Keeping your Lips Zipped around Mainstream Mamas – SO HARD!

[MegBoz]

A co-worker tells me she’s PG & delivering at GMBC, the hospital in Maryland with the highest CS rate (44%). I tell her that & she says, “Oh, well I’ll have to try to avoid that.”

I can’t help myself, I have to say it…

“Well, hospital & health care provider are the top predictors of whether or not you’ll have a CS – more so than your health or that of your baby.”

I think she just said, “hm,” or something & ended the convo.

I tried again once, just once to warn her she may be at risk & needs to educate herself in order to get evidence-based care that is mama & baby-friendly. I asked if she was taking a CB class. (She was maybe 5 mos along at this point.) She said she hadn’t thought about it yet, so I said lots of people recommend Hypnobabies & I like Bradley. Bradley is supposed to be 12 weeks, but I know a rebel instructor who condenses it into 3 weekends.

She just said, “Oh, I think that’s too much time for us to take out of our schedules.”


Now I’ve stopped trying.

I do realize that it COULD be that she’s high-risk & NEEDS an OB. We’re not very close so I don’t know for a fact that there isn’t a health issue. But I doubt it (She’s otherwise a very healthy lady.) & it could be she has an OBs who does practice evidence-based care. (But let’s be realistic here, with a 44% CS rate, odds are NOT in my co-workers favor that this will be the case.)

I have SUCH A HARD TIME keeping quiet around here. There are plenty of other mamas & PG ladies & I’m the only even semi-crunchy one. Everyone else is of the mindset, “Of course I’ll trust whatever the OB says to do! & Of course I want the epidural ASAP! Natural CB makes as much sense as natural dentistry.” It’s SO HARD for me. Anyone else?

It particularly bothers me feeling like they are so likely to become victims of mistreatment. I realize natural birth isn’t for everyone & I’m glad we all have options. But it’s the other anti-evidence based business that ticks me off. (cEFM even before they get the epidural, ‘nothing by mouth,’ induction for totally stupid nonsense reasons, pumping up Pit (possibly to distress), CS for ‘FTP’ (failure to be patient) etc. To sum it up, it upsets me that blindly* trusting your OB in America, all too often is a bad thing. (due to lack of evidence-based care.)

*Blindly meaning not educating yourself & questioning anything your OB tells you.

Oh, her baby shower is tomorrow. Hopefully we have much more discussion of baby care than birth, cuz otherwise I'll be biting my lip until it bleeds! I'm not looking forward to this.

[laohaire]

I guess one way to look at it is that she is obviously getting the care she wants. If a c-section was a concern to her, then she'd take steps to minimize the chances. Apparently a c-section isn't that big of a deal for her, and she's willing to take that risk. She probably feels she'd rather risk the c-section than deal with the stress of bucking that trend.

I think most women are satisfied with the care they receive, even if it doesn't make sense to you or me. And that's really the goal here - for every woman to get the care they want.

[MegBoz]

Originally Posted by laohaire

I guess one way to look at it is that she is obviously getting the care she wants. If a c-section was a concern to her, then she'd take steps to minimize the chances.

Good point, except that I think it's equally likely that she thinks "I will only have a CS if I really need one." & that is why she won't "take steps to minimize the chance that she'll have a CS." She trusts her OB. She trusts her OB & believes confidentally that she will only have a CS if it is necessary - so she sees no need to educate herself & question an OB.
Of course, we all know this isn't true and an absurd # of unnecessary CS are performed every day.

Originally Posted by laohaire

I think most women are satisfied with the care they receive, even if it doesn't make sense to you or me. And that's really the goal here - for every woman to get the care they want.

Actually, going back to my point above, I think you may be right that she WOULD be satisfied with the care she received even if it were an unnecessary CS because she will believe it WAS necessary. She will believe her induction was necessary or her big baby wouldn't have fit through her pelvis anyway. She will believe the baby was distressed & would have died if a CS wasn't done (nevermind the AROM & pit they pumped her with.)

Or if she has a vag birth & it's overall not a pleasant experience, she'll believe that is as good as it gets. Because birth is an awful thing anyway. We're not SUPPOSED to enjoy any of it. It's painful, dangerous, gruesome, etc. So that's what she'll expect. KWIM?

Again, obviously I have no idea what this particular lady is actually thinking, but we DO all know that lots of American women do think this way. Yet again, I must

[laohaire]

Originally Posted by MegBoz

Good point, except that I think it's equally likely that she thinks "I will only have a CS if I really need one." & that is why she won't "take steps to minimize the chance that she'll have a CS." She trusts her OB. She trusts her OB & believes confidentally that she will only have a CS if it is necessary - so she sees no need to educate herself & question an OB.
Of course, we all know this isn't true and an absurd # of unnecessary CS are performed every day.

I'm totally with ya, but we have different feelings about c/s than your coworker. Your coworker is satisfied to think that she might have one and is satisfied to think that if she does, it will be necessary. It would be the really rare OB that I would trust, but she is happy to trust hers.

Originally Posted by MegBoz

Actually, going back to my point above, I think you may be right that she WOULD be satisfied with the care she received even if it were an unnecessary CS because she will believe it WAS necessary. She will believe her induction was necessary or her big baby wouldn't have fit through her pelvis anyway. She will believe the baby was distressed & would have died if a CS wasn't done (nevermind the AROM & pit they pumped her with.)

Or if she has a vag birth & it's overall not a pleasant experience, she'll believe that is as good as it gets. Because birth is an awful thing anyway. We're not SUPPOSED to enjoy any of it. It's painful, dangerous, gruesome, etc. So that's what she'll expect. KWIM?

Again, obviously I have no idea what this particular lady is actually thinking, but we DO all know that lots of American women do think this way. Yet again, I must

I think what you're saying is that her trust is based on deception and therefore her satisfaction is based on false premises.

Well, I agree.

But on the other hand, I have to say that I think it's still a choice of hers. You've mentioned a few ways she can empower herself and surely she's heard of some dialogue or controversy about birth, so at this point she's choosing to be satisfied and not investigate further. So I guess the big question is - how much of this equation is based on deception (by obstetricians, by society at large) and how much is based on a woman's choice (to be satisfied with the deception).

I can see it either way - that a woman would sincerely not know at all that obstetricians do not practice evidence-based care (and I don't say that lightly) but rather convenienced (for the doctor)-based care, and liability-based care, and therefore her choice really isn't a choice at all. OR that the majority of women have at least an inkling that there are some questions about this, but prefer to stay comfortable with the medical model than to experience the discomfort (and absolutely, there IS discomfort) in seeking alternatives.

I don't know what the bottom-line difference is between women like you and me and women like your coworker. It's not just education or exposure to alternatives (though certainly those are factors) - because I think many women here have questioned things they've heard/seen and made the choice to educate themselves (others maybe didn't have to; perhaps were home birthed themselves and raised to embrace that model).

Other women have seen/heard the same things that triggered us to investigate, and did NOT decide to educate themselves further. In this case, I'm going to say that this is their choice, that they are very likely to feel satisfied with their births regardless of the outcome, and that's fine for them, I guess.

I guess.

Well, an interesting topic - if medically managed obstetrics is not ideal, then how much of the "blame" for its continuation lies with whom (doctors, insurance companies, and the women - we'll call them patients in this case)?

[accountclosed3]

here are my practices:

1. take a deep breath and remember that i don't like advice/information that i don't ask for;

2. assume that they are asking for information somewhere else;

3. if two demonstrates to be false, realize that i can't change it if they aren't asking;

4. say something supportive about whatever decision, or something that's just "non-commital" such as "i know many people who birthed there;"

5. ask questions to change the topic to one where you can agree and be happy.

this *works*. it makes my life so much easier.

also, i find that people will then start asking you things like "where did you birth?" and i answer "i homebirthed." and they might give me a weird look, and then go "oh, i could never do that!" and i go "it's not for everyone." and i smile and i say "you make good decisions for yourself. you'll be a good mama!"

because, i do honestly believe that, even if i don't agree with the decisions.

and then a few weeks later, i get questions like "weren't you scared?" or "how did you decide to homebirth?" and then i can say "oh, i thought that i would go to a doctor, but then i learned that homebirth is just as safe for mothers and babies as a hospital, and i thought "why not?"" and then i smile and assert that it was awesome.

and they say "wow, i don't know if it's really as safe as a hospital, though."

and then a few weeks later, they say "so, i read this thing about how homebirth is just as safe, but what if there's an emergency?" and then i say "well, emergencies do happen, but midwives are there to help with those emergencies that they can handle and to also tell you when you should transfer to get the help that only a hospital can provide."

and then you might discover that they may choose a homebirth for the next one, or try a birth class or whatever.

but i keep it all positive, about them, and my birth plans private (unless asked).

and i had a UC, so it gets very weird for people if they keep asking about my birth, because then i have to tell them about UC, which can eventually put them off homebirth, but i do say that we have great midwives in the area and i tell them about the birth center too, in case the aren't "ready" for homebirth, but also are starting to think that perhaps their doctor isn't the right way for them. or that perhaps, for the next birth, a more friendly hospital, birthcenter, or homebirth would be great.

[MegBoz]

Originally Posted by laohaire

But on the other hand, I have to say that I think it's still a choice of hers. You've mentioned a few ways she can empower herself and surely she's heard of some dialogue or controversy about birth, so at this point she's choosing to be satisfied and not investigate further.

Oh, yeah, good point. You're right - she has made the choice here.

Originally Posted by laohaire

OR that the majority of women have at least an inkling that there are some questions about this, but prefer to stay comfortable with the medical model than to experience the discomfort (and absolutely, there IS discomfort) in seeking alternatives.

"Discomfort" is a really fitting word here, IMO. I'm reminded how Henci Goer, in her book "Thinking Woman's Guide" creates an analogy that it's like sex education - she would rather the reader be uncomfortable than uninformed. (And, the implication here is that being informed will make you uncomfortable!)

Indeed it is very uncomfortable to know most OBs don't practice evidence-based care. When I first got PG, I was going to OBs who deliver at the world-renowned Johns Hopkins. Then, when I found out that cEFM for & "nothing by mouth" were standards for all-pregnancies, I was OUTTA THERE! These 2 thigns INFURIATE ME. The evidence is so clear - "nothing by mouth" in particular. So it really shook my world view to find out that this supposedly fabulous medical institution did things that were downright damaging to birthing women.

Now, I DREAD the day I have to deal with any medical crisis for my family or I - fearing that I can't trust ANY docs & will have to spend hours on research. Yeah, it's not fun.

Originally Posted by laohaire

Well, an interesting topic - if medically managed obstetrics is not ideal, then how much of the "blame" for its continuation lies with whom (doctors, insurance companies, and the women - we'll call them patients in this case)?

I would put society at large & the media in there as well. Even education. When we learned about sex ed & health in high school, we didn't learn much about birth. I heard about every STD and all about drugs, but I barely remember learning anything about birth or nutrition. (Um, & such knowledge would have been useful in life, wouldn't you think?) :

If women are raised to believe birth is horrific & dangerous, they're more likely to be complacent & trust their docs - even if they know the CS rate is higher than it ought to be... because maybe a CS isn't so bad since vaginal birth is awful anyway.... It's easy to see how this belief system can be internalized after a lifetime of exposure to these ideas:

1. That birth is just plain awful (You don't want to feel anything anyway)
2. Birth is a dangerous event that requires medical MANAGEMENT (not just supervision)
3. Doctors are to be trusted unquestioningly to manage medical events.

& there you go.

For me, it was just my personality. I like to learn as much as I can & enjoy reading. I just plain wanna know! I question things & don't like to be bossed around, so I wasn't about to blindly trust my OB.

[laohaire]

Originally Posted by MegBoz

Now, I DREAD the day I have to deal with any medical crisis for my family or I - fearing that I can't trust ANY docs & will have to spend hours on research. Yeah, it's not fun.

I have the SAME problem. Honestly, I didn't paint all docs with one broad stroke, I really didn't. The more I learned about obstetrics, the angrier I got, but I also figured that these issues might not happen with other specialists or general practitioners. But my personal experience dealing with doctors of different specialties has led me to the uncomfortable conclusion that, yeah, I'm on my own.

No, don't get me wrong, there are lots of absolutely brilliant doctors out there whose knowledge vastly overpower what little I have. And many of these are GOOD doctors as well; not just brilliant but also helpful, concerned, etc. But the point is that I realized I am responsible for deciding what is a good doctor! As opposed to simply making an appointment, showing up, and taking the doctor at his/her word without questioning: is this doctor knowledgable? Does the advice make sense? Have they asked all the right questions? Etc. At this point I believe we've found two outstanding doctors - our dentist and our opthamologist. They have EARNED my trust - but I didn't just give it to them blindly. And frankly, I will continue to assess them as well; I'll ask questions if something doesn't make sense, etc. They are human, and the health of my family is ultimately MY (and DH's) responsibility, period.

It does kind of freak me out to think we'd be on our own if something serious were to happen. But I'd bet money that mamas who take that responsibility square-on have significantly improved outcomes. Anecdotal evidence (like, well, stories from Reader's Digest, lol) seem to bear this out - when a mother is told "there's nothing wrong" or "there's nothing we can do" and refuses to take that as an answer, she's much more likely to find the real answer. So empowerment has bigger upsides than the discomfort, imho.

Originally Posted by MegBoz

I would put society at large & the media in there as well. Even education. When we learned about sex ed & health in high school, we didn't learn much about birth. I heard about every STD and all about drugs, but I barely remember learning anything about birth or nutrition. (Um, & such knowledge would have been useful in life, wouldn't you think?) :

Yeah, I didn't learn ANYTHING about birth in school. Nada. Nor nutrition, though I'm not sure how useful the standard line about it is anyway. (Well, same for birth).

Originally Posted by MegBoz

If women are raised to believe birth is horrific & dangerous, they're more likely to be complacent & trust their docs - even if they know the CS rate is higher than it ought to be... because maybe a CS isn't so bad since vaginal birth is awful anyway.... It's easy to see how this belief system can be internalized after a lifetime of exposure to these ideas:

1. That birth is just plain awful (You don't want to feel anything anyway)
2. Birth is a dangerous event that requires medical MANAGEMENT (not just supervision)
3. Doctors are to be trusted unquestioningly to manage medical events.

& there you go.

For me, it was just my personality. I like to learn as much as I can & enjoy reading. I just plain wanna know! I question things & don't like to be bossed around, so I wasn't about to blindly trust my OB.

As I age, I don't like to be bossed around either, but I would have been ok with it at age 21. Honestly, it would be nice to be able to relax and trust my doctor, trust my mechanic, trust my contractor. But they are all human, and humans tend to take the easy way out, and if I want good service I have to be on top of it.

[Storm Bride]

OP: If you do want to try again, there's one possible chink in her armour. When I had ds1, I trusted my doctor (GP, not an OB - I don't know anybody around here who has seen an OB for primary prenatal care with a first baby - even after my c-sections, I saw a GP, and the OB for backup). I still trust him, but he doesn't handle obstetrics, anymore. He and his wife (who was my GP for 3 of my other pregnancies) have an excellent reputation for always making it to their "patient's" births. I wasn't worried.

Only, things went down the crapper fast when I got to the hospital. They decided they were doing the c-section, and called my GP, but I was already on my way to OR when they called. He got there fast, and he did assist at the surgery. But, I was unconscious before he arrived, and had nothing to do with the decision to cut...nothing at all. Your co-worker might trust her OB, but how would she feel about any random doctor who might be on call at the hospital?

As for how to keep quiet? I don't know. I don't seem to have an "off" switch.

[Bluegoat]

I find it hard too. My cousins wife, who is due in January, was over for a party the other day, and I invited her to look through and borrow any of my books, there were a few on birth and some on breastfeeding, and one on baby care. She was not at all interested, and said she wasn't reading much, just going with the flow.

I just said, casually, well, it's nice to have an idea about procedures they might ask you about before you go into labour, since you probably won't want to hear the details at the time.

What I wanted to do was scream - They are going to take you to the cleaners if you don't know what to expect!

[secondseconds]

Do you realize that your co-worker probably felt like you were harassing her? In the future, try saying "I did a lot of research when I was pregnant so I know a lot about this stuff---if you want help or need information, let me know!"

[preemiemamarach]

How do I say this gently- OP, I think you need to relax.

As you said, you don't know why THIS woman went to an OB. I don't look like I have any obvious health problems, but I have a malformed uterus, history of 2nd tri twin loss, and a preemie under my belt. Oh, and a history of cervical cancer and pre-e. I have a high-risk OB, but she considered risking me out to a perinatologist. By looking at me, how could you know these things? I, too, want to avoid a c-section this time around (33 weeks now), and am really hopeful I can. My son was born vaginally at 33 weeks, but with a preemie, you have to be quite careful to monitor during labor in case c/s becomes medically necessary.

One of the things I find difficult when I talk to proponents of natural childbirth (I am a proponent of SAFE childbirth, whatever that means for the mother and baby) is that so many people assume that obstetricians are evil somehow. I trust my OB. She trusts me. I ask questions, she answers; she asks questions, too, and I answer them. Our goal for this pregnancy is a healthy baby as close to full term as possible. I am being very heavily managed medically because that's what is most likely to keep my baby in to something approaching full term. If anyone were to ask me why I didn't have a midwife, I would be happy to share, but most obviously don't ask.

So please, rather than assuming those of us making choices that are different from yours are uninformed- either ask, or (after offering helpful info) assume we have valid reasons and know what we're doing.

[MegBoz]

Originally Posted by Storm Bride

Your co-worker might trust her OB, but how would she feel about any random doctor who might be on call at the hospital?

Good point. Except I'm nearly certain it's a group practice. So she'll rotate through all the docs in the practice & then get whichever of them is on call at the hospital when she goes into labor. So she WILL have met them all.

Originally Posted by Storm Bride

As for how to keep quiet? I don't know. I don't seem to have an "off" switch.

Ha! Well, I guess I don't either. I manage to not reply to them, but I don't keep "quiet." Instead I come here or rant to my DH (who is DONE with hearing about it!) or email crunchy friends.

Actually, there is another co-worker who had a VBAC who was open to learning & she borrowed THREE books from me - "Exercising through your pregnancy," "Thinking Woman's Guide" & "Pushed." She DID have a VBAC just a few weeks ago! She is closer to the PG co-worker, so maybe there have more discussions I'm not aware of. (That co-worker told me she started reading "Pushed" & found it very scary. I didn't even say to her, "Oh, yeah, it is, but it's not even the scariest book I have. That would be 'Born in the USA.'")

The new-mama is coming to the shower tomorrow. I'm trying to see if she'll bring my books back so the PG one can take them. But at this point I don't know about offering them... since that would be more unsolicited advice. I'm afraid I'm too close to stepping over the line. Maybe I'll see if the new-mama can offer them up.

[MegBoz]

Originally Posted by laohaire

I have the SAME problem. Honestly, I didn't paint all docs with one broad stroke, I really didn't. The more I learned about obstetrics, the angrier I got, but I also figured that these issues might not happen with other specialists or general practitioners. But my personal experience dealing with doctors of different specialties has led me to the uncomfortable conclusion that, yeah, I'm on my own.

I remember reading in "Born in the USA" that the tendency to think surgery is always best extends beyond obstetrics. Something about a hip or knee surgery was proven to not be the best course of treatment & thousands of the procedures continue to be performed anyway.

Originally Posted by laohaire

They are human, and the health of my family is ultimately MY (and DH's) responsibility, period.

& to the rest of your post too.

[MegBoz]

Originally Posted by secondseconds

Do you realize that your co-worker probably felt like you were harassing her? In the future, try saying "I did a lot of research when I was pregnant so I know a lot about this stuff---if you want help or need information, let me know!"

Yeah, she knows I did tons of research because I told her while I was still PG (WAY before she got PG.) I told her how I discovered this chasm between evidence & real practice, how angry it made me, & how I switched out of OBs who deliver at world-renowned Johns Hopkins. So, she knows, so it wasn't weird for me to spit out the fact that GBMC has the highest CS rate & then let her know that hospital & provider CS rate are the TOP predictors for whether or not you'll have a CS.

But, as I've already posted, I'm trying to keep my lip zipped because I agree with you, if I keep going, I will be harassing her! I do NOT think the few things I've said thus far cross into the harassment area! But I think I can't say anymore now.

[GoestoShow]

.

Edited by GoestoShow - 12/7/10 at 7:11am

[MegBoz]

So I've obviously posted a lot here already, but I really did want to reply to this one specifically.

Originally Posted by preemiemamarach

How do I say this gently- OP, I think you need to relax.

I agree with you there! The state of American maternity care INFURIATES ME! I think it's a downright atrocity & it makes me absolutely positively furious. And I really wish that weren't the case. I DO need to chill about it, but it's hard for me. (Ha - hence this post!)

Originally Posted by preemiemamarach

As you said, you don't know why THIS woman went to an OB. I don't look like I have any obvious health problems...

I'm sorry to hear about that & I wish you the best.
& that's another reason I KNOW I need to chill & not say anything more. (I've said a few things that I think are fine to have said, but it's enough now - any more will get too pushy.)

BUT... as I mentioned, I know there ARE many women out there who DO blindly trust their OBs. So even if THIS particular woman is not one of those women, I know they exist. & I know they too-often get bad treatment. & it upsets me.

Originally Posted by preemiemamarach

One of the things I find difficult when I talk to proponents of natural childbirth (I am a proponent of SAFE childbirth, whatever that means for the mother and baby) is that so many people assume that obstetricians are evil somehow. I trust my OB. She trusts me.

Yes, I know there are plenty of awesome OBs, just as there are horrible MWs out there. People are individuals. Which is why whenever I post about the atrocious state of American maternity, I try to usually state things like, "On the whole, American OBs aren't practicing evidence-based care." or "All too often, blindly trusting your OB doesn't get you what's best for mama & baby." (And, IMO, more than about 5% is "too often" for Mamas to be treated with anti-evidence based practice!)

Sometimes I may omit that clarification - my posts are long enough already. But I do try to make it clear that I'm not "painting all docs with the same brush."

BUT - based on the stats, as I said, I think with such an outrageous CS rate, it IS more likely than not that a lot of Mamas at GBMC hospital are subjected to unnecessary medical intervention.

[Ruthla]

There are a few possibilities here:

1) Maybe she truly does have a high-risk pregnancy and does need medical management of her birth. She's under no obligation to explain her private medical details to you.

2) Maybe she's having a normal, healthy, pregnancy, knows full well about the dangers of medically managed pregnancy and birth, but is still too scared to "buck the trend" and choose something different for herself.

3) Maybe she's having a normal, healthy pg, and thinks she's doing the safest thing by trusting her OB. Perhaps she knows about your experiences and thinks you're absolutely nuts and endangered your own baby by NOT following the typical OB advice.

In any of those scenarios, you won't be able to change her mind. You need to trust her to make her own choices about her pg and birth, even if you would have made different choices in her place.

At this point, I think I'd focus on teaching her about breastfeeding and AP infant care. Maybe give her a copy of Dr Sears' The Baby Book for her baby shower?

[mama2mygirl]

I trust other women to know what they want for themselves.
I don't like it when mainstream women--or people for that matter--tell me what to do. So why would I do it to them?
I guess I could understand where you're coming from if she had started talking to you about your birth choice but she didn't.

[Girlprof]

OP, I have many of the same thoughts and experiences that you do. I left the major practice in town once I found out how high their intervention rates are and I've still had very close friends go there and deliver. Actually, two of my best friends delivered with this exact same practice and had really lovely births! Though two other friends had horrible intervention-packed nightmares. So, here is what I do.

If I here someone is going to that particular practice, I do generally say something like "I started out with them, but I wasn't all that happy so I changed." Then I let them pursue the matter. This has not really worked.

A much more satisfying approach is that I have started slipping info on child birth politics into my teaching. I teach college so my students are around 20. They haven't considered having babies yet, but they are really ready to be outraged by just about anything. I had them read parts of Pushed last semester. The guys didn't seem to care one way or another - one guy was ready to defend OBs even after reading Pushed. But the women - the women were really thinking about this issue. They were mad. They were talking to their mothers and their sisters - and of course, getting all the stuff from the book confirmed.

If there's any way you can arrange things to talk to a younger audience about this issue, I really recommend it.

[felix23]

Originally Posted by mama2mygirl

I trust other women to know what they want for themselves.
I don't like it when mainstream women--or people for that matter--tell me what to do. So why would I do it to them?
I guess I could understand where you're coming from if she had started talking to you about your birth choice but she didn't.

: I hate it when people automatically assume that women who choose hospital births and OBs are not educated. It may look like I am blindly following my OB, but part of my research was finding an OB that I COULD trust. If I didn't trust him to give me good advice I wouldn't go to him. And one of the reasons I chose him was because he is know for erring on the side of caution, so I did have a ton of interventions, but that is what I wanted. A lot of women here would have hated having him as an OB, but he is exactly what I needed and wanted.