There’s nothing wrong with medicalizing childbirth

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Aloha from Hawaii! Above is the view from the pool where I am writing this post.

I’m here for the ACOG district conference and I’ve been reviewing my notes for my talk on Friday. I’m struck by the fact that everything I plan to talk about — homebirth and, to a lesser extent, natural childbirth — is premised on a fundamental and erroneous belief, that there is a problem that exists with childbirth and that homebirth and natural childbirth can fix it.

The problem is that childbirth has been (dare I say it) …. medicalized. Oh, the horror!!

It’s horrible because … wait a second … what’s horrible about medicalizing childbirth?

The underlying belief of natural childbirth advocates is that childbirth has some kind of pristine essence that should not be changed in any way except, possibly, in the most dire emergency. The major efforts of professional homebirth and natural childbirth advocates are forcefully directed toward “problematizing” any medicalization of childbirth and then offering homebirth and natural childbirth as the solution to this “problem.”

But childbirth is a function just like any other bodily function and we don’t consider medicalizing other bodily functions to be a problem, so why should medicalizing childbirth be considered a problem?

For example:

Women routinely and deliberately medicalize fertility by using a variety of different forms of birth control. Most women highly value the ability to regulate their own fertility and very few people are singing the praises of having 10 children as a result of “unhindered” fertility.

Both men and women routinely medicalize aging. Instead of letting their blood pressure rise “unhindered” and end up with cardiovascular disease, they routinely visit doctors and take medications to lower the nearly inevitable high blood pressure that comes with the natural stiffening of aging arteries. And no one seems to have a problem “medicalizing” eyesight by using glasses to compensate for the entirely natural deterioration of near vision that occurs as a result of aging.

Or how about something even more basic still? We routinely medicalize body odor by regular bathing, using soap, shampoo and even deodorant. No one seems to think that is a problem. either.

In fact, I’m hard pressed to think of anybody complaining about “medicalization” of any other bodily function, so why complain about medicalizing childbirth?

Why? Because homebirth and natural childbirth completely depend on creating this faux “problem” in order to save us from it. They are committed to romanticizing childbirth, ignoring history, and ignoring science, all the while pretending that they are promoting “evidence based” practice.

Nothing could be further from the truth. Natural childbirth is based on no evidence of any kind. The white men who promulgated it simply made it up to comport with their personal views about the role of women in the world (specifically that the world would be a better place if women stopped agitating for political and economic rights, and, instead, stayed home and had babies as “nature intended”).

Indeed, homebirth and natural childbirth advocates implicitly recognize that scientific evidence is not on their side by routinely deleting comments that contain real scientific evidence and banning commentors whose knowledge of science extends beyond the “alternate world of internal legitimacy” created by the “journals,” conferences and “credentials” conjured into existence by themselves.

Nature is neither benign nor perfect. We seem to be able to recognize that in every other area of human health. No one complains that middle aged people who use reading glasses are “medicalizing” the vision experience. We don’t problematize reading glasses. No one complains that the elderly medicalize the cardiovascular experience by taking steps to control their blood pressure. We don’t problematize blood pressure medications. And no one is complaining that we have medicalized the body odor experience by bathing regularly with soap and shampoo.

So the next time you encounter homebirth and natural childbirth advocates fretting about medicalized childbirth, consider that there appears to be nothing wrong with medicalizing any other bodily process. The faux “problem” of medicalized childbirth isn’t a problem at all; it is simply the way that homebirth and natural childbirth advocates justify their existence.

And consider, too, that when you recognize that there is nothing wrong with medicalizing childbirth, there is no reason to feel guilty about giving birth whatever way works best for you.

  • ProChoiceRN

    Hmm.. Most Dr.’s I know recognize that the least amount of medicine possible is the best. Medicine is a double edged sword. Most of the time it’s easy to recognize which sword has the sharper edge, but not always. We still have so much to learn about the human body.

    • Dr Z

      True, we need the least amount of medicine but that is not the point here. If no medical intervention is needed, then we won’t do it. “Primum non nocere” (first, do no harm), as we call it in medical ethics.

      Dr Amy main arguments, as I see it, is why the double standard view when it comes to childbirth as compared to other medical interventions. If medicalizing childbirth is proven to work and is safe (yes it is) and improve mortality rates from childbirth (it clearly does), why bother?

      If we reverse the process and “unmedicalize” it, can we ensure that the safety record remains the same or improved? At the very least, common wisdom tells us that dismissing evidence-based medical interventions will reverse the safety profile of childbirth which we have been working hard for all these years.

  • ngozi

    The last paragraph of this essay/story is wonderful, just wonderful!

  • Susan

    Dr. Amy, when I stayed at that hotel I went to the Spa ( my very first Spa experience and I mostly loved it ) but I also had one of my best woo experiences too. I had the Hawaiian Rock Massage and the masseuse told me that she picked each and every rock out because the rocks literally talked to her. So you need to go have that experience with the talking rocks. Actually, I liked the aromatherapy massage quite a bit! Hope you are having a fabulous time and that you wowed them in the lecture! I so wish I could be there…..

    • auntbea

      This comment made me realize that a) my back is really tight and b) it has been far too long since I held a conversation with an inanimate object.

      • The Bofa on the Sofa

        Does a robotic vacuum cleaner count as an “inanimate object”?

        Because, if so, my last conversation with one was…7 hrs ago. His name is Otto.

  • anion

    I’ve been reading through the archives (I just discovered this site and it’s awesome), and have a question; I don’t know what the protocol is for commenting on older posts so thought I’d ask it here rather than drag everyone to an older post. I hope that’s okay.

    I was reading a post from March 2013 about “gut flora” and how the baby benefits somehow from vaginal flora (It’s the post about “paleo-birth,” sorry, I can’t link as a guest). I’ve heard before about how the baby supposedly derives some benefit from vaginal flora, but I don’t understand how that is the case. How exactly is the baby ingesting this flora? Are they licking the vaginal walls as they emerge, or…? How is this supposed to happen?

    (And as for medicalizing childbirth, if those evil OBs were truly so desperate to cut women open and steal our birthing experiences or whatever nonsense, I would have been allowed to choose an elective c-section right from the beginning, instead of having to actually go through labor. I know “too posh to push” is supposed to be a thing but I’ve never heard of a woman actually being allowed to say to her doctor, “I don’t want to give birth vaginally and would rather have a section,” and being permitted to just schedule one. It probably happens somewhere, but it didn’t happen for me, despite my desire for it. Luckily I did have my section, and when my OB–sweet, wonderful man that he was, who always encouraged his patients to labor as naturally as possible [with appropriate monitoring etc. in the hospital]–hopefully suggested I was a good candidate for VBAC with my second I told him I was not remotely interested in that and wanted another section, and was allowed to have one without argument.

    I’m not upset or angry that I had to go through labor [induced at 40 weeks 1 day, with the knowledge that I would likely have a section in the end due to my smallish pelvis and largish baby who hadn’t dropped], but it would have been nice to skip the whole thing and just be permitted to schedule a section. It seems like so many of the NCB people talk about elective c-sections as if they are rampant, but I don’t know anyone who was allowed to just choose one for a first baby for no reason other than they didn’t want vaginal birth [I personally found the idea horrifying, due to some abuse in my past; I would have done it if I had to but really didn’t want to].)

    • Awesomemom

      WelI am guessing the passage through the vajina would cause bacteria to be rubbed on the lips and nose and things would proceed from there. Also the baby would get bacteria from the moms breast skin if attempts to nurse were made.

      • Young CC Prof

        It’s pretty clear that any pathogens in the vagina wind up in the baby. If a mother has an active yeast infection at the time of delivery, the baby can get not just oral thrush but thrush in the stomach. Uncontrolled herpes can also spread to the newborn, and that’s pretty dreadful. Group B strep can cause very dangerous sepsis. (Therefore, in a woman in late pregnancy, controlling or curing infections, especially around the birth canal, is a matter of urgency. If the infection can’t be adequately treated before delivery, c-section is indicated.)

        So, it’s reasonable to conclude that the baby also picks up the normal flora. The question is, what effect does this have? Do the bacteria actually pass through the stomach to populate the gut? What’s the effect on the newborn from NOT being exposed to these particular bacteria?

        Right now, research on gut flora is at an interesting stage: We know it’s important, but we don’t fully understand what normal looks like, much less what variations from normal mean. We know that pro-biotics after a course of antibiotics is probably reasonable, but we don’t know the best organisms to recommend, or what dose, or when.

        However, have no fear! There are plenty of quacks who will sell you products to diagnose and treat problems with the gut flora!

        • anion

          Duh, of course. I didn’t even make the GBS/flora connection (this is why I’m a novelist and not a scientist). Thank you!

          I did do some looking into the idea of gut flora a few years ago (I won’t call it “research,” as it wasn’t reading scientific journals or studies) and thought the idea was really interesting, but at the time I didn’t really know anything about GBS and was more interested in the breastfeeding/formula feeding thing, and what I read focused more on the infant’s gut WRT breastfeeding than on anything it might pick up during birth.

        • thepragmatist

          The thing is, why do people think mom wouldn’t be giving babe her vagina flora post birth. I know it’s rather discussing to note, but regardless of delivery method, the afterbirth, bleeding, and so on is so messy, and mama is in such close contact to baby, I just don’t see how some “flora” isn’t passed over. At least, a few days PP and dragging myself around, I can’t say my handwashing was as rigorous as it normally is. I just wanted to feed the baby, lay down, feed the baby, lay down some more. It’s not like I was a filthy mess, but at the same time, I am sure I had some flora from all the lochia somewhere on my body.

          And never mind anyway, because if it’s important it’s a rather easy, cheap fix. Although I think rubbing your vaginal secretions on your child post-op might get you in some trouble. LOL

    • Karen in SC

      Welcome, anion! I like your name since I’m a chemistry instructor.

      If you are reading the archives, you might notice older entries where the comments don’t make sense (or are missing entirely). This is due to Dr. Amy switching to Disqus several months ago.

      • anion

        Thanks so much, Karen!

        Ha, the name started as a simply typo of “Anon” years ago, but then I caught the “an ion” thing and kept using it. Chemistry was not my friend in school–I was one of those kids for whom Biology was simple but chemistry was painful–but I like the idea of just being an ion, floating in a little sea of other ions (or whatever it is ions do). Positively charged. 🙂

        • Box of Salt

          Anion, I hate to burst your bubble, but you are negatively charged.

          However, I will point out that you are attracted to what’s postitive!

          • anion

            HAHAHAHA!! Good lord. See? I definitely am not a chemist.

            But “negatively charged; attracted to the positive” would be a great Twitter bio.

          • The Bofa on the Sofa

            The good thing is that negative ions are far better than positive ions, anyway. Positive ions are a mess. Negative ions are neater.

          • auntbea

            Please to explain how one classifies ions as “messy”.

          • The Bofa on the Sofa

            Mixtures of lots of different ones are messy. In contrast, anions are generally very clean, in that there are few different ones.

    • Anion – your comments on maternal request cesarean are interesting to me. I founded a facebook group “Cesarean by Choice Awareness Network” specifically for women who prefer elective cesarean delivery. Your experience is not unfamiliar – and I suspect has a great deal of geographic variability. You may also be interested in the book “Choosing Cesarean: A Natural Birth Plan” by Pauline McDonagh-Hull and Dr. Magnus Murphy. I wish I had better data on the phenomenon of first time mothers seeking elective cesareans and actually having that plan meaningfully explored and facilitated. I think it’s a bit of a travesty that it isn’t, particularly from an informed consent point of view – as planned vaginal delivery is also not without risks/benefits and women should be able to choose the treatment that best meets their needs after being informed of the risks and benefits of the options available.
      I am hopeful that litigation on this issue may bring some clarity and advance the interests of women who prefer cesarean delivery.

      • anion

        Thank you, I’ll look for that group! (I am sadly coming to grips with the fact that since I turned forty last month my wish for a third baby will never be anything but a wish, but I still think the issue is important and would like to draw attention to it for other women who felt as I did.)

        To be fair, I believe my OB’s hands were somewhat tied due to insurance (this was in South Florida, btw), and he did, either by accident or by design, facilitate my section by agreeing to induce me on my due date despite my not-dropped baby, and not overtly pressuring me to “keep trying” at the hospital. And like I said, when my reply to his VBAC suggestion was “Absolutely not,” he didn’t press the point.

        Perhaps if I’d been able to pay for it myself rather than through insurance, it might have been different, but I know he would have preferred me to deliver vaginally.

        • thepragmatist

          I often wonder what would happen if Western women knew what many women seem to already know in the developing world: c-section (of the first two children) is safer for babies. I just don’t see how to dice the data any other way. With a planned c-section you miss many of the most harrowing complications of vaginal birth. It’s interesting to note, BECAUSE we use “natural vaginal birth” as the gold standard of a “safe birth experience for baby” when often, it’s not nearly true. Meanwhile, babies born by at term by planned c-section (if there are a couple of c-section– I acknowledge risk increases per c-section), just do better. What would women, desperate to do best by their babies, do with this information! Of course, you can never, ever bring this up. And no, there is no informed consent for vaginal delivery given to women as standard care, but there also should be. I had the closest you get, but that is only because I had recently survived both abuse and a vicious rape prior to the becoming pregnant. And when I met my OB/GYN for the discussion I felt like a total failure, because I felt like I was going to harm my baby.

          I will note, surgery IS hard on mom… but let’s not forget emergency c-section is hardest of all, and it’s firmly an outcome of a failed attempted delivery, not a planned c-section, which is generally much safe for mom too. The data is there in terms of safety, despite attempts to hide it.

          Mrs. W, there is some data from our area. Women in BC request c-sections at a rate of 2.5% of all first time mothers. I could dig up the report– maybe– but I had a deadly (for the lap top) incident with a nap and tea. LOL

          • Renee

            If you aren’t having more than 2, maybe 3 babies, CS IS the safer option as far as the baby goes.

          • Haelmoon

            I actually do routinely tell women that a c-section is safer in many situations. The problem is, we cannot predict ahead of time who would benefit the most. Whenever I consent a women to an induction, particulary if there are unfavourable, I bring up a c-section.
            I tend to say for women, the best delivery is a safe one for mom and baby. A simple, uncomplicated vaginal delivery generally carried the least risk for both combined, but that is followed very closely by an uncomplicated elective c-section. However, labour is unpredictable, and the risk for complications for mom and baby is likely higher in an attempt for vaginal delivery, plus the intrapartum c-sections can be more difficult. However, a planned c-section is much more predictable, but not without its own risks of course.
            I think my job would be a lot weasier if I had a crystal ball. Deliver those vaginally that would do so without complication and do a c-section for the rest. I think that the mode of delivery should be discussed, including the risks and benefits of all modes.

    • Renee

      My OB now does elective CS, because she understands that women can choose. My first OB did not, and I had to go through a ridiculous labor and then a CS because of it. He did apologize after, but thtas no consolation at that point.

  • Antigonos CNM

    Supposedly the difference is between pathology and a natural body function. “Medicine” is for the former, while not for the latter. “Medicine” corrects physiologic anomalies, but all females of the species exist to give birth. Or so the reasoning goes. In fact, we use “interventions” to improve or facilitate natural functions all the time. Ever take something for constipation? It’s like using tools. While it has now been shown that animals use tools, so that humans aren’t the only “tool-using” beings [long regarded as the definitive difference between us and the “lower” animal orders], animals don’t seem to be constantly improving their tools whereas we do.

    And that returns me to what I call “medical Luddism”. What is incomprehensible [without huge amounts of explanation or education] is “not right” or “not meant to be”. The natural state is to be something like an earthworm — easily understood in its mechanisms. Once the mechanism becomes too complex for simple understanding, it becomes something to be feared, and avoided. Medicine used to be magical, and that was all right — magic is, by definition, mysterious. But science has rationalized medicine and so it is simply, to some people, frightening. Et in arcadia ego. So the response is, try to convince yourself that you don’t NEED any assistance, as a means of coping with the fear. This doesn’t work well with bad constipation [ever heard of fecal impaction?] and it doesn’t work well with a lot of other “natural functions”, birth among them.

    • Karen in SC

      Exactly! Fecal impaction can lead to sepsis, then death. I know a 25 yr old that died from that. Even a hospital couldn’t save him, perhaps he went in too late.

  • Captain Obvious

    A version is no longer a medicalize intervention. A MW is planning on performing one at home. Ugh.
    http://community.babycenter.com/post/a44822788/version_-_safety_and_timing

    • Antigonos CNM

      External or internal? I don’t know who needs more luck, the patient or the midwife. [Although, in the days when no one knew what they were doing in the first place, it does seem that midwives, who were intelligent to actually determine fetal lie, did attempt versions on occasion. I doubt the success rate — including delivery of a live mother and baby — was pretty low, but death of at least one was the probable outcome in the absence of any attempt to turn a malpresenting fetus.] Midwives, of course, did not have Piper’s forceps, even after they’d been invented, nor could they do a C/S.

    • Dr Kitty

      Can someone please log in there and tell her the risks include cord accident, abruption, premature labour, PROM, uterine rupture, foetal death, pain and failure of the procedure to work?

      I hope her OB is going to do that in person, and was just too busy getting over their shock at the very notion to tell her at the time? I also hope the OB is reporting the MW.

      • Antigonos CNM

        Reporting the midwife, if indeed one can call the person such, to whom? This is part of the entire regulatory problem with midwifery in the US. Is the person in question in a state which actually licenses midwives, and what sort of credentials does she have? Does the state in which she resides and/or practices actually have the means to restrain her from performing a medical action [is there a code of practice to which the midwife must legally adhere, or once she has a certificate, any certificate, and is registered with the state, can she act at her discretion? I don’t think there are many states which actually delineate what actions a midwife can or cannot perform, in the manner the UK does]

    • AmyP

      At 35 weeks, too.

      Don’t these things resolve (pardon the phrase) “naturally” a fair percentage of the time.

      • Antigonos CNM

        Yes, they do. In fact, nearly all fetuses are breech until about 32 weeks anyway. A baby can spontaneously turn from breech to vertex right up to the onset of labor, although that’s fairly uncommon. The reason an ECV is usually done close to term [38 or even 39 weeks] is because, if the baby can be turned easily, it can just as easily turn itself back to breech and you don’t want that. BTW, if a breech doesn’t turn easily during an ECV, it most likely won’t turn at all. I have actually seen twin breeches spontaneously turn to vertexes at 38 wks, which is rare indeed.

        ECV is one of those procedures which has done a 360 degree turn itself [sorry!] during my career. In the 60s we were taught that it was no longer done; too many risks, a C/S or even [for a multip] an assisted breech delivery was preferable. Like the Scanzoni maneuver for persistent OP presentation, it was a relic of the Bad Old Days when C/S was only a last resort. Then it made a comeback, as a means to avoid a C/S when a woman intended to have a lot more children [here in Israel, for example, among the ultra-Orthodox, it remains quite popular]. And now I see more and more doctors declining, once again, to attempt it, even though it is now done with ultrasound to visualize.

  • I’d argue that “demedicalizing” childbirth is the greatest disservice you could do to women and children – decisions that are not “medical decisions” do not demand informed consent. Conditions that are not “medical conditions” do not merit research or the scientific process – and do not benefit from the improvements that result. If we value women and children, as humans – the very least we can do, is medicalize an event that has a profound impact on their health and well-being over their lifespans. Women and children deserve to benefit from technological advancements as much as any other person.

    • thepragmatist

      Brilliant and true.

  • carovee

    I was watching PBS and when animals in the rainforest have to eat un-ripe fruit with toxic seeds they follow it by eating mud whose components can neutralize the toxin. So right there in the wild animals “medicalize” digestion. Please ponder that, HBers.

  • Carolina

    Re body order, many a hippie reject soap, shampoo, antiperspirant, etc. Seriously, look up “no-poo.” I can’t imagine how bad this smells/looks after a while.

    • Anj Fabian

      I keep wanting to have my own one subject trial but I can’t figure out how baking soda and/or vinegar creates the surfactant effect necessary to remove sebaceous secretions from my hair and scalp.

      • auntbea

        Isn’t the whole point to leave them there?

      • Cartwheel

        When I do it, I make a baking soda slurry. The baking soda is slightly gritty for scrubbing the scalp, and it also soaks up extra oil and removes any dirt. Then I rinse it out thoroughly, do a vinegar rinse to smooth down the cuticle of the hair, and rinse that out too. I do this about once every one to two weeks – more often if my hair gets anything actually icky in it, of course.

        The reason that I don’t use shampoo & conditioner is that I had chronically itchy scalp and dandruff. Every single commercial product I tried (including prescription ones) just made it worse. I read about the baking soda and vinegar thing, tried it, and it absolutely works. I’ve been doing it this way for about two years now and there’s really not a downside for me.

        I also don’t use deodorant – not for any particular reason, just because I don’t need it. I can’t explain why but it’s true, I periodically have it verified by third parties to make sure I’m not unbearably stinky and just can’t tell, but nope. If I’m not doing anything to get too actually dirty (and I don’t mean sweaty, I mean dirty), I pretty routinely shower once or twice a week at most. Even when I do shower, I often don’t use soap….

        Also I’m not a hippie, I have a medical degree and use it. So I’m just saying, everybody’s different.

        And auntbea below, ew, no, the point is not to leave them there. The point is to use something that is dirt cheap, has no real environmental effects, and works super well to solve my problem.

        • anion

          Yeah, I occasionally use baking soda to wash my hair or add it to my shampoo, and I’ve conditioned with vinegar as well. They do work, provided you don’t use a lot of hair products.

          Baking soda also cleared up my babies’ cradle cap very quickly, and I recommend it to my friends who have cradle cap babies (our were both at the “peanut-butter scalp” level before I started adding baking soda to their baby shampoo).

          But I’m a big fan of baking soda; I use it as a facial exfoliant as well, and it works wonderfully–and yes, it’s so much less expensive than those fancy exfoliants, many of which use too-sharp grains, and some of which are actually just baking soda in a gel base!

      • Bombshellrisa

        I don’t use baking soda, but I have been known to use white vinegar in my hair after washing my hair with well water at our other place or right before I get my hair highlighted again (the bleach pulls better on hair with no build up). Of course, highlights of that kind aren’t natural and the water from the well is more pure, so I shouldn’t be washing off all those lovely minerals.

      • Dr Kitty

        My grandmother used to boil rosemary leaves in a 20/80 mix of vinegar and water and use it as a final rinse after washing our hair. Personally, I prefer a nice conditioner, but it smelt nice and did make your hair squeaky clean.

    • Zornorph

      Matthew McConaughey doesn’t wear deodorant. Every time I see him in a movie, I think about how raunchy he must smell.

      • auntbea

        OMG! And there was movie where he played the Southern lawyer and was dripping sweat the whole time. Ew. (Although, to be fair, no one in my family wears much deodorant, because apparently whatever critters make you stinky have chosen not to colonize us.)

        • I don’t have a creative name

          Oh, “A Time to Kill”. Some parts of that movie were hard to watch – I wanted to kill them good ole’ boys myself – but my stars, is MM ever a hot piece of ass.

      • I don’t have a creative name

        That’s unfortunate that such a hunk of yummy man must smell like an overturned truck of rotting onions.

      • Renee

        He probably doesn’t smell at all. I found that after not wearing it for awhile, I rarely smell. IDK why this is, but I rarely use it. Not because I think it causes cancer or anything, just because it doesn’t generally make a difference.

        • The Bofa on the Sofa

          I found that after not wearing it for awhile, I rarely smell.

          Yeah? What does everybody else think? :p

          Seriously, we have foreign students who don’t bathe or use deodorant. They don’t realize they reek. I think people are not good at recognizing their own BO.

          • Dr Kitty

            Gotta say I agree with you Bofa, I’ve spent enough time in India around people who, while clean, did not use antiperspirant or deodorant. People smell, they just don’t realise it after a while.

            Mitchum powder-fresh roll-on for me!

    • yarnbarf

      Yes, a friend’s chiropractor told her that antiperspirant causes breast cancer by not letting the body drain toxins through the armpits.

      • anion

        I dropped some change into a cancer charity box on the street and was given a piece of paper by the guy holding it. I assumed it was a factsheet about what the charity was doing; instead it was a long psuedoscience diatribe about how deodorants (not even antiperspirants, as those are more rare in England anyway) cause cancer.

        I didn’t look at it until I got home, sadly, so couldn’t demand my money back. I don’t donate to woo.

      • Young CC Prof

        That myth’s been around a while. It’s one of those bad pennies.

        • I don’t have a creative name

          I read “pennies” as “penises”. Yikes. I need caffeine.

          But what is meant by “bad pennies” in this context anyway?

          • AlisonCummins

            It keeps turning up. If you’re a storekeeper and you refuse a bad (counterfeit) penny, evenually it will come back to you when another customer gets it and tries to spend it.

        • yarnbarf

          Confession: every few weeks I spend a day that I know I’m not leaving the house without deodorant/anti-perspirant. I figure a day of letting the glands operate naturally won’t hurt anything, and it does help with the smell the rest of the time. The first few times I tried it, it was like I had rubbed onions on instead of anti-perspirant.

          • The Bofa on the Sofa

            I have had problems with underarm rash, and therefore need (unfortunately) need to minimize my use of deodorant/anti-perspirants.

            I just try to avoid being around others.

  • Captain Obvious

    The Homebirth advocates cannot have it both ways. Either birth doesn’t need to be medicalized or it does. Sure, some Homebirth midwives sit in the corner knitting. But if that is all you are going to do, why even be there. But most Homebirth midwives medicalize and manage the births they are attending. They sweep membranes, recommend castor oil, EPO, garlic, black and blue cohash, nipple stim, walks or yoga positions, recommend sex, moxibustion, chiropractor adjustments, accupuncture and acupressure. They recommend EBF and LC visits. They recommend no vaccines or vitamin k. Sounds a lot like managing a labor or medicalizing it, just in a different way.

    • The Bofa on the Sofa

      “Medical” procedures are things done by doctors. If a midwife can do it, it’s not medical.

      HTH

    • PJ

      Medicalising with pseudo-science!

      • thepragmatist

        This.

    • Happy Sheep

      But but it’s not medical if it’s NATCHURULL!

    • Karen in SC

      As much as they are so against medical protocols, they are rabid about car seat regulations!

    • thepragmatist

      THIS is what I don’t understand. They can’t have it both ways: be recommended as “legitimate medical practitioners” with hospital privileges while eschewing medicine. Cake and having it too, and someone else cleans your mess up! I would even go on to say that with the degree of interference in “normal” pregnancy (from special diets to stave off a variety of complications, to ways to induce a pregnancy even just at term, to all the bizarre practices such as placental encapsulation and the like) NCB is interfering in some ways far more than traditional, SBM. Most OB/GYNs it seems just leave a woman to be pregnant unless there is a real problem. When I had issues, the midwifery side of my care suggested all kinds of things, the OB/GYN said, “Shit, that sucks.” If possible, she prescribed something to ease the situation (like when I was vomiting bile for the last 3 months of pregnancy). Difference is, the “prescriptions” from the midwife were totally ineffective, whereas the little yellow pill my OB/GYN prescribed made me stop vomiting and I (and baby) finally gained weight in the last two months! As much as I loved the personalized care of a midwife, they should never have more power than a specialized nurse and should be overseen by OB/GYNs while practicing, otherwise they truly become so navel-gazing as to become ridiculous without realizing it (and causing harm in the process). And I had a good midwife, by luck. I adored her, but she still suggested ridiculous things, and I am pretty sure her suggestion to treat very bad SPD with chiro gave me a tear in a disc in my spine.

  • Felicitasz

    “Aloha from Hawaii! Above is the view from the pool where I am writing this post.”

    Arrrrrrrrrrrghhhh 🙂
    (Next time fold me into your handbag, won’t you?)

    Thanks for posting, much to think about.

  • Enjoy your stay in Hawai! Besides, this is one of the reasons I can’t understand the Dutch: they made their country, shaped their land with canals. There is a huge dam to prevent floodings. They’re one of the most connected countries in the world, especially on Twitter. I often see airplanes flying above my house, since I live close to one of Europe’s greatest airports. But birth has to be natural. The doctors often ignore your questions and say “this will go away by itself”. The Dutch often resort to alternative medicine, becasue it is more “natural”. And as I said (and can I say it again, please) getting the flu shot or the chicken pox shot is close to being impossible. Why do we favor some “natural” things over other “natural” things, and some “unnatural things” are better than other “unnatural things”. And who gets to decide???

    • Anj Fabian

      The Netherlands – fighting natural processes for centuries.

    • thepragmatist

      Now quite a few years ago, I followed my friend (a pediatrician in Holland) through her pregnancy. She was determined to have an epidural during labour and delivery, considering all that she had seen as an attending pediatrician. Even though she chose to deliver in her own damn hospital, her first labour was a mess of her begging, and begging, and finally demanding, and still the epidural came too late. She was forcibly prevented from having that epidural. Her second child she was even more aggressive, even colluding with nurses she knew, and that time she got her epidural. But if a physician at the very hospital she works at cannot get an epidural, I cannot imagine how it is for other women!

  • guest
    • Dr Kitty

      I’m sick at home with time on my hands and you’ve sucked me into Designmom! How could you do this to me!

  • hurricanewarningdc

    Gotta add, too, that I frequently see the hypocrisy that you note. It’s amazing. Women who crow about who they NEVER eat processed foods and NEVER feed their kids red dye #gazillion and who NEVER would formula feed or use vaccines… have zero problem using illicit (and probably fake or harmful) drugs shipped off-prescription from online pharmacies in Vanuatu (cartel paradise) and funneled into their infants via breastmilk. They have zero problem using birth control or all kinds of random supplements intended to increase their chances of pregnancy. They put all kinds of garbage in their sick babies – but won’t give Tylenol to reduce fevers unless an ER is required. The mindlessness of the “educated” is mindboggling.

    • Sorin

      Love this post.

      You have described my SIL. She’s taking one of those non-FDA approved drugs that she had to order illegally off the internet to increase her milk production because she claims that fenugreek made her baby gassy. She also accepted about 100oz of breastmilk from a random stranger and fed it to her infant, yet she won’t take her own asthma medicine because she’s afraid that it might get into her breastmilk. And, of course, she thinks formula is poison. The disconnect and non-thinking is astounding.

      • Sullivan ThePoop

        Breastfeeding a baby with uncontrolled asthma puts the baby at greater risk for developing asthma.

        • Sorin

          Oh, really? Do you have any studies that I can pass along to SIL? Not that she’ll read it, but I’d at least feel like I tried to do something.

      • Young CC Prof

        Tell me this lady at least took her asthma medicine while pregnant? Because skipping it then would really put the baby at risk.

        And I freaking hate the Domperidone for milk supply crowd. THIS is why people with digestive disorders so bad they need to be fed through tubes can’t get domperidone. THIS is why the FDA hasn’t approved it yet.

        • Jessica

          A coworker of mine – someone I’m friends with and like a great deal – Sanctimommied me a bit during my pregnancy about diet. Never mind that I was so sick with morning sickness from weeks 9-15 that I required Zofran and continued to be sick once or twice a week into the third trimester – I should have eaten all sorts of healthy, organic, nutritious food that I could. not. keep. down. Oh, but I had a choice not to throw up – I could have just swallowed the vomit. True story.

          Aaaaaanyway, she is an asthmatic and would not take her medication during her two pregnancies because she was afraid of medications. It’s not like she was unaware of the dangers of asthma – her brother died at her feet when he was 18 from an asthma attack.

          Which was the greater risk: my cheeseburgers and steak during the first half of my pregnancy or her refusal to take asthma meds?

  • hurricanewarningdc

    Dr Amy, I see where you’re going with the “white men” angle, but just an opinion from a big fan: It may be a stronger (and more easily documented?) point to say that the people who promulgated this “natural birth” industry are those who have profited from its creation. Ego, cash, prestige… Perhaps it started with men who feel no shame in shaming women into unnecessary pain and suffering; it’s developed, though, through the greed and self-aggrandizement of both sexes. The Cheneys, Imafrauds, Lakes, Sears’ of the world who cash in by being the modern-day quacks and elixir salesmen. Naturally (pun intended), scientific evidence, medicine, hospitals, etc are shunned as they undermine their competitor to bolster their bottom line.

    Good luck on Friday!

  • CNM

    Hey Dr. Amy, be sure to take a visit to that ‘Dolphin Assisted Birth Center’ while you are in Hawaii! 😉

  • The Bofa on the Sofa

    One word: viagara

    Talk about “medicalizing”!

    Erections are normal. If men didn’t get erections, we wouldn’t be here. Throughout all of history, men have gotten erections with any medication at all. Oh sure, you can say viagara is just for old codgers who are beyond their reproductive years, but there are plenty of young guys who are taking it.

    We have no problem not everyone can get an erection, and we have no problem medicalizing it to help them.

    • KarenJJ

      The analogy also works because men were told for years that they can mentally control erections and that inability to obtain an erection was due to their mixed emotions around sex and masulinity. Trust sex, maybe your not enough of a man, maybe you don’t really want to have sex, relax…. Sounds similar to what women get told around trusting birth, breastfeeding and fertility.

      • Young CC Prof

        Excellent point. The Patriarchy also oppresses men, any time they “fail” at perfect and idealized manhood.

        • thepragmatist

          Amen to that. My now ex-husband (alas) had a serious sexual performance issue to which he developed an entirely bizarre set of coping skills (such as a sex addiction to voyeurism– see why he is now my ex!)… I tried to support him through his therapy work, but he gave up because it was just too hard for him. But in process of trying to support him, I learned an awful lot about what men experience when they don’t measure up sexually to the standards they are expected to meet. Derision, bullying, and cruelty, to name a few.

          He also failed to ever provide for our family (4 jobs in 3 years, and one failed attempt at an education provided by my family!) and not being able to be the breadwinner has completely and totally made him feel like a failure. I’m starting to see that it is just not him: but he wanted to be that man, I think. I’m sad for him, really, as he has no idea WHO he actually is and I do blame societal standards to a degree. Somewhere in there is a gentle, good man, but it’s buried under all the things he thinks he should be and cannot ever hope to be. It’s like me being able to erase my disability with a magic wand.

          • Antigonos CNM

            Yes, I think the anxieties foisted by society on some men are truly overwhelming. Pardon the coarseness, but whereas women can spread their legs and fake it, men have to always get it up. And the requirement to constantly prove themselves is not just sexual; it permeates their entire lives. While we are “born” to give birth and raise children [!!??] “effortlessly”.

          • Young CC Prof

            I had an ex like that. With many years of distance, I have a lot of sympathy for his situation, but ultimately I had to separate myself from it.

    • Captain Obvious

      Remember, for every negative drivel about men using Viagra is a happy woman receiving its benefits.

  • AlisonCummins

    Oh, but people do object to medicalizing all these things. There are women who prefer NFP because it leaves their bodies intact. Personally I didn’t use OC or an IUD because I didn’t want to change the way my body worked at all times for those specific times I wanted to have sex with a man. People don’t like taking blood pressure medication and they criticize pharmaceutical companies for promoting pills instead of diet and exercise so that they can make money. I’ve been told to rinse my skin but not use soap. I’ve been told that bodies’ natural odours are preferable to deodorant (and often agree). Many women are outraged by any suggestion that they douche. Many people prefer to endure some level of pain rather than medicalize it.

    I’m not saying all of these preferences are fully rational, just that it’s simply untrue that nobody objects to the medicalization of these other functions.

    • Elizabeth A

      I don’t see how an IUD or birth control pills make my body *not* intact. Can you explain that one?

      • anion

        Maybe she means functioning without interference? I used NFP after my first because birth control pills ruined my sex drive and made me break out–plus, the monthly expense of the pill was something we could do without, since I was a SAHM and money was tight.

        After my second (a happy surprise, which wasn’t NFP’s fault but ours because we got a little careless!) I got a Mirena coil, which I loved. I didn’t have any of the problems I’d had with the pill, and really liked not having periods–the money savings on tampons etc. over the course of five years was nice, too.

        I never thought of my body as “intact” or “not intact,” though, just “I like having no side effects and an extra $20 a month to feed us with.”

      • AlisonCummins

        Intact isn’t exactly the right word, but I couldn’t find the right one.
        I don’t have any piercings, not even my ears. I don’t have tattoos. I don’t shave my armpits and until I got a corporate job I didn’t shave my legs. I figure if my body ain’t broke, don’t fix it and I have a fairly low threshold for what constitutes “fixing.” If I could use the way my body worked to manage my fertility (NFP) that was more congruent with my temperament. Diaphragms and condoms were also great.

        I take an antidepressant and a mood stabilizer. It was very clear to me that something was broke and needed fixing. I spent two years trying to find a doctor who would help me — two years being told that I didn’t need meds, that I should find a way to manage without them. Doctors told me that, and when I tried to access help through the therapy system and psychologists were the gatekeepers they *definitely* thought I didn’t need meds, kind of like midwives tend to think women don’t need obstetricians. (This blog has given me valuable insight into my unrelated experiences.)

        When I finally started meds my entire life improved immediately. But lots of people — including doctors — prefer not to medicalize personality and emotion. It would be false to state that they don’t. That is a different question from whether it is appropriate.

        Anyway, my temperament and personal preference is to leave well enough alone though I’m able to recognize when it’s not well enough and I don’t have a career built around convincing other people that it’s well enough. I’m not the only one with my temperament and it’s false to assert that we don’t exist.

        • Elizabeth A

          I’m not asserting that anyone doesn’t exist, and I think it’s fine to have a preference against you personally using certain birth control methods, or in favor of using others or none at all.

          It’s the word “intact” that gets me. It implies that, if I have an IUD, or use BC pills, a piece has somehow broken off of me.

          • AlisonCummins

            You’re right, “intact” is the wrong word, and nobody taking control of their fertility in any way is breaking themselves! I just couldn’t think of the right word.

          • AlisonCummins

            Anyway, I didn’t use “intact” describing my own preferences. I think there are some groups — the catholic church and quiverfull movements come to mind — who do believe that a woman who isn’t either pregnant or ready to conceive at any moment *is* broken.

    • Sue

      AlisonCummins – you DO realise this is an essay on a blog site, don’t you? A piece of rhetoric? Amy is making a point, not answering a factual examination. I suggest she can take some poetic license here – her point is well-made (even for someone distracted by paradise).

      • AlisonCummins

        I don’t understand.
        If I say, “nobody thinks that spiders and cats are different kinds of animals” and argue on that basis that since we all agree that pet cats should be spayed it’s silly to argue that household spiders should not all be spayed as well, you would not accept my argument.
        It’s easy to reject the argument if you already reject the conclusion for other reasons, but you should reject it as soon as you encounter the first, false, premise. So I’ll use another example.
        If I say that “we all know that drinking too much water is bad for you, and we all agree that water and oil are the same thing, then we should all agree that drinking too much oil is bad for you” you won’t reject my argument on the basis of the conclusion — it’s true, drinking too much oil *is* bad for you — but on the basis of the premise. If I’m making this kind of argument on a dietetics blog I have just damaged my credibility. I have demonstrated that I don’t know how to think and indidated that anything else I say should be suspect.
        I *don’t want* Amy Tuteur, MD to damage her credibility. I *don’t want* her to make herself an easy target. Arguing from false premises does not advance her cause, it damages it. That is a bad thing!

        • Sue

          AlisonCummins – I think we are ultimately on the same page. My point was not to take every word of an essay on a blog too literally. But it the end, it;s up to you.

          • AlisonCummins

            If someone says things that don’t stand up to examination, in a blog post or anywhere, the only point they make is that the speaker hasn’t thought things through.
            The difference between making an argument in a blog post and in a scientific paper is in the degree of careful quantification, not in whether statements are true or not.

    • Paloma

      Are you aware that aging causes high blood pressure not because of diet and lack of exercise but because of the natural process that makes arteries lose the elasticity they have? No amount of changes to your diet and exercise will change this process, especially when you are 70 years old (exercise is kinda hard for older people). As much as we would love to find a drug-free way to help this it is very hard. It is not the same to have a pacient who is 40 and obese with high blood pressure (you shoukd try first to make them lose weight and take it from there) than to have a perfectly normal 70 year old who follows a normal diet and is not overweight. Pharmaceutical companies promote their products, obviously, but a doctor should be able to know when to use a drug and if the pros weiigh out the cons of using it.

      • AlisonCummins

        I agree.
        However, it is not true that *everybody* agrees. Arguing on the basis that chilbirth is the only bodily function where people reject medicalization is using false premises.

    • fiftyfifty1

      Yes, there are tiny factions that do object to medicalizing all these things. But they are considered to be fringe and weird by just about everybody both within medicine and in society as a whole. But the “problematizing” of the medicalization of childbirth is taken seriously as an idea in so many places: within government, by health researchers, at Mommy-and-Me classes and on the playgroud. It even has a presence within medicine itself.

      If you had bad body odor because you refused to wear deodorant or if you were stumbling around because you refused to wear glasses, a medical clinic would never even consider you as an employee. But sitting in the waiting room at my clinic are magazines with headlines promoting doulas and discouraging epidurals. This crazy woo philosophy has gone mainstream!

      • AlisonCummins

        Then you have never heard someone cluck-cluck-clucking over someone else’s blood-pressure medication. “They are so lazy! They are just taking pills! Doctors don’t educate people about diet and exercise, they just write prescriptions!” That is not fringe at all. (Fringe would be rejecting medical cancer treatment in favour of ridding your body of psychic trauma so that it can heal itself. Still, while those folks might be fringe they are not zero.)
        Quiverfull is fringe but the catholic church is not.
        Preferring not to take medication for pain if you don’t absolutely have to is not fringe.
        Using vinegar instead of purchased antiperspirant, or baking soda or neem twigs instead of purchased toothpaste, or washable pads instead of purchased tampons, are fringe practices. Still, people do them. A lot of people just like being self-reliant.
        I imagine that one thing that contributes to the interest in D-I-Y childbirth is the cost of it. When people need to look at the price tag — or even pay completely out of pocket — they think about alternatives. People might cluck about doctors who are so lazy they prescribe pills instead of educating their patients about diet and exercise, but blood pressure medication is cheap so there’s less incentive to question it. Hospital birth is expensive. You couple that with a completely normal personality trait of self-reliance, and another completely normal (unfortunately) personality trait of paranoia, and you get active interest in homebirth.
        Active interest in homebirth raises a lot more concern than interest in cranberry juice as a home remedy for urinary tract infections but it isn’t essentially different from it.
        *** *** ***
        Another way of thinking about this: if anybody imagines that the only context in which Big Pharma and the medical industry are criticised is chilbirth, they are insane. *Every* aspect of it is criticized. *Every* intervention is questioned.
        Not by everyone perhaps, but not by nobody.

        • Dr Kitty

          Alison, you need to step back a little.
          If everyone wrote the way you suggest there would be so many caveats and footnotes that a simple 2000 word blog post would end up five times as long and almost unreadable.

          Dr T’s point remains that the majority of people who seek to de-medicalise childbirth are NOT members of fringe groups who espouse that philosophy about other aspects of their lives. They feel this way only about pregnancy and birth, and she’s calling them on it.

          The fringe crowd who reject modern medicine, soap etc its entirety are not the subject of the article. She isn’t mentioning them, not because they don’t exist, or because she isn’t aware of them, but just because she doesn’t want to talk about them I this particular post.

          Why is that hard for you to understand?

          • AlisonCummins

            Right, and my point is that this is *not about fringe groups.* Not wanting medical intervention is actually the default. Appearing to like medical intervention is usually considered somewhat pathological — anxiety, hypochondria, delusion or attention-seeking to a greater or lesser degree.

            When people require immediate medical help they usually seek it out, though there is a subset (rumour has it they are often men) who will not seeing a doctor without insistent nagging by a partner.

            As Young CC Prof points out, even when they do see a doctor people often refuse medical intervention when the benefits are abstract, as in the specific example of blood pressure medication that Amy Tuteur, MD uses as an example of things people do not refuse!

            As I have pointed out elsewhere on this thread, also often when the costs are high. When something is very costly, whether in effort, suffering or material resources, people often downplay its value. It’s called sour grapes.
            So yes, completely normal, mainstream people commonly resist medical intervention, completely contrary to Amy Tuteur, MDs assertion. This is not about using hyperbole or not writing about fringe groups, this is about being wrong.

            Yes, there are commonly accepted interventions. They tend to be low-cost, low-risk, with concrete benefits and congruent with people’s self-image. Glasses fit that description and folks are often delighted to find that they can get by just fine with the non-prescription glasses they buy at the dollar store. Glasses have another advantage in that they are normalized by being highly visible on one’s peers, but still many (non-fringe) people reject them out of vanity.

            My grandmother would benefit from using a walker but she resists getting one. We all understand. We don’t ridicule her for resisting intervention.

            The interesting thing is not that everyone accepts medical intervention for everything happily except in the case of childbirth, because that’s the opposite of what’s true. The interesting thing is that some medical interventions enjoy broad acceptance and others don’t. Depending on who you are, medical care for pregnancy and childbirth may fit in one category or the other.

            With respect to fringe groups, some fringe groups are overrepresented in the homebirth movement, for instance quiverfull. They want to have at least a dozen children so they are highly motivated to avoid c-section and perceive a different risk/benefit balance than the rest of us might. They are also less likely to be covered by health insurance and more likely to reject vaccines and rely on faith healing. Amy Tuteur, MD may not be targeting quiverfull women in this post, and that’s fair enough, but the women I know who are interested in homebirth share things in common with them.

          • FormerPhysicist

            If this is an example of how you wish Dr. Amy would write – I have 5 characters for you:
            tl;dr

          • AlisonCummins

            Yeah, it’s why I’m not a blogger. But I do follow other blogs and Amy Tuteur, MD is the only one this careless.

        • fiftyfifty1

          Some people cluck-cluck about fat people who just take a blood pressure pill while continuing unhealthy habits, but almost nobody clucks-clucks if the person is not overweight. And a doc who encouraged their patients to continue on with uncontrolled hypertension would be severely reprimanded by their professional body.
          Paranoia is not a normal personality trait. It is by definition abnormal.
          And NOT every intervention by western medicine is questioned on a routine basis the way interventions in childbirth are. Governments officials do not rail against eyeglasses. There are not 1,000s of blogs devoted to going against the gyno’s recommendation to get regular pap smears. And when people get a colonoscopy, their peers do not devote even a moment of energy “educating” them that the procedure is perfectly possible (and cheaper!) when done without anesthesia.
          To conflate the objections of a handful of fringe and/or mentally ill people toward their pet objects of paranoia with the *widespread* and pervasive objection to interventions in childbirth is to miss the point.

          • Dr Kitty

            The average person in Northern Ireland contacts their GP six times a year.
            It is not to decline medications and report that they are fine with just diet, exercise and natural remedies.

    • Young CC Prof

      You’re right. And in fact not all of the people who object to medicalizing various aspects of life ARE fringe nutters. There are a significant number of people who reject medicine for high cholesterol or high blood pressure, who refuse at least some recommended vaccines, or who don’t “believe in” psychiatric treatment.

      However, proving that statins prevent cardiovascular death requires sophisticated statistical analysis, and outcomes of mental health treatment can be tough to measure. Proving the wisdom of medicalizing childbirth just requires you to believe in the existence of history, which moves “natural childbirth” into the realm of true denialism.

      • AlisonCummins

        Yes. And it’s the exact opposite of what Amy Tuteur, MD says.

        She doesn’t say, “Many people object to medicalizing various aspects of life, especially when the risks are abstract, but it takes a real denialist to object to medicalizing childbirth when it’s so obviously dangerous.”

        No. She says, “I’m hard pressed to think of anybody complaining about “medicalization” of any other bodily function, so why complain about medicalizing childbirth?”

        According to Amy Tuteur, MD, rejecting medication for high cholesterol or high blood pressure simply doesn’t happen. It doesn’t occur to anyone. Nobody has ever been criticized for taking medication. What is common is to reject medical care in pregnancy and birth, which she cannot understand because rejecting medical care never happens in any other circumstance.

        • Clarissa Darling

          Alison, I think you are taking this way too literally. It’s an exaggeration for the purpose of making a point. If I were to say “everybody owns a smart phone these days” would you feel the need to point out that not everyone really does own a smart phone? The point of that statement is not to mislead people into thinking that there is no one on earth without a smart phone, it’s to highlight how popular smart phones have become. Sure, I could say “smart phones have become very popular” but, that’s rather dull from a stylistic standpoint isn’t it? I doubt that it’s never crossed Dr. Amy’s mind that people reject medical technology for all kinds of reasons and not just in the case of child birth.

          • AlisonCummins

            This is the thing that frustrates me about Amy Tuteur MD. She’s smart, she knows her stuff, and then she rants and says a bunch of patently untrue things that make her look silly. When she’s called on it she says it’s her online persona, she’s not really like that. What, she’s precise in her thought and speech on her own time, but her online personal makes stuff up and posts it without thinking it through?
            She needs an editor. It’s really frustrating. I can’t link to her.
            And yes, if you said “everyone owns a smart phone these days” I would call you on it. The world is a lot bigger than your social circle and it’s important to remember that.

          • Clarissa Darling

            Dr. Amy is not “saying a bunch of patently untrue things that make her look silly” she is making use of a hyperbole, a literary device that been used by writers for quite some time with many an editor’s approval.

            http://en.wikipedia.org/wiki/Hyperbole

            My example of the smart phones is also a hyperbole. As such, there would be no need to call me out on anything because when writers/speakers use hyperbole they do so full well knowing that what they are saying is an exaggeration being made for illustrative purposes.

            Here ends my sincere efforts to explain this concept.

          • Amazed

            Ever heard of hyperbole? Because I regularly use it in my work. Up until now, I’ve never encountered an editor who batted an eyelid. Of course, they are well-versed in various literary devices. They are not spme random people who take themselves too seriously and enjoy calling people out online for some perceived faults.

            You’re only making yourself look silly and unable to read social situations, cues, and various places and topics of conversations. The world is quite big, true. But every conversation has a frame. Your posts only prove that you have no idea what that means. You see, that’s the thing that annoys me about people who lack eloquence and imagination – they insist that Everybody. Should. Be. Just. Like. Them.

            I hope Dr Amy never changes her approach. Certainly not for the benefit of someone who doesn’t have a grasp of literart devices and various situations.

          • AlisonCummins

            I know what hyperbole is, and being wrong isn’t it.
            I’ve taken another look at it here:
            http://www.skepticalob.com/2013/09/theres-nothing-wrong-with-medicalizing-childbirth.html#comment-1061256828

          • anion

            Whatever you do, don’t visit The Onion’s website. It will only upset you.

          • AlisonCummins

            I usually get quite a giggle out of the Onion.

          • anion

            I write fiction professionally, and I’ve never had either my agent or any of my editors complain about it, either; granted, it’s privileged because it is a fictional character’s POV, but still. None of my readers have ever had an issue with it on my blog, and I used it in a non-fic writing guide and got no complaints, either. Most people, thankfully, are capable of appropriately comprehending what they read.

          • Karen in SC

            You might consider linking to the sources Dr. Amy uses instead. Anything that spreads scientific fact instead of pseudoscience mumbo jumbo is great!

  • Zornorph

    “Nature is neither benign nor perfect.” THIS – 100 times over. Nature isn’t a child’s birthday party – it doesn’t care about everybody being included. So what if a percentage of babies or mothers die? As long as enough live to continue the species, that is all Nature cares about. Nature is a nasty piece of work and I will do everything I can to strip her power away.

    • Nature doesn’t even care if the species survives – extinction is an option.

    • Bombshellrisa

      What was that line from “World War Z”-“nature is the ultimate serial killer”.

      • kumquatwriter

        Beat me to it!!

    • Mrs Dennis

      ‘She’ doesn’t even care about that; species become extinct all the time. There IS no ‘she’; things just happen. Sorry to burst anyone’s illusions!

      • Kerlyssa

        Thank you. Every time I see someone saying Mother Nature ‘cares’ about this this and this, in my head I go, yeah, and physics just ‘cares’ that the colorado river flows south. Evolution is descriptive, not prescriptive.

    • T.

      This,… “Nature isn’t a child’s birthday party – it doesn’t care about everybody being included. So what if a percentage of babies or mothers die? As long as enough live to continue the species, that is all Nature cares about. Nature is a nasty piece of work and I will do everything I can to strip her power away.” I want to make a meme with this. Can I?

      • Zornorph

        Go right ahead.

  • Sue

    (Waves to Amy enviously) – enjoy the poolside!

  • Sue

    I preventively medicalise my feet by wearing shoes on rough ground. And I preventively medicalise my skin by using mosquito repellant. Unnatural, I know.

  • fiftyfifty1

    Funny that you should mention that people don’t usually “problematize” the medicalizing of fertility. You are right about that. But when they do, just like with the NCB example, you find an ulterior motive. Like in this week’s JAMA, a doctor Carolyn Manhart wrote a response to a previous Viewpoint that had argued that employers shouldn’t be legally able to single out and restrict coverage of birth control pills. Dr. Manhart’s response was that physicians should promote Natural Family Planning (NFP) instead because “Women’s health is more fully promoted when women’s fertility is considered a natural, healthy state not in need of medicalization” and that to rely on medical interventions was flawed because it meant that “pregnancy was treated as a preventable disease”. She then goes on to misrepresent an old WHO statement in order to make it sound like OCPs were a cancer risk (hmmm…who else likes to misuse old WHO statements?) Is it any surprise that this doctor is from Creighton University (a conservative Catholic institution)?

    Luckily, the original Viewpoint authors get a chance to rebut and ended their response with “Selective citation of the literature in the service of particular views should be avoided….We believe women’s autonomy should be defended from attempts of religious groups to distort the evidence and impose their own values on others.” Indeed!

    • This. This so reminds me of what the Church is saying in Poland- that NFP is more respectful of the woman and when the man (her husband of course) participates in charting temperature and mucus, he respects his wife even more. What????

      • Dr Kitty

        What confuses me is that two religions ( Catholicism and Orthodox Judaism) can read the same religious passages and come to such different conclusions about acceptable methods of contraception.

    • auntbea

      I’m pretty sure pregnancy is a preventable disease whether or not one uses birth control. I do not know anyone, for example, who was strolling down the street and then — pop! — was suddenly with child.

      • Therese

        Pretty sure their beef is with the disease part of that, not the preventable part.

    • Happy Sheep

      If we all start using NFP so that we aren’t medicalising our fertility, it will inevitably lead to a spike in an actual medical procedure: abortion.

    • yarnbarf

      Creighton is also closely associated with its own method of NFP.

  • Tired Momma

    Okay, good post. NOW TURN THAT COMPUTER OFF!! You are in Hawaii!! Honestly stop this or I will change your name to Gina.

    • KarenJJ

      That could confuse the court case..

  • amazonmom

    This is awesome! Just what I needed to read when I was having a moment of guilt over not wanting to TOLAC.

  • We’ve also tinkered with nature by using vehicles to get around and to provide shelter from the elements. Nature’s a bit of a cruel wench – I personally do not have a problem with making lemonade out of lemons – an existence with technology is better than one absent it.

    You’ve hit on one of my pet peeves. Read a lot of the articles on this, and “intervention” itself is seen as being a bad thing. I have a real problem when researches lump having a cesarean in the same category as having a hysterectomy.

    I think part of the issue is a certain cost-consciousness that is permeating healthcare – and given the desire to avoid using resources in the first place, promoting natural childbirth becomes second nature. This is particularly true when the health outcomes (and associated costs) of pregnancy and childbirth are often limited to just the 6 weeks post-partum. It becomes very easy to forget about the very real things being bought with health care expenditures during pregnancy and childbirth. Relieving pain is of value. Preventing life long disability is of value. Preventing death is of value. But we only want to value the costs associated with the interventions – and that is fundamentally flawed.

    • CanDoc

      WELL SAID!

  • Karen in SC

    The NCBer’s try to sound more legit by calling theirs “physiological” birth. As if it doesn’t get down to physiology in the hospital!

  • Karen in SC

    O. M. G. There’s a breast that’s not feeding a baby!!!

    • Zornorph

      I’ll suck on it, if that makes you feel better.

    • auntbea

      It’s covered up, too! If we are too ashamed to have naked breasts in public, however will we as a society learn to believe that it is normal for all women to have them?

  • Is that the Grand Wailea?

    • Amy Tuteur, MD

      Yes, it is!

      • Love that place. That’s where we stayed for our honeymoon! Have fun! 🙂

  • Monica

    Now all of the natural birth advocates are going to be running around unbathed and without deodorant just to prove a point to you. Thanks for that ;).

    Enjoy Hawaii. I’d be lying if I didn’t say I’m totes jealous of that beautiful pool side view of yours.