What hope, then?

[doctorjen]

Okay, so I just finished reading Pushed. It is so discouraging to be reminded of what modern American birth looks like, still. So discouraging to read the current cesarean section and VBAC numbers, and read some of those birth stories.
Add in the current climate in my own workplace (likely to ban VBACs outright at my hospital, and already I have lost my back up for primary VBACs and can no longer attend them, rising cesarean rates, rising induction rates, clients being persuaded to accept major medical interventions in the name of mythical promised safety.)
What hope is there?
Where are the women who should be picketing outside our hospitals instead of agreeing to medically unneeded cesareans?
Why do even my own clients meeking accept everything I say as truth and question nothing?
Any ideas on how, or if this trend will ever be reversed?

[Electra375]

For me, personally, I've moved over to the homebirth arena. The first year after my first hb, I lobbied our local gov for CPM licensure. Since then, I have gone about my business and hb'd again -- this is after having 2 c/s in the local hospital which is very c/s happy. The attitudes of most women using OBs and hospitals usually enrages me, so I stay clear of conversations b/c I am very opinionated and would not my anger to influence someone negatively.

What hope is there? What will change the current thinking? I don't know.

There are little movements going on through out the coutry Birth Matters is in VA, maybe else where. Friends of Midwives, I think is national. It's at a grass roots level and I've seen here in VA that it took from the early 90s to mid 2000 to make even little changes.

Other mothers talking about hb in a more mainstream environment, this is key, hbers need to leave their FNL communities and get out to talk to other moms. I'm attenting a mom's club in addition to our FNL. I bring with me my ideas of birth. Surprisingly these woman are interested! And my midwife is speaking to the group next week. Oh, I should say I had nothing to do w this event, the leaders of the group contacted my midwife, I just joined this group, so the word is slowly spreading. And I will work hard to keep my rage in tact!

Birth Circles, like LLL... that is they way to change the current attitude, 1 mind at a time. It's slow, but hopefully our daughters will know better.

I'm very proud to be able to tell my daughter I had her at home and it's perfectly safe and natural. I took her to the docs for a check up and the entire trip there "I'm not sick, why do I need a doctor" she's 3, I think I'm doing a good job!!!

[SublimeBirthGirl]

Normalizing homebirth is my hope as well. I've mostly given up on changing institutionalized birth. The few docs and midwives in that setting who believe in normal birth are being railroaded into doing things the "accepted" way. I'll continue to work for change in the system b/c most of my students will choose hospital birth. But I hope to work towards moving homebirth into the mainstream as well. I have hope for that, because of what's happened with breastfeeding over the last 30 years and continues to happen each day.

[pamamidwife]

I have no idea how it is going to change...I would imagine it's going to have to get worse before it gets better. Somehow normalizing homebirth and normal birth should be key, but we're going to see a sharp rise in cesareans, in maternal mortality, in women losing their reproductive organs, and their connection to their bodies and their babies.

Overall, I think we as women are deeply wounded in a belief in our bodies. We live in a culture that views breasts as only sexual, our vaginas smelly, periods something to hide from (or avoid altogether if you want to take a special birth control pill). When women get pregnant, they assume that they will be one of the small percentages that turns high risk. They automatically assume that they'll "try" vaginal childbirth/natural birth or that they'll 'try' breastfeeding. These things are just a given.

We also live in a culture that preaches massive consumerism. I'm guilty of buying more than I need and throwing out so much stuff to acommodate more. We look at STUFF for babies as a good thing (things people register for! the nurseries!) and we definitely want MORE stuff for our babies. Not because it seems to make our lives easier or help our babies, but because we're competing with the next mama who lives on our street.

Where does it end? I think education is key - but if a woman isn't ready to 'go there' (because it does rock your ENTIRE world to GO THERE), anything anyone says won't be heard. We just have to live the truth. Act like this is what is normal.

When you hear someone talk about how 'brave' you are for a homebirth, ask them why. Listen to them. Don't immediately counter with "well, women who go to the hospital are brave". Give them a chance to voice their concerns. Chances are, eventually they will come back with their own ideas and start to see something different - even without you saying much of anything.

Even here on MDC, I would venture to say that more than half the women are planning hospital births with MDs. It's not that they're not exposed to the information, they're just having to see over the huge wall that has been built before them. The cultural indoctrination of allopathic care - especially when it comes to women's issues - is not to be taken lightly. We've got a serious, serious road to walk.

[Stacymama]

Talking about homebirth with others, talking about how wonderful and positive it was. I also think that somehow reaching the younger generations, BEFORE they become pregnant, educating them about childbirth and how natural it is, is important. If you ask a girl in highschool or in college, how she pictures as normal birth, it's probably includes complete fear and total pain, that the thought of doing that without drugs seems utterly crazy to them.
The other thing that we can do is SHOW our children how normal birth is by including them in our birth, so they can see their brothers and sisters born, so that when it becomes their turn they remember, first hand what it looked like, not scary, no machines, no one yelling "push" with mom numb from the waste down.
It is reaching 1 momma at a time.

[636Jen]

I don't really have anything to add but I wanted to mention that Ann Arbor Michigan is building a new hospital that will add on 30 post pardum rooms and 30 labor rooms (I think that's the right number) When asked about why the rooms would be seperated, they said that they are expecting a 50% c-section rate.

I think it has to start with parents. Moms need to educate not only their girls, but their boys too. Teach them that birth isn't just about pain and that it can be a beautiful experience. Next, turn off the TV! Don't watch the Discovery Channel's birth shows. Women don't belong flat on their backs with people holding up their feet being told to push. (that's my opinion)

I feel that the doctors have a responsibility as well. They need to tell these "birth by design" women NO.


Side note: Someone should start a HOMEBIRTH tv show. We need to spread the word about midwifery and home/water births. I think Ricki Lake did a beautiful job and we need to keep pushing the idea that NORMAL, unmedicated birth is a good thing!!

(said the beginner midwife student who had three inductions) :



Jen

[rajahkat]

The crisis surrounding birth (and our medical system as a whole)is just an extention of the crisis of our society. I think you hit the nail on the head, Pam. It all comes back to consumerism and fear. We're taught that we have to buy something, hire someone in order to be safe and do things responsibly, while someone is profiting from it all.

Go to college or else you won't get a "good job" Got to have a good job so you can buy stuff, but don't let your credit score get chinked or else you won't be able to buy a house! Buy insurance "just in case".

We're stuck in a cycle of get scared then spend money (buy something or hire someone) to feel better.

Not to sound pessimistic, but I don't think it is going to get better. We're growing a society of people who are scared out of their wits, working jobs they hate so they can buy stuff they don't need. But they won't STOP paying $3 a gallon for gas for their cadillac tra la la because it's a status symbol to be able to do it.

I think our society will completely fall apart. Eventually enough people are going to run out of money, lose their homes, have nowhere to go and no food to eat. We'll have a majority of the population homeless and starving and severely rioting and overthrowing the government before anything is different. I think it'll be madmax before it gets better.

I don't know if changing the way we view birth is the key. Sometimes I think it is. Want to fix something? Start at the beginning of course! But is it really that simple? If a vast majority of women up and starting birthing at home, what would happen? Wouldn't the folks who profit from keeping women in offices under their care lobby all the harder for legislation against it?

[Joyce in the mts.]

I do believe there is hope. I work with a charity that gives clothing and baby gear, etc. away to economically-challenged women and families.

Since I started in July, I have probably had nearly a hundred encounters, perhaps a handful of them with pregnant women looking for some baby clothing and such. One of these women saw our lending library- with books on parenting, birth, etc.- and we got to talking about her preferences for her upcoming birth. She has given birth before and insists on a natural, unmedicated birth, as well as insisting on breastfeeding.

I was overjoyed and to me, that one woman represents others I have not yet met. So there is hope.

I would not invest my money or time in midwifery education (I have started my academic learning with Michigan School of Trad. Midwifery) at a time in my life- gonna be 49 (that's pushin' 50 y'know)- when I could be just having fun, if I didn't feel in my heart that there is hope for birth in this culture/country. (course having waited for over two decades to get to this point, also motivates my commitment, but I also feel strongly that women will begin to turn away from the "machines that go BING" and come around back to the natural way... it's the way of the power of all things to come full circle... this turning is often called "revolution".)

Meeting that one woman at my job makes me see clearly- she will pass her ideas on to her children- that she is just the tip of the iceberg.

So keep the faith. Yes, we are a sick country with sick notions about birth steeped in a love of consumption and industry, but we women can be part of the solution/revolution that is to come... even if we might have to lead so that the leaders will eventually HAVE TO follow. I believe this with all my heart.

Take heart

J.

[texaspeach]

I'm not a birth professional.. but I do think there is hope. I'm currently a nursing student, working on my bachelors, who hopes to one day be a CNM, CPM or possibly an MD. My partner and others around me are encouraging me to go on to med school because I feel so passionately about health care. a very close friend of mine is starting med school in January and has a very pro natural birth philosophy. For every one of her, there has to be at least another one. There is HOPE, it's just that we have to spread the message that having hope is allowed.

[mothercat]

I think the change will have to come from the women themselves.
Look at how many women were birthing in the hospital post WWII and the horrors of twilight sleep. Then in the 60's women began to decide that they didn't want that experience and began to birth at home in greater numbers, learning to be midwives through self study and then midwifing for their friends.

Most of the improvements that we now see in the labor wards (decorating, LDRPs, dad's present for birth) came about because of the number of women who chose not to use the hospital. It may all be marketing, but there have been improvements since the 50's.

I think it will take a rebellion from the childbearing women themselves leaving the medical system that will force the change. I am hopeful that this will happen. There have been many books and movies this year that are getting a lot of positive press. I think that it will just be a matter of time, but we will reach a tipping point back toward normal birth.

However, I think that the providers who believe in normal birth, also need to leave the system that is so harmful to their psyche. This is a huge decision and not always possible, but even a small number can make a big difference.

[Juvysen]

I am the assistant chair of a consumer based organization pushing for birth options called Homebirthers of New York, working on just such issues

[courtenay_e]

You know, Defenestrator was talking in another forum about a couple of clients in the past year (one of whom I shared with her) who came late in pregnancy from Medicaid teaching clinics because they could simply no longer bear being treated the way they were being treated. That made me really, very sad and disheartened. These young doctors are being taught to treat women like chattel. And I had another client just last month, who, trying to be polite, in transition with twins, was sitting in the tub with the shower running on her belly as the tub filled, and the Resident was asking STUPID and needless questions that she was answering anyway to be kind. He got frustrated with the fact that she was pausing before she answered him, and suddenly YELLED at her: "This is RIDICULOUS! I WILL NOT stand here in the TOILET and speak to you ANY LONGER. You will HAVE to get out of that tub until I'm done with these questions!!" At which point I looked him dead in the eye and said, "Sir, this is NOT about your comfort right now! If you feel the need to continue this questioning so you can check "vaginal birth of twins" off of your list, then you will do so to the benefit of the LABORING MOTHER!" I just could NOT keep my mouth shut. It didn't hurt that the nurses in the background were hi-fiving at me and cheering me on...and it just keeps going that way! But there IS hope in those two women who left the clinic for homebirths. And, actually, in the doctor responsible for that rude resident. When the Doc found out that Resident's attitued, he actually removed him from the room, never to return. That gave me hope, too. I guess it's baby steps, and talking all we can, to whomever will listen, and touching random and unexpected lives whenever we can. Prayer, frankly, helps me out...I pray EVERY day that my daughter will have better birth experiences than I have...and I had midwife attended births!

[Defenestrator]

I think that freestanding birth centers will have a major role. I've met more than one person who was uncomfortable birthing at home but felt ok in the birth center and being in a separate physical space from the hospital means that there is a higher threshold for surgery, pain medication, or other interventions that require a change of location.

[Defenestrator]

Oooh, I cross posted with Courtenay. I must have felt my ears burning

[earthmama369]

Originally Posted by pamamidwife

Even here on MDC, I would venture to say that more than half the women are planning hospital births with MDs. It's not that they're not exposed to the information, they're just having to see over the huge wall that has been built before them. The cultural indoctrination of allopathic care - especially when it comes to women's issues - is not to be taken lightly. We've got a serious, serious road to walk.

I'm not a birth professional; just popping onto this thread from the New Posts page. But I would venture to argue that many mothers make the informed choice to use a hospital rather than birth at home with a midwife because in many cases, insurance does not cover a homebirth and the out-of-pocket expenses can be quite high. Not everyone has $3K+ to spend on their birth.

Getting more major insurance companies to add midwives to their rosters would be a huge coup. If you want to see more women birthing at home, something in the cost structure needs to change to equalize the home/hospital options -- or at least bring them into the same stratosphere.

[jengacnm]

I apologize in advance if this turns into a ramble....

I believe that we will see a widening dichotomy in the not too distant future. Yes, there will be more c sections, but there will also be a backlash of women who want to AVOID c sections who will then go to midwives.

I definitely need to stay in my happy little world-I commend activists for the work they do. I've learned the hard way that I just can't remain fueled by anger.

My general belief is that many, MANY first time mamas don't really believe that THEY'LL have a c section. As the rate continues to climb, perhaps more women will become righteously afraid and start doing their homework.

Most women in my practice knew they wanted a midwife all along, but the ones I heap praise upon are the ones who transfer mid pregnancy-I commend them for their willingness to dispense with the "good girl" mentality and go elsewhere.

Ironically, finances may work in my favor. A handful of clients found their way towards me because they don't have insurance and make too much money to qualify for medicaid. Once they came to me, not only was I a bargain, but also a) I knew their names, and b) they didn't wait to be seen for two hours. Yes, I would rather a woman come to me because she believes in the work I do, but hey, whatever gets her in my door....

Then it's the one woman at a time thing...my three year old practice has already enjoyed a wave of "my friend Suzie Q had her baby with you and suggested I come here....".

In the Big Picture, more home birth midwives are needed. I've heard oft-quoted that 1% of any given population will choose home birth. Is the number that low simply because there aren't more home birth providers out there?

And here's a sort of rhetorical question...WHY are insurance companies allowing the c section rate to gallop away???? What happened to the incentives of a few decades ago when doctors were rewarded for having low c section rates???

OK, so there's my disorganized 2 cents...

[doctorjen]

I love all these thoughtful replies!

Anyway, it does seem to me that there may be a widening dichotomy in the birth culture. On the one hand I see in my professional life a move everywhere across the country towards more medicalization, less choice for women, a fear-of-birth-based training system, and women willingly putting themselves into this culture. I do think that many women want to believe that they won't be affected by the medicalization - their induction is necessary, and won't end in a cesarean, and their baby was truly in distress, or their cervix unable to open, or their pelvis too small to push out a baby.

And then I also see more public outcry than I have in the last few years, at least - with things like "Pushed" being published and a national figure making a movie like "The Business of Being Born." I'm thrilled to death to see that. On the other hand, though, I wrote my college honor's thesis on feminist ethics and women's reproductive health care 15 years ago, reading Emily Martin and Barbara Katz Rothman and Our Bodies, Ourselves - and 15 years later, nothing concrete is changed. In fact, in many ways things are worse.

In my own practice, I have seen my ability to be a decent birth attendant eroded by what is becoming standard of practice. It gets harder withstand peer reveiw, I have fewer choices to offer my clients (the no VBAC thing is especially killing me) and I seem, if anything, a few years into practice to be having fewer clients care much about what sort of things happen during their births. Instead, I've developed this reputation as the doctor who "doesn't like epidurals" and "won't cut an episiotomy but just let you tear" and any number of other evidence informed practices that go against the mainstream birth culture. It is awfully disheartening to go into a field because you believe strongly that you can make a difference, and then not feel like it matters to too many people. I have a few clients every year who choose me because of my practice philosophy, and the rest sort of put up with my eccentric ways. That is not how I imagined it to be years ago when I was training.

It is very hard to explain to a non-insider the fear based culture of birth care in the modern medical world. It's like a virus, and it spreads from teacher to trainee, and from doctor to client, and from mother to daughter. I want to know how to disrupt it and form new ways of belief.

[Joyce in the mts.]

Pretty interesting about the financial thing- insurance controlling the birth scene. People prefer insurance to getting exactly what they want. If they want hospital birthing with all the "what if's" seemingly covered- stuff happens just as often in the hospital as at home- then that's what they will get for care and experience and if they never have anything to compare that experience to, then they won't care and they won't question and they will settle for that.

I think that as poor as we were back in the day, we were better off in certain ways than folks are now. When I had my babies at home, we had insurance but didn't care- there were no midwives in the insurance system and even if there had been, I would not have dealt with them because I wanted homebirth. There were no legal midwives here. I had one illegal DEM and one who was more like a doula- also illegal. Both very good.

We found these birth attendants, we made payments to them as we could and when we had a hard time with that we were simply honest about it and worked it out. (we're all human and everyone has had hard times- we are all in it together)The bill got paid eventually.

We didn't care about the insurance! We wanted to bring our children into the world in a particular way and we worked it out with the attendants so we could. We were the parents and we were responsible for outcome and for working out fair payment. We protected those women so that they could practice and be available to folks who wanted them. They were really great attendants.

I don't get how folks don't see that they can work things out to have the experience they might really want. See maybe I am a different kind of person: I was never going to be happy unless I took responsibility for making it happen for myself, since it was my body, my baby and my experience. We rejected hospital birthing.

Thing is, I felt SO empowered by these experiences, by choosing the way we wanted to bring our babies into the world. We had to form good relationships with the attendants since we needed to pay as we went and work it out when we had trouble. A community formed around homebirth.

I had had one hospital birth for my oldest where I learned how to birth and then knew what I wanted once I'd had the experience. All my births were fairly routine on the continuum of normal for sure. There was a lot of trust in the process.

Insurance is great for certain things, but also has the potential of lulling us into complacency and very subtly also into complicity with the system- we allow ourselves to be limited by it, and in that process we enable the system to determine our experiences.

So where does the change begin? See it's all backwards! The system has folks thinking that they have to settle for bells and whistles because it's covered. The truth is that if more folks demanded reasonable ways of accessing care and assistance if they need it for birthing, then the system would still be available to those who truly need it, rather than making that stuff the standard for all.

See, natural and home birthing could really be the norm-- it's all cock-eyed in my opinion, and backwards because that is what is making money. But that is perhaps becoming a double-edged sword for all those buying into the insurance system... and now... it's tough to get away from such an entrenched routine for birthing, to the point where rejection of it all is met with resistence, and in some cases punitive attitudes and actions.

Yet women still go there. And if that is what they want, then more power to them. But it's up to others who don't want it to create the alternative and support it regardless- it can be worked out affordably if that's your bottom line.

Back in the day, when it looked as if homebirthing would be sane wave of the future for all those who could and wanted to, leaving hospital birthing to those needing it most, something happened to shortcircuit that movement. I don't know what happened specifically- perhaps malpractice and the distancing from the possibility of death and birth happening at the same time evne though there are no guarantees... could be that. Whatever it was created a backlash that hurt the bottom line for docs- $$.

So money is what is holding birth captive. Insurance is keeping women in their place because it's an economic incentive to keep doing what's always been done.

It's always most effective to create change by hitting the pocket book. This can also be used to change what is going on. By withholding $$ from what you don't want to support you help build alternatives and movements.

I say, (and I know I am an old radical and it's a radical idea) take the money out of the hands of those you don't want attending you and feed it into your desired practitioners instead, regardless. Take a risk! It's an investment and it's about personal power. If you are ready to take responsibility for the continuum of normal birthing, if you trust in that continuum and in your competent practitioner, then you have the option... work out payments if you have to. (when I use "you", obviously I mean "you" in general terms).

If you cannot get outside the box of the system, then that is up to you... but your care will not be up to you unless you decide what you want and get it.

That's all I know. Like I said, I am an old renegade, rebel, radical. I remember the time when homebirth seemed to be the way things were moving. I'd like to see that happen again.

Sorry to go on and on...

J.

[Juvysen]

Joyce, you're so right. This is what we ended up doing. Because of our insurance situation, going to the hospital *might* have cost us a couple hundred $, our homebirth was $3800 and WORTH EVERY PENNY. So we have to tighten our belts a bit... we did the right thing and I wouldn't trade it for the world.

I agree that to elicit change in this increasingly economically driven society, you gotta hit 'em in the pocket book. This is true of changes in birth, other healthcare situations, energy business, ecological concerns... pretty much everything. Empowered, informed consumerism is important

[Girlprof]

I'm not a birth professional - I'm a social scientist. And I think things are starting to change. There's been some real change in England in terms of increasing the number of MW attended births. This shift was brought about in reaction to the dissatifaction that mothers had with their birth experiences. Canada has also recently expanded midwifery availability. You're starting to see a whole range of groups raising the issue in the US as well. Scholars are starting to take note, too, which means there is something to study. It's probably not going to happen quickly and the endpoint is unpredictable. I'd bet against a dramatic increase in homebirths, but in favor of more midwives and much, much less intervention. Of course, it's much too soon to tell, but I'm pretty sure change is afoot.

Sarah