Homebirth advocates, do you love your baby more than you hate the hospital?

iStock_000017649500XSmall

A few questions for homebirth advocates:

Do you love your baby more than you hate the hospital? Or is avoiding a scary environment worth risking the life of your baby?

Which is more important: whether your baby lives or dies or whether you can brag to your friends about your defiance of medical authority?

Is birth an intimate moment sanctified by sharing it only with friends and not impersonal medical professionals, or is it a narcissism fest yielding professional photos and YouTube videos posted for the perusal of all 7 billion people on the planet?

Do you really want to be attended in labor by a mail order midwife (CPM – certified professional midwife) who likely obtained her “education” from a correspondence course and whose education requirements were recently “strengthened” to mandate a high school diploma?

Do you really think that reading books and websites written by laypeople is “research”?

You tell everyone that you will be quick to transfer to the hospital in an emergency where you trust that the obstetricians can save your babies life, but you don’t trust those same obstetricians to prevent the very emergency that will require their assistance. Does that make any sense?

If homebirth represents less than 1% of all births, but 100% of the income of homebirth midwives, who do you think has a greater financial interest in hiding the truth about homebirth, obstetricians or homebirth midwives?

I’m waiting anxiously for your replies.

  • Ainsley Nicholson

    The homebirth advocates I’ve talked to about the dangers of homebirth (especially homebirth with an un-educated attendant) used a very distorted version of this logic: “Of course our babies are more important to us than anything! Do you really think we would risk our precious babies? This proves homebirth must be safe, if we’ve chosen it!”

  • ngozi

    I just want to know what they do at a homebirth if the baby comes out blue. I am not trying to bash anyone, but I am just curious what they do.

    I just gave birth about 4 weeks ago, and my baby was clearly failing the NST. He came out blue and his blood sugar had just about bottomed out (I was GD). I had an emergency C-section that was so emergency they didn’t even have time to shave me. Even though in the past I had hated the thought of a C-section, I am glad I had one. I think that my baby would be dead without one.
    Even though getting up and down was terrible for a while, the C-section went far better than I thought it would. I’m not saying everyone should get a C-section every time, but I ended up being scared for several years about something that didn’t turn out to be all that bad (the C-section).

    • Young CC Prof

      There are some CPR variants that are used for newborn rescucitation, and sometimes they work quite nicely on those babies who have trouble starting to breathe on their own. Some midwives carry oxygen tanks with baby-sized masks.

      A neonatal team with a full set of hospital equipment works a lot more often, though, and a home birth midwife might not have recent training or actual experience at the very delicate task of newborn rescucitation. According to people who’ve done it, it’s not only unlike adult CPR, it’s unlike CPR on a baby who’s been using his lungs successfully for any length of time.

      And of course, if there’s only one midwife, she can call 911 OR try to revive the newborn OR manage the mother’s third stage of labor. When all three are necessary…

      • amazonmom

        A single midwife can’t handle the steps of NRP correctly without a second provider present. If you are at the stage where bag and mask is needed and you are still the only provider still in the home… Oh my that is bad. Who is keeping track of mom? So many double train wrecks discovered when EMS arrives only to find a close to dying mom or baby lying forgotten. How many HB midwives have 3 or more providers for a delivery if things go badly?

        • Young CC Prof

          Remember that horrible video about the deliberate homebirth of a breech baby, and how he got stuck for a couple minutes? I compared it to a similar story from a low-resource Doctors Without Borders clinic, but I later realized the home birth situation was actually considerably MORE dangerous.

          When the clinic doctor finally got the baby unstuck, he handed the poor thing over to a pair of nurses with lots of experience caring for distressed newborns. They revived the baby and the doctor could continue working on the mother until he was sure she was stable.

          When the home birth provider got the baby out, he didn’t have any extra hands at all. If both mother and baby had urgently needed his help, one would have died.

          • The Computer Ate My Nym

            Or both would have died as he tried to treat both and ended up giving adequate care to neither.

    • Dr Kitty

      Congratulations on the arrival of your baby!
      IIRC he’s not your first, so I do hope you’ve been able to rest and enjoy him a little.

    • NursingRN

      According to one story I read in another article on this website- the mother assertively tells her baby “Breathe, breathe honey, mama really needs you to breathe” as she has a massive hemorrhage and munches on Placenta.

      • ngozi

        Gaaah! Placenta munching. I think I’d throw up my stomach.

  • Wren

    I’ve been thinking a lot about the pain relief issue in labour. Why on earth is this even an issue? My husband just had a vasectomy yesterday. Yes, it’s a tender area but it really isn’t as big of a deal as birth, even according to him. No one suggested he have this very short, relatively easy procedure without a local anaesthetic or that he go without pain relief after that wore off. In fact, he was advised to take something for pain before he felt any pain. Why isn’t toughing that pain out somehow better for a man if toughing out labour is better for a woman?

    • fiftyfifty1

      Yes it’s crazy isn’t it? I think of the poster above and how she still feels upset about her daughter receiving pain meds in labor long after the birth. The reason she gives is that her daughter was “dead set” against pain meds before labor. How does a 16 year old develop an opinion about pain meds to the point that she feels so strongly about this? It can’t be explained by prior bad reaction to the meds–this was her first birth. It can’t be explained by the weird-out factor that some people have about the idea of a needle near their spine, because it wasn’t an epidural, she just had IV pain med. How did this kid get so indoctrinated? Why wouldn’t she be dead set against pain relief in dentistry or any other painful situation? Our culture views a woman’s pain in labor as different than any other pain. You are at risk of letting down your mom if you accept pain meds in labor! How screwed up and sad we are as a culture about this!

      • Dr Kitty

        I’m afraid my advice to all first time mothers consists of
        1) keep an open mind about pain relief options until you feel what labour is like for you.
        2) if you think you want an epidural, ask for it as soon as you want it, because it can take a while to organise, and once it is in it can take a while to work, so don’t wait until it is unbearable, because you might have another 90 minutes of that pain.

        Now I think that is sensible, realistic advice.
        I’m not telling anyone what to do, but I am trying to minimise the risk that a woman who wants an epidural will be told “it’s too late” before she can have one.

        • toni

          That is good advice but wonder how useful it is in reality. I posted about the BBC2 programme called (the?) midwives a little while ago. Did you see any of it? I already knew it was fairly common for nhs midwives to fob off women’s requests for pain relief because of what friends have told me and on several occasions on the show they were dismissive of women’s pain and gave paracetamol instead of anything that might actually work. So clearly they think this is good practice if they do it in front of the cameras. Seems that if you end up with a midwife with a prejudice against epidurals you’re not going to get one unless you’re very forceful and/or a doctor yourself.

        • Ainsley Nicholson

          That is good advice, but not just for first-time mothers. I had my first two deliveries without pain meds, partly because I have a general habit of avoiding them, and partly because the births went so quick that there wouldn’t have been time for an epidural anyway. With my third delivery, things went a lot slower, and after 10 hours of labor and very little progress, my doc and I agreed it was time for pitocin, and I was ready for that epidural.

        • AmyP

          I wish every doctor gave that speech.

        • Rachel L

          That is the advice we were given in the hospital birth education class.

      • toni

        I’m not so sure about that. I think it’s a common attitude that it’s better to go without pain remedies at least in the short term. That temporary suffering is good for a person, man or woman. I think my dad’s leg would have to be hanging by a thread before he went to a doctor for help. I’m sure we all know men and women like that. Courage and stoicism are valued in most cultures and I think that’s where casual belief in NCB comes from not misogyny. Or at least that’s my hope!

        • fiftyfifty1

          I agree that cultures value stoicism to some extent, but not enough that they try to bully people into declining pain meds the way they do with women in labor. Nobody asks people who have just completed a colonoscopy if they went med free, even though good research suggests that up to half of all people (most of them men due to their wider and easier to navigate colon) could get through a colonoscopy quite well with “coping methods” alone if they put their minds to it. As a matter of fact, in some 3rd world countries colonoscopies are almost always done without pain meds. Having a similar policy in our country would save a lot of money and even reduce the rate of the complication of rupture (because a person with an impending rupture would have a sharp spike in pain that would cause them to scream out and cause the gastroenterologist to take pause). And yet nobody is even considering trying to encourage people to go med free for this. Why not? Childbirth is the only type of pain where there is an entire industry built up that tries to talk you out of pain relief.

        • Wren

          The pain from a vasectomy is meant to be relatively short lived. The health care professionals my husband dealt with all encouraged ample use of pain medication. If he chose to tough it out, fine, but they encouraged the opposite.
          Women in labour, on the other hand, are often encouraged by health care professionals to tough it out.

          • toni

            I don’t think hcps should ever discourage good pain management, it’s their job to make you feel better. I’m just thinking of regular people who tend to feel pain pills are best avoided I don’t believe it’s because of any ill will necessarily or that they only feel that way about women’s pain. Not denying there are people who think childbirth is the only occasion where it is preferable to suffer as fifty fifty said there is a whole movement dedicated to the foregoing of pain relief in childbirth, never seen any blogs dedicated to dissuading people with broken bones not to take Percocet, but the majority of ‘suck it up’ types aren’t like that IMO.

          • toni

            Dissuading from*

          • Trixie

            Percocet is another thing I’m very grateful for, but really try to avoid, not out of philosophic stoicism, but because I don’t like how it makes me think and feel. Not having to take Percocet after was another reason I wanted to try to avoid a repeat c-section.

      • PrecipMom

        A 16 year old can develop being “dead set” against pain meds because if she proves people wrong about X, then maybe they will be less nasty to her about being a teenage mother. Not all cases, but that would be a possible scenario. It’s not always offensive. Sometimes it’s a defense where you’re trying to project an image that makes you seem more badass and less like someone who “deserves” to be bullied.

        • toni

          That’s quite insightful I hadnt thought about that but I agree. If I was a pregnant teenager I wouldn’t want to give anyone any reason to think I wasn’t up to the task.

          • PrecipMom

            Exactly. Now factor in one or two really nasty nurses and a discovery of Henci Goer and you may have someone choosing home birth for baby #2 but for very different reasons than the highly affluent, Whole Foods approach to pregnancy and birth.

          • toni

            If I were*
            sorry

        • fiftyfifty1

          That makes a lot of sense PrecipMom. I know my own mother who was a teen mom did everything she could to try to be the perfect patient and mother to try to win the respect of her own mother, her in-laws and the medical professionals. It’s just interesting to me that the definition of “perfect patient and mother” in our society involves refusing pain meds during labor. Logically it’s absurd. How can that make you a better mother? And refusing pain meds is expected only in labor. If the 16 year old had needed a cavity filled, she wouldn’t have felt the need to be “dead set” against the lidocaine. Nobody’s mom pressures you to avoid dental lidocaine. Her mom wouldn’t have been disappointed years later that she accepted dental lidocaine. Or been grasping for excuses (like positioning) about why she asked for the lidocaine (e.g. if only the dentist had drilled the cavity different she could have coped fine with the pain and then she wouldn’t have asked for that lidocaine)

          • PrecipMom

            I think it comes down to not being wiling to be seen as “taking the easy way out.” And it is patently absurd, but it has internal consistency. Gain respect for “doing things the hard way” in one area, have protection against people assuming you are lazy and apathetic in other areas.

      • Karyn Croushore Hodgins

        OK I had forgotten about this conversation and first of all let me say… I am not all that upset about it 3 years later. And I never said she was “dead set” against pain meds. But we had discussed it and she said she would like to try to go without if she could. My point was not being upset that she got pain meds… my whole point was that if they had let her get into a position other than lying on her back attached to a FHM, she would not have needed the meds. When she asked for meds, I was all for it,… she knew how she was feeling and how much she could handle….. my point was never that I was upset about her having meds… I had meds with all three of mine… my point was that her treatment was what necessitated the meds…. She is a great mom and the outcome was the same regardless of the fact that she had meds… I was trying to advocate for my daughter and for her wishes on the subject…. She actually was doing great and the pain was not all that bad for her until they made her get into bed and stay there…. pain relief is about so much more than getting a drug… and there are so many other ways that are effective… THAT is the point….

    • Rachel L

      I think the main reason women try to avoid pain medications in labour is for the health of their baby. That’s the difference between birth and a broken arm, dental work, vasectomy, etc. Most pain medications go into the baby’s blood stream. When the mother has been on opioids, the baby is usually less responsive. They can take longer to breathe, cry, etc. It also means they are sleepier in the first hours, which can impact the initiation of breastfeeding. It’s pretty simple, really, mums care about their babies.

      Also, labour is NOT the only case when women avoid pain medication! The same logic applies when pregnant and breastfeeding. I have a friend who needed some dental work done while pregnant and she did it with very little pain relief. It was awful for her, but she chose to do what was best for her developing baby. When pregnant and breastfeeding, we avoid alcohol, cold medication, any pain medication stronger than a paracetamol, and many other drugs. Not controversial. Just responsible parenting.

      One of the first conversations with a doctor upon becoming pregnant is about which foods, medications, etc to avoid. Cease drinking alcohol, try to avoid smoking, cut back on prescription medications or swap for less dangerous ones. Avoid avoid avoid.

      Likewise with breastfeeding, our thoughts are always “will this get into my milk?” Is it bad for my baby, or will it reduce my milk supply? It’s Breastfeeding 101.

      Mums are selfless and our first instinct is to protect our child. I’m
      not sure why this is being questioned at all. It’s plain as day to me.
      Why has no-one else replied with the obvious?

      (I’m not against pain relief in labour when needed. I used gas and air, and pethidine. But yes, for my child’s sake, I tried to avoid using more than necessary, just as I avoided drinking during pregnancy and I avoid many medications while breastfeeding.)

      • Young CC Prof

        Here’s the thing, though. With oral or IV pain medication (or even gas and air) during labor, the baby absorbs some of the medication and there is an increased risk of breathing difficulty as a result. With an epidural, the drugs are placed in the mother’s spine, not bloodstream. The baby has basically no exposure and it’s been well shown that epidural babies do not have any adverse side effects. They aren’t sleepy, they breathe just as well, etc. If you’re going to have pain relief in labor, epidural is the safest things for the baby, hands down.

        Now, not every laboring woman needs an epidural. Some have labors that are faster or less painful. But an awful lot of women don’t ask for or are discouraged from getting epidurals either because of misinformation about the risks, or out of some idea that pain relief in labor is morally wrong.

        For the first, I can only say, epidural drugs don’t hurt the baby, and a modern walking epidural doesn’t increase the risk of labor complications. Sources are available if you go looking, this is my favorite: http://theadequatemother.wordpress.com/category/epidurals/

        The second is a philosophical position rather than a scientific one, and I can only say that I roundly disagree. If someone is in severe pain, and a SAFE pain treatment is available, withholding it is unacceptable.

        • Rachel L

          Hi Young CC Professor,
          I agree that pain relief is NOT morally wrong. It’s sad that it has come to that for some people. I don’t think it’s morally wrong even if it DOES impact the child. As you say, pain relief is important.

          I agree that it’s a mother’s choice and her wishes should be respected, but often those wishes are to avoid pain relief. Sometimes a very minor risk takes on a huge significance when it comes to our children. (Vaccination comes to mind.) But we should all be free to be irrational ;D

          I’m not sure that I’ve heard of any cases of laboring women (in hospital) being denied pain relief when they ask for it, assuming it’s safe and appropriate at the time. When I asked for an epidural the midwife said “I’ll go get the doctor right away, but would you like an exam first in case you’re nearly there?” The way she asked was cautious, not putting any pressure on me at all, she was just giving me the option. It was my choice to have the exam, and it turned out I was in transition, and then it was my choice to keep going without the epidural (I really didn’t want a needle in my back – I have arthritis, and had to have a special meeting with an anesthetist during pregnancy in case I needed an epidural.) I was denied a second shot of Pethidine as I was pushing my baby out,
          but as I understand it that was reasonable, as I wouldn’t have been able to keep pushing (the previous shot had knocked me out for an hour).

          In my mind, the main reason to avoid epidurals is for the safety of the mother, not the baby. The serious complications are rare but can be really awful. I was glad to avoid it.

          I will say though that I’m not entirely sure about what you said about epidurals being entirely safe for the baby. (And walking epidurals are not available in many places, so we have to look at traditional epidurals too.*) My reading has shown otherwise, but I understand that there are respected professionals saying they have no impact on the baby. There are just as many saying that they do impact the child, though. Yes, the drug goes into the epidural space in the spine, but that doesn’t mean it all stays there.

          In the ante-natal classes I attended, at a major Australian teaching hospital, they said an epidural can affect the baby. I was in obstetric care, not a birth centre, and there was no whiff of “pain relief is wrong”, we just went through the pros and cons of each method, with the expectation that most of us would be using some form medical pain relief.

          One of the undisputed complications of epidurals is the perceived higher birth weight, when the mother has had a drip. The baby has absorbed additional fluids and then appears to have a large loss of weight. While this should be foreseen and accounted for, in too many cases the child is then given formula in an attempt to regain their birth weight. It’s sad that something so simple can become a barrier to breastfeeding. (I don’t think this is a reason to avoid epidurals by the way, but it’s something to be informed about if you choose one.)

          Thanks for the link, looks like there are a lot of really interesting articles there. I’ll definitely be having a read :)

          *In regards to walking epidurals, in Australia where I live, they are not widely available:
          “These epidurals are only offered in a few hospitals, usually the larger
          teaching hospitals. They require additional, specially trained staff,
          which most maternity units are not able to provide. The few hospitals
          that do offer walking epidurals have procedures in place to ensure that
          it is safe for you (and your baby) to move about with an epidural in
          place, and that they have enough staff to support you while you’re doing
          so”

          http://www.babycenter.com.au/a542575/ambulatory-or-walking-epidural#ixzz2or4rAMo7

          • AlisonCummins

            Rachel, here’s a post just for you! Your preferred method of pain relief posed more risk for your baby than an epidural would have. http://www.skepticalob.com/2013/12/midwives-pain-relief-and-hypocrisy.html

          • Rachel L

            The pain relief I used was not my “preferred method”, Alison. It was the method that was available to me. The method I wanted was restricted because I was attached to a monitor to make sure my baby was okay. That’s life.

            I’m not particularly interested in an argument on the relative risks. As I said, I avoided an epidural for MY OWN HEALTH, not my baby’s. I’m not opposed to epidurals, I may have one next time, who knows. I’m open to it if I need it, like I was this time, but I don’t want to have one if I can avoid it, as I’ve had enough back problems due to arthritis, and also the idea of it just freaks me out. None of that is an argument about the safety for the baby. It’s personal preference. I believe a mother’s comfort and safety is of equal importance.

            I don’t think I have anywhere argued that one pain relief method is better or worse. I’ve just shared what I personally preferred. My main point, anyway, was that pain relief is avoided for the sake of the child, NOT just because women want to “tough it out”. No doubt some women wish to prove themselves. I didn’t. I don’t think that matters. What matters is my health, and my child’s health. And the pain, goodness, it was horrific! I can’t imagine doing it without any pain relief ;)

          • Young CC Prof

            That’s a bit of a stretch. Someone told you epidurals pose a risk to the baby because IV fluids artificially inflate birth weight, which can lead to formula supplementation, which can interfere with breast feeding?

            Careful formula supplementation doesn’t interfere with breast feeding, and whether you get IV saline doesn’t depend on whether you have an epidural. Also, smart nurses are aware that well-hydrated babies have extra weight loss on Day 1.

          • Rachel L

            Okay, well I’m not going to be sucked into an argument on breastfeeding versus formula. As I said:

            “It’s sad that something so simple can become a barrier to breastfeeding.
            (I don’t think this is a reason to avoid epidurals by the way, but it’s
            something to be informed about if you choose one.)”

            My point in responding to Wren was that avoidance of pain medications during childbirth is not always simply about trying to be a superwoman. It’s just as often, if not more often because of the risks (real or perceived) to the baby. I’m not particularly interested in discussing the ins and outs of those risks. I was just offering an explanation to Wren.

          • Sally RNC-NIC

            A-men.

          • Trixie

            If IV fluids increase birth weight, and I believe there’s evidence that they do (and certainly this was anecdotally true in my two births), then the solution is to account for that during the baby’s first 24 hours. Not to just deny women epidurals. My first baby (lots of IV fluids) dropped from 7 lbs 3 oz to 6 lbs 6 oz, and because he was clearly nursing well and clearing meconium like a champ, no one ever talked to me about formula. He definitely peed a lot more in his first day than my baby born with only minimal IV fluids (2 bags of antibiotics for group b strep).

          • Rachel L

            Hi Trixie,
            I would never suggest that women be denied epidurals! And certainly not on the grounds of fluids. Please don’t twist my words around. I’m not against epidurals, or any other type of pain relief.

            And I didn’t suggest that epidurals are worse for the baby than other types of pain relief. The main reason I wanted to avoid one is because of the risks to myself!

            I absolutely agree that the solution is to account for the fluids, and adjust accordingly. Unfortunately I don’t see that being done nearly enough.

          • Trixie

            What risks to yourself?

          • Rachel L

            Tonight I actually heard a story of a woman being denied pain relief by a midwife in hospital. Pretty disappointing. Excuses excuses – hospital is too busy tonight, etc. She only wanted gas and air! Horrible. Thankfully that is rare, this is the first time I’ve heard of that happening in an Australian hospital.

      • Trixie

        Also, there are plenty of pain medications that are safe while breastfeeding. What do you think mothers have to do after c sections? Being a breastfeeding mother doesn’t mean you can never ever have a drink of alcohol or take medication for a headache. Even as a breast milk donor for preemies, I was allowed to havean occasionak drink as long as i waited a certain number of hours before pumping cor donation again. For my own, healthy baby, the risk was even lower.

  • Alexicographer

    I read Dr. T’s post, and many of the comments. I think those interested in the basic question raised — why do women (and couples) choose not to give birth in hospitals — could do worse than to read Anne Lyerly’s recent book Good Birth. I assume that Dr. T. is aware of it, but others may not be. Lyerly’s an OB, and her book is based on interviews with women before and after their birth experiences (in various locations) and with care providers, including midwives (I don’t remember whether limited to CNM’s or not). If there were one (more) book I wish I could have read before I gave birth to my son, I think it would have been this one (I had a good birth experience in a hospital that started under the management of CNMs and concluded with a c-section, and a healthy baby, after a long and unproductive labor).

    Much of what the book provides is distilled information (wisdom?) about aspects of the birth experience that women and their partners identify as important. But beyond that and possibly relevant to this discussion, Lyerly makes the point that birth is an experience that literally changes the world. That after it has happened, there is a person here who literally was not here before (obviously we can diverge her into a discussion of “when life starts,” but that really isn’t the point. Of course a full-term infant didn’t just miraculously appear from nowhere and existed before being born. But in terms of how people experience it, birth is in an important way the moment in which that new person arrives in the world and, for those most involved in the event, in their lives.). Lyerly does also discuss how death — care of terminally ill patients — shares aspects of this feature, in reverse of course, and is in someways (though not identically) similarly laden (and it is often described as something that in the US should more often happen outside of hospitals).

    I don’t know quite what this means or how to think about it, but I agree with Lyerly’s sense that (though it is perfectly easy to understand on a “rational” or “logical” level) there is something very weird-feeling about the way that people who have existed, can cease to exist, and people who haven’t existed can come into being. And I wonder whether it is, in fact, something about our emotional inability to understand/wrap our heads around that, or our desire to imbue such moments with meaning, that makes decision-making about birth (and death) different from other events that either necessarily or by choice may involve medical professionals.

    • Young CC Prof

      I just looked up the book and tried to read it, but it became apparent on Page 2 that the author doesn’t understand medical statistics. “Too many c-sections” and “The US spends more and gets worse outcomes…” (The US doesn’t actually get worse outcomes, and birth costs more here mainly because all medical care costs more here, due to the nature of our health care structure and payment systems.)

      Kinda lost interest at that point, as someone who comes to the table with the wrong facts is probably not going to help us arrive at useful conclusions. I like social science, but social science off a bad premise is just pie in the sky.

      On the other hand, yes, there is a social and psychological dimension to giving birth, entirely unlike most brief routine hospital admissions. (If I was going to have my gallbladder out, I sure wouldn’t bring a camera to remember the occasion!) Yes, people want to remember at least some aspects of it positively.

      Thing is, though, hospitals do that more and more already. Visitor policies in maternity wards are different, there’s more privacy, more control, etc. At my hospital, every time a baby is born, they play a song over the PA system that you can hear through the whole building, and many of the staff look up and smile, just for a moment.

      • rh1985

        See, I “care” about the birth to the extent it will be wonderful to meet my new baby after. As long as the experience isn’t hellish and I get appropriate pain relief, I really don’t care about the rest of the actual birth itself. I can’t wait to meet her but I don’t care about the actual birth experience beyond, as I said, it not being awful due to poor care, etc.

        • Young CC Prof

          Actually, while I was just showering, I was thinking more about this question. And birth ISN’T so unique. When I had my ankle repaired, after years of pain and disability, I saw it as very much a transitional thing. When I limped down the hall to the OR, slowly, having left my aids behind, I felt like old-me was going to die there and able-me was going to be born.

          I didn’t expect to enjoy the experience of being cut into and rearranged. However, my expectations were fully met, both the most critical and the secondary. Staff took my medical history, my pain was controlled, and the surgery was quite successful, with no complications or unexpected damage.

          I definitely see birth in a similar way. Yes, some aspects of it are going to suck, but ultimately, it’s one day out of my life, and then I get a wonderful baby to take home. I expect hospital staff to prevent disaster and minimize the pain and other unpleasantness as far as they reasonably can, beyond that, I don’t much care. (But I DO want pictures!)

          • Alexicographer

            I did care, though not, certainly, in a way that involved anything trumping bringing home a safe healthy baby and staying safe and healthy myself. And I think I would again, if I had the chance (I am past that stage in my life). Which is not, of course, to say I think you should, but I think plenty of people do.

            (For reference: I have also had an appendectomy (and subsequent treatment of a resulting abscess), extensive infertility treatment (6 IVFs and several FETs), an external version, and surgery to reconnect the ball of my humerus to the rest of it. I certainly cared a lot in all cases about the quality of the medical treatment I was getting, and I’d absolutely extend that to things like private rooms for recovery from the surgeries and attentive nursing care. But as a life-altering experience deserving attention as such, not so much (the IVFs, or at least the first couple, might have teetered on the edge of that line, but not the other stuff).

      • Siri Dennis

        What, like when Scandinavian car ferries play Anchors Aweigh upon departure? Baby’s away, my boys, baby’s away! All through the night she screamed, until she got the e p i d u r a l/ For a long time she pushed, it was no use/OB came to the rescue, now we have some very happy news! That kind of stuff? (Please hum the A A tune as you read the words)

        • Young CC Prof

          Actually, it’s those chimes mobiles play. Just a few bars, but everyone knows what it means.

          • fiftyfifty1

            Do they still do it for a stillbirth?

          • Young CC Prof

            I don’t know. Probably not.

          • Something From Nothing

            Exactly. It’s weird.

      • Captian Obvious

        Our hospital plays Brahms lullaby throughout the hospital with every birth.

        • Something From Nothing

          What is that all about? Our hospitals CEO just started that and I’m mystified that anyone thinks it is a good idea. It’s distracting, isn’t great for confidentiality in small hospitals, and is down right annoying.

      • Ainsley Nicholson

        I remember when my sis was battleing for her life in the burn unit, how lifeafirming it was to hear that little “a baby has been born” tune.

      • Alexicographer

        True enough, on hospitals — but doesn’t that make it still more puzzling that women choose to avoid them (I for one was perplexed by the thought that I might want to give birth in my house, of all the crazy ideas — and that’s even ignoring concerns about medical care and safety. I mean, hello?!? Who’s going to wash the sheets? Deal with the dogs? No thank you.).

        As for the rest, well, OK. But my sense is that the book is written with the intent that it be read by women facing needing to make decisions about where to give birth, and those are pretty soft-pitch lead ins. So I personally can’t get too riled and don’t know of other efforts similar in scope to figure out what women think (pro- or retroactively) about birth, so do still think there’s useful information in here if one’s willing to read through it, but fair enough if you’re not (there are of course plenty of other grounds on which we can pick through this sort of social science, after all — sample design, reliability of information gathered, and so on).

        • DaisyGrrl

          “I mean, hello?!? Who’s going to wash the sheets? Deal with the dogs? No thank you.).”

          I don’t know why, but I got the image of a big goofy lab garbage diving for placenta and the chaos that would ensue. “Rover’s got the placenta! No! Bad dog! Drop it!” All the while, dad running after dog, dog having a great time with yummy afterbirth, mom wondering who is going to clean up the damn mess…

          Yet another reason for hospital birth (although it would make a great story after a few years).

          • Alexicographer

            Haha. Yes, exactly. I had not even envisioned things in that much, er, detail, but yes, that’s pretty much it!

    • L

      THIS is the awful book that started me on the NCB path of lies and screwed up priorities. They actually use the phrase “caesarian epidemic,” as if it’s contagious and you’ll catch it in the hospital. They state, “if you don’t know your options, you don’t have any.” Then present options of hospital birth, birth center birth, or home birth, as if they are more or less equal, misleading me to think a birth center was a good compromise between two extremes. Other options include declining the pubic shave and enema, which is so relavent today! They continually rant about women having bad birth experience based on a freaking survey, ripe for cherry picking. This book is not science, but it’s disguised to look like it, which lures in well-meaning women who are genuinely trying to get educated about birth, not realizing it takes years of med school to actually do that. I have so many regrets and misinformation in my head, all starting with this stupid book.

      • L

        Sorry, I thought you were taking about Good Birth Safe Birth, a different book.

        • Alexicographer

          Ha. I did wonder as I started reading your reply what you were talking about, but, fair enough. I don’t think I’ve ever read the other book.

    • fiftyfifty1

      That’s interesting. The way you describe it seems kind of New Age-y in it’s tone. Is that how the book seems? Because the rise of the modern homebirth movement certainly has coincided with the rise of New Age beliefs. Certainly before the rise of New Age, birth and death were seen as important in many religions. But it seems to me that they were seen as important just because they were important not because of the *experience* so much. The judeo-xian Bible doesn’t seem to place any importance at all on a woman’s birthing experience (except to say it was a punishment from God). The only thing that seemed to matter was producing a male heir and that she was “unclean” for longer if she produced a female. Death was more of a big deal. It mattered where you got buried and which of your sons would be your heir.

      Does the book address at all breastfeeding and how it has morphed from being “a way to get the baby fed” to being ladden with so much “meaning” and morality? Because this has gone hand-in-hand with the whole NCB movement that has placed value judgements and “meaning” on how the baby arrives.

      So when I think about it, how we see birth seems so much more cultural than it seems to be inevitable. i.e. inevitable that women would want to birth at home because it’s natural that they should find the birth process so meaningful or something.

      • AmyP

        I believe Rousseau and Tolstoy were very big into breastfeeding. Rousseau in particular is probably a huge, unsung factor in modern breastfeeding ideology.

        “Tolstoy is reported to have mercilessly hectored his wife about breastfeeding their children herself, instead of following common practice and hiring peasant wet nurses. In Anna Karenina, Tolstoy pays quite a bit of attention to the nursing of infants. Kitty earns Rousseau’s highest seal of approval by breastfeeding Mitya herself.”

        As Countess Tolstoy had 13 children (and 8 that lived), there was presumably a lot of hectoring going on.

        Read more: http://www.oprah.com/oprahsbookclub/What-Was-on-Leo-Tolstoys-Bookshelf/3#ixzz2nYp2Jcn4

        • fiftyfifty1

          Fascinating!

          And now men don’t even have to do the work of hectoring us themselves! We women now hector each other!

          • Nashira

            Peer pressure has always been an essential tool used by the majority to keep them pesky minorities in line. :( Get a few people to buy into whatever line of control sounds good, and they’ll force that idea onto their peers out of fear. We all have to be good little girls. :/

        • The Computer Ate My Nym

          Tolstoy was a jerk. I finished War and Peace of the opinion that the Russian Revolution went too easy on the aristocrats. (Don’t be alarmed: I got over that opinion pretty quickly.)

          • auntbea

            I spent my entire senior year of high school trying to convince my AP lit teacher that Tolstoy was a misogynist. I failed to convince her, but have yet to abandon that position.

          • Kat

            Really? I thought that was commonly held thought in the discipline. I study American Lit, so my Russian Lit theory is well… lacking, but he wrote “The Kreutzer Sonata” and I couldn’t imagine anyone reading it and thinking Tolstoy wasn’t a very repressed and confused misogynist. The thematics are…we… really telling. / off topic. Sorry.

      • Alexicographer

        Honestly, I didn’t read the book with the intent of reporting on it here (or anywhere), and I read it a little while ago. So with those caveats in place, no, it didn’t strike me as the least bit new-agey, and if it discusses BFing at all, I don’t remember that (after reading the book myself I passed my copy along to a friend who is expecting — and planning to give birth in a hospital — so I cannot check my recollection against the book itself).

  • Lynnie

    I think a lot of people are afraid of hospitals and have it in their minds that they are for critically ill people. A hospital is a place to go to die. Also, the scare of getting MRSA or other hospital related infections scare people away from the hospital. Of course, the NCB advocates really don’t help by feeding those fears and making it seem worse than it really is. I, fortunately, had the privilege of getting my fear of hospitals abolished by me working there for 3 1/2 years before my son was born. I was a housekeeper and it was the last place I wanted to work because I was so afraid of hospitals. It was basically the last resort of for a job that fit my personality and skill set. (I would go crazy in an office job-I have to be moving, and I can’t stand customer service.) I was greatly surprised at how “friendly” a hospital could be. It wasn’t the scary place that kills people or has big nasty germs waiting to kill you. I learned, in great detail, how well the rooms are cleaned because I did it for years. I also had the opportunity to get acquainted with just the hospital environment. Also, I got to hear about and see some of the complications of birth, like the young mom who hemorrhaged and was saved because the OB rooms are right next to the OR. (Not breaking HIPAA, of course. We were called to clean up the aftermath.) So many people have never been hospitalized for any thing. I am one of them. I have only been admitted to the hospital twice, once for MY OWN birth and once for my son’s birth. I have had a few ER visits to get stitches, but that’s it. I pretty much avoided even entering that place before fate made it so I worked there, which I was grateful for in retrospect because I probably would have been stressed out and terrified in labor if I wasn’t familiar with the setting.

    I am not excusing the fear mongering of the NCB advocates. They are doing great harm to those who, like me are terrified of the clinical setting. Instead of helping women make good choices of where to give birth, they take advantage of those poor women and feed those fears and get them to make very unwise decisions.

    I remember when I was pregnant, my husband “knew” that a C-Section was a horrible, horrible thing. It was the last thing that we wanted to have happen…UNTIL we went to the childbirth class offered by the CNMs at the hospital. The CNM described the procedure and why they do it and my husband told me after the class that a C-Section was no where near as damaging to the mother’s body as he thought it would be and it wouldn’t be the end of the world if I needed one. I didn’t. I actually had an “easy” induced birth. But this shows that REAL education, not indoctrination can ease a person’s fears.

    • Captain Obvious

      How is MRSA spread? From people. When these people who are colonized with MRSA are not in the hospital, where do you think they are? At home, or visiting their family, potentially exposing them to MRSA.

      • Lynnie

        Exactly. I remember my boss telling me when I first started that the germs that put people in isolation rooms in the hospital are probably the same as meeting some random person out in public or on shopping carts in the store.

        • http://shameonbetterbirth.wordpress.com/ Shameon Betterbirth

          Why would they be the same? They are not subject to the same selection pressures, This isn’t to say that none of the bacteria in an ICU is in someones home (or vice versa) but the selection pressures will effect the population of bacteria in an environment. There isn’t much vanco being used in households, for insance. I thought people on this website were into science (like evolution)?

          edited to add: I am trying to find an article I read a few weeks back about this exaclty. It was about how immune systems develop in response to the environmental bacteria that is present- so living too ‘clean’ may not be such a great thing. The author was so good at conveying the nuance of this problem and the available research, I really wish I had bookmarked it.

          • Wren

            It may be in a different ratio, but where do you think the germs in an ICU are coming from? Community acquired MRSA is hardly a new concept.

          • Mishimoo

            Currently waiting on a culture to rule that out for my 5.5 month old. Probably isn’t, as there is no abscess and the rash is now nearly healed, but neither the doctor nor I had seen anything like it before. (I lived in the tropics for ~6 years, I’ve seen some interesting things) Better safe than sorry!

          • Captain Obvious

            Our telemetry unit did a pilot study swabbing every admission for 6 months. Approximately 30% of every admission came to the hospital with MRSA colonized on them already.
            You do understand the difference between colonized and infected.

          • Lynnie

            Her whole point was basically that we didn’t have to be especially terrified of getting sick from cleaning hospital rooms. We were to take precautions, of course. But we had a better chance of getting sick from the store than a patient because people out in public really don’t take precautions against infecting others when they have like the flu or something.

          • fiftyfifty1

            Shameon, you don’t understand science nearly as well as you think you do. The vast majority of MRSA infections absolutely are aquired in the community. A LOT of community-dwelling people are colonized with MRSA. When they enter the hospital they are tested on admission and isolated if they are positive. But prior to admission they were walking around, living their lives, picking their noses (the nose is staph’s favorite place to live because it is warm, moist and is constantly bathed in oxygen, staph is an obligate aerobe) and touching your shopping cart handle. So Lynnie’s point is absolutely valid. Nice of you to accuse her of being unscientific when it’s you that doesn’t know the science.

          • Lynnie

            I’m not very knowledgeable about the different kinds of diseases or how they are treated. My knowledge and experience in medical things is actually extremely limited. I was a housekeeper at a hospital for a couple years. My job was to clean. And from a cleaners point of view, a germ is a germ is a germ. Yes, certain germs required special cleaning procedures and extra protective measures. So, yes, I am not all that scientific when it comes to medical things. My whole and only point is that people are afraid of getting sicker from the hospital. Yes, it can happen, but it’s rare. There are all sorts of protective measures to keep infections from spreading.

          • Ainsley Nicholson

            True, bacteria are under differant selective pressures in hospitals than they are in the general community- they are more likely to be exposed to uncommon antibiotics and disinfectants in the hospital. There is likely to be a population of bacteria in any hospital that has circulated for a while and been under that selective pressure…if they can survive at all, they are likely to encounter sick people and could make those people sicker, and will be very hard to eradicate if they do. At the same time, people are constantly bringing in other populations of bacteria from the community that have been under selective pressure to survive and thrive in healthy people with robust immune systems. These bacteria are also very dangerous to sick people. They are also probably more common in the hospital environment than the hospital-adapted strains, simply because they are being brought in constantly.

      • http://shameonbetterbirth.wordpress.com/ Shameon Betterbirth

        Most people aren’t having surgery in their houses, and most people aren’t in the position to spread infection as far as a single lazy RN or MD could because they aren’t doing medical procedures on their neighbors and friends.

        • Captain Obvious

          Huh? If uncle joe is colonized with MRSA and your two year old daughter cuts her leg playing, if uncle joe helps clean her leg, he is probably infecting her leg right there in your own home. Most hospital staff are trying to prevent themselves from getting colonized from their patients. When I have a known MRSA carrier, the whole OR and post OP room is in isolation.

        • Sue

          MRSA is much more likely to be found on surgical wards with wounds and amongst the elderly with chronic disease. Labor and post-natal nursing staff, CNMs and OBs only work in these areas – they don’t work all around the hospital. Similarly, MRSA is very uncommon in Kids’ Wards.

          Labor and post-natal wards are filled with young healthy people – and almost all infections are brought in by the mothers – either vaginally or through PROM or chorioamnionitis.

      • Alexicographer

        I’m not a medical professional (nor trained to be one).

        Per a couple of abstracts pulled up via PubMed, “Historically, … MRSA was found almost exclusively in hospitals and/or health care-related facilities. However, in the late 1990s,community-associated MRSA strains emerged in the United States and rapidly became the leading cause of community-associated bacterial infections.” Which doesn’t mean that community-acquired MRSA is more common than hospital ditto, just that it’s more common in the community than other similar such infections. The full text might have more info. but I can’t access it free; abstract is here:
        http://www.ncbi.nlm.nih.gov/pubmed/22759601

        However, per http://www.ncbi.nlm.nih.gov/pubmed/22178559, “Community-acquired … MRSA (CA-MRSA) have emerged worldwide. These CA-MRSA are different from classical hospital-acquired MRSA. … They are mainly responsible for suppurative skin infections and rarely for invasive infections such as necrotizing pneumonia.” which to me at least sounds as though hospital-acquired MRSA (whether more or less common than community-acquired) is typically less serious.

        I’m not presenting this as an argument against giving birth in a hospital, but my admittedly quick read of the above suggests that it may well be rational to be more concerned about acquiring MRSA in the hospital than elsewhere.

        • Young CC Prof

          I would imagine that hospital patients wind up with pneumonia more often due to vulnerability, not to the inherent deadliness of hospital germs.

          MRSA gets a lot of press, but it isn’t naturally more lethal than other staph infections. In the absence of medical care, all staphylococcus aureus infections are equally harmful. MRSA is just that, methicillin-resistant, which means harder to cure if you get it. Your body’s natural defenses against bacteria are equally effective against all staph strains.

          The other question is, how much staph will one find in a maternity ward? Probably less than in other parts of the hospital, where you have folks actively being treated for nasty infections.

          • Mishimoo

            I’m not sure how often staph is found in a maternity ward, but I do know that my husband’s cousin was VERY offended about being quarantined when she delivered her eldest. She couldn’t understand why they wouldn’t let her into a normal ward with an active staph infection.

          • Lynnie

            I remember at least one isolation patient in the OB rooms when I was a housekeeper at in small town hospital. And we cleaned the heck out of that room. When someone comes in and is put on isolation when they check out, we clean the walls, the ceiling, take down the curtains, disinfect every thing that could have possibly been touched. We took “isolation cleans” (what we called them) very seriously. We did not want a disease being spread and it being traced to how the room was cleaned. I didn’t even work the OB area at that time, but I was pulled in to help with that room. It’s not all that common for a mom in labor to be in isolation, but as far as the cleaning staff goes, we try to make sure that there is as little chance as possible that a stray germ didn’t live long enough to infect another person, especially a baby.

        • Amy Tuteur, MD

          HA MRSA differs substantially from CA MRSA and therefore affects different types of people and causes different complications. HA MRSA typically affects chronically ill, immunocompromised patients who have been exposed to multiple antibiotics and represents a multi-drug resistant form of MRSA.

          CA MRSA can produce a toxin that disables white blood cells allowing an infection to spread unchecked because the bacteria disables the body’s ability to deal with it. CA MRSA is found in the community and can be deadly to people who are healthy.

          There are lots of risks to being in a hospital, but HA MRSA is not likely to be a risk for otherwise healthy people.

          • Alexicographer

            Makes sense, and thanks. My sense is that this information doesn’t come through in the general dialogue on MRSA, i.e. that plenty of people (certainly myself included) don’t know it.

  • Gene

    OT, but possibly related to NursingRN’s post earlier: FB birth announcement from a friend of a friend. She’s homebirthed before. I doubt they are the same person, but I don’t think she knows how easily should could have been.

    “I successfully vbac’ed after 3 c/s! One minute I was being rushed in for an emergency c/s with a BP of 56/28 and the next I pushed out (baby). There were no complications.”

    So, IN SHOCK, DYING in front of her family, and she thinks there were no complications. Because the baby arrived via vagina. Amazing.

    • Lynnie

      The vagina is the magic portal to happiness and rainbows and magical unicorns. Didn’t you know that?

      • Siri Dennis

        Sorry, mine’s a dead end. No use running in there to try to escape – you’ll be cornered in my uterus, that is if you can even get through my cervix. And no one, and I mean NO ONE! Is allowed anywhere near my peritoneum.
        .

      • The Bofa on the Sofa

        Speak it, Sister!

        (this is a guy talking, btw)

    • Anj Fabian

      [stunned]

      I think we need to have a sit down with some people and explain what exactly qualify as “complications”.

  • This is not my name

    I did not hate the hospital, I was AFRAID OF the hospital, therefore I decided not to go there unless I absolutely had no other choice.

    Hospitals should work on their PR at least as aggressively as the HB movement works on its PR. Seriously. I ended up going to the hospital for the sake of my baby, at the last possible moment but still long before an emergency transfer in panic. I would never have gone if not for my baby. It was not a trust issue concerning the OBs but a trust issue concerning the hospital protocol and choreography itself. I would like to see this problem addressed – it is so easy to see HBers as a bunch of defiant people having trouble with authority and then blaming them for the outcome but a good percentage of them are terrified people with a history of abuse and shattered physical boundaries, and the hospital represents something far worse for them than a “scary environment”. (Would you call a torture chamber a “scary environment” as such? Is not wanting to go there a sign of defiance or something else?) I am not saying that they are RIGHT in their judgement. I am just saying that hospitals could do a lot more for their PR and they could save lives just by doing this.

    • fiftyfifty1

      I disagree that they should do more PR. They are already doing plenty of PR. My hospital provides birthing suites, they welcome any number of people into your delivery room, You can chose an OB, an FP or a CNM. You can have a full water birth. This is all prominently displayed on their web site and in their videos. The videos profile interviews with providers where they encourage patients to “ask lots of questions” and “we want to be partners in your care”. And you know what, women are *overwhelmingly* satisfied with their experiences. We have satisfaction surveys coming out of our ears here. And yet there is still demand for homebirth. I have said it before and I will repeat: The hospitals are not driving women away, NCB is spiriting them away with its LIES.

      For hospitals to do more with PR in order to win over the fringe we would have to start doing what NCB does: LIE. The reason that NCB attracts customers is that they LIE about the biology, they LIE about the hospital environment, they LIE about their own processes, and most important the LIE about their outcomes and LIE about their death rates. Should we start lying too? “You go mama! Think good thoughts and all will turn out well! Birth is gentle! Birth will make you feel powerful! You won’t get post-partum depression! Nothing scary will ever happen during birth! You are in charge of the biology, not at the mercy of nature! This will make you the best mama ever! Your baby will be healthier than other babies! This will heal all the ways you feel broken!”—Total crap.

      Adults with problems with hospitals or authority etc. are not at fault for the traumatic events in their lives that have predisposed them to fear. At the same time they ARE responsible for addressing their own issues and fears. This includes being forthright with their medical providers. This includes getting therapy when needed. Bringing support people. Self care. This is what healthy adults (or adults in the process of getting healthy) do. Expecting some sort of special PR that tiptoes around the truth is not the way to go.

      • Stacey

        Same here. and all the options- even free doulas!- do nothing to make the NCB crowd happy.

        Fear of a hospital is a rational fear, as we all know that it’s the place you go when something is pretty wrong. I get that. But there is really no way around this. The beat they can do is offer as nice of an environment as possible. Many do.

      • ngozi

        I’d like to see my local hospital get rid of doctors who verbally and emotional abuse patients. I’m not asking for rainbows and cotton candy, just a little, if only a little respect.

    • fiftyfifty1

      When a person believes that a hospital is like a torture chamber, that is a sign that their mental health is really suffering. They need and deserve healing. Or health system has an excellent Womens Center that staffs some outstanding trauma counselors, including therapists skilled in helping patients with past history of physical, sexual and emotional abuse. We also provide comprehensive, culturally sensitive treatment for victims of torture. We also provide support groups for victims of abuse and torture and also DBT groups for those whose extensive trauma histories have caused persistant maladaptive behaviors.

      • http://shameonbetterbirth.wordpress.com/ Shameon Betterbirth

        A hospital can be like a torture chamber, absolutely. You don’t know much about how patients are treated if you think that you have to be mentally ill to perceive the hospital as torturous. I have so, so many stories about abysmal patient care which could reasonably be perceived as torture by a patient. I have worked at multiple hospitals, and in different states. Its not a rarity. Its just a reality of what can happen when people have power over each other without the accountability that should accompany it. I am shocked that someone who works with trauma victims is unaware of this side of human nature; its what I would realistically expect of the system based on the way it is structured.

        • Anj Fabian

          While I agree that there are stories about unacceptable patient care out there, in my experience the closest I even came to torture had nothing to do with the hospital and everything to do with being in labor.

          Anyone who thinks that giving birth outside of a hospital will spare them from a torturous experience apparently thinks that being in a hospital is at least as bad as being in labor. A disturbing thought.

          • ngozi

            My local hospital actually has a not-so-great reputation, and I have had several bad experiences there, but I can’t say I was ever truly tortured.

        • drsquid

          and i have worked at many hospitals in many states as well as in other countries and quite frankly have never seen what could be perceived as torture. the most i have seen is foreign grads not understanding that here we dont get to tell patients they have to do something (and that was one case of an ng tube someone didnt want.. and didnt get). what did you do at those hospitals?

          • Squillo

            When I worked in the local Big Effing Hospital, I saw 2 incidents that I would qualify as pretty close to torture. Both involved procedures with clearly inadequate anesthesia (local with sedation in one case, just local in another–so no anesthesiologist), and both were vulnerable patients: one was a non-English-speaker, the other was in the final stages of a terminal cancer and was not completely coherent. In the second case, the circumstances were also, I believed, completely unsafe and unacceptable. (I reported it to the chief of service.)

            It may be that adequate anesthesia would have been unsafe or impossible in either case, but there was no way to comfort either patient or explain to them what was happening. While I’m sure the surgeons’ intent was not to torture, I’m equally sure that both patients would have perceived their treatment as such.

          • Jessica Atchison

            I’m glad you’ve never seen poor treatment in hospitals. Personally I have often received excellent care, but occasionally not so much. I was hospitalized after gall bladder surgery. Specifically kept for two extra days for pain management as the surgery was complicated and required more extensive incisions than are normal for cholecystectomy these days. The first night in the hospital I woke up an needed to use the bathroom. I called for the nurse to help me as I was attached to an IV line. She eventually came and helped me to the bathroom and then left me in there. I hit the call button for help again when I was ready to go back to bed. 45 minutes and three calls later I was still in the bathroom in agony at this point from being upright. I finally got myself back to bed and called again for the nurse. This time she responded in a huff wanting to know what I could possibly want. I explained that I was now in agony and needed pain meds. She refused to get me any as my next dose was not due for another 15 minutes. I asked her to page my doctor and ask if it was ok to administer the dose early and she refused and then left the room telling me not to page her again because she wouldn’t answer. I laid there for another 45 minutes before she finally came back to administer my next dose, 30 minutes after it was due. She was so rough inserting the needle into my catheter that she shoved the whole thing through the vein and my IV infiltrated my hand. The entire bag of saline emptied out into the tissues of my hand, which was very painful. I was unable to get her to come back into the room to check what was going on with that. That was also the only dose of pain medication she administered the whole night. The next morning I reported her to the nursing supervisor as soon as she came on duty and I also reported her to my doctor. The response I got from her supervisor? “Oh yes, we know she’s a problem.” My doctor, on the other hand, was furious. He had specifically kept me for pain management, and I did not receive proper management. He said the nurse should have paged him if she had any questions about the timing of my dosage. She also should have waited in the room for me to finish in the bathroom and not left me alone.

            I was in the hospital another time for a broken ankle and broken shoulder.(different hospital) I was in the hospital for a week and a half, and the entire time I was in there I was not bathed once. I asked the nurses for help with bathing and was told “we don’t do that anymore.” My mom finally brought me some baby wipes and helped me bathe myself because I couldn’t stand the sensation of being so dirty any longer.

    • http://shameonbetterbirth.wordpress.com/ Shameon Betterbirth

      “PR” is usually a way to be deceptive, to fool people. They need to work on being accountable for staff behavior (including stuff like hand hygiene).

      • fiftyfifty1

        Do you think hospitals are not accountable for staff behavior? Are you aware of the numerous studies addressing the issue of ensuring hand hygiene? A massive effort of research and enforcement went into combating hospital-acquired infections once this problem became apparent. It has been hugely successful. It’s not cool to make accusations that aren’t supported. It just spreads misinformation.

  • NursingRN

    Last night at work we had a gal who was just dead set on laboring naturally and having her baby naturally kept refusing a section. She insisted on this after she was diagnosed with chorio still refusing a section, and guess how she spent her glorious birth? Intubated, septic in the ICU (after a stat section) baby? SICK, in the SCN with IV antibiotics.

    • amazonmom

      I would upvote this but that would seem wrong . What a train wreck.

    • Young CC Prof

      Yup, that’s what NCB teaches. We do too many sections, doctors are too quick to cut, so you should delay and delay and delay, until you just push out your baby naturally! Or until it’s obviously a dire emergency, then trust the hospital to rescue!

      • DaisyGrrl

        But now when her NCB friends tut tut about her c-section, she can say “but it was a necessary c-section. I’m not too posh to push!” and have herself a healing VBAC with dolphins next time.

        • Guest

          Way to go for kicking someone when they are down. Lovely. Go ahead and disagree with choices, but making sarcastic, nasty comments is completely unnecessary.

          • fiftyfifty1

            How is this kicking her when she is down? DaisyGrrl makes a valid point. She does it with wry humor, but wry humor expresses sadness and sympathy pretty clearly I feel if you take the time to read it.

            The peer pressure within NCB circles is very strong. The only c-sections they will accept are ones where they have *proof* that you almost died. This women, sad to say, will be able to provide the sort of proof they demand. But yes, they will expect her to try for a healing VBAC anyway (if she lives, which is not a given).

          • DaisyGrrl

            Thank you fiftyfifty1. I tend to deal with strong emotions through sarcasm/off-colour jokes. I truly do hope this woman lives and she and her baby thrive. It just makes me so sad and angry and frustrated that she got to this point.

            Refusing a c-section until it was life-or-death is problematic to me on so many levels. I wonder why this woman was so adamantly against the c-section? Was she convinced that her child would be asthmatic and autistic unless she gave birth vaginally? Did she have a pathological fear of being cut open? Maybe she truly preferred death over c-section (truly not a position I can understand). If she lives, has she sacrificed her future fertility? Will she blame herself for not trusting birth? What about the baby? How is he/she doing? What would the effect be if the mother dies and the baby grows up believing he killed her? If she’s left permanently injured from the infection? So much waste.

    • Ra

      And then the homebirth advocates will blame it all on the “cascade of interventions” rather than on the real cause.

    • http://shameonbetterbirth.wordpress.com/ Shameon Betterbirth

      thats too bad. the ICU is a horrible place to be.

    • DaisyGrrl

      So you guys didn’t tie her down and force her to have a section once dinner time roled around? You didn’t make up stories just to scare her into an unnecessarian? You respected her refusals? Impossible! That’s not how hospital birth works! (/sarcasm)

      • http://shameonbetterbirth.wordpress.com/ Shameon Betterbirth

        god damn I get sick of this kind of shit on here. A woman is in the ICU. Have some respect for the situation. Have some respect for women who were forced into c-sections.

        • fiftyfifty1

          Huh? Where does this come from? Very strange reply! A nurse expresses her frustration at having to watch a woman nearly die (and she may yet die!) because she has swallowed untrue ideology. Another person replies that this is a counter-example to the NCB trope that women will be forced into a C-section. And that sends you over the edge? You think that’s disrespectful? I am having a very difficult time seeing where you are coming from.

        • DaisyGrrl

          And I’m sick of the narrative that NCB pushes. One of the reasons that this woman and her child are doing poorly is from her refusal to have a medically indicated c-section before it became emergent. You know that as well as I do. The NCB mindset has unnecessarily endangered the lives of this woman and child and the medical professionals who are responsible for their wellbeing had to stand by and watch it happen! Because they weren’t forcing her into a c-section! I imagine it was difficult for them to watch the train wreck unfold in front of them.

          In the last few months, the only case I’ve heard of where a woman was literally forced into a c-section was one in which the woman was so out of her goddamn mind that she was incapable of consent and posed an actual risk to her child. I’m not sure what I think about that case yet, but it is certainly not a common scenario. And yes, the case is under all kinds of review to make sure that everyone’s rights were properly respected to the best of everyones abilities. Just because a woman wished in retrospect she didn’t have a c-section doesn’t mean she didn’t consent to it at the time it was offered.

          Compare that to the multiple unnecessary deaths of mothers and babies that are a direct result of the Natural Childbirth philosophy. It’s not even close. At least hospitals and the mainstream medical system have safeguards and are open to change based on feedback and evidence. You can’t say the same about NCB.

          • me

            “…and the medical professionals who are responsible for their well being had to stand by and watch it happen!”

            I agree with a lot of what you are saying here. BUT. Where were these medical professionals 6 months ago? The NCB-nutters are only able to get their ‘hooks’ into these women because the medical professionals spend precious little time on actual patient education. When the nurse rushes you in and out (weight, BP, pee in cup, okay wait for the doc) and the doc spends maybe 10 minutes with you, and no one seems to want to mention the word ‘labor’ until somewhere around the 36th week, are you really surprised that women take it upon themselves to google shit? And then of course, they encounter the NCB stuff. They might try to ask questions at an earlier visit, based on what they read, but doctors can be (not all of them, but enough) quite dismissive; I’ve had some even seem personally offended by simple questions. Or worse yet, they say, ‘we’ll talk about L&D at a later visit’, and leave you on your own until then.

            But they “had to” sit by, right?

            Yeah, not so much.

          • DaisyGrrl

            The OB wasn’t the only one in the room. There would have been no reason for the woman to have met the L&D nurses or the anesthesiologist before she went into labour. There would have been several professionals in the room by the end of it looking after both her and her baby who wouldn’t be expected to have any role in preparing her for what to expect. And yes, they “had to” stand by. She refused consent for a c-section. Doing a c-section against her consent would have been medical battery and ethically wrong.

            There have been previous threads discussing the horrible lack of quality science-based childbirth education. Part of the problem is that doctors don’t have the time to spend with each woman to go over all of the what ifs of labour (and most people can’t afford what it would cost to have an OB do proper educating). Organizations like Lamaze have taken over and infused the childbirth education with NCB rhetoric. Even ones offered through hospitals can have elements of woo. While it would be great for there to be evidence based classes that go over what to expect when you go into labour, what the hospital’s policies are, and what can go wrong, it’s not the reality in much of North America.

            The reality is that the woo is winning and many people don’t want to hear about what can go wrong. There’s a widespread superstition among many cultures that to speak of something bad is to invite it to happen.This trope exists in natural childbirth circles too (positive thinking ensures positive outcomes! If something goes wrong, it’s because you didn’t eat healthy/take supplements/do whatever). This leads to classes not covering much in the way of complications.

          • Stacey

            Yes. We are busy creating exactly what you just described, plus a social component, and cost is the primary obstacle. Its tough to compete financially w a cult thats willing to do all this stuff for free, and that has no expenditures.

            An OB cannot afford what it would cost; contrary to popular belief, they get very little per patient, and costs of practice are sky high.

            This does not mean it can’t be done. It will be done. It’s just goes to show the reason it doesn’t yet exist.

          • Karen in SC

            Good luck, Stacey! I think your idea is stellar and hope you have great success.

          • me

            I agree with everything you are saying here. It just seems disingenuous to claim that medical professionals had to “sit by”. No, they can’t force a c-section on an non-consenting patient. But why aren’t they addressing the need for better patient education from the get-go?

            I honestly believe (and obviously this is my opinion) that if there was better prenatal education, *early on* in pregnancy (ideally before conception, even), that more women would be “immune” to the NCB clap-trap. Okay, there will always be some that fall into it, but by focusing on good quality patient education, you could (theoretically) decrease the vulnerability of pregnant ladies AND make women have a more realistic view of what to expect, perhaps reducing the numbers of women who feel dissatisfied and/or traumatized by birth.

            I feel for the medical staff that feels powerless to get a woman in a bad situation to ‘see the light’. But when you wait until they are in labor to start the conversation, well, what do you expect?

          • AmyP

            I’ve told the story here before, but with my first OB, I asked her during one of my last appointments, “So, how is this going to go?” meaning labor. My OB said, and I quote, “The BABY decides!” Now, with several deliveries under my belt, I now know more or less what that means, but at the time, I was a babe in the wood and had had the usual NCB-flavored education, so I took that to mean something NCBish and asked no more. I had no idea that in my case, the baby had decided that with my Group B Strep, she’d really like me to be on an IV full of antibiotics from the minute I got to the hospital I had no idea that there was going to be an IV stand and that I was going to be covered with monitors, as in the childbirth education movies I had watched, you just see the laboring women walking freely around with no IV . My first OB could have told me, “You’ll have an IV, you’ll have a monitor on you, you’ll have a blood pressure cuff on all the time, I’ll probably give you pitocin, and by the way, I really recommend an epidural–you’ll love it and it’s fine for the baby!” and I would have been cool with that, but she never bothered to explain that to me. I would have been a much better patient (and been saved a lot of discomfort) if she had bothered to have that conversation. I had this nebulous impression from my childbirth education experiences and contacts with the NCB world that epidurals were somehow bad for the baby and going without pain relief somehow meritorious, but I wasn’t sure why, and I wasn’t a true believer.

            Fast forward to my current OB, and she really does explain stuff. She warned me at one of my last appointments that if there was a failure to progress, there might need to be a c-section, and I was fine with that. I just needed to be told stuff.

          • Trixie

            Minor point, but I actually did have to meet with the anesthesiologist in advance of my VBAC, and he spent about 15 minutes going over what to expect if I did need a c/s or just chose an epidural. He was extremely nice and professional and encouraging. I also signed a consent form at that time for a c/s in case an emergency one became necessary.

            Come to think of it, the first time around, at a different hospital, an anesthesia nurse called me at around 34 weeks to go over pain relief options over the phone.

          • AmyP

            And there’s the practical problem that there are LOTS of complications, so even if you have a complication, it probably won’t be one you remember from class.

            Some reassuring stuff about C-sections should be in every class, though, as they are so common.

          • Stacey

            I’m sorry you have had such experiences with OB care, but I have not. Out here, OBs are vilified no matter how much one one one care they provide, no matter how well theybexplain and how supportive they are. Hospitals here cater to every NCB desire, but are still evil, and avoided (4.5% OOH birth rate). Some of the HBers are so busy hating and pressuring moms to HB they are totally ignorant to whats even offered, They act like its 1950 in there….

            You ARE correct on one thing- women seek Dr Google and get NCB because pregnancy is overwhelming and isolating. Even with the very best OB, like mine, who takes as much time as needs and explains everything thoroughly, it’s easy to feel like you come out with more questions than you went in with.

            And this is why NCB is successful. It is there, organized, social, with support and acceptance, and plenty of answers. That they are mostly wrong and totally dangerous is beside the point. That is how moms get hooked. Often way before they are even TTC.

            Most OBs are working with immense patient loads, and have to do so because the Medicaid/insurance reimbursement rate for OB is so low they cannot stay in business otherwise. Plus, many areas are limited in OBs and MDs, so they take as many as possible so moms can get care.

            There is no excuse for rudeness or not explaining, but I can see how having to explain the same stuff, in response to an ignorant myth (like GBS is no big deal, so skip the test!) 100 times a week can get old. and when every minute you sound with one client, means one less for another, you make choices based on this reality.

            Compare this too an individual HB MW (plus assistant), who at their busiest, sees a few births a month. In this state, 95% do 1-5 births a YEAR. The remaining 5% of births are in busy freestanding BCs, but even then, busy means a birth or two a week. The busiest is a hospital owned BC, but even they don’t come anywhere near the caseload of an OB.

            If an OB had one, maybe 2 appointments a month, week, or even a day, they would be able to spend 2 hours at every appointment. They would be able to remember every family member by byname, and hold pot pucks and stuff. This is the biggest benefit of a HB MW, the time spent. Its too bad that this is a negative- the info shared is dangerous, and the close relationship hinders the moms ability to hold a MW accountable after a disaster.

            Anyway, as I have said elsewhere, SMB MUST offer an alternative to this. Obs must have good educational options, and social groups. There is a real need for a mainstream answer to NCB. Case loads won’t reduce anytime soon, but other solutions can bridge the gap.
            (I am proud to say it is in the works, and I hope to help create change.)

            There needs to be

          • fiftyfifty1

            “And this is why NCB is successful. It is there, organized, social, with support and acceptance, and plenty of answers.”

            Yep. And I think it’s great what you are doing to try to create a social alternative to NCB for pregnant women. It will work for a lot of women I am sure. However, I don’t think any program will convince 100% of women. It’s an unfair playing field because NCB is ready and willing to LIE, whereas a reputable group won’t. NCB is like a cult, and some women, for their own reasons, are just really susceptible to cult mentality.

          • fiftyfifty1

            Whoops, I see that you have already addressed the cult aspect of it below.

            Thanks again for the work you are doing on this.

          • Stacey

            Well you can’t please everyone, but having an alternative is necessary, and should help. So many times I have heard moms describe how they fell into woo, and it started with “I went to a moms group/ childbirth class/a breast feeding support group/ web forum and felt uncomfortable with all the crunchy stuff. But I didn’t say, or question, anything about the things they said as fact. Eventually, I thought they were right.”

            Even if it just makes a few moms listen to NCB lies more skeptical, it will be a win. I just hope it’s successful.

          • Anka

            Yes! This was exactly my experience, at a high-risk unit, no less! I am as anti-woo as the next person here, and will never succumb to it, but that doesn’t change the fact that most of my problems during pregnancy and birth were due to OB inattention/lack of care. My low-risk OB insisted on transferring me to a high-risk OB, either because of lack of knowledge or because she felt she had too many patients–it wasn’t clear. However, I wasn’t high-risk enough in the eyes of my high-risk OB, so he crowdsourced my care to his students and did not oversee them at all.

            I saw a different student each time, who said completely different things about my care from the previous student, would get twitchy and dismissive if I asked even one question–and all my questions WERE legit–and would tell me to read a book. All of the 50+ books I read on pregnancy and birth, if they mentioned my condition at all, would say that it was associated with an increased risk of early labor and miscarriage and that was it. All the students would pooh-pooh this and then refuse to say anything else. I would get 5 minutes per appointment, tops, while they read my file and asked me basic questions (yes this is my first baby, yes I know that you consider 34 to be elderly for birth purposes, no I do not smoke or drink, no, I REALLY don’t drink, no, I really DIDN’T use IVF even though I’m so OLD, etc). They also said completely different things about what I’d have to do about my high-end-of-normal glucose test results (treat it like GD! Don’t treat it like GD! Do nothing! See a dietician! Go to the GD bootcamp for 3 hours and see a dietician! Wait for the referral that will never come! Etc.). They’d be very scornful of me for googling, but they refused to answer any questions. I spent the entire pregnancy in a heightened state of anxiety for no damn good reason.

            Then, during labor, the very nice OB would come in and tell me everything looked good, and her nurses would repeat this, and her snotty resident would come in and tell me everything looked bad and I’d need a c-section, and HIS nurses would repeat that. It was deranging. After about 18 hours I started bawling from stress, and the OB was notified and straightened out the resident, who was furious, and I had a vaginal delivery. I have nothing against c-sections and would never EVER use the word “unnecessarean,” but it really seems that the resident wanted to do a c-section just because; once I started pushing, my vaginal delivery was ridiculously easy.

            I’m not a birthzilla, either! I’d just like not to be treated like a tantrum-throwing paranoid prima donna because I want consistent care and sufficient information, whether it means I see the same student or OB every time, or whether I see different ones but my OB give a sh*t enough to make sure they’re not telling me completely different things every time about my condition, the birth process, and what I can expect in the future in terms of fertility.

            Another thing is that my hospital was plastered with “be an informed patient! Be proactive about your care! Ask lots of questions!” signs, putting the onus for communication on me, the patient, which is fine, but asking the questions did not yield the desired result (me getting information and therefore alleviating my anxiety), and just seemed to piss off most of the healthcare professionals I saw.

            I know that there are a lot of brainwashed woo advocates out there, and that no amount of reasonable interfacing with them on the part of hospitals or the OBs is likely to make a dent, but when the hospital doesn’t (I’m not going to argue about whether it’s “can’t” or “won’t” because the end result is the same) spend any time on answering patients’ questions, it’s not totally shocking that patients would turn to woo or the internet. A little bit of patient education would have gone a long way with me and, I suspect, others like me.

        • thepragmatist

          I think one of the things you may have to get used to here is that this is the only place for these women (and some men) to vent their frustrations because they spend most of their time saving lives and making life and death decisions, so a little dark humour and shop talk happens. It is brutal, but I am not sure I can find fault with it. Obviously, they care very much for their patients. But I can imagine once you watch a few of these trainwrecks happen, that caring turns into hurt and then numbness. Although I dislike this kind of shop talk and didn’t personally do it in my job (worked with high-risk youth, another field with a lot of need to blow off at the end of the day). I just felt like that would disrespectful to my kids, and I loved the more difficult ones the most.

        • Captain Obvious

          Please explain to me this “women who were forced into cesareans”. I have 21 years experience. I have seen how the typical progression unfolds. If no intervention is done in a particular situation, I have seen mothers and babies end up with prolonged antibiotics, blood tranfusions, ventilator status, ECMO, prolonged hospital stays, sometimes in the ICU or transferred to university hospitals. Some mothers end up on blood thinners for septic thrombophlebitis. If I explain to a patient that the baby and herself are healthy now but I foresee a significant risk (say 5-25%) of these sequalae unfold maybe even death, and the patient agrees to the cesarean, is that an unnecesarean? So, are you telling me you process my recommendations that this hypothetical patient has a 75-95% chance of avoiding these horrific sequalae, so it is an unnecesarean?

      • NursingRN

        NO! We didn’t- and we even have a new crop of butcher- er, I mean OB residents here! Can you believe it?!

    • Mishimoo

      Poor baby! I really hope that the little darling turns out okay.

    • SarahSD

      That’s terrible. I hope she and the baby recover! To me, this is an example of why experience DOES matter. In the sense that if this woman had trusted her care providers, and consented to a C section sooner, things might not have gotten so bad. Do you think there was any point in the process (including earlier in her pregnancy) where the ideological and communicative rifts could have been bridged? I’m asking seriously because I think that getting pregnant women and their care providers (at least closer to) on the same page is actually really important, not just to protect their ‘experience’ but also for their safety.

      I have heard stories of women not wanting to take medical advice from doctors in pregnancy but then, oddly, resign themselves to accept the same recommendation from their midwife. The difference is that they trust the midwife. How can we get these women to trust, and feel listened to and respected by OBs? This is a real question.

      • NursingRN

        I think it comes down to what they’ve been reading- honestly. I mean we still get women in the hospital who are very unreasonable and have these grand birth plans- or they’re brought in from the freestanding birth center and they’ve already got a chip on their shoulder because they watched “The Business of Being Born” or they listened to some other kind of tripe. Thing is- when I was pregnant with my son who is 5 now- I and my husband were duped into this way of thinking: “The Cascade of Interventions”. Our childbirth education instructor- employed by the hospital (the one I work at now, actually) was not an RN, but she was a doula and from the get go she was all about NCB, and non-medicated birth, and how “Your body is MEANT to do this!” and prepping us for those evil RN’s and OB’s who will try to, at every opportunity undermine your ability to believe in your instincts. Because of all of this, and other things I read and believed, I ended up ruptured (my membranes I mean) for 30+ hours with mec stained fluid- ultimately ending in a stat section for fetal distress and the fact that I had a temp of 101 and was puking my guts out (partially because of the ITN I finally broke down and got). My son was OP so it didn’t matter HOW long I held out, it wasn’t going to happen and I didn’t really know any positions to get his head to move. He was in SCN on antibiotics for 48 hours and I was…a virtual zombie for about 7 hours after he was born. All because of fear tactics. All those meddling RN’s, CNM’s and OB’s are now my co-workers, and I can see it from the other side being an RN now. I’m embarrassed when I read my very arrogant and cocky birth plan and am grateful I didn’t end up like this lady!

      • Stacey

        There is nothing you can do to make them feel like OBs listen. Even the best OBs and hospitals are decried by these people.

        The best thing is to offer accurate education, and social groups where woo is not center stage. Organized, national.
        (I am working on something like this…)

        • Antigonos CNM

          I hope that not only is the baby is OK, but that the mother doesn’t wind up with scarred Fallopian tubes from infection.

          • fiftyfifty1

            Hell, I’m just hoping she lives at this point….

            (but yes, if she lives I also hope she has her fertility intact)

    • The Computer Ate My Nym

      Awful! If you feel comfortable with doing so, please tell us how things turned out!

      PS: I had chorio during what turned out to be an obstructed labor. My medwife assessed the situation, determined that I’d gone from low risk to high risk in a single move, and, pausing only to start gram negative antibiotic coverage, referred me straight to the OB who performed the c-section one informed consent later. Baby and I both left the hospital together three days later, looking so healthy that a man coming in with a laboring woman pointed us out as “see, you’ll be going home with a baby like that soon”. Which he would not have done if I’d looked traumatized or sick. Urgent c-sections save babies and their mothers.

      • ngozi

        Saved me and my baby about 4 weeks ago.

    • Captain Obvious

      Chorio itself is not an indication for cesarean. It would be advantageous not to do a cesarean. A cesarean with chorio would likely spread the bacteria worse. If your close to a vaginal birth with chorio, you keep on that path. Other indicators for cesarean would have to be present.

  • Dr Kitty

    All this NCB hate for the partograph
    My mother studied medicine in Zimbabwe in the 1970s, where the partograph was developed.
    The whole purpose of the partograph is to recognise when a Homebirth in a resource poor environment isn’t going to plan, so that there was time to transfer to a hospital or clinic (usually several hours away) before a crisis developed.

    Obstructed and prolonged labour is still responsible for 8% of maternal deaths, which is why the WHO advises universal use of the partograph in all settings, but particularly HB with traditional or skilled attendants.

    http://www.fistulacare.org/pages/in-action/partograph-meeting.php
    http://labspace.open.ac.uk/mod/oucontent/view.php?id=452290&section=20.4.2
    http://mnhtech.org/technology/technology-briefs/partograph/

    Partograph use is evidence based and, get this. REDUCES CS rates, stillbirth, labour augmentation, maternal infection and obstructed labour.
    http://www.ncbi.nlm.nih.gov/m/pubmed/7910888/
    http://www.ncbi.nlm.nih.gov/m/pubmed/12345820/?i=3&from=/7910888/related

    If NCB is about EBM they should be 100% behind partographs. The data is pretty robust.
    I’ll take a study with a sample size of 35,000 over “other ways of knowing”.

    • Antigonos CNM

      How well I remember partographs from my time at Cambridge. A very useful tool!

  • SarahSD

    I’m thinking about the relationship between yesterday’s post and today’s, especially in terms of how that post and the story behind it can answer some of the rhetorical questions you pose here, like why women are making what is presented here as an illogical and immoral choice to have a home birth. While it is easy enough to show that risk to babies is higher in homebirth, the risk of having a terrible, traumatic experience is harder to measure, may not be dependent on birth location at all, and may in fact be perceived to be very likely by some women in any childbirth setting, leading them to choose the setting that they feel gives them the best chance to avoid a traumatic experience over the small absolute risk of things going wrong for the baby in childbirth.

    I agree that valuing process over outcome, like many hb advocates seem
    to do, is messed up. But that doesn’t mean that experience is
    unimportant, especially if it is the thing that leads women to make these choices. I don’t think that demeaning people who make that choice and implying that they don’t love their babies is doing much to fix the problem of why they are making this choice in the first place. So while it is true that valuing experience over outcome is wrong and damaging (whether you could play music or take a bath or eat supper or push a baby out of your vagina is not more important than a living newborn), experience matters a great deal to your cause, since fear of a bad experience is the reason that many people choose homebirth. (This doesn’t even touch on the fact that enshrined in the most wooish NCB beliefs is NOT just that process/experience is more important than outcome, but the insane belief that a normal, uncomplicated childbirth IS DETERMINED BY a certain ideal process/experience.)

    Women’s traumatic experiences in childbirth are to a certain degree shaped by their expectations, and that the NCB philosophy fosters misleading expectations of what to expect from the experience of childbirth and from their care providers. And understanding that we have been fed untruths about interventions, from the impact of epidurals on the length of labor to the usefulness of CEFM, can certainly help women feel more at ease and less like the hospital is out to get them. And that’s one of the most valuable thing that I have gotten from reading here. This site does a great job educating people about the misleading parts
    of NCB culture that can prevent unnecessarily combative
    patient/caregiver relationships and foster better experiences.

    But a) that doesn’t mean that hospitals can do no wrong (even if they are on average, measurably safer), and b) even if they are practicing responsible, evidence based care, that doesn’t absolve them from having to deal with the patient’s feelings, expectations, limits, and autonomy, regardless of how annoying they might find the patient or whether they disagree with them. Hospital births can traumatize women, you can help to a certain degree by clearing up misconceptions about medical interventions, but I don’t believe that the fault is ALWAYS with NCB and never with the hospital. Many hospitals are wising up to the importance of womens’ experiences in labor, but there is still work to be done – it feels like this is something of a persistent blind spot here. Perhaps it’s a rhetorical choice.

    • http://shameonbetterbirth.wordpress.com/ Shameon Betterbirth

      thank you so much. You said so much of what I was trying to say.

    • Kat

      I’ve been reading Dr. Amy for going on two years now, and I think your comment here: “This doesn’t even touch on the fact that enshrined in the most wooish NCB beliefs is NOT just that process/experience is more important than outcome, but the insane belief that a normal, uncomplicated childbirth IS DETERMINED BY a certain ideal process/experience” is one of the most accurate portrayals of the ideology I’ve read.

      The issue is not that these women value their experience over their child, it’s that the NCB ideology manipulates women into thinking that the process is important and necessary to the overall health of the child. I think this issue is two fold as well. It’s both the belief that natural childbirth in a home is actually safer than a hospital childbirth as far as the birth of the child goes (that the lack of interventions, lack of stress of the mother in a hospital setting caused by whatever factors, and gain of birthing in a familiar environment allow labor to go better and will better produce a healthy child) and that the child will be better for the rest of his or her life because of the ideal birth (all those weird beliefs that C-Sections lower IQs and cause asthma or whatever.)

      I think realizing the mindset behind NCB as it is presented here actually makes it harder to fix. Like it’s easier to criticize a woman for valuing experience over her child and to change her mind. It’s much harder to address the implications of the manipulative narrative of the movement which makes women think they are valuing their child over the experience.

      I mean that not as an insult to Dr. Amy or anything by any means. What she writes is really great and has opened me up for involving myself in all sorts of skeptical thinking, rather a comment as to how difficult it may be to actually change minds.

      • SarahSD

        I totally agree that this is part of what makes it harder to change minds, and also part of what predisposes women to perceive their normal, conservatively interventive hospital births so negatively as to say they have experienced birth rape. It is NOT because they are selfishly valuing process over outcome. It is, among many other complicated reasons (like past medical trauma or sexual assault) because they fear that you may be hurting their baby by ruining their birth. That said, Dr. Amy did do a lot to change MY mind by showing how so many staples of NCB belief about childbirth are misleading or untrue. But if you don’t buy that, you’re not going to buy the idea that refusing interventions is selfishly valuing experience over outcome.

      • Young CC Prof

        That’s a really good point. And some of the NCB myths are extremely prevalent in society in general, which makes it really hard to fight back. A disturbing number of otherwise very rational people believe they are at least partly true, or that the truth lies somewhere between what doctors say and what natural-birth advocates say.

        My father believes to this day that my brother was born completely alert because Mom had no drugs. Um, maybe it was because her labor was just long and hard enough to get him properly awake, not long enough to exhaust him? Or maybe it was just HIM. My mother sends me natural-childbirth advice practically every day, even though I keep deconstructing it for her and explaining the harm.

        These are NOT inherently credulous people. They taught me skepticism, they taught me to see things from every side there was. But they believe in NCB at a level that they can’t be entirely shaken from.

        • Trixie

          No idea how long ago that was, but was he born in the era before epidurals?

          • Young CC Prof

            Definitely before GOOD epidurals! So yes, oral pain meds might have sedated him.

        • DaisyGrrl

          My mom is convinced my brother was more alert at his birth because she didn’t have an epidural for him. She was on Demerol instead.

          • Antigonos CNM

            Ha! Have you explained that Demerol crosses the placental barrier almost immediately while the medication in an epidural doesn’t even enter the bolld stream?

          • DaisyGrrl

            I didn’t bother going there. She had pretty tough labours with me and my sister and the epidurals gave her huge headaches. I only found out about the Demerol when my sister was pregnant and my focus was more on convincing mom that epidurals had changed so there’d be at least one person in the room encouraging sis to get one if needed (as it turned out, my sister did end up wanting one and my mom did have to advocate for her). At least my mom is now convinced that today’s epidurals are good (thanks to theadequatemother’s page).

          • Trixie

            I have to say, I had a good epidural the first time around. I am grateful that it was available because I truly needed the pain relief. But at the same time, it made me feel extremely…claustrophobic is maybe the best word. It seriously freaked me out not being able to feel my lower body. I felt trapped. This was not anybody’s fault, just the way I experienced it. It was unpleasant enough to me that I did my next birth with no pain meds. Of course, the second time was much faster and without a posterior baby. The pain of labor, to me, up to a certain threshold anyway, was preferable to the epidural.

            I guess my point is that while epidurals are a wonderful invention, there must also be others like me who find them to be unpleasant enough to try to avoid them.

          • fiftyfifty1

            “I guess my point is that while epidurals are a wonderful invention, there must also be others like me who find them to be unpleasant enough to try to avoid them.”

            Absolutely there are. Just like there are a few people who hate the whole “big numb lip” sensation of dental lidocaine enough that they ask the dentist to go without the next time if there is any way they can. However the majority of women who try to avoid epidurals are doing it not due to a well-reasoned weighing of their own personal pros and cons but rather due to NCB lies and NCB peer pressure.

          • Dr Kitty

            My mother dislikes the palpitations she gets from lidocaine with adrenaline. So she’s had root canals without LA.
            Now her dentist orders Lidocaine without adrenaline, just for her, because he doesn’t like to see people suffer if there is an easy fix.

            My mother, BTW, had four CS and thinks the root canals were worse.

          • DaisyGrrl

            Oh, absolutely. I have no doubt that my mom’s negative experiences also shaped my sister’s (any my own) perceptions about epidurals. My biggest concern for my sister was that she kept an open mind about pain relief options (including epidural) and that she be allowed to change her mind about getting an epidural while in labour if she wanted to. Her birth plan had no epidural on it and her husband had bought into the woo a bit (she was also delivering with midwives).

            Each person has to weigh what is important to them in terms of pain vs pain relief and what they’re willing to put up with. If my sister wants to go all natural next time, more power to her. I just really wanted someone in her corner who would let her know that it was okay to want an epidural and not a failure or weakness on her part.

          • Young CC Prof

            Good reasons not to get an epidural:

            1) I’m not in much pain right now.

            2) I’ve had one previously and I didn’t like it.

            3) It’s really important to me to have a natural birth.

            Bad reasons not to have an epidural:

            1) I heard it causes *Insert debunked myth here.*

            2) Someone who is NOT ME will be disappointed or judge me negatively for getting one.

          • Wren

            I’m not really sure #3 is a good reason if the pain has gotten bad enough that the woman really wants an epidural, primarily because of the reasons a natural birth is likely to be so important (other people and myths believed).

          • Young CC Prof

            Honestly, I think reason #3 shouldn’t exist either, but it’s so deep in the culture you need to allow for it as a sort of harm reduction strategy.

          • toni

            My SiL took three hours to push out her baby and needed vacuum assistance. The obstetrician told her it was likely the epidural hindering her pushing efforts. Is that not true? That was one of the things in the back of my mind when having my baby…

          • Young CC Prof

            The higher-dose epidurals slightly increase the risk of instrumental delivery like vacuum. The lower-dose “walking” epidurals seem not to. Neither one increases the risk of c-section.

          • Young CC Prof

            Heh. REALLY hoping I can convince my mom today’s epidurals are good. Now, the odds of me actually delivering vaginally are just under 50%, and dropping every day my baby stays breech, but just in case baby grows a sense of direction and I wind up laboring normally, my mother is NOT invited to the delivery room.

            Especially not as long as I’m getting emails about natural birth every freaking day.

          • Karen in SC

            Boundaries are good. My mother and mother-in-law were making themselves comfortable in my room, where I was laboring naturally (my choice), and I had to ask them to leave. Politely or not, I don’t remember. It was very sweet though, that they stayed in the waiting room and were able to come in right away and see their new grandson less than one hour old.

          • Karen in SC

            Hey, I’ll add to my own story :) to make it even sweeter. My husband & I are both brown haired and my son was a definite redhead. When the grandmothers came in, my nurse said, “I guess I don’t have to ask where he got that red hair” and both of them were red-haired, too.

          • auntbea

            I can’t IMAGINE having my mother in the delivery room, and she had no desire to be there. The last time she saw my vagina up close, I was still in diapers, and I see no need to reintroduce the two of them now.

          • An Actual Attorney

            A friend’s MIL kept trying to invite herself into the delivery. Friend’s fabulous husband finally said, “mom, if you want to see her vagina, you’ll have to do what everyone else does and pay for it on the internet.”

          • auntbea

            OMG!

          • The Bofa on the Sofa

            When we talk about people in L&D with dads, we note that, whomever you decide to have in the room, make sure it is clear between mom and dad what their role is, and that dad reserves the right to get them out if they start overstepping their role.

            I would add that, given dad’s role of supporting mom, if she doesn’t want someone there in the first place, he can make sure that happens.

            TBH, I’ve never heard any actual stories of unwanted MILs being there. One thing we tend to emphasize is the importance of the new parents to assert their control over decisions without shame. Not letting the old lady from church who never paid you the time of day before coming up and grabbing the baby and insisting that those who want to hold the baby wash their hands before doing so. Therefore, Dads in their supportive role will work to support mom’s wishes. I know there are those Ray Ramano types that are still connected to their mothers, and they get the press.

            One thing we also emphasize is that, if someone in the room is acting outside of their agreed upon role and needs to be removed, let the nurses know. They are always really good about it and can clear the room without hurting anyone’s feelings too bad.

            In my years of doing Dad’s boot camp, we only had one story of an overbearing mother, who tried to take over.

  • Zornorph

    I just wish everybody would have had the positive experience I had in the hospital. Of course, I wasn’t the one actually giving birth, but I discussed it with her afterwards and she was very pleased as well. But they were super nice and very respectful of her and my wishes. The only time I had to really speak up about something was administrative – they wanted to put her on the birth certificate and this is something my attorney told me should not happen. I had to tell them ‘no’ and call him up and have him speak to them. They did push just a little bit for me to go along, saying that they had called the authorities and this was the way it had to be, but I knew better and was just firm about it.
    But I give them an A+; I can’t imagine a better place to give birth.

    • Young CC Prof

      Honestly, I think generally positive birth experiences are a lot more common than a survey of the blogosphere might suggest. No, it’s not fun fun fun, but quite a few mothers have uncomplicated natural deliveries with good pain management and/or effective use of non-drug coping techniques, attended to by reasonably polite and skilled staff. Others have unremarkable c-sections, again with good pain management and reasonably polite and skilled staff.

      Those people just don’t tell their stories as broadly as those who have worse experiences.

      • Karyn Croushore Hodgins

        I have actually told pregnant women that who were terrified of labor. Just because it is on TV or on the internet does not make it true. I had very positive experiences with 2 of my 3 kids… and I like to tell people that… but what people remember is the woman who was screaming her head off in pain and had Nurse Ratchet taking care of her lol

        • AllieFoyle

          It’s funny because I feel the opposite way–that tv/movie portrayals really sanitize it and minimize the pain and horror.

          • Karyn Croushore Hodgins

            lol maybe it has something to do with the different experiences we have had… like I said… dilated 7 and didn’t even know I was in labor until the doc said to me… are you sure you are not feeling anything?

          • AllieFoyle

            Yeah… that was not my experience.

          • thepragmatist

            I had prelabour for about a week prior to the c-section. It was done at 38 weeks, which was probably a good thing. I’m pretty sure I had a tear in a disc in my spine by then, so every time I would have a contraction, it would send white shooting pain down both my legs. Mmmm, sounds spiritual. I spent the last two days prior to the c-section laying on my left side, willing the baby to not come yet, screaming into the couch with contractions that were doing nothing, and were absolutely not BH. He was OP every time my midwife checked and would not move. Ugh. It was awful. He was a very active baby in utero, always moving, and I was so small.

            It’s so hard to imagine, as I watch him sleeping next to me. All 3 feet of him, and his entire body pressed up against me for warmth and his head on my tummy, under my arm. (It’s cold in the house: our furnace is on the edge)… I would say that no matter how he got here, EVEN IF he had torn me terribly and I could not have had the c-section, I think I would still love him this very much. But I am sure glad I didn’t have to go through that.

            I actually wish my OB wasn’t such a good seamstress. She left me no scar. It’s almost gone. I wish it was still there, because it really makes me happy and proud. :) He calls it his “happy line” because he asked about it and I told him that was where he came from and it was the happiest day of my life. LOL. :) I wish everyone could feel so at peace with their c-sections.

          • Anj Fabian

            More women will show ask their doctors “What do you mean I’m not in labor!?” than will hear the doctor ask “Are you sure you don’t feel anything?”.

          • AmyP

            Or “what do you mean I’m only 3 cm dilated!!!!”

          • Mishimoo

            That’s me, every time! I’m normally >90% effaced by the time I go to the hospital. Once I’m fully effaced, they’re happy to do a maternal request amniotomy, and I hit transition within a few contractions.

          • Stacey

            I slept through my 1st labor, (40w) thanks to an epidural, and felt zero pain until days after the CS.

            I slept through the 2nd labor as well (33w) without a working epidural, and woke up feeling crampy, and pushed out baby in 4 pushes. I had expected pain, and panicked when I was told baby was coming out but my epidural problem wasn’t solved. And when I say panic, I mean cursed out every HCP in the room…… That it was easy was lucky for them. I felt pretty tricked as it was, so had there been pain I may have lost it.

            The lady in the next room during baby #2 went “natural”. She screamed like she was being dismembered while awake, for about 12-13 hours. Plus another 10-12 of mild yells and moans prior. I’m unsure how she didn’t pass out. Just hearing it was stressful and awful. I’m pretty sure she was in pain.

            You never know how it’s going to go, but having accurate expectations is key. If it ends up being an amazing, enlightening experience, then great. But if you go into it thinking pushing a baby out of a 10cm hole out of some of our most delicate parts won’t hurt, you are at a serious disadvantage. You are also unlikely to learn about your pain relief options, so that if you decide you need them, you are totally uninformed on what to expect and how they work.

          • thepragmatist

            Gah, I remember when my OB took me on a tour of LandD to put me at ease, we were sitting there trying to talk and this woman genuinely sounded like she was being dismembered. It was kind of funny because this was supposed to “ease my mind.” Needless to say, my OB went off to go help that poor woman and I am hoping, shot her the hell up with something ASAP (since anesthesia had probably gone home for the day by then).

            It just seems to me like torture. Why bother? I don’t even GET vaginal birth. That seems unreasonable, I suppose, but at the end of the day, if planned c-section is safer for babies and only marginally less safe for mom (and let’s not forget ER c-sections that really are unsafe for everyone) why are we still giving birth vaginally? For the scar? For avoidance of complications? It’s all a wash. And I personally just do not get the desire to have a baby vaginally AT ALL. It seems like one of the most painful things to do. Mother Nature doesn’t give a crap whether you piss yourself for the rest of your life, she just wants the species to flourish. But me, orgasms, healthy sexual functioning, and not pissing myself is high on the list of things I’d like my body to do. God, I have a friend who tore straight up into her clitoris. I can’t imagine! It gives me a headache. I would never deliver any other way but by c-section because frankly, vaginal birth seems barbaric to me!

          • Young CC Prof

            Mostly for tradition, I think?

            Also, if you are planning 4 or more children, then the risks of repeated c-sections and multiple incisions DO make vaginal birth safer for Mom overall in the absence of specific contraindications.

          • MaineJen

            I completely agree. It really bothers me now, when I see a labor and delivery on TV, because most of the time the ‘delivery’ episode or movie is slanted toward comedy. ‘Oh, look, haha, she’s in so much pain that she’s cursing at everyone! LOL!’ Labor was about the most UNfunny experience of my life. Just another way to minimize women’s pain, I guess.

        • Guestll

          See and there’s a flip side to that, and it’s the NCB side that says, your body was made to do this, your body is not a lemon, they’re “rushes” or “surges”, basically, the pain isn’t that bad, or it isn’t really pain at all. That’s what I was told, that’s what I believed, and ask me how well that worked out for me.
          The pain of labour follows the exact same pathways as the pain of a heart attack, kidney stones, broken bones. Everyone experiences pain differently and every labour and birth is different. It’s probably helpful to prepare for it to be the most potentially painful experience of your life. That’s not fear, that’s using common sense and being an adult.

          • Karyn Croushore Hodgins

            I guess I kind of get that. My point really is to ease their fears in the right now about something that will eventually happen… but perhaps I am doing them a disservice. Even though I do tell them it is different for everyone… but this is how it was for me…. so I say yes,… it could be that bad… but its not always

          • Guestll

            But you are but one person, and your experience is not the norm. You experienced transition without pain. Tell me how many times you’ve seen that? You pushed your children out very easily, even your first, within one or two pushes. Tell me how many times you’ve seen that?
            Karyn, I’ve posted this before, but I’ll say it here again — my mother was an L+D nurse. Three quick, easy, unmedicated vaginal deliveries. Going by that, she could have thought, well, it can be easy! Why worry, just look at how it was for me! Yet she never communicated that to her patients because the bulk of her experience, the hundreds of deliveries, told her otherwise. And then came her fourth child, me, and it was a long, complicated, painful labour and delivery. Every birth, every woman, every baby is different, but a pain-free process is not the norm for most.

          • toni

            Exactly. I had a pretty easy and quick delivery. Certainly not painless but nothing close to the pain of breaking my femur for example so I was pleasantly surprised and felt very very lucky indeed. I didn’t for a second think oh that must be what it feels like for everyone all other women are such wusses. There must be so many factors that determine the level of pain a woman will experience.. size of baby, mother’s anatomy, elasticity of tissues etc you can’t draw any conclusions from one delivery.

          • fiftyfifty1

            When first-time pregnant women ask me what to expect, one of my goals is to ease their fears too. But I don’t try to ease their fears by telling them that some women have it lucky. Because what if they aren’t one of the lucky ones?

            So what I say is that experiences range greatly from only mildly painful, to a pain that is much more severe than anything they have ever felt before. That it is totally luck of the draw how it turns out for them. That how the labor and delivery goes does not in any way indicate anything else about them as mothers. That if the pain is severe, epidurals are extremely safe and effective. And that I wish them all the best!

          • moto_librarian

            I am still resentful of my childbirth educator for lying to me about delivery. Over and over, we were told that if we could make it through transition, pushing would “feel good.” Although my water had broken early in the morning, I had only been contracting regularly for about 4 hours when we got to the hospital, and I was 9 cm. dilated. Imagine my shock when pushing felt like utter torture. I was screaming in a way that I will never be able to replicate. I was completely out of it when my son was finally born. It didn’t help that I experienced a cervical laceration and pph that resulted in a trip to the OR. I still remember waking up in the middle of the night and feeling betrayed by the NCB movement. Nothing about my “experience” was empowering; I thought that I was dying at one point.

          • The Bofa on the Sofa

            I’ll say it again. I will never experience the pain of labour, so can’t speak from that. However, one thing I do know is that 3000 years ago, the pain of childbirth was recognized as being so bad that it was attributed to being a punishment from God.

            I don’t know of any other pain that has been recognized that way.

            YMMV, but to say that childbirth, in general, is not all that painful just is completely crazy.

          • Karyn Croushore Hodgins

            Oh no.. no rushes… and my favorite are the freaks who equate it to orgasm…. if orgasms felt like that the human race would DIE OUT!… I never said it didn’t hurt!! It hurt…. just not as much as I expected it to hurt… and I got over it…

          • Guestll

            I’m glad it didn’t hurt as much as you expected and I’m glad you got over it. Such is the power of anecdata that I can say that it hurt way worse than I expected and 2.5 years later, I still think about it and recall quite clearly just how bad it was, to the point where it’s one reason why we’ve opted not to have more children.
            Do you get it?

          • drsquid

            i had an epidural and had to keep getting them to top it off because when it wore off even a little i was in way too much excruciating pain to push at all. but i took ibuprofen for my 2nd degree tear (same as when i had wisdom teeth out..) so i have an ok pain tolerance but this was unbearable horrific agonizing pain

          • AmyP

            My hospital labor education teacher called it “labor discomfort” as opposed to “labor pain.”

          • Stqcey

            Do you remember the NCB “theorist”. That wrote an entire paper on how pain and suffering were different? She that NCB might have pain, but no suffering, because you can decide to suffer or not?

            Splitting hairs in order to convince themselves, and moms out there, that the pain really isn’t a problem. What a helpful attitude (ha).

          • Young CC Prof

            As a person with chronic illness and chronic pain, yes, it is possible to have pain without suffering, to have pain and just not be emotionally distressed by it.

            However, this works a whole lot better with the lower levels of pain. I’ve never been above a 6 out of 10 without suffering!

      • The Bofa on the Sofa

        Honestly, I think generally positive birth experiences are a lot more common than a survey of the blogosphere might suggest.

        I think it depends on what you mean by “survey the blogosphere.” If you actually DID a survey of the blogosphere, maybe not. But if you just casually peruse around it (if that’s what you mean by survey), then hell yeah.

        People who are happy and content with their hospital experience don’t run around blabbing about it, because no one cares.

        • Young CC Prof

          Yes, I meant informal survey, reading around, the way most people get informed.

          Ah, reporting bias and recall bias. They make the world seem SO much more exciting than it really is!

        • Karyn Croushore Hodgins

          Its the same with those “random” patient satisfaction surveys they send out. The only ones who respond are the people who had negative experiences

          • Karen in SC

            I agree, though when given a form, I will always fill it out and give positive comments if warranted.

          • Karyn Croushore Hodgins

            I do the same. I also will call a manager in a restaurant to give positive feedback about our server… I don’t think people get to hear the positive side of anything enough

          • Karen in SC

            What a coincidence! In the mail today is a survey for the hospital rehab facility where I recently had several PT appointments. :)

      • http://shameonbetterbirth.wordpress.com/ Shameon Betterbirth

        I think negative experiences are a lot more common than people think. Most people have healthy babies. If you say you had a horrible time in birth anyway people just go “but you have a healthy baby”. They are told to forget it or not dwell on it by spouses or loved ones. Getting help for PPD is difficult in part because of stigma against mothers who aren’t appropriately grateful for the experience of childbirth. Its not socially acceptable to speak that way about having kids. I’m coming at this as a survivor of sexual violence as well- those experiences are very common, but the reaction to telling others is typically so awful that most women don’t discuss it very often.

        • Young CC Prof

          Oh, most women don’t ENJOY their births, and quite a few have bad experiences that haunt them. However, disastrous complications and/or gross mistreatment by staff are probably not the norm.

          • LibrarianSarah

            Would that be a problem with expectations though? I think the NCB ideology gives women this expectation that birth is going to be this wonderful, transformative, spiritual, orgasmic event when in reality it is a painful sucky experience. I never went into a hospital with the idea that I was going to enjoy my time there and I never have really enjoyed my time there. But nobody expects to enjoy surgery or illness so it is not a big deal that I had a shitty experience. Hospitals seem to bend over backwords to make the “experience” better for pregnant women while doing little for the experience of the sick. Maybe that says something about our culture.

          • Young CC Prof

            Yes, definitely I think unrealistic expectations are a problem among some women who recall their birth very negatively. If you are expecting to just get through it easily with no pain, then a very typical childbirth would seem overwhelmingly bad.

          • thepragmatist

            This is so true! I went into my birth experience absolutely terrified of the hospital, and because of my treatment, came to expect better care IN GENERAL from my medical practitioners from that point forward. It empowered me to have higher expectations and those expectations were dashed when I returned to the realm of the ill. If ONLY I was treated with the respect I was when I was delivering my son through the rest of my medical care!

        • Stacey

          IDK, the biggest survey of birth satisfaction put women saying they were satisfied, happy, with their care at well over 90%.

          I think there needs to be a distinction between a unpleasant, awful, even traumatic, experience, due to uncontrollable factors, and an unpleasant, awful, even traumatic experience due to disrespect or assault.

          DS birth was pretty crappy. It was long, annoying, unproductive, my parents were acting nuts, and it took too long to go to a CS (which I had asked for in the first place.). I puked the whole time, and had a long, intense panic attack during the CS.

          But I wouldn’t say I was unsatisfied with LnD, and sure wasn’t permanently upset over it. I expected LnD to be hellish, and expected to be treated awfully due to my medical history. That didn’t happen, instead, everyone was beyond polite and respected every bit of my personal space and boundaries. They wouldn’t even clean the floor without asking permission, and explaining why it was needed, and this attitude made all the difference in the OR.

          Had I been assaulted, or blown off when my concerns were voiced, Im sure it would look different to me.

          • Young CC Prof

            “I think there needs to be a distinction between a unpleasant, awful,
            even traumatic, experience, due to uncontrollable factors, and an
            unpleasant, awful, even traumatic experience due to disrespect or
            assault.”

            Well put. Very well put indeed.

            Birth isn’t supposed to be fun. The purpose of hospital care is to minimize the extent to which it sucks, and most of the time the hospital succeeds.

          • The Bofa on the Sofa

            At our last ped visit, I ran into a guy in the elevator with a 3 day old baby. He was getting some resources from the doctor for the baby. He was doing it because the baby’s mom was in the ICU.

            I bet if you ask her about her experience afterward, she will tell you it was not good. She almost died, or at least had something very serious going on, and she had to stay in the hospital while her baby went home.

            But that is not a fault of the hospital, who may have saved her life. That doesn’t mean it wasn’t a terrible experience.

  • Guest

    A person might choose homebirth for reasons other than ‘bragging rights’. They might be terrified of the hospital, interventions, and may have had a previous traumatic experience. They might think that they will have a less traumatic experience at home. I understand that. But I think that this website has opened my eyes to the fact that people can also have traumatic experiences at home, with complications or perhaps midwives that weren’t as caring as expected. I imagine that would be a terrible cruel shock to people who may have planned otherwise. Just something else to consider when thinking about a homebirth I guess.

    • Karyn Croushore Hodgins

      I will agree with you. In fact, until I found this site… I was right on board with Ricki Lake!!! But I think that both this site and Ricki Lake painted biased pictures!! CNM’s really don’t just show up at your house with dirty rags and rusty knives!!! And OBGYN’s really are not all trying to get to their golf games or home for dinner.

      • Carrie C

        Just to clarify, it’s the CPMs who show up at your home. The vast majority of CNMs in this country (USA) attend births in hospitals. There is a vast difference in their education, and it’s definitely worth making sure you know the difference!

        • Karyn Croushore Hodgins

          I am aware of that… I am a nurse….

          • Carrie C

            Oh ok, just making sure. A lot of people really don’t know the difference (or that there IS a difference), unfortunately!

          • AlisonCummins

            However, that’s not what you said. You referred to CNMs showing up to your home with rusty knives when the concern here is CPMs showing up with homeopathy and dirty birthing pools.

      • Guestll

        CNMs + rusty knives/OBs + golf games is a false dichotomy, though. Dr. Amy’s not here to disparage CNMs as a whole.
        CNMs, like RMs in my country (Canada) are integrated in to the hospital system. The whole premise of homebirth with a CNM or RM is the ability to transfer should the need arise, and the mitigation of risk through appropriate patient selection.
        I am a regular reader and poster and I don’t have a problem with low-risk homebirth with at least two qualified attendants and hospital integration. But we very often don’t see appropriate patient selection. Instead, we see primips and VBACs and breeches and twins. AMAers, previous PPH, prior obstructed labours, the list goes on.
        I was almost 40, with an IVF pregnancy, three prior miscarriages in the previous year, narrow pelvis, almost 9+ OP baby, and 41+4 gestation with my first live baby, and my primary RM was STILL telling me that homebirth was a good idea. I was not a good candidate for homebirth — I wasn’t even a good candidate for midwifery care.
        The problem is not CNMs with dirty rags and rusty knives, and nobody here, including Dr. Amy, is saying that it is. The problem is ideology translating to dangerous practices that aren’t in the best interests of the baby.

        • Karyn Croushore Hodgins

          I have not been on this site very long… only a few days… (can’t tear myself away now!) What I have read so far regarding Dr. Amy…. has led me to the impression that she feels like you should NEVER under any circumstances have a home birth. And I am aware of the difference between a CPM and a CNM… and I agree totally that CPM’s are not qualified and that CNM’s even should have more education and supervision. The screening of candidate should be more stringent… but to say that it is never safe… is absolutely untrue.
          My deliveries for example… 4 hours… 6 min of pushing… 3 hours …. 1 push…. With the first one the doc had to tell me I was in labor because I was dilated 7! No pain at all…. I think I met the criteria! lol

          • Guestll

            It’s only truly safe in hindsight, Karyn, and it’s not as safe or safer than hospital birth.

          • Guest

            I imagine (as I don’t have research to hand to back this up), that homebirth is likely to be made safer by CNM
            presence, and careful screening of the candidate. It is probably safe
            MOST of the time. Personally, I don’t think that most of the time is safe enough.

          • Trixie

            I live in an area where there are CNMs with hospital privileges doing home births, and from what I understand their outcomes are pretty good. It’s worth noting that this arrangement is mostly possible because their patient base is mostly Plain people with no insurance, who pay cash, and are not litigious. If the CNMs were not out there doing these home births, they’d be paying unlicensed lay midwives to do them, with tragic results. In fact, there are Amish who go with the lay midwives to save the $1,000 or so extra it costs to go with the CNM group.

          • Trixie

            But the length and ease of your labors doesn’t mean you couldn’t , for example, suffer a life-threatening hemorrhage.

          • MaineJen

            I don’t think I have to tell you that your experiences are NOT typical…

          • drsquid

            i will go out on a limb and say i dont think you should ever under any circumstances give birth at home. the risks just arent worth it. when i compare the people who are heart broken over losing their baby (or brain damage, or dying themselves) vs the risk of being offered pain meds i just dont get it. i dont have dental work done at home with no pain meds, i wouldnt recommend toughing out a kidney stone at home, home fracture setting etc. and those things are LOWER risk. you have 9 months to shop around for a hospital with a birth pool, and bouncy balls, and comfy beds etc. spend that couple grand on a hotel near the hospital when you get close if you picked one far away from home rather than an undertrained person at home

          • theNormalDistribution

            Dr. Amy feels that women should be fully informed about their choice to birth at home and the risks involved. No one is telling you what you should or should not do, but I think that most people who actually have a good understanding of those risks would choose not to have a homebirth. I imagine Dr. Amy agrees.

            The fact that you had painless, uncomplicated labor is not evidence that anyone else will. Even the most low-risk birth is still very, very risky.

          • PrecipMom

            Pain is a really poor marker of whether a birth is going to have complications. Precipitous births can have complications, and you can have absolutely everything look beautiful until that cord prolapses or the placenta abrupts or the shoulders catch. It is absolutely possible to have a painless birth of a baby with an initial Apgar of 0.

            Low risk is not no risk, and if you are in the tiny but unlucky number of women who really do encounter split second complications where everything goes to hell with 5-10 minutes to fix it? No. Being at home is not safe, and there is no marker or test to determine which mother and baby that is going to be. You can take a calculated risk, but it’s still a risk and if you gambled wrong, the consequences for mother and baby are severe.

          • Stacey

            Yes, in RETROSPECT, HB would have been fine.
            and thats the problem. You never know if you’re going to be hit with a rare, or even common, complication. several moms on here had lovely HBs, then had a gruesome loss with the next HB.

            Keep reading. I think you will gain a better understanding of Dr Amy. Just know her tone is what it is because it makes people listen. If she was all sweet, no one would bother.

            AFAIK, Dr Amy, and the majority of commentors, think HB can be an OK option when certain qualifications are met, but right now, few places qualify.

            More important than whether any of us personally like HB, is that moms get accurate info. If a mom says “sure, the risk is 2x higher w a CNM, but its worth it” that’s fine. whether I would HB or not. We also say the same for CS on demand. Because we value moms choices

  • Karyn

    The people on this site, including the good doc act like home birth midwifes show up with some dirty rags and a rusty knife to cute the cord. I don’t buy into the whole Ricki Lake thing but I also don’t swallow everything the OB tells me. Because honestly sometimes those interventions are simply for the convenience of the OB. This is why some states have enacted laws regarding scheduling C-sections.
    I think the right is somewhere in the middle. I think with a qualified Certified NURSE Midwife who has Physician back up, it is possible to have a successful, safe home birth. And I also think that if so many OB’s didn’t say… well you have been in labor for 12 hours so you should just have a C-section…. I had a student tell me about her experience with that (and she is not the only one I have heard it from) maybe so many woman would not be choosing the home birth option. This OB said 12 hours is too long.. baby was not in any distress at all and she was dilated 4…. I told her that her mistake was going to the hospital too soon.
    My mother was in active labor with me for 42 hours, she was Eclamptic, and I was still born vaginally. That would NEVER have happened in this day and Age.
    My youngest was breech…. my sister was born breech vaginally… my doc would not even let me try….
    I think there has to be a happy medium with letting women experience childbirth the way it was done a century ago while still keeping them safe… that middle road has to be somewhere.
    My daughter had a baby as a 16 year old and good old mom (who is an RN who teaches Maternal Child Health) went in with her. That poor kid had the worst back labor…. and all she wanted to do was stand and lean over the side of the bed. But she was told he was “high risk” even though the only indicator of that was her age…. and had to be on the FHM all the time. Looking back… I would never have listened to them when they told me to bring her right in after her water broke…. nope… labor at home deliver at the hospital….She would not have needed that shot of Stadol if they had just let her position herself for comfort.
    Sorry so long winded… but I have pretty strong opinions about women owning their bodies and their own labor and delivery

    • Captain Obvious

      42 hours with seizures?

      • Karyn Croushore Hodgins

        Yes 42 hours… mag sulfate drip and all…. And I am not saying they should not have sectioned her…. I think her case was pretty extreme and a lot of trauma would have been avoided if they had… what I am saying is that docs today are TOO quick to section them… in my case… my dad had to actually make the choice about which one of us survived… so yes… she should have had a C-section… and it was a darned good thing she was in a hospital… we both survived by the way… I am the oldest of 3

        • DaisyGrrl

          You realize that the risks of c-sections today are profoundly different than the risks of c-sections when you were born? I realize I don’t know when you were born…I am making a judgement based on you having a 16 year old daughter that you are over 30…but still.
          C-sections have become sufficiently safe that they are less risky than taking a wait and see approach. The problem is that we as humans are terrible at risk assessment when it comes to the type of probabilities involved in deciding when to section. Is it better to have a 1% risk or a 0.1% risk? There’s a huge difference but at the same time, the absolute risk appears small either way. It only starts to look different when you apply it on a population scale.

          • Karyn Croushore Hodgins

            Of course I realize that they are substantially safer today than they were in 1972… which is when I was born… and I believe I stated that that SHOULD have sectioned my mom…. even if the risks were higher then. I was just giving an extreme example of when they could have sectioned someone but didn’t….
            And doing a C-section because someone has been in labor for 12 hours and is not going fast enough… if the baby is not in any distress at all? Not acceptable! Failure to progress …. no… failure to get him home in time for dinner…. it was 430 in the afternoon

          • DaisyGrrl

            Per their side of the story. Don’t forget that women have to CONSENT to a c-section. The doctor didn’t tie her down and cut the baby from her whilst she screamed her protests. If he did, I would expect that to be part of the story.

            Did the conversation seriously go Doc: “hey, it’s been 12 hours and I’m getting bored. Wanna c-section?” Mom: “Um…” Doc: “Great! Let’s slice you open.”

            I suspect it went more like this: Doc: “It’s been 12 hours and I’m not seeing progress/I’m concerned about some signs of distress. We can wait and see, but I think a c-section is advisable at this point.” Mom: “Okay, I want my baby to be safe.”

            Mom might later feel like she jumped the gun, but how much of that was because she’s been told that most c-sections are unnecessary combined with a perfectly healthy baby?

          • Karyn Croushore Hodgins

            “I suspect it went more like this: Doc: “It’s been 12 hours and I’m not seeing progress/I’m concerned about some signs of distress. We can wait and see, but I think a c-section is advisable at this point.” Mom: “Okay, I want my baby to be safe.”
            It did go like that… but a 19 year old hears… you better do this or you are a bad mom…. this is what she told me… and how she perceived it… and perception is reality…. she did say she wanted to wait until the next doc on call who she knew on a personal basis came in…

          • auntbea

            Okay….but how should it have gone differently? What could the doctor have said that wouldn’t have made your mother feel pressured? Should he just not have said anything? Provided no advice?

          • AlisonCummins

            Isn’t a lot of this stuff supposed to be covered in prenatal classes? “About a quarter of you will have c-sections and these are some of the reasons why. Sometimes they are done when the baby isn’t in obvious distress and these are some of the reasons why. These are some of the alternatives that are sometimes available. These are some of the upsides and downsides. Each birth is different so if c-section is discussed you should be talking to your ob.”

            I’ve never taken a prenatal class so maybe I’m naïve?

          • Young CC Prof

            The good prenatal classes do exactly that. Not all are good.

          • Karen in SC

            “It did go like that.” What, then, should doctors do to make sure that the patient’s perception is correct, add the phrase, “If you chose a c-section, you are not a bad mother?”

          • Carrie C

            That’s the thing; I mean, doctors are people, too. Patients want them to be psychologists – to say the PERFECT thing to make them feel better. Yeah, it would be great if all OBs had perfectly tailored bedside manner, but that’s just not realistic. They’re responsible for the physical health of mom and baby during delivery. Yeah, it would be great if some OBs were a little more sensitive, but that’s not really their job. I know an EXCELLENT OB who many people think is a curmudgeon. He’s my favorite doctor, though, because he’s knowledgeable and good at what he does. I don’t need him–or expect him–to give me pep talks and hugs when I’m unsure about something. I really do think this whole atmosphere surrounding the idea that you’re a bad mom if you choose a c-section can be traced directly back to the militant members of the natural birth movement. My mom had an emergency c-section when I was born, and she never had any thoughts of being a “bad mother” or anything like that; I think most women her age who had c-sections didn’t question it, because they knew that’s what was necessary for the best possible outcome for their babies. Sure, maybe it COULD have ended well another way, but what’s the point in questioning that? Really? You are here, you are healthy, your baby is here and healthy, and THAT’S what matters. Delivery is such a tiny part of motherhood, and the natural birth movement makes it into the WHOLE part of motherhood–to the point that women want to have babies AS SOON AS POSSIBLE after their c-section so they can try at a natural birth again.

          • AllieFoyle

            Also consider the hypothetical alternative scenario where that woman is not offered that c-section and goes on to have a difficult, complicated birth with long-term emotional or physical sequelae and wishes desperately that she had been offered it.

          • DiomedesV

            Perception is reality? Since when?

          • me

            How often do doctors really present the options as ‘gee this is what I would advise, but it’s up to you’? IME doctors tell you what they want to do, no alternatives are presented unless you specifically ask about them (assuming you are aware of the alternatives in the first place), and there almost always seems to be a sense of urgency (as in, you must decide right now, no questions, no discussion). The only doc I’ve ever had actually present me with treatment options and actually use the words ‘it’s up to you’ was a DO (following a colpo with a cin 1 result, she offered to re-pap every 3 months and see what happens, or do a LEEP; I love paps so much I opted for the LEEP). She actually took the time to present options and the likelihood of resolution for either, and didn’t pressure me one way or the other.

            I realize in labor there tends to be more of a sense of urgency (you can’t just go home and sleep on it), but people do tend to push for what it is they would prefer as the right course of action, including in medicine.

            I’m not sure what the solution is, particularly in labor…. even in a non-emergency, there is so much going on and it can be quite overwhelming so taking time to stop and really consider your options is something of a luxury. Even more so when the doc doesn’t say, ‘here are your options, I’ll let you talk with your partner and be back in 20 minutes to see what you decided’. Maybe doing that would help… sometimes having a few moments to think about things can help eliminate the regret that often comes with ‘hasty’ decisions.

          • Young CC Prof

            Actually, my friend was given a choice. “Well, his heart rate shows distress. If you push really hard for the next few minutes, he MIGHT come out OK. Or, we can just do the section.”

            Turns out his cord was getting pinched underneath him. He might indeed have been delivered successfully before hypoxia set in, or he might not have.

          • me

            Okay… heart rate shows distress = emergency. Not a time to say, ‘gee this is what I want to do, but it’s up to you’. When the baby is in distress there won’t be time for discussion, weighing of options, just waiting another hour and seeing how it goes, etc. Which is so not what I was talking about.

          • Karyn Croushore Hodgins

            Totally agree…. the situations I am talking about are non-emergent…. baby is fine, mom is fine…. doc thinks she has been there too long

          • Young CC Prof

            I don’t think that happens as often as some people believe it does. I’m sure it has happened, but I don’t think it’s common. Even some mothers who think it happened to them may be mistaken.

          • Guestll

            What’s he/she supposed to, wait until the shit hits the fan? It’s a judgment call.

          • AllieFoyle

            Please consider that the doctor might have been drawing upon a great deal of accumulated experience and knowledge in making that recommendation, and also, for many women, the option to proceed to c-section at that point might have been very welcome.

          • DaisyGrrl

            I saw the point to that story being that the mother was given an option and consented to a c-section in an urgent situation. Just because the option is consent to a c-section or risk your baby’s life doesn’t mean she wasn’t given a meaningful choice.

          • thepragmatist

            If I get a good vibe from a doctor (involving my child) I will often ask, “If this was your kid, what would YOU do about it?” to get a bead on the practitioners feelings about what is on the table. I am one of those obnoxious moms with a great deal of lay knowledge who wants all the options laid out and does not subscribe AT ALL to the idea that children do not feel pain or feel pain differently. I also refuse to hide pain from my child. If something is going to hurt, I warn him. If something is not going to hurt that much, I tell him. I’ve been told so many times that this is wrong, but let me tell you, he is a trooper and he trust me to tell the truth, so calms right down. Anyway, I almost always ask my doctors to tell me what they would do if they were me and it was their child. I find that if you ask them this about yourself, they take it as an attack, though.

            This backfired on me once though when an ER doc told me matter-of-factly he would just hold down his own infant and do stitches without anesthetic because “he won’t remember it anyway”. Yeah, no. That guy still hates me. Ditto. He made me sit in triage for 6 hours for the conscious sedation even though the hospital was pretty much empty at that time. Nice. I also had a pediatrician tell me that if my son was his, and he was a single parent, he’d just lock him in his room for 20 minutes for some quiet time and that he advised all of the single parents to do that. GAH! No thanks.

          • FormerPhysicist

            My first OB gave me a choice.
            “You’ve been in labor X long and she seems stuck and you’re not progressing. You can try for another two hours and if you don’t progress in that time we’ll do a c/s. Or we can do a c/s now.”

            My response (really!):
            “Excuse me, I hired you for your expertise. You’ve done hundreds or thousands of these. This is my first time, I didn’t go to medical school, and I can’t see or feel what’s going on anyhow. YOU make the decision, YOU’RE the OB.”

            His response:
            Laughter, and “ok, we’ll start prepping for the c/s now.”

            My husband was there and fine with all of it. But still teases me about my professing love for the anesthesiologist.

          • KarenJJ

            I had a choice too.

            Obgyn: Your baby is doing OK in there but she still hasn’t engaged, you’ve been at this for a while and there is some meconium. You could continue and see how this goes or I could get things set up for a c-section now for you.

            Me: Holy crap my baby is swimming around poo! Get her out!!

          • me

            In all fairness, my experience is definitely coloring my perception: my first OB delivery involved an episiotomy cut without my knowledge or consent (non emergency). I found out after the fact, and extensive damage had occurred. Went on to have two more children, with CNMs, and the difference in their manner (explaining things, making sure I understood what was happening, giving me control over the decision making process, etc) was night and day. Not saying all OBs are like the one that delivered my oldest child (likely I just got a ‘lemon’, tho he was head of the OB Dept at the hospital I delivered at, so that doesn’t bode well), but I was floored by the difference in care. Especially with regard to respect and consent.

            So I bow out here, admitting that I’m biased. Once bitten, twice shy. I go to my GP for well woman care, am not planning any more kids, but would prefer a CNM if I changed my mind, and would only resort to an OB again if something was terribly wrong with me. But not being able to take a crap comfortably for about 4 months following what amounts to medical battery will do that to a person.

          • toni

            Sorry that happened to you. I’d be fuming if a doctor did that to me.

          • Amy M

            Me too.

            OB:Do you want a C-section?
            Me: Do I need one?
            OB: Not at the moment.
            Me: Ok, I’ll try for vaginal birth then.

            Later on, different OB on call:
            OB: I’d like to give you Pitocin to get things moving, or we could do a C-section. Think about it. (he explained further.)
            Me: Ok, try the pitocin. (it worked)

          • Mishimoo

            Our GPs are pretty easygoing, but I think that’s because we have a really good working relationship. They don’t need to take an authoritative stance, they can offer friendly advice and know that we’ll take it instead of arguing.

          • drsquid

            my ob spontaneously at one of my visits said… btw you can deliver vaginally or c section, whichever you want (of course depending on twin a’s position). she didnt push either way. i told her i wanted two healthy babies. so when she let me push for 2.5 hrs with twin b i knew he was safe and she wasnt just avoiding fighting with me about a section because she knew i was fine with it and only wanted what was safe.

          • batmom

            They did in my case. I was exhausted and every time I pushed, the baby’s heart rate slowed to a crawl and then stopped. It rebounded, but after hours of no progress I was too terrified to keep pushing every time I heard the beeps slow, stop, and restart. So I said, “I’m done. I can’t do this any more.” I signed the consent form (in retrospect, I was obviously out of gas — I could barely hold the pen.)

            The CNM brought in the OB, who introduced himself and said that we could try forceps first, but if it didn’t work, we’d have to do a C-section. The forceps worked; my kid had wedged his head sideways and he had a giant bruise from labor, but all the OB did was turn him a little and it turned out I was pushing productively enough to get him out.

            So at least in my experience, I certainly wasn’t pressured. I was at the hospital sixteen hours by the time I delivered and I’d been in labor around twenty-one hours.

        • Captain Obvious

          All I am saying is pre-eclampsia is not an indication for cesarean. You don’t want to perform an emergency cesarean while a woman is seizing either. you first have to stabilize mom. If you have a seizure and become stabilized, then you might continue with an induction of labor on mag sulfate. If you have HELLP syndrome and are remote from delivery, you should get a cesarean. I wonder if your mom continued to have seizures or just one.

          • Karyn Croushore Hodgins

            The way she always presented it to me was this horrific “I had grand mal seizures and your dad had to decide which one of us lived.” lol… She was a little crusty about the fact that I had really easy deliveries lol… so I am not sure if she had lots of seizures or just the one…. She definitely was traumatized by the whole thing… my dad told me once that for the first 2 weeks of my life he had to have a nurse come in to take care of me because my mom insisted I was dead and that they gave her someone else’s baby…

          • MaineJen

            LOL?

    • Amy Tuteur, MD

      Women who choose to have every intervention in the book also own their bodies.

      • Karyn Croushore Hodgins

        It is not about choices… it is about how those choices are presented to her… you need to do this or you are a bad mother kind of feeling…
        Is 12 hours really too long to be in labor if the baby is not in distress and the mom clearly does not want a C-section?

        • Karen in SC

          There are lots of factors. “Not in distress” can be a clear fact, or maybe borderline and maybe the anesthesiologists go off duty soon so later there would be a delay in calling out. Maybe there is a heads up presentation and in the OB’s experience the labor will go on for several more hours. Maybe OBs should present these factors better, but it doesn’t mean they are not present.

          • Karyn Croushore Hodgins

            And had THAT been the way it was presented to the patient… perhaps she would not have the feelings about her experience that she had…. and would not be talking about giving birth at home the next time…

          • fiftyfifty1

            Or maybe she just drank the NCB koolaid that tells women that they are bad if they take pain meds and gives them a lot of negative peer pressure if they do. Then the only way to redeem themselves is to “do better next time”, and no better way to do that then to stay at home where they can’t possibly “cave”.

            What are women anyway? Mighty birth warriors or poor little babies who get sooooo upset at being offered pain meds (in a way that wasn’t somehow exactly right!!) that they can never bring themselves to birth in the hospital ever again.

            I am an adult. I do not need to be flattered and I do not need my feelings tiptoed around. I am a grown woman.

        • Something From Nothing

          What about, real women don’t use pain relief in labour? The way those “choices” are presented goes both ways. In my experience midwives don’t know much about informed consent or informed refusal.

          • Karyn Croushore Hodgins

            oh I don’t buy that at all… I think that if you choose pain relief… that is totally up to you…
            <—— Epidural with one and Stadol with another… but I also think that we are too quick to push pain relief on mom's who don't want it… and we are very good as nurses (and yes I am talking about myself as well) at finding the perfect moment to encourage pain meds

          • DaisyGrrl

            My experience with my friends has been the opposite. I’ve seen more than one person refused pain relief upon request. My sister’s epidural was refused for hours until very late in her labour (I suspect they were trying to put her off until they could say “oh, it’s too late now. Time to push!”). There was no reason for it. She was labouring on a weekday afternoon so anesthesiologist coverage should have been available.
            There’s nothing wrong with offering pain meds. There’s nothing wrong with accepting them. There is something wrong with denying a patient their choice to be medicated or not medicated.

          • AllieFoyle

            As someone who desperately wanted, requested in advance, begged for, screamed continuously for hours for, and did not receive pain medication, I have to say I find the idea that nurses should try harder not to offer pain relief utterly reprehensible.

          • Karyn Croushore Hodgins

            I agree that your situation is inexcusable… but if you were screaming for it… you should have had it… but if you had stated before you delivered that you really didn’t want it… you should not have been pushed to have it… there is a huge difference.
            I didn’t say try harder not to offer it… I said don’t push it on someone who doesn’t want it

          • DaisyGrrl

            There’s nothing wrong with changing your mind. As a nurse, I would expect you to evaluate my pain on a regular basis and offer pain relief as warranted. I would expect this regardless of my medical condition (broken bone, abdominal pain, labour), and regardless of my previous answers. There is nothing wrong with that.
            Pain at 5/10 might be tolerable to someone for 4 hours then they change their mind after 5 hours. That’s the patients’ perogative and the health care providers should respect that.

          • Nashira

            “There is nothing wrong with that.
            Pain at 5/10 might be tolerable to someone for 4 hours then they change their mind after 5 hours.”

            Yes yes yes yes yes. I’m dealing with a moderately bad, stubborn ulcerative colitis flare right now. I could handle two days at an average of 6 with spikes to 8. I couldn’t handle more than that. Pain is exhausting, and the longer you’re in pain, the harder it is to deal with it. There’s no reason why labor pain should be any different from my UC pain, in that regard.

          • Young CC Prof

            Yeah, I’d rather staff err on the side of offering.

            People offering me drugs I don’t need or want: Mildly annoying.

            Staff “forgetting” to offer, or not providing in a timely manner when asked: Really freaking awful.

          • Siri Dennis

            I have a vivid memory of a crunchy couple with a long, detailed birth plan; everything had to be natural, but pretty soon mum became distressed (they had attended antenatal classes and had their drinks spiked with Koolaid) and wanted Entonox. Little while later, exam reveals 2-3cm dilatation. Mum requests epidural. Dad says, But we agreed we wouldn’t have one! She klonked him on the head with the mouthpiece, then got her epi.

          • Dr Kitty

            “We decided we wouldn’t have one”
            Yeah…this is not a time for joint decision making.
            He doesn’t get a vote.

          • Young CC Prof

            Definitely. How to support your wife’s birth plan, step 7: When she changes her mind during labor (or has it changed due to complications) you DON’T FREAKING ARGUE.

            The only people Dad should be arguing with are the staff, and only to express points that Mom is too out of it to be making clearly enough.

          • fiftyfifty1

            “and we are very good as nurses (and yes I am talking about myself as well) at finding the perfect moment to encourage pain meds”

            The time to offer pain meds is when a person seems to be in pain. That’s the rule for every. other. nursing. situation. in. the. hospital. But somehow following these same rules with laboring women is wrong?!

            I don’t get why you see going without pain meds as being some sort of victory. And that offering them to women when they are experiencing the worst of their pain is somehow morally wrong. How hard is it to say “no thanks” if the pain really isn’t that bad? And if the pain really is that bad, what’s the harm in offering the med? Why are you putting such a value judgement on women and their pain?

          • Guestll

            Agree 100%. That’s been my experience as well. A lot of talk about informed consent, with misinformation guiding the process.
            Here’s what guided my “informed consent” to decline GDM testing — I was very thin and had not gained much weight due to bad NVP. My primary RM said, “You can do the test if you want, but I wouldn’t bother. If you have gestational diabetes, I will eat broken glass.”

          • Karyn Croushore Hodgins

            I think that informed consent is not always very informed and that practitioners are sometimes guilty of forgetting the informed part… but then so is the health care consumer… they say they didn’t know… but then they didn’t ask. I can play devils advocate… neither side is right!

          • AllieFoyle

            Patients ought not to be expected to be experts, and it follows that they therefore should not be expected to even know the right questions to ask. The onus really is on the hcp to make sure all the bases are covered.

          • Guestll

            It’s her job to know and understand GDM, not mine. It’s her job to know that even very thin women can suffer from GDM, not mine. It’s her job to present the facts. It’s my job to make the choice based on those facts.

          • thepragmatist

            HOW DO YOU KNOW WHAT QUESTIONS TO ASK? You’re supposed to be in the hands of the expert. I don’t go to a mechanic and know what questions to ask. I go there to find out why the hell my car is making that terrible sound every time I rev the engine. If I knew what the question was, I would answer it myself and mostly likely fix it myself.

          • thepragmatist

            I think this is how my son ended up with crashing blood sugars at birth… Thanks MW for dismissing the importance of the GD testing!

        • AllieFoyle

          I just cannot manage much outrage at a situation like that. The physician expresses concern, has a conversation with the patient, and they agree on a course of action. What exactly is wrong with that?

          I reserve my outrage for providers who provide truly negligent or abusive care, who fail to obtain informed consent, who ignore requests for pain relief or intervention because of a personal preference for natural childbirth and/or a lack of respect for women’s autonomy and dignity.

    • auntbea

      She was eclamptic and they didn’t immediately section her? THANK GOD that wouldn’t happen today.

      • Karyn Croushore Hodgins

        I agree!! In fact today… most of the time interventions would happen before she progressed to ecclampsia.. and I am all for that….

    • Young CC Prof

      Thing is, it’s a bit more complicated than that. 50 years ago, even 35, doctors allowed mothers to simply push out frank breech babies. Most of the time, this turned out OK. Not all the time.

      50 years ago, the probability of a mother dying of complications as a result of a c-section was significant, maybe as high as 4%, so doctors did everything possible to avoid it. Now, the probability of a reasonably healthy woman dying or suffering serious lasting harm from a c-section is far far smaller, so if the baby even might be in trouble, they cut.

      It’s all about risk-benefit analysis. When the risks of surgery go way down, all of a sudden the risks of avoiding surgery start to look unacceptable.

      • theadequatemother

        50 years ago the intrapartum fetal mortality in breech vaginal birth was 5%.

        Who likes those odds?

        • fiftyfifty1

          “Who likes those odds?”

          People who also think that seizing in labor is not that big of a deal.

          A deliver that kills the baby 1 out of every 20 birth and 42 hours of active labor followed by a seizure are now “middle road” I guess. But a woman getting a shot of Stadol for pain during labor is a real problem!

    • fiftyfifty1

      Your mother was in *active labor* with you for 42 hours with pre-eclampsia and they dilly-dallied long enough that she became *Eclamptic* and you think that is a GOOD thing?!!! You think that’s the “middle road”? You think we should wait longer and let women SEIZE just so they can deliver vaginally?? Either you have really drank the Koolaid or despite your supposed nurses training you have no idea what eclampsia means or what its risks are.

      As for your story about your daughter, there is absolutely no reason you can’t lean over the bed and have continuous fetal monitoring at the same time. I did it for hours. Why would that position affect the belt at all? Now if she was ruptured but the head was not yet engaged, now *that’s* a reason to be in bed. You don’t want a cord prolapse, right? It’s got nothing to do with age. Your story doesn’t make sense at all.

  • Mel

    “You tell everyone that you will be quick to transfer to the hospital in an emergency where you trust that the obstetricians can save your babies life, but you don’t trust those same obstetricians to prevent the very emergency that will require their assistance. Does that make any sense?”

    And this is the main reason why if my husband and I are blessed with children that I will give birth in a hospital. It is usually easier to prevent a crisis than fix the crisis. I teach. It’s a whole lot easier to fix a student’s misunderstandings/confusion as soon as it happens rather than have a totally lost student ask for help 10 minutes before the test. I really don’t want to put myself, my husband, my baby or the medical staff – through a crisis/crash situation because I thought birthing at home would be easier/more natural.

  • http://Www.awaitingjuno.blogspot.com/ Mrs. W

    I think there are questions every woman must ask herself as to what her priorities are and what trade offs she is willing to accept for herself and her child. I do think this post is a little unfair, in that it basically equates those who are choosing homebirth with being “bad mothers”. We need to get to a place where women are, regardless of pregnancy status, treated like full humans and given informed consent with regards to the medical decisions they are making.
    Making moms who are considering homebirth feel like garbage for doing so is a low blow – as low as some the tripe written by certain bloggers who feel the need to be superior due to their specific choices.

    • C T

      Agreed. It would be a better post if it left out the following:

      “Do you love your baby more than you hate the hospital?

      Which is more important: whether your baby lives or dies or whether you can brag to your friends about your defiance of medical authority?

      Is birth an intimate moment sanctified by sharing it only with friends and not impersonal medical professionals, or is it a narcissism fest yielding professional photos and YouTube videos posted for the perusal of all 7 billion people on the planet?”

      But the other content is not condemnatory of specific mothers but rather of the NCB-homebirth mindset in general.

    • auntbea

      This is an interesting question that we have tried (unsuccessfully, I believe) to deal with before. Because there are, in the world, mothers who are objectively bad. And there are choices parents can make that substantially increase their child’s risk of harm for no apparent benefit, and that we, as a society, have deemed unacceptable. Most of us, for example, would judge a mother who did not put her child in a carseat, and would probably call CPS while we were at it.

      But there also all sorts of parenting choices that don’t really make of a difference in the long run, like formula feeding or diapering or homeschooling, and most people on this board are quite fine with not judging people who make different choices of this type.

      The question, therefore, is which category homebirthing falls into. Car seats? Or formula feeding?

      • thepragmatist

        I think it falls into neither, because it involves a fetus. So this makes it an even more difficult question to answer, as a fetus is not a person under the law (although CPS can be called on a mother with a fetus inside her). But it adds another layer when we’re not dealing with a child that is out of the womb. I would say that home-birthing the Canadian way, with two registered midwives, appropriate risk-out, and a hospital on stand-by is a breast vs bottle debate, as the risks really are very, very low. But homebirthing with an unlicensed CPM is definitely along the lines of letting your children bop around in the back seat without a belt on.

        The issue comes that the fetus is in a woman’s body. And I think there are many of us here, on this forum/blog, who would take special interest/offense at the thought of stripping a woman of the right to do what she wants with her body during pregnancy. I do. So, to me, the only way to deal with the issue is to go after the unlicensed/poorly licensed midwives who are taking money to exploit women. I can’t possibly condone choosing to go after birth attendants who are unpaid and who have been requested to attend a birth by a mother. It starts to fall too closely across a line of autonomy that I’m not politically willing to cross.

        Education about women’s bodies must start in highschool and it must be much more thorough than it is now, for one. We must teach our girls to think critically about their bodies and sexuality and to question authority, whether it is a doctor or a midwife, and to think critically about the information presented to them. I was converted to NCB in University level classes of all places. This is something that is being actively pedaled to young women and girls. The NCB movement as presented in feminist works like “Our Bodies, Ourselves” which definitely had a very anti-hospital stance on birthing, has taken control of the dialogue of birthing. It needs to be science-based and much more detailed. Women and girls need to learn, IN HIGHSCHOOL, about the birthing process, and not just a cursory class, but a thorough semester, like I spent in University learning about Women’s Health in a Women’s Studies program. I still didn’t learn about things like presentation of fetus and so on. We shouldn’t wait to explain these things. We should start young and we should make sure that the entire birthing process is explained like it is here, in Dr. Amy’s factual posts. Tearing, positioning, and the like. We need to discuss birth. All I got in highschool science class (Biology) was a brief section (maybe a week) and there was nary a mention of these things, if I recall correctly. So I would say we need to start there.

    • Guest

      “We need to get to a place where women are, regardless of pregnancy status, treated like full humans and given informed consent with regards to the medical decisions they are making.” No, I’m sorry. Being treated like a full human means we’re honest about the facts, even if it hurts your feelings. The facts are that babies born at home are at greater risk for severe injury or death than babies born in the hospital. Dr. Amy may be blunt, she may be tactless, but she is telling the truth. A full human being has a choice whether or not to feel like garbage about it, and a choice what to do with what she has been told.

      • AllieFoyle

        I think you are completely missing Mrs. W’s point, and probably Dr. Amy’s as well, judging by her response.

    • Amy Tuteur, MD

      I debated with myself for several hours before I posted this. I don’t for a moment think that women who choose homebirth don’t love their babies. I decided to post it because I thought the language was unusually thought provoking and might resonate with homebirth advocates since that is the way that they talk about women who make choices that differ from theirs.

      • Karyn Croushore Hodgins

        I think that talking about hating the hospital is a misleading statement a little… because frankly who LIKES it?? I think it is hatred of patient treatment at the hospital in the day and age of big business and cost savings… I don’t even know that it is fear based… for me… it was experience based… we are told to be sheep when it comes to delivering babies… when my oldest was born (I was only 19 and not old enough to realize I could question) I was told I HAD to have an episiotomy… walking was painful for weeks! now… 22 years later… not evidence based….
        When I had his sister 4 years later… no drugs, (in spite of the pit drip)…. no episiotomy… and I was able to go grocery shopping on the way home…. Experience told me to take a little bit of control over a situation where I only had a little to begin with

        • Young CC Prof

          We DON’T want women to be sheep, we want them to be informed. What upsets me is people actively spreading disinformation, and the extreme popularity and wide acceptance of said disinformation.

          Going into a vaginal birth, a woman should know what failure to progress is and what the common signs are, along with a few other common complications. Ideally she and the doctor have already discussed some contingency plans, what kind of interventions might happen and why.

          I’m sure it happened somewhere, that a doctor has diagnosed failure to progress in a mother who was actually progressing just fine. (The reverse has also certainly happened at some point, that a mother was told she was doing fine when in fact labor had totally stalled and the baby was in danger.) I don’t think it happens as often as NCB advocates think it does.

          What shouldn’t happen is that a mother goes to deliver believing that things like failure to progress and cephalo-pelvic disproportion don’t exist. They are real, they used to kill mothers and babies fairly often. At that point, you’ve got a patient who’s primed to resist lifesaving interventions at almost all costs, which could be Bad.

          • Karyn Croushore Hodgins

            I could not agree with you more. I think everyone she be informed and encouraged to question. I don’t think anyone should ever die in childbirth. But the direction the healthcare system is going… and this is not the OB’s fault or the fault of the patient… is cost effective, fill that bed mentalities….
            People are NOT encouraged to question… and I don’t make that as a general statement but the experience I have had in my area where our two major hospitals have now merged with big insurance companies…. they want you to just lay there and do what you are told… and it is wrong….
            Question… question… and then question some more so it is possible to make a truly informed decision…
            I don’t look down on anyone who chooses interventions for whatever reason they chose them. What I get upset over are those who are not made to feel that it is okay to question, so they have interventions foisted upon them.
            For example, why could my daughter not avoid the pain med that she didn’t really want when she would have had pain relief by repositioning. All we wanted to do was have her monitoring intermittent… she was progressing fine… we knew that by this time… but we all know that teenagers have a lower pain threshold.
            She literally labored and gave birth in 5 hours…. so she could have tolerated that… without meds…. had she been allowed to reposition.
            And if you are wondering why I didn’t question this at the time… I did.. and just repeatedly heard that she was “high risk” Then when I got her up and repositioned, I was told that if I did it again, I would be asked to leave….

          • AllieFoyle

            I wonder why you are so caught up in your daughter receiving pain relief? Did it have some sort of long-term negative effect? Did she consent to it? If the answers are no and yes, respectively, why is it something that continues to bother you?

          • Karyn Croushore Hodgins

            It doesn’t bother me that she had it. It bothers me that she had it when prior to being in labor she point blank said she didn’t want it… even in labor… she didn’t really want it… until they told her to quit moving around so she could be comfortable… she was handling the pain of labor fine as long as she could move…. when they would not let her move… her choice was sort of taken away from her… in that she could NOT tolerate the pain when she was laying flat on her back so she didn’t screw up the precious monitors…
            And I am caught up in it because she is my daughter… and I love her… and that alone made her experience with giving birth more traumatic than it needed to be… she was already a terrified 16 year old…

          • AllieFoyle

            Well, with all due respect, many women (myself included) have no idea of the magnitude of pain before they experience it and are surprised by how painful it actually is.

          • Karyn Croushore Hodgins

            Lol.. yes I totally get that… I was all about no pain meds until I felt the pain of being induced! Then I wanted them. And I got them…. and they made me puke…. but I made the choice to have them. My point about my daughter was that medications are not always necessary and her pain was relieved with a simple repositioning…

          • Nashira

            I can deal with my UC flare pain with repositioning too, but omfg pain killers are a hell of a lot nicer.

          • thepragmatist

            I can deal with my pain in many ways but nothing is as effective as a Fentanyl patch. Let’s be real. I rest, I try to pace myself, I use distraction, guided visualization, even sex/orgasm– and I’ve used many different medications to try and treat the pain. But give me that old fashion morphine, as the song goes, any day. I do understand why people are so anti-opiates, but at the same time, I don’t. I think that opiates are unfairly singled out because SOME people choose to abuse them. Even then, opiates are much gentler on the body than alcohol or large doses of NSAIDS, for example.

            Some of the drug trials I’ve had to avoid opiate treatment ended with abjectly horrifying consequences. I’m Bipolar, so SSRIs are out and I think they’re a bit of a joke anyway. At a recent pain seminar, one woman said, “I still feel pain, I just don’t care about it anymore,” and I wasn’t sure if I thought that was a good or bad thing. Ha. At one point I was even put on an amphetamine! I’ve been given nabilone, the cancer drug, and even smoked pot (does. not. help. truly.) and had some small success with adding Tegretol (oh how I miss it) right up until I broke out into a rash covering 100% of my body! Tegretol was a great drug. Boo. I was trialed on Pregabalin and it made me spin like I was drunk and pass out, so that I couldn’t function, although a small dose is helpful. But it always comes back to narcotics because let’s be real: THEY WORK!

            Truly, I am very sorry there’s an illicit drug trade. I get it. I didn’t do it. Making me take ten different medications in one year to avoid titrating me up to a stronger opiate was pretty gnarly. I feel like I’ve earned my fentanyl patch now and they can peel it off my cold dead arm if they try to take it away and make me go through all that again or back to being in pain all the time. It was hell on my body, all those drugs, and I’m happy with my medication combination, even if I am constantly judged.

            I still have to attend these pain clinics and follow intense protocol to get my meds, and it is so humiliating. Meanwhile, my ex-husband can have as much Ritalin as he wants and no one says anything, even though it makes him a psycho, and it’s sold and abused too. I’m so sick of being stigmatized for needing opiate pain relief that I’m getting angry about it.

            We have such a fear of opiates, but people pop Advil like candy. I read on here, in the comments once, that if Advil was licensed today it wouldn’t make it past the FDA because of how dangerous it is. I’m walking proof. It destroyed my GI tract, really. I have to take a proton-pump inhibitor every day and I’m in my early 30′s. THAT’S what you get when you force someone to endure an injury with OTC meds alone. I throw up any NSAID that comes near me. It’s so much like NCB because it’s not logical at all: instead of prescribing a balance of NSAIDs and opiates, I had a doctor ration out codeine like it was heroin and advise me to take 600-800mgs of Advil every 4-6 hours. Thanks, buddy. I think back to the midwife who had me taking 1500mgs of Tylenol every 4-6 hours and shake my head, too. Pretty much sure it’s head to head with alcohol now for liver damage. And OPIATES are bad? I’ve researched and researched and they just do not appear to have the same side effect profile: in fact, they seem to be rather safe in comparison.

            The latest craze is anti-psychotics. Really? REALLY?

            Right, no thanks.

            Meanwhile, I take a medication for Bipolar that makes my hair fall out, has caused me to lose 40 pounds, gives me hormonal acne and has appeared to disrupt my menstrual cycle, and I will probably take it for the rest of my life, and all my GP can talk about is how “toxic” the opiates are. He asked me awhile ago if I intended to take them for the rest of my life? My answer was, “Am I going to be in pain for the rest of my life?” That dumbfounded him. Then, he came back at me with the bit about them being horrible, toxic drugs, and I pointed out the bit about my Bipolar medication. It’s a horrible, nasty drug. It causes cancer. It gave me so much. I’ve accepted I am disabled and that there will be consequences to these medications. It’s all about quality of life, for me. Is my life good? Can I parent? Yes? Ok. Good enough. I’m not here, as a patient, to satisfy some edict from the College of Physicians and Surgeons about who should and should not get pain medicine. I read the 109 pages of the paper produced on the subject for Canadian physicians, in detail and carefully. There is so much sexism and bias and morality in there, it’s preposterous.

            I do not think this is just about NCB. Every ten years it seems we just pick a class of drugs to stigmatize. Right now it’s opiates. Ten years ago, everyone was telling me I had to get off my anti-anxiety medication, that I would end up in detox at 30, that they would stop working, yada yada yada. Here I am, many years later, stable on anti-anxiety medicine that made it possible for me to work through out my twenties. Never did end up in detox, or needing more and more as promised. Now it’s the pain medicine I rely on to live day to day. Next it will be something else. I’m not sure why this happens but I am not sure these policies are really driven by evidence-based research, but more by 1. realistic concern about the illicit drug trade; but 2. a puritan ethos of stoicism; as well as 3. the idea that someone SOMEWHERE might be getting high and we can’t have that!

          • Nashira

            Oh hon, hell yes to this. In addition to the newly diagnosed, but long present, ulcerative colitis, I have trigeminal neuralgia. The best part of the UC flare was two weeks on vicodin and then percocet, when my face didn’t fucking hurt for the first time in more than ten years. But I’m not allowed to access those meds on a regular basis, not even for dental work, which means I don’t go to the dentist. I actually tried really hard to save some of the percocet so I could go to the dentist, but my abdomen hurt SO BADLY that it was either take them now or start hurting myself. (When I am overwhelmed by how I feel, especially in severe pain, I get very strong urges to self-injure. It’s complicated but I don’t SI any more; I know that the urge is a sign that I need better pain control STAT. Which is why I called my GI doc as soon as I was coherent enough to talk instead of cry, and he fixed my meds.)

            But because opiates are omgbadhorrible in the view of the US DEA, and no matter how valid your need is for them, clearly we’re all just one step away from being nasty evil drug addicts. (Because it’s not like addiction is a separate spectrum of disease, or that one can be addicted to so many other things than opiates…) It makes me so freaking angry but nobody would even think of listening to us, the chronic pain patients, because we’re just druggies and everyone knows druggies are bad, not ill themselves. God help you if you both have chronic pain and current or past struggles with addiction, then it’s like you’re doubly fucked.

            I can’t get it straight in my mind right now, but I have noticed a definite association between people viewing folks w/ addictions as sub-human and worthless, as opposed to sick folks who need *appropriate* treatment which may include methadone/suboxone/prescribed heroin/whatever, and viewing folks w/ chronic pain as sub-humans and worthless, as opposed to sick folks who need appropriate treatment which may include insert narcotic here. They look at us in our worst moments and decide we’re like that always and… I don’t know, um, gonna stop ‘talking’. This is weirdly triggering right now, glrk.

          • AlisonCummins

            Why was she sixteen? You’re complaining about failures of communication, but the biggest ones here that I see are the ones that resulted in her becoming pregnant as a teenager.

            Did you not communicate with her about birth control? Were you not someone she could go to easily to ask for help accessing effective birth control? Did you not teach her to advocate for herself so that she wasn’t having unprotected sex?

            Did you have so much invested in the concept of motherhood as a measure of a woman’s worth that she thought that other things she might do with her life were not important?

            The fact that nurses offered her pain relief when she was in pain and respected her right to change her mind doesn’t sound like a problem to me. It sounds like redirection.

          • Karyn Croushore Hodgins

            Oh for GOD’s sake… now we are going to talk about what a horrible mother I am because my daughter got pregnant at 16? Well let me reassure you that I DID have the conversation with her about birth control and after having a mother from who I had to hide everything, I DID remain open-minded about sex in our world of kids being bombarded with it from birth. And I certainly encouraged her as well as my boys to please come to me when they were contemplating sex and we would get it taken care of. Sometimes, you do everything right and still get the same result. Trust me, as a nurse I have gone through all the reasons in my head why it was MY fault that she got pregnant at 16. Now that the baby is almost 3, I realized something…. sometimes even teenagers have to take responsibility for their own actions.
            As far as the pain meds are concerned… let me say AGAIN…. it has nothing to do about my daughter using the right to change her mind about pain meds…. it is about the fact that she was not allowed to exercise her preference for pain relief… which was moving around. I have a hard enough time getting this kid to take a Tylenol…. always have… she did not want pain meds “if at all possible” those were her words…. what I have been resentful of…. was the fact that by putting her into a position where she could not relieve her pain on her own… ie walking around… the option was taken from her.
            And as far as me being disappointed in her… on the contrary, I am VERY proud of her. She did have a baby as a sophomore in high school. She also graduated from that high school with a 3.9 GPA and is an engineering major at Penn State. She also works full time and is a fantastic mother… so no… while I would have made other choices about how her life went, I am not disappointed in her at all.
            I apologize to anyone who I have offended. I think now that I have gotten defensive and have been told what a rotten mother I am because my daughter got pregnant as a teenager, I will stay away from this site now. Apparently, if you don’t get on here and just follow what everyone says like sheep, you get lambasted by everyone.
            For those of you who missed it and responded to anything I said as if I was a total idiot… I would like to say I have a Master’s in Nursing and have been teaching in a nursing school for 4 years. I do know a little about what I am talking about….

          • MaineJen

            Who decided that she didn’t want pain meds? Her? Did she decide on that before labor, or did she change her mind during? A 5 hour labor is still painful…I was in labor for only 6 hours with my daughter, and spent the last hour of that in *blissful* relief of an epidural. Short labors are intense. And you have no way of knowing how long or short it’s going to be, while you’re going through it.

          • Trixie

            So do you frequently discuss with your daughter how she didn’t live up to your standards by giving birth without pain meds? Because it’s pretty messed up that you’re so emotionally invested in her decision to receive pain relief.

          • Wren

            You know, my mother has three grandchildren. One was born via C-section with a spinal, one via an epidural and induction and one via a “natural” delivery. I’m so glad it doesn’t matter to her how it happens and she was not invested in how her daughters chose to deliver, and certainly not in whether we had pain meds.

          • Young CC Prof

            I sincerely hope not. At twice that girl’s age, I’m still feeling pressured by my mother into a natural childbirth. If I hadn’t found this site, I’d probably be upside-down with an ice pack and a flashlight right now, trying to get my breech baby to turn so I can have my Ideal Natural Birth after all.

        • Carolina

          *raises hand* I LOVED the hospital after I gave birth. Three wonderful, healthy meals a day that I did not have to plan, prepare, or clean up after. Nurses caring for my baby while I slept and only waking me to nurse/check vitals. Help breastfeeding. Pain medicine on demand (I had a compound fracture in my wrist too). The experience was lovely. I know several people who joked about not wanting to leave the maternity wing.

      • http://Www.awaitingjuno.blogspot.com/ Mrs. W

        I can appreciate that. I do think it is a travesty that women aren’t given the whole picture with respect to their choices and the risks attached to them. I wish it wasn’t so – and I think doctors are in a much better position to advise their patients. Frankly, I find the whole “trust birth” mantra to be very patronizing – or maybe matronizing is a better word. Either way, its not good to be treated as anything less than a full grown woman.

  • C T

    Ironically, the existence of homebirth as an option makes hospitals and OBs pay more attention to patient satisfaction. From what I’ve seen locally (Colorado), I think it’s less concern about market share than it is a desire to avoid their patients opting for homebirth with its increased risks.

    • Young CC Prof

      And, you know, not enjoying the cleanup of home births gone wrong, which I imagine some hospitals have seen far too much of.

      • C T

        “not enjoying”…that’s a nice way to put having to deal with the anguish of telling a new mother that the brain damage her baby sustained in a homebirth wreck means that the baby will die after being taken off life sustaining machines…and watching the bereft parents sadly walk empty-handed from the hospital

        When the baby could so easily have been saved with one of those “evil” C-sections.

        • DaisyGrrl

          Don’t forget getting sued by the parents because the HB midwife is judgement proof and that brain-damaged baby is going to need expensive care for life.

    • http://shameonbetterbirth.wordpress.com/ Shameon Betterbirth

      They pay more attention to it unless you’ve already picked an out of hospital birth. If you end up transferring the hospital staff basically hates you automatically. That is something I wish I had been told beforehand by NCBers.

      • Karen in SC

        That trope has been contradicted by several first hand accounts here and at Hurt by Homebirth and other blogs. I am very sorry it happened to you, since it absolutely should not happen, but I don’t think it’s a system wide problem.

        • http://shameonbetterbirth.wordpress.com/ Shameon Betterbirth

          What happened to me is not “contradicted” by someone elses story, nor is it a trope.It happened to me at a hospital that is down the street from a birth center so they get a ton of these transfers, and I was treated horribly by several shifts of doctors and nurses on both the L&D and postpartum unit. Its not a coincidence. I’ve seen the same thing in other non-maternity units whenever a patient is seen as being non-compliant. Asking too many questions can make the staff hate you, depending on the culture of the unit. Medical professionals in hospitals are people like everyone else, and a fair amount of them are mean. There isn’t a consequence for them being mean unless they hurt you physically as a result of that.

          • auntbea

            Your experience is not something that can be contradicted by someone else’s story, no. But it is also not something you can extrapolate to all hospitals or even most hospitals. It sounded like that it was you were doing, which is what Karen was responding to. Whether the typical hospital is hostile to transfers is an open question.

          • http://shameonbetterbirth.wordpress.com/ Shameon Betterbirth

            I worked in several hospitals over the years, and its LUCK if you get a unit with fucked up culture or not. What I really hate is everyone waxing poetic about how great the hospital is, if only you had gone there first, etc. I got treated like shit by everyone. I don’t want people to think they are safe based on their location, because its nonsense.

          • Drsquid

            I have worked in many many hospitals and i will agree there are unfriendly people who work in them and there are bad cultures in some hospitals… That said I do not believe you that everyone was mean to you. I just don’t. Nothing all is all or nothing. I had a great hospital experience. I didn’t like some of the people but I wouldn’t say they were mean. I haven’t actually read your birth story so I don’t know if you arrived in an emergency and it was people being a bit terse while dealing with an emergency or not but… I do not and will not believe that everyone in any hospital (store, office etc) is mean. Life doesn’t work that way.

      • C T

        Yeah, I was just going epidural-less (low blood pressure, easier labors than the norm, some NCB influence, etc.), and I experienced some hostility from a nurse with baby #3 for it. Some nurses really don’t like dealing with NCB-swayed patients (just read RN forums if you doubt it), and I can sympathize with their feelings as long as they don’t get unprofessional about it. When my OB for #4 heard about the nurse, she energetically apologized for the nurse’s behavior; I didn’t really care anymore, but the unnecessary apology on behalf of unrelated hospital staff convinced me that there is currently a culture at the hospital of promoting patient satisfaction as well as safety.

      • Durango

        Well, based on my very brief OB clinical rotation in nursing school, I found the home birth transfer patients to be very rude and defensive from the get-go. As a former homebirther I was obviously not going automatically hate any patient, but being treated so rudely certainly made an impression.

  • http://shameonbetterbirth.wordpress.com/ Shameon Betterbirth

    This is a false dichotomy. Babies need their mothers to take care of them. I’m not a baby container who is unaffected by the outside world or how I am treated by other people.

    I got hurt by NCB, really badly, but this argument sucks. It pushed me in the opposite direction when I read it on this website the first time. It convinced me that women like me who are concerned about being traumatized by birth are dismissed as simply being selfish by OBs. I can state without a doubt that being traumatized does affect the ability of a woman to take care of her baby and herself. Its a valid fear and I wasn’t foolish for having it. I was foolish for thinking natural childbirth was the answer.

    • Amy Tuteur, MD

      Don’t you think that fear of hospitals is a major (but unacknowledged) factor in the choice of homebirth?

      • http://shameonbetterbirth.wordpress.com/ Shameon Betterbirth

        Its not unacknowledged at all. People talk about it all the time. I don’t think women are unreasonable for having those fears, especially when most of the time it is based off of negative personal experience with hospitals. I’m just letting you know how off putting this line of argument was when I was pregnant and researching NCB.

        • auntbea

          Interesting. I see how the above could be taken as dismissive, and seen as off-putting, and, really, there isn’t much reason in this day and age for hospitals not to try to make the mother’s experience positive, let alone untraumatic.

          But I also am not sure how bad a hospital would have to be for me to risk my baby at homebirth. Where I work in Uganda, laboring women are actually beaten by the nurses if they make too much noise while laboring on a dirty floor in a room full of 40 scared other women. And yet, most of those women have traveled miles to give birth at the hospital because they know that when it comes down to it, the hospital may be their only chance to save their babies or themselves.

          • http://shameonbetterbirth.wordpress.com/ Shameon Betterbirth

            I knew I was at risk for being traumatized because of an abuse history. I felt that it was a much more likely scenario than a catastrophic medical problem. As I’ve noted over and over, there is basically no consequence for doctors (or midwives) that do this to patients, so why would they stop?

          • ratiomom

            Rest assured that if a hospital staff member, doctor, CNM or nurse, was accused of sexually harassing a patient the way you were treated by your hb midwives, there WOULD be consequences. Major ones.
            Hospitals that protect suspected sexual offenders are opening themselves up to so much litigation that they would bankrupt themselves if someone took them to court over it. Touching a patients clitoris during a cervical check is most definitely not something a hospital employee would get away with.

          • http://shameonbetterbirth.wordpress.com/ Shameon Betterbirth

            BULLSHIT. It happened to a woman at the hospital in utah this past year and the staff didn’t do a fucking thing. They told her to wait until monday to call the police. The cops probably didn’t do much either, knowing their <5% rate of conviction for sex crimes. Women who come out against sexual violence are almost never supported by the justice system- the victims are put on trial consistently. What planet do you live on?

        • Amy Tuteur, MD

          I didn’t say it is unreasonable. I just think it deserves more attention. Women who convince themselves that homebirth is “safe” often don’t acknowledge to themselves that this is a convenient way to avoid the hospital. Better to confront hospital fear head on.

          • http://shameonbetterbirth.wordpress.com/ Shameon Betterbirth

            Post about it then. It was my situation for sure. Let me know if you have questions about the mindset of someone picking out of hospital birth for such reasons (though I’ve written so much about it already you probably don’t need any help).

          • R T

            I have to agree with her on this one. The fear of the hospital and what might happen to them, for some women, greatly outweighs their fear something will happen to their baby. Statically speaking a major complication in childbirth is probably lower than the chance these women will feel traumatized in the hospital. I had two very traumatizing experience during my pregnancy while hospitalized. First, a doctor who I had never met looked at my chart and prescribed me oral medication for my GD. I had already told every single other doctor in his practice I wanted to do injected insulin only. I was not informed I had been perscribed it and it was brought to me in a cup with my regular meds. I spotted the unfamiliar pill and took it out, set it aside and called my nurse. She informed me it was a new medication I needed to take for my GD. I was livid! You don’t go around prescribing medicine for someone you have never met and then try to sneak it in with their current meds! I tore that doctor a knew one when he came to my room AFTER I refused to take the med. Second, as I have posted here, I was refused pain meds for 7 hours when the pain reliever they put in my spinal for my csection failed. You better believe this experiences colored my view of my future choices should I get pregnant again! I’m not doing a homebirth, but I will be very hard pressed to consent to another csection. Yes, my children are immensely important to me, but so is me immensely important to me, lol! This is coming from someone who lost a baby late second trimester. I know what it feels like to suffer that grief, but I also know what it feels like to scream and writh in agony for 7 hours after a csection with doctors and nurses accusing me of being drug seeking.

  • GuestB

    “You tell everyone that you will be quick to transfer to the hospital in an emergency where you trust that the obstetricians can save your babies life, but you don’t trust those same obstetricians to prevent the very emergency that will require their assistance. Does that make any sense?”
    This. A million times.