5 things you need to know to protect yourself from the seductive marketing tactics of the natural childbirth industry

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Natural childbirth advocates may be wrong about nearly all their empirical claims, but when it comes to marketing brilliance, they are second to none. Indeed, their marketing tactics are so seductive that many people who would have no trouble recognizing conventional marketing are chastened and distressed when they realize they’ve fallen for the marketing tropes deployed by natural childbirth organizations, celebrity natural childbirth advocates and by the legions of lay women who have been taught to proselytize the beliefs of the faithful.

However, knowledge is power, and you can protect yourself from even the most seductive marketing if you learn to recognize the tactics.

Here is a list of the top 5 marketing seductions that are the hallmark of contemporary natural childbirth advocacy.

1. Never forget that natural childbirth is an industry

This is the gateway seduction that many people, even sophisticated people, fail to recognize

Natural childbirth did not start as an industry. It started in the 1930’s and 1940’s as a way to control women (Lamaze originated with Russian adherents of Pavlov) and encourage more births (Grantly Dick-Read was a eugenicist who wanted white women of the “better classes” to have more children). The philosophy of natural childbirth crossed the Atlantic in the 1950’s, and, as with many imports, was adapted to the particular needs of American women.

Childbirth in the US in the 1950’s and 1960’s was, like most of contemporary medicine, afflicted with quite a few patriarchal practices that made things easier for doctors but were not beneficial, or perhaps even harmful, to women. These included assuming that women would rather be unconscious for their births, and banning fathers from the delivery room. It was natural childbirth advocacy that questioned those harmful practices and eventually ended them. The contemporary patient experience is far better than ever because of natural childbirth advocacy.

Natural childbirth advocates could have declared victory in the 1980’s and gone home; all their demands had been met. The moment that natural childbirth became an industry was the moment that they refused to declare victory and instead moved the goalposts. The original goalposts of the American natural childbirth movement were conscious deliveries, fathers in the delivery room, childbirth education, and research into and abolition of practices like perineal shaving and enemas that either had no benefit or were harmful. The new goalposts are no pain relief in childbirth, no C-sections, the promotion of midwifery, the promotion of doulas, the promotion of childbirth educators and the defiance of standard obstetric and public health recommendations. In other words, the promotion of itself and its continued existence.

Why do even sophisticated people fail to recognize that natural childbirth is an industry? Probably because they equate “industry” with massive amounts of money. True, individual professionals natural childbirth advocates don’t make a lot of money, but for most, it represents 100% of their income. That’s why they have a tremendous financial incentive to convince you to buy their products and services.

2. The primary product being sold by the natural childbirth industry is distrust of obstetricians

Read any natural childbirth book, website or message board and you will see that obstetricians are denigrated in the most scurrilous terms. Obstetricians supposedly don’t follow the scientific evidence. They aren’t up to date on best practices. They just want to get to their golf games. They will ignore or dismiss your most important desires. The derogation of modern obstetrics is absolutely critical to promoting the natural childbirth industry. They have chosen to set themselves up in opposition to obstetricians and have created a zero-sum calculus whereby natural childbirth advocacy can only “win” when standard obstetric preventive care “loses.”

This tactic isn’t merely grossly unprofessional; it is startlingly unethical. Most women, by inclination or through emergency need, will have to interact with obstetricians, so to deliberately encourage suspicion, derision and hostility does women no service; it only benefits the natural childbirth industry.

Run, don’t walk, far from anyone who sets out to destroy your relationship with the care providers whom you almost certainly will have to employ.

3. Natural childbirth advocacy seeks to create personal conflict and hostility between women and their obstetricians

The surest way to encourage distrust of obstetricians is to create conflict between patients and their providers. Natural childbirth advocacy creates that conflict by making false empirical claims about childbirth and obstetrics. They say that childbirth is inherently safe, but that’s a bald faced lie. They say that obstetricians don’t follow the scientific evidence, when it is natural childbirth advocates themselves who wouldn’t know the scientific evidence if they fell over it. Most pernicious, and most outrageous, in my view, is that natural childbirth advocates insinuate or proclaim that obstetricians don’t care about you or your baby and will actively work to harm your baby unless you aggressively resist that harm.

Consider the birth plan. It is now, through the influence of natural childbirth advocates, consider di rigueur for every birth, despite the fact that it has NEVER been shown to affect outcomes in the slightest and its only measurable effect is to decrease satisfaction among women who create one. The primary purpose of a birth plan, in my view, it to create conflict between a women and her obstetrician by encouraging a confrontational attitude, including demands that are outdated (no perineal shaving) or nonsensical (no vitamin K). Natural childbirth advocates tell you to create a birth plan and then demand that your doctor follow it; of course they warn you in advance that your doctor will become wary of you and react unfavorably to your plan (not surprisingly since it is filled with irrelevant, nonsensical and even harmful demands), and then when your doctor does react unfavorably, they claim that that means he or she cares less about you and your baby than they do.

4. Natural childbirth advocacy seeks to divert attention from having a healthy baby to having a natural childbirth experience.

Presumably you got pregnant because you wanted a baby and you fervently hope, and will do nearly anything to ensure, that your baby is healthy. But focusing on a healthy baby diverts attention from what natural childbirth advocacy offers, a preapproved scripted “experience.” Hence you will find natural childbirth advocates telling you that a healthy baby is guaranteed (false), a health baby is not enough (false for most women) or that anyone who doesn’t give priority to your experience is providing substandard care.

5. Natural childbirth uses flattery to disarm opposition.

In ordinary circumstances most of us recognize marketing tactics. We understand that those trying to sell us something have a vested interest in the sale, denigrate the competition in order to elevate themselves by comparison, and most of us would never fall for elevating the experience of a product over its safety. So why are so many women hoodwinked by the same marketing tactics when deployed by the natural childbirth industry? The reason is flattery. The natural childbirth industry flatters you into believing that you know as much (or more!) than your obstetrician, that you are so powerful that your very thoughts can ensure the perfect birth, and that by entering the fellowship of natural childbirth advocates you demonstrate that you are “educated,” strong enough to defy authority, an authentic woman, and, most important, that you are superior to other mothers. Who wouldn’t want to believe all that?

So how do you protect yourself? You recognize that you are being subjected to marketing; you recognize that you are being manipulated into distrusting your obstetrician; you refuse to engage in the confrontational behavior recommended by natural childbirth advocacy; you recognize that a healthy baby is not in any way guaranteed and that you may have to compromise your desires for a specific experience to ensure that your baby is healthy; and you recognize phony attempts at flattery for what they are.

The bottom line is this: a group of lay people who profit only when you choose the products and services of the natural childbirth industry are trying to convince you that they, the lay people, know more about pregnancy and childbirth than the women and men who have devoted 4 years of college, 4 years of medical school, 4 years of internship and residency, and many years of experience to protecting the health of mothers and babies. And though these lay people of the natural childbirth industry refuse to take ANY responsibility for your health or the health of your baby when you follow their advice, they are trying to convince you that they care more about the outcome than the doctors who take full legal and ethical responsibility for your health and the health of your baby.

The only remaining question is whether you are capable of seeing through the marketing rhetoric to the truth.

  • cc

    This is crap. It seems to suggest everyone who doesn’t want medical interventions distrusts OB doctors.. quite the contrary. I trust my body and my doctors ability to help me give birth without pitocin, epidurals, opiates or other painkillers.. natural birth does not mean paying a midwife and giving birth in a field..

    • fiftyfifty1

      “It seems to suggest everyone who doesn’t want medical interventions distrusts OB doctors.”

      So if your OB doctor told you that s/he recommended an induction or augmentation with pitocin for your labor, what then? You say you are going to reject pitocin, but what if the OB says you need it? How is rejecting OB advice different from distrusting your OB?

      As for your decision not to have an epidural or opiates, knock yourself out! If that’s simply your personal preference, the more power to you. Many of the regular commenters on this blog have had med-free births. It’s just that they are under no illusion that that makes them or their births “better”.

      • denise

        Seriously, nobody gives a f… if you want an epidural or not. It is pain management. If you need it, you ask for it. If not, don’t.

    • Amy Tuteur, MD

      Why do you trust your body?

      Do you trust it to never have a miscarriage? The natural miscarriage rate is 20%. If 1 out of 5 pregnancies naturally ends in the death of the embryo, why woud you trust any aspect of pregnancy to be safe?

      Don’t you get it? Trust birth is a marketing tactic designed to counter the reality that in a life threatening emergency, birth workers won’t be able to do anything besides call for an obstetrician. They tell you to trust your body because the truth is pretty ugly: If you take themedical advice of a birth worker, your baby will very likely die if anything goes wrong. So just trust your body and pretend that nothing will go wrong.

      It amazes me that the same people who would scrutinize the marketing message of a major corporation swallow any nonsensical marketing message that natural childbirth advocates make up.

    • Roadstergal

      I can trust my body to see without interventions all day long; it doesn’t change the fact that it won’t.

    • sdsures

      It’s just the opposite for me – I *can’t* trust my body. I can’t even trust it to reliably tell me when I get hungry or need to sleep.

    • sdsures

      How do you know you won’t need pitocin? Failure to progress and pain control are completely separate issues.

      What if your baby gets stuck? You can’t just ask it to back up and try again, like a car parking blunder.

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  • And in systems that are geared towards “saving money” – each woman opting out of an epidural saves the system some cash, leading to an undersupply of epidurals. Illustrated by: Canada, the UK

    • truthiee

      That might explain why I was unable to get an epidural for my last two children. I had a midwife, and both times I asked for one. It seemed like an obstacle and the childbirth ‘experience’ was absolutely horrible. –Canada

      • sdsures

        *hugs*

    • Sarah

      That’s clearly the rationale. I reckon denying me an epidural ended up costing the NHS more money than just getting it when I asked would have done, though.

      • Agree – the toll of denied epidural often goes unmeasured. There’s a bit of evidence that supports the theory that inadequately managed labour pain can lead to the development of post-natal PTSD.

        • Sarah

          Indeed. I also remained under the midwife postpartum for a week or so longer than usual due to my head being in a bit of a mess, which is more expensive than transferring to the health visitor team as early as possible. Then I complained, which took resources to deal with, and I have required more reassurance during midwife appointments this pregnancy. I reckon by the time I’m done, the whole thing will have cost more than it would have done if they’d just given me what I needed in the first place.

        • toni

          wouldn’t surprise me at all. I had a pretty easy time of it and had chosen to do without the epidural because the contractions didnt bother me that much and still was in a bit of shock afterwards. I didn’t want to talk about how it went to anyone who asked for a few days and although seeing my son being raised up to me between my legs was absolutely magical, the actual birth felt violating. God knows how I would feel if I had been denied an epidural I wanted and it ended up being difficult or protracted

    • Bugsy

      Hmm…my son was born in the U.S., and getting an epidural was not a problem there. We’re now living in Canada, so any future kids will be born here. Wonder what I’ll have to do to get my beloved epidural?

      • DaisyGrrl

        Depends where you live. I understand that you could have a tough time in a more rural environment or in BC (undersupply of anesthesiologists, but my info is waaay out of date).

        • Bugsy

          Hmm, how about metro Vancouver?

          • Mtbakergirl

            My unscientific sample is that women’s hospital has the necessary anesthesia staffing, and perhaps st.paul’s or surrey memorial, but any hospital any smaller than that can be quite hit or miss e.g., one simultaneous csection to your delivery or one trauma in the er and the you are bumped down the list. My advice is refuse to be sent home if you go in in early labour to increase your chances that an anesthesiologist will become available at some point, and have a pushy support person who refuses to be satisfied with “oh yes, we will call them soon” from the nurses. At least that is what I’m going to try next time 🙂

          • Women’s hospital also has the legacy of Dr. M. Klein…who was pretty pro NCB. I’d choose St. Paul’s personally.

          • Bugsy

            Thanks, Mrs. W and Mtbakergirl. Any thoughts on Richmond Hospital…or where can I figure out if they offer obstetric anesthesiology?

          • Bombshellrisa

            I have no advice but I am jealous you live in Richmond-it’s my first stop once I get over the border. We used to go to the Beard Papa at the food court at Richmond town center. I did end up at St Paul’s for something unrelated to pregnancy and my care was pretty good (my personal experience with learning that of you are really unable to move and hurting and sick, being right across the street from a hospital and being to to stare at it through the window while you retch is too far away).

          • Bugsy

            The awesome food here (and the fact we can’t afford Vancouver real estate) is part of the reason why we chose Richmond. 🙂 We have two Beard Papas now – Richmond Centre & Aberdeen Centre. Yum!

            Thanks for the tips on the hospitals; very much appreciated!

          • Bombshellrisa

            Just told DH there is another Beard Papa-he is excited.

          • Bugsy

            Completely off-topic from the post on which we’re commenting: here’s a great blog if you’re ever looking for new places to check out in Richmond: http://www.365daysofdining.com Yumm!

          • Metro Vancouver is probably the best place to be in BC with the highest rates of epidural use, however rates are still lower than in other parts of Canada.

      • Epidural availability varies a great deal in Canada so a lot depends on where in Canada you happen to give birth. To improve your odds find a hospital with dedicated obstetric anesthesiology or at least 24/7 anesthesia coverage and let your wishes be known well in advance…maybe even ask for an anesthesia consult prior to delivery.

      • Samantha06

        I’ve been working in BC for 3 years and haven’t seen any major issues with epidurals. The hospital I’m in now is in a larger city and we have a dedicated OB anesthesiologist 24/7. The smaller hospital I worked in had good coverage but sometimes there was a wait if the doctor was in a case.

        • Bugsy

          Ok, thanks! I really appreciate your putting my mind at ease. 🙂

          • Samantha06

            You’re welcome and welcome to BC! 🙂 I think Mrs. W is correct. Research different hospitals first and see what their anesthesia coverage is like. Most of them have scheduled tours of L&D too, so I would check that out as well.. An anesthesiology consult is a good idea too.

    • denise

      I am from Montreal. Unlike the UK, Canada does not rely on midwifery. It is relatively a small portion of women who choose a midwife. Especially in Qc. Epidurals, at least at any major hospital, is no issue. What I would pay attention to though, is make sure to run away from any hospital that is known as “doulas’ favorite”. Montreal’s Lasalle Hospital, “doulas’ favorite” almost killed my daughter. They would make GPs deliver normal pregnancies. The attending GP called the OB when I had complications. The OB was in a C-section. Instead of calling the second OB on duty, they made me wait saying it wasn’t urgent. My daughter’s first APGAR was one.

    • sdsures

      I was born and raised in Winnipeg for 28 years, then moved to the UK. I’ll be interested to see if there are any differences in maternity care – but since I’ve only experienced non-maternity related medical care in both countries, I’m sure I’ll be OK with whatever my doctors recommend. They have MDs. I do not.

      Not once in any of my medical procedures was I pressured to choose certain things over others “to save money”. The only thing I can remember that I asked for specifically was to be anesthetised with IV meds instead of gas before my operations, because the mask makes me panic. They were very nice, and explained why they use a mask (to give supplementary oxygen to the patient before intubation). I understood that, and they suggested I might like to hold the mask myself instead of the usual procedure of a nurse or anesthetist doing so. I did, and it really helped with my anxiety, and both me and my doctors were completely content with the way things proceeded.

      • demodocus

        One of my docs did recommend buying the generic prescription to save *me* money. the pHARMa shill 😉

  • alia

    Are OBs naturally immune to financial incentives then? If it’s all a business… how much does a hospital birth cost compared to a midwife birth?

    • KarenJJ

      How much of an obgyn’s income is from delivering babies and how much of a homebirth midwife’s income is? My obgyn also did a lot of women’s health care apart from delivering babies. A midwife can only deliver low-risk babies. So once you take out the income from delivering low-risk babies you’re still left with a sizeable career. Homebirth midwives – nothing.

      • Echidna Lactation Consultant

        Some OB-GYNs are dropping the OB part entirely, and maintaining a full-time practice in just well-woman care. Makes sense: most American women have more than 50 non-childbearing years in which they aren’t pregnant, postpartum, or trying to conceive, but still have reproductive organs that need screening tests and routine care. Even post-hysterectomy women still need regular exams.

        By contrast, in the average woman’s life she’ll need someone to catch or surgically remove maybe two babies. You see your doctor a lot more when you’re pregnant, but most of us spend most of our lives not pregnant. Or never become pregnant.

        • Smoochagator

          Or, as is the case at my OB/GYN practice, after a doctor has spent many years delivering babies and wants to transition to pre-retirement, he or she adds younger doctors to the practice to provide OB services and just does well-woman visits and gynecological surgery.

          • Yeah, that might be what the doctor I’m thinking of is doing. He may be gradually retiring and maybe just not accepting new patients, and the ones he has have all aged into menopause.

    • fiftyfifty1

      Are you saying that you are concerned that OBs are making medical decisions based on financial incentives? That’s a hypothesis I’m willing to entertain, because I believe we all have the potential to respond to $ incentives.

      But let’s dig deeper. Tell me what specific decisions you believe OBs are making based on financial incentives, and let’s break it down to see whether it might be true, and then whether there might be bad outcomes based on this.

      • Medwife

        If I am attending a labor while my supervising OB is seeing clinic patients, that’s a potential motivator for him to _avoid_ intervening, if anything. The more NSVDs the better. In my perception I have not seen this play out but there you go. I have a low threshold to call him in and he has never hesitated to come.

        • Sue

          But that’s a collaborative relationship, Medwife. HBMWs seem to be lone rogues – they don’t do team-work.

    • Guesteleh

      You shouldn’t just ask how much the birth costs but also how much it costs the hospital and OB to provide the service. Full staff of highly trained clinicians in a variety of specialties plus the cost of maintaining medical equipment, the operating suite, the NICU, etc. When you pay the midwife all you get is the midwife and if you have to transfer, you have to pay the cost of the hospital on top of the full midwife fee (which is due before the birth and usually is not covered by Medicaid or private insurance). Costs can’t be examined in a vacuum.

      • Sara Lucy

        There are a number of states where homebirths with CPMs or LMs are covered by private insurance and Medicaid.

        I worry about women on Medicaid going to homebirth especially, because of the low reimbursement rates. First, if you want a homebirth you have to find a midwife who can bill medicaid so your options are limited. Then, the midwife is doing both the billing and providing the care. Too much room for personal bias to interfere with what is most likely going to be substandard care to begin with.

        I chose this route about 8 years ago when I was using Medicaid for my first and it was a horrible experience. Thankfully I ended up in the hospital.

        I saw the midwife complaining on facebook a few years later how much her “medicaid moms” had cost her– and in a tone that was definitely putting the blame on the moms. Nevermind that she used her Medicaid acceptance as a selling point, claiming that “every woman should be able to have a blessed birth regardless of her ability to pay.”

        Whatever.

        • Ash

          AK, Washington, Oregon. So not that many

          • Sara Lucy

            Nope, there are many more than that. FL, VA, VT to name a few.

          • Ash

            Looks like you’re right–it seems like the MANA midwife state by state page is not updated about some of these things.

          • Guestelehs

            NY requires midwives to have a CNM to get reimbursed so at least the training standards are higher. Then again, that CNM in Business of Being Born presided over the deaths of at least two babies that I know of and she’s being sued.

          • Junebug

            Idaho also pays medicaid.

        • Medwife

          Because a birth is only “blessed” if it’s at home with a CPM? Nice.

    • Cobalt

      OBs will never run out of patients. They provide too many important women’s health services; even in countries where midwives are the norm for low risk pregnancies OBs have plenty of business. There have also been studies showing that putting them on salary, so there is no incentive to do any specific procedure based on their own finances, doesn’t change intervention rates.

      • Ob in OZ

        Exactly. The biggest insult to my professionalism was when insurance companies wanted to reimburse the same or slightly less for a c-section as compared to a vaginal delivery. Did they really think this would mean less c-sections? Of course not.

    • The Bofa on the Sofa

      What’s the marginal value of a patient to an OB vs to a midwife?

      How much does an OB make for a delivery? A few hundred bucks, maybe? The hospital gets more, but they also have a lot more staff to compensate and capital overhead. OBs get their compensation by volume and gyno services. Finally, very many OBs are actually overextended in terms of services, and are actually turning away patients. Those OBs ARE immune to financial incentives of adding or losing patients.

      A homebirth midwife gets the whole shebang, and has almost nothing in overhead, and most have so few clients that they can’t even afford to pay insurance, so they claim.

      • Guest

        Also, by this logic, OBs and MFMs who are attending physicians or hospitalists who are on salary have no direct incentive to tell patients not to give birth at home.

        • The Bofa on the Sofa

          Well, no financial incentive. They have a professional incentive, of course.

    • AlisonCummins

      I think someone said elsewhere that an OB gets a flat fee on the order of $150 per delivery, whether it’s vaginal or c-section?

      Anyway, only about 1% of american women give birth at home, so homebirth would represent about a 1% drop in income — except that many of the women who give birth at home need obstetrical care anyway, and babies born at home may need hospital care anyway. (A baby who was planned to be born at home is about 18x more likely than a baby born in hospital to need cooling to prevent brain damage.)

    • staceyjw

      Here is a good comparison for you-

      The OBs here get somewhere around $1500-2000 per birth. No matter what happens. It takes about 10 years of grueling school and 80+ hours a week, plus a million hoops to jump. And that is just to see patients…. Oh yeah, then there are taxes to be paid, insurance to be wrangled with, etc.
      VS
      A local HB MW, with zero school, maybe a CPM, maybe not, charges an average of $4,000. Up front. In cash. She has no overhead, other than maybe a birth kit. Whoops, mom buys those too! No insurance. Nothing. Its all profit.

      OBs HAVE to take more patients, just to make it work, while HB MWs can do very well for themselves with a minimal case load.
      AND NO INVESTMENT IN TIME NOR COST, on the HB MW side.

      Business-wise-
      I know that my OB LOSES money on a good number of her patients, thanks to low Medicaid reimbursement. The rest are so close to break even financially that any little thing that takes up more time puts her in the red.

      You make a good salary as an OB, but it’s really not that much when you consider the amount of education, the risk and the insane workload. If you are smart and hardworking enough to be an OB, you could easily have gone into finance and made triple, for much less headache.

      • Trixie

        Don’t be silly — MWs make their clients buy the birth kits from special websites that give the MW a cut on the back end.

    • yentavegan

      The OB who delivered baby #2 and baby #3 insisted that I sign a document acknowledging that I was aware that he would resign from being my obstetrician for baby#4 anytime including during labor if I was not cooperative. That is how big a pain in the ass all the NCB propaganda had made me.
      He could have just taken my money if all he cared about was financial incentives.
      BTW it took me years to appreciate that he was in the right and I was being ridiculous.

      • toni

        Have you spoken to him since you’ve changed your mind about NCB

        • yentavegan

          By the time I came to my senses he had retired.

    • Sue

      ”how much does a hospital birth cost compared to a midwife birth?”

      You are asking as if you think that they are two comparable products.

      Like ”how much does dental work done under sedation cost, conmpared to having some guy do it at home with pliers?”

  • Vg2010

    I have to admit that I am a bit bipolar when it comes to the birth experience. I come from Venezuela, and very few women give birth there – csections are pretty much the default and birth is seen as a barbaric experience that risks your life, that of your child (or could cause him disabilities as it happened to my mom’s friend in France, little boy lacked oxigen and was severely disabled during his short life), threatens to destroy your vagina and causes you pain. So I always thought I would fight for one when the time came.
    I moved to Canada over 10 years ago, and I am a bit of a hippy – I dont like GMOs, try to eat organic, avoided dairy and gluten while doing my femara rounds to ovulate, love doing crazy things like warm lemon water and oil pulling. So when I finally got pregnant, I did consider getting a doula to help manage the pain during my hospital birth. But then realized that even if the doula helps massage my pain away,I dont think she can do much to avoid tears in my vagina – or to accelerate the birth process. And the more research I did, the more I saw that it could become a confrontation between the doula and the medical team (which I definetely dont want because even if I wanted to manage pain, I would never do so at the expense of medical advice) so I ditched the doula idea and I’m back to square one (considering telling my doctor that I want a csection).
    That is to say that I can see the appeal of a “natural” “intervention-free” experience where you breath your pain but don’t think anyone can feel morally superior because of those choices….

    • just me

      And I still don’t get the whole breathing thru the pain. Why? Do these people get fillings at the dentist without Novocain?

      • Vg2010

        FTM, so obviously I have no clue. But they sell it (or I envisioned it) as a very yoga like experience… like concentrate on something else… there is something very romantic about doing things the way our ancestors did it… and I am glad to be giving birth in a hospital where they will let you have 2 people with you, use a bath, and a birthing ball and walk around… and I went to visit a friend while she was in the first stages of her labor… but there has to be a line between: you can try to do it yourself AND you need to measure risks because it is much better to use pitocin to help you progress than it is to leave you almost 20 hrs without dilating after your water broke…

        • The Bofa on the Sofa

          But they sell it (or I envisioned it) as a very yoga like experience… like concentrate on something else.

          Can they just give you a spoon to bite on?

          • Vg2010

            Wonderful image (NOT). I remember reading a lot about massages, and breathing… but I can tell you more after my prenatal couple yoga class that is supposed to be about preparing for birth (I think they will provide us with techniques that we will promptly forget)

          • The Bofa on the Sofa

            What if you told them, Oh, I just plan to get an epidural, so what’s next?

          • Bugsy

            I can only imagine the looks of horror and silent disapproval she would have received…Dr. Kitty *obviously* needs to be educated.

          • Dr Kitty

            I stopped going to the pre natal yoga class once I realised that it wasn’t about gentle exercise and some breathing techniques for labour, but about doing everything all natural.

            I didn’t tell them I was a Dr, and when I said that I was probably going to have a CS, I got a lot of sad faces, pitying glances and “helpful” suggestions of how I should just wait it out, refuse interventions and think positive thoughts…uh…nope. I was not on the same page with those ladies.

          • Who?

            Yoga does bring out the crazy.

            My teacher is a bit of a loon, with what I suspect is an eating disorder, but the yoga is great for strength and flexibility and I treat the need to calmly and patiently forebear as a personal development opportunity.

            Luckily the class members all have a few miles on the clock, and none of us are too bothered or taken in by the nutty aspects.

          • KarenJJ

            I was very fortunate in that my yoga teacher was very softly spoken with a french accent and I was far too deaf to hear what exactly she was saying.

          • Who?

            I had the gas and air through a mouth tube-hate masks-and my teeth prints were in it by the time baby arrived. Completely unaware how hard I was biting on that thing, Husband wanted to keep it as a souvenir, I was not in need of any reminders!

        • Who?

          Yeah, I do a lot of yoga, and have had two natural deliveries, trust me the two activities have nothing at all in common, and anyone who wants to tell you otherwise is either inexperienced in one or both areas, or trying to sell you something.

        • KarenJJ

          I did yoga and hypnobirthing prior to labour. It helped a lot with feeling happy and calm and healthy. It didn’t manage the pain.

        • araikwao

          I found focusing on breathing helpful, because it made me feel less like I was going out of my mind with pain – sort of controlled the panic. It still bloody hurt, but made me feel more in control (kind of. I know I wasn’t actually controlling anything.)

        • Sue

          ”But they sell it (or I envisioned it) as a very yoga like experience”

          It could be exactly like yoga, except for the excrutiating pain that wracks you repeatedly, at increasing frequency, for hours. But other than that…

        • Allie P

          I did prenatal yoga. I found it really helpful for really consciously identifying the muscles I needed for pushing. I had no intention of going without an epi and did not (epidurals are the BEST!), but the nurse was like “Oh, let’s do a practice push before the doc gets here” and the second I started she was like, “STOP STOP STOP, you’ve got this down.” I think she figured, as a first time mom with an epi, I wasn’t sure *what* I was supposed to push.

    • fiftyfifty1

      I’m not sure what you will end up choosing, but I think that whatever you choose will be a sensible choice. It seems to me that you have good self-awareness and are able to tell the difference between your personal *style* (hippy, natural, organic) and what might be scientifically indicated in a given situation. Really, I think that a natural hippy style is great. For instance, whatever “warm lemon water and oil pulling” is, it sounds lovely and relaxing. The problem with an organic style only comes when people start to believe that style equals science or equals morality. Doesn’t sound like you are at risk of that.

      Good luck on a lovely and safe birth, however it happens!

      • Vg2010

        Thank you so much for that! a lot of this pregnancy (week 25 now) has been about reconciling different tendencies, and The way you described it made me feel like they dont have to be opposites but can exist with each other. To be honest, this website has helped me a lot when it comes to accepting that Im not crazy for wanting my baby to come first. I dont really care about my pain or my recovery, but I want a heslthy baby that doesnt suffer any damage during birt.
        I am waiting until around week 32 or so to make my decision and talk to my obgyn. I feel if women can have home births legally, I should be able to elect a section – especially because I understand the risks pretty well.

        • mishabear

          If you actually think you may want a C-section, IMO you should really bring it up with your OB much sooner. Based on comments of another Canadian poster (Mrs. W?), MRCS (maternal request, no medical indication C-sections) aren’t common and there can be quite a lot of push back. At 32 weeks, you may be leaving yourself up sh!t creek with no paddle, if your OB/hospital is not accommodating.

          Just from personal experience in BC, I overheard the nurses in the intermediate nursery tell a woman (her baby aspirated meconium due to long/hard labor) that she couldn’t have a MRCS with her next. She needed to at least try to have a vaginal birth. Not sure though whether this was MSP/hospital policy or just something the nurses made up.

          • Vg2010

            Sigh. I have an appointment tomorrow and I think I have my arguments in order – but im terrified of being told no and losing the option. My husband is great though, he thinks vaginal is natural but always states that it’s my body and My choice, so at least I dont need to worry about that…

            Will need to sleep on it…

          • Allie

            Good luck. Let us know how it works out.

          • Good luck – also if you are seriously considering MRCS – I’d encourage you to join the facebook group “Cesarean by Choice Awareness Network”. My blog “Awaiting Juno” might be another resource. Pauline Hull wrote a great book “Choosing Cesarean: A Natural Birth Plan” this is also worth a read.

          • Vg2010

            Mrs W. i have read your blog for so many years (I am not big in commenting)! I didn’t know that you were here! I requested to join the group – and will see if I get lo ger than a min with my obgyn today and ask about a MRCS…. thanks for the advice

          • Allie

            I live in BC and the first part of your comment is definitely true. Vg2010 should raise the issue sooner to ensure an elective CS absent any medical indications. However, regarding the second part. perhaps the nurses were pushing their own opinion. I’ve known many women giving birth for the second time after a CS and CS is always an option in that case. In fact, depending on your OB, you might have to push to attempt a VBAC. I have the greatest amount of respect for nurses, but some of them really seem to buy into the woo and some seem to just get burnt out and enjoy taunting their patients.

          • Samantha06

            I’m in BC too. I’ve only been here for three years, but I have never seen or heard any of the nurses I’ve worked with “taunt” patients. I haven’t met any supportive of the woo either and I’ve worked in two hospitals in different cities.

          • Cobalt

            I’ve had 2 L&D nurses that were awful. The few dozen others I’ve met were all great. Nurses are human too, they can have days when their bedside manner really suffers. And every now and then, someone is just a rude person in general.

          • Samantha06

            That’s a shame. I agree nurses do have bad days, but rudeness to patients is just not appropriate… unless they are a NCB advocate with an attitude! *snark*!

          • Allie

            It’s a very small percentage. I’ve only witnessed it personally twice, once in a care home setting and once with my grandma’s post-hysterectomy nurse (and yes, in that case I would definitely describe it as ‘taunting,’ although to be fair, my grandma knew damn well she was being difficult too), but my SIL had a very bad experience with a nurse pushing the breastfeeding while she was recovering from an emergency CS (so extra stressful and scary on top of the physical toll). I did not witness that personally though.

          • Samantha06

            I think the breastfeeding thing is lack of knowledge and mostly due to the BFI. It seems to be ingrained in the BFI hospitals, and nurses who don’t have much experience in a non-BFI hospital think that is the norm and push it at all costs. I’d worked in rooming-in hospitals, but we always had a nursery too and the breast-feeding push wasn’t so militant like it is now.

          • Bugsy

            misha, Allie, Samantha: unrelated to this particular post, but since you all are familiar with BC: how hard is it to get an epidural up here and/or what would I need to do to ensure one with any future L&Ds? Thx.

          • Samantha06

            I haven’t seen any difficulties, but I’ve only worked in two hospitals here. In the smaller, rural hospital I worked in, there might be a wait time as they didn’t have an anesthesiologist in-house, or if he/she was in another case. However, in the bigger hospital I’m in now, we have our own OB anesthesiologist in-house 24/7.

        • Ob in OZ

          You’re right, and yet this is the hyopcracy of the natural birth movement and why it is anti-choice for women. They say you should make a birth plan, but only if it is like their birth plan. Interestingly goverment policy has folloed the same path. A big policy from state government about women and choice regarding induction of labor, followed 2 paragraphs later by not allowing an induction of labor at term based on a women’s request alone. So you can request a c-section at 39 weeks and most medical organizations (and now some public health care systems) will say it is ok, but if you request to be induced at that time, your reason for the request and whether there are benefits (there are) and risks (some, but minimal and specifics would mitigate this) does not matter. Funny if it wasn’t so insulting.

        • Trixie

          I hope you get the birth you want, up to and including a maternal request cesarean, but I’m not sure that in a country like Canada, assuming you are low risk to begin with, a cesarean has better outcomes than vaginal birth.

        • Vg2010

          I want to thank everyone for their support and advice. I saw my dr today and asked him about the MRCS. He said his practice follows the position of the SOGC (which makes perfect sense since he is the head of the gynecology department in the hospital where I will give birth).
          That being said, he was very non-judgmental (which almost made me cry – stupid pregnancy hormones) and actually explained to my husband that a section was much safer for the baby even if it wasn’t for me (his comment was: if the baby were the only patient, they would all be born by section) – I really expected to hear some of the BS that you read on any statement about vaginal vs c-section and it made me feel reassured. We talked about risks and monitoring, and even though the option is no longer there (at least with the practice where I am going), I feel reassured that they will not allow for any unneeded risks, and that a c-section will take place the moment than the baby and I need it. I actually like him a lot better now than I did before this morning (we usually spend 2 to 5 mins together in my appointments, so I don’t really know him), but the way he addressed the conversation and his answers increased my respect for him (and isn’t it sad that I have to feel grateful for being treated like a grown up as opposed to a fearful child throwing a tantrum?)
          Once again, THANK YOU

          • toni

            Glad you’re feeling better. Best wishes!

      • Trixie

        Oil pulling is where swishing oil in your mouth does wooish things for your health.

        • Bombshellrisa

          Yep-sesame oil. It “removes toxins”

          • Sarah

            Sesame seed oil is nice, though. I like swishing it with some vegetables. It removes hunger.

          • Bombshellrisa

            I wonder if I could count my chili wasabi green beans as a “natural flu shot” or bill it as the ultimate “detox” food? Instead pineapple nice, ginger, garlic and cayenne, I use ginger, garlic, red pepper flakes, wasabi and sesame oil. Yum yum

          • KarenJJ

            Yeah sure you can. I’ll have a glass of red when I have a cold in winter to “kill the bugs”. If I do placebos I want them to be a pleasant experience.

          • Mishimoo

            Sunflower of Coconut oil, for detoxing amalgam fillings (depending on who you ask).

          • Who?

            Whoever you ask a silly question, the answer must, by definition, be silly.

          • Samantha06

            I asked the hygienist about that and she said she has seen a few patients who do oil pulling and (of course) it does absolutely nothing! So we got into a discussion about all the woo out there and she said when someone comes in and refuses flouride treatments or something else, she doesn’t even try to reason with them or talk them out of it anymore. She said they’ve made up their minds and she is tired of beating her head against a brick wall. I said, I know exactly how you feel!

          • Who?

            My dentist is keen for me to have an artificial tooth implanted. I’m quite keen to have a bridge, the only objection to which he seems to have is that bridges are ‘old school’. I told him I was too so that’s all good.

            The relief on his face though when I told him that my objection is not to do with concerns about heavy metal poisoning, was a surprise, apparently he gets that a lot.

          • Samantha06

            I would imagine so! A few of my metal fillings started deteriorating a few years ago, so I just had them all replaced with the white resin, and I’m quite happy with them. It’s nice having an “all white” mouth, although I never bought into the hype about the metal fillings anyway.

          • Who?

            Yes I have all white fillings now, which are good.

            The implant costs about 3 times as much as the bridge, and seems to take months to get done, and no one has made any sort of attempt to say why I need to do anything at all with the space, which has been there about 45 years. The best they come up with is vague things about improving my bite, but never quite the same story twice.

            I think there’s a lot of hype in dentistry, sorting through it is tricky.

          • Samantha06

            I wonder if it’s because as we age and lose some bone, the teeth surrounding the space will move? I don’t know, just a guess..

          • Who?

            My jawbone is apparently awesome-cue jokes about the amount of talking I do.

            I agree you would think there should be a killer punch response like that to the question of why prefer one solution over the other-but the answer I get is ‘well, bridges are old school, so…’.

            If someone could give me a reason to prefer the more expensive, time consuming and invasive procedure, I’d be on board-assuming they could first tell me why I need it at all apart from ‘because I say so’-but so far, no go.

          • Samantha06

            I don’t really know anything about bridges. Are they removable or are they like a crown? I don’t know which route I would go. I would definitely have to consider all those factors too.

          • Who?

            It’s a conundrum. The whole way the dentist is handling it just reminded me of the midwife thing-trust me, I know what you need, don’t bother your head about the details, it will all be great if you just do as I say.

            No doubt it will work out eventually!

          • Samantha06

            Yeah, that’s a tough one. Sort of puts a barrier between you and your care provider.

          • Ash

            You have to consider the adjoining teeth. Think of the neighbor teeth on either side of the empty space to be the supports of the bridge. For most single space bridges you have to alter the side teeth which can make them more prone to infection and decay in the long run (some people are more diligent at hygiene than others). Also depends on the neighbor teeth as they are now and the expected longevity of the bridge. In any case, you could always see another dentist for a second opinion.

          • Who?

            All that makes such good sense, if only that was what I was hearing. It’s frustrating to ask questions and not be answered properly. We previously had a nice dentist who was hard to get to, I might head back and see him. Like I say, it would be good to make a decision-but I need some actual information.

          • Smoochagator

            The only reason I choose metal fillings is because they’re cheaper. And I have no problem admitting that!

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  • theadequatemother

    This is a really good post.

  • NoLongerCrunching

    By the way, Dr. Dunning (of Dunning-Kruger fame) is doing an interview on Reddit right now:

    http://www.reddit.com/r/science/comments/2m6d68/science_ama_seriesim_david_dunning_a_social/

  • moto_librarian

    For me, pregnancy was both physically and emotionally draining. Concerns about my babies were constantly with me. During the first trimester, I think I held my breath during every trip to the restroom, terrified that I would find blood and be having a miscarriage. Once I started to feel movement, I would obsess about how often I felt them move. I worried about the results of routine testing, ultrasounds, etc. I wanted both of my children to be born full-term and healthy.

    When it came to “preparing” for childbirth with our first, we took the course recommended by our CNM practice. If I were to take that class today, I would get kicked out within the first 10 minutes because I am certain that I would laugh my ass off at the “birth goddess” video that the instructor showed. My husband thought it was ridiculous, but at the time, I was incensed with him for not taking it seriously. I read about the “cascade of interventions,” watched Penny Simkin as she helped women achieve their beautiful natural births, internalized the idea that if I could get through transition, pushing would feel “good.” Then we actually had our baby, and I began to learn that I had been fed a steaming pile of bullshit and I had ate it up.

    I believe that one of the reasons that NCBers are so persuasive is because they prey on women’s worries about their unborn children and their well-founded anxieties about giving birth. You want to do what’s best for your child, and after months of avoiding caffeine, alcohol, soft cheese, and not taking anything stronger than acetaminophen, it seems quite plausible that an epidural could be damaging. You also hear repeatedly that breastfeeding is natural, and you certainly don’t want to screw up your baby’s virgin gut with formula. And so on and so forth. As someone who teaches information literacy skills for a living, I am embarrassed by how easily I was swayed into believing a variety of things that actually had no clinical evidence to back them up. Prenatal education really needs to have a component that addresses woo head on.

    • guest

      Don’t feel embarrassed–it’s easy to buy those arguments because they don’t always sound so clinical, because if they did you would have known to demand more evidence. So very much of the woo they’re selling is emotional/spiritual, and for that you only have your own feelings to rely on. Their arguments center around being natural (sounds better than artificial) and being a good mother (because who wants to be a bad mother?). It’s only when you start unpacking the specifics of these arguments that they sound ridiculous, such as babies not breastfed immediately after birth having trouble bonding.

      • Smoochagator

        It never really occurred to me before, but how do these people “know” that a bottle-fed baby has “trouble bonding?” How do they measure for bonding? They can’t! It’s completely subjective, of course, so they can say whatever they want to about it.

    • Young CC Prof

      When I got pregnant, I was already an avowed skeptic, mildly active in the pro-vaccine and anti-quackery movement. I had NO intention of trusting birth, and I knew that the “benefits” of breastfeeding were primarily the result of confounding variables. I believe I said that I wanted a natural birth, but only in a hospital where I could get immediate help if things went wrong.

      And yet I believed there were too many c-sections, and that avoiding a c-section was a goal to work towards in its own right. I believed induction was harmful and it was usually better just to wait for labor. Why? Because “everyone knows” that. On those matters, there’s almost a single voice from the mainstream media. And when this site and others pushed me to question those assumptions and examine the evidence for myself, I was shocked.

      • Roadstergal

        For me, breastfeeding was the eye-opener this blog gave me. It’s funny, the woman who posted a while back that dolls and toys with bottles would make girls think bottle feeding was normal – I know I had some of those toys as a girl, but the societal pressure around breastfeeding is so high that I just vaguely ‘knew’ it was always 100% better, and I’m grateful to this site for all of the good information it’s given me that’s allowed me to change my mind.

        But when it comes to C-sections – man, even though I was pretty young at the time, when I first I heard about C-sections, I thought it was the most brilliant thing ever. Not being required to force a baby out of your vagina! It sounded so civilized and futuristic (futuristic in the good, Star Trek way). The idea that women are denied requested C-sections in this day just seems so barbaric and inhumane to me.

  • atmtx

    I wish I had seen this before I had my first! We got a doula, who was honestly pretty great. However, she did encourage us to make a birth plan. I was resistant, seeing them as a roadmap to hell, but she was strongly encouraging it and gave us a few samples. I took the least confrontational one and if I didn’t understand the medical reason for something (like delayed clamping), I deleted it. There was also something about managing third stage and avoiding pitocin. I didn’t understand what the benefits/risks were, so I took them off. Mine came down to a few preferences and the whole “experience” actually went to plan. Postpartum, however, was an absolute nightmare. *shudder*

    Then between that child and the second, I had an awakening, found myself here, and read just about everything on this site. I didn’t make a plan, and just rolled with it. That “experience” was AWESOME. I was so, so very happy and much more satisfied with the whole thing. Postpartum was an absolute dream in every respect.

    We had a perfectly healthy, beautiful baby both times, so the outcome was the same in that regard. However, I wonder about people who mourn their first hard birth, where they weren’t “educated” and “informed,” then rave about their second birth that was a homebirth, birth center, midwife, placenta-eating, whatever. They claim the relaxed environment of being home made everything much easier.

    I had an unmedicated hospital birth with the first, then a hospital birth with epidural for the second. The second was worlds easier in every respect. So there goes that favorite trope of theirs, right?

    • The Bofa on the Sofa

      I deleted it. There was also something about managing third stage and avoiding pitocin. I didn’t understand what the benefits/risks were, so I took them off.

      I agree with you here, I would be very leery of a birth plan that is talking about medical care. Let the birth plan focus on things like logistics and environment. Who we want in the room, what music should be playing, what are the lights like around my head, who cuts the cord, things like that.

      “Don’t use pitocin” is talking about medical care that you can’t know whether you will need until you are in it.

      • Trixie

        I wish I would’ve put, “immediately after I deliver, support person will obtain many large sandwiches and a milkshake for the mother.” Man, hospital food at 1 am is terrible!

        • The Bofa on the Sofa

          Does Jimmy Jojhns deliver at that hour?

          • Trixie

            I have no idea what Jimmy Johns is. There was a Sheetz down the road, though.

          • The Bofa on the Sofa

            http://www.jimmyjohns.com

            Their marketing thing is that they deliver so fast, it’s basically before you order

            They are fast, though. They deliver locally on bike, so never deal with traffic.

          • kerlyssa

            I worked at one of those for about two minutes. We had a weird map of where we would deliver, based entirely on how fast we could get there- it was like 3 miles in one direction, and 5 blocks in the other, etc, because of traffic. Looked a bit like a blockey starfish.

          • Trixie

            Well heck, there is one two miles from me. I’ve never heard it mentioned by anyone I know or seen any ads for it.

          • atmtx

            That’s because it’s gross and their bread tastes like glue.

          • Trixie

            Ah, well, that explains a lot!

          • KeeperOfTheBooks

            Oh my gosh. Had a C-section here, and by the time I got out of recovery I was STARVING. Jimmy Johns would have been heaven.

            Actually, a genuine New York pastrami-on-rye would have been Heaven, if we’re gonna be technical, but since New York is 1500 miles away, I’d take JJs.

            *ponders the feasibility of opening a JJs franchise inside my hospital*

        • atmtx

          My hospital had delicious cold cut sandwiches at all hours of the day. With a cookie. It was heaven.

          • Dr Kitty

            My husband, on being told to bring me something nice to eat when he visited at dinner time the day after my CS brough me a packet of plain crackers and a bottle of Evian.

            Let’s just say that by the time I had my appendix out last year, his post operative food offerings had greatly improved, and I got soup from my favourite Thai restaurant.

            The NHS believes that everyone wants cold white toast with low fat spread, strawberry jam and tea after surgery.
            I do not, but I’ll take it over dry crackers and room temperature bottled water!

          • Who?

            I gave birth in an NHS hospital and got the Sunday roast for lunch. It was great.

          • toni

            I think tea and toast is the NHS tradition though. That would have been just the ticket for me (with butter,not marg) but I got pork chops, mash, roast vegetables pecan pie and ice cream. just so much food, I couldn’t manage it. not one of those people that are ravenous after having a baby i guess

          • Who?

            I was starving. From memory they’d put it aside for my husband but he thought better of eating it in front of me at that time. The midwife did tell me I might throw it all back up but there was an emesis basin to hand, which in the end wasn’t needed.

          • Bugsy

            Ooooh, sign me up!

        • moto_librarian

          I woke up in the middle of the night after my pph because the nurse insisted that I needed to use the bathroom. I had not had anything to eat since around 11 am, and nothing to drink since mid-afternoon. I passed out on the toilet, and then started shaking uncontrollably. The CNM on call came in and asked if I was hungry. When I said yes, she brought me a Coke, and I got into the stash of trail mix I had packed for my husband. Nothing had ever tasted better.

        • Cobalt

          I was HUNGRY after delivery each time, and with the baby suddenly on the outside of my ribs I felt like a bottomless pit. Never did manage to deliver during normal eating hours, I had to eat those dinky dry sandwiches and wait for breakfast.

          If I ever have another, I’m putting 2pm delivery in my birth plan, with food preordered.

          • Mishimoo

            Remember to get that notarised!

          • The Bofa on the Sofa

            “Get it notarized” has to become a running punchline here, it really does.

          • Mishimoo

            I am giving serious thought to becoming a Notary Noir (because the idea amuses me), but that’s probably not applicable to childbirth. Though, since Big Pharma IS evil, it might work.

        • Bugsy

          My little boy was born at 8 AM after an all-night labor following 3 months of gestational diabetes. By 9:30 AM, I’d sent my husband to the deli across the street to get a roast beef sandwich on a massive kaiser roll and a can of coke. Yum!!!

      • Adelaide

        There is an ob at our small rural hospital who gives pitocin after every delivery he performs. He gave it to a friend of mine without consent after an uneventful delivery. After her husband noticed the extra bag on her IV, it took threatening to rip her own IV out to get the pitocin stopped. She’s was up all night with painful after birth contractions.

        While I know this is not the norm for most obs, it does make a good argument for specifically asking for no pit unless it is needed.

        Birth plans may be over the top, but there should be a safe, effective way for women to communicate their preferences for medical decisions prior to delivery, and in a way that they know their preferences have been noted.

        • Therese

          It is standard to give pitocin after birth to prevent hemorrhage.

          • Bombshellrisa

            I wonder too if they are being more proactive because they are rural and have less in the way of resources blood bank and surgical team wise.

        • The Bofa on the Sofa

          While I know this is not the norm for most obs, it does make a good argument for specifically asking for no pit unless it is needed.

          “It’s what we know that isn’t so that is the problem.”

        • toni

          I think it’s the norm here to get an injection of pitocin after delivery, it’s any easy way to prevent PPH. I think those after birth ctx happen regardless and I’d be worried if I didnt get them tbh

          • Cobalt

            It was the standard at the hospital where I delivered my first. No one told me that, though. The nurse came up to my IV line with a needle full of I-didn’t-know-what and was about to inject it without saying anything. I was scared and angry about that. A lot. I was also totally fine with getting meds to prevent hemorrhage, but it felt like they were sneaking up on me. It didn’t help that that same nurse had already freaked me out a bunch of times.

          • Ash

            It seems like only in obstetrics that patients expect to be told every single medication that’s given while an inpatient. I’m not trying to discount the patient’s right to know what medications and procedures are given, but for example, if someone is undergoing orthopedic surgery or most other procedures, there is not an explanation of exactly which medication is given, the dosage, and the exact class.
            “We are giving you Cefazolin as standard of care for infection prophylaxis”
            “We are hanging a bag of crystalloid”
            “We are giving you fentanyl, which is an opioid, and midazolam, a benzodiazapine in preparation for your nerve block”
            It would be endless.
            And it seems like most patients are perfectly OK with this. In many hospital situations, the staff would have to talk pretty much endlessly to explain each and every medication given while someone is in the hospital and I don’t think it’d improve patient understanding of their medical care or patient satisfaction if every single medication required a thorough explanation and patient consent.

            Is it really so bad that the clinical staff has standard of care for preventing postpartum hemorrhage?

          • toni

            that’s interesting. i’ve been hospitalised a lot and, in western hospitals (and singapore hosptials) at least it’s very rare for someone to have come into my room and just given me something without saying what it was and what is was for. I think it’s only polite to keep the patient informed. I’ve learnt quite a lot from nurses just from them explaining how different medicines work. The only exception is when I’ve been asleep or half asleep and not up to having a conversation

          • Ash

            I agree that when entering a room, the heatlhcare provider should identify themselves and their purpose (giving medicine, etc). I question whether it’s necessary to require consent for standard of care medications for prevention fo postpartum hemorrhage. My other question is, why was your friend set up to think that a Pitocin infusion is a bad thing? For example, patients might have a plan for their family member to be present in the waiting room and informed of surgical updates, but do any surgical patients walk in and have a plan saying “No prophylactic antibiotics?” This would not happen if people were not set up to think that Pitocin is inherently bad! Why should a birth plan say “No pitocin”?

            Pain should be controlled–the patient has every right to page the nurse and say “I’m having a lot of pain right now, what can be done?” Pain management can be addressed without having a plan ahead of time to reject certain things.

          • toni

            I don’t know about Adelaide’s friend but I’ve heard objections to it that really just amount to ‘it’s not natural’ and ‘why interfere before there’s a problem?’ as far as I know though there aren’t any risks to it(?) and all it does is stop the bleeding faster. No downsides. Just looked at NCT website and they claim an upside to a physiological third stage is that you can do delayed cord clamping whereas when oxytocin is used you have to clamp immediately

          • Young CC Prof

            As I’ve said several times, trying to avoid a c-section is not unreasonable, there are legitimate down sides. (The lengths a few people go to are a little nuts, but that’s beside the point.)

            Pursuing physiological third stage is impressively crazy.

          • toni

            The NHS are pretty encouraging of ‘physiological’ third stage though. All the literature I’ve read presents active management and no active management as two equally valid options. But they also don’t screen for GBS and won’t induce you before 42 weeks so..

          • Elaine

            I had delayed cord clamping and then pitocin afterwards. *headscratch*.

          • Young CC Prof

            Um, I have multiple drug allergies. I do want to be told every time I’m given something, assuming I’m awake enough to converse and there isn’t an emergency going on. I don’t need the whole package insert, just, “OK, this is your pain medication.”

          • toni

            that’s a thought. there are sometimes miscommunications about drug allergies/contraindications. Telling the patient what they’re getting could help avoid a disaster

          • EastCoaster

            I also expect to be told everything. The last time I was in the hospital (not for birth), I asked about everything in the IV and everything I took orally.

            I’m not a jerk about it at all, but I have a good medical background and want to know. Including dose. And I don’t just swallow random pills. None of the nurses I encountered had any problem with my “hey, what is this?” and one even sat with me for a minute while she looked up potential side effects.

          • Mishimoo

            Exactly! The last time I was in A&E, I made sure that they knew about my allergies and what reactions I have. After being given paracetamol and ibuprofen, even though it was logged, I still answered the questions about what I’d been given, the dosage, and when. Thanks to my allergies, I ended up under observation while trialling aspirin and oxycodone in an attempt to get on top of my pain levels. The only time a nurse looked at me funny was when I refused fentanyl on the grounds that I’d rather deal with the pain than the risk. (I am not ashamed to admit that it scares the hell out of me and I’d rather leave it as an absolute last resort).

          • Sue

            Mishimoo – allergies and adverse reactions should be obsessively documented to minimise risk – this is correct practice.

            It’s quite different to refusing a standard medication because you, personally, don’t think it is standard-of-care. (Like pitocin to minimise PPH)

          • Cobalt

            When I had surgery (just once, urgent, while lactating, and under general, so really small sample) they did a drug allergy check and offered to go over all the meds with me. It had also already argued against narcotics when obviously in extreme pain, so they knew I was weird about drugs, too.

            When I had my babies, the only medication I’ve had during delivery was the 3rd stage pitocin, and had no prior knowledge of any standard use of it. For that particular delivery, I had had that same nurse take away my contact lenses (so I was nearly blind), and then she repeatedly offered me narcotics (I don’t do narcotics, the loss of self and addiction risk terrifies me) after I said I didn’t want them or an epidural. She also criticized my pushing efforts and told my friend I probably couldn’t get my baby out. According to her, I didn’t even put my hospital gown on right. By the time the baby was out, I was so distrustful of her that I was honestly afraid she had a shot of morphine or something. Once another nurse told me what it was, and what it was for, I was totally fine with it. For subsequent babies I expected it, for the last one, when the placenta was taking it’s time, I asked for it.

            And yes, walking up to a conscious, aware, immediately postpartum woman planning to inject them with an unknown and unexpected medication is wrong. The non-emergency standard of care can include “I want to give you a hormone injection to prevent hemorrhage.”

          • Elaine

            I hate people just coming at me with something and wanting to administer it. I don’t think it’s so hard to (my preference) ask me or at least tell me what they are doing. It takes five seconds. Maybe there are some scenarios where the patient isn’t being briefed on what everything is that they are receiving (like when they are under general anesthetic, unconscious, during a code, etc.), but in general, it doesn’t take that long to tell them and they should be told. I too got the attempt to hook up the pitocin without saying anything, and that bugged me too.

          • Who?

            Maybe it’s around pregnant and delivering women (all being well) not being sick. If I go to the doctor and get a jab, even if it wasn’t one I was expecting when I walked in, I’m told what it is. When medication is prescribed, the doc and pharmacist talk me through it.

            Even if you are actually sick it’s nice to be told if you’re going to be jabbed, or if whatever is going into your drip is being changed or updated. Just one human to another.

            In an emergency-whether I recognise it as such or not-feel free to jab away though. You can tell me about it later.

          • jenny

            “Hi, I’m here to give you your lovenox, that is to prevent clots from forming in your legs after surgery.” Doesn’t add that much time onto the process and increases safety.

          • Young CC Prof

            Exactly. I like to know for three reasons:

            1) Pure intellectual curiosity

            2) Although I trust my medical providers to know more than me, mistakes can happen, and I can be one last line of defense against errors.

            3) I expect to leave the hospital relatively soon, at which point I will be responsible for my own health again, and knowing exactly what was done to me in the hospital may be useful.

          • toni

            my nurse injected it into the cannula in my hand. she said ‘this is to help get the placenta out’ and then paused for me to say something. I was like ‘yes, fine go ahead’. I already knew about that procedure and wanted it. I’ve said before that I think they should give you a leaflet describing all the common interventions at one of the prenatal appointments so we’re not taken so much by surprise by things like amnio hooks, fetal scalp thingies, perineal stretching/massage etc. there isn’t time to go over every possible eventuality/equipment used at your appointments. maybe they do distribute that information at other ob practices but not mine. when i’ve had surgeries I usually got an info sheet explaining what they would do to me pre-surgery and after waking up so there are no surprises.

        • fiftyfifty1

          Pitocin has an extremely short half life. As in if you stop the IV, the effects of the pit are *completely* gone within minutes. The fact that she blames being “up all night with painful after birth contractions” on the IV pit shows how completely ignorant of biology and physiology she is.

        • Sue

          When you agree to have your medical care in a certain facility, with particular clinicians, how much should you dictate what care system they use or what policies they follow?

          Shouldn’t the team use their standard operating procedure, unless there is a contraindication? That’s generally the safest way.

          Picking and choosing what you will ”consent” to, in the absence of the clinical knowledge, is potentially very hazardous, not to mention hubristic. By all means ask why certain things are done, but to forcefully REFUSE?

        • Samantha06

          I agree with Sue’s post. Did your friend discuss her preferences with her OB prior to delivery? It’s ridiculous and adversarial to “threaten to rip out her own IV” because of something the OB deemed necessary. And what would have happened if she’d had a PPH after she “demanded” the oxytocin be stopped? Would she have refused the oxytocin or any other intervention for that matter, to treat a PPH? Because it’s far worse to have to treat it after the fact, than try to prevent it in the first place. It doesn’t sound like your friend knew what she was talking about. Furthermore, I doubt the after-pains were caused by the IV oxytocin as once it’s stopped, it’s out of the system in minutes.

        • Who?

          I read ‘small rural hospital’ and wonder whether this is what gives rise to this practice, if that’s what it is.

          So it would be good for the doc to know there’s a concern, so he can explain his rationale, which may well be about risk mitigation in those circumstances. He’s the one getting sued if someone has a PPH go badly and there are insufficient staff and facilities to deal with it.

        • birthbuddy

          “up all night with painful after birth contractions” sounds like exaggerated nonsense to me.

          • jenny

            IDK. I couldn’t fall asleep after my third child was born until I got some percocet….which didn’t come until almost 5 am! The afterpains were a bitch and they do get worse with every baby. But they have nothing to do with pitocin; just the normal process of the uterus involuting.

    • just me

      I sort of never got around to making a birth plan. Which wouldn’t have mattered seeing how things turned out (2 inductions, babies fine). But really my plan would have been only “have healthy baby.”

      Ha, my somewhat naive and young niece was against pitocin, etc, then broke her waters 2 wks early doing something stupid, failed to go into labor despite pitocin and had a c-section. Then for her 2nd my mil was talking about when the baby was due and I was like “don’t they have a date-isn’t she having a c-section?” Mil: “no, she’s having a *natural* birth”. Me: disgusted silence. Why take the risk? Thankfully everyone was fine, but I’m sure part of it had to do with my niece wanting to feel superior (her FB (I stopped reading a while ago) was full of posts of her bragging about how much she was exercising with a new baby (the 1st)– well, yeah, nice that you don’t work and have tons of people to help out while you train for marathons, etc.)

      • toni

        Is there some medical reason why you dont think she should have tried for a VBAC? Why were you disgusted? Your post came across a wee bit mean spirited

        • just me

          Sorry, I just don’t think it’s worth the risk. Uterus rupture, death, etc.

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          • toni

            Fair enough that you wouldn’t choose a VBAC for yourself but many many mainstream obstetricians recommend a TOL for their patients these days so no need to be disgusted with your niece unless she chose it against medical advice

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      • fiftyfifty1

        What sort of stupid thing can a person do to break their own waters? ‘Cause from my personal experience working L&D it ain’t that easy, even when that is your goal. You have to get the hook tool all the way up there and then get it into the cervical opening (which is not actually easy if it is not already dilated 4+ cm), and then you have to manage to actually hook that slippery old bag. Now granted, I’m an FP not and OB who has done it hundreds of times, but still, she was able to break her own bag?!

        • KarenJJ

          I don’t know about someone breaking their own waters, but with my eldest I was in labour and spent most of the day on the fitball and decided to lie down to try something different. During the first contraction after I lay down my baby also did a huge kick of sorts and I felt my waters pop.

          I still maintain that she kicked her way out.

        • just me

          Was trying to leave that out in the rare event she might read this, but: cartwheel.

          • fiftyfifty1

            naw, coincidence.

          • toni

            I imagine that was a coincidence as well. as long as you are agile and don’t fall I think a cartwheel is fine. They are very well cushioned in there. My doctor told me I could do pretty much anything I was able to do pre-pregnancy (except horse riding) and to be sure not to exhaust myself or overheat.

    • Sue

      What you get from each professional you choose is basically what they are selling. And what they are ABLE to sell.

      A HBMW will try to sell you a HB
      A doula will try to sell you things a doula can do
      A hospital CNM can offer you a hospital-based birth with certain drugs and referral to anesthesiologist or OB if required
      An OB can offer you a hospital-based birth with or without any of the possible interventions, referral to anesthesiologist and Cesarean delivery if required.

  • Jans

    Another marketing tactic is to only publish positive stories and “customer testimonials”. Negative feedback is censored and deleted. No relation to snake oil here!

    In fact that’s how I discovered Dr. Amy’s website recently. I was looking for birth stories trying to get a sense of what having a baby might be like. For some reason all the hospital birth stories seemed pretty balanced in terms of women reporting things going smoothly vs. saying well I had this issue crop up but it was treated with this procedure, and it wasn’t fun but everyone is now home and healthy. Contrast this with homebirth stories that were ALL describing wonderful perfect experiences with zero stories mentioning complications to mom or baby. So this seemed puzzling enough to google “homebirth complications” and up popped Skeptical OB. I didn’t even know NCB was a *thing* until I ran across this site.

    • The Bofa on the Sofa

      It’s your first post (on Discus). Welcome!!!!

      • Jans

        Thanks! It could be my last for a while too. Baby is due any day now 🙂

        • Dr Kitty

          Rest up, and enjoy your last few days of baby-free life.
          Best wishes for a healthy baby and a short, easy birth!

        • Cobalt

          Best wishes for a safe and easy delivery and postpartum!

  • fiftyfifty1

    “These included assuming that women would rather be unconscious for their births”
    Yes they shouldn’t have assumed. They should have asked. Medicine then (all areas of medicine, and actually society in general) was too paternalistic then.
    Many women DID want relief from labor, however. I know my grandmother did. Twilight sleep was a very imperfect form of relief and had a number of downsides. But it was the best that was available at the time. Women fought to have it available.

    • Sarah

      I wish I could still get it now!

    • Roadstergal

      It’s been a long time since I read The First Four Years, but I do remember that when Laura was ready to deliver Rose, she was in so much pain that when the doctor gave her anesthesia to knock her out, it was nothing but relief.

      • Roadstergal

        “She was being borne away on a wave of pain. A gust of cold, fresh air brought her back and she saw a tall man drop his snowy overcoat by the door and come toward her in the lamplight.

        She vaguely felt a cloth touch her face and smelled a keen odor. Then she drifted away into a blessed darkness where there was no pain.”

        Laura (nineteen) wakes up with an eight-pound girl next to her.

        • The Bofa on the Sofa

          The First Four Years just so did not have the writing charm of the rest of the series. I know Rose tried, and the material was tough, but it just never worked.

          • moto_librarian

            I thought the First Four Years was never intended to be published? Also, there is a prevailing thought that Rose was the actual author of all of the Little House Books.

          • The Bofa on the Sofa

            I wouldn’t have been surprised if Laura had started putting it together and deciding that it wasn’t going to work. At least, that would be consistent with the fact that it doesn’t.

            I have a hard time believing the “Rose wrote it all” view. For example, we know Rose wrote TFFY, right? It just reads so different from the other books that it is best explained by a different author.

          • moto_librarian

            Yeah, I’m not convinced that Rose wrote the books, but current scholarship makes a decent case for it. I loved the Little House books so much, so it’s hard for me to think about anyone other than Laura being the real author.

            I have read a journal of the voyage to the Ozarks that Laura kept. The tone of that journal is more similar to The First Four Years. Personally, that makes it more believable that Laura wrote it, but never got it into publishable shape.

          • fiftyfifty1

            Oh but now there is even newer scholarship that said Laura did write it all and that Rose had less to do with it than thought.

            Sheesh, it’s getting to be like Shakespeare.

          • Roadstergal

            It was definitely different in tone, but there were some aspects of it that I liked. It felt more _real_, in some ways.

            I re-visted the books a few years ago, and had to stop before I got through them all… the corporal punishment, the easy racism – it’s definitely different for me to read now.

          • AlisonCummins

            I didn’t mind the accounts of racism — it was never endorsed, just observed.

            I’d much rather have an honest portrayal of how people at that time and place thought and behaved than a whitewashed version where all the white people were fair, respectful and open-minded. Racism is and was a real thing.

          • The Bofa on the Sofa

            Oh, I don’t know, Ma was certainly racist (against Indians). Pa, outside of his blackface appearance, was far more accepting of people as they were.

            Although I do agree, they are a reflection of their times, and there isn’t much wrong with that.

          • Roadstergal

            I’d never pretend that racism and child-beating weren’t real things. But it does disrupt my enjoyment of a childhood treasure to stumble over depictions of them that do come across as endorsement to me. JIMO, I can well see people who aren’t-me still enjoying them. 🙂

          • AlisonCummins

            Oh yes, certainly jarring, even when I was a child! Absolutely.

          • AlisonCummins

            Rose rewrote the rest of the series putting her personal libertarian spin on it. For instance, Rose had Laura working to send Mary away to college. In reality, she got a grant from the state.

            The First Four Years was just Laura.

    • Trixie

      My grandma labored all the way through, and then got knocked out for pushing. She had all the pain without the joy of seeing her babies right away.

    • KeeperOfTheBooks

      Indeed. My husband is something of an amateur historian, and pre-DD, a lot of his knowledge of childbirth was based on writings from the Victorian period. When I was deepest into the NCB woo, he respected my decisions but also pointed out that there was a *reason* that Queen Victoria wrote to one of her daughters about how awesome the anesthesia (perhaps twilight sleep? Ether? Something like that?) was at the time, and that it’s the reason she and Albert had as many kids as they did. I believe she even said she would have insisted on stopping after they got an heir if she COULDN’T have access to anesthesia. I’m sure it was imperfect, but it was probably also a heck of a lot better than nothing.

  • Zoey

    Thanks for this post. Reading this now, I’m kind of embarrassed that I fell for this marketing hook, line and sinker when I was pregnant with my first.

    The one marketing tactic that really got me was flattery. The whole idea that I was one of those “educated” moms that didn’t blindly follow what my OB said and “did my own research.” It’s laughable how ignorant I was then, but so confident in my “research” and my choices.

    In some ways I’m glad that my carefully dictated birth plan didn’t pan out because if I had an easy, natural birth I wonder if I would still be as arrogantly ignorant as I was then. I’d hope not, but who knows?

    • The Bofa on the Sofa

      The one marketing tactic that really got me was flattery. The whole idea that I was one of those “educated” moms that didn’t blindly follow what my OB said and “did my own research.”

      Yeah, it’s easy to fall for the flattery, but I have to ask, did you ever turn that around and think, “That means those people I know who did follow their OB were stupid”? Or did you just not think about those implications?

      • Zoey

        You know, I did actually believe for awhile that my friends that did follow their OB’s advice were stupid. Or at the very least, not as educated as me. That, in similar circumstances, I would make different decisions and my outcome would be different.
        Ironically, I ended up having very much the same experience as a friend that I had thought of as uneducated and the cognitive dissonance was hard for a few months afterwards. “But…but…I was educated! How could this happen to me?”

        • The Bofa on the Sofa

          You know, I did actually believe for awhile that my friends that did follow their OB’s advice were stupid.

          So to follow up on that, how did you rationalize that with your other encounters with them? Did you think they were stupid only in this respect, or was a general property all the way across?

          You never said to yourself, “I’ve never thought they were dumb, how can they miss this?”

          Thanks for responding, this is an aspect that always fascinates me. When I find myself at odds with others, and people who I normally think are reasonable, MY response is to question myself more. Maybe it’s my insecurities that others don’t have.

          Which I think would be a surprise to a lot of people here, that I have insecurities about whether I’m right or not? Then again, there is a difference. If it’s something I’ve done, I’m far more to accept it. I know about the risks of childbirth compared to the risks of drunk driving because I “did the research,” And real research, in the light of “created new information,” and not just “looked it up on-line.”

          • Zoey

            In my case, I knew my friends weren’t stupid people. They were university educated, successful, intelligent.

            But NCB ideology tells you that there is a big medical establishment conspiracy to suppress “the truth” about the obstetric model of childbirth and justify unnecessary interventions. Maybe stupid isn’t the right idea here, it’s more like they just haven’t learned “the truth” yet.
            And I think I didn’t really spend a lot of time questioning while I was still pregnant. There just wasn’t time. It was maybe 8 weeks from when I discovered “the truth” to when I had my son, and I was busy during that time hiring my doula, and writing my birth affirmations, and reading up on birth interventions to add to my birth plan. Plus regular life stuff like work etc. It was mostly afterwards when my ideology couldn’t reconcile with my experience that I started actually questioning things.

          • The Bofa on the Sofa

            Ah, so you went with the “they just don’t see through the conspiracy” approach. Another follow-up (I hope you don’t mind, this is fascinating): are you normally one to follow conspiracies? Or was it just this one? (presumably a result of the flattery, I would figure).

          • Sue

            Similar dynamics happen in anti-vax land.

            Many anti-vaxers are the parents of children with developmental and/or behavioural issues, who desperately clutch at an external locus of blame (vaccines, the medical establishment, Big Pharma, the ebil Gummint) in order to cope.

            The shysters take advantage of their vulnerability and play to their fragile egos by allowing them to portray their rebellion as heroism.

          • KarenJJ

            It’s a lot easier to fall for knowledge outside the medical profession when you are not getting answers from the medical profession.

          • The Bofa on the Sofa

            Yep, people would rather hear lies from fools than the truth from experts.

          • Life Tip

            I know you were directing this question to Zoey in particular, but personally I think I kinda felt that I had found the information but other women perhaps weren’t looking hard enough for information to “educate themselves” or perhaps they weren’t trying. I never really got too deep in the woo. At least, I wasn’t deep enough to hesitate at all for the c-section, but I was influenced enough by what I had read to beat myself up for not breastfeeding/skin to skin right away or not wanting to room in. Which is sort of funny now I guess. All that information that made me feel superior or special for a month or two (based on nothing) actually made me feel really bad about myself (also based on nothing). Fair play, I guess. Luckily I only started falling down the woo-hole during the last month or two of my first pregnancy, and I came to my senses shortly after my son was born. Not long enough to make too much of an ass of myself.

          • The Bofa on the Sofa

            I think I kinda felt that I had found the information but other women perhaps weren’t looking hard enough for information to “educate themselves” or perhaps they weren’t trying.

            And how did you justify the different views of the doctors? Did you think they didn’t know the information, or was that a conspiracy to suppress it (as with Zoey)?

          • Life Tip

            I didn’t get too caught up in the pregnancy/homebirth woo. My downfall was more AP/breastfeeding immediately/skin to skin/co-sleeping. So I wasn’t really adversarial with my OB. If I mentioned those things to her, she just sorta smiled/nodded and said I could do those things as long as everything was fine. So I felt she was on board with my choices (although looking back it was probably just humoring the patient).

            I was just annoying enough to think I was better than other pregnant/new moms, not that I was actually better than my doctor. Yay?

    • Sue

      ”The one marketing tactic that really got me was flattery. The whole idea that I was one of those “educated” moms that didn’t blindly follow what my OB”

      Zoey – this is SO insightful. The way many non-science-based ”therapists” work is by getting you to feel that you are an independent thinker because you are rejecting orthodoxy, or the Big Medical Industrial Complex. What these people substitute, however, is directed simplistic advice. Much more paternalistic than the orthodoxy, but in the guise of rebellion. It’s very seductive.

  • mikerbiker

    Thanks for this article- It seems even Emily Yoffe endorses the “comfortable environment” of homebirth while rightly chastizing the anti-vax midwives her letter writer hired. http://www.slate.com/articles/life/dear_prudence/2014/11/dear_prudence_our_midwives_are_anti_vaccination_activists_should_we_fire.html

    • fiftyfifty1

      I didn’t read it as her endorsing the comfortable environment of homebirth so much as her telling the couple that since *they* had said that they chose homebirth out of concerns about comfort, that they should dump the midwives because they were clearly no longer comfortable with them.

      • mikerbiker

        Thanks for your comment- perhaps you’re right.

        • fiftyfifty1

          I hope I am. It would be sad if Prudie were actually a crazy NCB groupie.

  • Briar

    This article is great. I have to agree fully, as I am a pregnant woman, FTM, and the woo-squad has been trying to recruit me for months. This blog post is verbatim whoat I have seen and experienced. Luckily I am smart enough to see their bull for what it is and ignore them.