Is everything that goes wrong the fault of doctors? - Page 2

[eilonwy]

Originally posted by citizenfong
I have to add my opinion here. Doctors and other interventionists get blamed for doing so much wrong because so much of what they do is wrong.

Could you give some concrete examples here? Something that doctors who've studied medicine within the past 30 years do, maybe?

We no longer have ANY idea about what the range of normal in pregnancy and birth is, because almost NO ONE has unhindered pregnancy/birth. Since I started researching UC about a year ago I have met so many women who had perfectly healthy births with factors that would have NEVER been allowed to develop under the care of docs. Like the woman who labored, not just prodomal labor, for 11 days before giving birth. Or the woman who started off and on labor at 33 weeks. Her water broke at 36 weeks. 3 days later she gave birth to a 7 lb. baby who was obviously ready to be born. Just a few examples.

You found these extreme examples (and yes, they are extreme) because these are what you were looking for. Last week on Oprah, I saw a show about a doctor who has been doing surgeries on women in rural parts of Africa (Ethiopia, I think) who had a common complication of prolonged labors: they developed holes between their bladders or colons and their birth canal, thus rendering them unable to contain urine or feces. Most of their babies were born dead after labors of between 2 and 14 days. I disagree with the idea that we have no sense of what's normal in childbirth.

The thing is this: so much of what OBs do is superstition, voodoo, non-evidence-based malarky. Therefore, when you examine a birth story/situation and find X, Y, and Z that a doctor shouldn't have done, there is no way of really knowing how much ensuing damage is a result of malpractice-avoidance medicine and how much actually would have occurred otherwise. Am I making sense here?

You are making sense, but I entirely disagree. First of all, most of what OBs do is, in fact, based on evidence. Just because it's evidence that you don't like doesn't mean it doesn't exist. Secondly, if you can't tell for a fact that a doctor caused X, Y, and Z and you don't know exactly what the consequences of X, Y, and Z are, how can you assume that the doctor was at fault?

Although, the more research I've done, and the more birth stories I've read/heard, the more obvious it becomes that many, many complications are the result of obstetrical interferance, since they never seem to occur in UC (or many homebirth) situations.

That's ridiculous. What you mean is, they never have occured in any of the cases you've read about. Of course they haven't, because you're not doing open research. You're starting with the premise that UC is the safest way to go for everyone, and looking for proof that supports your premise. Of course you're finding exactly what you're looking for, because you're not looking for anything else.

So the bottom line is that if I blame OBs for everything I KNOW they are doing to muck up the birth process, and if every OB I've ever heard of is doing them, it's going to seem like a lot of blame.

For what's it's worth, I am happy to be living in a time when good nutrition is easy, information is extremely accessable, and emergency medicine that I AGREE to is available just down the street.

It does seem like a lot of blame, and much of it seems unwarranted.

It's not that I think that homebirth or UC are bad things, even. I'm just mystified at the attitude that OBs are responsible for all the things that can go wrong. It's interesting to me that I feel this way, because my doctor was an idiot. I understand why people have homebirths and UC, especially women who've had births with complications that were definately caused by a doctors interventions and women who had easy births with no complications at all. I don't understand how anyone can say that it's the best choice for most women who've had complicated births, because I don't see doctors as being wholly responsible for complications.

I had a horrendously complicated birth, but that wasn't (entirely) my doctor's fault. The only thing I think she could (and should) have done differently was do a ceserian, and that's hardly less intervention. My birth was complicated by the fact that my water broke 4.5 days before my son was born, and it did not replenish itself (someone said on a thread that it always does, and there's no such thing as a dry birth-- they are very much mistaken). We developed an infection, and I labored for 3 days with no medication and no progress. If it hadn't been for medical intervention, there is no doubt in my mind that my son would not have survived his birth. It's doubtful that I would have survived his birth. It makes me sick when people talk about all the horrible things that "only go wrong in hospital births". Please! Do a little more research, and ask some more open-ended questions before you make these judgements. It doesn't make any sense. If medical intervention is such a horrible thing, and most women can give birth unassisted, why is it that at the turn of the century 1 in 4 women died in childbirth, while the rate today is miniscule? Why is it that the rate of stillbirth was ridiculously high, while today it is relatively rare?

[Greaseball]

I saw a show about a doctor who has been doing surgeries on women in rural parts of Africa (Ethiopia, I think) who had a common complication of prolonged labors: they developed holes between their bladders or colons and their birth canal, thus rendering them unable to contain urine or feces.

OK, here are my open-ended questions:

Homebirth does not mean unhindered birth. Even a UC can be complicated if a mother tries to use medical interventions on herself. I would say these births need to be looked at more in-depth, instead of saying "Everything went wrong because they were at home." What about mothers who are in hard labor for several days to a week at home and have healthy babies? How do we explain that? How do we explain c-section mothers who have incontinence?

Do you really know why women started dying in childbirth? They were doing fine until hospitals were invented. Doctors there refused to wash their hands after surgeries or after touching dead bodies. They attended births covered in blood and grime from previous operations. Women labored in beds from which corpses were recently moved. Hospital-acquired infections are still a leading cause of death in this country, and maternal death can be prevented. Mothers and babies who deliver in hospitals have higher rates of death.

Living conditions are responsible for a large number of fetal and maternal deaths. Sometimes it's not always poverty that is the cause - in the 19th century, rich women who gave birth at home had a lot of deformed or dead babies. The reason was that these women were corseted as soon as they hit puberty, and they wore their corsets through pregnancy. The babies did not have room to develop properly. (The women were also not allowed out in public when they were showing, and when they became "agitated" from being shut-ins, their husbands would call the doctor who would come over and dope the woman up with opium. Yum! This was all related to the restrictions of their social class.)

What OBs do is based on time and money, not evidence. It used to be that 9 and 10-lb babies were healthy and normal, now they are harmful. Did the "evidence" change from one decade to the next? What "evidence" says that in 1970 it was safe to vaginally deliver breech babies, but in 1990 it wasn't? Why was it once normal for a woman to carry over 42 weeks, and now it's abnormal? What about doctors in other countries - do they use evidence? If so, where is the evidence that Swedish women need cesareans 4% of the time but American women need them 26% of the time, and Brazilian women need them 95% of the time? Where is the evidence that says although a woman giving birth in a hospital in New York City can safely labor for 18 hours and push for 4 hours, women in Atlanta can only labor for 12 hours and push for 2 hours? Is it something in the air?

Evidence shows that almost all babies can be safely born at home with little or no intervention. It's easy to miss that when you don't want to see it. I'm sure all of us who are pregnant are informed consumers of birth, and are planning births that feel right to us. I think homebirth is a mistake for women who don't want to be there, and hospital birth is a mistake for women who want to be at home. I believe if you don't give birth at the place you would prefer, you will have complications.

[captain optimism]

Though I agree with you in general, Eilonwy, I have to take issue with your citation of late 19th-early 20th century stillbirth and maternal mortality statistics. Women in that era died in childbirth in large measure because their doctors carried illnesses when they didn't wash their hands! This was called childbed fever. It was a tremendous example of the inferiority of doctors to midwives and an interesting case in the professionalization of medicine.

Of course, doctors today do wash their hands, as do midwives of every stripe.

I have been amazed, as I read here and listen to people's birth stories, that doctors do incredibly dumb things that screw up people's births. We make progress as a society but we don't make it uniformly.

The pushing example is a good one. I pushed for more like 8 hours. Then my baby came out. I didn't have a c-section. That was also in a hospital. Institutions vary.

I also want to add that homebirths here in the US are a skewed sample, because they are often moms who are healthy to start with and who think through their births carefully. (and obviously, I think that's good!)

[candiland]

Eilonwy,
Please do some research. Obstetrics is NOT evidence-based. I highly recommend Henci Goer's "Obstetric Myths Vs. Research Realities". Most of what happens within the ob. establishment is only done because it has been done for such a loooong time now....
Some concrete examples of what I, as an experienced doula, have seen with my hospital clients:
1.) Insisting on a heplock or iv. An iv. is part of hospital protocol to help keep the woman from becoming dehydrated. But research shows us that iv.s actually dilute the hormones in the woman's bloodsteam that causes the uterus to contract. As you can imagine, this can easily lead to the use of labor-augmenting drugs. The iv. is also a huge pain in the butt...... a woman wishing for the safest kind of birth - a natural birth - has to be able to move about freely and completely uninhibited to go into a labor trance to help her deal with the pain. But when she has to wheel the iv. around, maneuver the line, be careful with her hands so she doesn't experience discomfort from the iv., etc., it also paves the way for the inability to enter that labor trance and can pave the way for medication.
2.) The external fetal monitor. See the need for uninhibited laboring, above. The monitor is not evidence-based, either. It has not been proven to save any mothers or babies or decrease the incidence of cerebral palsy, yet it drastically increases the number of cesareans performed.
3.) Not letting a woman eat and drink to taste. It used to be thought that anything taken by mouth could be vomited and choked upon if the woman needed emergency general anesthesia. Yet all the research shows that the majority of women who need an emergency section get an epidural. And - this is the real kicker - it is shown that if a woman DOESN'T have anything in her stomach when she's knocked out and then aspirates her stomach contents, it is MORE DANGEROUS to aspirate stomach acid than it is to aspirate stomach acid diluted by food and drink!:LOL
Women also get very weak and discouraged when they labor for hours and hours without nourishment. Labor is like running a marathon...... women need lots of high energy food and lots to drink to cope with the intensity of what their bodies are going through!
4.) Induction. Induction is verrrry rarely indicated, yet many women today are getting induced. Inductions have actually INCREASED the chances that these babies need to be sent to NICU because they are - SURPRISE! - not ready to come out yet, so many have serious breathing problems because the lungs are not fully formed until the VERY end of a pregnancy. Also, inductions often don't "take" because the mother's body and the baby know it isn't time to give birth yet. This leads to thousands of unnecessary cesareans every year. Cesareans are much more dangerous than a normal vaginal delivery.
I really could go on for several more paragraphs, but I'd like to take a nap now that the kids are asleep. Please do some research for yourself. You will be shocked with what you find. I know I was.
Edited to add: my midwife has a 5% transferral rate and a 4% cesarean rate. (She only does homebirths.) Yet her maternal and fetal outcomes far exceed even the local freestanding birth center! And she rarely risks women out, either. She's even done twins and breeches at home. She's also had drug addicts, low income women, you name it...... so it's not a demographic issue, either. Is it just luck? I'm sure that's what all of the, er, evidence-based obstetricians would say!:LOL

[IdentityCrisisMama]

I just wanted to add that it is not just doctors doing stupid things that screw up births. I have suspected all along that the fetal heart monitor’s diagnosis was the reason that I transferred to the hospital. Now, in the end I think the transfer was for the best (for me, not for baby Aya) but the fetal monitor was my choice and the choice of a very well respected homebirth midwife.

For me, I wish all interventions (including the very first ones…even a HPT) came on an “as need” basis.

If I have another birth I’ll look for a midwife with a better fit to my personality and pass on the fetal monitor unless the need comes (I don’t know when that will be).

Congrats on pushing for 8 hours! I thought 5 was a long time…

So, UC is “UnComplicated Birth”?

[Greaseball]

UC is unassisted childbirth, meaning no professional assistance in the form of doctors or midwives. I was born this way in the late 70s, with just mom and dad there.

That's right, the EFM does not work well. I will be monitored intermittently during labor at home but with a Doppler.

[kimberlylibby]

In response to the no salt thing.... good grief, I heard that every WEEK from my ob.

He'd say "Wow, you gained 4 lb this week" (I had pre-eclampsia) and then say "Make sure you have NO salt"

[IdentityCrisisMama]

So why is unassisted birth UC? Is it for Unassisted Childbirth? I have always been a touch confused about the term unassisted birth because I have heard it being used for births with midwives in attendance.

Thanks, I always need to learn these new things. I even needed to learn what ICM was and it’s my user name, IdentityCrisisMama, that people reduced down to ICM.

[eilonwy]

Originally posted by Greaseball
OK, here are my open-ended questions:

Homebirth does not mean unhindered birth. Even a UC can be complicated if a mother tries to use medical interventions on herself. I would say these births need to be looked at more in-depth, instead of saying "Everything went wrong because they were at home." What about mothers who are in hard labor for several days to a week at home and have healthy babies? How do we explain that? How do we explain c-section mothers who have incontinence?

The women I refered to did not "use medical interventions on themselves". They were young women who had complications because they were alone, many of which could have easily been prevented by the presence of even a single knowledgeable person. These things went wrong not because they were at home, but because they were alone and uninformed, a deadly combination. Mothers who are in hard labor for several days to a week and have healthy babies are the exception, and that's all I said. You hear those stories because those are the ones you look for. Lots of women have had hard labor for several days and had dead babies at the end to show for all their work.

C-section mothers who have incontinence can certainly be explained, almost exclusively, by incompotent doctors, but that's a far cry from saying all doctors are incompotent.

Do you really know why women started dying in childbirth? They were doing fine until hospitals were invented. Doctors there refused to wash their hands after surgeries or after touching dead bodies. They attended births covered in blood and grime from previous operations. Women labored in beds from which corpses were recently moved.

I knew that this was going to come up. Yes, I've heard of childbed fever and am well aware of the whole icky corpse aspect. So explain to me why the death in childbirth rate was the same for women living on farms as for women living in the cities? Women giving birth on the prarie also had a 1 in 4 chance of dying in childbirth.

Hospital-acquired infections are still a leading cause of death in this country, and maternal death can be prevented. Mothers and babies who deliver in hospitals have higher rates of death.

Perhaps because the mothers who have hospital birth are more likely to have other complications? Yes, infection is a bigger concern in a hospital setting, but there are many other causes of maternal and perinatal death.

What OBs do is based on time and money, not evidence. It used to be that 9 and 10-lb babies were healthy and normal, now they are harmful. Did the "evidence" change from one decade to the next? What "evidence" says that in 1970 it was safe to vaginally deliver breech babies, but in 1990 it wasn't? Why was it once normal for a woman to carry over 42 weeks, and now it's abnormal?

That has much more to do with lawsuits than it does to do with the incompotence of doctors. All it takes is two women who sue because they tried to deliver breach and ended up with a dead baby and there will be policy changes implemented. Many doctors are more than willing to attempt a breech delivery, especially with multiparous women. If the woman is informed and insists, and her doctor is a reasonable human being, she can certainly have a breech birth in a hospital. I don't know if I have encountered super-progressive doctors or not, but I think that you're talking about doctors who still live in the dark ages. Granted, they're out there practicing, but I find it hard to believe that they are the majority.

What about doctors in other countries - do they use evidence? If so, where is the evidence that Swedish women need cesareans 4% of the time but American women need them 26% of the time, and Brazilian women need them 95% of the time?

In Sweeden, people are not nearly as lawsuit happy as they are in the US. In Brazil, women and OB's are currently much more concerned with convinience than anything else. Those facts have absolutely no bearing on this discussion.

If getting sued means that you will never again be able to do the thing you went to school for and have wanted to do for years, wouldn't it be prudent to avoid getting sued? How is that being motivated only by money? What about OBs who work in free clinics, are they motivated by money?

Where is the evidence that says although a woman giving birth in a hospital in New York City can safely labor for 18 hours and push for 4 hours, women in Atlanta can only labor for 12 hours and push for 2 hours? Is it something in the air?

Again, it has to do much more with how lawsuit-happy the area is. I didn't say that every single thing that doctors, or anyone for that matter does is based soley on evidence, only that there is evidence out there to support certain actions. For example: a breech position with a first time (untested) pelvis is more likely to lead to complications then a vertex position. Babies are more likely to be stillborn if they go beyond 43 weeks gestation. And no, that doesn't explain why women are induced at 40 weeks sometimes. Again, I have never heard this from a practicing doctor itrw. In fact, I was given my due date and told to wrap my head around a date two weeks later because they wouldn't consider induction before that if nothing was seriously wrong.

Evidence shows that almost all babies can be safely born at home with little or no intervention. It's easy to miss that when you don't want to see it.

Quite to the contrary, I *do* want to see it. And I understand that for most people, pregnancy is a normal condition and birth is also a normal condition of being human. I don't believe that it's a pathology. I do, however, believe that things can go wrong during birth regardless of how ideal the conditions are. I've met lots of people who had hospital deliveries and should have given birth at home; my mother, for example. It was just a waste of time for them to go to the hospital at all. What I have a problem with is people saying that the reason my delivery, for example, was complicated was because it was in a hospital. It's not true. Homebirthing advocates live in a dream world where things only go wrong if they're in the hospital, and that doesn't seem remotely realistic to me. Just because you pass by the homebirth and UC stories that end in death for the mother or child, or in other serious complications, doesn't mean those stories aren't out there. It's not safe for everyone to attempt a home delivery, and it's not reasonable to expect everyone to want to, regardless of how well informed we are.

[Defenestrator]

Originally posted by eilonwy

First of all, most of what OBs do is, in fact, based on evidence. Just because it's evidence that you don't like doesn't mean it doesn't exist. Secondly, if you can't tell for a fact that a doctor caused X, Y, and Z and you don't know exactly what the consequences of X, Y, and Z are, how can you assume that the doctor was at fault?

I have to strongly disagree with the idea that what most OBs do is based on evidence. There is a great lack of scientific evidence available about pregnant and laboring women because of the numerous ethical problems that exist with doing a double-blind controlled study with pregnant women and their babies. Most Obstetrical practice, whether carried out by doctors or midwives, is instead based on habits passed down through the oral tradition and personal experience. The problem with this is that many severe complications occur at a rate of one in a thousand or one in ten thousand, so an OB can honestly say, "Well, I've used cytotec many times and never seen a uterine rupture, so I believe it is safe." If that same drug takes maternal mortality from a rate of 3 per 100,000 to 6 per 100,000, effectively doubling it, or if cesareans kill four times as many moms as vaginal births, most OBs will never notice because their own experience will never involve those kinds of numbers. I can give you example after example of OBs continuing to practice procedures which have specifically been proven in study after study to be ineffective, untrustworthy or harmful, from early cord clamping to withholding food and drink during labor to episiotomy (still practiced in more than 60% of births attended by private physicians) to third-trimester ultrasound for weight estimation to induction at less than 42 weeks for a healthy postdates pregnancy. Happily, many other out-of-date procedures, like shaving the pubic hair before birth (thought to prevent infection, actually made it worse) have fallen by the wayside, but change comes very, very slow in the medical community, unless inspired by litigation.

Litigation and other pressures have led to something more insidious than lack of evidence-based practice in my opinion. Many women are being over-aggressively treated for complications that arise in late pregnancy and during labor, resulting in live babies and mothers, but at the cost of additional maternal recovery time, physical trauma to mom and baby, and increased chances of separation. To get to the bottom of what I mean, I will show another example. If a woman is diagnosed with breast cancer, the best thing to do to maximize her chances of remission would be a double mastectomy, with possible removal of lymph nodes, aggressive chemotherapy and radiation, and some kind of continuing drug therapy. However, cancer specialists, using evidence, have come up with a number of other options and can present women with other choices, like perhaps a lumpectomy + radiation and no other treatment. Obviously the second choice, while marginally less successful than more radical treatment, has significant benefits in its lesser trauma and recovery time. A woman with breast cancer is given a whole spectrum of treatment options and is given evidence about the likely benefit of each.

Many pregnant women are being given the birth equivalent of a double mastectomy. If a baby is "too big," an induction or cesarean is ordered (sometimes by a court of law, as we have seen recently). Women who are post-dates are being told they will be "allowed" to go to a certain date. Women who have strep B are told that if they don't accept antibiotics in labor, their babies can be ordered to undergo spinal taps, NICU stays and their own antibiotic courses. Women are often not allowed to choose less aggressive interventions -- when they decline the advice of their Obstetricians and Pediatricians in the birth setting, they are often threatened with court orders.

Homebirth and hospital-based midwives are often guilty of their own practices which are not backed up by evidence. I love Spiritual Midwifery, but cringe when I read some of the things that they do in that book. More common are midwives who put their clients through an exhaustive regimen of supplements and teas and exercises, adding expense and bother to a healthy pregnancy that didn't really need the extra support. Midwives can be too slow to intervene in ways that might prove dangerous as well.

I think that some interventions are absolutely necessary -- some because of problems caused by previous decisions, others which would have been necessary regardless of birth setting. I attended a mom in labor as a doula last year who had a very necessary vacuum extraction, but her 26-hour labor would have been greatly minimized by better care, perhaps eliminating the need for a surgical birth. The thing about interventions, though, is that the community seems to want to take the evidence about when an intervention is warranted, and then write a protocol that is much, much more conservative. The OP gave an example of premature rupture of membranes -- the WHO recommends induction after 48 hours, the ACOG, 24, and most hospitals in my area, 6-12. There is a pretty huge range amongst those numbers. The ACOG has recommended that testing begin to determine placental health and fetal well-being after 42 weeks in a post-date pregnancy, but many doctors begin such testing immediately after 40 weeks, and induce at 41.

One thing that I have come to believe about birth is that if a practitioner has a tool, he or she will use it. In the homebirth practice I work in, we do not have easy access to ultrasound, so it is not a tool we use routinely. My favorite group of hospital-based midwives can't perform cesareans, vacuum extractions or use forceps, and so when they choose to use those tools, they must turn over care to an OB or resident. Consequently, they don't use those options unless they really, really have to. But the OBs, who know that they are likely to produce a relatively healthy baby if they order an immediate cesarean when there is meconium or a deceleration, vs. entering into the unknown by allowing a labor to continue, will often strongly advise a c-birth. There is huge pressure on them to make those recommendations, and I don't blame them, but I also would not choose them for my own care unless my health mandated it.

You are right, though, about the uncertainty of the impact of individual interventions in labor. Did the morphine given in labor cause lingering fetal distress or was it the exhaustion? Was the induction the cause of the meconium or the post-date baby? Did the epidural make it impossible to push out the baby or was it the weak contractions? Hard to know. What the evidence points at, though, is that low-intervention practitioners, like hospital and home-based midwives, achieve simliar if not superior results with matched populations to those achieved by OBs, with fewer interventions. If it is possible to intervene less and still and achieve healthy mom and baby, why not intervene less?

[IdentityCrisisMama]

Originally posted by eilonwy
It's not safe for everyone to attempt a home delivery, and it's not reasonable to expect everyone to want to, regardless of how well informed we are.

I think this quote and your OP are very different issues. This quote is totally understandable but it is a very different issue from doctors being blamed for all labor complications, which was the topic of our OP. No one is saying that *everyone* should be expected to attempt a homebirth. Are they?

Do you want to talk about people choosing homebirth OR do you want to talk about doctors being blamed for all labor complications?

BTW, I live in Germany and I just heard the C-Section rate here is 30%. Can anyone back that up

[Alstrameria]

Great thread! I always wonder where the unfortunate woman gave birth who was ignored, bullied and who had her birth experience coopted by evil OBs. I feel for them.

I had a great labour and birth. I felt cared for and respected by my entire birth team, my doctor included. Never for a moment did I feel my voice was not heard, or that my needs were ignored. In fact, I felt empowerd and confident. I chose to give birth in our hospital because that's where I feel comfortable. I'll make the same choice this time. I had no interventions at all, no meds, no IV, no monitor. Because I said so.

Am I lucky? Sheltered? Fortunate to have a family physician who cares for me and a delivery doctor who shares my birth philosophy? I guess so, but why can't everybody? Surely I don't have the only doctor who can be trusted to care for me?

Jen

[Greaseball]

The women I refered to did not "use medical interventions on themselves".

I wasn't talking about forceps and epidurals...did they lie on their backs? Did they restrict food and drink? Did they perform cervical checks on themselves, as some UC women do today? If they were uninformed, why was that so? Too many women are uninformed today and it's very sad.

So explain to me why the death in childbirth rate was the same for women living on farms as for women living in the cities?

Poverty can cause malnutrition, which can cause unhealthy fetuses and a deformed pelvis in the mother, which can lead to a true case of CPD.

Lawsuits brought on by women are given as the main reason for all the obstetrical problems in this country today. It's another way doctors have of blaming women. In reality, it's very hard to sue a doctor. If you can even find a lawyer who is willing to accept the case, you most likely will not win.

OBs who work in free clinics are paid out of tax dollars, and many of them resent the work they do, the clients, and the lower pay they receive. Medicaid will typically pay only 70% of a bill, and the doctor just goes without the extra 30%. To make up for this, some doctors do all they can to increase the cost of the patient's stay. Some use every intervention they can, and bill for that; others don't use the interventions but bill for them anyway. The patient never sees the bill, so no one knows. (I used to work in a hospital as a Medicaid billing person, and this is common practice.) There are some highly educated professionals who are happy to work for a reduced income to serve an underprivileged population, but they tend to be midwives and not OBs.

In Brazil, women are motivated by wanting to "keep their vaginas honeymoon fresh." These thoughts do not originate within the minds of women; men (and doctors) have a hand in this!

It is prudent to avoid getting sued, but there is no excuse for doing so at the expense of the patient. Some people don't realize that interventions come with risks.

For example: a breech position with a first time (untested) pelvis is more likely to lead to complications then a vertex position.

In a hospital, yes. At home with a midwife experienced in breech delivery, no. OBs do not learn breech deliveries in medical school, so it would be risky for them to attend one.

Babies are more likely to be stillborn if they go beyond 43 weeks gestation.

In an unhealthy mother with a poor diet, there is a slight increase in that risk. Not enough to make me induce at 43 weeks, though. I feel the risks of induction are much greater. If I were considering induction I'd try breast pumps and sex. I'm glad we have magazines like Mothering that can explain some of the ways to lower the risks of carrying beyond 43 weeks. There are some articles in the archives.

What I have a problem with is people saying that the reason my delivery, for example, was complicated was because it was in a hospital.

That would be impossible to determine without knowing the nature of your pregnancy and birth. Most likely, you had some interventions that carry a degree of risk. Vaginal exams, for example, can cause infection if the water is broken. Very rarely can a woman give birth in a hospital without a vaginal exam. You often need it to be admitted at all. It could be if you were at home, you would have had exams as well. Exams are largely useless. No one "needs to know" how close you are; trust me, the babies all come out even if it's unknown how dilated a woman is.

If you really want to know what complicated your delivery, I'd run it by a midwife. Not any of us; hearing about something online isn't enough. The homebirth stories that end in death are so incredibly rare; that's why it's easy to overlook them. Many home births end in infant death because the baby had a fatal birth defect to begin with, as was the case with the most recent ACOG study. Women who choose home birth are less likely to abort a fetus with such a defect.

[emmalala]

No, I have that doctor too! I'm on my 3rd pg with her and can honestly say that none of the nasty unhelpful things that get talked about on MDC have even been mentioned.

I guess I am a statistical fluke, but here I am, and here too is my great OB.

[anothermama]

I haven't read the replies yet....

BUT! I think the what goes wrong in most normal, otherwise healthy women is USUALLY the fault of medical intervention.

Some women go into pregnancy unhealthy, and those are different circumstances.

But most women are normal, most women can birth just fine and end up with interventions anyways. I think it's not only the fault of the ob's but the fault of societ for keeping women in the dark about their health care in the first place.

[cottonwood]

Whew, a lot to respond to here!

"“If medical intervention is such a horrible thing, and most women can give birth unassisted, why is it that at the turn of the century 1 in 4 women died in childbirth,”

Medical intervention is *not* a horrible thing. Unnecessary medical intervention is a horrible thing. And there is a lot of that in modern obstetrics. Someone mentioned Henci Goer's The Thinking Woman's Guide to a Better Birth, which is basically a report on the medical literature that exists about birth (mostly describing managed birth, because that is mostly what there is in the USA.) Have you had a chance to look at that book? Even more technical is her book Obstetrics Myths vs. Research Realities. I'd be interested to hear what you think of the stats she's compiled.

I think you mentioned that much unnecessary intervention is due to fear of litigation, and I agree. Is it still then the doctor's fault? As far as I'm concerned, yes. I understand that they have to protect themselves, but it should not be at the expense of those they claim to serve. Here is a relevant article by Marsden Wagner, M.D., former director of Women's and Children's Health for the World Health Organization:

http://www.midwiferytoday.com/articl...ogyinbirth.asp

“I knew that this was going to come up. Yes, I've heard of childbed fever and am well aware of the whole icky corpse aspect. So explain to me why the death in childbirth rate was the same for women living on farms as for women living in the cities? Women giving birth on the prarie also had a 1 in 4 chance of dying in childbirth.”

What are your sources for this statistic? 1 in 4 for rural women seems awfully high to me. Even so, I would expect death rates throughout history to be much higher than they are now (heck they were higher for everyone, not just women in birth.) Women living on farms at that time did not have access to antibiotics, and were often living in unsanitary conditions, malnourished, overworked, and pregnant too often (since there was no birth control) putting more stress on already stressed bodies. Furthermore, they were often attended by country doctors and midwives who had their own ways of interfering. And they had no access to emergency medical care. (Which is what doctors generally do fairly well, and exactly what I am happy to have them for.)

“If the woman is informed and insists, and her doctor is a reasonable human being, she can certainly have a breech birth in a hospital.”

Not so. Most doctors are not trained in medical school to do breech births, so they (rightly) refuse to do them.

“Homebirthing advocates live in a dream world where things only go wrong if they're in the hospital, and that doesn't seem remotely realistic to me.”

Okay, forgive me, but this is kind of funny. Haven't you just been railing against making generalizations about doctors? Yet here you are generalizing about homebirthers. So I guess it's not generalizations per se that you have a problem with? (By the way, I'm a homebirther, and it doesn't seem remotely realistic to me either. Who woulda thought? :LOL )

“Just because you pass by the homebirth and UC stories that end in death for the mother or child, or in other serious complications, doesn't mean those stories aren't out there.”

Did some homebirther here actually claim that?

“It's not safe for everyone to attempt a home delivery, and it's not reasonable to expect everyone to want to, regardless of how well informed we are.”

Uhhhh, no, it's not. Who on earth is saying these crazy things, anyway? [edited to clarify: I was *agreeing* that it's not safe for everyone to attempt a home delivery, and it's *not* reasonable to expect everyone to want to; and then asking, who are the crazy people that are saying that it *is* safe for everyone to attempt a home delivery and that it's reasonable to expect everyone to want to? Sorry about the confusion...]

[cottonwood]

Someone wrote earlier about the fact that we (as a society) do not know what normal birth looks like anymore. I agree.

"By medicalizing birth, i.e. separating a woman from her own environment and surrounding her with strange people using strange machines to do strange things to her in an effort to assist her (and some of this may occasionally be necessary), the woman's state of mind and body is so altered that her ways of carrying through this intimate act must also be altered and the state of the baby born must equally be altered. The result is that it is no longer possible to know what births would have been like before these manipulations. Most health care providers no longer know what "non-medicalized" birth is. This is an overwhelmingly important issue." -- The World Health Organization

[cottonwood]

Citizenfong wrote: "Doctors and other interventionists get blamed for doing so much wrong because so much of what they do is wrong."

Eilonwy replied: "Could you give some concrete examples here? Something that doctors who've studied medicine within the past 30 years do, maybe?"

I'll take a stab at that.

Many doctors, nurses, and midwives:

…rupture membranes “to get labor going”, even when baby is not in danger, risking infection and cord prolapse.

…do internal exams after rupture of membranes, even though this greatly increases risk of infection.

…do cervical checks to determine dilation, even though dilation is not a good indicator of how close or far away the birth is, and therefore can easily lead to a wrong diagnosis of “failure to progress” and from there invasive and risky interventions or surgery. All because birth isn’t on a certain arbitrary time table.

…do cesarean section for “failure to progress” (which, as long as baby is not in distress, really just means failure to be patient.)

…do cesarean section for “big babies” (over nine lbs. by ultrasound, which is often wrong, resulting in babies being forced to be born prematurely; and if they are not early, the doctor has still subjected the mother to unnecessary surgery, which carries its own risks of course.)

…induce so that the baby “won’t get too big.” (See above)

…use induction drugs for VBAC (just "to get labor going," see above,) which increases risk of uterine rupture.

…use cytotec to induce labor, even though it puts the mother at higher risk of uterine rupture than other induction drugs. (It's used because it is much cheaper and "very effective"!

...induce with pitocin even when baby is not in danger (failure to be patient, see above) even though pitocin induction carries risks, not least of which is that it makes the labor harder so that it is much harder for the mother to refuse drugs, which also carry risks.

…advocate induction just because they or the mother is tired of waiting, even though induction greatly increases chance of other interventions that carry risks to maternal and infant health.

…advocate “purple pushing” also known as vasalva pushing; holding breath during labor decreased oxygen to baby, increasing risk of distress, increasing risk of perineal trauma, increasing risk of prolonging 2nd stage, because of swelling of tissues that are not yet meant to have pressure on them, tiring mother out so that she may not be able to complete labor without mechnical help (forceps, vacuum extractor, surgery, episiotomy) (and no, there is NO scientific evidence that this kind of pushing is effective or safe)

…insist that women labor for a certain amount of time in bed (which makes monitoring easier, despite the fact that it is possible to monitor women when they are upright and moving around) even though being bed-ridden usually makes labor pains worse

…tell laboring women not to make so much noise

…tell laboring women not to eat or drink (there is no longer any medical reason for this, but the practice persists)

…tell women that epidurals are “completely safe” (well, okay, just one doctor that I know of, I heard an OB say this on national television )

…do episiotomies (nearly all episiotomies are unnecessary, i.e., they are not done because baby is in distress and needs to be born immediately; one reason they are done is because doctors still believe that episiotomies reduce risk of tearing, which is completely scientifically false.)

…expect women to give birth in a reclining position. Marsden Wagner, M.D., writes: “For more than 25 years we have known scientifically that this is the worst of all possible positions for a woman giving birth.”

Okay, I've gotta take a breather but I'll be back with more, don't you worry...

[cottonwood]

Defenstrator wrote: "Did the morphine given in labor cause lingering fetal distress or was it the exhaustion? Was the induction the cause of the meconium or the post-date baby? Did the epidural make it impossible to push out the baby or was it the weak contractions?"

(Not arguing with you, just running with it...) And what in the management of the labor contributed to the exhaustion? And what in the management of labor or birth environment caused the contractions to be weak? The baby being post-dates is obviously not due to obstetrical intervention however how many other things about the management of the labor could have caused the baby to go into distress and pass meconium? We can take it back and back and back, and eventually we might find a way to blame nature or the woman's body. But more likely way before we get there we will have found a whole host of things about the routine management of any labor, of which it is completely logical and scientific to conlude that they contributed to its dysfunction.

The fact is, we don't know that in any of these cases there wouldn't have been fetal distress or dysfunctional labor even without interventions. But does anybody really believe that drugs will make the situation any better? I mean, so you have a baby who naturally goes into fetal distress. What sense does it make to argue over whether the morphine had anything to do with it? Of course morphine is going to make a distressed infant even more distressed. I mean, drugs in labor (and various other procedures) may not be the inital cause of distress or dysfunction, but are certainly likely to make it worse.

[Greaseball]

One thing that goes wrong at hospitals (and occasionally at home, if a mother is not comfortable with the midwife) is a woman is so scared or agitated that her labor stops. She does not feel safe, so her body will not let the baby go. I've heard a lot of stories from women who were in transition at home and then their contractions stopped when they got to the hospital. Sometimes their cervix even closed back up.

I think it's a mistake to try and speed up something that was obviously meant to take a long time. The way hospitals are run, like factories, makes it so women don't get to take the time they need. The sooner a woman gets out of the birth room, the sooner another woman can get in, meaning more money for the hospital. If there is one thing I can be proud of in my life it's that I probably made my hospital lose money.

I think women need to be uninhibited when they give birth. Some say that chanting, primal screaming or masturbation helped a lot. But try doing any of these things in the hospital when you never know who is coming into your room to stick her arm in your vagina. Some women want a period of complete privacy; also not an option when you "have to" do another monitor strip. "Progressive" hospitals are letting mothers have non-husband family and friends there, but will still limit the number of people. And try getting your favorite pets in there! What if you want to order pizza? Play Trivial Pursuit without a bunch of meaningless interruptions? Take a walk by the river? (Most places think they are "progressive" because they allow mothers to walk down the hall for a certain period of time, as long as they are back in their rooms for, you know, all the stuff. They won't let you leave the labor ward, though.) Everything done to them is done against what their bodies are crying out for. Not an ideal situation.

Most likely, not letting a woman do exactly as she pleases in labor won't lead to a baby's death, but will probably lead to several interventions.