Shawnee, no they didn't. I know that MT is sympathetic to UC issues, so I assume that it was just because of space constraints or else they felt I could have been more succinct. I was disappointed, though.
Regarding the "fact" that 10-15% of births require assistance, well, that's ridiculous. It's only a fact conditionally speaking. Conditional on the type of environment and mother's health and approach to birth and degree of medicalization and a host of other factors. I find it hard to believe that Gaskin really believes that results culled mostly from hospital birth stats apply equally well to (truly) natural and undisturbed birth. I just cannot wrap my mind around why she felt it appropriate and logical to use that as part of her argument against UC. The real fact of the matter is that we don't know what the stats look like for birth under ideal conditions, but that we can at the very least assume that they are far better than for birth under unideal conditions.
Originally Posted by Ruthla
Only in the case of shoulder dystocia, (and perhaps a few other situations I'm not personally aware of) would a midwife's presence at a home birth make a difference, medically. How common are those situations anyway?
Well, there's catastrophic rupture, and placental abruption to name a couple. But, like you say, how common are these situations? Or, more to the point, how common are they when not created by some interference with the natural process? It's impossible to know, because even in UCs there's often some kind of subtle and maybe unperceived interference, from previous c-sections to the husband acting as midwife to the modern difficulty of suppressing the control of the neocortex, etc.
|Even if she thinks a good midwife would be ideal, does she recognize that UC can be far safer than a hospital birth under those circumstances?
Even Henci Goer, who is also not a fan of UC (at least publicly because there are no studies to show it to be safe,) admits (in her book The Thinking Woman's Guide to a Better Birth) that UC is in generally safer than hospital birth.
|I wonder if she's deluded by her own importance at births or simply unaware of reality outside The Farm.
Wellll... her style of midwifery (as seen in Spiritual Midwifery) is
based on the premise that the midwife is this archetypal guru character that women need
to be guided by, psychologically, spiritually, physically. In contrast, here's Laura Shanley:
|Midwives are not the saviors of birth (as I've heard several of them say). They are not the exclusive holders of the "sacred knowledge." They are not the "Goddesses of Birth" - unless they are the ones giving birth. Every woman is her own birth savior. Every woman has the sacred knowledge. Every woman is wise if she allows herself to be.
So if you're used to being regarded as a savior, for people to claim autonomy has to be a little threatening. Even our dear Pamamidwife here at MDC has talked about struggling with ego issues pertaining to her role as midwife, and the pedestal she's been put on is much shorter than Ina May's. I guess I had half hoped that she'd find a way to gracefully step off that pedestal by continuing to grow and learn, as Pam has. To be above the fear-mongering and lack of critical thinking that those trained in medicine so often display.
FWIW, her response to my letter (and to be fair, I have no idea how much Midwifery Today edited out of her letter) addressed *only* my point that she should know that midwives are legally expected to apply standards that do not necessarily serve the individual. She wrote, "If Linda Hessel is right that there are lots of state laws [not what I said, but whatever] that actually require that midwives time contractions and check dilation, midwives and women together should go back to the legislature to fix them. Tennessee midwives don't work under conditions like this and I don't see why anyone should have such provisions in their laws."
Now, this is pretty amazing to me. She's been president of MANA and travels all over to speak at conferences. She's not isolated. How can she not know that in many places midwives must be licensed to practice legally, and that licensure often requires not just proof of education but also agreement to adhere to a certain protocol? In some places any type of midwifery is illegal and the political climate is so hostile that sometimes midwives are willing to make concessions to be able to practice at all. Even here in Oregon where we have quite a bit of freedom, that's in part due to the thousands of dollars each year paid to a lobbyist. Our situation is not at all secure. And then there's the fact that, like doctors, midwives sometimes practice defensively. The midwife who attended my first birth kept a very careful chart of all vitals because in the event of a poor outcome it would help her to legally protect herself. It is just naive to think that these sorts of things do not affect the birth process, and if the only option a woman has outside of a hospital birth is to hire a midwife who practices this way, how is she going to manage to have an undisturbed (safe) birth? This is a real problem. And here we have Ina May dismissively and simplistically telling us that we just need to go the legislature to fix it, as if it is just that simple. It does make me feel like she is to some degree unaware of the reality outside the Farm, as you put it.