Pro-homebirth risk ethics - Page 5

[pfamilygal]

For many of my patients (mostly teenagers), the hospital birth is a very good thing. It is the first place where they are introduce to the idea of breastfeeding, infant care and self-care. Many of my patients don't have the first clue about babies ("wow - I didn't think babies pooped until they ate food!"). So they are actually learning a lot at the hospital. That is my favorite part of doing postpartum, being able to teach patients. I've had patients who didn't know you could breastfeed for more than six months ("doesn't your milk just go away?"). Patients who had never changed a diaper, patients who didn't know the baby had a cord (much less how to care for it.). I think this shows how the art of mothering has died in a way. At least in the sense that your mom would show you how to be a mom. For most new mommies the grandma might fly in for a couple days and help with housework and then hit the road. I wish my mom could have stayed with me to show me how to mother. But we don't have the community we used to. I think the abandonment of women and community is the real ethical issue.

As far as epidurals being "unethical" due to the minute risk, if you feel it is unethical for you, don't have one. I am a very tense person in labor. I was induced with my first (due to severe PIH/pulmonary edema/renal insufficiency) and after 17 hrs of pitocin had dilated one freaking inch. I was lying on my left side to keep my bp down and placental perfusion up. I was so tired of all the pain. I told the doctor that we needed to try an epidural. If I didn't start dilating soon we were looking at a c/s (at that point I had not urinated in 3 days). Lo and behold, I relaxed after the epidural and let my body do it's thing. I had a nice vaginal delivery of a perfect healthy newborn and breastfed in the delivery room. He was away from my side for a total of one hour during our stay. With baby #2 I made it 23 hrs before taking the epidural and dilated really fast after finally relaxing with it. I push a whole 2 times and she was delivered up onto my chest and she nursed immediately. Even though she was 34 weeks she only went to the nursery once, for her hearing test. So there are hospitals that are safe and good to deliver in. And epidurals can be a really good thing.

I think homebirth is fascinating, but not an option for me. I have early babies and don't think it would be safe popping out a 33 weeker in the bathtub (oh how I would love a waterbirth though).

[WC_hapamama]

Originally Posted by applejuice

I am old enough to remember DES being given to prevent miscarriage, radium boxes on healthy thymus glands, and wholesale tonsillectomies being done to keep from getting colds. I also remember classmates with braces on their legs, classmates losing a year of school due to rheumatic fever, and playmates whose sibling was alittle "slow" because it was commonplace in maternity wards to hold a mothers legs together to prevent the baby's birth until the doctor arrived.

People never learn.

They keep repeating the same mistakes.

If you do not like to get bit, stay away from snakes.

Ah... you're A LOT older than I am then. I'm only 29.

A lot of the stuff you're describing sounds like the stuff my Grandma and Dad have told me about... Dad is 56.

I remember cringing in horror that first time I took my oldest son to visit my grandmother, when she suggested that I use her kitchen to make that gawdawful formula concoction out of canned milk and karo syrup.

The only worse formula horror story I've heard of is the stuff MIL had to use on DH when she weaned him at 6 months old. He was milk and soy allergic, so the formula they gave him was made from, get this, beef hearts! :Puke

I don't play with snakes... but I make it a point to know which ones are poisonous so I can take extra precautions around them.

[Mamma Mia]

Originally Posted by WC_hapamama

This is not true.

I've had 3 hospital births (4th coming up in December). I've dealt with a total of 3 different OBs and more L&D nurses than I can remember. None of them ever told me such a thing.

No offense, but your three experiences don't negate anyone else's. I'm glad you didn't have the experience applejuice described, but I bet it's more common (or similar actions/words are) than you think.

[Mamma Mia]

Originally Posted by Raven

I think to focus needs to be shifted. The ethical blunder lies within the hands of the medical profession who LIE to women.

Word, Raven.

[Mamma Mia]

Originally Posted by alegna

Two topics from liseux's post- I will address one at a time.

Okay- is there any place that one would choose to birth that would be unethical? Would it be unethical to CHOOSE to birth on a trapeeze, while swinging without a net? Of course. Then is there a case where it COULD be unethical to choose to birth in a hospital? Of course. For example, you KNOW for a fact that the baby will be taken from you without reason and treated harshly and subjected to a serious chance of infection and there is no other reason to be in said hospital, then yes, that choice WOULD be unethical.

-Angela

I want to gently point out that not all hospitals treat babies this way.

[Mamma Mia]

Originally Posted by alegna

Okay- we accept that these are unethical happenings. Then does not the woman have an ethical responsibility to protect her child from such things? What if there is no way she can protect her child from them in the hospital? What if it is highly unlikely that she can protect her child in the hospital? IMO in those cases her only ethical choice (assuming no other medical issues of course) is to choose another place to birth.

-Angela

I think we know that mothers *can* and do protect their babies from circumcision in the hositals and free formula only gets to babies if their mothers give it to them or allow hospital staff to. I'm sure someone around here has heard a horror story, but almost all of the time, if a mother chooses not to give formula or circ it doesn't happen.

[alegna]

Originally Posted by Mamma Mia

I want to gently point out that not all hospitals treat babies this way.

Of course not. I am merely saying that to choose to birth in one that did, would be unethical IMO.

-Angela

[Mamma Mia]

Originally Posted by alegna

HOWEVER, women also have an ethical obligation to do their own research and make their own decisions in order to protect themselves and their children.

-Angela

I think this statement comes form a pretty privileged place. An extremely large number of women in this country (US, I assume you're here as well) do not have access to information. A single mother on welfare working 12 hour shifts needs the few hours of waking time she has not working to be the the child she already has. She doesn't even have time to read if someone handed her concise reading material with everything she needed to know, let alone the fact that she may not even have the reading comprehension to do it.

Again, I get really uncomfortable when people dictate what women have an ethical obligation to do.

[Mamma Mia]

Originally Posted by alegna

And actually, in some cases, I have no problem telling people that their choices were hands down wrong. And if they think that of my choices, I am more than happy to discuss my reasoning.

-Angela

I am really amazed by this. Who are you to tell people their choices are wrong? This is the behavior of someone who is insecure in their own actions, not an outspoken advocate for homebirth. Telling people they are wrong "hands down" doesn't take into account their personal situation and more importantly, it alienates them! It is a dangerous road to travel, especially for one hellbent on trying to change the world.

Once, I was more like you. I thought that people who didn't plan to breastfeed shouldn't bother having kids. I once thought that people who knowingly chose hospital birth, if only for pain relief, knowing the risks, were clearly wrong in their choice. I'm glad that I have become less harsh and unforgiving. I think becoming a doula has a bit to do with it because my job is to be with women and help them have the birth *they* want, not the birth *I* think they should have. I've found that allowing for the fact that there are serious cultural, class, race, religious, etc, issues tied into birth and mothering, it's best if I keep a gentle advocate's stance. I'm not going to change anyone's mind by telling them theya re wrong and arguing my case or making them feel guilty. I am able to provide information to people when they are ready to hear it and help them enact changes or different choices in the future. I hope you think about it.

[alegna]

Originally Posted by Mamma Mia

I think this statement comes form a pretty privileged place. An extremely large number of women in this country (US, I assume you're here as well) do not have access to information. A single mother on welfare working 12 hour shifts needs the few hours of waking time she has not working to be the the child she already has. She doesn't even have time to read if someone handed her concise reading material with everything she needed to know, let alone the fact that she may not even have the reading comprehension to do it.

Again, I get really uncomfortable when people dictate what women have an ethical obligation to do.

You're right that many women do not have as much information at their access as I might have. THAT is why I think that homebirth (as a safer option than the current hospital set-up) should be the general standard of care. Then if women DID research more or decide for whatever reason that they WANTED a hospital birth, they could do that, but for a normal pregnancy and birth the standard would be homebirth.

I am perfectly comfortable saying that all women (in fact all people) have an ethical obligation to do their best to protect their children. That is simple biology.

-Angela

[Mamma Mia]

Originally Posted by annakiss

I'm starting to wonder what the practicality of this discussion is. You're not interested in law-making, you don't care what God thinks about it - what are you trying to accomplish here? Unless we can say absolutely that all hospitals are inherently dangerous to birthing women and the larger culture accepts that, then all we're doing is blaming women for their births. I have friends with vaccine-damaged children - should they be blamed for the decisions they made at the time with the information they had? Women aren't going to the hospital in a vacuum. They're going there with the larger culture's understanding that hospitals are safe places to birth. Are women responsible for the well-being of themselves and their babies? Absolutely, but that doesn't mean we need to point fingers at them for mistakes that they make unknowingly. As mothers we have enough guilt.

For instance, my first son was born with a cleft lip and palate. I know now that cigarette smoking can contribute to the incidence of clefts. At the time I got pregnant, I was a smoker. I wasn't planning on getting pregnant, but I made an irresponsible decision about contraception one night. Do I need everyone to blame me for my son's defect when I didn't know I was going to get pregnant and when lots of women smoke throughout pregnancy without incidence? Okay, so I didn't go out of my way to smoke while pregnant and in fact quit immediately after finding out, but it is then unethical to sell cigarettes to women of child-bearing age? I suppose that it's unethical to make cigarettes at all, but they do and I'm not going to tell people they can't knowingly damage their bodies.

We could extend and extend this argument to it being unethical to eat junk food, or it being unethical to watch television or do anything potentially harmful. Doing anything where risks far outweigh the benefits could be labled immoral. But what is the point in determining it if there is nothing to be done? Simply to place blame is all I can come up with.

Yes, that!

[alegna]

Originally Posted by Mamma Mia

I am really amazed by this. Who are you to tell people their choices are wrong? This is the behavior of someone who is insecure in their own actions, not an outspoken advocate for homebirth.

Who am I? I am someone who is very well educated in some subjects. And thanks for the assumption, but no, I'm lots of things, but insecure in my actions is not one of them...

-Angela

[Mamma Mia]

Originally Posted by alegna

You're right that many women do not have as much information at their access as I might have. THAT is why I think that homebirth (as a safer option than the current hospital set-up) should be the general standard of care. Then if women DID research more or decide for whatever reason that they WANTED a hospital birth, they could do that, but for a normal pregnancy and birth the standard would be homebirth.

I am perfectly comfortable saying that all women (in fact all people) have an ethical obligation to do their best to protect their children. That is simple biology.

-Angela

And so do co-parents where they exist. It is not simple biology when sicussing HB vs hospital birth though. As I said before, even knowing the risks for a child, if a woman feels safer in the hospital, she may stall or freak out and deprive the baby of oxygen during the birth at home. Her stress can lead to loads of complications. And at this point it is moot to say that HB should be the standard of care. It is beyond idealist. People ahve been indoctrinated literally since birth that hositals are where babies are born. You can't make a new law and expect everyone to just go along with it.

You cannot change people from where you want them to be, you can only gently work on changing their hearts from where they are.

I see gentle hospital birth becoming more popular and to me, this is inspiring. Hospitals are hiring more and more CNMs (albeit for $$ reasons) to do L&D. These are positive steps. Just like almost everything else, change wil come slowly. Judging people's actions as wrong or unethical isn't really going to help the situation get better.

[Mamma Mia]

Originally Posted by alegna

Who am I? I am someone who is very well educated in some subjects. And thanks for the assumption, but no, I'm lots of things, but insecure in my actions is not one of them...

-Angela

I didn't say you were insecure in your actions, but the behavior youa re describing, is the behavior of someone who is. Not the image to put forth when working for change, IMO.

[applejuice]

My mom was prescribed DES for me. I was born alittle early. But I am still here. If she had taken it, there is a chance I would never have become a mother.

Some of my contemporaries were not as lucky.

[tinyshoes]

Originally Posted by Mamma Mia

People ahve been indoctrinated literally since birth that hositals are where babies are born.

The recent passing of Rosa Parks at age 92 makes me think about the value of the change one fed-up person can have, on a topic....on a nation.

Just because this generation, and the one before it is cool with hosptial birth doesn't mean the standard of care will never change to homebirth (like it is in the Netherlands, for example.) I'm 28--my mom and grandmother gave birth in the hosptial, but my great-granny.....and EVERY woman ancestor I have before her, did it at home.

I do agree, Mamma Mia, that it is a positive, to see that gentler births are becoming popular, and the vogue of doulas is especially inspirational. The increase in breastfeeding rates in the USA are another indicator of a return to a more natural style of USA parenting. However, we do have a 28% c-section rate, which, according to the WHO, is 18 percentage points above where it needs to be, and the Happy Vaginal Birthing camp would say that only 2-3% of c-sections are neccesary (I'm inventing that number based on stats from The Farm.)

I wonder...are we talking about ethics? or just being lame? For example, thinking about the Netherlands, where midwife-attended homebirths are the norm, and the Netherlands comes somewhere within the Top Ten for infant mortality in the world (vs. 28th or 36th for the USA, depending on your source) do they think hosptial births are unethical? Or just bizarre? lame-o?

Like, if you feel depressed and need therapy, you see a phsycologist. You don't see a neurosugeon! OBs are MDs who are surgeons. Midwives would be akin to the phsycologist...maybe even the phsychiatrist...do you need a surgeon if you just need assistance during an unusually stressful time of life?

I'm just tossin' the idea that the question might not be as deep as ethics...could it be a question of overkill? Are OB-attended births the SUVs of American birth culture?

HEEEEEEEEEYYYY.....what about that????? has there been a thread about the wastefulness of different birth techniques?

[alegna]

Originally Posted by tinyshoes

The recent passing of Rosa Parks at age 92 makes me think about the value of the change one fed-up person can have, on a topic....on a nation.

Just because this generation, and the one before it is cool with hosptial birth doesn't mean the standard of care will never change to homebirth (like it is in the Netherlands, for example.) I'm 28--my mom and grandmother gave birth in the hosptial, but my great-granny.....and EVERY woman ancestor I have before her, did it at home.

This is something I am hopeful of. In the big picture, things like this have changed VERY quickly in the US. My husband's parents were probably both born at home (one was for sure, not sure on the other) Sure it was rural Louisiana, but it was the norm. It was just what you did. I think that it is within the realm of possibility that it will change again.

(as an interesting aside, in that area kids were also often nursed until they went to school- at 7)

-Angela

[applejuice]

Originally Posted by tinyshoes

do they think hosptial births are unethical? Or just bizarre? lame-o?

I was in France last summer and I connected with some Netherlanders.
We talked about their health care system and their birth practices. The people I spoke with told me they consider themselves very progressive and modern with having midwives and homebirths.

They consider Americans overly aggressive and old school in terms of health care and obstetrics...much as they view our foreign policies.

[alegna]

Originally Posted by tinyshoes

I do agree, Mamma Mia, that it is a positive, to see that gentler births are becoming popular, and the vogue of doulas is especially inspirational. The increase in breastfeeding rates in the USA are another indicator of a return to a more natural style of USA parenting. However, we do have a 28% c-section rate, which, according to the WHO, is 18 percentage points above where it needs to be, and the Happy Vaginal Birthing camp would say that only 2-3% of c-sections are neccesary (I'm inventing that number based on stats from The Farm.)

Answering in bits again- easier for me to think on one topic at a time.

I'm glad you brought up the section rate. I meant to earlier. Around here it's even higher than that, especially in the city. When I ran individual hospitals only 2 came anywhere near the national average (TX is above the national average also) But not only that, most hospitals were above 30%. Several were at 40%. One is rumored to be near 50%. Given that WHO says that maternal and infant health is at issue above 10%, is it ethical to birth in a hospital with a 30% section rate? What about 50%?

-Angela

[applejuice]

Originally Posted by alegna

This is something I am hopeful of. In the big picture, things like this have changed VERY quickly in the US. My husband's parents were probably both born at home (one was for sure, not sure on the other) Sure it was rural Louisiana, but it was the norm. It was just what you did. I think that it is within the realm of possibility that it will change again.

(as an interesting aside, in that area kids were also often nursed until they went to school- at 7)

-Angela

Wow good post!

Upper class women went to the hospital beginning around 1900, but the big boom in hospital birthing took place after WW2...my own midwife who lived through the period said it was to fill the hospital beds left empty after the war.
Hospitals know when a woman births in their hospitals, they often are bonded to it and the doctors and nurses and the maternity wards are actually big $$$ for hospitals.

Women go on to work in the hospital, volunteer in many capacities.

Having babies inthe hospital is a cultural thing for Americans and the world of the 20th century.