What Women Aren't Told About Childbirth - Page 2

[~pi]

To GISDiva: That's true, and it's also true that demand can drive change. I.e. if more women demanded better care, change might be easier to achieve.

I just think that putting so much blame on other women (or even individual health care practitioners such as doctors, who are caught in the same machine) is way too easy, and ignores the real problem.

Originally Posted by GISDiva

I wonder more about the women I know though, who don't have any of those limitations, who are generally well-informed people.

Are you sure that they don't have any limitations? Limitations are not always visible, you know. And cognitive and emotional limitations count, too.

[~pi]

Originally Posted by Storm Bride

I could have researched until my hands were all paper cuts...and I'd still have ended up being doped with general anesthetic and cut open over my protests.

[michiganmidwife]

Originally Posted by ~pi

To GISDiva: That's true, and it's also true that demand can drive change. I.e. if more women demanded better care, change might be easier to achieve.

I just think that putting so much blame on other women (or even individual health care practitioners such as doctors, who are caught in the same machine) is way too easy, and ignores the real problem.


Are you sure that they don't have any limitations? Limitations are not always visible, you know. And cognitive and emotional limitations count, too.

Worth mentioning. Historically, women have demanded better care. They insisted that they did not want to birth alone in a "delivery room" without their husbands. They did not want shaves, enemas, legs in stirrups, betadine scrubs, episiotomies etc. They have prepared for natural childbirth by taking the appropriate classes and so on. The response has been met with pretty wall paper and a "home like" environment that is, IMO, misleading. It leads women to think that a healthy, normal attitude is prevalent in the medical setting. Well... it's not. All of these changes were forced as a result of consumer demand. Not because birth became more "normal" in the medical model. Despite these changes, the big business of medicine wins out. Birth is less normal in this country now than it has ever been. And I know it can be a hard pill to swallow, but the absolute fact is that what a woman wants for her "birth experience" is never a part of the equation when medical decisions are being made about her care. The all encompassing, holistic approach of looking at each individual WHOLE person, situation etc. does not exist in the medical model. Because (and we've heard it a million times) of the litigious society in which we live, where no one takes personal responsibility or even realizes that no one is to blame in many unperfect circumstances, the medical system has to practice defensive medicine regardless of whether the defensive choices are good or bad for a particular woman or situation. I think that single biggest thing that could drive significant change toward normalizing birth is a cultural understanding and acceptance of the tenative nature of pregnancy and birth. Until then we just have to accept that it is what it is and be grateful that MOST women do have options if they find themselves wanting a different model of care.

~Bridgett

[michiganmidwife]

Originally Posted by ~pi

To GISDiva: That's true, and it's also true that demand can drive change. I.e. if more women demanded better care, change might be easier to achieve.

I just think that putting so much blame on other women (or even individual health care practitioners such as doctors, who are caught in the same machine) is way too easy, and ignores the real problem.


Are you sure that they don't have any limitations? Limitations are not always visible, you know. And cognitive and emotional limitations count, too.

Worth mentioning. Historically, women have demanded better care. They insisted that they did not want to birth alone in a "delivery room" without their husbands. They did not want shaves, enemas, legs in stirrups, betadine scrubs, episiotomies etc. They have prepared for natural childbirth by taking the appropriate classes and so on. The response has been met with pretty wall paper and a "home like" environment that is, IMO, misleading. It leads women to think that a healthy, normal attitude is prevalent in the medical setting. Well... it's not. All of these changes were forced as a result of consumer demand. Not because birth became more "normal" in the medical model. Despite these changes, the big business of medicine wins out. Birth is less normal in this country now than it has ever been. And I know it can be a hard pill to swallow, but the absolute fact is that what a woman wants for her "birth experience" is never a part of the equation when medical decisions are being made about her care. The all encompassing, holistic approach of looking at each individual WHOLE person, situation etc. does not exist in the medical model. Because (and we've heard it a million times) of the litigious society in which we live, where no one takes personal responsibility or even realizes that no one is to blame in many unperfect circumstances, the medical system has to practice defensive medicine regardless of whether the defensive choices are good or bad for a particular woman or situation. I think that single biggest thing that could drive significant change toward normalizing birth is a cultural understanding and acceptance of the tenative nature of pregnancy and birth. Until then we just have to accept that it is what it is and be grateful that MOST women do have options if they find themselves wanting a different model of care.

~Bridgett

[neverdoingitagain]

Originally Posted by jillmamma

I'd also like to see doctors quit scheduling inductions because "you are just about 40 weeks anyway, and I will be out of town the week you are due, so that way I can be there instead of my backup".:

Or at 35 weeks, since its your 6th baby and apparently it'll just slip out you body after 35 weeks. :

[mothercat]

~pi
I have to agree with you about the choices women make in pregnancy and childbirth being based on ignorance. This is like saying that a woman who needs food stamps could make better food choices if she just educated herself a bit more. The truth is that $84.00 per month per person doesn't go far no matter how educated you are or the choices you would like to make.

I think that the childbirth education and referral groups need to do everything they can to get the word out that some providers and facilities are better or worse than others.

There is a group near me that I hope is doing a better job of this now than they were. There was a provider that they received a lot of complaints about, but they never passed that info along to the women who inquired about her. Their response was that they provided the questions to ask and the responses to expect to indicate a mother/baby friendly provider. However, women needed to educate themselves and use their discretion. This is assuming that women had the interpersonal skills to make that happen. Providing the partial information they did (Q&A) w/o telling women the rest of what they knew is the same thing as telling her the benefits of any given intervention w/o telling the downside. It is not a truly informed and educated choice because she doesn't have all the info she needs.

If any one has been following the thread about disappointment in your midwife, there is a link to three articles from Midwifery Today describing and discussing midwives as bullies. The bullies know the answers that these women expect and tell them what they want to hear. The women think they have made an informed choice, but w/o knowing the really bad experiences some women have had with that provider, then their choice is not fully informed.

I like the NYC project where women go on-line and rate the provider and facilities. Then the information is there w/o the woman having to ferret out who knows what, so she gets the whole picture.

[Anglyn]

I just had my fourth baby six months ago and I had a nurse literally struggle with me trying to pin me down to insert an IV that I said multiple times I did not want. I had to ask if there was pitocin in it and there WAS despite the fact that I went from one centimeter to pushing out baby in an hour and a half. WTF did I need pitocin for? To rupture my uterus? The hour and a half was spent with them telling me that I was not in labour, it was braxton hix and they tried to sedate me with a sleeping pill. The IV came when they finally checked me and realized I was fully dilated. They thought now would be a good time for an epidural. I told them it was too late, he was coming NOW and all they wanted to do was get that IV into me. My baby literally shot out and landed on the mattress with no one to catch him. ONly my mom and dh even bothered to look when I yelled "Is that the head?" Then the nursing staff claimed that they could not have known I was truly in labor, despite the fact that dh, my mohter and myself told them how fast it goes once it truly starts and that Ive had three other kids and I know when Im in labor. They were very condescending in explaining to me that every labor is diffren and bh really hurt (despite the docs assurance that they DONT). They wouldnt call my doc so she got there twenty min after the fact. At some point after the baby was born I quit struggling because I was focused on him, since he was born in the caul and a little blue. My cries of "is he ok?" were also ignored and by the time I heard him cry and relaxed, the IV was in. And don't you know I got a bill for those IV fluids as well as for "general labor and delivery". Hm. He delievered himself. DH looked at me afterwards and said, "we could have done this at home" and I wish to hell we had because the next two days were spent with someone waking me up every hour to check on me. Where was that concern when I needed it?

What does all that have to do with informed consent? Well, I still never consented to that IV that I finally yanked out on my own.

[michiganmidwife]

Originally Posted by mothercat

~pi
I have to agree with you about the choices women make in pregnancy and childbirth being based on ignorance. This is like saying that a woman who needs food stamps could make better food choices if she just educated herself a bit more. The truth is that $84.00 per month per person doesn't go far no matter how educated you are or the choices you would like to make.

I think Women should educate themselves about choices in pregnancy despite their socioeconomic status. Staying ignorant is no help to an already oppressed population.
I also think a pound of apples goes further financially and nutritionally than a pound of pop-tarts. No matter what your grocery budget is, it makes more sense to eat healthy food.
I guess the point is that even women who who don't have the luxury of considering alternative care if they wanted to, should still feel that they can have some measure of security knowing how best to work within the confines or parameters of where they are receiving their care.

~Bridgett

[~pi]

Originally Posted by michiganmidwife

Staying ignorant is no help to an already oppressed population.

This is true ...

Originally Posted by michiganmidwife

I think Women should educate themselves about choices in pregnancy despite their socioeconomic status.

... but how do you propose actually achieving this?

Originally Posted by michiganmidwife

I also think a pound of apples goes further financially and nutritionally than a pound of pop-tarts. No matter what your grocery budget is, it makes more sense to eat healthy food.

I invite you to actually do a little digging into the economics of food supply. There is plenty of research to support the idea that it is significantly more difficult for many low income people to find decent (or any) produce, partly because grocery stores have moved out of low SES areas, leaving behind mainly convenience stores.

And sure, a pregnant, urban, single mom of two could make the trek out to the grocery store in the suburbs. On the bus. After her shift at her second job ends. Then she could bring home her pound of apples and feed that to her children while she educates herself about birth options. :

Originally Posted by michiganmidwife

I guess the point is that even women who who don't have the luxury of considering alternative care if they wanted to, should still feel that they can have some measure of security knowing how best to work within the confines or parameters of where they are receiving their care.

What good does that feeling do when it isn't actually true? Have you read some of the posts made here by women who were well-educated and had interventions applied to them against their will?

Just out of curiosity, do you have any clinical criteria that would preclude a woman from being accepted as a potential client? How about financial criteria? Do you offer free classes?

[applejuice]

I am sick and tired of reading on these forums that homebirths are for upper class women. That is a lie. My mom had me and my sibs at home and was asked if it was because she could not afford a hospital. When I had my four at home, everyone thought it was because I was a hippie (no, I am not). Now a days, everyone blames their insurance for limiting their choices.

Please stop letting other people and organizations make important decisions for you. Vote with your feet and stay home for your birth. Hire a midwife, a doula, and educate yourself and your Partner. Stop playing the victim. People spend more time planning a vacation or dinner out than they do planning a birth, an event that will decide their obstetrical health history for a lifetime and affect the healthy beginning of life of their baby. You are going to live the rest of your life with the decisions others make for you in labor, delivery, and recovery.

Harsh, but terribly true.

[thismama]

Fruit does not fill you up. Carbs and protein fill you up. Fruit is a luxury item, yes even apples.

And yes, homebirth is much easier for upper class women. "Hire and midwife and a doula"... ummm... with money, yes? And even here, where midwifery is covered by the national health care plan (Woot! for universal health care), homebirth is still much more doable if you have money. I live in a shared house, and while I will homebirth, that choice is not as straightforward as it would be if I owned my own home. We also have neighbours very close by, on one side the windows of both houses line up perfectly because they are cheap and poorly constructed. Someone could call the police, which wouldn't be the end of the world, but which would interrupt my birthing and is a source of stress. And, if I lived in an apartment I would be even less comfortable.

Plus our bathtub is small and not so functional due to crappy landlord maintenance issues (ah! that seem to come with cheap rentals IME). Water is fabulous pain relief. So I need to find cash to rent a birthing tub, and figure out if our old floorboards can hold it. Oh yeah, and a doula, because I am a single mother and have literally NOBODY to be my birth partner. Poverty and single motherhood goes hand in hand, so where you find poverty, you will find higher numbers of single mothers.

For the record, I am not poor. I just have a limited income, and homebirth is less accessible for me than for upper class women. True poverty absolutely can impede homebirth. And we can sit around in our big houses with our 'pull up your bootstraps' mentality, but if the fact is poor women are hospital birthing in larger numbers, our armchair quarterbacking their decisions without having lived them doesn't really do much good, except perhaps for our own egos.

[glendora]

Originally Posted by applejuice

I am sick and tired of reading on these forums that homebirths are for upper class women. That is a lie. My mom had me and my sibs at home and was asked if it was because she could not afford a hospital. When I had my four at home, everyone thought it was because I was a hippie (no, I am not). Now a days, everyone blames their insurance for limiting their choices.

Please stop letting other people and organizations make important decisions for you. Vote with your feet and stay home for your birth. Hire a midwife, a doula, and educate yourself and your Partner. Stop playing the victim. People spend more time planning a vacation or dinner out than they do planning a birth, an event that will decide their obstetrical health history for a lifetime and affect the healthy beginning of life of their baby. You are going to live the rest of your life with the decisions others make for you in labor, delivery, and recovery.

Harsh, but terribly true.

You may be sick and tired of it, but last time I checked women living at poverty level don't exactly have a couple of grand lying around--which is how much a homebirth would cost in my county. And, add another grand or so for a doula. Likewise, if you don't have that extra couple of thousand bucks lying around, you aren't hanging out planning vacations and fancy soirées, either.

Homebirth may have been cheap when your mama birthed, but it's not that way anymore.

Reality is pretty harsh, too. The difference between "free" and 2-5k is significant, whether you like it or not. Particularly when a third of all pregnancies in this country are "unplanned."

[thismama]

Originally Posted by glendora

Reality is pretty harsh, too. The difference between "free" and 2-5k is significant, whether you like it or not. Particularly when a third of all pregnancies in this country are considered unplanned.

OMG yes! 5K kept me out of university from age 19 until I turned 30. When my grandfather died and left me that amount. More money than I had ever seen. And... I am not poor.

A few thousand dollars can make ALL the difference. And even if you have it, if it's all you have who could justify using it for a homebirth when you'd have to leave a newborn baby to go back to work fulltime? Yk? If I had 2-5K and no paid mat leave (which most poor women in the US do not have), I would be birthing at the hospie and staying home with my infant for as long as I could.

[mothercat]

Originally Posted by ~pi

I invite you to actually do a little digging into the economics of food supply. There is plenty of research to support the idea that it is significantly more difficult for many low income people to find decent (or any) produce, partly because grocery stores have moved out of low SES areas, leaving behind mainly convenience stores.

And sure, a pregnant, urban, single mom of two could make the trek out to the grocery store in the suburbs. On the bus. After her shift at her second job ends. Then she could bring home her pound of apples and feed that to her children while she educates herself about birth options. :


What good does that feeling do when it isn't actually true? Have you read some of the posts made here by women who were well-educated and had interventions applied to them against their will?

Just out of curiosity, do you have any clinical criteria that would preclude a woman from being accepted as a potential client? How about financial criteria? Do you offer free classes?

oh ~pi, a woman after my own heart.
I didn't realize how bad the situation was until I read a booklet by a Detroit midwife, Melva Craft-Blackshear. She detailed precisely what you are talking about for inner city Detroit women. But what she researched and wrote applies to most rural areas and certainly to the urban areas.
However, it also has a trickle down effect to other things related to pregnancy and childbirth. The chronic stress of lack of money, lack of jobs, lack of reliable transportation. It begins to effect the immune system and then you start to see the great inflammations of pregnancy like PTL pPROM, short cervix, pre-e. All of these problems are pretty directly related to poor diet.
As midwives we tell women that they need "x" amount of protein and lots of fresh (organic, if possible) fruits and veggies. Most of them agree that this is what they should be doing, but do we ask the questions about whether this is financially possible? It is a very hard subject to discuss sometimes, but it is analogous to McDonald's situation. Telling women to eat this way w/o helping them to find the resources to be sure it happens is another story.

I always keep smoothies, juice and other healthy snacks available at my office. There are moms and kids that I know come in hungry for lack of resources. Everyone knows that this stuff is available and they make use of it.
Whenever I suggest protein powder or other supplements, I always ask if it will be financially feasible. If not, then we try to find other alternatives.

[applejuice]

My family is pretty ordinary and middle to low class, yet we managed to have 8 of 9 babies at home; as a mother myself, I had 4 of 4 at home. People make decisions everyday and need to set priorities in life. That is it. What is important to you?

Class envy will get no one anywhere.

I never had health insurance on any continuous basis, and when I did have it, it never dictated to me the kind of care I received. I had maternity insurance with my first baby that only covered a caesarean or catastrophic occasions through my husband's work. I elected to pay out of pocket for a home birth. In 1980, that was $850.

Three years later it was $1,200, but I had insurance that covered 80/20, with $1,000 down. I had no insurance for the others. By 1992, I paid $5000 for a homebirth with the same midwife, plus lab expenses.

We make choices each day. I took a class at a community college in women's health; I asked alot of questions and was told to leave the class.

Interesting. Women are there to learn about their own health choices, but if someone asks questions that the teacher cannot answer, they are the problem, not the student who asks the question. Kill the messenger, and all of that rot...

[~pi]

Originally Posted by applejuice

Please stop letting other people and organizations make important decisions for you. Vote with your feet and stay home for your birth. Hire a midwife, a doula, and educate yourself and your Partner. Stop playing the victim.

First of all, I think you're fooling yourself if you think that finances never create any barriers for women in this respect.

Secondly, the limitations that I listed above include many issues besides finances. There are also limitations due to geography, education, psychosocial factors, accessibility of health care, and clinical characteristics.

Finances would not have made a lick of difference in my birth choices. I live in a place where midwifery (along with most other health care) is fully funded. However, I have type 1 diabetes, which means that I risk straight out of midwifery care, despite the fact that theoretically, midwives could liaise with my endocrinologist just as well as my OB did.

I'm genuinely curious: what would you suggest in my case?

[applejuice]

I'm genuinely curious: what would you suggest in my case?

I suggest you quit letting others make decisions for you. You are an adult, and with adulthood, comes the responsibility to make your own decisions and live with the consequences. Stop blaming others. Get a good midwife if it is so prevalent in your area, laison with a good dietician and endrocronologist, check your glucose each morning, track it, and do the best you can. I do not know how your diabetes affects your pregnancy, labor, recovery, lactation, but I do know that a good midwife can catch your baby under obstetrical supervision if there are so many in your area.

My mom and I gave birth at home in a state and at a time when that state had not certified any midwives for decades. This did not stop us. My mom has had blood sugar and other health issues also. I have two sisters who are diabetics. I am not.

I just love the way MDC members attack when personal responsibility and priorities are an issue. You should ask questions of your HCPs the same way.

[mamajama]

poverty does not occur in a vacuum. There are often a myriad of social factors at play in the life of a low income person, ie. health issues, lack of support, lack of stable housing, lack of self-confidence/feelings of self worth, lack of access to resources such as computers for informations and networking, lack of educational opportunities, high levels of stress etc. I can also guarantee that most women who do not homebirth due to lack of money, are not spending the money instead on vacations.

prioritise you say? I spent years prioritising on a subsistance level with no room to plan ahead or budget. It was hand to mouth all the way around here. That has changed now, but I would NEVER presume to tell a mother living in poverty to learn to prioritise. They are some of the most amazing budgeters and prioritisers around to be able to survive and even thrive under such constant incredible strain.

[rixafreeze]

My home birth cost me next to nothing: just a few basic birth supplies and that was it. Having a UC helped: no midwife to pay!

To the person worried about the cost of birth pools: many women use those $20 inflatable fishy pools with great success. You don't need to rent a fancy Aquadoula to have a comfortable water birth. And as far as the floor support issue goes--if you'd be comfortable having a group of 5-6 people stand in the middle of the room, then you should be entirely fine filling a fishy pool. It's the same weight.

[thismama]

UC is all well and good for *some* people, but it is not the solution for everyone.

I find it so ironic that in many countries a huge priority is attempting to provide qualified birth attendants for labouring mothers, in an effort to lower the infant and maternal mortality rates. And here we talk about giving up those attendants, especially when we are discussing poor women and affording the cost of medical support for birth!

I hardly think that is the solution, and further I think it is very dangerous territory to start advocating UC as a cost saving measure. Doesn't the US already have one of the highest infant mortality rates in the developed world, thanks in large part to the lack of universal health care?