What hope, then? - Page 2

[azjen43]

So many good points are being made here, I'm really glad this conversation is happening....Here are a few points I can think of now:

We're talking about a cultural/societal shift and I think that needs to start with young women and girls. I think we should begin the conversation about birth as a normal, natural process in our homes with our own daughters, as well as part of a comprehensive sex ed program. (Don't even get me started on this! )

While I love being part of the birth community in my area, I often feel that we are preaching to the choir. I think we need to reach out to more mainstream-leaning women in a way that allows them to see and hear about normal birth as just that: normal. How to get that conversation started?

And finally, I agree about economics and insurance being a major part of the problem.... again, it seems like a huge hurdle to overcome, but if women started to demand coverage for homebirth midwives, it seems that surely, the insurance companies would see the benefit of using low intervention practitioners, thus saving thousands of dollars. I also agree that free-standing birth centers are an essential part of the picture. The only one in our area just closed recently, a real loss for the women of our community.

One more thing: When I first read this book, I kept thinking, this book needs to be required reading for OBs... I wonder, Dr. Jen if you would comment on the likelyhood that any of these docs would read this? Would many OBs (and other docs) take the time to read a book that's directed at the general public and that's so critical of their profession? Or do they usually just stick with professional journals, etc? What about books like Marsden Wagner's , Ina May Gaskin's, Penny Simkin's, or even Henci Goer's? Do OBs read any of the stuff that is so influential in the natural birth movement? If not, how can they be encouraged to do so?

[storychick]

I have never been able to figure out why the insurance companies arent rushing to insure midwives -- it is so much cheaper for them to pay the $4K for a homebirth than the 10K+ for a hospital birth with the works... How will this change? That is going to be a huge factor, I think.

But I think it is true that it will be up the women in the end, to demand different. Unfortunately I dont see that happening soon -- people like their numbed experiences too much and dont want to hear about anything different, the fear is so strong... I tell my birth stories proudly but I dont know that it makes a difference, I wish I felt it did.

I have Pushed and Born in the USA on my bedside table (Amazon just delivered them 2 days ago!) but I am almost afraid to read them, for fear I will be so : I read A Midwife's Story first instead (and now I want to go be Amish lol).

[A&L+1]

Funny you mention, Penny Armstrong and Sheryl Feldman's A Midwife's Story, storychick. I was about to post that the only way that I can deal with my post-Pushed feelings is to slowly read A Wise Birth by them. It is a fabulous read in my opinion and speaks to many of the issues brought up in this thread. Sure, it was written in 1990 and things are WORSE now in many ways than they were then, but so much of what they write about applies to this discussion now -- OB training, midwife regulations, insurance, mainstream acceptance of "wounded birth", need to control, sexism, fast-food attitude, etc. are all touched on in the book.

I was one of those women who thought I could have a totally fabulous hospital birth. I sincerely thought I could. It is not so difficult for me to imagine why perfectly intelligent and knowledgable women CHOOSE to put themselves in an abusive place to birth. I did it. I did it because <to be perfectly honest> I thought I was better than all those other women who were railroaded into interventions. I thought my wits and education would protect me and my low-intervention doctor would respect me. Sadly, I learned the hard way when her back up doctor came to my daughter's birth. I agree that every woman who is part of the change matters - that is how we will see change. I would love to be able to prevent women from choosing circumstances that may lead to less than ideal birth, but I changed after my traumatic birth and that matters too. As dark as it is to imagine, if things do get worse before they get better, I think we can count on a lot of pissed off women to fuel the medicalized birth backlash.

[636Jen]

Not only rushing to pay for midwives over doctors but why not birth control over the cost of a birth?

As far as mothers talking to daughters, I have to comment on this. My mom didn't talk to me about A-N-Y-T-H-I-N-G. I had three periods before I said anything. When I finally said something, she just said, "There are pads under the sink in my bathroom." That was it! I never had a sex talk either.

Until recently, I never felt part of a sisterhood. I grew up in a city during the 80s around a lot of cliques. For some reason, girls hated other girls if they weren't in their particular "group." It always felt like a competition and there was no unity. I'm so happy that I found this path because it's so different from what I grew up knowing and it's what I've always longed for and felt was right.

I hope to instill those values in my kids, especially my daughter. I will definitely talk to her about everything and make her feel like the door is always open if she has any questions or problems. I really feel that it all starts with the MOMS.

[Dia]

Originally Posted by jengacnm

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???

Well, as someone who has worked in the health insurance industry, with executive level folks, for my entire professional career, I can tell you this - decision-makers that set policies in place are MDs employed by insurance companies. I don't think they are taking anything into consideration other than what is completely mainstream.

But from insurer perspective, this doesn't make sense to me either...I don't personally understand the disconnect - in nearly all other medical situations, insurance company's goals essentially are to minimize cost, i.e., try to minimize utilization. Frankly when it comes to birth / women's health issues...there seems to be an overemphasis. Meaning as women, we NEED to be fixed. At least this is my personal sense.

P***es me off to no end.

Perhaps I need a new job...

[courtenay_e]

Just a side note...i don't base any of my actions, words, or advocacy in anger. That would only hurt me and not make any point except that I'm "one of those crazy activists". I think midwifery care is based in peace, and so I try to peacefully put forth the message that midwifery care is caring for normal women who have normal healthy births, that it's safe and etc. Nope. No anger here for me. A profound PROFOUND need to have my daughter safe when it's her turn, and frankly, my sister (!), my cousin, my friend, and they'll all be coming along MUCH sooner than my daughter? They all deserve that safety, and gentle care. My need to educate and even possibly protect them from the traumas I see in many hospital births spurs me on...but not anger.

[A&L+1]

Originally Posted by courtenay_e

Just a side note...i don't base any of my actions, words, or advocacy in anger. That would only hurt me and not make any point except that I'm "one of those crazy activists". I think midwifery care is based in peace, and so I try to peacefully put forth the message that midwifery care is caring for normal women who have normal healthy births, that it's safe and etc. Nope. No anger here for me.

But, women are angry. I see no point in denying that many more will be angry because each day more are being traumatized by birth. Maybe that won’t mean more public outcry but rather more post-partum depression and internalized anger. I don’t know, but I wholeheartedly agree that midwifery and gentle birth should be the peaceful refuge you describe and is the answer to reducing birth trauma. I don’t think that we should be raving, strident, normal-birth lunatics either. At the same time, the revolution of our country away from non-gentle birth will probably involve a whole lot of passionate truth telling about the traumas women have experienced. I don't like the idea that women or midwives or gentle birth advocates shouldn't be angry or shouldn't show their anger. That strikes me as a sexist "women should be gentle and sweet and they'll get what they want" kind of approach. I am not implying that is what you are saying since you are only talking about how *you* feel and what you try to present to the world. I just wanted to comment on how I see anger as an important motivator and a key element to social change.

To get back to the OP, I think one thing that will help foster change is to create more ways for the average woman to talk about birth. That’s why all these new media efforts - Pushed, Ricki Lake, mainstream magazine articles - are encouraging. I think change is happening.

[mandib50]

i'm not directly involved in the birth scene in alberta . what i do know is that from when i had my first homebirth, to my last, things as far as midwifery really changed. midwives were registered, but not funded, and the numbers of midwives dropped substantially. costs of midwifery care have pretty much tripled since my first homebirth. with registration came more rules for homebirth. as far as i know, some provinces are much worse than alberta for regulating what must be done and cannot be done at home, but still, i am so grateful i had my HBAC before registration was implemented.

i don't really know what goes on in hospitals other than what i hear other women say about their experiences, which is enough to make my heart sad
somehow women seem so complacent about accepting the status quo for birth it really is puzzling to me. not only do they accept it but they seem rather content with their birth experience.

on the other hand, i have a friend who is wanting to get pregnant who went from wanting her doctor at the hospital to being turned onto homebirth. i am also starting midwifery studies and have the support of 2 local doctors, one who said he would do anything possible to help me become a midwife, and the other who said to let them know as soon as i can practice because they would be really interested. the neat thing about it is i live in rural alberta, so their attitudes are pretty shocking to me given the reception that other doctors have given me over the years in regards to my homebirths. they probably have no clue as to my philosophy of care but i really do feel like it is a positive step forward.

and the other hopeful thing is that there is another woman in my community also pursuing midwifery which for a town of 2400 is pretty remarkable!

i know that nurse practitioners in canada have said that they are very supportive of midwifery and are pushing for funding and would like to work in collaboration with midwives.

so ... there are glimmers or hope here and there. for anything substantial to occur, women are going to have to demand change and not stop until it happens.

until then, i will quietly follow my own path and hope to plant small seeds in my community that, with time, will turn into something wonderful.

[pamamidwife]

I agree with Lisa...I'm angry, too. I'm angry for alot of reasons and don't always see midwifery or birth activism being about doing things peacefully. sometimes an uprising is less than peaceful - and it's still solid and progressive. When they take away our fundamental freedoms re: birth and risk jailing women for serving families in birth, there's no room for honey IMO. I'm all about the vinegar!

I don't care if people write me off as a crazy natural birth activist. That's what I am! I will stand up and yell for women in this revolution. However, when dealing with people face to face, I'm much more calm, but not lenient about the dangers and risks.

But really, it's not us gentle birth activists that need to yell - it's the consumers/women that are being sought out as $$$ makers by hospitals. With big bucks being made in L&D at hospitals (sometimes one of the top 2 moneymakers for hospitals), people in charge are more likely to listen to them.

[jengacnm]

[QUOTE=mandib50;9340036]i'm not directly involved in the birth scene in alberta . what i do know is that from when i had my first homebirth, to my last, things as far as midwifery really changed. midwives were registered, but not funded, and the numbers of midwives dropped substantially. costs of midwifery care have pretty much tripled since my first homebirth. with registration came more rules for homebirth. as far as i know, some provinces are much worse than alberta for regulating what must be done and cannot be done at home, but still, i am so grateful i had my HBAC before registration was implemented.

: Registered but not funded? Meaning they don't get reimbursed by the national health system?

[courtenay_e]

Originally Posted by pamamidwife

I agree with Lisa...I'm angry, too. I'm angry for alot of reasons and don't always see midwifery or birth activism being about doing things peacefully. sometimes an uprising is less than peaceful - and it's still solid and progressive. When they take away our fundamental freedoms re: birth and risk jailing women for serving families in birth, there's no room for honey IMO. I'm all about the vinegar!

I don't care if people write me off as a crazy natural birth activist. That's what I am! I will stand up and yell for women in this revolution. However, when dealing with people face to face, I'm much more calm, but not lenient about the dangers and risks.

But really, it's not us gentle birth activists that need to yell - it's the consumers/women that are being sought out as $$$ makers by hospitals. With big bucks being made in L&D at hospitals (sometimes one of the top 2 moneymakers for hospitals), people in charge are more likely to listen to them.

I guess it comes, for me, from abuse as a child. I learned that to be angry gave me ulcers. To work for change in my environment using available tools (psychiatrist, social worker, school counselor, mother) changed my environment. Not that that will necessarily work in the political, big money environment we're talking about! Not that I don't get furious and sickened by much of what I see...but were I to stay angry, I personally would have a difficult time thinking clearly enough to work for change. It DOES make me very FOCUSED. And I certainly would NEVER describe myself as quiet or meek. Don't mess with me when I'm serious about something...but I also...anger begets violence in my world. I'm more of a turn the other cheek kinda gal. Did you know that that saying comes from the fact that turning the other side of one's face would mean that the abuser would have to degrade themselves by using the hand they wipe themselves with to strike? I think using ingenuity can get us farther than anger. But, again, that's my style left over from too much anger and not enough power as a child. *shrug*

[courtenay_e]

Oh, and people usually see me as a crazy birth activist, too. My in-laws are horrified... and I'm very blessed and honored to say that my husband is PROUD.

[mandib50]

Originally Posted by jengacnm

: Registered but not funded? Meaning they don't get reimbursed by the national health system?

yep. actually funding would be through the provincial health care system, but regardless, no funding here. midwives have to pay insurance and were just excused from paying GST. currently it is up to each regional health authority in alberta to approve funding for midwives in their area, however, nothing has happened. very very frustrating.