Originally Posted by stik
MegBoz, I'm deeply frustrated with your analogies. They're hyperbolic, illogical, and dismissive of the experiences of many women who have benefited from obstetric care.
For the record, the dentist analogy was a rephrasing of what the Hopkins nurse said. I did NOT intend that to apply to American maternity care on the whole. SHE was the one who said, "We're not used to healthy patients [and that's why we require NPO and cEFM for all births.]" I don't see the dentist removing healthy teeth as the least bit of a hyperbolic & illogical statement to rephrase exactly what she said. What Hopkins is doing with NPO and cEFM for all births is doing things that are known to be damaging to healthy people and using "we're a high risk facility" as an excuse for those protocols that damage the normal process for healthy women. That is EXACTLY the same as the dentist removing healthy teeth because "that is what we're used to here." He is damaging healthy people in the name of "habit."
I agree with you that the dentist analogy WOULD be 'dismissive" of the good maternity care many women have received if I'd used it to describe all American care, but I did NOT use it in that way.
"There are problems in the US healthcare system (that are in no way limited to the state of OB care), but despite these problems, many women have had good, safe experiences within the system."
If you'd like to continue this debate with me personally, please use the quoting feature. Never have I ever said that every single solitary American woman has a bad experience. As a matter of fact, I've "typed until I'm blue in the face" saying it is "in aggregate" that the US system has problems. To call it "dreadful" on the whole doesn't mean there aren't many women who, nonetheless, have had fantastic experiences. Just as I've written REPEATEDLY that of course many CS that happen are necessary (I'm not an idiot - I don't honestly think everyone can or should have an unmedicated vaginal birth.)
Not only that, I had my own DS in a hospital and it was a great experience & I highly recommend the hospital!! So please stop these attempts at putting words in my mouth. If you have an issue with words I have stated, please quote.
"I don't think the system is dreadful in aggregate. I think that's a myth put forward by an angry minority that isn't particularly well-versed in the history of OB and maternity care in the US (or that misreads it, as a poster did on the last page when she blamed doctors for problems that were caused by poverty and poor industrial working conditions), and that isn't aware of conditions worldwide."
As I said before, I don't see the relevance of history. I'm honestly baffled at your continuation of bringing history into it. The issue should be comparing modern American maternity care with modern evidence-based practices, not comparing modern American vs. historical American care. Just because it's better than it used to be doesn't necessarily make it good. I would say the same thing of sexism or racism. Both issues are infinitely better now than decades past, but does that mean there are no more problems?! Of course not! & just because we have it better than we used to have it, doesn't mean we ought to shut up & be happy.
Likewise, I know maternity care is much better in the US than many other nations, but I don't see how that possibly negates the presence of any problems. There are still problems with maternity care in the US - the fact that it's better here than elsewhere doesn't change that. Again, better than horrible doesn't equal good.
As for calling it a "myth" that American maternity care is dreadful in aggregate - that is based on stats! Please- open up a copy of "Born in the USA" by Dr. Marsden Wagner & look at the chart with evidence-based rates vs. actual US rates (it's within the first several pages.) The numbers don't lie - there is a chasm between evidence & practice. There is no "myth" at play here - unless you think all all the evidence-based rates are unreliable & inaccurate, but an abundance of research studies from many different nations have contributed to those numbers.
"Hospitals in many areas are deeply invested in providing moms with good birth experiences because they recognize that mothers make most health care decisions for their families, and will not to return to a facility where they were treated poorly."
I'm growing weary of this discussion & I probably ought to just zip it, because I'm fairly certain I keep repeating myself. It's one thing for me to repeat points in new threads, but when I keep repeating the same points on the same thread, it's probably time to step away. But anyway--- here goes.
I don't think the majority of HCPs have any negative intentions. Quite on the contrary, most of them probably want to do the best they can to ensure a healthy baby & mama first & foremost, and provide compassionate care as well. The problem is they are uninformed & out of touch with research! I think the title of Marsdan Wagner's article "Fish can't see the water they swim in" describes it best... they are so immersed in medicalized birth, they think the danger lies in being more hands off.
That Hopkins nurse I spoke with confirmed my suspicion that she'd be very nervous not being able to "see" my baby on the EFM continuously (as she put it.) I have no doubt that she believes cEFM is best & is necessary & she's just doing her job the best way she knows how. No malicious intent present. No desire to teach the crazy hippies a lesson. No mysogynist desire to punish women. Nope.
In other words... I agree with you that hospitals & HCPs WANT to provide Moms with good birth experiences.... but I also still say that American maternity care is dreadful.
Lack of malicious intent shouldn't excuse poor care. I'm sure we all know the cliche, "Good intentions pave the path to hell." Good intentions aren't "good enough." HCPs need to practice evidence-based care, and that means they must be familiar with evidence.
Being better than the past, being better than some other nations, and being based upon good intentions all don't excuse away anti-evidence based care.
Frankly, I find these 3 points all utterly irrelevant on the question of the quality of American maternity care.