of drugs is inaccurate to say the least. This is not general anesthesia. It is a delivery of drugs to a specific location. Yes, some of the drugs make their way into the bloodstream. I haven’t seen any science that says there is any damage.
I think it is flawed reasoning to suggest that because many women have natural childbirths that epidurals are harmful. It would be equally flawed to say that because a large number of women get epidurals that in itself proves that they are NOT harmful.
The studies showing a greater likelyhood of c-section with an epidural are flawed in that they don’t take into account the length of labor. The longer you are in labor the more likely you are to need a c-section eventually. Also, the longer you are in labor the more likely you are to eventually ask for an epidural. No studies that control for this have shown an increased rate of c-section with use of epidurals.
I am really out of my depth here. This is probably best left to experts, which neither of us are.
I think it all has to do with the Dr. you select, the hospital and the staff – talk to them before hand, find out how many births they do an hour – 100 is good 300 not so good, tour the facilities etc. Personally I have not had any children yet, but my father is an OBGYN and is wonderful – spends more evenings on the phone dealing with his patients issues when he’s not on “the clock” than you could ever possibly imagine. I think a lot of people don’t realize the number of hours an OBGYN puts into their schedules. My father has done over 5,000 deliveries in his life time and is still going strong. Yes, there are times he has missed a delivery, but that’s why he has partner’s and why there is always a physician on staff. I’ll have to say I’m going to go out of my way to find an LDS Dr. for my first, because there is something different about how they approach their work. I’ve only seen the difference in small ways going to my annual exams, but they are generally more considerate, and have a better run operation than most. That’s just my experience and I’m not saying non-lds Dr’s are bad – just find what’s right for you so you don’t end up with yelling people in the delivery room (that jsut astounds me by the way) I just feel like I needed to stand up for the Dr’s out there a little bit.
anon–surely you didn’t mean 100 births an hour? (year?)
Geoff asks, “Why do so many women try to have natural births then?”
I’ll answer, and no one will like my answer. There is a cabal of pseudo-scientific myths and a desire for “natural” living bouyed by a false sense of female machismo that combines to cause many pregnant women to desire ‘natural’ birth. I would have no complaints about those desiring natural births, except that:
(1) they generally claim that their way is best, without acknowledging that different women see different risks as tolerable and should decide accordingly. For example, I chose two (and will choose again) elective c-sections because I find the risks associated with that choice (which are real) less problematic than the risks associated with any type (medical model or natural) vaginal delivery. (But I realize other women will see the risks differently, and that’s fine.)
(2) they rely on really poor data (that they usually cannot produce) as evidence for the superiority of their choices.
(3) they guilt women who choose differently than they do.
While these three things do not apply to all women who choose and advocate natural births, it applies to many that I have encountered.
Forgot one thing:
To be fair, I think that many practices relating to childbirth, whether done through ignorance of what was best or convience for the doctor (my aunt had one of those fabled 4:30pm-on-a-Friday c-sections) created a climate where the natural birth advocates realized that something was rotten, but I think they have thrown the baby out with the bathwater, so to speak.
People who have babies at home are kind of….um…..retarded. What if your baby is gagging on muconium? How are you going to asperate him/her at HOME? Think the doula knows what to do? Think again….
Childbirth is a natural process that’s been going on for a very long time. 😀 (Duh)
Modern medicine has minimized the mortality rate for both baby and mum. Hooray! Of course we made up for that advance by just killing them before the birth. Boo! Hiss!
More doctors are coming around to utilizing medicines and treatments that, while not Western, has been around for thousands of years. Good for them! Humility and being open to the idea that our hemisphere didn’t invent remedies and cures goes a lot way in helping all of us live healthier lives.
Geoff, your experience sounds awful. My friends who had epidurals have all been allowed to have their husbands hold them during the needle insertion. I’d say you were in a lawsuit-phobic hospital except they did things they ought to be sued for. Cut me against my permission? I think not.
My friends who have used midwives and doulas all met with the doctors and hospitals ahead of time to make their expectations clear. Congrats on #3 and if there’s a 4th one in the works, I’d say use a midwife and a different hospital!
While I didn’t have a doula with either of my babies I did have a midwife for both. I think that the best advice I got from my midwife was to have a birth plan but to also be flexible, things don’t always go as planned. She said that she had a patient that had never let go of the fact that in her first delivery things didn’t go the way she wanted them to go, that was over 10 yrs ago. I’ve never heard of the husband having to leave the room while getting the epidural, that is odd to me, my husband was with me both times and was very comforting to me during it ( I hate needles, even ones I can’t see.) And while my first baby’s delivery didn’t go as planned, I had a midwife whom I met 2 hrs before she delivered my son, the end result was what I wanted a healthy baby.
“People who have babies at home are kind of….um…..retarded.”
I guess your pseudonym says it all.
“Modern medicine has minimized the mortality rate for both baby and mum.”
Certainly in a small number of cases, but other advances in modern science (such as nutrition and hygiene) have possibly made a larger impact in minimising birth mortality rates.
“Certainly in a small number of cases, but other advances in modern science (such as nutrition and hygiene) have possibly made a larger impact in minimising birth mortality rates.”
Please provide some evidence for this statement lest you become my (2) above.
Cracker
LOL…retarded huh? Well then you don’t know me very well. I know exactly what to do when things like that happen. I also know that homebirth is just as safe as hospital birth. Homebirthers research it backwards and forwards. What do you think people did before there were hospitals? Also, a doula knows what to do as well. It’s not that hard.
Julie, as a childbirth educator, I have seen both sides of the coin. Being a natural birther, I am very passionate about birth and that women be educated. Yes, it’s true that natural birthers can be very strong opinioned, but so can the non natural ones (I have been called some very nasty names). As far as data, I can give you data up the ying yang if you want, but there isn’t room to post it on here. It’s not poorly constructed or unauthentised. It’s out there,
I will give you a few examples here:
Presented on October 20, 1976 before the 104th annual meeting of the American Public Health Association:
So far, the largest and most complete study on the comparison of hospital birth outcomes to that of homebirth outcomes was done by Dr. Lewis Mehl and associates in 1976. In the study, 1046 homebirths were compared with 1046 hospital births of equivalent populations in the United States. For each home-birth patient, a hospital-birth patient was matched for age, length of gestation, parity (number of pregnancies), risk factor score, education and socio-economic status, race, presentation of the baby and individual major risk factors. The homebirth population also had trained attendants and prenatal care.
The results of this study showed a three times greater likelihood of cesarean operation if a woman gave birth in a hospital instead of at home with the hospital standing by. The hospital population revealed twenty times more use of forceps, twice as much use of oxytocin to accelerate or induce labor, greater incidence of episiotomy (while at the same time having more severe tears in need of major repair). The hospital group showed six times more infant distress in labor, five times more cases of maternal high blood pressure, and three times greater incidence of postpartum hemorrhage. There was four times more infection among the newborn; three times more babies that needed help to begin breathing. While the hospital group had thirty cases of birth injuries, including skull fractures, facial nerve palsies, brachial nerve injuries and severe cephalohematomas, there were no such injuries at home.
The infant death rate of the study was low in both cases and essentially the same. There were no maternal deaths for either home or hospital. The main differences were in the significant improvement of the mother’s and baby’s health if the couple planned a homebirth, and this was true despite the fact that the homebirth statistics of the study included those who began labor at home but ultimately needed to be transferred to the hospital.
(“Home Birth Versus Hospital Birth: Comparisons of Outcomes of Matched Populations,” Dr. Lewis Mehl. Presented on October 20, 1976 before the 104th annual meeting of the American Public Health Association. For further information contact the Institute for Childbirth and Family Research, 2522 Dana St., Suite 201, Berkeley, CA 94704)
“It is important to clarify that safety is measured by death (mortality) or illness (morbidity) during the labor and birth process and shortly thereafter. The United States has consistently high maternal and perinatal mortality and morbidity rates compared to other industrialized countries. In 1990 the United States was ranked twenty-third by the Population Reference Bureau, which publishes the mortality and morbidity statistics. This means that there are twenty-two other countries where it is safer for women to give birth than in the United States.”
(“Gentle Birth Choices,” Barbara Harper, R.N. . Rochester, Vermont: Healing Arts Press, 1994. Page 52.)
“A six-year study done by the Texas Department of Health for the years 1983-1989 revealed that the infant mortality rate for non-nurse midwives attending homebirths was 1.9 per 1,000 compared with the doctors’ rate of 5.7 per 1,000.”
Berstein & Bryant, Texas Lay Midwifery Program, Six Year Report, 1983-1989. Appendix VIIIf. Austin, TX: Texas Department of Health.)
Records kept from 1969-73 in England and Wales indicate still birth rates of 4.5 per 1000 births for home deliveries as opposed to 14.8 per 1000 births for hospital deliveries.
(“The Place of Birth”, Sheila Kitzinger & John Davis, eds., 1978 Oxford University Press, pp. 62-63)
A very reliable resource is Obstetric Myths vs. Research Realities by Henci Goer.
I believe a woman should have the choice to birth where she chooses, but when people start telling me (and you didn’t completely) that I am “retarded” or uneducated, I beg to differ. I have a lot of education about the safety of birth at home and my choices to birth at home are based on very substantial, credited information and after much prayer. What is best, is up to the mother and the Lord. After becoming educated a woman can make a choice. What I see so very often, are women who come out of horrible birth experiences and find they were lied to, told they needed to have such and such procedure, that their baby was in danger, that they were in danger, when in fact, the interventions created the danger, or it was not actually present. The interventions were introduced to speed up a perfectly natural, normal process and created distress for the baby and the mother. One of the biggest myths is that the lithotomy (laying down, or slightly reclining) position is preferable for birth. This position was created in the 18th century by a French OB who found it more convenient to catch the baby of his royal patient. It is one of the things that creates more problems for the mother and the baby (cutting off oxygen supply to the baby and the uterus) and creating extensive stress on the perineum, usually causing tearing (I haven’t torn in either of my births so far, but then I was on hands and knees, so there was little chance of it happening, plus the skin didn’t get close to tearing…it has to turn white before it will tear, and neither time, did it even get close to that).
Anyway, I have recieved a lot of flak for the choices I have made in birth, been called some horrible things, etc etc. I have never done the same to anyone else who has chosen differently. I teach my classes to those who want to know, share my information and opinions appropriately and don’t judge. But I get the same from the other side. More often than you would care to believe. So it works both ways. The interesting thing is, I find much of the information from the “non natural” side is flawed.
Geoff –
no apologies needed. I wasn’t upset with your lack of Greek knowledge so much as the one thing that almost turned me off to midwives/doulas: The bizarre propoganda that played on people’s ignorance and elevated “natural” to some sort of religion (I call it the “cult of naturalism” – but that’s a rant for another time)
We did quite a bit of research before settling on our midwife, and even then we had a hospital on reserve in case of emergency.
But all in all, it went spectacularly, we had no complications. I’m a convert, essentially. Good certified Nurse-Midwives are awesome.
Julie,
As I mentioned here, the infant mortality rate in he United states is higher than many industrialised nations. One would presume that if a country as technologically, medically and scientifically advanced as the United States has a relatively high infant mortality rate, then it must be something other than simple medical advances that has minimised infant mortality rate.
In addition, when comparing countries that are not industrialised, it seem that there may be a correlation between level of nourishment and infant mortality.
That being said, I don’t see how I would become ‘your number 2’ since I have not specified what choices I have made, have not claimed them as superior, and did not use my statement to support such a claim.
For that matter, are you going to ask Adeline to provide evidence for her statement?
Mary–
(First, let me say that I have no beef against homebirthers who acknowledge that they are increasing certain risks while minimizing others through their choices.)
“I also know that homebirth is just as safe as hospital birth. Homebirthers research it backwards and forwards.”
And I’m sure that Scientologists ‘research’ the validity of scientology backwards and forwards, too.
“What do you think people did before there were hospitals? “
Um, they died from childbirth in record numbers is what they did.
Your study that you present is flawed for the following reasons:
(1) unless the women were randomly assigned to either home or hospital birth, the populations were NOT truly matched
(2) as far as the outcome of the study, it, too is flawed. A c-section in itself is not a negative outcome (although it *can* lead to negative outcomes, it can also avoid them). In other words, there is a bias by the researchers here. This is true of many of the other outcomes mentioned.
(3) The study is from 1976. Do you think anything might have changed since then? (grin) My mother had c/s in 1975 and 1980 and let me tell you that her experiences were NOTHING like my c/s in 2001 and 2004. I think that invalidates the study for our purposes.
(4) never trust anything out of Berkeley. (just kidding. I say that because I went to school in Bk)
I’ll quote the rest of your studies and then respond to them:
“It is important to clarify that safety is measured by death (mortality) or illness (morbidity) during the labor and birth process and shortly thereafter. The United States has consistently high maternal and perinatal mortality and morbidity rates compared to other industrialized countries. In 1990 the United States was ranked twenty-third by the Population Reference Bureau, which publishes the mortality and morbidity statistics. This means that there are twenty-two other countries where it is safer for women to give birth than in the United States.”
(“Gentle Birth Choices,” Barbara Harper, R.N. . Rochester, Vermont: Healing Arts Press, 1994. Page 52.)
The logic here is so poor, Mary. Is there any evidence that women in those 22 other countries had parallel risk factors to US women and/or more homebirths? This is not evidence.
“A six-year study done by the Texas Department of Health for the years 1983-1989 revealed that the infant mortality rate for non-nurse midwives attending homebirths was 1.9 per 1,000 compared with the doctors’ rate of 5.7 per 1,000.”
Berstein & Bryant, Texas Lay Midwifery Program, Six Year Report, 1983-1989. Appendix VIIIf. Austin, TX: Texas Department of Health.)
Yes, because doctors see patients that have risk factors that would mean that they would not choose homebirths. This is a terrible data point.
Records kept from 1969-73 in England and Wales indicate still birth rates of 4.5 per 1000 births for home deliveries as opposed to 14.8 per 1000 births for hospital deliveries.
(“The Place of Birth”, Sheila Kitzinger & John Davis, eds., 1978 Oxford University Press, pp. 62-63)
See above: these are not matched for risk.
I’d like to see you respond to this study:
http://www.acog.org/from_home/publications/green_journal/wrapper.cfm?document=/from_home/publications/green_journal/2002/ong13594fla.htm
(and don’t just link me to the response in Mothering Magazine, which is an embarrassment from a magazine that I generally like.)
I agree with you that women should choose based on which risks they care to avoid, and needless to say I would never call you retarded for the educated choice that you made, but I have a huge problem with anyone who uses bad science to encourage women to make choices.
I agree with you about interventions–there is a cascade effect. Much better to just cut out (haha) the middle man and start with a planned c-section. (I’m joking here.)
Kim–
See my comments to your wife: I can think of a million factors besides numbers of home/natural births responsible for the fact that US has a higher infant mortality than other countries.
Again, any studies? Do you think all of those women in Sierra Leone are dying because they are being induced in pastel-and-floral themed maternity wards?
Huh? Julie, where did I mention in either of my two comments anything about induction or the type of births a person chooses?
Kim–
You didn’t, obviously, mention in induction. I was using it as an example of one of the boogeymen of the natural childbirth adocates.
Could an administrator do us all a favor and block the troll? Even the nastiest comments in here are at least TRYING to be constructive, while Cracker is simply here to try and rattle up them thar mormons.
Julie:
Here is your evidence:
In the 1800s a Vienna physician observed that in his hospital, the mortailty rate for women in the division run by doctors and medical studnets was three times the mortailyt rate in the unit run exclusively by midwives and nuns. He alsonoted that there were no differen in the kinds of patients in either section, since women were simply assigned to one of the other section on alternate days. As a result, womn in the physician-run unit wereas frightened of the doctors as they were tobirth iteself, believing that the doctors’ interference was the precurser of death.
They were correct, further study found that the doctors were not washing their hands after attending diseased, dying patients, but going straight to deliver babies, still covered in blood.
A scientist named Joseph Lister theorized, at this time that it was microorganisms that were the cause of postsurigcal and postbirth infections, and he introduced spraying physicians hands with antiseptic before attending births. It took a long time for this to be enforced, but death by childbed fever (which was increasingly common in those days) began to decrease. (Immaculate Deception II, Suzanne Arms, page 57-58).
“According to a new study, “Maternal Obesity and Risk for Birth Defects”, PEDIATRICS Vol. 111 No. 5 May 2003, pp. 1152-1158, obese women are more likely than average-weight women to have infants with spina bifida, omphaocele, heart defects, and multiple anomalies. The writers of the article admit that the reasons for these links are uncertain, but MAY include “nutritional deficits in women with poor eating habits”.
What we are saying, then, is NOT that being overweight causes disease, but having poor eating habits causes disease. Why are most overweight women overweight? The same thing that causes the women to be overweight also causes the babies to have birth defects – lack of appropriate vitamins and minerals for proper growth and development.”
Ok…and this site explains the importance (extreme importance of nutrition in pregnancy and how it affects birth)
http://www.blueribbonbaby.org/reference.shtml
http://www.blueribbonbaby.org/bibliography.shtml#COR
Now, I can’t find any research the shows that any hospital intervention (i.e. forceps, vacuum extraction, epidural, episiotomy, lithotomy position, fetal monitor, etc.) actually IMPROVES outcome in childbirth. But there is lots of data that shows nutrition and proper hygeine does improve childbirth outcome.
Julie
I refer you to the books above mentioned.
I also refer you to Shelia Kitzinger. I have to get supper started, and I don’t have time to respond to extensively.
I checked the link you sent me to and it says it is no longer available.
http://www.naturalchildbirth.org/natural/resources/homebirth/homebirth01.htm
My question for you, if maternal and infant mortality in other countries is so much better than in the US (and other western countries) what’s the reason? So far I can see less interventions, better education and better nutrition.
However, outcomes are improving for women and babies in western countries because of better nutrition.
“Outcomes of planned home births with certified professional midwives: large prospective study in North America
Kenneth C Johnson, senior epidemiologist1, Betty-Anne Daviss, project manager2
1 Surveillance and Risk Assessment Division, Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada, PL 6702A, Ottawa, ON, Canada K1A OK9, 2 Safe Motherhood/Newborn Initiative, International Federation of Gynecology and Obstetrics, Ottawa, Canada
Correspondence to: K C Johnson ken_lcdc_johnson@phac-aspc.gc.ca
Objective To evaluate the safety of home births in North America involving direct entry midwives, in jurisdictions where the practice is not well integrated into the healthcare system.
Design Prospective cohort study.
Setting All home births involving certified professional midwives across the United States (98% of cohort) and Canada, 2000.
Participants All 5418 women expecting to deliver in 2000 supported by midwives with a common certification and who planned to deliver at home when labour began.
Main outcome measures Intrapartum and neonatal mortality, perinatal transfer to hospital care, medical intervention during labour, breast feeding, and maternal satisfaction.
Results 655 (12.1%) women who intended to deliver at home when labour began were transferred to hospital. Medical intervention rates included epidural (4.7%), episiotomy (2.1%), forceps (1.0%), vacuum extraction (0.6%), and caesarean section (3.7%); these rates were substantially lower than for low risk US women having hospital births. The intrapartum and neonatal mortality among women considered at low risk at start of labour, excluding deaths concerning life threatening congenital anomalies, was 1.7 deaths per 1000 planned home births, similar to risks in other studies of low risk home and hospital births in North America. No mothers died. No discrepancies were found for perinatal outcomes independently validated.
Conclusions Planned home birth for low risk women in North America using certified professional midwives was associated with lower rates of medical intervention but similar intrapartum and neonatal mortality to that of low risk hospital births in the United States.”
“Outcomes of intended home births in nurse-midwifery practice: a prospective descriptive study.
Murphy PA, Fullerton J.
Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York 10032, USA. pam15@columbia.edu
OBJECTIVE: To describe the outcomes of intended home birth in the practices of certified nurse-midwives. METHODS: Twenty-nine US nurse-midwifery practices were recruited for the study in 1994. Women presenting for intended home birth in these practices were enrolled in the study from late 1994 to late 1995. Outcomes for all enrolled women were ascertained. Validity and reliability of submitted data were established. RESULTS: Of 1404 enrolled women intending home births, 6% miscarried, terminated the pregnancy or changed plans. Another 7.4% became ineligible for home birth prior to the onset of labor at term due to the development of perinatal problems and were referred for planned hospital birth. Of those women beginning labor with the intention of delivering at home, 102 (8.3%) were transferred to the hospital during labor. Ten mothers (0.8%) were transferred to the hospital after delivery, and 14 infants (1.1%) were transferred after birth. Overall intrapartal fetal and neonatal mortality for women beginning labor with the intention of delivering at home was 2.5 per 1000. For women actually delivering at home, intrapartal fetal and neonatal mortality was 1.8 per 1000. CONCLUSION: Home birth can be accomplished with good outcomes under the care of qualified practitioners and within a system that facilitates transfer to hospital care when necessary. Intrapartal mortality during intended home birth is concentrated in postdates pregnancies with evidence of meconium passage.
Publication Types:
* Review
* Review, Multicase
PMID: 9721790 [PubMed – indexed for MEDLINE]”
“Meta-analysis of the safety of home birth
Birth 1997 Mar;24(1):4-13; discussion 14-6
Olsen O
What is the relative safety of homebirth compared with hospital birth? Ole Olsen, a researcher from the University of Copenhagen, recently examined several studies of planned homebirth backed up by a modern hospital system compared with planned hospital birth. A total of nearly 25,000 births from five different countries were studied.
The results: There was no difference in survival rates between the babies born at home and those born in the hospital. However, there were several significant differences between the two groups. Fewer medical interventions occurred in the homebirth group. Fewer home-born babies were born in poor condition. The homebirth mothers were less likely to have suffered lacerations during birth. They were less likely to have had their labors induced or augmented by medications or to have had cesarean sections, forceps or vacuum extractor deliveries. As for maternal deaths, there were none in either group. “
And as Suzanne Arms explains, women were dying due to the fact the doctors didn’t wash their hands properly, and not because of the actual birth itself. Plenty of women had safe births and good outcomes when attended by midwives who practised good hygeine.
You can keep your c-sections 🙂 I will keep my natural births. One of the nice things is I can be back to running within a week. That’s only one thing. With my last birth I could have experienced the entire experience again, labour and birth and all, I felt that good. I look forward to another birth in a couple of months too.
“In the 1800s a Vienna physician observed that in his hospital, the mortailty rate for women in the division run by doctors and medical studnets was three times the mortailyt rate in the unit run exclusively by midwives and nuns. He alsonoted that there were no differen in the kinds of patients in either section, since women were simply assigned to one of the other section on alternate days. As a result, womn in the physician-run unit wereas frightened of the doctors as they were tobirth iteself, believing that the doctors’ interference was the precurser of death.”
Um, Mary, a lot has changed in the way doctors practice medicine in 200 years! (And, I might add, in women’s comfort level with their doctors, who are now often female) There is no reason at all to think this is still valid today.
“Ok…and this site explains the importance (extreme importance of nutrition in pregnancy and how it affects birth)
I checked these links and you will need to explain them to me–what are they trying to show? Do they actually break down nutrition versus medical intervention in birth outcomes? If so, show me.
Now, I can’t find any research the shows that any hospital intervention (i.e. forceps, vacuum extraction, epidural, episiotomy, lithotomy position, fetal monitor, etc.) actually IMPROVES outcome in childbirth.
I’ll speak specifically to epidurals: they improve a very significant outcome: THEY REDUCE PAIN. I think this is a classic example of what I mentioned above about throwing out the baby with the bathwater: as far as I know, there is no benefit to the mother or baby of the lithotomy position (bathwater).
Big picture, again: I think that the risks of various birthing options are not so much greater or lower as they are different. I reject the idea that an ideologically motivated group (i.e., home birth advocates) can decide for other women which risks are acceptable and which must be avoided at all costs.
Also, what is your respone to the ACOG article?
Cracker, please make your comments more constructive or they will be deleted.
#32 is a response to #30. This is a response to #31.
“I checked the link you sent me to and it says it is no longer available.”
Try again, be sure to scroll across the page. It does work.
“My question for you, if maternal and infant mortality in other countries is so much better than in the US (and other western countries) what’s the reason? So far I can see less interventions, better education and better nutrition.
However, outcomes are improving for women and babies in western countries because of better nutrition.”
Since neither you nor I have MDs, I question to validty of two-non-doctors sitting around and debating based on arguments that bagin “so far as I can see.” I’d like to see some evidence to support your positions.
“Outcomes of planned home births with certified professional midwives: large prospective study in North America
Kenneth C Johnson, senior epidemiologist1, Betty-Anne Daviss, project manager2
Main outcome measures Intrapartum and neonatal mortality, perinatal transfer to hospital care, medical intervention during labour, breast feeding, and maternal satisfaction.”
Stop right there. I see bias in what they were measuring: medical intervention during labor is NOT a negative outcome unless your personal preference so indicates. I would also think that women engaging in the countercultural act of homebirth would have a very big incentive to describe their satisfaction as very high. This also goes for the other studies that you mention: they show that for a self-selected cohort home birth is about as safe as hospital births. This is hardly surprising, and hardly much evidence in favor of home birth as the best choice for all. (Again, I have no problem with individual women choosing this, I just have problems with home birth ‘pushers’.)
“You can keep your c-sections 🙂 I will keep my natural births. One of the nice things is I can be back to running within a week. That’s only one thing. With my last birth I could have experienced the entire experience again, labour and birth and all, I felt that good. I look forward to another birth in a couple of months too.”
If you consider running a nice thing, you might need to explore whether your birth choices have led to mental problems. (JUST KIDDING!!!) My experience, by the way, was a much quicker return to normal activities after my c/s than my natural birth.
Ok, I have to do this piece by piece.
Epidurals don’t reduce pain for everyone. I know plenty of women who discovered the epidural “didn’t take”. And having experienced pain in birth, without any relief, one thing I realised is that immediately after the birth, as long as thre have been NO inteverventions, drugs or otherwise, the pain stops. But I am not against the educated use of drugs in birth. It is definitely personal choice. My personal choice is I avoid all drugs, I have for almost 20 years now. And before that the most I had was aspirin or tylenol.
“Since neither you nor I have MDs, I question to validty of two-non-doctors sitting around and debating based on arguments that bagin “so far as I can see.” I’d like to see some evidence to support your positions.”
Sure, you will have to give me some time though, so send me your email (to siever@canada.com) and I will get it for you. If you check our Dr. Tom Brewer’s sige and who.org you will find ample research, however.
Now, those sites don’t break down interventions versus nutrition. There may be research showing such, but I don’t have any at this point. I keep those seperate as they are seperate issues. Nutrition in pregnancy and birth is very important, as countless studies have shown…babies are born healthier, mothers recover better.
“Big picture, again: I think that the risks of various birthing options are not so much greater or lower as they are different. I reject the idea that an ideologically motivated group (i.e., home birth advocates) can decide for other women which risks are acceptable and which must be avoided at all costs.”
I agree they are different. However, you are suggesting that I am deciding for others what to do. This isn’t the case, for several reasons. It’s not in my nature, it goes against my philososphy as a childbirth educator and it’s not my agenda. My choices are valid (most of my research is in the books I own, and I just don’t have time to sit and type it all down for you, which is why I am directing you to the books themselves. The research is there. Another good book is Naomi Wolf’s ‘Misconceptions”.) and that’s all that matters to me. But I often can’t keep silent when comments are made that don’t ring true. Now, research can be flawed, on both sides of the issue. As you should know.
My response to the article. Ok, I will let MANA do it for me:
http://www.mana.org/WAHomeBirthStudy.pdf
and…
http://www.midwife.org/press/display.cfm?id=279
Then you have:
Kenneth C Johnson and Betty-Anne Daviss, Outcomes of planned home births with certified professional midwives: large prospective study in North America, BMJ, Jun 2005; 330: 1416
This prospective study of more than 5,000 births in US and Canada concludes that “Planned home birth for low risk women in North America using certified professional midwives was associated with lower rates of medical intervention but similar intrapartum and neonatal mortality to that of low risk hospital births in the United States.” (more detailed information at the source listed)
http://www.ecmaj.ca/cgi/content/full/166/3/315
Yes, I love to run. And being 7 months pregnant, I am still enjoying it. 🙂
I am glad you recovered quickly from your section, especially since it is major abdominal surgery. Sounds like your health is in good shape.
Geoff, I thought your post at Meridian was fascinating. Thanks to you and your wife for sharing your experiences at the hospital.
Mary–
All I needed to read was your acknowledgement that the risks are different, not ‘less’, and I feel that our conversation is over. I have no problem, as I stated above, when people in either camp recognize that. But you’d be amazed how many home birth advocates I meet that refuse to acknowledge that birth choice means choosing risks, minimizing some risks and increasing others.
Julie
Yes, and ditto. You would be amazed at how many people I meet who say that my choices are dangerous and irresponsible and bordering on child abuse. The key is informed decisions and personal responsibility, which is my goal in all areas, especially in health and birth.
Yes, the risks are different, and they vary tremendously depending on the woman involved and the hospital and doctor involved. It really doesn’t matter what is safer on average because individual women make the decision. What is safe for a woman like Mary would be very different than what would be safe for someone like me, who has had three c-sections for good reasons. And hospitals and doctors vary in their willingness to do interventions (such as Pitocin) that can introduce higher risk to a hospital birth.
Geoff, I transported to the hospital after an attempted homebirth with one of my children. The midwife came along with me to assist with labor before we decided the whole thing was pointless and I got the c-section. Although I hadn’t met the doctor before, he was just as kind and gentle as can be. The hospital staff was very polite and didn’t do anything without my consent. The nurse, OB and my midwife worked together politely. I was very impressed with and grateful for their professionalism, since they could have treated me very differently.
Also, what interventions a woman might want or not want depend on the goals for her family. For example, if a woman wants a very large family, c-sections aren’t the best way to go, if she has any choice in the matter. If that woman knew that being induced made her more likely to get a c-section, she would want to avoid an induction for a supposed big baby or being a couple of days past her due date if the baby is in good health.
This has been a fascinating read for one who has no children yet, but is trying. I always assumed I’d be in a hospital with a doctor with a medical degree. I’d like to see what recommendations you have for making the decision – or choosing the risks – when deciding which way to go, and more importantly what options are available. I know I wouldn’t be comfortable with a home birth, and I know for sure I want someone with a medical degree by my side in case something horrible happens, but beyond that I don’t know what options are available. Since there are many here who have had different experiences I’d like some references on options if you wouldn’t mind sharing.
Women should be able to make informed choices about their birthing decisions – I think we can all agree on that. But C-sections are major surgery. Unless there is some medical determination that a vaginal birth would be dangerous to the mother or baby, I guess I just don’t understand why you would choose to be cut open instead of having the baby “naturally”.
I don’t think people should be judged for choosing one way or the other, and it’s kind of sad to hear women competing with each other for the worst and most painful labor stories.
We’ve had our four children
Kristen likes to labor at home, doesn’t use epidurals or other pain medication during labor, likes to walk during contractions if possible, likes to room in with the baby after delivering, and likes to nurse immediately after delivering, among other things.
Bottom line — know what you want, and shop around to find a practice that thinks like you do.
For some insight into one possible reason for asking people to leave the room during an epidural see this story at msnbc http://www.msnbc.msn.com/id/8506245/
Kent, this is an interesting insight, and I appreciate some people are scared of needles, but give me a break, watching your wive’s private parts cut up with a pair of scissors has gotta be 100 times more frightening and fainting-inducing than an epidural needle. Luckily, I have no fear of blood or operations, so I was fine. But you have provided a reason why some anesthesiologists might not want anybody there. The issue is that there appears to be no consistent policy.
Emily, the Henci Goer book referenced earlier in the thread has excellent scholarly information. The book she wrote towards more of a lay audience is “The Thinking Woman’s Guide to a Better Birth,” and it also has excellent information in it for making decisions.
Tess wrote, “Women should be able to make informed choices about their birthing decisions – I think we can all agree on that. But C-sections are major surgery. Unless there is some medical determination that a vaginal birth would be dangerous to the mother or baby, I guess I just don’t understand why you would choose to be cut open instead of having the baby “naturally”.”
Let me tell you why. MEN AND ANYONE WITH A WEAK STOMACH SHOULD NOT READ THIS.
I am 5 feet tall and normally weigh 125 pounds. My first baby was 10 pounds and 3 ounces. I had him vaginally. I had internal tearing which necessitated internal stitches. I had a serious episiotomy which meant that I could not move any part of my body below the waist without extreme pain for six weeks. I leaked urine for about six months (thank heavens it stopped on its own–many women will continue to have urinary incontience and possibly fecal incontience for their ENTIRE lives–I was 22 when I had this baby. Many women will also have pain and/or loss of sensation with sex.) The baby was born at 4:44am after four hours of pushing and that alone would have taken me months to recover from. The trauma of the experience led to me developing PTSD with hallucinations and flashbacks and general anxiety and depression for about one year.
Sorry you asked?
If I had known anything or done any research, I would have chosen to have him by c-section. The risks of a planned (as opposed to an emergency . . .) c-section are not that great. Studies indicate that 1/3 of female British OBs wouls choose an elective c-section for themselves for NO medical reason. I am pretty darn lucky that I had no permanent damage from this birth–I beat the odds. I think any small woman with a large baby should seriously consider what she is getting herself into by attempting a natural birth.
Follow-up: my next two births were elective c-sections without the slightest problem. Beautiful, empowering experiences. I plan on having one more baby, and of course by c-section.
More info: http://www.newshe.com/articles/csection.shtml
This is the story of a female urologist and why her experiences caused her to have an elective c-section.
Also, I agree with Bryce that the attitude that you need to take is to shop around for what YOU want–and you need to figure out what you want on your own.
Geoff,
Different people have different, unexpected reactions to watching a large needle being inserted into their loved one’s spine. It isn’t a matter of “fear of blood or operations”. You might be the manliest man around, skin your own deer, etc and the sight of that needle might make you faint. There is no way of knowing ahead of time.
Julie, you provide an excellent reason for women to have a c-section. I have known other women in your position who made the same decision, and more power to them. It is worth noting, however, that there are some doctors who push women to have unnecessary c-sections. At the hospital we chose, 54 percent of pregancies end in c-sections. That seems a bit high, don’t you think?
At the same time, there does appear to be a section of society that unfairly judges women like yourself who have elective c-sections, and you’re right to feel justified in your choice.
Julie – Obviously, there were medical reasons for your c-sections, and it’s terrible you (and your doctors) didn’t realize the risks of a vaginal birth for your first baby.
I guess I just see that a woman’s body is designed to carry and have babies, and, if there is no medical reason why you shouldn’t have the baby naturally, why should a c-section be an “option”? Should OB’s give women information on having elective c-sections as opposed to going through painful labor? I think I’d prefer to be put to sleep and wake up with a baby than to endure the horrors of childbirth. And recognizing that I’m a product of a misogynistic culture, it seems that choosing a c-section when a woman is perfectly capable of delivering a healthy baby is a bit of a cop out.
Julie, when you say that many women experience fecal incontinence for the rest of their lives—do you mean small women with large babies, or women with internal tearing, or major episiotomies, or what? In all honesty, I’ve never ever even heard of this, and certainly have never known a woman who experienced it.
Geoff B–
I don’t think that we should look for a magic number of c-sections, we should look at the reasons for them. There was some thing of a scandal when we were in CA over a hospital that was NOT doing c/s on poor Hispanic women who were dying (or their babies were) in record numbers. And then we have hospitals where out of laziness or fear of lawsuits, women are pressured into them. Not OK, either. So I think the reasons for or against are more important than the numbers.
Tess–
I suppose we are reduced to quibbling about what constitutes ‘medical reasons’ here. As far as a woman’s body being ‘designed to carry and have babies’, a look at the historical data would suggest that women are also designed to die in childbirth in high numbers, to lose babies with mismatched rh factor (I would be short two if not three sons without that medical intervention), and to have really bad teeth! I don’t put much weight in arguments about what is ‘natural.’ You don’t hear much call for ‘natural’ dentistry, do you?
You asked, “Should OB’s give women information on having elective c-sections as opposed to going through painful labor?”
I think in an ideal world, a newly pregnant woman would get a fact sheet showing the latest data on the risks and benefits of all flavors of birth: stats for the hospital, stats on homebirth, stats on emergency c/s, stats on elective c/s. Then she can decide which risks she most wants to avoid.
“And recognizing that I’m a product of a misogynistic culture, it seems that choosing a c-section when a woman is perfectly capable of delivering a healthy baby is a bit of a cop out.”
Why? I think we would want women to evaluate the data and make their own decisions. If you want to talk misogyny, I have a real problem with the idea that 10+ hours of intense pain is something that we don’t even weigh in the balance when making decisions about birth. I can guarentee you that if men gave birth, their pain would be a serious consideration. But no one seems to think to ask women how they feel about suffering.
The last data point I saw was 4% of women who deliver vaginally will have problems with this. This article does, I think, a good job of presenting the risks and benefits of various birth modes:
http://www.cmaj.ca/cgi/content/full/170/5/813?ijkey=047c22b9ef16168054e5285513187292733696f2&keytype2=tf_ipsecsha
My guess is you don’t hear about it because very few women would ever discuss it! Again, I thank heaven that I was spared these problems–I know that the risk goes up for large babies with smallish moms.
Oops, #50 was directed as Rosalynde’s question.
Tess-
I thought I was done posting and I went to go straighten up, but the more I think about your ‘cop-out’ language (regardless if it was personally directed at me or not), the more amazed I became. Is it a cop out to have a tooth pulled instead of suffering until if comes out on its own in a week? Is it a copout to have a bone set instead of allowing it to heal on its own? The phrase ‘cop-out’ suggests an entire philosophy about birth that is inconsistent with every other medical practice. If a woman chooses a non-medical model for her birth, I say ‘more power to her.’ (Go Mary Seiver!) But no one has a right to impose her philosophy of birth (and it is a philosophy, not a science) on another person.
Julie – I’m speaking for the uneducated masses when I say ELECTIVE c-sections seem like a “cop out”. I said in one of my earlier comments that I would prefer to have a pain-free delivery. And if elective c-sections were seen as a “legitimate” option to natural childbirth, then I think many, many more women would choose elective c-sections.
I feel like you’re being a bit extreme in using the infected tooth analogy. The infected tooth is a tooth that has been destroyed and needs to be taken out. A child is something a mother and father creates and that, in a potentially dangerous but “natural” process, a woman’s body is generally capable of delivering. Thank goodness for medical improvements that have reduced the deaths of infants and their mothers. I just think most people are of the opinion today that elective c-sections cross the very hazy line from palliative to “unnatural”.
So, it would be hard for me to justify having an elective c-section without feeling a bit guilty. From reading through your comments and some of the research – you’re probably right that this bias is misguided. Maybe in a few years this bias will change, and more women will feel more comfortable forgoing vaginal birth and embracing elective c-sections.
By the way, I don’t think your c-sections were a cop out. And, at the end of the day, who cares what anyone thinks about your choices? This is a personal choice that women should make independently of social pressure.
P.S. By natural childbirth, I mean vaginal childbirth – not unmedicated childbirth.
Geoff,
We have had all three of our children at the hospital and had wonderful experiences (my wife doesn’t like the pain, but aside from that, they have all been good experiences). We have never had a Doula or Midwife. However, our doctor was in his fifties and had a ton of experience and good temperment. I would suggest that perhaps it’s these two factors that creates a more pleasant birthing experience no matter the type or place of birth. If a doctor or midwife has had experience, then if somebody says that they have gone fast in the past, they probably know that this could very well be true, even if they haven’t seen this person go through it in the past. If a couple shows up with a doula and your doctor has had experience with doulas, then it should be more pleasant.
Our first was born without the help of a missed epideral. The second didn’t have time for an epidural. The third (just over a month ago) we had an epideral which took and my wife thourougly enjoyed the experience as she wasn’t in pain like the previous two. In any case, we have three perfect children with no effects due to our choices. I will bet that most posting here have no lasting defects on their children due to their tastes and decisions on child birth.
I will say, however, that I am greatful that my wife has taken the time to learn about the different choices and has made her choice accordingly. She often gets after me for not reading up on it, but I tell her she has done enough for the both of us. And, in the middle of a contraction, she would tell me I didn’t know anything anyways, so why bother 🙂
I don’t think purely elective c-sections are done, if by elective you mean “I want one for no particular medical reason.” Julie definitely had a medical reason for her c-sections. I did as well, as the baby just wasn’t going to come out any other way. When doctors say “elective c-section,” they mean “scheduled,” not that you are doing it just for the heck of it. (“Emergency c-section” means “unscheduled c-section.” It may or may not include rushing.)
Maybe some doctors will give you a c-section if you just say you want one, but it’s not accepted practice. They would have to invent some reason to put in your notes.
Sara R- that was another question I had about elective c-sections – I didn’t think OB’s would let a woman “choose” to have a c-section, but it sounds like from Julie’s research that some women are given a choice to have their baby by c-section with no medical reason at all. Also, would insurance companies pay for elective c-sections (c-sections that aren’t “medically” necessary)? Aren’t they more expensive than vaginal births?
“I had internal tearing which necessitated internal stitches”
How is this different than artificial tearing of the abdomen during a C-section and the subsequent stitches to help the wound heal?
Of our four children, the first was delivered by a disinterested OB/GYN (the only game in town) — an old-schooler of the unstated opinion that women didn’t deliver babies, DOCTORS deliver babies.
Our latter three were delivered by certified nurse-midwives in comfortable medical surroundings. I consider that to be the best of both worlds: medically trained professionals who have access to surgery and other worst-case situations, but who understand that childbirth is a natural bodily process, not a medical condition to be treated.
In larger terms, I have adopted an attitude toward doctors, nurses, and other medical professionals which I trot out only if they seem entirely unwilling to consider our wishes:
“Let me make something clear to you. *I* am in charge here. You are the *employee.* You are here right now because I am *paying* for you to be here. You can be fired, and you will be if you don’t figure out right now who is the boss here.”
(In my experience, actually, it’s nurses more than doctors who tend to get imperious and need to be reminded of their place in the food chain.)
I’m sorry you had such a tense experience. I had my 2nd child at home, largely due to my desire to only have kind, supportive people around while I was giving birth. It’s hard enough without dealing with jerks.
Kim–
(I’m trying to think of a delicate way to answer your question.) Like I said, I’ve had 3 c-sections, despite planning a homebirth for one of those sections. For one of those c-sections my abdominal wound didn’t heal properly and I had to have daily wound care (which was Not Fun) till 6 weeks postpartum. Despite this I’d rather go through that than the internal tearing and stitches. If you imagined yourself in a woman’s place, you probably can figure out why. If you had the choice between an abdominal wound or a wound of a much more personal place of your body, you’d probably choose the abdominal wound too, even if it was “less natural.”
Julie’s situation doesn’t happen all the time, and as far as I know there’s no way to accurately predict a baby big enough to do serious damage. (Ultrasound estimates of a baby’s weight are routinely way off. My first baby was estimated to be 1 1/4 pounds heavier than she really was.) C-sections carry their own risks that not only visit themselves on the mother and baby, but on future babies as well. Some doctors think that the risks of a vaginal birth and a c-section are roughly equal to the present baby, but when you look at a repeat c/s (or VBAC) versus a repeat vaginal birth, the repeat vaginal birth is way safer for mother and baby. I think some of the doctors that are advocating for elective c-sections assume that women don’t want large families and don’t take the health of future children into account, because I’ve never heard a doctor spell out that risk.
Mary, unless Julie tells me differently, I think that the confusion about elective c-sections is a confusion about definitions. Julie’s c-sections were medically indicated by her previous traumatic vaginal birth, but the doctor probably called it “elective” which normal people interpret to mean “for no good reason.” If I had another baby, the doctor would also call my next c-section “elective” even though I really have no choice in the matter; no doctor would let anyone with my history try a VBAC. There may be some doctors who do provide truly elective c-sections, but they would have to jot down some reason (“suspected macrosomia”–big baby–for example) in the chart so there is some reason there.
Purely elective c-sections are not uncommon. The vanity c-section is often requested in Hollywood in order to avoid some of the unpleasant long term effects of a vaginal delivery. I would not consider Julie’s case to be what people mean when they say “elective c-section”.
Sara R wrote, ” I don’t think purely elective c-sections are done, if by elective you mean “I want one for no particular medical reason.”
While whether mine were elective or not depends on how you define the word, I would say that based on the debate in the medical and ethics journals that you can find online by googling ‘patient choice cesarean,’ that there is a significant number of women doing this. As far as payment, I have no idea if OBs are fudging the notes or if patients are paying outright or what. I do doubt that insurance companies would cover them. Viagra, yes, of course.
Kim asks, “How is this different than artificial tearing of the abdomen during a C-section and the subsequent stitches to help the wound heal?”
Well, the c/s didn’t hurt like hell for starters. If you imagine someone stretching the skin of your penis until the skin itself ripped you might get an approximate sense of the experience. Internal tearing and episiotomies are also in high traffic areas, compared to the abdomen, if you know what I mean. Plus, c/s incisions didn’t come close to affecting my mobility or follow up pain (I’m talking 6-8 weeks later) the way the others did. Full disclosure: the only problem I have had from my c/s incision is on one occassion I got a charlie horse in it while doing yoga, which was weird beyond belief, but didn’t actually hurt and went away in five minutes.
Sara R–You do have a point about multiple repeated c/s that doesn’t often make it into the literature because they assume no one is having nine kids these days. I think that as far as electives go, I’ve read three as an ideal limit.
You are also right, Sara, that there is a definitional issue. I am seeing ‘patient choice c-section’ to mean ‘truly elective as opposed to planned-but-not-an-emergency.’ But the language isn’t always consistent.
The host of the Splendid Sun blog emailed me a link to this page, wanting to know my thoughts on the matter. He knows I’m a Neonatologist (I take ’em on hand-off from the OB) and am very judgemental and opinionated on such topics. Currently I’m on call in-house watching over about 50 sick infants…I can’t think of a better way to pass the time.
Being the doc who takes care of the product of these deliveries, I don’t really care how or where the mom delivers the baby as long as it does not increase the risks to the infant. You can do home deliveries, or in a pool, or with dolphins (don’t laugh, it happens), or strapped to the back of a camel; as long as it does not jeopardize the welfare of the neonate, have at it. That being said, there are some minimal conditions that must be met before I would ever recommend a home or birthing center delivery:
1. A qualified professional be present who can recognize a problem when it happens and be able to intervene. That means they must be NRP certified and have the appropriate equipment necessary to resussitate a coding neonate.
2. The place of delivery must be in reasonable proximity to a facility with OB care in the event that the above person recognizes a problem and can get mom and baby there ASAP.
3. The mom must have outstanding prenatal care with regular follow-up and the pregnancy is deemed low risk. That means a term gestation (>37 weeks), and not post-dates (
“Ultrasound estimates of a baby’s weight are routinely way off.”
Why would the baby’s weight be an issue? I would think a baby with 17in head who weighed 7lbs would produce more chance of complications than 9lb baby with a 13in head.
Julie,
So it wasn’t the tearing, per se, that made you decide for C-sections, but the fact that is was uncontrolled like a C-section is?
My post got cut off–it continues:
3. The mom nust have outstandin prenatal care with regular follow-up and the pregnancy is deemed low risk. That means a term gestation(>37 weeks) and not post-dates (
Let me try this again, I’m having problems:
3. The mom nust have outstandin prenatal care with regular follow-up and the pregnancy is deemed low risk. That means a term gestation(>37 weeks) and not post-dates (less than 42 weeks), good placental attachment, no detected fetal anomalies, no advanced maternal age, no prior c-sections (sorry, if you want a VBAC, do it in a hospital), no gestational diabetes, no pregnancy induced hypertension…I could go on.
4. The newborn must get adequate treatment and follow-up. This means a vitamin K shot and antibiotic ointment to the eyes within 24 hours, evaluation for hyperbilirubinemia (jaundice), evaluation for appropriate weight loss and gain, blood for state screens sent, and timely vaccines (if you are anti-vaccination, stop right now–I will be very unkind if you follow that tripe).
If you can meet the above conditions, knock yourself out. It is a woman’s perogative to make those choices. I only take issue when your childbirth choices endanger the life or welfare of the little ones. Do what you will to your own bodies, just leave the babies out of it. Better yet, keep the babies in the forefront of your decision-making process. Whether you feel the need to be at one with nature, or you have a scalpel fetish, make your decision based on what is best for the baby. I must say that it has been interesting reading the dueling citations above, however off the mark some of them are. At least you all give a crap about childbirth enough to write your opinions here. I spend way too much time dealing with the fallout from pregnancies that the mothers wanted to pretend weren’t there, and then they abused themselved and their unborn children.
I tried to have my last baby curled up tightly in the fetal position with my hands gripping the bars of the bed. The natural childbirth nurse said I could have my baby any position I wanted to be in. They kept telling me to turn over and put my feet in the stirrups and I screamed, “NO!Donna said I could have my baby any position I wanted and this is the position I want!” My husband and the doctor pried my fingers one by one and physically turned me over. I still think it probably would have worked, somehow.
Also, I had an episiotomy with all my kids, it was routine back then, short, easy deliveries, very little pain afterward. Although I am the only woman I know who’s ever said that. I will say quietly “Mine didn’t hurt.” and feel sort of superior like my friend must feel when she tells me she doesn’t have pain in labor.
When you think about it, descriptively, it seems like it should hurt. Boy, there are a lot of my troubles out there I would trade for a painful episiotomy, though, having lived long enough to know. That wouldn’t even be in my top 100. Although I forgot who you were, you who descriptively described it, were I you, it might be.
I had all my children natural as well, not on purpose. I highly recommend the epidural.
Gee, Kim, I would have thought that my extremely graphic descriptions up to this point would have made it entirely obvious that the issue is pain. How have you managed to miss that point?
Chris S.–Thanks for weighing in; it is nice to hear from an actual professional for a change.
j
Julie,
The comment to which I had first responded—where you mentioned the reasons why you chose a C-section (comment #30)—made no mention of pain.
Kim–
I thought we were working on #58, 30# was Cracker’s comment, not mine.
If you meant #44, you had a serious failure of imagination if you thought that muscle and flesh could tear or a woman could push on a 10# baby without pain involved.
Sorry, I meant #44. My mistake. #30 is just so impressed in my mind. 😉
Whether pain is involved in tearing is beside the point. It wasn’t mentioned, so I just based my response on the reasons you listed, not implied ones.
Kim,
Does a c-section involve tearing? I would have thought it involved cutting–very different.
It does involve cutting. Fundamentally, tearing tissue and cutting tissue are quite similar.
Kim,
As someone who will never undergo childbirth, you glibly dismiss womens’ pain during the process and confidently assert that vaginal tearing is “quite similar” to a c-section. And you do so disagreeing with the statements of a woman who has actually undergone them both.
Julie’s argument is that, based on her own experiences, a c-section was better for her. (Not all women — but for some, including her).
You seem determined to challenge her position. It’s an argument that you CANNOT win. The more you try to challenge Julie (on a topic about which she knows infinitely more that you ever will), the more you will look like an insensitive jerk.
I am not dismissing anyone’s pain, glibly or otherwise, Kaimi. What I said was tearing of tissue and cutting of tissue is fundamentally the same thing.
Will you please show me where I disagreed with her regarding the pain she underwent? I must have missed the comment where I did so.
Julie’s comment regarding a C-section being better for her was irrelevant to my comments. I said nothing regarding whether it was better or worse.
I also fail to see how I am challenging her. I simply asked her to explain how natural tearing of vaginal tissue and subsequent stitching was different than an abdominal surgical procedure and subsequent stitching. She explained to me how she viewed them as different. I thought the issue was over, but it seems you and others seem intent on dragging it out. If you put less effort into reading into things and more effort into reading what was actually said, you’d see that. Perhaps even the name calling could have been avoided.
Kaimi
My husband is not an insensitive jerk. he was, and will be, with me, throughout my births. He saw the pain I went through, and let me tell you I didn’t have any relief, and for my first birth it was more incredibly strong than anything I went through. He was an amazing source of comfort and strength to me. He doesn’t “glibly dismiss” anything a labouring mother has gone through, and if you read his version of our birth stories, you will see that. I don’t think there is any man who can more understand what birth is like, from a man’s persepctive than my husband. He caught our babies, he supported me, and he was totally in it for me. He didn’t think about his own comfort or convenience at all. Every single thing he did was for me and our baby. My first labour was 24 hours and my second was 12 and he was completely and fully selfless throughout them both. And he will do it again in just a couple of months. THAT is the type of husband and man he is. He was a fully responsible attendant and support at our births.
He wasn’t challenging or dismissing Julie at all and if you actually read his comments you would see that. So don’t you dare call him an insensitive jerk.
Kim and Mary,
I’m responding to a few particular statements. In particular, Kim’s states that pain due to vaginal tearing is “beside the point” (#73) which seems to completely miss Julie’s point that her pain was a huge factor in making her decision.
Also, his repeated assertions that c-section cutting and vaginal tearing are fundamentally the same thing are hard to view as anything other than a challenge to Julie’s position, which is that for her the two had hugely differing personal consequences.
I shouldn’t have called you a jerk, Kim, but I got upset at seeing a friend’s pain dismissed as beside the point. I’m sorry for calling you that.
I am glad to see somebody who is willing to apologize.
As with most topics where people can hold very polar views, things can get a little out of hand. Lets put away the boxing gloves, everyone. 🙂 By the way, it makes me very nervous when people insult other people. I feel so bad for the person being insulted. Then, if that person gets insulted, in turn, it wrecks further havoc. Well, I discovered from reading a book that such feelings are common to my background. So sorry if I have no business getting involved.
I appreciate and accept your apology, Kaimi. It takes a man to be humble enough to apologise. I’m sure I don’t do it often enough.
The pain due to vaginal tearing was beside the point. The point was that I did not see pain listed as one of the reasons Julie chose C-sections for her subsequent births. The fact that pain accompanies vaginal tearing (a fact I am in no way disputing) was beyond the point of comment #58.
I have never said that C-sections and tearing during vaginal births are fundamentally the same thing. What I said is that cutting and tearing tissue is fundamentally the same thing. In both tearing of tissue and cutting of tissue, the tissue is separated.
“It takes a man to be humble enough to apologise.”
Lest I offend someone else, I am in no way suggesting women are incapable of apologising or being humble.
Kim, I’m wondering if you read paragraph 4 of comment 63. This is where Julie answers your question the first time with a graphic description of the differences in pain between her vaginal birth and her c/s. Two comments later (#65) you “restate” her position with something she didn’t say.
I think I figured it out. Kim asked what the difference is between a vaginal tear and stitches and an abdominal tear (incision, actually) and stitches. The difference is in which body part is torn or cut. I doubt Julie would have been more enthusiastic about vaginal surgery than vaginal tearing, so it’s not a matter of the cut being controlled or uncontrolled. The two body parts differ greatly in function and sensitivity. Does that answer your specific question clearly enough?
Nature is great and usually works, but it’s a fallen world and nature doesn’t work all the time. I don’t think it’s wise to introduce interventions where unnecessary, because they often lead to problems of their own. But when nature fails, I’m grateful for modern medicine. My kids and I wouldn’t be here without c-sections.
Thank you, Kaimi, for your very good and salient points, which I agree with, despite your apology. I wish you had been on the Today Show with Tom Cruise.
My sister had four children naturally, terrible deliveries all, because she had a small pelvis and huge babies with big heads.
She decided to have her last baby c-section, hoping to avoid all those terrible labors. I don’t know where she thought it would be less painful, well, they give you drugs which help, but boy, did she complain about the multitude of inconveniences and discomfort (doctor’s euphemism for pain) for a long, long time. She changed her mind about the c-section a few days later, but oh well, too late for that.
Hey, Kim, I’ve never read anything from you, admittedly in the relatively short time I’ve been here, admitting you were wrong or apologizing, and I think you get pretty mean, Mary’s objections to the contrary. Wonder what that means?
“I’ve never read anything from you…admitting you were wrong or apologizing, and I think you get pretty mean…”
Uh. Ok. I am really not sure how to take this and am at a loss to even understand where this came from. For that matter, I can’t recall you admitting you were wrong or apologising on here either; does that make you pretty mean?
Feel free to point out where I was wrong in a comment, or where I needed to apologise. Feel free to point out where I was getting pretty mean.
What, where’s Mary to come to your defense and tell me what a sweetheart you are?
The last time we “talked,” I apologized. Don’t think I’ll be doing that to you any time soon again.
But actually, I apologize a lot. I regret a lot. Just not this time.
Rand across this in a news article today after having read this post and the comments:
Full story here.
I think you’re going to see a lot more husbands asked to leave the room.
You could actually file malpractice claims based on some of these things.
Just wanted to weigh in on c-section recovery – I had three c-sections, all planned in advance, for medical purposes – I really had no choice in the matter. I realize I may not be a typical example, but with all three c-sections, I was up and running within 3 days. By the time I was released from the hospital (after 3 days), I was ready to roll, for all intents and purposes, and never required anything stronger than tylenol for pain relief. I went skiing 2.5 weeks after my second c-section. I’ve never had any complications or difficulties stemming from my c-sections. The women in my family are all pretty hardy, so perhaps I have some genetic predisposition towards healing quickly, I don’t know.
I have seen (anecdotally) a great difference in recovery experiences between women who had c-sections with no labor, and women who labored for hours, ending in c-section. The women who labored first generally had terrible recoveries – their bodies had to recover from both labor and c-section.
My only point is that c-section recovery runs the gamut, just like labor recovery. Some women recover extremely quickly, some do not. (I know, no kidding.)
Sue M–
Sorry to tell you this sister, but you missed a huge opportunity to milk your “majoy abdominal surgery” and spend several weeks in bed ‘recuperating’ by reading novels, napping, and asking that snacks be brought to you on a little tray.
(Here’s one thing natural birth advocates are good for: by insisting on how terrible c-sections are, they create an environment where this type of behavior is possible.)
P.S.–Please do not tell my husband, mother, and everyone else who took care of my house and children for a month about this.
You bring up an interesting point, Julie. Mary was up walking around doing, visiting her visiting teaching sisters when she was in labour with our son. The Relief Society president saw her when she was out for he daily walk. When the Relief Society president found out the next day that she birthed him a few hours after talking to her, she was absolutely shocked that Mary wasn’t bed ridden that day. She was even more shocked when Mary was out and about the following day.
I’m not sure what it is, but many people seem to treat pregnancy/childbirth like it is some sort of debilitating disease. I’m considering making sure the Relief Society doesn’t bring suppers over when this baby is born. After all, I make the suppers, so what’s the point? That would sure ruffle some feathers.
Kim Siever–
Actually, despite my joking aron in #92, I have very mixed feelings about this: I think the fact that women brag about being “up and at ’em” just a few hours or days after giving birth can be (notice I said ‘can be’, not ‘is’) (1) sick female machismo, (2) part of our cultural downplaying of the seriousness of pregnancy/birth/motherhood (3) an unfair expectation that women will continue to serve their families despite anything they might go through.
No, women don’t need a ten day hospital stay after a normal birth. But I’m not entirely comfortable with the growing expectation that they’ll be back to normal immediately. Depending on the woman, that may not be appropriate. Even if completely recuperated from the birth, she’s still up every few hours with a newborn!
Hey, I’m not downplaying the seriousness of labor/c-section/anything! I’m just one of those people who heals quickly and hates to be stuck in bed. The point of my post was to say that not all c-section recoveries are horrible.
Now ask me how I fared when my newborn decided to stop sleeping at night, and you will hear a story of grief and woe, certainly. The sleep deprivation was truly debilitating.
Julie,
Naturally, it all depends on the type of birth.
Got to the discussion late but love the interchange. As a board certified Ob/Gyn in Utah and one who has had experience with lay midwifery in Montana as well as the whole academic environment (as an Assist. Clinical Professor at Stanford)you have certainly picked a topic ripe with controversy. In Calif. if ever a department meeting was going slowly, all one had to do was bring up whether or not Ob/Gyn residents should be required to observe abortions in the name of education, and the meeting would fly apart as the topic always elicited some fairly strong heat and not much light. In Utah, one can get the same reaction by entering into the home birth / midwife / Ob/Gyn debate. The state just passed a lay midwife bill during this year’s legislative session, and as one involved in the process, it has been an education to say the least. As time is short at present I just thought I might leave a few comments.
1. All false dichotomies are falacious. The whole ALL C sections are bad / all home births are good–ALL midwives are caring / ALL Obs are impersonal and insensitive, etc. really doesn’t do justice to the issues, especially if one’s evidence is anecdotal at best. In you want to play the competing studies game, be my guest. I’ll get our Internal Review Board medical statistician to try and explain why all evidence is not created equal. It gets pretty complicated comparing meta analyses to single institution studies, to compensate for type II beta error, as well as to try and control for a whole host of bias errors (and the birthing experience is rife with bias.) I don’t know many women who would ordinarily insist on giving birth in a hospital but would be willing to be randomized to a home birth as part of a study to see “IF home births are as safe as hospital births.” But since most of us live by anecdotal data, let me give you some of my own. For example, gender is always an issue in Obstetrics. There are those who adamently hold that men should not be in Obstetrics, feeling that never having had a mentrual period or having felt labor disqualifies them in some important sense. During the five years I was at Stanford there were only 2 male Ob residents in the entire program so I had a chance to observe “women caring for women.” Not surprisingly, the experiences were all over the map. There are compassionate women just as there are insensitive women. There were female residents who had experienced “natural” childbirth who openly disparaged women who chose an epidural. There were those who had gotten an epidural themselves, who disparaged those who chose not to avail themselves of simple pain relief. So in the end, it was the personality and not the gender that ultimately mattered.
There are doctors who don’t listen well, who schedule inductions for convenience and only show up 30 seconds before birth. I have seen them. There are also midwives, both lay and certified, that don’t know what they are doing in some circumstances. I have personally been on the receiving end of home births gone bad where the patient is “dropped off” at the emergency room for the Obstetrician covering the ER to pick up, often at considerable legal risk to the covering doctor.
2. Epidurals. There are good epidurals and bad epidurals. In fact, there are many different kinds of epidurals (different type and quantity of infused narcotic/anaestetic.) Ideal epidurals slow labor slightly but don’t lead to incresed C sections based on numerous studies. Some data suggest that a first-time mom who gets an epidural before being dilated to 4 cm. does have a higher risk of C section. There are of course “wet taps,” “spinal headaches,” etc. Usually quite rare in well-trained Anestetist’s hands. I have seen, however, Anestetists give a very dense block such that the women couldn’t even move her legs so that the Anestetist wouldn’t get called repeatedly to adjust the epidural dose (since one can dose an epidural light or heavy and finding the right medium is a bit of an art.) There are always variations in anatomy that make some epidurals work better than others. The bottom line, however, is that a women needs to be in control to have the safest possible experience both for herself and her baby. It really doesn’t matter how that control is achieved: Lamaze, Bradley, hypnobirthing, epidural, etc. Epidurals are pain control, nothing more, nothing less. Medicine seems to catch a lot of flack for how it deals with pain–criticized for giving too little in cancer and end of life care, and criticized for giving too much in childbirth.
3. Midwives. As I have mentioned above, there are excellent ones and there are mediocre ones. I would strongly suggest a licenced, hospital-based one if one wants the best of both worlds. They have better training, better backup, better outcome data, etc. compared to lay midwives. Recently, in the news a 12-year-old boy delivered his own brother in the bathtub of a Chicago apt. A highway patrolman delivered a baby on the side of I-15 here in Utah. What is the point? That a 12-year-old has enough training to practice Obstetrics? The question is what level of risk are you willing to accept? (95% success, 99%, 100%?) Medicine has probably irresponsibly implied and attorneys have mandated 100%. If one expects 100% good outcomes, the level of uncertainty that will trigger intervention i.e. Cesarian is pretty low. If we all agreed that 90% was all we were after then everyone should deliver at home. It’s much cheaper. One can say that lay midwives only deliver low-risk patients but how do they know what a high-risk patient looks like if they have never cared for them? That is the problem we find. Lay midwives will sometimes sit way too long on a problem they have never seen before. While some risk is easy to spot–a hypertensive, diabetic mom with three prior cesarians, some is very subtle and some doesn’t give any warning at all. For example, 1-2% of pregnancies experience an abruption (where the placenta suddenly detaches from the wall of the uterus.) Hypertension and cigarette smoking are risk factors but most come with no warning at all. If one doesn’t have the ability to immediately intervene it can be deadly for the baby. When I was growing up in Montana, due to a shortage of rural practicing Obstetricians, one could be licenced as a lay midwife with only 5 hours of training. Times have changed there but in Utah there was no licencing until the last legislative session. Lay midwives couldn’t be sued because they weren’t “practicing medicine.” They weren’t paid but could accept donations. Wink wink. So there was no accountability, no data, nothing but a lot of emotional ad hominems thrown around. The certified nurse midwife group out of the University of Washington is a model for data collection. They publish some good stuff often with conclusions different from what they had expected (which is one reason I respect their outcomes.) They found for example that all these anaecdotal reports that perineal massage prevented tears and lacerations didn’t have any basis in fact. The best thing was just to do nothing and let the baby deliver. A good admonition for both midwives and Obstetricians. In the end, I have seen countless cases where both baby and/or mother would have died had they not had immediately available hospital facilities. It’s hard to be involved in even one of those experiences without it significantly influencing one’s outlook.
4. Doulas. As above. There are very good ones, good about being part of a team and there are domineering ones who I have seen demean the husband in front of his wife and who were very hostile to hospital protocol. Most hospital protocol is in place for a good reason. My experience with the vast majority of doulas has been very positive and I would recommend one. My own wife used one for our firstborn.
5. C-sections. We are in the middle of a sea change as far as cesarians go. It has gotten to the point that, due to the ideal of autonomy, patients can request a primary cesarian if they want one. Some may shake their heads and wonder why one would ever do that. While there is a higher relative morbidity rate with cesarians compared to normal spontaneous vaginal deliveries, the absolute risk is very low for both. There is some data that seem to suggest less perineal nerve trauma (less urinary stress incontinance in the future, etc.) with cesarian. In fact, in some surveys, women obstetricians would choose a primary cesarian for themselves in up to 30% of the respondents. Couple this with the fact the number one reason Obstetricians get sued is “failure to perform a timely cesarian section” and one starts to understand why it has been so hard to get the C-section rate below 20% in this country. I have never been sued in my life but pay around $100,000/year in premiums. I personally feel that the best vaginal delivery is superior to the best cesarian but one can’t often predict beforehand. The whole issue of vaginal births after prior cesarian section is also a hotly debated subject as of late.
In the end, all I can say is to ask as many questions as you can about the philosophy of your health care provider, be it midwife or Obstetrician. Personality conflicts early on should be a big red flag. There is no “normal” pregnant woman when it comes to labor. Some want to sit back, get an epidural, watch a movie, push when it’s time and not worry about it. Some want to be part of every decision, want to experience the full gamut of physical sensations, want a birthing ball, squat bar, jacuzzi, and doula involved. Figure out what you want, be open and flexible, pick someone who listens to you and who you feel you have rapport with and enjoy the experience. In the end, the only two goals I have as an Obstetrician are “healthy baby / healthy mom.” All the rest is style.
Robert, I am definately on the homebirth side of this debate but I really enjoyed and appreciated your post and agree with most all of what you said. Thanks for your openmindedness and the advice you give at the end about choosing a care provider is excellent. So is someone else’s earlier advice (Bruce?) about the patient being in control…. we are so acculturated in the US to view the doctor as the absolute authority figure, and hospital routines and atmospheres contribute even more to this.
On the topic of lay midwifery, which several comments have disparaged, consider that many women in rural areas of this country live several hours from the nearest hospital and medical personnell are scarce/overworked. Certified Professional Midwives are not nurses, but have strict requirements for certification and are a good option in these areas — and backwards states like mine where the AMA has blocked all attempts to license lay midwives and prevents CNMs from attending homebirths as well, leaving those who want to birth outside of the hospital with no ‘legal’ options. I am blessed to live a mile from a hospital and be attended by a CPM with 20+ years experience and great OB back-up.
Julie
And just to let you know, I am not the type who brags about being up and at ’em :). So far I do really well with pregnancies, births and afterwards. I am very fortunate in this, especially since the getting pregnant is very difficult for me and causes me a great deal of heart ache in the trying stage.
As a CBE I strongly encourage my mums to take care of themselves, not push themselves too much and not be expected to jump back into everything they are doing ESECIALLY if they have had c-sections. Taking time to look after yourself is very important and I think it would be wonderful if all new mothers had someone come in and take care of the house and cooking for a good month after the baby is born so mum can have that time to be pampered and be with baby. However, that’s rarely going to happen, sigh. Such is life. I envy the cultures where this is the norm (and required). They sure have their priorities right!
Mary–
I’m sure you aren’ that typet. But can you see how your husband’s comment in #92 could be read as contributing to the kind of environment where women are expected to (or feel guilty if they are not) scrubbing floors as soon as the placenta is delivered?
It works both ways, Julie. Mary certainly wasn’t scrubbing floors or running marathons after our son was born. Neither was she confining herself to the bed, however, as the Relief Society president and others assumed she should.
Not really, but that’s probably becuase I know him and what context he was putting it in. What he was trying to say is that childbirth doesn’t automatically put one in an invalid state. I even now get bugged when people ask me in concerned voices how I am feeling. I’m feeling fine, thanks very much :). And that was the attitude after I gave birth, that they were stunned I could actually function “normally”. Well I could. I hadn’t had a traumatic or hard birth, and I was in fine shape. Now if I had been through a harder experience, and most espeically ahd a c-section, it would be another story. But women seem to be “expected” to recover at the same rate, whether it is vaginal or c-section, which I think is definitely unfair for the c-section births because there is much more involved, and more to recover from. I feel that all women should be allowed to return to normal activity at their own rate. Some can be quicker, some not so quick. But no one should be made to feel they should be expected to live under a specific set of rules set by someone else. If they feel up to doing more, than sure, do it and they shouldn’t be made to feel like they are “overdoing” it, especially if they aren’t (if they are, then they should relax more, but that’s listening to one’s body). If not, they shouldn’t be made to feel guilty about it. It’s that specific attitude about childbirth that I try to change in my classes. It usually works with the attendees. I wish it did with the general population.
I had an 8 lb. baby in one of those unpleasant stressed hospital inductions where my wishes were ignored. I had a second degree perineal tear and I had knifelike pain on the left and urinary incontinence afterwards–these two symptoms lasted for two years until I finally found a surgeon to help me. I had to travel out of state to find this one doctor. My problem was pudendal nerve entrapment, and it is something that can happen as a result of childbirth. In the most severe cases, fecal incontinence can happen as a result of damage to the pudendal nerve. There can also be damage to the rectum itself which can sometimes be repaired by surgery but sometimes cannot. The pudendal nerve cannot simply be cut to stop the pain, because it is a mixed nerve–it gives sensation to the genitals as well as controlling both of the continence issues. It is INCREDIBLY hard to find a doctor who understands the pudendal nerve and how to help; I spent a year meeting doctors all over the state capitol city in which I live, and nobody had a clue.
My second degree tear was sewn too high and when I was finally healed enough from the nerve surgery to resume a normal sex life, the skin would tear open and bleed. There isn’t a surgery to repair this, but the surgery that they will give you (perineoplasty) removes quite a bit of the lower vaginal area and perineum. It is a miserable surgical experience and I can honestly say sex is ruined for me. I’ll guarantee you that I want no part of pregnancy ever again–I wouldn’t want to risk a fast vaginal birth.
As much as I was “for” natural childbirth before this, I am pretty much a believer in c-sections now. I think of how different my life might be had I had one for any reason at all.