giving birth the "most dangerous thing a woman will do in her lifetime" ?! - Page 2

[MeepyCat]

[QUOTE=Banana731;15825102]

Originally Posted by MeepyCat

I have driven on the freeways L.A. I have broken down on them. I have hitchhiked, I have hitchhiked with drunks. I once dated a guy who went on to murder his parents. I have walked, by myself, across many of the sketchier parts of my home city, at night. Without my contacts in. The most dangerous thing I have ever done is *still* giving birth.



do you really think giving birth is more dangerous than driving drunk or driving while your texting, etc?

In my first delivery, I spiked a fever of 102 and began hallucinating. At one point, I stopped understanding idioms and became convinced that everyone was lying to me - I was in the most altered mental state I had ever been in, and I became seriously irrational. I was not acting in my best interests at that point, and I needed help. (I think a decently trained midwife could have handled it, and I am glad I wasn't alone.) My second delivery was an emergency section for previa with unstable hemorrhage. Yes, it was more dangerous than driving while texting.

[Banana731]

[QUOTE=MeepyCat;15825292]

Originally Posted by Banana731

In my first delivery, I spiked a fever of 102 and began hallucinating. At one point, I stopped understanding idioms and became convinced that everyone was lying to me - I was in the most altered mental state I had ever been in, and I became seriously irrational. I was not acting in my best interests at that point, and I needed help. (I think a decently trained midwife could have handled it, and I am glad I wasn't alone.) My second delivery was an emergency section for previa with unstable hemorrhage. Yes, it was more dangerous than driving while texting.

Neither of your experiences is exactly normal, though. I'm not sure that it's appropriate to generalize using uncommon compilcations.

[MeepyCat]

[QUOTE=Banana731;15825440]

Originally Posted by MeepyCat

Neither of your experiences is exactly normal, though. I'm not sure that it's appropriate to generalize using uncommon compilcations.

I don't have to generalize, though. Compare the number of incidents in which people text while driving to the number of incidents in which people are injured doing so. Ditto for drunk driving, whatever you like. Then do the same for birth. More people die because they ignore basic rules of road safety than die in childbirth, but those people ignore basic rules of road safety over and over, multiple times per day. Most women give birth only a few times, if at all.

[MeepyCat]

Originally Posted by mamabadger

It is not a question of thinking individual doctors are bad, dishonest, untrustworthy, or malevolent. Most of them are good people, and do what they can to help their patients, according to what they have been taught. If they were taught wrong, that does not make them evil, just misinformed. Obstetricians of past decades who insisted on separating mothers and newborns for 48 hours after birth; who did routine episiotomies and forceps deliveries; who strapped women to delivery tables, shaved off their pubic hair, or exposed them to X-rays during pregnancy - usually did it in a sincere effort to help their patients. Saying these things were misguided is not attacking doctors. Neither is pointing to the flaws in current obstetric thinking or practice.

Mamabadger, one of the things that routinely makes me crazy about this kind of conversation is that, in general, people *don't* point out the flaws in current obstetric thinking or practice. They point out the flaws in outdated obstetric thinking (as you have in your post), or they point out flaws that don't actually exist in obstetric thinking (like inattention to nutrition, which made an appearance upthread).

One of the other things that makes me crazy is the dichotomy that gets set up, where all of the highly-trained professionals are described as misinformed, misguided or malevolent, and individual women are universally believed to know and understand absolutely everything about birth and their own bodies. The truth, for both groups, is somewhere in the grey middle. And it's reasonable for individual doctors to be dismayed to hear themselves and their profession described the way they so often are on these boards.

[tessie]

Every time I read something saying that birth isn't dangerous, it's hygiene that's the issue, I'm reminded of the White Ribbon Alliance campaign. The women whose stories are published on the site didn't die because their doctors didn't wash their hands, they died because of a lack of affordable, quality and easily accessible healthcare.

Yes, your circumstances increase (or decrease) your risk but birth does have inherent risks. You can prepare as much as you like but you don't know going into it if you'll be the one that pops out a kid like shelling peas or the one who bleeds out. Not that I'm suggesting we treat all births as high risk, far from it (I'm very much in favour of the midwife led model), but having access to a healthcare provider with half a clue does reduce maternal death rates.

UC as it is on this board is very much born out of first world privilege.

[MsBlack]

Yes, tessie, in an important way, you are right--UC as we know it here IS born of first world privilege: that is, we are by and large well fed, well housed and sufficiently educated to learn how to take care of our health. With a very wide range of all those things among us, sure--but still, I'd venture to guess that all who post and lurk here are tons better off, even if on foodstamps or living in some form of assisted housing, than the great majority of women on the planet. This is something I've never forgotten in my darkest hours of financial stress (which have been pretty dark from time to time, including brief periods of being homeless and longer stints of living in gov-assisted housing).

However, that is actually the point. Women who are reasonably well fed and sheltered, and informed enough to take reasonably good care of themselves, are the least likely to have birth complications requiring med assistance. A few of us on this thread are testament to the fact that even among us, occasionally med assistance is needed. And we are the exceptions to the rule. Again, no one is saying that birth always works out perfectly well!

And your point about the white ribbon alliance...??? Yes, the plight of those women is tragic beyond words...and yet, what they need are not more doctors, because doctors don't provide 'health care'--they provide illness care. Those families do need actual health care: they need more good food, clean water and shelter, they need less bombing and imperialism and murder of their native cultures and ruination of the native lands that once provided them with food, shelter, medicine, HOME. They need what most of us enjoy, to some far greater degree than they have, every day...the ordinary things that ennable most women to enjoy normal birth, the great majority of the time.

You can talk about exceptions to the rule like placenta previa til the cows come home...you can cite places in the world where bombs are falling and food is scarce due to imperialism and the rape of native cultures. lands and food supplies...and you *still* won't be talking about 'normal birth', and it's wonderful design that most often works just fine--when it has 1/2 a chance, through decent nutrition and all the other normal things that make the great majority of us 'normally healthy'.

And meepycat--i don't know where you live, but in most places OBs don't give much thought to nutrition, and do practice all kinds of NON evidence based care that hurt women and babies in ways large and small, every day. The maternity system is a total mess--and it exists for profit, not for women and babies.

[stik]

I live 3000 miles away from MeepyCat, and every single one of the 9 obstetric practitioners I have seen in the course of two pregnancies talked about nutrition - 6 doctors and three midwives, for pregnancies in 2001 and 2007. This includes three doctors and one midwife who I saw for less than 15 minutes each and never saw again.

I had awesome uncomplicated pregnancies and easy births. They really didn't have much to talk about besides nutrition. So they did. A lot.

People do a lot of things for profit, but practicing obstetrics is risky and time-consuming method. I don't think all doctors are altruistic saints, completely unmotivated by financial gain. I do think, though, that if you're looking for a quick buck, obstetrics is a poor choice of medical specialty.

[jeminijad]

Originally Posted by MeepyCat

Mamabadger, one of the things that routinely makes me crazy about this kind of conversation is that, in general, people *don't* point out the flaws in current obstetric thinking or practice. They point out the flaws in outdated obstetric thinking (as you have in your post), or they point out flaws that don't actually exist in obstetric thinking (like inattention to nutrition, which made an appearance upthread).

Meepy, a great deal of what is 'outdated' obstetric thinking academically is still current in practice. Nothing by mouth; continuous fetal monitoring; induction for suspected macrosomia; cytotec. All of which have led to bad outcomes for some women. You can't dismiss it as in the past when it still happens every day.

Any as for nutrition... I've seen 4 OB practices, and the most I got was a flyer from the nurse practitioner with the sadly misguided information on it regarding the Food Pyramid.

[Belle]

Originally Posted by stik

I live 3000 miles away from MeepyCat, and every single one of the 9 obstetric practitioners I have seen in the course of two pregnancies talked about nutrition - 6 doctors and three midwives, for pregnancies in 2001 and 2007. This includes three doctors and one midwife who I saw for less than 15 minutes each and never saw again.

Mine did not. Its great that your practice did. The nutrion advice I got was to eat saltines (to combat HG) and later to take tums to prevent leg cramps. Neither piece of advice was helpful.

[tessie]

MsBlack, on phone so this will be brief. I completely agree that there needs to be more than just more than just more drs or midwives. I doubt anyone would disagree. However, improved access to quality, affordable and local medical care does need to be up there. Sometimes it does just boil down to one midwife for a thousand pregnant women not being enough, no matter how fantastic your nutrition might be.

[mamabadger]

Originally Posted by MeepyCat

Mamabadger, one of the things that routinely makes me crazy about this kind of conversation is that, in general, people *don't* point out the flaws in current obstetric thinking or practice. They point out the flaws in outdated obstetric thinking (as you have in your post), or they point out flaws that don't actually exist in obstetric thinking (like inattention to nutrition, which made an appearance upthread).

I brought up problems in obstetrics from past decades for two reasons.

First, because the high maternal mortality in "the old days" had been cited as proof that childbirth was dangerous unless made safe by obstetrical intervention. My point was that obstetrics may well have caused as many deaths or injuries as it prevented.

Second, because it is easier to look at flaws in obstetrics objectively when they are long past. Everybody, including OBs, now agree that these practices are useless or dangerous, even though doctors at the time thought they were protecting their patients' health. We do not have to worry about offending the long-dead doctors who refused to wash their hands before attending a birth, or did routine high forceps deliveries to save babies from the trauma of vaginal birth. It is harder to be critical of practices still in place, because doctors and patients take it personally. But at what point did medicine stop harming women out of ignorance, and suddenly start doing only beneficial, evidence-based procedures? Obstetrics did a great deal of harm in the past, partly because of its underlying attitude to women and childbirth, an attitude which still exists.

[borncrunchy]

I have to say something here. I doubt that meepycat or anyone who actually believes that birth is inherently dangerous will listen, or even be able to wrap their heads around this concept, but I still feel the need to say this. Birth is not inherently dangerous. Yes complications arise, many of which can be anticipated by warning signs during pregnancy, and almost all others will have warning signs during labor. The few that are surprise instances, like cord prolapse, and placental abrubtion are more common in hospitals due to routine amniotomy and pitocin use, and even if they do happen at home, the chances that (especially in my case, considering I live less than 2 miles from a hospital) the outcome would be different in a hospital is slim. I know that at my hospital, OB's are rarely on site, and if I was there and the need for an emergency section arose, it would take just as long if not longer for the dr to arrive and the OR to be ready, as it would if we called on the way to the hospital. Then there are things like pp hemorrhage, which can usually be handled at home or at least managed at home until help (emt's or ER) can be aquired.

And then there are the routine use of interventions in US hospitals, most of which have not been proven effective, beneficial, or to decrease infant or maternal morbidity or mortality, and have in fact been proven to be useful only in emergencies, or during complication, but not good for use in the average, healthy pregnancy, with the majority of average, healthy moms and babies. Some that come to mind are the lithotomy potition for pushing, which is only beneficial to Dr's and never to moms, unless that is the position she has chosen herself as the most comfortable, routine IV fluids, which disrupt the bodies natural ability to produce Oxytocin, often necessitating artificial oxytocin which causes the uterus to contract in a very unnatural way and often causes signs of fetal distress due to oxygen deprivation, and increases the chances of a cesarean that would never have been needed if mom had been able to hydrate herself with water.

Not allowing mom to eat or drink, which when considering what a strenous activity labor and birth are, just simply doesn't make sense. You would never tell an athlete to fast and only take IV fluids during a football game, let alone a triathalon. Not allowing mom out of bed, because moving around and changing positions have been proven to make mom more comfortable, as well as help labor along, continuous fetal monitoring, which has been proven to increase the rate of csections without a change in fetal outcomes, and has been recommended for use only when intermitent monitoring suggests a problem, constant cervical checks which introduce bacteria to the vagina, and can increase the risk of infection for mom and baby, especially if the membranes have been ruptured. Routine amniotomy which increases the risk of cord prolapse, and the need for pitocin to get baby delivered by that all important 24 hour mark.

The 1cm per hour rule, which does not apply to first time mothers or any mother actually, because the study was done in the 1950's and the subjects where all given atrificial pitocin. Routine use of epidurals, which have a list of often undisclosed risks, including drop in blood pressure and due to the fact that mom must receive 2 liters of IV fluid before getting an epidural, theres a risk of fluid overload which could also affect the baby, spinal headache, spinal cord damage, and in rare cases, which are usually attributed to the anesthesiologists mistakes, maternal and or fetal death. Routine use of Pitocin to augment a labor that doesn't fall into the already abnormal "normal", which as described above can cause issues with baby, but as Dr. Marsden Wagner has warned, we don't really know the full long term affects of. The hormones released by mom and baby in a natural spontaneous labor and delivery are so complex and so hard to study let alone recreate to an exact science that disrupting this process with artificial oxytocin is just dangerous.

The routine inductions done weeks and months before baby is ready to come, which are very commonly done for physician and patient convenience without actually disclosing how risky it is, along with being done "just in case" when there really wasn't a need. Like when the Drs suspect a large baby at 37 weeks, just to induce, have it fail because baby wasn't ready, and shows signs of distress or failure to progress, and baby is born via csection (unnecessarily), and ends up being only 5 lbs and has to spend a month in the NICU.

YES, these interventions are great in an emergency, but they are NOT beneficial when used on all women, regardless of her health, and regardless of whether she wants them or not. The active management of obstetric patients can also cause longterm psychological effects to the mom. Telling her that her body is incapable to birthing her baby without all of these high tech devices and drugs. We don't really know what the long term affects of all of these interventions will REALLY have on women and babies.

Now I did not list all of the possible complications, but the bottom line is, in the US, with healthy women, who have had healthy, uncomplicated pregnancies, and even some who have experienced complications, who have either educated themselves and their birth attendants to spot an issue like a decel, or excess bleeding or any of the other complications that a midwife can handle at home and either deal with it or get help, or have hired a trained midwife, and have a reasonable back up plan should a complication arise, the RISKS of going to the hospital and enduring the routine and often dangerous interventions, are higher than the risks of staying home, IMO.

Yes birth can be dangerous, and OB's are great to have available for when complications arise and things do go wrong, and no, it is not "inherently" safe, but it is also not "inherently" dangerous, and it is no way the most dangerous thing I will do in my life. My body works fine, and I can deliver my 3rd son at home with a trained midwife or without because I know that my body works just fine and if there is a problem, or a complication, I am so close to a hospital I could walk if I had to. I am WAY more affraid to go back to the hospital where I gave birth to my 2 older sons, due to the staff and OB's lack of understanding of the actual birth process, and that their job is to handle to emergencies and not manage a labor or birth that is happening just fine on it's own. I don't need the natural process of labor and birth to be managed with drugs, machines and rules that have nothing to do with scientific evidence, because there isn't a problem. Should a problem arise, or should my midwife feel or my mother or husband or myself feel the need to go to the hospital because something just "doesn't feel right", I will, without question, because I want the Drs and the technology there if something is wrong, but otherwise, I will be home, delivering my baby the way it has been done by thousands of women for thousands of years. The difference is that I have access to medical care should it become necessary.

[borncrunchy]

Originally Posted by mamabadger

I brought up problems in obstetrics from past decades for two reasons.

First, because the high maternal mortality in "the old days" had been cited as proof that childbirth was dangerous unless made safe by obstetrical intervention. My point was that obstetrics may well have caused as many deaths or injuries as it prevented.

Second, because it is easier to look at flaws in obstetrics objectively when they are long past. Everybody, including OBs, now agree that these practices are useless or dangerous, even though doctors at the time thought they were protecting their patients' health. We do not have to worry about offending the long-dead doctors who refused to wash their hands before attending a birth, or did routine high forceps deliveries to save babies from the trauma of vaginal birth. It is harder to be critical of practices still in place, because doctors and patients take it personally. But at what point did medicine stop harming women out of ignorance, and suddenly start doing only beneficial, evidence-based procedures? Obstetrics did a great deal of harm in the past, partly because of its underlying attitude to women and childbirth, an attitude which still exists.

This exactly. OB's at the time thought that what they were doing was beneficial, and it took many years to stop the routine practices that probably killed more moms and babies than it saved. The evidence that most routine practices today are harmful is here, but unfortunatly, it still may take many many years before OBs and the medical personel realize it and start removing these things from routine use. Yes, some of these things should be around for the complications or emergencies, but ALL of them should be removed from the routine care of all laboring women.

[zapzipzee]

I didn't have time to read others responses. But, when my husband was in clinicals for L&D, he actually talked to the doctor about UC. She told him that in most cases it was perfectly safe. My husband also witnessed this doctor perform all sorts of interventions though.

[Rosegarden77]

Just some observations...

They key word in this post being HEALTHY-as in HEALTHY pregnancy.

Modern medicine has done some wonderful things for a lot of people. Many technologies used in medicine and our daily life are wonderful too. However, modern medicine applied to childbirth today is not healthy for healthy pregnancies. Medicine today is not preventative, it is more about management and control-control being the operative word.

Frankly, the prevailing attitude that gets modern medicine in trouble with prenatal care and maternal outcomes is the over-arching paternalistic attitude that "doc knows best" or that modern medicine can conquer nature without respecting the wisdom of nature. "Gotta help the poor little helpless hysterical woman get her baby out of her too small pelvis!" Please-I implore everyone to research the roots/history of women and medicine. The devaluing and discounting of our innate rights as women-and more pointedly as newborns and birthing women- has the stink of "female Hysteria" written all over it:

http://en.wikipedia.org/wiki/Female_hysteria

http://bigthink.com/ideas/18074 legislated out of existence in 1957-yea-you read that right-1957-37 years after we won the right to vote.

Just google and read...from reputable sources of course

This is a human rights issue.

The right to labor and birth on our own terms is not selfish, it is not about being white and "over-privileged". I know I don't fit that demographic. It is about our innate rights as human beings to allow a perfectly healthy bodily function unfold. We are doing ourselves a grave disservice by allowing ourselves to become so detached from such a natural process that we think medical interventions that end up damaging our bodies are A-OK.

And no, I am not drinking the "cranium too big for pelvis" kool-aid being pushed as a THEORY in biology and anthropology. I have taken several bio courses and rec'd my degree in Anthro-(went on to grad and law school) didn't drink the kool-aid then-not drinkin' it now. It was presented as just a theory. Makes no sense for us to evolve as a species to where childbirth is so "dangerous" to birth offspring. If that truly were the case there would be no (idiotic) arguments for Zero Population Growth. Obviously, our ancestors did just fine. Again, it is a theory-not a proven fact-very few tenets of science are proven facts/laws. The reasoning is that there are recorded exceptions during each trial and also because new info is always being learned to update those theories.

As it stands, it has factually been proven through research statistics from the ACOG that we are not doing right by our mothers and children in this country-and there is no good excuse for it! Their very own research shows they are intervening far too much and causing more problems than preventing problems.

In my opinion, it took them far too long to reverse their stance on VBACs:
http://www.medscape.com/viewarticle/725597

America has a very imperialistic and paternalistic attitude towards childbirth -in many ways as women we have been subjected to this attitude for far too long. I see the issue of childbirth not unlike that of our hard won right to vote. We have only had the right to vote for 90 years (1920) and we have been birthing babies since the beginning of time. So why so much distrust in a woman's ability to birth a baby SAFELY? Why?

Over-medicalized birth is a self-fulfilling prophecy.

What I find the most disturbing are women doctors who buy into this paternal attitude without question--some then find themselves on the receiving end of such treatment and then they realize just how dangerous this line of thinking is to a HEALTHY pregnancy. There is absolutely no reason to treat all maternal patients like they need to be medically managed for the worst case scenario. None. Oh sure, it avoids being sued or an inconvenient call to the hospital at all hours. But the first tenet of medicine is to DO NO HARM. Statistics show these policies of intervention DO HARM. These policies serve the medical establishment-they do not serve most child-bearing women.

It is these policies that are driving women to seek unassisted births. I think I am going to walk around during this pregnancy with a t-shirt that states "Keep Your Hands OFF Me and My Baby". Or-at the very least-"Keep Your Hands OFF My Vagina".

Unassisted birth is the Childbirth Manifesto of the 21st century put into action.

(stepping off soapbox)

Rosa
Mom to 3 and due in February 2011 with baby#4
Planning a with a "hands-off" MW

[MsBlack]

Thank You, Rosa!

I agree totally

[lovestolearn]

Rosa~ That was brilliant!

[accountclosed3]

I assume that the questions is asserted in the UC forum to gain a *UCer's perspective* of whether or not we, "as UCers" find the statement to be true or false, and how we come to a position on that statement based on whether we find it true or false, or "what it all means."

So, here is my crack, dear OP, as to "what it all means."

let's assume that it is true. to my mind, if it is true, then it is absolute. It is true regardless of the woman's station or location. Birth is the riskiest thing a woman will do.

This often leads people to thinking about *risk avoidance* but the reality is, if there is a risk, it is inherent and cannot be avoided. It can only be *mitigated.* and of course, there are many ways of mitigating the risk.

But ultimately, the risk still exists. In order to actually mitigate risks, you have to come to terms with the risk itself. that is to say, you have to come to terms with your mitigations not working out.

when i was learning rock climbing--an inherently risky and dangerous sport with many opportunities for injury and death--we were taught about how to mitigate the risk with proper knots, with learning how to lead and anchor, and so on. But the primary aspect of our training was not that, but rather this: learning to understand and work with fear.

what really created risk was our fear. fear was also our lifesaver. we had to come to terms with the fear of heights, the fear of falling, the fear of injury, the fear of death. We had to look it square in the face and see What It Is.

We had to Know It.

So it is with the risk of birth. Even if you have the best doctors and the best evidence based care in the best hospital and the best health and the best nutrition and the best pelvis and the best baby and the best best best everything the Risk still exists, and therefore so does the Fear of It.

The Risk/Fear of death and injury exists. Yes, it has many mitigations in that list--things that decrease the likelyhood of the risk becoming reality. BUT the risk still exists.

So, the only thing that we can do, therefore, is come to terms with it. Look at our death, our infant's death, our injury, our infant's injury Square in the Eyes and Know It.

Do this. and you'll know what you need to mitigate and how.

[MsBlack]

Nicely put, Zoebird!

[tessie]

Zoebird, are you saying that we do what we can to reduce the risk but accept that things might go to shit regardless?

If you're not saying something along those lines then I fear that you might as well be speaking Martian.

Just a side note, but I do find it slightly irritating that birth on mothering.com almost always refers to birth in America. I appreciate that a high proportion of mamas here are American but most of the world is not.