Is promoting unmedicated vaginal birth unethical?

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Years ago when I first read the phrase “promoting normal birth” I was confused. Why would a healthcare professional be promoting any set of procedures or any particular approach to a health issue? I thought it was the job of health professionals to promote safety.

It is unethical for a medical professional to promotes one procedure over another when both are equally effective in dealing with the issue at hand. An ethical medical professional recommends whatever is safest for the patient, not whatever is most pleasing to or most lucrative for him or herself. There are no real medical publications claiming to promote one form of treatment or even one philosophy over another. Real medical publications promote health and promote safety, not the opportunity to confirm one’s prejudices or line one’s pockets.

In contrast, many midwives unabashedly promote one form of birth over another, ineffective pain relief measures over effective pain relief, and rejecting technology in favor of “unhindered” birth. Indeed, the entire midwifery corp of the UK is strictly committed to unmedicated vaginal birth, going to far as developing and maintaining the Royal College of Midwives “Campaign for Normal Birth.”

So I have a question for natural childbirth advocates, midwives and other birth workers: isn’t that unethical? Or more to the point: how can it possibly be ethical to promote one way of giving birth over any other?

Furthermore, aren’t attempts to promote unmedicated vaginal birth an abuse of midwives’ power over patients? Shouldn’t they be providing accurate, value-free medical information to patients and then honoring whatever decisions patients make? How can they justify promoting their own beliefs about birth over their patients desires?

I ask these questions because I’m anxious to see whether any natural childbirth advocates are willing to grapple with the ethical implications of their efforts to promote unhindered, unmedicated vaginal birth. I suspect that no one will.

  • ktmckinsey

    As a woman who’s had two children one with an epidural and one without and someone who hopes to become a CNM someday, I completely agree with you. I think there’s a level of fanaticism that comes along with certain branches of midwifery practice (maybe most of we’re honest). I chose to have both my children in a hospital under the supervision of a midwife with an OB as backup. Why? Because, well, shit happens. Also, let’s not kid ourselves. For many women, myself included, “natural” childbirth is the most painful thing they’ll ever experience. It’s not something I would push on someone and I feel that’s what many midwives do. I always say that my unmedicated childbirth experience was the most amazing experience I never want to have again. If we went for baby number 3 (not happening), I’d get the epi.

    Also, if I ever get to the point where I’m a CNM, I plan to be very honest about women’s options and never practice outside a hospital birthing center environment. To do otherwise seems unethical.

  • I definitely agree with your post. NCB techniques however aren’t without value. I just gave birth 2 weeks ago and knew I wouldn’t be able to have an epidural because of a bleeding condition. I arrived at the hospital very dialated and was strongly urged by the doctor not to take any narcotics because of how close I seemed to delivery. Because however I was prepared to mentally work my way through contractions without drugs my experience wasn’t awful. The hospital staff was also incredibly supportive. Drugs would have been nice and my preference but researching NCB ahead of time allowed me to not labor in fear. Ironically when transition hit in my previous 3 labor’s I panicked in each for about 20 minutes most likely because the epidural/narcotics were no longer strong enough and I was blind sided by pain. All 3 of my births played out the way they needed to though. My doctors guided me to the safest course each time for me and my babies and that’s what ultimately matters.

    • Jocelyn

      Congrats on your new baby!

    • Young CC Prof

      Definitely, certain mental techniques to help endure pain are real things and they can be useful. Glad it worked out for you.

    • SporkParade

      Congrats. I knew I would possibly be in the same boat that you were in, but ended up being very annoyed by the NCB mentality. Yes, I need to have useful techniques for unmedicated birth (I anticipate that I will prefer pain to the feeling of narcotics), but there was no coverage of what interventions might be medically indicated and why and there was quite a bit of advice that seemed to me to be dangerous. For example, the teacher actually said that cord prolapse almost never happens, so there’s no need to be worried about the possibility if labor begins with rupture of membranes.

  • perpetual lurker

    Well, I think the point’s been made below, but speaking as someone who had a VBAC about two weeks ago, I can say it’s really, really hard not to just laugh in the face of anyone who compares labor pain to the “discomfort of exercise/working out.”

    I thought I’d have another go at natural this time around. Within 2 hours my contractions were 2 minutes apart, very painful and only getting worse, and by 2 hours later I was at 6cm, with an unbearable urge to bear down, horrible pain between contractions exacerbated, not helped, by moving around, and was basically screaming in pain. It felt like my insides were trying to come out of my rectum, and between contractions it felt like someone was wringing out my uterus like a wet towel.

    Now, mind you I don’t do CrossFit or anything, but I’m pretty sure working out doesn’t feel like that.

    (The good news – baby’s here and we’re both doing well. And my epidural was AMAZING.)

    • Guesteleh

      Congratulations!

      • perpetual lurker

        Thank you, all! So nice to get some love over the interwebz. Fingers crossed I’ll avoid the gnarly PPD I suffered last time – so far, so good, but I remain vigilant. And who knows – maybe the expert epidural I got was part of this remarkably smooth transition!

    • Mishimoo

      Oooh congratulations on the safe arrival! Glad you’re both doing well and that you got an awesome epidural.

    • Jocelyn

      Congrats!

    • Sue

      Congrats and welcome to little baby perpetual!

    • attitude devant

      Hurts like a mother, don’t it? Congratulations!!!

    • Montserrat Blanco

      Congratulations!!!!

    • Amazed

      Congrats!

    • ktmckinsey

      Yeah… I love exercise and I have a high pain tolerence, but when I delivered my daughter without medication I felt like I was dying (and was afraid I wasn’t). I’m sure the whole freaking ward heard me screaming and I had no intention of stopping because, well, it helped me get her out. I will say that the chemical high you get after unmedicated birth is second to none. You feel like you touched the face of god/contacted your ancestors/received some divine wisdome… That said, the epi with my first was pretty nice too. 🙂

      Congratulations on your little one!

  • Jenny

    http://youtu.be/lCfXxtoAN-I
    OT: I am traumatized by this video! I am not qualified to tell if the episiotomy was necessary or not (maybe someone could comment) but I am horrified by the way this doctor treated his patient.
    I’m usually annoyed by NBA complaining about how bad they they got treated in the hospital and all the interventions that were forced on them but I understand why this women would be very upset.

    • Siri

      Blimey, she really IS flat on her back!! I always thought that was an exaggeration by NCB enthusiasts. In the UK she’d have been semi-reclined, making pushing a bit easier. Charming doc, by the way. How many snips with the scissors? And such a lovely bedside manner…

      • toni

        I know it says she was anaesthetised but even so that looks very uncomfortable to be lying like that when you’re pregnant. Puts her in her place I suppose… ugh

        I gave birth in a US hospital and I was semi reclined. more sitting up than reclining though.

    • toni

      I saw this a while ago and posted it hoping it was unusual http://www.skepticalob.com/2014/01/homebirth-midwives-reveal-death-rate-450-higher-than-hospital-birth-announce-that-it-shows-homebirth-is-safe.html#comment-1227343950 this is isn’t the entire conversation.. I think that’s way down at the bottom of the thread. Only two people commented though. It was hard to watch. I’m angry on her behalf as well.

      • Siri

        I haven’t ever seen an epis done piecemeal like that, hack hack hack hack snip snippity snip. They are usually done once the head is crowning, so the skin is stretched paper thin.

        • Amazed

          So it not only looked terrifying, it was botched up?

          Disgusting.

          • theNormalDistribution

            Seeing videos like this makes me wonder how so many women can view MRCS in a negative light.

          • Amazed

            Same here.

        • toni

          Yeah it’s usually described as a small, simple incision to ease delivery and/or protect the perineum from long tern damage. His method looked brutal. She must have been hurting for a long time afterwards. And if that’s something we can expect of an episiotomy they should tell us that at our antenatal visits and offer us all CS.

      • Jenny

        I guess she tried to sue the doctor who did this but since there was no permanent damage done and no dead baby, no lawyer agreed to represent her.

        • Guesteleh

          I can’t believe this woman had no legal recourse. It’s horrifying. And the hospital QI committee didn’t care either? Nightmare. There are parts of the U.S. where healthcare quality is just flat out shitty. But those aren’t the areas that have a lot of NCB/homebirth woo. Tends to be rural and Southern.

          • toni

            I just watched the first few seconds to see if it was the same video I saw months ago (I never want to see that again!) and I think I detect an accent, possibly Spanish? I know episiotomies are still pretty routine in S. America so maybe because everyone gets them they don’t even wait for the crowning when it’s easier to cut? Also what is he wittering on about in the beginning about doing it herself in Kentucky? Maybe he’s losing it..

      • lawyer jane

        Ugh. My SIL gave birth in a New Jersey hospital with a dr who apparently “cuts” every patient. The nurses whispered to her that they would help her hold off pushing until a better doc came on duty.

    • Amazed

      Looks pretty terrifying to me.

    • they don’t tell you about that

      That was like 3 big snips, icky to watch, but the baby had been stuck on the perineum for multiple contractions and he came right out after it was done, so maybe the doctor was right when he told her that the baby wouldn’t come out without tearing her through the anus. I was a bit disturbed by the stirrups since I didn’t have them. I had an epidural and I was always positioned on my side in order to help the baby turn. My babies’ heads always got stuck up high and once they turned past the top entrance, they shot right out and I tore only an inch. She had a different problem. The protracted pushing gave me an anal prolapse during my last labor. During my first labor, the protracted pushing distressed my baby and he came out unconscious and blue. The NCB concept of *no sense of urgency* has consequences for the baby. Extended pushing has consequences for the mom too. I’m guessing that the doc in that video, unsympathetic as he was, wanted to avoid those consequences.

  • BklynMom

    I am a Lamaze educator and I realize you may not believe this, but I do not push any agenda in my classes. I really don’t. I am strongly committed to that. I do not promote home birth over hospital birth, ( I’m not much of a home birth advocate, but that’s another comment for another thread I think!) I do not tell women that if they choose pain relief they have somehow “failed”, I do not portray OB’s as the enemy, I do not tell them that non-pharmacologic pain relief is “better” and the only “right way” to have a baby (but I DO tell them what some of the side of effects of pain medications and induction medications might be of course). I provide everyone with evidence-based information (much of it from ACOG) and very simply encourage each person to make well informed decisions. I remind them that they have a right to know what is happening to them and why, they have a right to ask questions, they have a right to say no to unnecessary interventions or procedures provided they feel well-informed about what saying “no” could mean for them or their baby (Obviously, I let them know what “yes” could mean for them as well!) I very simply provide couples with information about the labor and delivery process that they didn’t know before. My only “agenda” is to provide couples with the information they need to make informed decisions when their big day arrives. No one should be in the dark about the side effects of pain medications for labor, hospital procedures, episiotomies, different types of fetal monitoring, etc… It’s sad to me that so much of the “natural birth community” has moved away from simply providing information… Just trusting that people are equipped to make good decisions for themselves. You’re right in that many natural birth advocates are pushing an agenda when they provide childbirth education and that really is unethical. But so many others are not. There’s nothing unethical about providing helpful, sometimes life changing information to couples who are terrified of the birth process; giving them the tools they need to make important decisions for themselves.

    • The Computer Ate My Nym

      I DO tell them what some of the side of effects of pain medications and induction medications might be of course

      Do you tell them about the risks of refusing pain medications? If not, you’re giving incomplete information.

      • BklynMom

        What I tell them is that it’s their decision. Risks of refusing pain medications? What would those risks be? Are you saying they may experience excruciating pain and therefore would be suffering and have a miserable birth experience? If that’s what you’re saying, I would agree with you that no one should feel they are suffering. I tell every expectant mom that what’s right for her may not be right for someone else. The moment she feels her pain has turned into true suffering and she feels out of control because of it, she should consider some type of pain relief, if that’s what she feels is right for her. The pain of labor does not have to equal suffering and misery. I teach women that labor pain is not like the pain you’d receive from suffering a terrible injury but more like the pain and discomfort you allow yourself to experience when exercising/working out. It’s pain that serves an important purpose. Some women can see their labor pain that way & others cannot. I’m not in any position to judge the women who attend my classes and I don’t do it. I just let them know what the side effects of various medications might be, what some of the benefits of having an unmedicated birth might be and they ultimately decide what’s best.

        • Zornorph

          See, I’m a dude but I don’t get you when you talk about pain ‘serving an important purpose’, especially when you compare it to working out (where the slogan is, no pain, no gain’. Pain is pain – I see absolutly nothing gained by experiencing pain in childbirth. The only reason you are feeling pain is because a bowling ball is coming out of your ha-la-la. How is that helpful? I’m not an expert on working out, so I can’t say if the no pain/no gain thing is really valid there, but at least you could argue that you are building up muscles. Unless you are planning to give birth on a weekly basis, the same doesn’t apply during childbirth.

          • Amazed

            That’s the reason I don;t get the whole “crossing the streets has risks, just like giving birth at home!” You have to cross the street, presumably like 10 000 times in a year or two. You don’t have a choice. But even Michelle Dugar hadn’t built her family quite to that number. I have to cross the street all those times. Right. I am comfortable with that risk. when I am at the zoo, you can be the hell sure that I don’t try to squeeze my hand between the bars and pet the lion. That risk , I am not comfortable with. At all.

          • The Bofa, Being of the Sofa

            Even so, when I cross the street, I STILL take precautions, like “look both ways”, to minimize my risk.

          • Amazed

            Yeah, here is that. To take it farther, you wouldn’t just look both ways when you’re crossing a six-lane road, would you? You’d take greater precautions, first of all would be NOT crossing it in any other spot but one with traffic lights, yes?

          • Allie

            Oh, Zornorph… out of the mouths of dudes : )

          • Sally RNC-NIC

            Rock on, Zornorph! Dig it.

        • Young CC Prof

          Most of the time the only risk of not getting pain medication is, well, pain. In some women it is severe enough to potentially cause psychological injury.

          Sometimes, the right dose of epidural lets women push in a more controlled manner, reducing the risk of tearing or allowing the provider to manage a nuchal cord.

          And under certain circumstances, if something goes horribly wrong very quickly, having the epidural catheter already in helps a lot.

          • fiftyfifty1

            I would add SLEEP to the list of epidural benfits. A woman in painful labor for 30 hours will not be sleeping. If she went into labor in the evening, she can easily go 48 hours without sleep. This can have serious physical and psychiatric consequences.

        • fiftyfifty1

          I’m not biased, I’m just presenting the RISKS of medications and the BENEFITS of unmedicated birth. See, I present both sides!!!

          • BklynMom

            Wow….quite a statement when you don’t even know me. Are there true “risks” to unmedicated birth? What risks are you referring to? I most certainly do present both sides and considering you don’t have any idea who I am you can’t tell me otherwise. What exactly are you referring to when you talk about the risks of unmedicated birth? Please enlighten me.

          • The Computer Ate My Nym

            Are there true “risks” to unmedicated birth?

            Yes. Obviously, if a patient has a complication or even a “normal variant”, the patient or the fetus can die. It is not unknown for women to have PTSD after a painful birth. Bonding with the baby may be harder if the birth is associated with suffering. An unmedicated birth is often a less than ideally monitored birth, so that complications can come up without being noticed more easily.

            These are just my first few (completely unordered) thoughts. I’m sure I’ve missed some issues.

          • The Bofa, Being of the Sofa

            Wow….quite a statement when you don’t even know me.

            “by your fruits, we shall know ye…”

            All we know is what you say. And the things you say tell us about you.

          • BklynMom

            So harsh. Wow. You reveal yourself by your fruit as well. No, you absolutely don’t know me. Any of you. And the medical community wonders why women would prefer to make the sometimes risky decision to have a homebirth… so frustrating. You won’t just tastefully, respectfully discuss these issues without feeling you have to attack someone you don’t even know. Don’t you understand it’s precisely this hostility that is drawing women to make the decision to have their babies at home? They know no one will really, really listen to them anywhere else. I’m done.

          • Amazed

            By all means, run away. And keep listening to women and misleading them. After all, that’se all you can offer, isn’t it? You can’t offer pain relief because you aren’t qualified to procure it. You can’t offer educated advice because you’re a layperson. But you can listen and sweet-talk women into doing what you deem best.

            Talk about “benign” dictatorship.

          • Roadstergal

            I tastefully and respectfully posted a link to a study that showed that there are tangible risks to uncontrolled pain during birth, and tangible benefits to pain control (the BF thing should make your crunchiest clients happy). Are you going to change your advice based on this new knowledge?

            And I don’t know about anyone else here, but the reason I’m tempted to be harsh is because I’ve seen the NCB movement suck in and cause mental harm to someone very dear to me and hurt our relationship, and it’s frustrating and painful and I don’t know what to do about it. (So instead, I hang out here.)

          • fiftyfifty1

            Harsh?! How is what Bofa says harsh?
            “All we know is what you say”
            How can anyone argue with that? We can’t see you, we don’t know you personally. All we know is what you write.
            “And the things you say tell us about you”
            If this isn’t true, what is? Don’t the things we say tell others about us unless we are an actor in a play, or for some weird reason intentionally saying the opposite of how we really feel?
            “by your fruits…”
            So was it quoting a Bible verse what made his reply seem harsh to you? I’m not religious myself, but I think he was using it in a literary sense, not trying to say you needed more religion.

          • The Bofa, Being of the Sofa

            If “by your fruits ye shall be known” is hostile, then take it up with Jesus

            Although apparently I am supposed to feel bad or something because she thinks I’m a meany.

            Yes, what I write tells people about me. That’s they way it has to be, because I don’t go around sharing my Facebook profile with everyone (then again, there isn’t much information on my Facebook page about me, either (it doesn’t even have my name on it), because I only use it to interact with a couple of people)

          • Elaine

            “Don’t you understand it’s precisely this hostility that is drawing women to make the decision to have their babies at home? They know no one will really, really listen to them anywhere else.”

            I do actually somewhat agree with this. I do think it’s important for providers to recognize what draws people to the natural/crunchy/non-evidence-based side, and poor bedside manner sometimes helps tip people that direction. But the job of an OB is not to be nice to you and agree with you and be your friend, it’s to help you make informed decisions about your birth and to help you and the baby make it out of the birth healthy. Of course it’s desirable to have a provider you feel like you have a good rapport with, but it’s important to not lose sight of what their role as a provider is, either. If non-experts like Lamaze teachers and doulas would recognize this and encourage their clients to recognize it too, it would probably do a lot to help relations between moms and doctors. But there are a lot of these non-experts who see this anxiety on the part of moms and exploit it to push their own agenda or to set themselves up as the expert.

          • The Bofa, Being of the Sofa

            So harsh. You reveal yourself by your fruit as well.

            Yes, I agree.

            How is that harsh? It’s true.

            If you feel that people are being hostile to you, look at what you say, because THAT is what they are responding to.

            As far as I know, you deliver puppies to orphans at Christmastime. However, that doesn’t change the fact that what you have said about pain and things you tell your couples in your class are very problematic.

          • Amy Tuteur, MD

            They prefer dangerous things in many cases because people like you fill their heads with misinformation pretending that you are counseling them when you are really just indoctrinating them with your personal beliefs that have no basis in science.

          • Sally RNC-NIC

            So women make the “risky decision” (thank you, by the way) to deliver at home because we’re passionate about maternal and fetal/neonate care and have the clinical experience to express valid concerns when we hear/read something that goes against the standards of care? Give me a break. LD, mother-baby, and my favorite…NICU nurses….are our mamas (and babies) biggest cheerleaders. We’re ferociously protective of our patients, and we advocate our asses off to make their experience enjoyable….safety will aways come first….but we can certainly have fun and celebrate every new little birthday!

          • yugaya

            ” …the sometimes risky decision to have a homebirth.” is ALWAYS the decision to have less safe birth. End of story.

          • fiftyfifty1

            I’m just quoting YOU. These are your own words:

            ” I just let them know what the side effects of various medications might be, what some of the benefits of having an unmedicated birth might be and they ultimately decide what’s best”

          • moto_librarian

            Risks of unmedicated birth:
            1. Inability to control your pushing to the point where you suffer 2nd, 3rd, 4th degree tearing, or even a cervical laceration;
            2. Pelvic floor damage related to tearing;
            3. PPD;
            4. Having to endure emergency obstetric procedures (like the manual examination of your uterus) without anesthesia.

          • DaisyGrrl

            5. PTSD related to events surrounding #4. I saw a photo on facebook yesterday where a woman claimed her epidural had worn off by the time they started her stat c-section. She felt everything until the general anesethesia kicked in. Nightmares. Forever.

          • Elaine

            Something I’ve always wondered about, though, is how the risk of pelvic floor damage from pushing with vs. without an epidural plays out. Having given birth without an epidural, I pushed to the point of “comfort” (which is not really the right word, but I can’t come up with a better one), and wonder if a patient with an epidural wouldn’t feel pushing to the point of tearing. A serious question. I have not given birth with an epidural so I wouldn’t know.

            I experienced #4 myself when I ended up with a manual placenta extraction. Not fun. I don’t regret forgoing the epidural, but I won’t minimize that experience either.

          • moto_librarian

            I think it depends, Elaine. I had an unmedicated delivery with my first, and my contractions did not space out much when I was complete. My midwife tried to have me breathe through a couple so I could rest, but my entire body flexed and I could not stop pushing. I had a cervical laceration that was diagnosed via a manual exam. It was awful.

            With my second, my epidural was repaired and redosed when I was complete. Numb to my toes, but I felt the pressure and urge to push just fine. I was able to slow down and control things much better (an epidural was actually part of my midwife’s strategy for helping me to avoid a recurrence of the cervical tear). I had a 2nd degree tear (had one with my first as well), but that likely would have been avoided if my son had not gone into distress requiring a prompt delivery.

          • auntbea

            5. Delay or need for GA in case of emergency c-section.

          • S

            You’re saying you present both sides… so why would you need others to tell you the risks of unmedicated birth?

            I assume because you think they don’t exist. If not, then why the quotation marks?

          • Amy Tuteur, MD

            Why on earth do you think you are qualified to counsel anyone on any aspect of medical care? You are not a medical provider. You are no more qualified to provide medical advice than a legal secretary is qualified to provide legal advice.

          • Maria

            BklynMom – I truly believe you care deeply about those who take your classes and I really do believe you feel you present as balanced a view of the birth process as possible, but I also know that if you have a background rooted in Lamaze you really are coming from a position that natural, unmedicated birth is overall better for women and babies. No matter how much you try to “balance” that view, it will unconsciously color how you present your information. I also understand that most couples who seek out a Lamaze based birth class are going in thinking they at least want to try for an unmedicated birth, so they may not push back as much as some others would when you present the risks of “interventions” and the benefits of unmedicated birth. (I put interventions in quotation marks because I tend to view them as procedures and treatments) I do think, though, that it is important to not downplay the very real pain that is involved in unmedicated birth. It is important that those women who decide to get an epidural or other pain management during birth do not feel that somehow they are at fault for “giving in”, that they just didn’t “work through” the pain well enough. In my birth class, the woman leading the class had us hold ice cubes in our hands for 5 minutes to simulate the discomfort of a contraction. At the time I felt is was a silly exercise, but after going through labor before I could get my epidural I felt a little bitter that she felt it was in anyway an apt comparison. It belittled the pain that I experienced. Had I had her class as my only forum regarding my choices and options during birth, I would have felt like somehow there was something wrong with me that I was in so much pain. I am lucky to be surrounded by common sense women, to have had a wonderful OB and other doctors to see during my pregnancy, and to be relatively comfortable in the medical world. I knew enough of the risks AND benefits of an epidural before my birth and could make a decision based on solid information. Please make sure the women and couples in your class can say the same thing after they have given birth.

          • yugaya

            “Are there true “risks” to unmedicated birth?”

            WHO estimate says that maternal mortality rate in truly natural, unmedicated birth without any interventions ( the “divine” and “empowering” process ” that our bodies were “designed for” and “know” how to do right ) is 1 000 – 1 500 dead mothers per 100 000 live births. That’s the true risk of every natural unmedicated birth.

            Do you share with your clients that number and let them compare it with maternal mortality rate in USA in year 2013 which with all the necessary AND unnecessary interventions and medicating of the natural birth process was 18.5 deaths per 100,000 live births?

          • Karen in SC

            It is really hard sometimes to see our own biases and in other situations, our privileges. This group and others have opened my eyes to the times I wasn’t as objective as I thought I was.

        • Roadstergal

          “Risks of refusing pain medications? What would those risks be?”

          Uh, PPD?
          http://journals.lww.com/anesthesia-analgesia/Fulltext/2014/08000/Epidural_Labor_Analgesia_Is_Associated_with_a.21.aspx

          The same study also showed that BF increased with pain control.

          • Guesteleh

            Wasn’t there a study demonstrating epidurals were associated with decreased risk of CS? Or maybe it was inductions that reduced CS? I can’t remember.

          • Roadstergal

            I’ve seen regulars here post good data that inductions reduce CS rates. Which makes a ton of sense. But Interventions!11!!!

          • Young CC Prof

            Inductions (at term or postterm) reduce c-sections. http://www.cmaj.ca/content/early/2014/04/28/cmaj.130925

            Epidurals appear to have no effect on the probability of a c-section overall.

        • fiftyfifty1

          “It’s pain that serves an important purpose. Some women can see their labor pain that way & others cannot. I’m not in any position to judge”
          So the pain is a “good pain” and some women are able to see that, but some sadly, just aren’t able. But you’re not judging. Got it.

        • Box of Salt

          BklynMom ” I teach women that labor pain is not like the pain you’d receive from
          suffering a terrible injury but more like the pain and discomfort you
          allow yourself to experience when exercising/working out.”

          But that is total nonsense. Do you know what the difference is between exercise and labor? When you feel pain exercise and labor? When you’re working out, you can choose to stop, and end the pain

          In fact, if a person exercising experiences pain as intense as I felt during labor, that person should probably stop exercising because an injury has probably occurred.

          • Box of Salt

            Oops. Repost with corrected edit.

            BklynMom ” I teach women that labor pain is not like the pain you’d receive from suffering a terrible injury but more like the pain and discomfort you allow yourself to experience when exercising/working out.”

            But that is total nonsense. Do you know what the difference is between exercise and labor? When you feel pain during exercise you can choose to stop, and end the pain

            In fact, if a person exercising experiences pain as intense as I felt during labor, that person should probably stop exercising because an injury has probably occurred.

        • moto_librarian

          “The pain of labor does not have to equal suffering and misery. I teach women that labor pain is not like the pain you’d receive from suffering a terrible injury but more like the pain and discomfort you allow yourself to experience when exercising/working out. It’s pain that serves an important purpose. Some women can see their labor pain that way & others cannot.”

          This is bullshit. What you are saying is dangerously close to “it’s all in your head.” It IMO.ies that unmedicated childbirth is some feat of mental strength and superiority. Pain is pain. Telling women that it is somehow different from other pain is misogynist.

          • Jenny_from_da_Bloc

            Like how Jane says a little hand holding and support will ease the pain and negate the need for medical pain relief.

        • lawyer jane

          ” teach women that labor pain is not like the pain you’d receive from
          suffering a terrible injury but more like the pain and discomfort you
          allow yourself to experience when exercising/working out.”

          OMG, you SO have an agenda, you are just so deeply embedded in it that you can’t see it. Perhaps your labor pain was like a nice Sunday jog. Labor pain to me (and many women) is nothing like discomfort or exercising. It is exruciating, distressing pain, full stop.

        • Jocelyn

          “I teach women that labor pain is not like the pain you’d receive from
          suffering a terrible injury but more like the pain and discomfort you
          allow yourself to experience when exercising/working out. It’s pain that
          serves an important purpose.”

          Red flag, red flag, red flag. BklynMom, I think that you really care about the women you are teaching, but that is utter crap. This pain does not have a purpose. Whether or not someone feels pain during labor, the baby will come out either way. The pain does not accomplish anything. It has NO purpose.

          And let me tell you – the pain I felt during my “natural,” unmedicated labor was FAR, FAR worse than the pain I felt when I shattered my jaw. The pain I felt during labor was worse than the pain of my severe allergic reactions that are comparable to heart attacks. The “discomfort” I feel during working out is not even on the same SCALE as labor pain. What you are telling women is a LIE.

          • FormerPhysicist

            I’m supposed to STOP any exercise that causes me pain and either not do it or go back and learn proper form for that exercise. Many exercises I just STOP.

          • GiddyUpGo123

            I really cannot imagine how hard you would have to be working out to come even anywhere close to feeling like you were in labor. I think you’d have to have come pretty close to killing yourself.

          • AllieFoyle

            It’s such a stupid comparison. Unbelievably stupid coming from people who hold themselves out as experts. Seriously, have they ever given birth? What kind of workouts do they do? Generally when I work out I manage to avoid genital lacerations and internal injuries that need to be repaired surgically. I have yet to see anyone push themselves at the gym to the point that they are screaming uncontrollably from the pain for hours.

          • Amazed

            Actually, I imagine the quote you’re citing is true… for professional athletes. I distinctly remember a rhythmic gymnast who was telling the story of her silver medal from the world championship: first, it was pain. Then, it was more pain. And finally, it became pain that could no longer be tolerated. The head couch told her that she was simulating. The scan showed a broken foot. A month before the world championship. It was her decision to turn her back to health and focus on her exercise instead, out of fear that should she miss the championship, she might say goodbye to her slot in the national team.

            Somehow, I doubt BklynMom was talking about exercise like this.

        • thesouthway

          “I teach women that labor pain is not like the pain you’d receive from suffering a terrible injury but more like the pain and discomfort you allow yourself to experience when exercising/working out. It’s pain that serves an important purpose.”

          I am so thankful that I did not choose to go to a birthing class (despite being heavily encouraged to) because I would have risked having someone like you as a birthing instructor. You may truly care about the women you are instructing but you should think long and hard about the messages that you are sending them.

          When my epidural “failed” because of positioning/gravity, it was the worst pain I have ever experienced. It did not feel purposeful and if I ever felt pain like that exercising, I would assume something was very wrong. All I wanted to do was to crawl out of my skin and die and NO amount of breathing or visualizing or hypnobirthing helped. It wasn’t until the anesthesiologist came in and upgraded (his words) me to the C-section grade epidural that I felt any relief. If I would have had to endure the next 10 hours feeling that pain, plus another three hours pushing (a good portion of that with my OB’s hands inside of me helping bub along), and then having my cervical tear and 2nd degree perianal tear repaired…well, I can’t even imagine the depths of my anger and despair.

          You may believe that labor pain is productive and purposeful. It may even have been for you or women that you know/have taught. But it is not for everyone and you have no right pushing an agenda (yes, an agenda) that celebrates it as “good” pain. You are setting women up for unnecessary mental and physical anguish in the name of giving them choices. I hope these responses help you to understand that you are not one of the “good Lamaze instructors” and that you are parroting the same old NCB lies in the name of educating and helping women.

        • Guestll

          You’re absolutely right about one thing, childbirth wasn’t like the pain I received from suffering a terrible injury (in my case, breaking both my tibula and fibula) it was much, much worse. You’re partially right about the pain serving an important purpose — ALL pain serves an important purpose. You might want to look into that.

          Pain is pain is pain, the pain of a MI or a kidney stone follows the exact same neural pathways as the pain of childbirth. You can manipulate it any way you want, you can tell your clients that some women can see it your enlightened way while others can’t, but pain is pain is pain.

          I really want to know something, why do you advise your clients to wait to consider analgesia until “she feels her pain has turned into true suffering and she feels out of control because of it”? Why does that matter to you, when she chooses pain relief? What if she chooses it before it gets to that point? What if she wants an epidural placed before she begins to register pain? Why is that relevant to you?

          Other people here have handed your ass to you quite nicely and deservedly so I won’t bother, other than to say you are so blind to your own agenda, to even HAVING an agenda…

        • AllieFoyle

          I teach women that labor pain is not like the pain you’d receive from suffering a terrible injury but more like the pain and discomfort you allow yourself to experience when exercising/working out.

          Then what you are doing is wrong and unethical.

          Not only is that a ridiculous comparison, but for some women –maybe more than you realize– giving birth does involve physical injury and damage.

          I do believe you care about the women you teach, so please consider that by downplaying the potential for severe pain and emphasizing only the risks of pain relief, you may be setting up some women to suffer needlessly.

        • Dr Kitty

          As I said down thread, my mother, a woman who chooses to have unmedicated root canals and describes them as “a bit sore” described her only experience of labour as “sheer agony”.

          This is a woman who was driving and walking the dog a week after a CS, and who has run several marathons.

          She’s not a stranger to pain or pushing through the wall, and not someone who could be described as having a low pain threshold.

          And she found labour agonising- worse than any other pain she has ever experienced (which she reminds me every year on my birthday- thanks mum!)

          I’m afraid she would laugh at your analogy.

          • The Bofa, Being of the Sofa

            I’m afraid she would laugh at your analogy.

            As I have said many times, the pain of childbirth was recognized 3000 years ago as being so severe that it was attributed to being punishment from God.

            They didn’t say that about the pain of exercise, or the pain of a toothache, or the pain of a serious injury.

            I will never feel the pain of childbirth, but I don’t have to do so to know that BklynMom is full of shit. I’m sure she has clients who fall for her shit. A large number of them are going to be in for a major disappointment. Others will know from the beginning that she is full of it.

            ETA: Now THIS is a “harsh” response; then again, I don’t have much patience for nonsense

        • Sally RNC-NIC

          Pain is subjective. Another example of setting women up for disappointment. “This doesn’t feel like a hard workout, I’m a failure! Waaaaaaaa!” Making generalized statements as to what labor pain feels like is beyond nuts. Pain is individualized. And like others on this post, I feel very, very strongly that non-medical professionals should NOT be providing pharmaceutical information and advice. PERIOD.

    • NoLongerCrunching

      Shouldn’t it be the HCP’s job to have the risks/benefits discussion? As an LC, I am not qualified to discuss risks and benefits of for example using domperidone. I could point patients to published information, but with the caveat that they should discuss the idea with their HCP. Information I have access to may not be the most current, and quite simply a non-medically trained person does just not have the training to have that discussion.

      • BklynMom

        I encourage every single couple I meet with to discuss everything they hear from me with their doctor or midwife. Every couple. Every class.

        • fiftyfifty1

          Here are the RISKS of all the interventions your OB may suggest and here are the BENEFITS of not doing what the OB suggests and instead going natural. But really this is where I add my standard disclaimer that of course you should talk to your OB about it.

          • BklynMom

            No. That’s not the way I present it. At all. I never, ever want anyone to feel that they should not completely trust their provider. Ever. But for heaven’s sake they should know what to expect from their bodies & what to expect at the hospital shouldn’t they? They should know what the evidence says, shouldn’t they?? They should know that they can ditch a provider that’s not following best evidence (according to ACOG), shouldn’t they?? Again, you’re attempting to fit me into your preconceived notion of what a Lamaze class is or what a natural birth advocate committed to promoting evidence based care is really like. I assure you that I’m not like many other natural birth advocates you’ve come across (That’s why I’m even here on Dr. Amy’s page.) Sad to me that this is your view, but whatever…. with that, I’m outta here as I’ve got lots of other stuff to do today. 🙂

          • Amazed

            And who are you to tell them what to expect of their bodies and the hospital? You aren’t a healthcare provider and you are overstepping the limits of your expertise very seriously. As to your complacency that you know best what the evidence says and what best evidece according to ACOG is, well, that rendered me speechless. Almost. I still have this to say: when you graduate from a med school, you might have some basis for the outragerous way you skew information to further your agenda. Not a moment before.

            Lots of other stuff? Learning some more misinformation from your own misinformed educators so you can still help women lean on the side of good pain, I mean the pain you deem good for others? Have a nice time with it.

          • fiftyfifty1

            ” They should know that they can ditch a provider that’s not following best evidence (according to ACOG), shouldn’t they”
            AGOC guidelines are guidelines, not rules. But you encourage women to fire OBs who suggest interventions that you, in your limited understanding, deem are not “best evidence”. You are not medically trained and *you do not know these women’s individual cases or risk factors*. That is seriously unethical on your part.

          • Life Tip

            All qualification and evidence issues aside. Why do you consider yourself a natural birth advocate? Do you feel it is better, and therefore worth advocating? And if you don’t believe it is superior, why advocate for women to do it?

          • Sally RNC-NIC

            The key word here is “expect.” Setting birth expectations is insane. No birth is perfect. Which leads to disappointment, resentment and anger for mom’s whose expectations were not met.

        • NoLongerCrunching

          What I mean is that all you say should be to discuss the risks and benefits of having or not having a particular intervention with their HCP. If you discuss the risks and benefits, first of all you may not be aware of all of the rest of the benefits, and second of all you having that discussion may give them a false sense of security that they have been informed.

      • Cobalt

        I have never had an OB discuss pain management options with me, until the doctor I got just before this last birth. And that was a quick “what have you used in prior deliveries?”. I brought it up once with a different OB earlier in that pregnancy, as I have a lot of sacro-illiac joint pain from injuries and have a lot of trouble laying on my back (his preferred delivery position). His response: if you have an epidural, you won’t feel it. That did not address any of my real fears about managing the injury (especially trying to avoid further damage or SI complications) or my severe anxiety about getting an epidural. Thankfully, it turned out to be a non-issue, the new OB was fine with me delivering on my side and I had no SI trouble.

        My point is that many OBs don’t discuss pain management. It may be because of hostility from NCB patients, and the assumption that everyone knows about epidurals, but the omission isn’t really useful in the long run.

    • AmyH

      I was here earlier and didn’t want to be the first to jump in, but what stood out to me was “the side effects of different types of fetal monitoring.” Hopefully that doesn’t mean “CFM is dangerous because it might let the OB notice heart decels and they might suggest an intervention to get the baby out sooner and the intervention could be unnecessary because after all the baby had a good chance of surviving without it.”

    • LibrarianSarah

      Listing off all the possible side effects of epidurals without having the qualifications or know how to evaluate the likelihood of someone experiencing those side effects is not “unbiased, evidence based information.” It is a scare tactic. Every medication has a list of possible side effects a mile long because it is in the pharmaceutical company can get in a world of legal trouble if it is found that they failed to list a possible side effect even if the chances of it happened would be the same as winning the lottery (roughly 1 in 62 million btw).

    • lawyer jane

      Do you tell them that the latest studies indicate that induction REDUCES the risk of c-section? Do you tell them that some studies show that unmedicated childbirth can lead to PTSD? Do you tell them that labor pain really hurts, like any other kind of pain, and that in the moment the labor pain is the most important consideration for many women? Do you tell them that epidurals do not increase the risk of c-section? Do you inform them about what labor with an epidural will feel like, and how to request a “light” epidural? & etc.

      • guest

        Lamaze has changed drastically over the last 25 years. The new Lamaze is one of (if not the largest) the largest driving forces behind the NCB movement. Virtually all of their literature promotes natural methods (without mentioning any adverse risks), & warn about modern medicine (& always mentioning even the flimsiest data about possible adverse effects). Lamaze international makes no mention of any risks of home birth (in fact they point out how it may be safer than hospital birth), but makes it standard policy to educate it’s followers to the risks of any professional medical intervention. BklynMom is just towing the standardized line.

    • Renee

      #notallNCBers
      The existence of one (even a few) Lamaze teacher that doesn’t push NCB does not detract from the very real, damaging, anti woman, NCB culture being promoted mostly by para-professionals and MWs.

      While I am glad you aren’t an NCB pusher, I want to know where you get the knowledge to counsel on these things. Even info on basic stuff, like inductions, has changed over the last few years. How do you keep up on this stuff? It seems to me that we have lots of laypeople out there claiming knowledge of really important things, that they may not actually grasp.

      You also say unnecessary interventions as if this is something that can be known up front. The things I think qualify as something you could know was unnecessary, like enemas, epistiotomies, aren’t even done regularly anymore. Other things NCBers claim as unneeded, like EFM are in no way unnecessary, or not useful. The whole idea of unnecessary shows a large misunderstanding of how modern OB works. Its preventative care.

  • araikwao

    OT, a question for the US readers about antenatal care: I have a relative who lives in the USA who’s pregnant with her first. She’s about 24 weeks now, and no-one has palpated her abdomen ever! Is this normal? In Aus, we are taught to check fundal height at every visit (well, after 12 weeks, at least), knowing that a single measurement isn’t helpful but the trend may be.
    (I guess my motivation is partly just out of interest, but also that we are very close, and if there’s a hint that any of her care is inadequate, I want it fixed ASAP!!)

    • anh

      they always palpated my abdoman, but they didn’t take fundal measurements until about 26 weeks

    • RNMomma

      No abdominal palpation here either except once until late 20 something weeks when they started doing measurements (don’t quite remember which week.

    • Jenny_from_da_Bloc

      My OB started doing fundal heights at 20 wks or so

    • SporkParade

      Not in the US, but I’ve never been palpated or had fundal height measured. However, I get a quickie ultrasound with each doctor’s visit.

    • Medwife

      I palpate for a rough measurement of fundal height until 20 weeks, then start with the tape measure. That’s what I’m familiar with as standard of care. I’m in the US.

    • Somewhereinthemiddle

      I can’t remember my first pregnancy which was with an OB, but I don’t remember palpation being a part of the exam but fundal height was. My 2nd pregnancy, also with an (different) OB had both palpation and fundal height, but he was an old school OB. My third, with a CNM, I had both.

  • Ukdoctor

    The reason unmedicated natural childbirth is promoted in the uk because it is cheap! Women with epidurals need closer monitoring hence more midwives, to offer them round the clock you need more anaesthetists. Expensive… Plus we don’t have enough midwives or doctors….. So try to persuade women they can do without .( Ps uk midwives are more like American labour and delivery nurses I think., they also work in the community )

    • The Bofa, Being of the Sofa

      And as I have said, I can understand why administrators would push for it as a cost-cutting measure, but why would doctors want to do it? Aside from appeasing their administrators, of course…

      • The Computer Ate My Nym

        They’re probably given a quota: so many of your births must be “natural” or your pay will be cut or you’ll be given an “unsatisfactory” rating or even be fired. Besides, it’s easier and they’ve probably never hired anyone to replace that last OB who quit because she couldn’t deal with the harassment about “natural birth”.

        • The Bofa, Being of the Sofa

          Yep.

          Of course, there is no reason why the doctor should have to be happy with it.

          I do a lot of things in my work because we have restricted funds. That doesn’t mean that is the way I want to do it.

      • Jenny_from_da_Bloc

        I think we are forgetting that the NHS is administered by the UK government. It is the UK government trying to cut costs at any cost. They have post code lotteries for life saving drugs over there and refuse children with CP surgeries all the time. I always come across these articles on the Daily Mail and the Telegraph

        • The Bofa, Being of the Sofa

          I’m not forgetting that, Jenny, it is just irrelevant.

          Administrators try to cut costs. Regardless of who they are, that’s what they do.

          And doctors have to go along with it. But that doesn’t mean that should be their goal, or want to do it that way.

          • Jenny_from_da_Bloc

            Very true.

          • Jenny_from_da_Bloc

            Very true

    • Roadstergal

      Do UK Obs/midwives tell women in so many words when they ‘persuade’ them? “Look, this isn’t really better in any objective sense, and there’s a decent chance it will have some negative consequences for you, but it’s cheaper, and you know, austerity and all! I need to get you and most of your friends to go unmedicated, or I might get disciplined or fired.” I’d think this would be an awfully effective way to get women making some noise about changing policies…

  • I do not think it is ethical – informed consent requires the risks and benefits of the available options and providers can advise on which option they think is best in the circumstances but to promote goes a step beyond advising.

  • Allie

    It’s the job of health care professionals to provide sufficient information on the risks and benefits of the treatment options so the patient can make an informed decision. In any other medical context, a patient has the right to refuse treatment, including life-saving treatment, provided they have the capacity to understand the risks and benefits of doing so. In child birth, the well-being of the baby cannot be disregarded, and in my jurisdiction there are criminal code offences relating to failure to procure assistance in child birth. In my view, it is absolutely unethical for a health care provider to promote an agenda, and I even have serious qualms about the relationship between doctors and pharmaceutical companies. While it is important for doctors to have accurate information about treatment options, and it can benefit patients if doctors have access to free samples, doctors must be cautious always to provide the best information about risks as well as benefits of prescription medications.

  • Jenny_from_da_Bloc

    I just finished a breast feeding class at a local hospital, I went because I had a free voucher from work. 90% of the women in the class want a natural birth because they don’t want to drug their babies with “narcotics and epidurals.” Another woman and I were instant pariahs for choosing repeat C/S instead of VBAC. The LC even said, “Expect it to be more difficult to bf.” I left during the break and went shopping, the woo was too ridiculous to stay any longer.

    • It is rather awful the degree of stigmatism that those who opt out of the norm face. It’s really uncalled for.

      • ali

        I think the problem is that for some women a c section is normal! That language about a normal birth is ridiculous

    • The Bofa, Being of the Sofa

      “Expect it to be more difficult to bf.”

      Aside from it being bullshit, the other question is, so what if if is? Then I’ll just use alternate methods.

      Of course, if breastfeeding is so important that you have to lie about it….

      • NoLongerCrunching

        It usually is more difficult, because of positional/comfort issues. But that is hardly a reason to factor into whether a cs is medically appropriate.

        • Jenny_from_da_Bloc

          Nothing a pillow and some dilaudid can’t fix! : )I just found the whole situation to be condesceding and kind of beneath me, especially since they seemed so judgemental.

          • Young CC Prof

            Also, more difficult than what? Your first birth, which was also a c-section and may have been an emergency c-section? “Warning” a repeat c-section mom about the horrors of c-section just seems weird. Presumably she already knows the drill. She may not know every potential complication, but she certainly knows what a typical recovery is like!

          • The Bofa, Being of the Sofa

            Also, more difficult than what?

            Is initiating breastfeeding after a scheduled c-section that occurs at noon (with ours, we only needed to be to the hospital by 10 am) after you have a full night’s sleep more difficult than after a vaginal birth (epidural or not) at 3 am, where you’ve spent 30 hrs in labor?

          • Jenny_from_da_Bloc

            Exactly, I know what’s up for sure. I’m definitely prepared and know what to expect barring any complications

        • Elaine

          Well, you could factor it in if you are a good VBAC candidate trying to decide between VBAC or RCS. But then you also have to consider the possibility of going for a VBAC, ending up with a c/s anyway, and having both the positional/comfort issues of a c/s and the recovery from a long labor.

          • Jenny_from_da_Bloc

            But, I’m not a good candidate, it is completely impossible for me to have a VBAC or a vaginal birth and honestly I wouldn’t want to have a vaginal birth even if I could. I’m fine with my choice to have a RCS because it is the best and only choice for me. What the LC said isn’t true to begin with and she probably shouldn’t be asking people how they plan to give birth in front of 15 other people then trying to play us with lies. I never had a problem BF because of my 1st c/s, I had a problem with supply and demand.

          • Elaine

            Oh, yeah, I get that. I was making a more general response to No Longer Crunching’s comment about whether or not to factor the positional/comfort stuff into the VBAC/RCS decision, not aimed at you specifically.

            That class does sound like bunk. I would have left too.

        • D/

          That is hands down the primary assessment/ intervention that I find repeatedly necessary when working with moms after a cs … “Are you comfortable?” … “Let’s get you (and keep you) comfortable!”

          Ironically it is not at all unusual for me to see moms refusing (or rationing) pain meds because they are breastfeeding to the point actually making breastfeeding more difficult 🙁

    • Roadstergal

      Wasn’t it decided in a previous thread that, since a C/S gets the placenta out more efficiently than vaginal birth, that it was beneficial for BF? :p

      (If that matters to you. If it doesn’t, as noted, no big.)

      • Jenny_from_da_Bloc

        Lol, I don’t know! But that does make sense.

  • fiftyfifty1

    But, but, but, if women get effective pain relief during labor instead of having to rely on just my support and encouragement, why then they won’t look at me afterwards and say “I never could have done it without you”! Instead the anesthesiologist will get all the attention!

    • theadequatemother

      Oh no worries there. We are loved for all of five minutes and then forgotten pretty quickly. It’s still the midwives and the OBs that get the cards and chocolates. This is why anesthesiologists are so svelt…well this and the complete lack of lunch breaks. 😉

      • MaineJen

        I looooooved my anesthesiologists. But you are right, if I ever have another baby I will be sure that they get a thank you card, too 🙂

      • FormerPhysicist

        I loved my anesthesiologist. Until I got the bill and found out they bill separately from the hospital, and were not in my PPO (even though both the hospital and the OB practice were) so that their bill was essentially not covered.

      • The Computer Ate My Nym

        If it helps any, I still love my anesthesiologist. But since I don’t remember her name and am a little uncertain if I ever actually saw her (the epidural goes in the back and I can’t remember who did the consent), it’s hard to give her chocolates. You should start demanding follow up visits so you can get your fair share of chocolate.

      • fiftyfifty1

        “We are loved for all of five minutes”
        Liar! I still regard the anesthesiologist who did my CS as a god. Pain free CS recovery! Amazing!!!!

      • AnotherAmy

        Seven years later this coming Monday, I still love, if that’s the right word, my anesthesiologist. I was already unconscious when we ‘met,’ but that ‘hinky’ feeling he had saved my life. I likely would have bled out during my general anesthesia emergency c-section. Even though I don’t know who he is, I think of him on occasion, especially around my daughter’s birthday, and thank him for listening to that voice inside.

  • toofargone

    I just think it is sad that a classes that used to be available to provide mechanisms to cope with labor pain for those that desired to go without epidural pain relief have turned into classes pushing a “my way is better than your way” agenda. There is nothing wrong with teaching women nonpharmacologic was to manage pain. What kills me is all the horrible medical advice that has come with it, the NCB agenda that their way is the safer way. Herein lies the ethical issues. Like you state here, it is not ethical to push one over the other. I have taken a Lamaze class and a hypnobirthing class. Both of which were pretty professional. (The hypnobirthing class did push it a tiny bit but was very much judgement free.) My hypnobirthing instructor even said that if you find yourself getting an epidural/c-section, the techniques learned here are still helpful. It can help you get through a uncomfortable ECV or decrease anxiety for insertion of epidural catheter or urgent c-section. I found the cheesey affirmations helpful in decreasing my anxiety (I totally was worried that my daughter would be born in the car or hospital lobby since my son was born so fast). I just hate looking for helpful information on pain management and having too weed out all the crud in the process.

    • Young CC Prof

      Indeed. My mother described her Lamaze class that way, practical descriptions of childbirth, including some of the interventions that might become necessary, along with training in certain mental techniques to endure pain.

      Honestly, I think the switch happened when epidurals became readily available in most hospitals. In the 70’s and 80’s, Twilight was out, epidurals weren’t common yet, nor was their safety data terribly complete, so learning to cope with pain was just practical. Now, women who want to be just practical about it are more likely to get the epidural.

      • SporkParade

        I think you’re right, just comparing my mom’s experience with my experience. I wanted a natural childbirth class because I was told for medical reasons that an epidural might not be an option and I would rather avoid narcotic pain relief. The techniques were great, but I felt like the attitude was, “Bad things will happen if you are informed about complications and interventions.” So I got that information from reading the Skeptical OB instead. 🙂

  • MS

    Of course its unethical. How is being compelled (by a lack of objective, accurate information about pain relief) or forced to endure an unmedicated vaginal birth for no reason any different from the “strap ’em down and drag ’em out” strategy of the past? In both circumstances patients are being coerced into complying with the HCP’s wishes/ideology and denied any real choice or bodily autonomy.

  • lawyer jane

    I think they are conflating epidural/pain relief with c-section. I chose care providers who “promoted” vaginal birth because I wanted to avoid a c-section. I think that’s a valid preference since c-sections are not without risk. That ended up being a stable preference of mine. I didn’t give much thought to the epidural thing, just assumed that it was part of the package – no epidural, no c-section.

    • Courtney84

      Except, there are plenty if reasons a woman can end having a surgical delivery that have nothing to do with what natural birth advocates claim will prevent c-section. I don’t think there is any harm in doing prenatal yoga, doing exercises from Spinningbabies.com, or eating a lot of kale. I guess so long as you don’t have other health concerns that require a specific diet there’s no harm in the Brewer diet. None of those lifestyle choices have been scientifically demonstrated to reduce pre-e, c-sections, or any other complications. It’s a bunch of junk that is spewed the convince woman if they don’t buy the right products, the right books, or enroll in the right classes they will “fail” at birth, they will “fail” at feeding their child and it will be all their own fault.

      75% of first time mom’s are going to “avoid” a c-section here in the US. I really don’t think the kale or the yoga has much to do with it.

    • RKD314

      Not having an epidural doesn’t prevent you from getting a c section if you need one. It just means that instead of the much safer epidural, you have to be put under with anesthesia. Secondly, vaginal birth is also not without risk.

      I totally understand the sentiment of wanting to avoid surgery, but all you need to do in that case is say that you don’t want a c section unless it’s necessary to save you or your baby. No one will make you get one, and having an epidural certainly doesn’t lead to getting one.

    • Smoochagator

      The problem is that so many NCBers push the idea – which is NOT supported by evidence – that getting an epidural WILL increase your chances of getting a C-section. They also say that an epidural will affect your baby negatively, also untrue. With my first birth, I desperately wanted to avoid surgery and that’s why I made the NCB choices I did, including planning a homebirth. I really wish I had understood then what I do now, that avoiding surgery should not be the #1 concern of any expectant mother, and that choosing to forego pain relief didn’t improve my chances all that much.

  • attitude devant

    I think the only way to make sense of pushing the med-free labor is that it allows labor to occur at home or in a free-standing center. Once you start doing meds, you’re at the hospital, and rightfully so. And once you’re at the hospital, there are pesky protocols to follow, and people will know if you the midwife are NOT complying with them. And there the midwives are no longer in charge. I think THAT’S what they can’t stand. At our hospital the midwives can send their moms to a birth center (no pain meds, only low-risk patients as defined by our protocols) OR the hospital (pain meds available, high-risk). But they practice in a very structured partnership with the OBs backing them up. Independent midwives push back against pain relief because pain relief threatens their autonomy. Plain and simple.

    When I see our favorite Kiwi midwife crowing about how great her system is, and how it’s better for the moms to be ‘supported’ in labor than for them to be offered pain relief, I think, “Yep, better for midwifery….”

    When I was in OB training in the late 80s, epidurals were a HUGE deal. Some hospitals had them, some did not. Mothers flocked to the hospitals that had them, and good regional anesthesia became a big sales point for maternity wards. When one of the hospitals our major Northeast city announced they were not going to give epidurals to Medicaid patients (because the reimbursement was already low) there was a huge outcry—this was seen as an ethical and patient rights issue. We made the hospital back down. Now? It’s startling to see the lies peddled about them, all in an attempt to make people voluntarily comply with Big Midwifery’s need to keep labor painful—just so the midwives don’t have to act as a team with anesthesia and OBs. Lovely.

    • CrownedMedwife

      For what it’s worth, aside from Neonatologists and RN’s, OB’s and Anesthesiologists are the only ones I want on my team. CPMs, Naturopaths, Chiropractors and Doulas (functioning outside their scope of support person) need not apply.

      • Bombshellrisa

        And a good RT if needed!

        • CrownedMedwife

          Ah yes! Absolutely!

      • attitude devant

        I feel ya. I’m old enough to remember when healthcare wasn’t a team sport. It seems obvious to me that everything is better for all concerned when teamwork is the order of the day.

        • CrownedMedwife

          I’m reminded of an OB early in my career who chanted “Go team!” just before a birth. It wasn’t till many years and healthcare experiences later that I really comprehended the depth of those words. Yep, go team!

    • Wharves of Sorrow

      That is something I worry about, that a woman’s right to choose medicated childbirth, especially poor women, will be taken away because of this NB propaganda. It’s sad how its hard to access medicated birth in Europe. You shouldn’t have to fight for it, especially when the midwives are biased against it.

  • CrownedMedwife

    I was really hoping to see a post to this effect after the long discussion being held regarding pain management during an earlier post. During the course of that discussion being held, I have attended six births; four unmedicated and 2 epidurals. All good outcomes with healthy mothers and babies. The epidural rate for my patients is admittedly, and without regret, the opposite of what the last few days have shown. The mothers who requested epidurals had timely placement and excellent pain management.

    The mothers who intended to labor without an epidural did so with labor support and verbalized coping well. That is, except for one. Days later I am still left with a gnawing in my stomach for letting her down, although she doesn’t see it that way. I counsel every mother on pain management options, the efficacy and SAFETY of each; everything from position changes, hydrotherapy, sterile water papules, narcotics and epidurals. This particular mother had an especially long and exhaustive labor. While she coped well initially, it became obvious during the final hours that she was not coping well. I’ll admit it. I broke the birth plan request and offered an epidural. She declined. I reasoned back. She replied with a concern for safety of the baby. THIS is where I feel like I let her down. These discussions occur in the weeks and months prior to birth. Now, exhausted, fearful and terrified of the pain is NOT the time to convince a concerned mother of the safety of an epidural.

    So there, hubris of NCB, you won this time. Your misinformation and scare tactics may have prevented the mother from hearing and trusting in my words and counseling this time. But that only means I will step it up a notch further, because no amount of ‘hand-holding’ or ‘singing’ would have resolved the terror in this mother’s eyes or absolved her of her pain. This mother reflects upon her birth with satisfaction at having avoided an epidural, but how unfair for her to have had to made her pain management decisions in a moment of agony based upon the fear promoted by NCB culture.

    • OlyBinewski

      You sound like a compassionate provider. Just by offering her the option, I think you should feel like you did what you could. She’s happy with her birth and even if she only declined due to incorrect fears, she still got to make the choice she wanted.

      • CrownedMedwife

        Yes, she did get to make her choice, but it goes beyond that. She made her choice based on a culture with its agenda at hand, not with her best interests at heart and not with accurate information. That’s where she was let down. Aside from that, been at this long enough to know that look of sheer terror and at those moments there are no amount of breathing techniques, handholding, affirmations or whatnot soothes the fear or resolves the pain. That, to me, is horrific.

        • Guest Poster

          YOU were horrified by what she went through. She was not. She faced the worst of it and is happy with her birth. We got it, you don’t AGREE with her decision. Well, guess what? That’s OK. You don’t have to agree, because it’s not your job to APPROVE of her choices.

          Did you fail her….yes, by offering her an epidural. It sounds like she made it very clear to you during prenatals and via her birth plan that she would ask for one. A woman who births in the hospital knows epidurals are READILY available. If they want it, they WILL ask for it. Clearly, she didn’t want it. Move on.

          • theNormalDistribution

            No. You’re just inserting the narrative that you personally like into the story. CrownedMedwife herself admitted that this mother did not understand the risks of epidural. The only way you could know if the mother was not horrified and happy with what she went through, was if CrownedMedwife had actually made sure that she fully understood the risks (or rather, lack thereof) of epidural ahead of time, and then she *still* declined to have one when the pain was at its worst. As it is, she could very easily have been desperate for pain relief but too scared to accept it. Unless you are her, you have no idea.

          • Elizabeth A

            While I would hope that a woman who wants the epidural will ask for it, I don’t think CrownedMedwife failed by offering. Many, many women wind up with ego in this. They think that, by getting the epidural, they’re being lazy, giving up, or giving in. Having a compassionate provider offer an epidural may help those women acknowledge that they want one, or may help relieve the fear that they’ll be judged harshly if they seek pain relief.

          • Young CC Prof

            Also, some people shut down when they’re in extreme pain. They’re too focused on surviving the next moment to even figure out how to ask for help, or that help is available.

          • CrownedMedwife

            Ah, well please do explain what you would ration one does in the moment of an exhausted, terrified mother screaming for relief, asking for death and looking at her provider with tears in her eyes to save her from going on any further. One could choose to continue supporting her with breathing techniques, suggesting more position changes, affirmations and pressure points, reminding her she can do it. This, after all, is the crux of NCB isn’t it? I’ve accompanied countless women through their journeys and there is a point in which a compassionate and humane provider realizes it is time to cross that line. I don’t regret that for a moment. She truly believed she was going to die of the pain and holding her hand was not going to convince her otherwise. I cannot imagine the trauma of crying out with that extent of fear and the implications of it being ignored for the sake of a birth plan or to comply with misgiven ideals in a NCB culture. I do not now, or ever, make any apologies for being that kind of provider. Period. I do regret that she flew under the radar of being drawn into unrealistic fears of adequate pain management.

          • anh

            My midwife never offered me an epidural per my request. But when I finally whimpered “how soon can I have one” she held me and said I could have one immediately. I’ll never forget her saying “you’ve been such a brave, strong girl” just like how Dumbledore said it to Harry in the meta-Kings Cross in book 7. It was the most compassionate thing anyone has ever done for me.

          • lawyer jane

            My midwife was clearly put off that I asked for one and tried to talk me out of it, although immediately after I had the baby she told me “you did the right thing to get the epidural when you did. I was like, WTF lady, who asked you for approval??

          • Mishimoo

            Mine offered to wrangle me one even though I was at 9cm, because I said that I was getting tired. The fact that she was willing to go and argue for one, to bring other professionals in to help instead of insisting on doing everything herself, and modelling these behaviours and ethics in front of her student; that means the world to me.

          • MaineJen

            This is one of the reasons I really, really loved my OB; I asked her during my first pregnancy how late would be ‘too late’ to ask for the epidural; she said not to worry about it. “I don’t believe in ‘too late,'” she said. “You’re a first time mom. Even if you are fully dilated, you could have hours of pushing ahead of you. Unless you are actively pushing, it’s not too late.” Indeed, I ended up getting it at around 9cm (and not a moment too soon!).

          • moto_librarian

            Any compassionate human being would be horrified to witness someone in such extreme pain, particularly when said human knows that there is safe and effective analgesia available!

            Do you get off on watching someone writhe in pain, Guest Poster? Where exactly is YOUR humanity?

          • Amy Tuteur, MD

            No, she was failed by the philosophy of natural childbirth, which is both sadistic and sexist in imaging that women are improved by severe pain, and bizarrely fantasizes that refusing pain relief is an “achievement.”

          • AmyP

            “A woman who births in the hospital knows epidurals are READILY available.”

            Actually, I don’t think that’s true, either that epidurals are necessarily readily available at a moment’s notice or that women think that they are readily available.

          • CrownedMedwife

            …or they are so paralyzed by the fear induced by NCB propaganda that mentally an epidural is not an accessible OR available option.

          • AmyP

            Exactly–if you think epidurals are unsafe for the baby, it doesn’t matter how quickly you think you can get one.

          • guest

            The patient was ill-informed, or possibly misinformed. She wasn’t making decisions based on facts presented by objective, educated professionals. Professional, scientific health care does not exist to support spiritual birthing strategies dreamed up by advisers who have more in common with Shamans than Doctors.

          • MaineJen

            She offered pain relief to someone who was obviously suffering…how terrible. Where are your priorities, guest poster? This midwife ‘failed’ her? Please. This midwife succeeded in being a compassionate human being, in that she does not enjoy watching someone else suffer in pain when she doesn’t have to. People change their minds about getting pain relief in labor all the time; this woman may have been one of those. Save your judgement.

          • Belle

            wow.. hope you aren’t a care provider.. how cold..

          • Deborah

            I can see where you are coming from but what you have to bear in mind is that sometimes, particularly it seems for women, decisions are made based on firmly held ideological and or cultural beliefs which are harmful to women. Female genital mutilation is one example where it is in fact the women themselves who push this practice. It is not just a nice thing to do to try and eliminate this practice – it is the right thing to do. But for this to happen there needs to be an ideological, cultural shift away. What this poster is getting at is that due to her client’s firmly fixed false belief that epidurals are unsafe for babies she was forced to endure an agonising birth. It is frustrating for midwives who are not caught up in the ideologies of the natural birth movement to find themselves in this situation as it is obviously not the time to begin to try and dismantle the woman’s beliefs surrounding birth, the expectations she has placed on it and the sense of self worth she has invested in it.

          • Michelle

            FGN is not pushed by women, it is demanded by men who hold all the resources and power and in the context of an culture and society that affords them few rights and therefore limited or no option other than to do the task. The practice perpetuates itself, a girl that isn’t subject to FGM is not considered marriageable by men and has few choices in life other than that and will suffer marginalisation and the disapproval of society. Obviously this does need to change, but that needs to meet local situations and cultural norms and change the mindset of more than just women.

            The woman did have and was aware of the choices so it wasn’t ‘fixed’ as such, but other factors like misinformation hyping the risks and downplaying the benefits and secondarily pressure to have an ‘ideal’ birth created a situation where the women was led to make less than ideal choices for pain relief, and where the health care provider was left with feeling like they’d failed and that the woman didn’t trust them despite their best efforts otherwise.

            Ultimately though, none of those choices come out of nowhere and it comes across as blaming the woman to portray that (and FGM) as something that just came out of nowhere when clearly external ideology and pressure to conform played a big part. A part that meant when it was necessary to have good pain relief it was refused even though the pain was agonising and it sounds like they’d been adequately counselled otherwise.

          • RKD314

            I think what Deborah means is that quite often, female family members (usually older ones, like grandmothers) push FGM. Certainly they do so because of the reasons you gave, that it’s considered socially normal for them and the girl won’t be marriageable without. But it doesn’t mean they aren’t complicit.

          • Stacy48918

            If someone comes into the ER with a broken leg but doesn’t ask for pain medication, is the doctor wrong not to give them some?

            Broken bones are painful. Compassionate care dictates that pain medication should be offered.

            Labor is painful. Compassionate care dictates that pain medication should be offered. The patient has the right to decline, but the doctor is wrong not to offer.

            Little NCB delicate flowers need to realize that when someone at a hospital just OFFERS pain medication they are doing it from a place of compassionate care, not trying to derail your “ideal birth”.

          • Medwife

            I have had patients who became so out of their minds with pain they couldn’t even tell you where they were, let alone recall “oh hey, this is way beyond my coping level, time to ask for that epidural!” I would rather have violated her birth plan than have her be traumatized by having wanted pain relief and not been able to put together the words to ask. It’s not shoving a needle in her back after refusal. If a woman doesn’t want pain meds, she can decline them.

          • Sally RNC-NIC

            Question. Why are you here? What’s your story? Do you work in the medical field? Birth plans are not official documents. When pain is identified….pain exceeding established pain goals…it’s our ethical duty to offer relief.

            Your CAPITAL EMPHASIS and your snarky ‘tude….mixed with your exclusion relevant information make your post just dumb. You have no argument…just a strong opinion re: a situation you had absolutely nothing to do with personally….you’re making assumptions.

            I think it’s you who need to move on.

            P.S. Dear god, please learn how to present an intelligent argument if you ever decide to return. We just have a low tolerance for weak platforms.

        • Belle

          Yes, it certainly is… then when you have a controlling doula, it makes it that much worse… the poor patient is screaming out of control and begging for an epidural, and the idiot doula is telling her she “doesn’t need it” and to just “breathe through the pain”… totally disgusting..

    • attitude devant

      I was blindsided by this too. A few years ago I made it my policy to discuss pain relief early and often. Not to push it, but to correct misconceptions.

      • In my introduction to “preparation for childbirth” classes, I try very hard to put the idea that giving birth is like going to a cafeteria or smorgasbord. Everyone enters the restaurant hungry, and everyone wants to leave it feeling well-fed, but no two persons have the same appetites or food preferences, so matching the order to the individual is the point, not trying to make everyone eat the same thing, because “it’s good for you”. After all, nuts are a very nutritious food, but can cause great harm if you’re allergic to them.

        I’ve found this analogy to be very effective.

    • Belle

      And what’s sad is that she feels triumphant that she avoided an epidural.. that mindset is so skewed.. the fact that their self-esteem seems to hinge on whether or not they “broke down” and got an epidural is very troubling.. I don’t know of anyone who would have dental procedures done without anesthesia, or who thinks it’s a feather in their caps.. why suffer through a painful, stressful labor without it? Shame on the NCB crowd..

      • Mishimoo

        Indeed! I’m remarkably resistant to local anaesthetic, so I always have dental procedures without completely effective pain relief. That doesn’t mean that I tell everyone else that they should do it simply because I can bear it, it means that when I find a dentist who listens to me, gives as much anaesthetic as is safe, and performs the best nerve block I’ve ever had – I end up recommending them to everyone, especially people who are scared of the dentist.

        • MaineJen

          Me too. I actually had some cavities repaired as a child without anesthetic…it was horrific and I wouldn’t wish it on anyone. (They thought I would be “afraid of the needle” and the cavities were so small they didn’t take “much” drilling. Yeah. He was an old-school dentist.) I agree that now that I’ve finally found a GOOD dentist, I recommend them to everyone. 🙂

          • Mishimoo

            Oh goodness, that’s awful!!
            I had one where it was started without anaesthetic for the same reason, and then they changed their mind after hitting the nerve. (Not that it made any difference).

            Our current dentist thanked me for insisting on anaesthesia for our eldest, apparently they’ve had a spate of parents refusing anaesthesia for their kids because it’s “too dangerous”. I’d rather take the small risk and make the visit as painless as possible, than make them scared of the dentist and risk them dying of something preventable.

          • MaineJen

            How ridiculous. There really is nothing like tooth pain…it’s a very “bright” pain, very intense and it’s difficult to think of anything else when you’re having it. …kinda like the worst part of labor.

          • me

            Yeah, it was a no brainer when my oldest fell and damaged her teeth and needed caps. She was 5 years old, already scared of the dentist of course. No way I was going to have them strap her down and try to do it with a local while she was conscious (tho it was an option). To the hospital, under general for us. All she remembered was falling asleep – she asked “When is dentist (name) going to fix my teeth?” when she woke up, lol. It took a while to convince her that her teeth had, in fact, been fixed.

            Now she’s seven and has very little fear of the dentist. I can’t imagine how hard it would be to take her had I gone the other direction. Ugh.

        • RKD314

          My husband is from Ukraine and there it is normal to have no anesthetic for cavity drilling. I decided to try it once, and actually it was fine. I am terrified of needles, so the shot was always worse.

          Childbirth is completely different though!

          • Dr Kitty

            My mother doesn’t like feeling her mouth numb or the palpitations she gets with adrenaline+local anaesthetic.
            So she gets all her dental work done without local, including root canals.

            She still describes the few hours of dysfunctional induced labour ( when you are 42 weeks, your water has been broken for 24hrs and there are no contractions, induction is not avoidable) as the most painful experience if her life.

            Someone who CHOOSES un medicated root canals over feeling sweaty and shaky and numb for an hour or two describes that labour as “sheer agony” and all 4 of her CS recoveries as “a bit uncomfortable”.

            So, for my mother CS recovery is mild pain, root canals are a bit sore and labour was the worst pain of her life, meaning it had to have been bloody awful for her.

        • Belle

          How awful to be resistant to local anesthetic! I’ve seen that in a laboring woman a time or two and it’s horrible.. I certainly hope you have found a great dentist who can adequately anesthetize you!

          • Mishimoo

            My current one is awesome – gives me as much anaesthetic as is safe and gives me lots of breaks to rest my jaw (I have Joint Hypermobility Syndrome). I’m happy because even though it’s not pain free, it decreases the pain level by about two-thirds which is so much better than other dentists. I like that they take me seriously and do their best to make me as comfortable as possible.

    • Bombshellrisa

      For what it’s worth, you acted professionally and I don’t think you let this woman down. When I had my first child, I didn’t realize just how much labor could hurt and when I started feeling like I could no longer handle what was happening, my nurse from hell started telling me I was “doing great” and that I “didn’t want to cave” and get an epidural. I did mentioned I was nervous about the risks to the baby and she played those up. So by the time I was screaming and screaming and she HAD to address the issue (she kept telling me to take slow deep breaths), I was at 10 centimeters. If she would have at least called anesthesia and had the doc come up and talk to me about my specific concern, and I still refused, at least I would have been properly informed by someone without the NCB agenda.

      • Wharves of Sorrow

        I’m sorry you went through that.

      • Belle

        Wow, that’s horrible.. I’m sorry for your awful experience..

  • lilin

    If you assume that unmedicated vaginal birth is automatically “better” than any other kind of birth, then no, it’s not unethical. And that is what midwives assume.

    The problem is, there’s no reason they should assume that.

    • Amy Tuteur, MD

      “If you assume that unmedicated vaginal birth is automatically “better”
      than any other kind of birth, then no, it’s not unethical.”

      Let’s look at that a little closer. Suppose an obstetrician claimed to believe that C-sections are better than any other form of birth. Would that make it ethical for him to pressure all his patients into C-sections?

      • lilin

        I think it would be unethical for him to pressure them into it, but not to promote it over natural birth when talking to patients about their options, or to establish health campaigns to promote it to the public.

        For me, the damage in the home birth movement isn’t necessarily lack of ethics. It’s them assuming that natural birth at home is the platonic ideal of birth, with no real reason for it. That makes them incapable of dealing with evidence. Even if mortality rates are higher for home birth or natural birth, natural birth is “better” because natural birth is better. Even if injury rates are higher, natural birth is “better” because natural birth is better. Pain relief? Doesn’t matter. Natural birth is always better. There’s no way to argue with it.

        Some midwives and home birthers are unethical even within their own moral framework. But whether they’re unethical or not, for me, doesn’t matter. They made a wrong assumption and that does damage.

  • OlyBinewski

    Most of my thirtysomething Seattle friends who are pregnant for the first time are planning on having a midwife and an actual medical doctor at their bedside. Every single woman also has indicated they are striving to give birth without pain relief. It’s so strange to me. I don’t want to be a jerk to any of them, but I’m so interested in knowing why they want a midwife present at all. Presumably, they are having the birth in a hospital because they are unwilling to take any medical chances and they are all having regular prenatal care. Why the midwife? It’s like they already understand that midwife services are less than those a doctor can provide. It seems weird to want an extraneous person during a birth. What exactly is the midwife providing in this situation? There is a very real message being received that somehow you’re doing something wrong by not wanting to have a midwife around, even if you’re already planning to have modern medicine be available. Absolutely none of my pregnant friends are willing to say aloud that they want pain relief or that they ever intend to bottle feed. They all admit they are concerned about pain during the birth but are embarrassed to say even that much. I offended a friend by asking “well, if you want to be in the hospital during the birth, aren’t you concerned the midwife will just get in the way of the obstretrician?” But I truly want to know.

    • Bombshellrisa

      So I have to ask, are these midwives being hired as doulas? I am from Seattle and I know a lot of people who would hire a CPM as their doula in an attempt to have a natural birth and avoid interventions. They also believe that it will make breastfeeding work better. There are so many hospitals in the area where midwives deliver that it makes no sense to hire out to use one as a doula when you can get good midwifery care and deliver in a hospital with all the benefits of that safety net

      • OlyBinewski

        The way one friend presented it to me was that she had a regular OB but she is also separately visiting a midwife and she expects both to be present at the birth in the hospital. I do wonder what the official capacity of the midwife will be, since she’s choosing the midwife herself.

        • Bombshellrisa

          None unless the midwife is a CNM with privileges at the hospital in question

        • Medwife

          Almost certainly to “help her advocate for herself”. Don’t even get me started!

    • Therese

      Usually in the hospital the midwife handles all the uncomplicated deliveries and if any complications arise that are beyond the scope of the midwife then the OB is called in. Maybe this is what your friends are doing or are you sure they’re all going to have the midwife AND the doctor in the room when giving birth?

      • OlyBinewski

        I have one friend who sends to be doing just that- she views the OB as the backup. The other friend seems to think both will be attending her simultaneously. She already had the OB but is seeking a midwife on her own. She’s narrowed it down between two midwives, so I feel like maybe she is being fed some misinformation.

        • Bombshellrisa

          Does she understand that unless the midwife is a CNM with privileges at that hospital that the midwife will be considered a nuisance, not someone to collaborate with? Please tell me these midwives are NOT associated with Puget Sound Birth Center.

          • OlyBinewski

            I’m extremely curious and its something I’ll ask her more about. I am going to get the name of her midwife once she chooses because how she’s presented it to me so far really makes me wonder.

          • Bombshellrisa

            Midwiveswashington.org has the license info for Washington CPMs. What is setting off alarm bells is a midwife agreeing to do this. Is this a midwife who is currently licensed and practicing? Because someone with patients and a practice usually wouldn’t take on a doula job. The only reason why a midwife would do this is if they couldn’t make money attending an actual birth. Or worse, if they are billing insurance or charging the patient for the global fee, knowing well and good they aren’t providing real prenatal care or delivering the baby

          • OlyBinewski

            I’m beginning to wonder if she means to labor at home and not go to the hospital unless something goes wrong. And in that case, presumes the midwife is going to continue attending her? Yikes. She was taking about getting her insurance to cover the cost of both and that it was difficult…

          • Bombshellrisa

            It’s got to be a CPM-no CNM would be doing this.

          • Guest

            I know someone in that area who had a midwife serve as their doula in the hospital. Eventually the midwife split during the birth because she had another client going into labor at home. As it was, the midwife almost missed catching her homebirth client’s baby and the woman in the hospital got an epidural. The woman I know was very happy with the support she got and didn’t see anything wrong with the midwife’s behavior.

          • Bombshellrisa

            Seattle area has many doulas, there are also volunteer doulas who help low income mothers. So why hire a midwife to do that job? Unless you believed having a midwife there would help you avoid interventions or a c-section. It just make sense at all.

          • The Bofa, Being of the Sofa

            Seattle area has many doulas, there are also volunteer doulas who help low income mothers. So why hire a midwife to do that job? Unless you believed having a midwife there would help you avoid interventions or a c-section. It just makes no sense at all.

            Of course it makes sense. It’s so that you can boast to all your friends how you had a midwife AND an OB. You just have to view this from “the perspective of privilege.”

            Of course, that means the next person will have to have a doula, midwife and OB. And the next will have two doulas, etc. Etc. Etc. Etc.

            It’s boasting. That’s all it is. It’s boasting by the privileged.

          • Bombshellrisa

            Oh, privilege. Got it. More bragging rights. It’s not enough to drink $12 a tin “pregnancy blend” tea and use Eboost ($26 a box), get a $1000 stroller and have to have a Coach diaper bag. You also have to hire a midwife to hold the space in your hospital room so all those medical interventions you are supremely privileged to have access to can be scoffed at by a birth junkie.

          • The Bofa, Being of the Sofa

            Pretty much.

            As I told you, it makes perfect sense.

          • Somewhereinthemiddle

            I totally snorted in laughter at this comment being so illustrative of the privilege portion of the program. So true isn’t it? And as it turns out, sooo many of those things are superfluous. Although, I will say that I was pleased as all hell to have the privilege of a postpartum doula/ baby nurse for several weeks after our third was born. It.was.awesome.

          • Bombshellrisa

            Sometimes it’s the only way to make it through and well worth their fee!

        • Somewhereinthemiddle

          Does she (or you) mean a doula NOT a midwife? I’m asking this sincerely since I’ve come into contact with folks who didn’t know the difference.

          Having a doula there would make a whole lot more sense both in the telling of the story and in who someone would want attending their birth.

          • OlyBinewski

            She’s stated that she didn’t need a doula since her husband is the support person and that she thinks the midwife is going to be a better champion of a natural birth, so she is aware the difference. She’s never had a broken bone or any medical issues, so I think she’s just naive about hospitals and medicine in general.

          • staceyjw

            Sounds like she is using the MW as a way to run interference, and prevent the OB from doing all those evil things oBs do, like monitoring.
            Sounds awful for the OB, TBH.

          • CrownedMedwife

            That was my first thought. It sounds like a nightmare in the making and I feel for that OB if he or she is blindsided in that situation. Animosity written all over it.

          • Somewhereinthemiddle

            Huh, interesting. I do know of a very few midwives (not CNMs though) who will act as doulas, but it seems super expensive. Not to mention the fact that I would imagine that a doula would probably have a more useful skillset as a doula than someone who is used to functioning primarily as a midwife. Midwives typically don’t do as much as the hands on stuff, even the more “crunchy” ones and don’t seem like they would provide that much support, you know?

            Unless she is using the midwife as a buffer to her OB and if she feels like she needs a buffer from her OB, then she probably doesn’t trust them. Not trusting a medical provider is a good reason to look for a different provider. 😉

            I have used and am a big fan of doulas, so having a support person there seems like a good idea to me. But having a midwife there to act as a doula seems like an interesting choice from my point of view.

        • Therese

          Then it sounds like your second friend is having the midwife there as a doula.

    • gretta

      If this isn’t the epitome of privilege, I’m not sure what is….

    • Roadstergal

      I think these questions are important. People definitely do lash out when you challenge their assumptions, but if you do it kindly, respectfully, like a caring and concerned friend – well, speaking for myself, I really hope it has the possibility to plant a little seed of questioning these things…

    • Allie

      I’m in Canada and had my pre-natal care provided through a birth program that comprises midwives (of the licenced and university educated variety) and medical doctors. Who attends at your birth depends on who is on call at the time. One of the medical doctors was on call when I first went to the hospital and a midwife took over shortly after I was admitted since the doctor had been on call for a long time by that point. When I had been pushing for almost two hours, the midwife said she would call an OB if I didn’t make some progress by the two-hour mark. I was already 10 cm by the time I got to the hospital, so it was too late for drugs, or I would gladly have taken them. People have very strange attitudes about pain relief in general and they get especially strange when it comes to childbirth. At the end of the day, I think it comes down to fashion. For some reason, it’s trendy to have a midwife and no drugs and breastfeed right now. The pendulum always swings back, so I’m sure soon enough some Hollywood starlet will be photographed with a baby bottle and then that will be trendy.

    • RNMomma

      I don’t think midwives would necessarily get in the way. Sure it can happen, but I think it often is a team effort. I worked in a hospital where NPs and PAs were first call for their patients. It was a great system. They rounded everyday with the attending MDs and would call with any concerns that was beyond their scope of practice. I may be foolish in saying this, but it would seem to me that any respectable hospital will have a good system and good providers like this *most* of the time.

      • RNMomma

        Just read the rest of the thread. A midwife who does not have hospital privileges would most definitely be in the way… In my experience a professional midwife (CNM) would not put herself in that situation unless it was for someone like a family member or close friend.

        • Bombshellrisa

          Not just no privileges-no medical training. I can name at least ten midwives who would be willing to do this (all CPM) in Seattle, and I have an idea about how they are going about billing for it, which in my mind is the most unethical part.

  • staceyjw

    i expect crickets.

  • The Bofa, Being of the Sofa

    As I mentioned in a response earlier today, the medical provider should be promoting making options available to patients, so that they can have a choice. Especially when there is no medical benefit or cost of doing one or the other, then you give the patients the option to use their personal preferences.

    Of course, that is especially the case when you have an approach that you know empirically that a very large number of women (a significant majority, in fact) want and will use if they have the choice, and you better have a darn good explanation for why you won’t have it.

    As I said, I can understand why administrators want to cut costs, but that is not a reason why practitioners should WANT to do it. They may be forced to do it by policy, but that doesn’t have to stop them for promoting it, or at least advocating for it.

    You’d think that people with an NCB bent would be all for making things like epidurals available, because they always like to talk about empowerment, and empowerment involves the ability to make decisions.

    • attitude devant

      Cueing Jane in 1, 2, 3….

      • The Bofa, Being of the Sofa

        She’s in New Zealand. She is probably sleeping.

      • moto_librarian

        After what she said about Charley Hooper in the previous thread, she can just fuck right off.

    • CrownedMedwife

      Your last statement sums it and NCB does not empower at all. It places woman into its predefined roles and expectations, based on fear and falsehoods.
      Modern medicine and Obstetric care empowers when it lets women know; these are ways for babies to be born, these are ways to manage pain in labor; these are ways to feed your baby. These are your options and we will support the decision you make because you are making the decision that is right for you.