The balance between education and respect - Page 6

[captain optimism]

Originally posted by OnTheFence



Frankly I think these predictions are ludicrous. Again I am not into conspiracy theory nor do I think that the first things you listed WILL ever happen. Over the past ten years I have seen things go back and forth. For instance, my SIL wanted a repeat csection in 1996 but her insurance would not allow her nor her doctor, she had to have a trial of labor and attempt a VBAC or else insurance would not pay. She did have a successful VBAC. In fact this was a policy of BCBS int he late 90s and in the year 2000. At the hospital I gave birth in, natural birth is advocated and advised.

One thing I have seen repeatedly on these boards and on other internet discussion groups: women's experience of birth, the attitudes of their practitioners and of the hospitals and other institutions involved, vary a lot from place to place. Not only that, and this is a crushing shame to our society in the US, people's birth experiences differ according to their social status. That's why even if in many states there is a push from malpractice insurers for OB GYNs to try to raise the number of c/s births, in other places you may get more support for vaginal and even for drug free births, in hospitals and from doctors.

The first few times I saw women posting that their OBs were putting them on weight-loss diets in pregnancy, that hospitals were regularly encouraging new moms to supplement with formula, etc. etc., I couldn't believe it. But now, having discussed this stuff with a lot of people at work and in my community IRL, I can see that positive change in these areas is not consistent.

It's like other things that relate to women's lives. You might think, "No one ever told ME that 'girls can't do math'." But someone else your age was more than told it, she was prevented from enrolling in Calculus in high school. You think, "My insurer encourages natural childbirth" while someone else is dealing with a hospital who is telling them they have to wear a fetal monitor throughout labor. Maybe at a hospital in the same city where you had a birthing center birth in a tub of water!

That's one of the big values of these boards, that we can learn about what other people's experiences have been.

[Greaseball]

Many of these things have already happened, just not everywhere.

Pam and I are in the same state, and the routine 39-week induction is true. Planned cesareans usually occur at 38 weeks.

The time after rupture that delivery must be completed is getting shorter. It used to be that 48 hours was standard. Now, depending on the hospital, it's anywhere from 20 to 6 hours.

Some hospitals do use routine 3rd trimester u/s to predict weight, and will section for 9 lbs and up. For a woman under 5 feet tall, the hospital in my city will section for a 7-lber.

Many hospitals do have time limits for delivery, or what they consider FTP. If you labor over 24 hours at a hospital, you will be considered FTP. In some hospitals, the limit is 8 hours, especially for a woman who has already had children. Others stick to the "18 hours for a first-timer, 12 hours for all others" rule. They also have limits for the pushing phase, usually 2 to 4 hours.

Vaginal deliveries of breeches are rare in hospitals, though in the 70s only 10% of them were cesarean. A woman will likely have a hard time finding a doctor who will deliver a vaginal breech. Some will even plan a c/s for a posterior presentation. Some twins are still delivered vaginally, though only if both are head-down, and the hospital will often insist on an epidural and forceps.

Perhaps, OTF, you hadn't done any research? I don't just make all this up for no reason, and I don't just go by what is in my city or state. I'm sure if, in 1970, I had predicted the things that go on today, I would be considered a raving lunatic. But in the end, look who's right!

[OnTheFence]

I have done research. Lots. I also know how people, websites, etc like to skew things and over dramatize, like I believe you are doing, to fit their own agenda.
My belief at this point that SOME midwives, doulas, and natural birth advocates are so far to the left and are just as bad as the medical establishments they soo oppose.
Nothing is as black and white. Its like do you believe there is no balance?

Where is the statistics to back up your claim that babies are being induced at 39 weeks and surgicall birthed at 38 weeks as routine practice?

Where are the actual articles and statistics for these 7lb babies that are being born surgically or by induction because of their weight?

The only thing to me that has any ring of truth, that I actually have a basis of facts for is that there are less breech vaginal births. And that is for a barrage of reasons. Some I agree with, some I dont. Also, I think you have to break down the types of breech, complications, etc to really get a clearer picture of what is going on. I do agree that doctors are not as skilled in this area as they should be and that a surgical birth is likely to CYA.

[Greaseball]

Where is the statistics to back up your claim that babies are being induced at 39 weeks and surgical birthed at 38 weeks as routine practice?

Where are all your articles that say it isn't so?

If you really want sources for my info, the main one is the Mothering Perinatal Healthcare Index, and just about every other Mothering magazine. I have listed some books in other posts, the main one being Open Season. All this info is, of course, based on those fancy journals and research papers.

You could also check with the midwives here on MDC, if you feel you would believe anything they had to say. Perhaps they could get you some journals and papers.

Some things come from mainstream doctors, nurses, and birth educators. The 7-lb section rule was mentioned in the hospital childbirth class by the instructor. I don't think there will be a whole research paper dedicated to it.

I don't have an agenda. I have nothing to gain or lose no matter how a woman gives birth. If a woman on this board decides to have all her children by elective surgery, it doesn't hurt me any. If another woman has them all at home, how will it benefit me? Maybe if I had a career as a midwife, CBE or doula that would make more sense.

I don't feel I have to "prove" my knowledge beyond that. I'm sure that you would have something negative to say about whatever statistic, website, or journal I showed you, so what's the point? I'll just list the basics (maybe someone else will get something out of them) and accept the fact that we won't see eye to eye.

[pamamidwife]

I cannot offer you any published "studies" since these are not done on routine practices by physicians.

I can only offer what is true in my community. And, unfortunately, very little of the interventions that are done in my area are evidence-based (from across the board inductions at 39 weeks - which an OB told me all the women LOVE to automatic cesareans for "big" babies).

I've mentioned before that in the state of Oregon, lower malpractice premiums are being offered by the only two insurance providers here for practices with higher cesarean rates.

This comes straight from the horses mouth, OTF - a local OB in a very busy practice that is frustrated about he is mandated to practice.

(Said OB had a homebirth with a midwife, too, if that discounts his word)

I think that we're getting away from the point here. Yes, there are two extremes that are blind and dangerous on both ends. I hope you're able to hear those of us who feel that a healthy mom and a healthy baby are important.

My "agenda" isn't to get every woman to birth at home. On the contrary, I don't believe that most women in America are good candidates for homebirth for many reasons (social conditioning, poor nutrition, etc.). I am not looking to earn more money through the coercion of women.

However, there are so many great books on the topic. I wish more women had information beyond what their doctor may provide them - or even what their midwife may provide them. A truly informed choice requires more than just one side, right?

[pamamidwife]

I just wanted to add, too, that it isn't about being right.

It's about offering women CHOICES in their care.

I just had a memory of about four years ago, on another board, where I ripped apart a woman's choice to have an induction on her 38 week baby after her last baby, at a 41 week checkup, had died.

I cringe to think about this. However, I bring it up to make a point: that sometimes we CAN be judgemental and harsh. That we assume that what is right for us is right for everyone. However, I could NEVER imagine the fear and hurt in this woman's heart. I didn't hear her when she spoke of her grief over not being induced on her due date with her previous pregnancy.

I was under the belief that I was right and she was WRONG>

That is where we get messed up on this issue. We all live in different parts of the world, with different care providers. Some offer full choice, others cannot or will not.

I've heard horror stories from homebirth midwives, from CNMs and from doctors. None of these groups are homogoneous. We are all human and we have our own biases.

Let's reiterate some of the common ground that we've established:


That, before posting, you think about WHY you are posting. What is it that you want to convey? What are your intentions? To tell someone they are wrong - or to offer another viewpoint on the subject? To publicly "one-up" another person or to offer some facts?

Intention when responding is going to be the most helpful for those of us involved in birth activism. I think this could apply to those who do not consider themselves birth activists, too.

What if we all lived like this?

[mamallama]

I changed my mind...someone else said it better!

[tinyshoes]

Originally posted by pamamidwife
Really, even 20 years ago, would we have even guessed that we'd be seeing a 25% cesarean rate?

C'mon, Pamamidwife, --didn't you get your Novermber/December 2003 issue of Mothering? Page 24 has the correct percentage, if I may be so bold as to cite a source and correct you:

26.1%

That's the national average from the CDC, and it is the all-time high.

So when I read Greaseball's predictions, I'm not falling of my seat. Isn't Brazil the place where the c-sec rate is 80%?

edited to add winking emoticon to emphasis the intended tounge-in-cheeck nature of my 'correcting'.

[pamamidwife]

I stand corrected.

Yes, Brazil has a majority cesarean rate. Only the poor women have vaginal births.

Lately, all the publicity about vaginal integrity being saved by cesarean sections is really irking me...

The truth is, prolonged second stages (pushing, usually caused by a command to push before women are ready, epidurals, and poor positioning of babies), episiotomies and instrumental deliveries are to blame for the increase in pelvic floor issues.

Well, that and our sedentary lifestyles.

But, egads, one reason why Brazilian women favor cesareans is pelvic floor integrity.

[lauraess]

an I reply very Late, anyone going to listen?

I started reading from the beginning of this thread , thinking it was just beginning maybe yesterday or today and then after coming to points of extreme agreement and places where I wanted to cry over the emotion and relatedness of it all -- i realized there were 6 pages. Couldnt read em all!!

so.. the reason this discussion hit me was not only because i cant believe i didnt see it sooner, but because im personally trying to find a way to deal with this issue involving my young, pregnant freind and her decisions in pregnancy and childbirth and my passionate beliefs that stem from my own births and the education i have given myself over the years. I want her to understand yet i get soo worked up about the drs and the issue of womens empowerment and the whole damn thing i come off like im attacking her. I was trying to keep my mouth shut till i could offer something useful and then today i made a comment and then more and ya-da-ya-da ... she soon made up a good reason to get off the phone w/ me.

I love what EVERYONE wrote ( what i had time to read, anyway) and hope i can be gentle and respectful of her thru her pregnancy.

If anyone has any specific ways i could temper my comments and advice (SOMEONE EARLY ON IN THE THREAD SAID THEY WERE LEARNING THIS)```` PLEASE HELP! I DONT WANT TO HURT THIS RELATIONSHIP, I ONLY WANT HER TO MAKE INFORMED DECISIONS THAT ARE HEALTHY FOR HER AND HER BABY.

tHANKS AGAIN FOR ALL YOUR WORDS OF WISDOM!
laura

[2BMamaof3]

Originally posted by pamamidwife
I just wanted to add, too, that it isn't about being right.

It's about offering women CHOICES in their care.


********************************

Let's reiterate some of the common ground that we've established:


That, before posting, you think about WHY you are posting. What is it that you want to convey? What are your intentions? To tell someone they are wrong - or to offer another viewpoint on the subject? To publicly "one-up" another person or to offer some facts?

Intention when responding is going to be the most helpful for those of us involved in birth activism. I think this could apply to those who do not consider themselves birth activists, too.

What if we all lived like this?

Pam, I think you've really hit the nail on the head with this post. I am a birth activist. But I do not EVER want to make anyone feel bad over whatever has happened in birth (choice or not!).

I believe the changes need to happen at the service level (doctors/nurses/hospitals...and right now...INSURANCE COMPANIES!!!). Informed choice is important...but if the medical establishment is going to force care on anyone, it should be based on evidence based practice!

I guess my "agenda" is to have evidence based practice be the goal...however, if we choose to do something that is not "best" as proven through evidence-based practice...it is still our choice!!!


My confusion is when I've said something or agreed with something like this: "You know the pros and cons of the choice...you are making the choice, that for you, is the best." And whether or not it is a choice based in "best practices/evidence based" is moot to me...because it is her choice! My confusion comes in because that statment is often interpreted in a negative way...and I guess I don't understand why. Because to me it is about choice...informed or not...I support someone's right to choose. I try to judge a situation before offering my opinion to any pregnant woman. Sure, I may not agree (for me)...but it is ultimately each of our choice.

Thanks,
Abby

[mamallama]

I think the part regarding evidence based care & choice is very interesting.

We all talk about the emotional and psychological aspects of birth, and how much influence they have over the physiological aspect of birth.

Some women have a feeling deep in their bones that they are going to need x, y or z; things that would not be indicated by evidence based care. This is where the emotional and psychological aspects of birth come in. Are x, y and z really necessary for a safe and satisfying birth? It's not up to me to say.

I don't understand the negative interpretation either. The fact is that the emotional & psychological aspects of giving birth impact the psysiology. The mother's emotions and her state of mind cannot be wrong, therefore her thoughts on what she needs for an optimal birth are of paramount importance.

[mamallama]

lauraess--baby steps. Ask open-ended questions and listen. As some of the moms on this thread have said, pregnant women are overwhelmed by friends, aquaintences and veritable strangers giving well-meaning advice. What women need most is someone to listen to their concerns and give them the space to find their own voices.

If you need to vent about the current state of maternity care in the US, do it somewhere else!

[lauraess]

Thanks Mamallama!
It seems she's not so mad she couldnt call. we talked. she apologized for not showing me much respect (calling me "her little liberal friend" after i left her a message saying i wish she hadnt gotten an u/s because they are controversial. And I apologized for judging her as not understanding what i was talking about.
so, you're very right. a lot of things were said during this thread discussion that i could learn from.
I must listen and listen and offer gently, no lecturing.
After i get over being such a pushy freind maybe I'll be able to give her some sites to look at.
Laura

[Greaseball]

Isn't Brazil the place where the c-sec rate is 80%?

Actually, the last thing I read was that it was 95% among rich women (those other 5% must be accidents!) and 65% among poor women.

[emmalala]

Great thread! I'm sorry to be posting so late but I had a thought about why cs moms appear to be defensive and giving a lot of explanation.

From her perspective, she may feel that someone who judges her doesn't know enough about her experience. So *she* wants to educate about what specifically happened and how.

I can well understand how cs moms are feeling attacked - it hurts to see that some posters to this thread have felt the need to explain their birth experience, I don't see that the birth activists have done that...

I'm seeing how that arrogant/ignorant split is arising. Don't know if this post helps anyone, of course...

[Peppermint]

Originally posted by emmalala
Great thread! I'm sorry to be posting so late but I had a thought about why cs moms appear to be defensive and giving a lot of explanation.

From her perspective, she may feel that someone who judges her doesn't know enough about her experience. So *she* wants to educate about what specifically happened and how.

I think you hit the nail on the head, thanks!

[eilonwy]

I realize that this thread is really long, but could someone please answer my questions? I seriously want to know. Thanks.

Originally posted by eilonwy

I have some questions:

1)What does it mean to be a "birth advocate"? I'm really confused about this. What does it mean to be an advocate for babies or laboring mothers? Who/what is it that you're advocating for?

2)What are your motivations for this? Are they altruistic, or do you just like being "better" than other people (this is the impression I get from most self-proclaimed "advocates" of any cause).

3)What is it that you want to change, or see change?

4)Who is responsible for causing these changes to happen?

5)What outcomes are you hoping to see? Natural births, homebirths, unassisted births, what is it that you are looking for?

I think it's unrealistic to expect women to be thrilled when you pick apart their birth story and tell them what they/the doctor/the midwife/etc should have done differently to produce the outcome *you* think is best. I think it's exceptionally rude for women to say "Oh, I've never been through what you have but I know why you were wrong and what I would have done in that situation." I totally disagree. I have been told some very negative things on these boards (and I don't think I'm allowed to quote them) implying that my decisions regarding my son's birth and my upcoming birth are selfish and heartless. What could you possibly be hoping to improve by saying such things? All I can see it doing is boosting your ego.

It's one thing to post "having an epidural increases your risk of a, b, and c". It's another thing entirely to tell lies "If you have an epidural, you won't be able to nurse your baby" or "Your baby will be born drugged if you choose to have an epidural" or "If you love your baby then you can put up with the pain of labor."

I've noticed that people here tend to assume that if you didn't have a homebirth and/or you aren't planning one that you are wholly uneducated about normal childbirth, or that your doctor is. There's also an assumption that if you see an OB instead of a midwife, for whatever reason, then you are automatically going to have problems, that even if you want an intervention-free birth you probably won't get one. These things aren't true. I've done the research, honest. Just because you want to have a homebirth and I want to go to the hospital and get an epidural does not mean that I'm completely unaware of the potential risks. Whatever it is that you're advocating for, please keep in mind that not everyone out there is ignorant just because they made/are making different choices from your own.

[captain optimism]

Originally posted by eilonwy
I realize that this thread is really long, but could someone please answer my questions? I seriously want to know. Thanks.

I think I might qualify as a birth advocate, a little bit. i'm not political about it, but I did loan all the good birth books i bought to my friend when she got pregnant, and I'm about to do the same thing again for another friend.

1. I'm advocating for women to have good experiences and healthy children, through information about good prenatal care and self-care.

2. I am motivated by caring for the individual women I talk with about this. As you know about me, I had not the greatest birth experience, and there are things I did that I hope to persuade others to avoid! (I think I was under a lot of stress around the birth and I also feel like my labor might have gone better in a place where I was allowed to eat and drink.) I also made some good choices. So I can't really feel superior to other women.

(At least, not about birth. )

I'm also motivated by feminism. I think there is still a model that's hanging around our culture that what women do in childbirth is for the sake of their doctors, not for their own sakes!

3. I want to see women and their children get appropriate health care during pregnancy and after birth. That means, no unnecessary drugs or surgeries. I think there are some steps women can take while pregnant to make sure they get good care, like reading about pregnancy, like visiting prospective birth places before selecting them, like meeting their pediatricians while still pregnant--that kind of thing.

4. I think if we want birth to change that we have to vote with our feet. the hospital where I gave birth brags about low c/s rates. Why? Because they know women where I live want that.

5. I would like to see more healthy births with good outcomes for mothers and babies. I am not attached to homes, hospitals or birth centers as places where that should happen. Wherever!

[KKmama]

I wanted to (very sincerely) respond to something Pam said... (I think in response to my asking that birth activists target drs and hospitals instead of/in addition to pg women.)

All the positive changes that have been made in hospital care has come from consumer driven desires.

Not necessarily... I have kind of a complicated example... there's a hospital about an hour and a half me that used to have a very low epidural rate (~14%, from what I was told). But then they decided they wanted to have an anaesthesiologist available 24 hrs (I believe so they could do VBAC? that seems to be one of the requirements these days for hospitals to offer them). But then of course in order to justify this staffing, more women need to avail themselves of the service. So the epidural rate has been creeping up. There's good and bad here, and I'm not sure how consumer driven either is. I also think that in order to keep the epidural level low, it might take some pushing from activists to change the way they are "selling" them to patients.