Is everything that goes wrong the fault of doctors? - Mothering Forums

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Old 01-21-2004, 02:25 AM - Thread Starter
 
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It seems to me that everything anyone on these boards mentions about anything in labor and delivery going wrong is somehow directly the fault of doctors. Do you honestly believe that nothing at all goes wrong in labor or delivery if a doctor isn't at the bottom of it? I'm just curious here. I never thought I was a champion of the medical establishment, but I don't believe that doctors are responsible for every single thing that can go wrong. It doesn't seem logical to me and I want to know why most of you (all?) seem to think that way.

Rynna, Mama to Bean (8), Boobah (6), Bella (4) and Bear (2)
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Old 01-21-2004, 02:52 AM
 
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"Do you honestly believe that nothing at all goes wrong in labor or delivery if a doctor isn't at the bottom of it?"

Of course not. It's just that there is so often evidence that the problem has to do with the management of labor or the hospital environment. Doctors (and other medical professionals) can't really help being blamed -- the system itself is flawed and not conducive to normal birth, and their job is to work within that system. It doesn't leave them a lot of room to do things right.
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Old 01-21-2004, 02:57 AM
 
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I certainly cannot speak for anyone other than myself, but I will see if I can put into words my thoughts (it's late, i'm tired, but I will try). Do things happen during childbirth that are not the fault of doctors? Yes, of course. No one would say that birth is absolutely fool proof, and that adverse events cannot happen. And I believe that doctors have their place in the contiuum of prenatal and childbirth care. BUT (and this is a HUGE but), they do not belong in the realm of normal prenatal, childbirth and post natal care. Pregnancy is not a sickness, yet the vast majority of the medical establishment treat it as such. And if a condition is treated like an illness, than it is almost self prophisying that SOMETHING will happen, or that something minor and manageable may be interpreted as something major and treated as such. One little (seemingly harmless) intervention/test/procedure often becomes a full blown medical emergency (at least in their eyes, and often in reality) and situation dominos and suddenly someone is being operated on, is sick or sometimes is dead. Would that negative outcome have happened if there had not been a doctor there? Who is to say? CERTAINLY not them. If you can get a doctor to admit that BECAUSE of their care/intervention/interference into a normal biological event that there was a negative outcome, I will pay you a dollar (maybe even $10 ). I have a general mistrust for the medical establishment because 1)they are egotistical and have God complexes, 2)always think they are right even if they are talking out their ass, 3)have interjected themselves into and corrupted the natural process of childbirth with widespread fear of the process, distaste for the events, and paranoia of "what if", and 4) are taught to treat patient symptoms and conditions in a ideopathic way (I hope that is the right term), and not as a holistic system.

And like I said, there are serious conditions that warrent medical care during pregnancy. If that care is absent, than a serious complication MAY occur. Any midwife worth her salt can tell pretty quickly who has/will have a normal pregnancy and who is a more complicated case that may require a referral... It isn't fool proof, but we must accept that there is ALWAYS risk involved in pregancy and childbirth and our general health is the best indicator of whether that risk is small or large. IMHO, the vast majority of times, doctors do not belong involved in pregancy and childbirth and often bring many of the problems we see in normal cases with them in their assumption that pregnancy and chilbirth are sicknesses and that SOMETHING must be wrong to justify their presence/existence...it is almost self-prophesy.

*edited to say: i should qualify my opinions with the fact that my father was a doctor, my cousin (who has had, count them, 4 C-sections and will be having a 5th in a couple of months) is married to a doctor, and my sister is a paramedic with the most screwed up sense of "normal" that I have ever seen. So I speak from my personal and professional interactions with the "medical establishment".

Mama to three small people; wife to one big person; pet-person to cats and dogs..."Be the change you want to see in the world"-- Gandhi
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Old 01-21-2004, 03:21 AM
 
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Yep, almost always. They are taught to work against a woman's body, rather than with it. Some midwives, even home birth midwives, have the same mentality, which is why home birth does not work for some people.

We all know there are situations when obstetricians and medical interventions are truly needed, and I'm grateful they are available. But the vast majority of the time, they are useless. For a woman with a normal pregnancy, they are harmful.

Almost everything that can go wrong with a baby - such as decreased heart rate or other distress - is the result of some procedure the doctor did to make birth faster, more convenient, or more "like normal." Then they blame it on the woman's "defective female body."

I don't know many doctors who are willing to sit back and let a woman labor for three days (which, BTW, is not harmful to a baby) or do many of the other things she may need to do to get comfortable. Doctors who try to let everything happen naturally make less money for more time spent with the woman. Do you know of any obstetricians interested in a reduced income?

Even women who are told they are high risk by doctors are often told the exact opposite by midwives, who (aside from mothers) are the true professionals of birth.

I think a woman needs to give birth in a place that makes her feel comfortable if she is going to have a labor that feels normal for her. For some women this is the hospital. If a woman chooses to have interventions, she should be aware of the proper guidelines for their use. For example, when pitocin is administered, the woman is never supposed to be left alone. Yet many women are. This causes problems because the doctor is harder to reach when the baby goes into distress.

In countries with the lowest infant mortality rates, doctors practice the opposite of the way they do in the US. They stay with patients in the hospital for longer, and are personally responsible for their care instead of delegating tasks to residents or nurses. They receive the same fee for each birth, regardless of how many interventions are used, so there is no financial incentive to interfere. They actually attend only 5% of all births - the rest are attended by hospital or home birth midwives.
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Old 01-21-2004, 05:20 AM
 
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what greaseball said.

Erin, 33, salty southern mama, sitting by the sea with my DH35, DD10, DS4, &DD2!
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Old 01-21-2004, 05:06 PM
 
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Well... I'm not really happy with the state of malpractice insurance and how defensive it has made drs. about childbirth, but... my parents probably should have sued the pants off the dr. who delivered my brother (~35 yrs ago).

She was late, he did a totally botched induction/augmentation of labor, she probably should have had a cesarean at that point, and he had a birth injury that led to some pretty big developmental disabilities. It not only screwed up his life, but it put a huge burden on my parents' weak marriage...
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Old 01-21-2004, 05:32 PM - Thread Starter
 
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Originally posted by KKmama
Well... I'm not really happy with the state of malpractice insurance and how defensive it has made drs. about childbirth, but... my parents probably should have sued the pants off the dr. who delivered my brother (~35 yrs ago).

She was late, he did a totally botched induction/augmentation of labor, she probably should have had a cesarean at that point, and he had a birth injury that led to some pretty big developmental disabilities. It not only screwed up his life, but it put a huge burden on my parents' weak marriage...
yes, but do you think that if she'd had a super crunchy homebirthing midwife or an UC that everything would have been fine? because that's the impression i get from most people on the boards, even though it's not entirely logical to me.. hence my op.

Rynna, Mama to Bean (8), Boobah (6), Bella (4) and Bear (2)
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Old 01-21-2004, 05:41 PM
 
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No, I don't think that the perfect cure for my mom would have been a midwife/homebirth/UC (especially if I consider what kind of person my mom is). I think a *competent dr.* would have been sufficient in her case. Eg, when she had me, she was with a different dr., an ob who had been delivering babies for over 30 years. I was 3 lbs bigger (10 lbs 2 oz ), and the whole birth was a much better, easier process for her. I don't think all of it was because I was the 2nd kid; she thinks a lot of it was just that she had a better dr. and he knew what he was doing.

For what it's worth, I haven't opted for the homebirth/UC route, either. With ds, I had a CNM and an emergency cesarean (which I think explains why he's with us today, happy and healthy). With this one, I'm going for a hospital VBAC with obs. (My only other option is direct entry midwives and homebirth, and it's just not for me.)
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Old 01-21-2004, 05:41 PM
 
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All I really know is my own experience of childbirth. And I do know that what went wrong the first time was indeed because of things the doctor did. Now, it's true that there's no telling whether things would have been better or not without the interventions that snowballed into an emergency c-section.
And, the first thing that went wrong was, in fact, that I went to the hospital when I shouldn't have, and that was totally my mistake and not that of anyone else.

Anyway, you can read the stories of my births and that of others. Mine, at least, is a classic example of intervention upon intervention leading up to the dreaded c-section, when I should have been safe at home waiting for labor to start on its own.

Things do sometimes go wrong regardless. But there's a lot more trauma when things go wrong because of something done to you by a doctor. That's why it seems we are always blaming the doctors.
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Old 01-21-2004, 05:46 PM
 
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yes, but do you think that if she'd had a super crunchy homebirthing midwife or an UC that everything would have been fine?
In cases like these, the answer is usually yes. Inductions are one of the most dangerous interventions and they are less likely to be used in a home birth. Induction with pitocin or cytotec can cause uterine rupture, even in a woman who has never had a cesarean. (In fact, the rate of rupture is the same for women with and without a previous c/s when pitocin is used. When pit is not used, rupture hardly ever happens.)

Though a normal pregnancy is 37 to 43 weeks, many doctors won't even let a woman get to 40 weeks today. My midwife had a client go 48 weeks and says she is fine with that.

Birth injuries can cause lifelong problems, and they are present in hospital births more than at home. Every non-biased study has shown that homebirth is safer for most mothers and babies than hospital birth.

Doctors also give women advice that can cause life-threatening problems. Women who follow the doctor's advice of minimal weight gain, low-calorie and sodium restricted diets are more likely to develop eclampsia than those who are under the care of midwives and receive instruction in real nutrition and are "allowed" to gain as much weight as they need.

Homebirthing mothers report less pain with birth, if they have had previous hospital births. They tell me the pain they experienced in the hospital was abnormal and came from the interventions, while the pain at home was normal, natural and had a purpose. I'll let you know how I rate it when the time comes!
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Old 01-21-2004, 05:58 PM
 
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I am with you, OP. No, I don’t think doctors should be or are always to blame with problems.

Personally, I had a fetal monitor for my planned homebirth and was transferred for a decreased fetal heart rate but the only interventions I had had were a midwife and the fetal monitor. I had a good experience at the hospital…well, I good would be stretching it a bit, I guess. In the end, I'm okay with the transfer and happy that they were there because I feel that I "needed" it. I do shutter to think about the outcome of my dautgher’s birth if labor wasn’t primarily at home. I’m sure I would have been medicated and probably had a c-section. I’m just happy that I chose home birth AND had doctors available for backup.

My mother, OTOH, had 5 hospital births with (male) doctors. She had 4 unmediated births and one long hard labor with Demerol.

I do think that “medicated” births or births that begin with the premise that birth is not normal are the bigger problem, and they do happen more with doctors.

OTOH, I am thankful that most (if not all) possible interventions exist if anyone were to need them. It’s the incredible over use that is the problem, IMO.

Mama to DD September 2001 and DD April 2011 *Winner for most typos* eat.gif
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Old 01-21-2004, 06:18 PM - Thread Starter
 
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Originally posted by Greaseball
Doctors also give women advice that can cause life-threatening problems. Women who follow the doctor's advice of minimal weight gain, low-calorie and sodium restricted diets are more likely to develop eclampsia than those who are under the care of midwives and receive instruction in real nutrition and are "allowed" to gain as much weight as they need.
Okay, I know that there are people here who have gotten this advice, but it's totally outdated. I've never had anyone tell me anything like this, and I'm a fat person. In fact, any doctor with any sense will tell you that you don't need to restrict sodium, or eat a low-calorie diet. This particular example is one of many things which homebirthing advocates assume that all doctors do. It certainly has not been my experience.

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Homebirthing mothers report less pain with birth, if they have had previous hospital births. They tell me the pain they experienced in the hospital was abnormal and came from the interventions, while the pain at home was normal, natural and had a purpose.
It is my understanding that most women who've had prior births report less pain in subsequent births, regardless of where they happen and who is with them.

Rynna, Mama to Bean (8), Boobah (6), Bella (4) and Bear (2)
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Old 01-21-2004, 06:31 PM
 
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Do you honestly believe that nothing at all goes wrong in labor or delivery if a doctor isn't at the bottom of it?


No. I wish I did believe that. I don't think everything that can go wrong with a birth is the fault of the birth practitioner. Bodies are mysterious. Birth isn't the only process that can go wrong.

I feel very lucky to have used a hospital in a period after a lot of homebirth and natural birth ideas had been incorporated into the medical model. I think I probably would have been pressured into a C-section if that hadn't been true. It was a doctor who told my midwife to go for it (with the vaginal birth) and not to give up (and do a c-section.)

I met a really great OB socially over the weekend. I kind of wish I hadn't met her socially. I would totally go to her for care on my next baby. I like it when people are really knowledgeable and can answer questions. In my ideal world, I'd have a doctor and a midwife attend me at home, like my great-grandmother had. The doctor was her 1st cousin and everyone in the family really trusted him and knew him well. That would be very cool.

Divorced mom of one awesome boy born 2-3-2003.
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Old 01-21-2004, 06:42 PM
 
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I have to add my opinion here. Doctors and other interventionists get blamed for doing so much wrong because so much of what they do is wrong. Whether or not something would have occurred if an intervening HCP was not there is something that is VERY difficult to determine. Why? Because what percentage of births fall in that category?

We no longer have ANY idea about what the range of normal in pregnancy and birth is, because almost NO ONE has unhindered pregnancy/birth. Since I started researching UC about a year ago I have met so many women who had perfectly healthy births with factors that would have NEVER been allowed to develop under the care of docs. Like the woman who labored, not just prodomal labor, for 11 days before giving birth. Or the woman who started off and on labor at 33 weeks. Her water broke at 36 weeks. 3 days later she gave birth to a 7 lb. baby who was obviously ready to be born. Just a few examples.

The thing is this: so much of what OBs do is superstition, voodoo, non-evidence-based malarky. Therefore, when you examine a birth story/situation and find X, Y, and Z that a doctor shouldn't have done, there is no way of really knowing how much ensuing damage is a result of malpractice-avoidance medicine and how much actually would have occurred otherwise. Am I making sense here? Although, the more research I've done, and the more birth stories I've read/heard, the more obvious it becomes that many, many complications are the result of obstetrical interferance, since they never seem to occur in UC (or many homebirth) situations.

So the bottom line is that if I blame OBs for everything I KNOW they are doing to muck up the birth process, and if every OB I've ever heard of is doing them, it's going to seem like a lot of blame.

For what's it's worth, I am happy to be living in a time when good nutrition is easy, information is extremely accessable, and emergency medicine that I AGREE to is available just down the street.

Tracy, doula and Army wife and homeschooling mama to A and E
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Old 01-21-2004, 06:48 PM
 
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Originally posted by eilonwy
Okay, I know that there are people here who have gotten this advice, but it's totally outdated. I've never had anyone tell me anything like this, and I'm a fat person. In fact, any doctor with any sense will tell you that you don't need to restrict sodium, or eat a low-calorie diet. This particular example is one of many things which homebirthing advocates assume that all doctors do. It certainly has not been my experience.
This went up while I was typing and I wanted to address it. It's not that it is assumed that every OB does ALL the things I/other homebirth advocates disagree with. But I have yet to hear of a single OB who doesn't do at least one thing as standard practice that I think is at least unnecessary and at most extremely potentially harmful.

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Old 01-21-2004, 07:05 PM
 
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Just fyi, I was told by my ob that she "strongly reccomended" not gaining more than 10lbs, 15 max. Yah, I was heavy, but weighed 175 at 5'4", not morbidly obese or anything. I was told not to add any salt to my diet (fine, I don't cook w/it anyway) and if my morning sickness kept me from eating, "good, maybe you can encourage that." I went on to have a medwife who had no problem w/my weight gain (plenty of other issues there though!)

And this was happening this time last year! So, unfortunately, it is still a problem. Do I think that my ob/medwife is to blame for all that went wrong, no, but I did look to them for guidance, advice and knowledge seeing as how I had never been pregnant before and that was their business. I should have educated myself more, but didn't quite realize that was an option, you know?

Born mainstream, bred mainstream, just recently changing streams....
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Old 01-21-2004, 07:09 PM
 
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It is my understanding that most women who've had prior births report less pain in subsequent births, regardless of where they happen and who is with them.
I'm talking about women who have had a few at home and a few in the hospital. They say all of the hospital births were more painful than all of the home births. This includes the hospital births that were medicated - medication does not "take" for some people.

About the diet, that advice is outdated (or should be) but some doctors today still follow it. They may "allow" 25 lbs instead of the previous 12, but they don't seem to realize that what's most important is not the amount of weight gained, but the quality of food eaten. I read of a mother on these boards who gained 90 lbs on the highest quality of food and the weight was all gone a week after the birth. "Eat for two" is common sense, yet many OBs prescribe diets that are not enough for one. Some still recommend fasting and diuretiucs, though thankfully (I think) they no longer prescribe amphetamines.

Even fat people need to gain a certain amount of weight. Most likely, if a woman eats high-quality food whenever she is hungry and does not deny herself any food for fear of gaining weight, she will gain the right amount of weight for her. I gained a very small amount of weight last time; this time I'm only halfway there and have already gained more than what I did last time. I know I'm doing it right this time, just as I was last time. Though I know several doctors who would disagree.

Obstetricians are trained as surgeons, and to handle high-risk pregnancy and birth. Most of them have never seen a normal birth, which makes them just as uneducated about birth as any lay person. If I were to have a high risk delivery, I'd want someone who specialized in that. If I had no risk factors, I'd want someone who specialized in normal birth.

There are very few things a MOTHER can do that are wrong and that will complicate her labor. Most of these things are listening to the doctor - believing him when he tells you walking in labor is harmful, that it's best if you don't eat or drink, that you need to be induced after x weeks or x hours in labor, etc. But what can a mother do wrong other than listen to the doctor? I think that's why people say it's the doctor's fault; he's the one giving the bad advice.

I hear a lot of stories about how everything was done right, and yet a c-section or other intervention was still needed. But in these stories, there is also mention of induction, medication, lithotomy position, vaginal exams, IVs, continuous fetal monitors...so how can someone say the baby couldn't have been affected by these interventions? People tell me "natural childbirth" doesn't work since it didn't work for them. I guess we all have different ideas of what natural childbirth is. For me, it doesn't include routine medical interventions. If no interventions or restrictions are used at my homebirth and the baby still goes into distress, I can go to the hospital knowing it's the right thing to do and that it was probably one of those rare cases that couldn't be prevented. I'm glad I have both choices, home and hospital, available to me.

It's common sense that one intervention leads to another. How many women come out of the hospital with only one intervention done to them? (I guess they would have to define what an intervention is for themselves.) Drugs lead to pitocin, monitors restrict movement (I am NOT impressed with the units that are supposedly portable, nor do I think it's OK to restrict movement "just for the strip"), IV solutions are no substitute for real food; you still have a good chance of becoming exhausted and requesting assisted delivery. Forceps and vacuums sometimes require an episiotomy, vaginal exams encourage reliance on arbitrary numbers and a diagnosis of FTP...the best way to avoid a cascade of interventions is to avoid the first one, which is more likely to happen at home.

I had 7 interventions in the hospital, which were all interrelated. I believe if I had been at home I wouldn't have needed any. I guess I'll see how I do next time around.
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Old 01-21-2004, 07:12 PM
 
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I'm gonna jump in with my two cents and I hope that I don't offend anyone. I think that if you choose to have a hospital birth then you choose to birth within their timeline and protocol. If you choose an alternative route you may have a larger role in making desisions regarding your childs birth.

I birthed our dd in a hospital with a very progressive doctor who adovocated my alternative views throughout the entire pregnancy but when it came time to birth I fell into the hospitals 'guidelines for safe childbirth' even though I had a Doctor who understood my desires. After a relatively easy, unintervened labour with no drugs, iv or continual monitering, the time came to push. I pushed for 5 and a half hours and at that time the head of ob and delivery decided that it would be dangerous to continue and that I needed a section. If I had been at a birthing center with midwives or at home it may have been different. Was the Doctor at 'Fault'. I actually say no because the doctor was following the proctocol of the hospital that is definately influenced by malpractice suites and the 'bottom line'. I take responsiblity as well because I knew what I was 'getting into' by opting to birth in a hospital. I had a monitrice present as well who in the end became inpatient and felt the section was the way to go even though my dd was not in any danger and never was stressed. If we choose to have another child, we have the tools to make the appropriate birthing choices for ourselves.
I think that it is too black or white to say that Doctors are responsible all the time:
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Old 01-21-2004, 07:12 PM
 
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I hope nobody gets grossed out by this comparision. A friend of mine who is a LM gave this analogy. Birth is like having a bowel movement. It happens naturally and is not a medical condition. But sometimes for whatever reason help is needed.

Birth is a natural experience. But sometime things can go wrong, it is not the moms or the medical staffs fault.
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Old 01-21-2004, 07:15 PM
 
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Originally posted by citizenfong
...many complications are the result of obstetrical interferance, since they never seem to occur in UC (or many homebirth) situations.

What is the UC birth that you refer to?

Mama to DD September 2001 and DD April 2011 *Winner for most typos* eat.gif
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Old 01-21-2004, 07:18 PM - Thread Starter
 
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Originally posted by citizenfong
I have to add my opinion here. Doctors and other interventionists get blamed for doing so much wrong because so much of what they do is wrong.
Could you give some concrete examples here? Something that doctors who've studied medicine within the past 30 years do, maybe?

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We no longer have ANY idea about what the range of normal in pregnancy and birth is, because almost NO ONE has unhindered pregnancy/birth. Since I started researching UC about a year ago I have met so many women who had perfectly healthy births with factors that would have NEVER been allowed to develop under the care of docs. Like the woman who labored, not just prodomal labor, for 11 days before giving birth. Or the woman who started off and on labor at 33 weeks. Her water broke at 36 weeks. 3 days later she gave birth to a 7 lb. baby who was obviously ready to be born. Just a few examples.
You found these extreme examples (and yes, they are extreme) because these are what you were looking for. Last week on Oprah, I saw a show about a doctor who has been doing surgeries on women in rural parts of Africa (Ethiopia, I think) who had a common complication of prolonged labors: they developed holes between their bladders or colons and their birth canal, thus rendering them unable to contain urine or feces. Most of their babies were born dead after labors of between 2 and 14 days. I disagree with the idea that we have no sense of what's normal in childbirth.

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The thing is this: so much of what OBs do is superstition, voodoo, non-evidence-based malarky. Therefore, when you examine a birth story/situation and find X, Y, and Z that a doctor shouldn't have done, there is no way of really knowing how much ensuing damage is a result of malpractice-avoidance medicine and how much actually would have occurred otherwise. Am I making sense here?
You are making sense, but I entirely disagree. First of all, most of what OBs do is, in fact, based on evidence. Just because it's evidence that you don't like doesn't mean it doesn't exist. Secondly, if you can't tell for a fact that a doctor caused X, Y, and Z and you don't know exactly what the consequences of X, Y, and Z are, how can you assume that the doctor was at fault?

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Although, the more research I've done, and the more birth stories I've read/heard, the more obvious it becomes that many, many complications are the result of obstetrical interferance, since they never seem to occur in UC (or many homebirth) situations.
That's ridiculous. What you mean is, they never have occured in any of the cases you've read about. Of course they haven't, because you're not doing open research. You're starting with the premise that UC is the safest way to go for everyone, and looking for proof that supports your premise. Of course you're finding exactly what you're looking for, because you're not looking for anything else.

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So the bottom line is that if I blame OBs for everything I KNOW they are doing to muck up the birth process, and if every OB I've ever heard of is doing them, it's going to seem like a lot of blame.

For what's it's worth, I am happy to be living in a time when good nutrition is easy, information is extremely accessable, and emergency medicine that I AGREE to is available just down the street.
It does seem like a lot of blame, and much of it seems unwarranted.

It's not that I think that homebirth or UC are bad things, even. I'm just mystified at the attitude that OBs are responsible for all the things that can go wrong. It's interesting to me that I feel this way, because my doctor was an idiot. I understand why people have homebirths and UC, especially women who've had births with complications that were definately caused by a doctors interventions and women who had easy births with no complications at all. I don't understand how anyone can say that it's the best choice for most women who've had complicated births, because I don't see doctors as being wholly responsible for complications.

I had a horrendously complicated birth, but that wasn't (entirely) my doctor's fault. The only thing I think she could (and should) have done differently was do a ceserian, and that's hardly less intervention. My birth was complicated by the fact that my water broke 4.5 days before my son was born, and it did not replenish itself (someone said on a thread that it always does, and there's no such thing as a dry birth-- they are very much mistaken). We developed an infection, and I labored for 3 days with no medication and no progress. If it hadn't been for medical intervention, there is no doubt in my mind that my son would not have survived his birth. It's doubtful that I would have survived his birth. It makes me sick when people talk about all the horrible things that "only go wrong in hospital births". Please! Do a little more research, and ask some more open-ended questions before you make these judgements. It doesn't make any sense. If medical intervention is such a horrible thing, and most women can give birth unassisted, why is it that at the turn of the century 1 in 4 women died in childbirth, while the rate today is miniscule? Why is it that the rate of stillbirth was ridiculously high, while today it is relatively rare?

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Old 01-21-2004, 07:35 PM
 
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I saw a show about a doctor who has been doing surgeries on women in rural parts of Africa (Ethiopia, I think) who had a common complication of prolonged labors: they developed holes between their bladders or colons and their birth canal, thus rendering them unable to contain urine or feces.
OK, here are my open-ended questions:

Homebirth does not mean unhindered birth. Even a UC can be complicated if a mother tries to use medical interventions on herself. I would say these births need to be looked at more in-depth, instead of saying "Everything went wrong because they were at home." What about mothers who are in hard labor for several days to a week at home and have healthy babies? How do we explain that? How do we explain c-section mothers who have incontinence?

Do you really know why women started dying in childbirth? They were doing fine until hospitals were invented. Doctors there refused to wash their hands after surgeries or after touching dead bodies. They attended births covered in blood and grime from previous operations. Women labored in beds from which corpses were recently moved. Hospital-acquired infections are still a leading cause of death in this country, and maternal death can be prevented. Mothers and babies who deliver in hospitals have higher rates of death.

Living conditions are responsible for a large number of fetal and maternal deaths. Sometimes it's not always poverty that is the cause - in the 19th century, rich women who gave birth at home had a lot of deformed or dead babies. The reason was that these women were corseted as soon as they hit puberty, and they wore their corsets through pregnancy. The babies did not have room to develop properly. (The women were also not allowed out in public when they were showing, and when they became "agitated" from being shut-ins, their husbands would call the doctor who would come over and dope the woman up with opium. Yum! This was all related to the restrictions of their social class.)

What OBs do is based on time and money, not evidence. It used to be that 9 and 10-lb babies were healthy and normal, now they are harmful. Did the "evidence" change from one decade to the next? What "evidence" says that in 1970 it was safe to vaginally deliver breech babies, but in 1990 it wasn't? Why was it once normal for a woman to carry over 42 weeks, and now it's abnormal? What about doctors in other countries - do they use evidence? If so, where is the evidence that Swedish women need cesareans 4% of the time but American women need them 26% of the time, and Brazilian women need them 95% of the time? Where is the evidence that says although a woman giving birth in a hospital in New York City can safely labor for 18 hours and push for 4 hours, women in Atlanta can only labor for 12 hours and push for 2 hours? Is it something in the air?

Evidence shows that almost all babies can be safely born at home with little or no intervention. It's easy to miss that when you don't want to see it. I'm sure all of us who are pregnant are informed consumers of birth, and are planning births that feel right to us. I think homebirth is a mistake for women who don't want to be there, and hospital birth is a mistake for women who want to be at home. I believe if you don't give birth at the place you would prefer, you will have complications.
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Old 01-21-2004, 07:40 PM
 
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Though I agree with you in general, Eilonwy, I have to take issue with your citation of late 19th-early 20th century stillbirth and maternal mortality statistics. Women in that era died in childbirth in large measure because their doctors carried illnesses when they didn't wash their hands! This was called childbed fever. It was a tremendous example of the inferiority of doctors to midwives and an interesting case in the professionalization of medicine.

Of course, doctors today do wash their hands, as do midwives of every stripe.

I have been amazed, as I read here and listen to people's birth stories, that doctors do incredibly dumb things that screw up people's births. We make progress as a society but we don't make it uniformly.

The pushing example is a good one. I pushed for more like 8 hours. Then my baby came out. I didn't have a c-section. That was also in a hospital. Institutions vary.

I also want to add that homebirths here in the US are a skewed sample, because they are often moms who are healthy to start with and who think through their births carefully. (and obviously, I think that's good!)

Divorced mom of one awesome boy born 2-3-2003.
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Old 01-21-2004, 07:41 PM
 
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Eilonwy,
Please do some research. Obstetrics is NOT evidence-based. I highly recommend Henci Goer's "Obstetric Myths Vs. Research Realities". Most of what happens within the ob. establishment is only done because it has been done for such a loooong time now....
Some concrete examples of what I, as an experienced doula, have seen with my hospital clients:
1.) Insisting on a heplock or iv. An iv. is part of hospital protocol to help keep the woman from becoming dehydrated. But research shows us that iv.s actually dilute the hormones in the woman's bloodsteam that causes the uterus to contract. As you can imagine, this can easily lead to the use of labor-augmenting drugs. The iv. is also a huge pain in the butt...... a woman wishing for the safest kind of birth - a natural birth - has to be able to move about freely and completely uninhibited to go into a labor trance to help her deal with the pain. But when she has to wheel the iv. around, maneuver the line, be careful with her hands so she doesn't experience discomfort from the iv., etc., it also paves the way for the inability to enter that labor trance and can pave the way for medication.
2.) The external fetal monitor. See the need for uninhibited laboring, above. The monitor is not evidence-based, either. It has not been proven to save any mothers or babies or decrease the incidence of cerebral palsy, yet it drastically increases the number of cesareans performed.
3.) Not letting a woman eat and drink to taste. It used to be thought that anything taken by mouth could be vomited and choked upon if the woman needed emergency general anesthesia. Yet all the research shows that the majority of women who need an emergency section get an epidural. And - this is the real kicker - it is shown that if a woman DOESN'T have anything in her stomach when she's knocked out and then aspirates her stomach contents, it is MORE DANGEROUS to aspirate stomach acid than it is to aspirate stomach acid diluted by food and drink!:LOL
Women also get very weak and discouraged when they labor for hours and hours without nourishment. Labor is like running a marathon...... women need lots of high energy food and lots to drink to cope with the intensity of what their bodies are going through!
4.) Induction. Induction is verrrry rarely indicated, yet many women today are getting induced. Inductions have actually INCREASED the chances that these babies need to be sent to NICU because they are - SURPRISE! - not ready to come out yet, so many have serious breathing problems because the lungs are not fully formed until the VERY end of a pregnancy. Also, inductions often don't "take" because the mother's body and the baby know it isn't time to give birth yet. This leads to thousands of unnecessary cesareans every year. Cesareans are much more dangerous than a normal vaginal delivery.
I really could go on for several more paragraphs, but I'd like to take a nap now that the kids are asleep. Please do some research for yourself. You will be shocked with what you find. I know I was.
Edited to add: my midwife has a 5% transferral rate and a 4% cesarean rate. (She only does homebirths.) Yet her maternal and fetal outcomes far exceed even the local freestanding birth center! And she rarely risks women out, either. She's even done twins and breeches at home. She's also had drug addicts, low income women, you name it...... so it's not a demographic issue, either. Is it just luck? I'm sure that's what all of the, er, evidence-based obstetricians would say!:LOL
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Old 01-21-2004, 08:01 PM
 
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I just wanted to add that it is not just doctors doing stupid things that screw up births. I have suspected all along that the fetal heart monitor’s diagnosis was the reason that I transferred to the hospital. Now, in the end I think the transfer was for the best (for me, not for baby Aya) but the fetal monitor was my choice and the choice of a very well respected homebirth midwife.

For me, I wish all interventions (including the very first ones…even a HPT) came on an “as need” basis.

If I have another birth I’ll look for a midwife with a better fit to my personality and pass on the fetal monitor unless the need comes (I don’t know when that will be).

Congrats on pushing for 8 hours! I thought 5 was a long time…

So, UC is “UnComplicated Birth”?

Mama to DD September 2001 and DD April 2011 *Winner for most typos* eat.gif
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Old 01-21-2004, 08:10 PM
 
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UC is unassisted childbirth, meaning no professional assistance in the form of doctors or midwives. I was born this way in the late 70s, with just mom and dad there.

That's right, the EFM does not work well. I will be monitored intermittently during labor at home but with a Doppler.
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Old 01-21-2004, 08:24 PM
 
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In response to the no salt thing.... good grief, I heard that every WEEK from my ob.

He'd say "Wow, you gained 4 lb this week" (I had pre-eclampsia) and then say "Make sure you have NO salt"
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Old 01-21-2004, 08:25 PM
 
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So why is unassisted birth UC? Is it for Unassisted Childbirth? I have always been a touch confused about the term unassisted birth because I have heard it being used for births with midwives in attendance.

Thanks, I always need to learn these new things. I even needed to learn what ICM was and it’s my user name, IdentityCrisisMama, that people reduced down to ICM.

Mama to DD September 2001 and DD April 2011 *Winner for most typos* eat.gif
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Old 01-21-2004, 08:26 PM - Thread Starter
 
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Originally posted by Greaseball
OK, here are my open-ended questions:

Homebirth does not mean unhindered birth. Even a UC can be complicated if a mother tries to use medical interventions on herself. I would say these births need to be looked at more in-depth, instead of saying "Everything went wrong because they were at home." What about mothers who are in hard labor for several days to a week at home and have healthy babies? How do we explain that? How do we explain c-section mothers who have incontinence?
The women I refered to did not "use medical interventions on themselves". They were young women who had complications because they were alone, many of which could have easily been prevented by the presence of even a single knowledgeable person. These things went wrong not because they were at home, but because they were alone and uninformed, a deadly combination. Mothers who are in hard labor for several days to a week and have healthy babies are the exception, and that's all I said. You hear those stories because those are the ones you look for. Lots of women have had hard labor for several days and had dead babies at the end to show for all their work.

C-section mothers who have incontinence can certainly be explained, almost exclusively, by incompotent doctors, but that's a far cry from saying all doctors are incompotent.


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Do you really know why women started dying in childbirth? They were doing fine until hospitals were invented. Doctors there refused to wash their hands after surgeries or after touching dead bodies. They attended births covered in blood and grime from previous operations. Women labored in beds from which corpses were recently moved.
I knew that this was going to come up. Yes, I've heard of childbed fever and am well aware of the whole icky corpse aspect. So explain to me why the death in childbirth rate was the same for women living on farms as for women living in the cities? Women giving birth on the prarie also had a 1 in 4 chance of dying in childbirth.


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Hospital-acquired infections are still a leading cause of death in this country, and maternal death can be prevented. Mothers and babies who deliver in hospitals have higher rates of death.
Perhaps because the mothers who have hospital birth are more likely to have other complications? Yes, infection is a bigger concern in a hospital setting, but there are many other causes of maternal and perinatal death.

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What OBs do is based on time and money, not evidence. It used to be that 9 and 10-lb babies were healthy and normal, now they are harmful. Did the "evidence" change from one decade to the next? What "evidence" says that in 1970 it was safe to vaginally deliver breech babies, but in 1990 it wasn't? Why was it once normal for a woman to carry over 42 weeks, and now it's abnormal?
That has much more to do with lawsuits than it does to do with the incompotence of doctors. All it takes is two women who sue because they tried to deliver breach and ended up with a dead baby and there will be policy changes implemented. Many doctors are more than willing to attempt a breech delivery, especially with multiparous women. If the woman is informed and insists, and her doctor is a reasonable human being, she can certainly have a breech birth in a hospital. I don't know if I have encountered super-progressive doctors or not, but I think that you're talking about doctors who still live in the dark ages. Granted, they're out there practicing, but I find it hard to believe that they are the majority.

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What about doctors in other countries - do they use evidence? If so, where is the evidence that Swedish women need cesareans 4% of the time but American women need them 26% of the time, and Brazilian women need them 95% of the time?
In Sweeden, people are not nearly as lawsuit happy as they are in the US. In Brazil, women and OB's are currently much more concerned with convinience than anything else. Those facts have absolutely no bearing on this discussion.

If getting sued means that you will never again be able to do the thing you went to school for and have wanted to do for years, wouldn't it be prudent to avoid getting sued? How is that being motivated only by money? What about OBs who work in free clinics, are they motivated by money?

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Where is the evidence that says although a woman giving birth in a hospital in New York City can safely labor for 18 hours and push for 4 hours, women in Atlanta can only labor for 12 hours and push for 2 hours? Is it something in the air?
Again, it has to do much more with how lawsuit-happy the area is. I didn't say that every single thing that doctors, or anyone for that matter does is based soley on evidence, only that there is evidence out there to support certain actions. For example: a breech position with a first time (untested) pelvis is more likely to lead to complications then a vertex position. Babies are more likely to be stillborn if they go beyond 43 weeks gestation. And no, that doesn't explain why women are induced at 40 weeks sometimes. Again, I have never heard this from a practicing doctor itrw. In fact, I was given my due date and told to wrap my head around a date two weeks later because they wouldn't consider induction before that if nothing was seriously wrong.

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Evidence shows that almost all babies can be safely born at home with little or no intervention. It's easy to miss that when you don't want to see it.
Quite to the contrary, I *do* want to see it. And I understand that for most people, pregnancy is a normal condition and birth is also a normal condition of being human. I don't believe that it's a pathology. I do, however, believe that things can go wrong during birth regardless of how ideal the conditions are. I've met lots of people who had hospital deliveries and should have given birth at home; my mother, for example. It was just a waste of time for them to go to the hospital at all. What I have a problem with is people saying that the reason my delivery, for example, was complicated was because it was in a hospital. It's not true. Homebirthing advocates live in a dream world where things only go wrong if they're in the hospital, and that doesn't seem remotely realistic to me. Just because you pass by the homebirth and UC stories that end in death for the mother or child, or in other serious complications, doesn't mean those stories aren't out there. It's not safe for everyone to attempt a home delivery, and it's not reasonable to expect everyone to want to, regardless of how well informed we are.

Rynna, Mama to Bean (8), Boobah (6), Bella (4) and Bear (2)
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Old 01-21-2004, 08:31 PM
 
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Originally posted by eilonwy

First of all, most of what OBs do is, in fact, based on evidence. Just because it's evidence that you don't like doesn't mean it doesn't exist. Secondly, if you can't tell for a fact that a doctor caused X, Y, and Z and you don't know exactly what the consequences of X, Y, and Z are, how can you assume that the doctor was at fault?

I have to strongly disagree with the idea that what most OBs do is based on evidence. There is a great lack of scientific evidence available about pregnant and laboring women because of the numerous ethical problems that exist with doing a double-blind controlled study with pregnant women and their babies. Most Obstetrical practice, whether carried out by doctors or midwives, is instead based on habits passed down through the oral tradition and personal experience. The problem with this is that many severe complications occur at a rate of one in a thousand or one in ten thousand, so an OB can honestly say, "Well, I've used cytotec many times and never seen a uterine rupture, so I believe it is safe." If that same drug takes maternal mortality from a rate of 3 per 100,000 to 6 per 100,000, effectively doubling it, or if cesareans kill four times as many moms as vaginal births, most OBs will never notice because their own experience will never involve those kinds of numbers. I can give you example after example of OBs continuing to practice procedures which have specifically been proven in study after study to be ineffective, untrustworthy or harmful, from early cord clamping to withholding food and drink during labor to episiotomy (still practiced in more than 60% of births attended by private physicians) to third-trimester ultrasound for weight estimation to induction at less than 42 weeks for a healthy postdates pregnancy. Happily, many other out-of-date procedures, like shaving the pubic hair before birth (thought to prevent infection, actually made it worse) have fallen by the wayside, but change comes very, very slow in the medical community, unless inspired by litigation.

Litigation and other pressures have led to something more insidious than lack of evidence-based practice in my opinion. Many women are being over-aggressively treated for complications that arise in late pregnancy and during labor, resulting in live babies and mothers, but at the cost of additional maternal recovery time, physical trauma to mom and baby, and increased chances of separation. To get to the bottom of what I mean, I will show another example. If a woman is diagnosed with breast cancer, the best thing to do to maximize her chances of remission would be a double mastectomy, with possible removal of lymph nodes, aggressive chemotherapy and radiation, and some kind of continuing drug therapy. However, cancer specialists, using evidence, have come up with a number of other options and can present women with other choices, like perhaps a lumpectomy + radiation and no other treatment. Obviously the second choice, while marginally less successful than more radical treatment, has significant benefits in its lesser trauma and recovery time. A woman with breast cancer is given a whole spectrum of treatment options and is given evidence about the likely benefit of each.

Many pregnant women are being given the birth equivalent of a double mastectomy. If a baby is "too big," an induction or cesarean is ordered (sometimes by a court of law, as we have seen recently). Women who are post-dates are being told they will be "allowed" to go to a certain date. Women who have strep B are told that if they don't accept antibiotics in labor, their babies can be ordered to undergo spinal taps, NICU stays and their own antibiotic courses. Women are often not allowed to choose less aggressive interventions -- when they decline the advice of their Obstetricians and Pediatricians in the birth setting, they are often threatened with court orders.

Homebirth and hospital-based midwives are often guilty of their own practices which are not backed up by evidence. I love Spiritual Midwifery, but cringe when I read some of the things that they do in that book. More common are midwives who put their clients through an exhaustive regimen of supplements and teas and exercises, adding expense and bother to a healthy pregnancy that didn't really need the extra support. Midwives can be too slow to intervene in ways that might prove dangerous as well.

I think that some interventions are absolutely necessary -- some because of problems caused by previous decisions, others which would have been necessary regardless of birth setting. I attended a mom in labor as a doula last year who had a very necessary vacuum extraction, but her 26-hour labor would have been greatly minimized by better care, perhaps eliminating the need for a surgical birth. The thing about interventions, though, is that the community seems to want to take the evidence about when an intervention is warranted, and then write a protocol that is much, much more conservative. The OP gave an example of premature rupture of membranes -- the WHO recommends induction after 48 hours, the ACOG, 24, and most hospitals in my area, 6-12. There is a pretty huge range amongst those numbers. The ACOG has recommended that testing begin to determine placental health and fetal well-being after 42 weeks in a post-date pregnancy, but many doctors begin such testing immediately after 40 weeks, and induce at 41.

One thing that I have come to believe about birth is that if a practitioner has a tool, he or she will use it. In the homebirth practice I work in, we do not have easy access to ultrasound, so it is not a tool we use routinely. My favorite group of hospital-based midwives can't perform cesareans, vacuum extractions or use forceps, and so when they choose to use those tools, they must turn over care to an OB or resident. Consequently, they don't use those options unless they really, really have to. But the OBs, who know that they are likely to produce a relatively healthy baby if they order an immediate cesarean when there is meconium or a deceleration, vs. entering into the unknown by allowing a labor to continue, will often strongly advise a c-birth. There is huge pressure on them to make those recommendations, and I don't blame them, but I also would not choose them for my own care unless my health mandated it.

You are right, though, about the uncertainty of the impact of individual interventions in labor. Did the morphine given in labor cause lingering fetal distress or was it the exhaustion? Was the induction the cause of the meconium or the post-date baby? Did the epidural make it impossible to push out the baby or was it the weak contractions? Hard to know. What the evidence points at, though, is that low-intervention practitioners, like hospital and home-based midwives, achieve simliar if not superior results with matched populations to those achieved by OBs, with fewer interventions. If it is possible to intervene less and still and achieve healthy mom and baby, why not intervene less?

Stacia -- intrepid mama, midwife, and doula. Changing the world one 'zine at a time.
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