The balance between education and respect - Page 5

[cottonwood]

[deleted because part of other person's post it was referring to has been edited out]

[3_opihi]

First, I wanted to say Pamamidwife, what a great thread. Maybe its through open discussions like these that we can really start to open a dialogue -- and work through the issues. So thank you, it really means alot to me on a very personal level.

I want to relate to you my own story. I don't mean to generalize for anyone else - I just want to tell you where I was coming from and why I felt the way I did. (I'm sorry if I repeat anything. I haven't had the time to read all the threads).

To make a long story short, and without getting into all the gory details, I had a very long, traumatic first labor. It ended up with a brow presentation, pitocin drip, level 4 episiotimy, and a massive hemmorhage...Although it was the best day of my life, it was also, traumatic, painful,scary...and a whole host of other emotions.

I don't know how to express the level of pain, in words, that I experienced, both physically, and emotionally with this. The closest I can relate it to is a sexual assault. Please, I don't mean to get into a philisophical debate about what sexual assault is. I am just talking about me, and my feelings, and personally I feel that when someone cuts through your genitals without your consent -it is an assault. What I'm trying to get at is that there are a whole host of feelings that go along with this kind of trauma -guilt, fear, anger,denial....

For a long time, I felt I had to defend my story to birth activists. I felt their anger was directed at me, instead of the medical profession. I felt there was no validation of me, the woman, and the pain and raw exposure, helplessness, and sorrow I had experienced as a new mother. Instead I felt like all I got was you should have done this...and you should have done that...I knew what I should have done. So, I lashed out in anger, in defense. I think alot of it was misdirected. For me, lashing out at someone was a chance to *finally* defend myself, and my body. I convinced myself that I had a choice (when I never did). Instead of lashing out at the medical profession, the male model of medical care - I lashed out at those who I *thought* were constantly throwing the experience of my trauma back in my face. I lashed out at those who I felt weren't validating my pain, or listening to it---but instead were lashing back at me with anger of their own, statistics, and articles and such...

I think for both mothers and activists there is a tendency to have misdirected anger. We need to start looking at each other, holding hands and saying "I hear the feelings of anger and powerlessness in your words." For activists, I mean the powerlessness and anger to change the system.

Now, does that mean we have no power. Egads!!! Of course not!! We can change the system! We just need to start listening to each other. Maybe its not so much about education, but COMMUNICATION. I feel like education is so one sided, like its just throwing facts at someone. But communication entails listening and compassion, and in turn, leads to education, and respect.

I don't know...I have so much more to say, but can't find the words. I suppose the point of all this rambling, is what someone else already said : We should question our anger, and where it stems from. Please, I hope no one takes no offense to my post. Like I said, its just my story and my feelings.

(By the way, I did have a beautiful homebirth with my second baby. I even got to catch him myself. A very healing birth. )

[ladylee]

Maybe its not so much about education, but COMMUNICATION.

MM-this is such a great point.

No one likes to feel like they're being talked "at." And I completely agree with you about the displaced anger-totally counterproductive.

I'm glad your second birth was a healing experience for you-I felt my second birth was also a tremendously healing process.

[Missgrl]

moderator's note: This thread in temporarily closed until some requested editing can be done.~missgrl

[Missgrl]

The thread is now unlocked for further discsussion, and so members are free to complete the requested editing. Please remember the User Conduct
Agreement when posting.

[mamabutterfly]

[T Thanks Missgrl... Hooray for MDC mods ]

Just spent an hour I should have been sleeping reading this thread. Thanks to all for your thoughtful words, and to those who shared personal experiences.

Hmmm... what do I want to say? I'm a doula-in-training. Very aware that this greatest place of growth for me in this work will be cultivating non-judgement and learning to support and nurture in a way that is not about me (or even about what I think I know!), but about how I can offer support in another woman's experience. That experience will be uniquely her own. We can talk prenatally, maybe I will have an opportunity if asked to share from my library of books and birth videos. But like all of life the "outcome" will be out of my control, of course. At best I think I will strive to help the woman to have a positive birth memory, whatever the details.

However I do have a lot of information from my studying over 4 years. I do have very strong passions abotu the current state of women's health care and the country's dominant views on birth. It is painful for me to know how inadequate a lot of health care options are. But my judgement is entirely of systems and not of women.

I'm realizing that in the long run I want to become an advocate for changes in maternity care on a societal level (or a local level like increasing access to birth centers). In the mean time, when a friend & I are talking about her previous birth experience -- and especially when I'm reading a post on MDC (for heaven's sake, I know next-to-nothing about another user's life, for all that I spend hours & hours here, lol!) -- I see my role as offering all the hugs and encouraging words I can.

Have I made sense? For me the focus is on creating improvements in on the large scale, and nurturing relationships on the small scale.

hugs, mb

[LiamnEmma]

anothermama, I hope you come back and read some more, because your last post just made me sooo sad. I've been musing about it on and off all day. I really don't think you're awful or that your research is wasted, and I do agree with your message! I think that's what lots of people are trying to say, that your message is fine! We're just trying to communicate, as people who have had high intervention births and also as educated women ourselves, what might help you get your message out more broadly and deeply. I feel badly too because I recognize your passion for a topic and your need to have others feel as passionately as you do, and I know how hard it is to have that/those moments hit when you just think, "Is no one *ever* going to hear me?!" Anyway, I hope you come back. We all learn from each other....hopefully.

Leah

[Peppermint]

mamabutterfly

Sound like you are going to be so great as a doula . I think you have the perfect balance with your intentions, I was very happy to read you post.

[mamabutterfly]

Aww, Thanks, Patty!

[Missgrl]

Thanks mamabutterfy!
I think this is a worthy discussion and hope it continues.

[eilonwy]

Originally posted by Greaseball

I know what you mean about "my cesarean was necessary!" I think if people are really secure about their decisions, they will not get defensive.

Okay, I haven't read this entire thread (I'm working on it!) but *this* is the attitude that gets me so upset. So-called "birth advocates" (and I'm really not sure who you're advocating for) say really nasty things to people, imply that you don't love your babies if you make different decisions from theirs, and then wonder why you get defensive about it. "If the total numbness of your body is more important to you than your baby having the best possible birth experience, you go right ahead." (Not an exact quote, but close enough). How am I not supposed to feel defensive after reading that? I'm just sick and tired of people saying things like this, implying that I don't want to learn the truth, that I'm some kind of cheerleader for the medical establishment, or worst of all that I don't love my babies because I choose to give birth in a hospital. (Please don't say no one has ever said that, because it would only mean that you've never read the responses to my posts). Hell yes I'm defensive, and it's not because I'm not "secure about my decisions" it's because people keep implying that they know more about my birth experience than I do.

I have only seen two posts (though I'm sure there are more) where people said things like "You're crazy to try an unassisted birth." More often, it's "Unassisted childbirth is not for me." I have seen dozens of posts saying things like "You're crazy to plan a medicated birth/cbirth/go to a hospital" and very few posts saying simply "Hospital birth is not for me." I would ask why "birth advocates" are so defensive, if they're so secure in their decisions.

(And now I'm going to finish reading this thread)

[Peppermint]

I guess it all depends on the person, but when I am secure about something, I take the time to defend it, and when I am not I do not spend time defending it.

For example- I will defend my c-births b/c they were right for me and my babies. I will not defend the fact that I only BF my first dd for 4 months, and was supplementing by 2 weeks. In the instance of the BF, I was "duped" by a staff pediatrician- I was severely doubting my body's ability to do something that it COULD do. I am not at all defensive of my BF, but am very sad and regretful about it. So in either instance, the c-births or the BF, I don't need anyone's opinon unless I ask for it- which I did with BF, I joined LLL during my 2nd pregnancy, and I asked the women what I could've done differently, and b/c I was open to hearing what they were saying, they made a huge difference in my life

So, for me the defensiveness is a sign of when I know I am right, not a sign that I am insecure in my decision -to each their own on that though- maybe some people are as Greaseball suggested

[eilonwy]

Okay, I have read this entire thread, and I have a few things to say before I begin:

1)I really wish I'd found it earlier because this is wicked long! :LOL

2)There are lots of incredibly excellent points here, and I'm really impressed at how civil this thread has been over all five pages. It sounds like people are actually communicating and that's a nice change of pace. I enjoyed reading it.

My own birth story is somewhat similar to Captain Optimisms; my water broke before labor began. In my case, it was *long* before labor began, and I wasn't absolutely positive that it had broken. My son was born 4.5 days after my water broke, and then he spent a week in the NICU. I won't go into details here, I don't think this is the right place for it.

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?

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.

[Greaseball]

I guess to me, not being defensive means these things -

I don't feel the need to explain my decisions to other people. If they work for me, that's good enough.

I also don't come into forums I know I will disagree with, such as the vax or family bed forum and tell everyone that they really need to look at both sides of the issue and that what they are saying really doesn't work for everyone.

And I accept the fact that others just aren't going to see it my way.

But I guess it means different things for different people...

[KKmama]

As far as being defensive goes... (just trying to sincerely help you understand why a c birth mom might feel defensive, Greaseball)... if you get a lot of people questioning your decisions and/or your medical history, you might think (akin to the rationale of the birth advocates) that if you explain to them what happened and why, they'll understand, leave you alone, and maybe be more understanding to others in the future.

Thank you, Eilonwy, you said things more eloquently I did, *especially* in the last paragraph of your 2nd post. Your questions are excellent, too.

I've educated myself, and I've chosen the best options which were available to me and which I felt would allow me the best birthing situation I can get. I appreciate the information that's out there which has helped me come to my decisions--*that* has been really useful. I also appreciate the info which will help me work with my care providers to get what I want. I've had to make some compromises (hey--that's life), in part due to what's available, in part due to what insurance covers/what we can afford. So I'm planning on an unmedicated hospital VBAC with an OB and doula, at the area hospital which has the the best stats and the OB practice that has the best stats. I would have preferred a CNM, but it would have cost more, been a lot farther away, and been in a hospital with far worse stats (don't know that the area CNMs have better stats than my OB practice, either).

The local hospital has some really great things going for it. There are jacuzzis in all L&D rooms,and even bathtubs in the PP rooms (specifically for perineal soaking). Equipment is hidden away and brought out only when needed. Squatting bars and birth stools and balls are available. There is no nursery (not even a NICU)--*ALL* of the babies room in with their parents, in queen-sized hospital beds (and in the "NICU", each baby has its own room, with an adjoining room for the parents). The intervention rates are much lower than the rest of the hospitals available to me. Apparently, there's better nursing success, lactation consultants available to everyone (everyone is charged for a LC visit, so I assume a visit is standard), and they even use cloth diapers. I'm assuming that these changes came in part because parents asked for them, but I'm also assuming that "birth advocates" (who are probably a little louder and more organized with information) have pushed for changes, too. Thus my earnest suggestion that doctors and hospitals might be better targets than birthing women...

[pamamidwife]

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

If the consumers demand change, the hospital will accomodate.

This is just a fact. The hospital is in itself a business, and businesses need to make money. If a hospital finds that it is losing business, they will start making changes.


Another aspect is the political push to change malpractice insurance protocols. It's these protocols that are practiced every day in doctors offices and hospitals. Nearly all of them are NOT evidence-based medicine. It would be great to have a healthcare system that is truly based on full informed choice and evidence-based research instead of fear of litigation.

Where does it start? Where does it begin? It's a circle - it cannot be one or the other. It's everything - consumers, doctors, insurance companies, hospital staff and administrators, attorneys, etc.

I wish there were easy answers on changing birth in our culture. However, I think it's going to get a bit worse before it starts getting better. ?

[OnTheFence]

<<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." >>

This irritates me as well. There is one thing to inform, another to exagerate the facts. I know many women who have had epidurals with no side effects, their babies were not dopey, nursed great and the epidural actually helped the woman give birth or speed things up once she relaxed. However, I too have read in this forum from supposed birth advocates that people choosing an epidural must be uneducated or not care about their babies or the outcome of their births.

After my surgical birth with Jack I was asked how drugged he was from my epidural by a homebirth friend of mine. When I told her he wasnt drugged, she just gave me this look like I was full of crap. My epidural was in 12 minutes before his birth and I had no preop drugs or sedatives or any drugs for nausea. I believe I *knew* if he was drugged or not.

[Greaseball]

However, I think it's going to get a bit worse before it starts getting better. ?

Here are my predictions, though I don't necessarily know what years they will happen.

First, some new policies will be written and doctors will pass these along to patients:
1.) Hospitals will encourage mothers to arrive immediately after the first contraction.
2.) Delivery must be complete 2 hours after the membranes rupture, whether naturally or artificially.
3.) A mother must have an ultrasound on arrival at the hospital. Any baby with an estimated weight of 8 lbs or more will be delivered by immediate c-section.
4.) The human gestational period will be considered 38 weeks. One day overdue is grounds for pitocin induction.
6.) Delivery must be completed within 8 hours of checking into the hospital.
7.) Need I say that VBACs and vaginal deliveries of breeches or twins will not happen?

As a result, the majority of births will be surgical. FTP and CPD diagnoses will become more liberal, often being diagnosed before labor begins.

And then...

1.) The national average for c/s births will be 80%. Every childbearing woman delivering in a hospital can expect to have at least one. In many hospitals, vaginal deliveries will happen only by accident.
2.) Insurance companies will no longer pay for them. Later, they will stop covering pregnancy at all.
3.) Women will be looking at home birth for financial reasons alone. They will discover it's the only way for them to have a vaginal birth. Midwives will be in demand.
4.) Women will be astounded at how safe and easy birth can be, they'll tell all their friends, who will then see the same midwives, while obstetrics becomes one of the lowest-paid medical specialties.

Unfortunately, I don't think it will start to get better until we are well out of our childbearing years.

[OnTheFence]

I read this a little while ago and had to go get a drink before posting a reply to this.

Originally posted by Greaseball
Here are my predictions, though I don't necessarily know what years they will happen.

First, some new policies will be written and doctors will pass these along to patients:
1.) Hospitals will encourage mothers to arrive immediately after the first contraction.
2.) Delivery must be complete 2 hours after the membranes rupture, whether naturally or artificially.
3.) A mother must have an ultrasound on arrival at the hospital. Any baby with an estimated weight of 8 lbs or more will be delivered by immediate c-section.
4.) The human gestational period will be considered 38 weeks. One day overdue is grounds for pitocin induction.
6.) Delivery must be completed within 8 hours of checking into the hospital.
7.) Need I say that VBACs and vaginal deliveries of breeches or twins will not happen?

As a result, the majority of births will be surgical. FTP and CPD diagnoses will become more liberal, often being diagnosed before labor begins.

And then...

1.) The national average for c/s births will be 80%. Every childbearing woman delivering in a hospital can expect to have at least one. In many hospitals, vaginal deliveries will happen only by accident.
2.) Insurance companies will no longer pay for them. Later, they will stop covering pregnancy at all.
3.) Women will be looking at home birth for financial reasons alone. They will discover it's the only way for them to have a vaginal birth. Midwives will be in demand.
4.) Women will be astounded at how safe and easy birth can be, they'll tell all their friends, who will then see the same midwives, while obstetrics becomes one of the lowest-paid medical specialties.

Unfortunately, I don't think it will start to get better until we are well out of our childbearing years.

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. I know this because my sister was a birth instructor there for 4 years and we know the lady who heads the childbirth education courses. The childbirth classes are not geared to make patients compliant. I cant say this for other hospitals in the area but I can for this one. More and more women I know, even mainstream mommas are wanting more natural births or little intervention. Some of the things you stated are off the wall entirely, especially the part about 38 weeks gestations and pit inductions. Oregon must be like Mars. I live in a pretty backwards place and I dont see any of the things you mentioned happening here during my childbirth years or my children's childbirth years.

[pamamidwife]

In my city, there are TWO large OB practices that are routinely inducing at 39 weeks. The stripping of the membranes and routine vaginal exams start at 36 weeks.

I think that Greaseball was saying that it could get as crazy as that.

Really, even 20 years ago, would we have even guessed that we'd be seeing a 25% cesarean rate? Or a 30% induction rate? That all breech babies would be delivered surgically?

The atmosphere in birth even four years ago is vastly different than it is today. Four years ago, women were still being encouraged to VBAC across the board. Many hospitals and doctors were advised to decrease their cesarean rates. Today, the tides have turned - and it's not from new evidence that is pouring out of the research. It's from malpractice fear.

Some things may sound far-fetched to us now - but don't seem too far fetched for 20 years from now.

I predict that many insurance companies will start questioning covering elective cesareans - although it seems that doctors can always find a reason to do them to get them covered. Still, the cost of health insurance will continue to rise because of the increase in elective cesareans and other health issues (obesity, poor nutrition, etc.).