Improving Birth.org offers twelve signs you can trust your provider is emotionally manipulating you

The Little Engine That Could

Improving Birth.org Vice-President Christen Pascucci offers twelve helpful signs that your provider is emotionally manipulating you.

Of course she didn’t call it that. She called it Twelve Signs You Can Trust Your Provider.

Who is Christen Pascucci and how is she qualified to write about choosing safe, competent providers?

Duh! She’s a mother and a baby transited her vagina! That makes her qualified to opine on any aspect of obstetric care.

Before we review Pascucci’s Signs, lets step back for a minute and consider why you hire an obstetric provider in the first place. As I have written many times in the past, anyone can deliver a baby if there are not going to be complications. All you have to do is hold out your hands and make sure the baby doesn’t hit the floor. Dads, policemen and taxi drivers do it on a regular basis.

The reason to choose a professional provider is because childbirth is inherently dangerous and many complications do not announce themselves until they occur during the process of birth. You choose a provider to prevent, diagnose and manage complications, limiting the possibility of severe injury or death of the baby or mother.

What should you consider when determining if a provider is qualified to provide safe, high quality, evidence based care?

  • Education – In the case of an obstetrician, that means four years of college and four years of medical school. In the case of a midwife (and following the requirements for midwives in ALL first world countries besides the US) that means a college or master’s level degree in midwifery
  • Training – In the case of an obstetrician that means four years of additional training beyond medical school. In the case of a midwife, that means years of in hospital training preventing, diagnosing and managing complications
  • Credentials – For obstetricians, an MD and, preferably, certification by the American Board of Obstetrics and Gynecology; in the case of a midwife that means a certified nurse-midwife (CNM).
  • Ability and commitment to keep up with the obstetric literature on a monthly basis. New discoveries are being made every day and knowledge is constantly advancing. You cannot trust a provider who doesn’t personally read and analyze the major obstetric journals.

One of the ways that you can tell that Improving Birth.org is substituting emotional manipulation for qualifications is that their list of twelve DOESN’T include education, training, credentials or fluency in the obstetric literature. That’s hardly surprising when you consider that the folks at Improving Birth.org think that a vaginal birth qualifies you to provide medical advice to pregnant women; it’s obvious that they have no standards at all.

What does Pascucci in her infinite experience and wisdom consider to be important? Gems like these:

Your provider recognizes that you are the one delivering the baby. Sounds funny, doesn’t it? The truth is, women are the ones doing the heavy lifting in childbirth and care should be centered around them.

And:

Your birth feels like a special event and not a drive-through service.

Or how about this?

Your provider uses language like, “We encourage you to…” and “We support you in…” —not “You’re not allowed” or “We will let you.”

And who can forget this?

Your provider believes in you, with a focus on wellness–what you can do, not what you can’t do.

Earth to Christen! Earth to Christen! These are not signs that you can trust your provider. These are signs that your provider is emotionally manipulating you, often in an effort to divert attention from the fact that she lacks the education, training, credentials and familiarity with the scientific literature to provide safe, competent care, protecting your health and life and your baby’s health and life.

Instead, Pascucci claims:

If a provider is great at what they do, they understand that women are strong and capable. You are no exception.

Improving Birth.org apparently imagines that women are children who must be chivvied along by fulsome and entirely meaningless praise, ignorant enough and emotionally needy enough to be fobbed off with the obstetric version of the children’s book The Little Engine Who Could.

I suppose if you are a woman who imagines that the depth and breadth of obstetric care is best captured by “I think you can … I think you can …” you will be impressed by this. For women who are mature enough and educated enough to understand that professional training and credentials matter more than atmospherics you will recognize this for what it is:

It’s not a list of signs you can trust your provider. It’s a list of signs that your provider is substituting emotional manipulation for competence and praying you won’t notice the difference.

Hopefully women won’t fall for it.

  • Charybdis

    “I will be choosing homebirth if I ever chose to deliver children, and it
    is because I do not mind any increased risks or mortality rates… It is most important to me to feel rape-free.”

    Have you ever BEEN raped? It is a singularly unpleasant experience and there are no words to really describe the experience. You have NO control over what is happening and are just trying to survive the experience. I think using “rape” as a descriptor for any situation where you have little to no control over what is happening and any choices presented are ones you personally do not like, but are still choices nonetheless (you need to have the baby’s heart rate monitored, you can have the monitor strapped to your belly or we have a wireless version so you don’t have to be restricted to the bed, when you EXPRESSLY STATED you wanted NO MONITORING in your “birth plan”) is a poor choice of a metaphor. Rape is a crime of violence and control, childbirth is not. If “rape” is the best comparison you can make because it involves the same body parts (genital region, anal region, vagina and cervix) and things being inserted in the vagina (hand for cervical check, checking engagement, perhaps attaching a fetal scalp monitor), you need to reframe that thinking. It is rather insulting and insensitive to those who HAVE been raped.

    It is like someone with a bad tension headache stating that they have an awful migraine. It is not the same damn thing at all. Migraines are a result of a neuro glitch. It is related to epilepsy. It often presents as crippling, incapacitating head pain, complete with nausea, vomiting, sensitivity to light and sound and involves a prodrome and postrdrome stage. Some migraine attacks don’t have the head pain. Can a bad tension headache hurt? You bet your ass it can . Is it the same thing as a migraine? No, it is not. But people often say “I’ve got a migraine” when they mean they have a bad headache. So the whole ‘birth rape’ thing is NOT the same thing as actually being raped. The results (feeling out of control, feeling like you are not being listened to, maybe not understanding why something is being done) may be similar, but the cause is not the same.

    Thinking positive and being “sure” that you are going to sail through a home birth with a substandard “care provider” because you “trust your body and trust birth” is not a good, rational-type decision. If you value YOUR EXPERIENCE over the safety of your child who you have no doubt gone out of your way to gestate thoughtfully, lovingly and with a lot of positive visualization and organic eating, then your priorities are a bit skewed.

    If you meet the criteria of a healthy, low-risk pregnancy and have a CNM that will do a home birth or a second-best “birth center” birth, then by all means, knock yourself out. Lay in your tub, take showers, bounce on the birthing ball, walk, change position all you want. Hell, do Tae-Bo if you want to. Massage your perineum with oil, light your candles, play your music, have your snacks, whatever. Most likely, if you meet the low-risk criteria, your birth will probably go well and you will have your warm, fuzzy homebirth experience that you covet so much. But if a problem arises, and they DO arise, no matter how much you “trust your body and birth”, things need to happen very quickly, as the time window for the best outcome is only minutes long. Minutes, maybe seconds long, not hours or days.

    What I have always wondered is this: if you (general you, not specifically YOU) have such disdain for hospital birth and medical interventions, why do you then insist on going to the hospital when things go awry? Then you are virtually GUARANTEED medical interventions: an emergency c-section, NICU for the baby, IV’s, medications to cause the uterus to clamp down, possibly manual removal of the placenta (hand on the uterine side of the cervix), all the things you were SURE you would avoid by staying at home and “trusting your body and birth”. Because, you know, some babies aren’t meant to survive. But it always happens to “someone else, not me. It can’t happen to me”. Until it does, then what?

  • IndieThinker

    “Duh! She’s a mother and a baby transited her vagina! That makes her qualified to opine on any aspect of obstetric care.”

    I am sorry to say, but I find this does not advocate patient empowerment. I also suspect this derives from sexist thoughts that you do not believe a woman can be active in her health. Of course, all of us women are qualified to opine on some aspects of obstetric care. I do not see many “medical” studies from you friendly OBGYNs, for instance, on why some women feel violated after hospital birth. It has coined a term known as “birth rape”. If you OBGYNs were sincere about “caring” for women, you would also take into account her viewpoints on some of your male-invented “exams” that some women construe as being rape-like (such as episiotomies, penetrative vaginal “exams”, etc). Stress, PTSD, anxiety, anger, etc. are all also related to our health as women. And the patient is more qualified to opine her opinion on how she feels about obstetric care than any of you obstetrical staff could.

    Personally, I have always been very feministic in my thinking, and know that means that not everything can be controlled for women in such a cookie-cutter fashion. I will be choosing homebirth if I ever chose to deliver children, and it is because I do not mind any increased risks or mortality rates (although I am skeptical of your skepticism on that). It is most important to me to feel rape-free.

    “All you have to do is hold out your hands and make sure the baby doesn’t hit the floor. Dads, policemen and taxi drivers do it on a regular basis.”

    This reeks of sexism and homophobia. Let us also include Moms and police women.

    • Stephanie Siller Smith

      “I will be choosing homebirth if I ever chose to deliver children, and it is because I do not mind any increased risks or mortality rates” Spoken like a true home birther.

    • Daleth

      I will be choosing homebirth if I ever chose to deliver children, and it
      is because I do not mind any increased risks or mortality rates… It is most important to me to feel rape-free.

      Wow. This kind of takes my breath away. You “don’t mind” that your child might die, as long as you don’t have to have a nurse checking your cervix? Is that really what you mean? You “don’t mind” your baby dying as long as you don’t have to experience a few minutes of emotional trauma? Really?

      Just as a tip, if you choose a cesarean delivery you won’t get any vaginal exams or episiotomies and you also won’t run any risk of perineal tearing. As an added bonus, your baby won’t run any of the potentially deadly risks of vaginal birth (cord compression, etc.). I’m mentioning this because I know that some rape survivors have chosen c-sections for precisely that reason. It is a perfect solution, IMHO, because in addition to sparing the mother any trauma, it’s actually safer for the baby than a vaginal delivery.

      • Hilary

        “if you choose a cesarean delivery you won’t get any vaginal exams”

        Not necessarily true … I had a planned (medically indicated) cesarean but went into preterm labor. I had nurses checking to see how dilated I was every hour or two, trying to keep me in labor as long as possible before they HAD to do the section. The reality is that once you get pregnant, a lot of things are out of your control, whether you’re in a hospital or not. It’s impossible to say what will or won’t happen.

        In response to the person above, I felt traumatized by the experience of labor and birth but not for one second do I blame the wonderful nurses and doctors who delivered my son. The trauma was from the complications of his birth, NOT the interventions that resulted in his and my survival.

    • Fallow

      Can decide why you are so nonchalant about your future child’s possible death. Is it just because you have never had a child, and have no clue that a real parent would do anything to spare their child pain, let alone a slow suffering death? Maybe you think it’s a game?

      Or do you not care, because you’re a sociopath? It’s certainly not because you’re a “feminist”. That’s just a non-sequitor.

      I’m a survivor of multiple sexual assaults, and I chose the cervical exams and crowd of doctors and nurses all staring at my vagina, over any chance my child would die a preventable death with a high-school graduate birth attendant. Not everyone who’s been sexually assaulted prioritizes their PTSD (which I do have) over their child’s life. Part of being a parent is elevating your child’s basic needs over your own comfort.

    • Erin

      I equate birth with rape not because the Doctors did bad things to me whilst trying to save my life and that of my son but because I managed to relive actually being raped. It’s weird but vaginal exams don’t bother me in the slightest, Adam’s apples, sweat, not being able to breathe and hands in my hair get me every time though. Yes, Doctors (and Midwives) can make it worse.. hell.. being told that I “shouldn’t have got pregnant with unresolved issues” didn’t help but it’s not the same thing. Was I in control during my section, of course not, but I wouldn’t be in control if my appendix ruptured either and no one tends to tell those Doctors that they are chauvinistic bullies intent on raping women and ruining their lives.
      (Off to discuss what actually happened when my son made his entrance versus what my mind decided to re-play with the hospital on Wednesday and am absolutely terrified).

      • Dr Kitty

        Erin, best of luck and good wishes for Wednesday. Hope you have someone going with you who can take care of you before, during and after.
        Don’t be afraid to call time on the meeting and ask to continue it in a less overwhelming medium (email, phone) if it gets too much.

        • Erin

          Thanks. Going on my own but my husband has promised lots of hugs, broad shoulders to cry on and said I can buy all of Waterstones if I feel like it when finished. They offered to come to me or a neutral location but stupid stubborn me was “no, I’ll come to you… I’m not scared of a hospital”. Planning on treating myself should I not melt down in the carpark 🙂

          Plus it’s a measure of progress, because it’s something I just couldn’t have done a few months ago (assuming of course I manage on Wednesday).

          • The Computer Ate My Nym

            Best of luck to you! Treat yourself even if you do have a meltdown in the carpark! You are being incredibly brave facing this. If you find that you just can’t, call them back and say that you do need a neutral location. The hospital is clearly willing to work with you on what happened and if the people on the case are any good at all they’ll understand that this is not easy for you and that you may need to change things.

    • Who?

      Isn’t the issue though that how an individual feels about obstetric care has nothing to do with the cold hard facts of obstetric care. Those facts are that you, or your baby, are far more likely to wind up dead or permanently damaged if you choose home birth.

      In the suffering competition between the risk of ‘feeling’ raped, and of knowing that someone died or was permanently damaged because of a choice you made, which suffering would you pick?

    • toni

      Right… if your child dies at a homebirth you’ll hold their cold, limp body and think “well at least I never had to have a cervical check!”
      No.

  • Amazed

    It may surprise you to hear that the complaint system is similarly dysfunctional or absent for women who receive hospital care….The “healthy baby” comment is, I think, universally reviled by anyone who knows what they’re talking about.

    And this, my dear friends, is what said Pascucci had to say on Danielle Yeager’s page.

    Because Danielle looks like a kind person who won’t snap at anyone out of fear of offending someone’s feelings, her page is gathering more and more bitches around there.

    I really, really appreciate this site, Dr Amy… Don’t change the tone, EVER!

    • Amy Tuteur, MD

      Leaving a comment like that on In Light of Gavin Michael is pretty obnoxious, especially since Pascucci has no idea what she is talking about. I left a comment for her.

      https://www.facebook.com/GavinMichaelBrooks/posts/620842064704442

      • Amazed

        It’s beyond obnoxious, Dr A. It’s also an attempt to “normalize” Gavin Michael’s death, and it’s also an attempt to create a false contrast between terrible experience and a healthy baby versus great experience and a dead baby.

        Guess what? Many loss mothers, like Danielle, had both the terrible experience and the dead child. Of course, Cristen prefers to sidestep around the issue.

  • KG

    I miss the point here. It is a bad thing for a women to feel encouraged and supported? Seems like the folks on this blog would find it difficult to offer that degree of respect to a woman desiring something that is not supported by your opinion. Let’s be reasonable here.
    It is ok to choose not to breastfeed, but unacceptable to choose unmedicared birth?

    • KarenJJ

      How did you get the idea that it is unacceptable to choose unmedicated birth? Considering the author has had two unmedicated births, I doubt she’d call it unacceptable.

    • Young CC Prof

      I support you if you decide to breastfeed or bottle-feed.

      I support you if you choose unmedicated birth, or use epidural or other medicines to relieve pain.

      I support you if you want a maternal request c-section, or a birth with minimal intervention, or a VBAC.

      If you want to choose something that is really unsafe for your particular medical situation, however, I don’t see how it would be terribly supportive of me to lie and say it’s a great idea.

    • Who?

      Choose what you want. Be realistic about the risks and benefits. Be aware of who is selling what.

      If you want to do something against medical advice (that is, actual doctors with years of university education and professional training, as well as experience) you will not be supported to do so on this blog. If you think that unmedicated birth is ‘better’ than medicated birth, you will not be supported in that view. But if you want an unmedicated birth, and your medical advisers (see above for definition) agree, great. If they don’t you will be encouraged to look further into your decision.

      Breastfeed or don’t who cares so long as you and baby are happy and well.

    • Samantha06

      Ah you’re back trying to push the NCB agenda again…

  • Liz Leyden

    “Your provider uses language like, “We encourage you to…” and “We support
    you in…” —not “You’re not allowed” or “We will let you.””

    What if you want to do something they don’t encourage or support?

    • DaisyGrrl

      “We support your right to risk your life by refusing medical treatment, but we encourage you to remove your head from your behind and follow our recommendations.”

      Somehow, I don’t think this is what NCB folk want to hear, but it meets their criteria.

  • Having a provider tell you what you want to hear is not a sign that you can “trust” that provider. A provider that values and respects informed consent (and actually knows what that means), a provider who knows what the treatment options are and the associated risks and benefits and counsels according, a provider who puts your best interest ahead of their own, a provider who has a track record of integrity and is held accountable not only by their own profession, but if necessary by the legal system (ie. one that holds malpractice insurance) – those are signs of a provider you can “trust”. Currently, many midwives in the US operate in a manner that should leave many women skeptical of their ability to “trust” the advice and care being given.

    • Who?

      ‘If it sounds too good to be true, it probably is’ applies just as much to medical care as it does to finance.

  • lilin

    Is there a Yelp for midwives? I’m just reminded of the horror stories we’ve all heard, and I think there should be some kind of third-party service for which the midwives can’t manipulate the reviews.

    “My baby died and my midwife said that some babies aren’t meant to live.”

    “My midwife tried to talk me out of going to the hospital.”

    “My midwives shamed me for 30 minutes for saying I’ll vaccinate my baby.” (Actual story: http://www.slate.com/articles/life/dear_prudence/2014/11/dear_prudence_our_midwives_are_anti_vaccination_activists_should_we_fire.html?wpsrc=fol_tw)

    You can’t trust them to leave criticism up on their own sites.

    • Bombshellrisa

      The best reason thing we can all do is post the link to “From Calling to Courtroom”. Who needs third party reviews when the midwives own admissions in that book prove that they are not providers who can be trusted? I did a little googling and found the midwife who published it was a nurse who was practicing midwifery illegally and had her nursing license taken away for it. And she still practices. She is married to a lawyer who helped her devise the strategies in the book and probably advises the other midwives who find themselves “persecuted”

    • Stacy48918

      Yelp is awful though. They manipulate the reviews that are posted based on who is paying them. I hate Yelp.

      • Hannah

        For a time I didn’t actually believe that, as it had always been accurate for me. Then I couldn’t figure out why the salon where I bought my wedding dress only had five terrible reviews, especially when they had such great ones on wedding wire. Then I noticed the very tiny ‘see filtered reviews’ link and clicked it… found over 120 great reviews that had been hidden from the public. Now I believe it and try not to use it anymore… and if I have to, I look at the filtered reviews!

    • Staceyjw

      There is “Oregon Midwife Info”. It’s not a review site but does post all the actual complaints made and actions against the HB MWs. This leaves a LOT out, because few moms ever make formal complaints, but it is saving moms from hiring known killers so it’s been very successful.
      It’s Oregon only. Other states also need these registries.

      • lilin

        That definitely is a great site. If only other states had them.

    • Kg

      My baby suffers from seizures because my ob was waiting for the oncoming OB to take me to the or

      I developed chorio because my OB missed my PROM and sent me home. aPHARS 4/6.

      I had a c/s because my OB wanted to leave by 5
      I had a C/S bc my OB wanted to go to sleep by 10
      I had a C/S bc I did not progress for 1 hour
      I had a C/S bc my OB kept pushing the piticin, then heart tones were down

      All day long we could discuss the failings of many healthhcare providers. C/S are a risk to the health of the mom and somewhat to the baby they are a lifesaving procedure, not one of convenience.
      Inductions…46% risk of c/s with a bishop less than 4. Safe, really? Again, provider and patient need to assess risk.
      Breastfeeding- is not ever going to be matched by formula. Sadly, some women can’t for a number of reasons. Conversely, most can. Of recent weeks. Most women I have seen in postpartum want to breast feed exclusively. Unfortunately, they have already been given formula bc they “didn’t have enough milk” on day 1. That is not respecting the woman. That is a matter of convenience for those caring for her.

      The purpose of this site is to exploit and exaggerate the exceptions. This blog is a means to promote one’s personal beliefs.

      • KarenJJ

        “This blog is a means to promote one’s personal beliefs.”

        As opposed to all the other blogs out there?

        • Rachele Willoughby

          Remember, these are people who think blogs and scientific journals are *the same thing*.

      • lilin

        You realize that you’re just raving, right? When did I say anything was safe or unsafe? When did I mention c/s?

        All I’m asking is if there is an independent review site for midwives, so that women can get information about the person they hire to help birth their child. If that threatens you, as it clearly does, you think midwives have something to hide.

  • Bombshellrisa

    Signs you can trust your provider
    1) They went to an accredited school whose degrees are accepted by other accredited schools.
    2) they are not offended when you wish to seek another opinion
    3) realize the limits of their competency and refer you to the care provider who can best address your needs
    4) don’t accept gold or riding lawn mowers or bales of hay as payment
    5) provide their own gloves and Chux pads

    • Young CC Prof

      For #4, some real doctors in poor rural areas may indeed accept work or goods in lieu of cash from patients who don’t have much cash.

      But most places in the USA, it’s a bit eyebrow-raising.

      • Bombshellrisa

        I didn’t think about that!

      • Staceyjw

        Docs, or any other professional or service/goods provider, that takes barter or work trade is awesome. It really makes the difference for the cash poor, who are willing to work or trade. I get all of my kids classes this way; they would never get to participate otherwise. You would be surprised who will barter if you just ask.
        But I get what you meant.

    • Trixie

      Bales of hay? That one happened?

      • Cobalt

        Hay is expensive, especially good hay that has been stored inside.

        • Spamamander

          Still fairly decent here in Eastern WA where it’s grown, $10 a bale orchard grass $11-$12 alfalfa. $225-$250 a ton.

      • Bombshellrisa

        I don’t know that it actually happened, but there were two midwives who were in Eastern Washington and Eastern Oregon who listed them as a possible form of payment. One the midwives raised horses, so I can see that.

        • Cobalt

          Who stacks it? That’s the real question.

          • AmyH

            It’s part of the exercise for the pregnant mother so that she’ll be in good shape and labor will progress more smoothly.

  • anonymous

    Here’s my dissection of her statements:

    > You are treated like an individual.

    And OBs don’t do this? Really? Our OB was phenomenal. Listened to us, and took care of any concerns.

    > Your provider recognizes that you are the one delivering the baby.

    Ah yes, as opposed to the person outside that is cutting the grass.

    > Your provider practices based on current scientific evidence, over “traditional” birth practices.

    So basically, CPMs, DEMs, Doulas, etc are all out. Good.

    > Your provider is transparent about his or her philosophy and track record.

    Again, any doctor is going to do this. How many midwives have fled states where they’ve presided over a death–or four?

    > Your birth feels like a special event and not a drive-through service.

    When would birth ever feel like drive-through service. I’ve never met an OB that behaves like this.

    > You are listened to and treated like a respected adult.

    When my wife was in labor, she was not rational. Not in the least. She was spitting, swearing, screaming, and cursing anyone and everyone, and that was after the epidural. In a medical situation, the doctor is not only responsible for the mother but also the baby. Obeying every whim of someone that may or may not be thinking rationally is not the best idea.

    > Your birth plan is welcomed with open arms.

    Birth plans are more or less useless and outdated.

    > Your doula is welcomed with open arms.

    Nope. Your doula is not a doctor, OB, etc. Unless she has actual, medical training from a real degree-granting institution then there’s no point in letting her in on the process. If she had actual training, she wouldn’t be calling herself a doula. My aunt graciously agreed to help out with my wife the day of her labor until we got to the hospital, but my aunt is also a registered RN.

    > Your provider is consistent.

    Situations change. What looks good at 30 weeks may be markedly differently at 40 weeks. If your doctor can’t change, then you need to change to another doctor.

    > Your provider believes in you, with a focus on wellness–what you can do, not what you can’t do.

    Believing in something and knowing limits is a difference that seems to be lost on a lot of uneducated “birth professionals.” Our second was BIG. Like “oh wow, you’d having a cesarean and I’m going to notify the whole team so they’re on standby” big. My wife is tiny, waif thin. She flat out said “you can’t birth this baby vaginally.” We believed her, she’s the pro, and when our daughter came out, we both totally understood why.

    I’m frankly not sure what she’s trying to do with this article. It seems as though she’s more or less telling people to stay away from midwives but in the next breath telling people to go to a “crunchy” doctor or something.

    Amy’s analysis of how to trust your provider is more or less spot on. We went with a credentialed OB with a spectacular track record that, for her age, had a large number of births under her belt(when we checked into it, we found she had been at a teaching hospital in a very populated area, exactly as she said she was) and had stellar references from a few people that we knew. The only complaint I could find with her was “she’s too blunt.” Which I consider to be a complement in medicine, coming from a family with several people in the medical profession. I don’t want to hear “this might be a problem” I want to hear “this is a problem and here’s how we deal with it.” Doctors aren’t hired to be “nice.” You can have a fine bedside manner and not beat around the bush.

    • Schnitzelbank

      I actually had a delivery that was like drive-thru service. It was great. I was induced, labored comfortably with an epidural, and when it was time to push, my OB showed up. Because I was feeling comfortable, we chit-chatted during the 20 minutes I pushed. Baby came out, everyone was healthy, she gave me a high-five and was gone within the hour. Couldn’t have asked for better drive-thru service!

      • Sue

        A delivery that is “like a drive-thru service” probably reflects well-functioning systems, and calm, systematic care that can recognise and respond to complications quickly and systematically. Sounds good to me.

  • I have a thing about the term “wellness”. Whatever happened to good old “health”?
    Some day, when I’ve not got something better to do [=never], I’m going to make a compendium of all the jargon I hate, beginning with “to birth”.

    • Amy M

      I do that at meetings at work. I have a section in the back of my meeting notebook, with a list of 1)silly jargon 2)made up words that the speaker used and 3)real words used incorrectly. I know its immature, but it makes me listen.

      • Carolina

        My current pet peeve is “decision” used as a verb, i.e. “What else do we need to decision this process?” What in the fresh hell does that mean? What’s wrong with “make a decision” or “to decide”?

        • Roadstergal

          “Right-sizing” trials.

          (Tangentially, when my husband was SCUBA certified and I did the class along with him as a refresher, the instructor used ‘motivate’ to mean ‘move.’ “Let’s all motivate this direction.” Six years later, we’re still using that term for comic effect.)

          • toni

            wtf

            People must think they sound clever adding unnecessary syllables to words.

          • toni

            Which reminds me.. I really dislike the words ‘obligated’ and ‘medication’. I know they aren’t technically incorrect but what’s wrong with ‘obliged’ and ‘medicine’?

          • Mom of 2

            On that note, I’ve always said “dilation” when referencing a pt in labor. Other people I work with say “dilitation.” Anyone know which is technically correct?

          • Mom of 2

            That is, referencing a pt in labor’s cervix, not the pt herself 🙂

          • Dr Kitty

            Dilatation is the older form.

          • Mom of 2

            Ahh, thanks. I’ve been at this 4 years, the ones who say it definitely tend to be the really experienced nurses (20+ years).

          • I’ve always said “dilatation”, as in “during dilatation, the cervix dilates”.

          • SporkParade

            Of course, in pregnant lady forums, the word is “dialate.” Drives me nuts.

          • me

            I guess that’s a regional thing. I’ve lived in places where everyone was obliged to take their medicine, and in other places where they were obligated to take their medication 😉 That one doesn’t bother me.

          • Amy M

            How about “orientated?”

          • Roadstergal

            My pet peeve in common use is ‘preventative.” “Preventive.” It’s all you need.

          • Amy M

            Or using “myself” instead of “I” or “me.” It’s grammatically incorrect. “The meeting will consist of John, Peg and myself, and we’ll talk about blah, blah.” No, the meeting will consist of John, Peg and me.
            John and myself decided to do x. No you dope, John and I decided. Saying “myself” doesn’t make you sound smarter.

          • Cobalt

            It’s backlash against the teeny-bopper style: “Whatevs yo”.

          • Someday, when a participant in a discussion says “Thank you for sharing” I might just jump up and throttle the speaker.

          • Who?

            That would be you sharing, potentially inappropriately.

            I also hate ‘Chatham House Rules’. There’s one rule. It is a big one, but just one.

          • My first husband, who was French, said that the quickest way to learn to speak French was to take an English word, divide it into as many syllables as possible, but leave off the last one

          • DaisyGrrl

            That’s a good one. When I’m speaking French my rule of thumb is that any English word with three or more syllables can be used in a pinch as long as I make it sound French enough.

          • Rachele Willoughby

            My dad says “motorvate” also for giggles.

        • toni

          I’ve never heard anyone use it like that. how bizarre.

          • KarenJJ

            I feel like we’re in the backwoods here. I’m still getting pro-active and synergy.

          • Who?

            sooo last century…

        • Amy M

          Oh I hate when they say “the ask.” As in “What’s the ask here.” The word they are looking for is “request”, so it should be “What are the higher-ups requesting” or even “What are the higher-ups looking for?”

        • The Computer Ate My Nym

          Incentivizing. Has anyone done “incentivizing” yet? Or “quality”? I feel like that character from the Princess Bride every time I hear an administrator talking about “quality”: I don’t think it means what you think it means.

      • Who?

        Take it to the next level-jargon bingo. It’s fun to play, and when you get a full card, you decide how to celebrate!

        Oh, and I hate ‘meet with’ as in, ‘we will meet with Mary and Fred’. Let’s see them, or meet them, or even have a meeting with them.

        • Amy M

          I never even hear that one—-by me, its “reach out.” “Let’s reach out to Mary and Fred”, as though they need a support group, rather than a notification that there will be a meeting.

          • The Bofa on the Sofa

            My personal biggie is the “unnecessary at”

            Unless you are quoting Blazing Saddles.

            “Where is the book at?”

            My SIL is a Communication Professor, and I had to call her on it. I have noticed that, since then, she has been better about it.

          • Amy M

            Yeah, that always makes me think of Blazing Saddles too!!!

          • My old office was big on “touch base.” I spent so much time touching base with people you’d think we had a softball team.

          • An Actual Attorney

            My “favorite” is “out of pocket” for unavailable. As in, “I’ll be out of pocket all tomorrow.” Whose pocket are you usually in anyway?

      • Amy

        Standards-based. The worst, most meaningless phrase in education today.

      • Young CC Prof

        Referring to a professor as “a faculty.” Call me a teacher, professor, adviser, instructor, member of the faculty. If you’re paying my salary, feel free to call me an employee. But don’t call me a faculty!

        • The Bofa on the Sofa

          Faculty is actually a plural.

          “The faculty are completely disfunctional.”

          • Young CC Prof

            Exactly!

      • MaineJen

        That’s awesome. Stealing.

      • MaineJen
    • anonymous

      “Health” can be an objective term, something that can be quantified. My BP is 110/80, therefore I’m in good health. “Wellness” is one of those nebulous terms that get thrown around that are so subjective as to mean anything.

  • Ash

    Signs that you trust your provider:
    They are willing to criticize other people in their profession who recommend bad decisions. Example: There are some MDs who reject vaccines (Wakefield, Mercola, etc) but there are more willing to stand up and say that vaccination is an important health policy.

    Traditional birth attendants: Someone wants to attend twins, VBACs, breech presentation at home? “We support other midwives’ decisions” Yeah, dumb decisions.

  • Dr Kitty

    Signs you can trust your provider:

    When your beliefs or actions are posing a risk to your health or the health of your baby they will waste no time in telling you.

    When they receive new information that changes risk they will re-assess previous plans and see if they are still tenable.

    They will tailor their advice to your specific situation, so they might not tell you the same stuff they told your friend.

    NCB see those as reasons to distrust, feeling that there might be a “bait and switch”, I see it as evidence of truly individualised care.

  • PickAUserNameForDisqus

    OMG, my hypno-bithing teacher (who in hindsight I should have just given the hundreds of dollars to, and had date nights with hubby instead of spending time in her class) actually brought out ‘The Little Engine That Could’ as an example of a mantra that should help me through labor. This post just cracked me up!

  • noelle

    My favourite was:

    ‘Your provider is consistent. When it comes to their philosophy, your plans, and how your birth is going to go (barring any changes in health status, of course), what they said at 20 weeks is the same as what they say at 30 and 40 weeks.’

    We all know what they think is a change in ‘health status’…everything is just a variation of normal, isn’t it? So what they’re really saying is that nothing should change ever.

    I think I just lost IQ points from reading that article. (And the citations. Two are ACOG, everything else is a blog. How can they think those are good citations????)

  • Anj Fabian

    If I see this again, I may start cursing:

    ” If you have not had serious talks with your provider about diet,
    exercise, and stress levels, you are missing a component of great care:
    preventing common complications like gestational diabetes. ”

    NO! You can’t “prevent” GDS. It’s hormonal. It’s caused by the placenta. It’s not caused by or prevented by diet or exercise. Those things can be important in TREATING it, but they can’t prevent it. It doesn’t work. It doesn’t affect the mechanism of the placenta generating hormones and the woman’s body responding to them.

    • Bombshellrisa

      That is one of my pet peeves and a sure sign a provider is a quack-the “nutrition talk”. My doctor gave me a couple handouts about things that could be harmful, a wallet size guide about eating fish. When I had an elevated glucose level after the test, I went to a nurse practitioner who specialized in diabetes education and worked only with patients who have GD. She talked about nutrition and exercise, but there was a specific need. Most home birth midwives talk about nutrition “guaranteeing” things like the mother’s health or a short labor and quick delivery, which is impossible.

      • Amy M

        Yeah, like the looney-tunes who think they can prevent pre-e by eating a specific diet. Or worse, the ones who think they can change their blood type (so they don’t have Rh incompatibility). I swear I am not making that up. If only I’d eaten a GMO-free diet! I might not have had ID twins!! (j/k) (I’m willing to bet someone out there believes that GMOs could cause twinning.)

        • Amy M

          http://academicsreview.org/reviewed-content/genetic-roulette/section-7/7-2-rbst-doesn%E2%80%99t-cause-twin-births/

          There’s one where some dope decided that the increased rate of fraternal twinning was due to rBST in milk. Nothing to do with IVF or waiting until a later age to conceive, nope. It’s the milk. Uh-huh.

          I don’t understand why people suddenly latched onto GMOs. They’ve been around a long time, why are they a problem all of a sudden? I get that the people who freak out about GMOs don’t understand what they are, and how they are made, and very often are looking for something to blame [insert problem here] on, but really? Is it because the vaccine-autism link was so thoroughly debunked, they need another buggaboo in its place?

          To bring it back to the topic of the post, I have no doubt that many of the CPMs suggest that pregnant women avoid GMOs, because “they might be toxic to the baby!” or some such nonsense. I wonder if any of them directly blame GMOs for GD or pre-e or whatever complication arises.

          • Bombshellrisa

            I wonder that too, especially since a lot of the CPMs put something about eating properly in any contract of care they make a patient sign. It’s just another way to refuse to take responsibility for mediocre care.

          • Sarah

            I don’t think people who demonise GMOs have necessarily absorbed the message that the vaccine/autism thing was debunked, tbh.

        • KarenJJ

          I’ve had one person that thought my grandmother must have eaten something like yeast that caused a spelling mistake in my Dad’s DNA…

          • Sue

            Was that person named Candida, by any chance? 😉

      • AmyH

        And yet WTE’s app had some article a while back on GD and talke about preventing it. I’m nobody – my childbirth education happens here, in large part – but I thought it sounded fishy.

        And I’m sure no mom has ever felt guilty on account of reading it.

        • Elaine

          I read a little about the history of the Brewer Diet when I was pregnant with my first, and it sounded like it was developed as an alternative to the truly rotten diets (all carbs and saturated fat, I think) that some poor Southern women in Doc Brewer’s practice area were eating, and it reduced the risk of pre-eclampsia in this population. It doesn’t seem outlandish to me that if dietary improvements can lower blood pressure in non-pregnant people that they could also reduce the risk of pre-eclampsia, not to zero but to better than what it was before.

          I definitely got it crammed down my throat when I took a childbirth class. I could not eat that much food. It was kind of nuts.

          • Young CC Prof

            Maybe. It’s certainly plausible that a reasonably healthy diet works better than a really unhealthy one. But that much protein just doesn’t seem like a good idea. One of the key signs is spilling protein in the urine, and eating a sufficient protein overdose will cause anyone to start urinating it, with resulting strain on and potential damage to the kidneys.

          • AmyH

            GD – I meant gestational diabetes, in response to bombshellrisa’s comment.

          • Sue

            Elaine, the Brewer Diet DOES sound outlandish if you understand the physiology.

            Brewer was equating the swollen ankles of pregnancy (caused by a combination of raised venous pressure in the legs and expanded vascular space) with the swelling from fluid leakage in very low protein diets (like is seen in starvation during famines). The latter only occurs when you have very very low serum protein, such that the blood vessels can;t contain all the fluid (reduced oncotic pressure). It’s very hard to get this sort of protein malnutrition just from eating junk food – you actually need to be starving.

            The only way that dietary manipulation reduces blood pressure is by (i) reduction in excessive salt intake; or (ii) weight loss in the obese person, where the obesity causes the high blood pressure, not the diet.

            So, healthy diets are great – pregnant or not – but Brewer had it wrong, and those who follow him don’t understand how he got it wrong.

      • Trixie

        And many NCB classes tack on the Brewer Diet as a part of the curriculum.

    • The Computer Ate My Nym

      Interesting. Type II DM can be prevented–or at least delayed–by changes in diet and exercise. At least sometimes. Sort of. I’d always assumed that GDS was a variant of type II DM, but I guess it has a different mechanism of action.

      • Anj Fabian

        Since GDS is a risk factor for DM II, I suspect that the woman’s body responds more readily to the placental hormones – and that’s probably why she is more at risk.

        If it was purely the placenta and every person responded the same way to those hormones, I’d expect GDS to be more random.

        • The Computer Ate My Nym

          But is GDS a risk factor because of common predisposing factors or does GDS actually in some way contribute causally to DM II? Maybe the stress of pregnancy is doing some permanent damage to the pancreas (or muscles, etc) in some women, leading to GDS and an increased risk of DM II later on. Could you decrease your risk of future DM by having fewer pregnancies? (Note: I’m BSing here. I’m terrible with DM.)

          • 50% of overweight women who have GDM in pregnancy will go on to develop type 2 diabetes in later life.

            AFAIK, the only real connection between GDM and type 2 is that in both cases the woman has plenty of circulating insulin — but that her cells are resistant to it [type 1 diabetes is essentially pancreatic failure to produce insulin] and do not use it. In a sense, type 1 and type 2 are not really the same disease, even though the blood sugar levels rise in both and symptoms can be the same.

          • Amy M

            T1D is autoimmune, currently, it is not believed that T2D is.

          • Elle Bee

            “Currently, it is not believed…” I can almost guarantee you that the science will eventually show that it is. There is already some research to suggest that islet cell autoimmunity is present in up to 15% of T2DM patients, and that T2DM patients frequently have higher levels of various autoantibodies. One day they will figure out that at least some people with T2DM (or “prediabetes”) aren’t sick because they’re fat, but are fat because they’re sick. And the medical community will owe a whole lot of people an apology for stigmatizing something beyond individual control.

          • Roadstergal

            Snaps, some of my work is in the sciency parts of diabetes, and I can’t guarantee you anything. 🙁

            There are definitely genetic predispositions to T2D, not as strong as T1D. There can be autoantibodies in T2D, but it’s difficult to determine how causative they are. When you have insulin insensitivity, the pancreas starts working overtime to churn it out, so you’re setting up a situation where immune responses can indeed be secondary. Simply observationally. there is a lot more ability to control T2D risk with lifestyle interventions.

            Partly because the triggers for T1D are not well-established, in contrast, and the age at which T1D hits has a strong influence on how aggressive it is. When you’re young, it’s a highly aggressive disease that just wipes out beta cells, and you need external insulin or you die. The older you are at time of onset, the less aggressive the disease is, which is why you might hear some alt-med testimonials about controlling T1D with diet and exercise. But overall, control of blood sugar is the most important factor in long-term outcomes in T1D, and frequent blood sugar monitoring and proper use of insulin is the best way to control blood sugar.

          • araikwao

            Wait, perhaps I misunderstood you, but genetics is more of a guarantee for you getting T2DM than T1.

          • fiftyfifty1

            Both DM1 and DM2 have big genetic components. Which one has the bigger genetic component depends on how you look at it.

            DM2 is very common. If both your parents have it, and you live long enough, you are almost certain to get it yourself. There are many genes that contribute to DM2. Some are variants that decrease insulin sensitivity. Others influence behavior (genes that influence appetite/eating and tendency toward physical activity). Environmental factors such as exercise, stress, diet composition and access to calories are extremely important. They can make the difference between developing DM2 as a 12 year old vs as an 80 year old. Even if you don’t have a family history of DM2, you are still at risk of developing it if your lifestyle has enough risk factors.

            DM1 is rare. Even if one or both of your parents have it, it is far from a sure thing. There are thought to be very few genes that count toward risk. Even if you test positive for one of the “bad” gene variants, odds are still in your favor you won’t get it, because it is thought that an environmental insult of some kind (infection or exposure) needs to “trigger” the bad gene. On the other hand, if you don’t carry one of the “bad” gene variants then it is *extremely* unlikely that you will ever get DM1. We don’t yet know the environmental steps we can take to prevent DM1.

          • araikwao

            Yes, thank you for developing that further for me!I shouldn’t be here, I should be studying, so my comments are very short and poorly communicated because I feel guilty about my procrastination..

          • SporkParade

            Thanks for pointing out the genetics. My family history includes both GD and T2D in individuals at a healthy weight, so it kind of drove me up a wall during pregnancy when women on the internet forums would say they turned down GD screening because they “eat right and exercise.”

          • Amy M

            Yeah, that’s why I said “currently”–I think the research is heading in that direction too. 🙂

          • Sue

            But Elle Bee – isn’t T2DM an issue of peripheral insulin RESISTANCE?

            Insulin secretion only increases once the peripheral resistance starts, cos more insulin is required for effect.

    • fiftyfifty1

      Well…..I suppose you can have *some* influence on the results of your GDM test. If for instance you were diagnosed with gestational diabetes during your first pregnancy, but before your second pregnancy were successful with losing some weight through diet and exercise (not easy!) and so were 20lbs lower weight than the previous pregnancy at the time of the glucola test. You might “pass” this time when previously you “failed”. But I know plenty of women who don’t have any weight to lose who test positive in every pregnancy despite being very active and eating an excellent diet. That’s just their genetic lot in life.

    • Bugsy

      Thank you for this post. I was borderline underweight when I got pregnant with my son, and was pretty surprised to be diagnosed with GD in my pregnancy with him. The toxicophobe in my life was as well, even though she was thinner than me and barely ate sugar.

      My GD was diet controlled until 3 days before I gave birth, when my sugars went out of whack and my OB told me to cut all carbs. I resumed a normal diet immediately upon delivery, and my 1-hr postpartum glucose test was as low as the fasting numbers I’d had during pregnancy. It very much was the placenta at work.

      • Cobalt

        And that first postpartum stack of homemade chocolate chip cookies was magical for me. I’d been craving them for months.

    • Cobalt

      I did not have GD in my last pregnancy, despite having it in the two prior. Starting weight with all three was within a few pounds of same, and my gain pattern in the last two was very, very similar. The non-GD baby was a pound lighter than the one before, came a week and a half sooner, and had a dysfunctional placenta. Maybe GD, like morning sickness, is one of those “your awful symptoms are because your hormones are working” things? What’s the science say?

      • Bugsy

        I don’t know what science says, but you’re giving me hope!

  • Anj Fabian

    The bullet points about vaguely positive language, doulas and birth plans translate to “Your provider should not set any boundaries or expectations.”

    If at some point, it becomes necessary to communicate to the patient that the premise her birth plan is based on no longer applies, the patient will be completely unprepared for the new situation she finds herself in.

    I don’t think that’s fair. It contradicts this:
    “You are listened to and treated like a respected adult.”

    NCB seems to vacillate between women being awesome and powerful – and women being delicate, fragile creatures who need constant reassurance and praise.

    • dbistola

      That’s very interesting! My ob who has been practicing since the 60’s barely touched on nutrition, maybe guided me about some unsafe food choices. For this old veteran with thousands of successful outcomes under his belt to relegate nutrition to the back seat speaks volumes.
      I never thought of that: “Nutrition” is frequently the domain of the quack.

      • Young CC Prof

        In the world of actual medicine, nutrition is fairly simple for most people. There are a wide range of basically healthy diets, and there’s no good evidence that one is better than another. Yes, pregnant women need to avoid certain foods and beverages, and get more of certain vitamins and minerals, but explaining that shouldn’t take more than about five minutes. (Nutrition for someone who has multiple food allergies, or diabetes and gallbladder disease simultaneously, can be more complicated, but that’s not what I’m talking about.)

        Quacks subscribe to a very detailed and internally inconsistent “nutritional science” which requires enormous effort and training to follow and is in large part made up.

        • Sue

          Yep – lots of pseudo-science in the ”nutritional space”.

          • Who?

            I just spent a couple of hours at a home demo of a food preparation appliance that is taking middle class Australia by storm.

            One of the selling points is that there are no (or only minimal, or only minimal and not ‘activated’ at the temperatures the part reaches) BPAs in the plastics on this product.

            The facilitator raised it, and since no one took the point and I am practicing forebearance, I didn’t mention that worrying about BPAs in the first world is like worrying about, I don’t know, some other non-problem.

            Though they did go on about ‘healthy food’ while peddling recipes with astonishing quantities of ‘rock salt’-that’s the healthy kind, in case you weren’t aware-and opining that ‘salt isn’t bad for everyone, some people need it’.

  • Anj Fabian

    Maybe I should hire a PMS doula?

    “are important physiological processes and crucial hormonal events that require patience and gentleness”

    • The Computer Ate My Nym

      How about a menopause doula? Or a menarche doula?

      • Pillabi

        I need a doula to manage keeping up with disqus updates.

      • In Victorian times, the “monthly nurse” did fulfill these sort of functions. Of course, the menses were viewed as a reason to assume invalidhood for the duration.

      • Roadstergal

        A menarche doula! Yes! To help a young girl navigate all of the lovely blood-soaking-up options, to provide emotional and practical support when you make big ketchup stains all over the crotch of a pretty pair of colored jeans, to support you asking your doctor for help with various options to control debilitating cramps…

        (My dad once told me, when I was at home twisting in agony on the bed as a teenager, that my mom had hideous period pain that only went away when she had her first baby. When I finally got put on hormonal birth control, my period pain disappeared as if it had never been. We are truly living in an age of miracle and wonder (and plastic applicators, hallelujah).)

        • Amy M

          My mom told me that her mom slapped her in the face when she got her first period. Evidently, it was a tradition in the old country (Hungary), to keep demons or bad spirits away. Maybe that would be a job of the menarche doula? (My mom did not slap me in the face.)

  • Anj Fabian

    “> Your provider practices based on current scientific evidence, over “traditional” birth practices. Many very nice, well-meaning providers still practice the way they learned as a student.”

    They then steer the reader to their Resources and Information page.
    I checked to see if ACOG or AJOG were listed. Nope. Ina May’s book is listed. Exactly where do they think the current research is found? Ina May’s thinking apparently congealed in the 1970s.

    • The Bofa on the Sofa

      Classic.

      “Doctors just practice the way they learned as a student.”

      vs

      “Women have been giving birth naturally for thousands of years…”

      • The Computer Ate My Nym

        Actually, doctors who keep practicing the way they learned as students are going to fail their boards. I just did the oncology recert and there wasn’t much on it that was the same as when I took the boards initially 10 years ago. The field has basically turned over entirely. I don’t think ob is changing quite as rapidly (there’s less reason for change given OB’s already excellent results), but I can’t imagine anyone who doesn’t change their practice being allowed to call themselves an OB for long.

        • Gee whiz, if I practiced [until my retirement in 2012] solely on the basis of what I’d learned as a nursing student, I wouldn’t know how to read a fetal monitor or ultrasound, since neither had been invented then.

          • The Computer Ate My Nym

            When I was in training, there was precisely one drug that ended in “ib” in clinical practice and maybe 2 that ended in “ab” (the ib drugs are tyrosine kinase inhibitors, the ab drugs, as you might expect, are antibodies). Now…I’ve lost count. They work too. Not as well as we’d like, but suddenly we can alter the natural history of cancers that used to just run people over. It’s progress, if not as much as we’d like.

  • Pillabi

    And the winner is… number 4! “Your provider is transparent about his or her philosophy and track record” i.e.: “There should be no mystery about how many episiotomies they cut or their criteria for recommending a c-section.” … What about transparency about DEAD BABIES?

    • The Bofa on the Sofa

      Yeah, it’s not like the ACOG has published guidelines for doctors to follow. Of course, midwives have no actual guidelines to follow and so make shit up as they want.

      You want transparency about how they practice?

      • Pillabi

        who do you mean with “they”? personally I want transparency about how everyone practices, and what my personal experiences is concerned, when my ob/gyn was sued by a patient it was reported on the local newspaper (he was cleared, btw)

  • Young CC Prof

    I’ve always thought, “Willing to tell me when I’m spouting BS” is a sign I can trust a provider. But see, that’s because I’m looking for someone I can trust with my health or my child’s health, not someone I can trust to make me feel special.