Fed up with midwifesplainin’

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Over the weekend we were treated to the spectacle of not one, but two separate midwives actively engaged in midwifesplainin’.

What’s midwifesplainin’? It’s when a midwife tells women whether they are or are not in pain, whether they do or do not “need” pain relief, whether their own assessment of their pain level and tolerance is real or the result of brainwashing, and how their babies should be fed.

People say that doctors are condescending, but we’ve got nothing on midwives. Doctors may condescend to patients when explaining medical conditions or treatments, but these are objective phenomenon. Midwives bring paternalism to a whole new level when they substitute their subjective assessment of a patient’s experience of pain with the patient’s actual, stated experience.

Before delving into the phenomenon of midwifesplainin’, I want to make it clear that this was something I never saw in the many years I worked with certified nurse midwives. The CNMs I worked with were highly trained, deeply compassionate, and although they may held strong views on what a “good birth” meant for them personally, I never saw them substitute their beliefs for a laboring woman’s own experience. Apparently in the last 20 years, midwifery has been thoroughly radicalized, particularly in the UK and Australia. And it would be hard to find better examples of that than our visitors, Rob, a midwifery student (or aspiring student) from the UK, and Katie, a midwife from Australia, .

They are both masters of midwifesplainin’!

Rob, a midwifery student, parachuted in to “educate” me and the commentors, who between us have literally 100+ years of actually caring for laboring women, and many of whom have actually given birth. If that’s not chutzpah, I don’t know what it is. According to Rob, I am “woefully misinformed” so he has patiently midwifesplained the facts of birth:

Natural childbirth is better…. it is healthier, more empowering, superior and it’s far better for mum and baby. It may not be safer, but thankfully we have skilled midwives and behind those skilled OBS who are there as backup when complications do arise, or to manage high risk cases…

But what if women don’t feel that unmedicated vaginal birth is better for them and their babies? Too bad. Rob midwifesplained why what he thinks trumps their personal experiences.

When it was explained to Rob by a number of different commentors, most of them women, that women WANT epidurals, Rob midwifesplained why we can’t trust women to evaluate their own pain; obviously women who want relief must have been brainwashed. Rob doesn’t think that women can be trusted to assess their own pain.

Most people want them? Haha… only in America 😉 I blame the media for that. Most people in the USA believe giving birth means lying down on their back in a hospital… that is simply wrong and not the way. Media and medicalised models have not helped. We’re coming at this from entirely different models of midwifery from two entirely separate countries but I know which I’d prefer to give birth in (if I were a woman of course).

Rob midwifesplains that what HE thinks is far more important than what women think:

Normalising elective cs (and to some extent epidurals) in the minds of the public just doesn’t feel right to me.

Poor Rob! It doesn’t feel right to him.

Like most practitioners of midwifesplainin’, Rob is very censorious:

Amy you should be very ashamed of yourself. You are totally devoid of compassion and have a very biased view which you put across in the most unprofessional and vile way. I dare say lots of women are glad you no longer practice. You do not come across as any kind of advocate for women. The whole tone of this site, your attitude and that of some other commentators here depict people who have home-births as baby murders along with their midwives. You thrive on scaremongering and twisting facts to suit your own aims with no thought for others or even women’s rights.

A few people will be glad that I will not grace your website ever again, but none more so than me. Reader beware…. this website is pure poison.

He must think his poison remark is pure brilliance, he repeated less than 24 hour after he said it the first time.

Actually, I think Rob ought to be ashamed, ashamed that he thinks women should not be trusted to evaluate their own pain and determine whether and how they want to treat it. That’s the mind boggling paternalism of midwifesplainin’ is all its glory.

Katie from Australia is a practicing midwife, and, as such, an expert in midwifesplainin’:

Why is there no mention in this discussion about the negative effect of birth interventions on the mother and babies’ ability to breastfeed? Sure some interventions are necessary but we need more research on how we can ameliorate the negative effect they can have on breastfeeding.

That would probably be because birth interventions DON’T have any impact on women’s ability to breastfeed.

But midwifesplainers are always undaunted by actual scientific evidence. And they are undaunted by the fact that they haven’t bothered to read the scientific literature that we are discussing. When asked for references to support her claims, Katie says:

My time is limited to explain.

Poor Katie; how sad that she has so little time to devote to us that she can’t bother to read the literature that she is busily midwifesplainin’ to us.

I am not saying that epidurals and C/Sections don’t have their place. Women may want epidurals and C/Sections are sometimes necessary, but they also want to breastfeed…

This may include a sleepy baby who doesn’t initiate or has dampened breast seeking behaviour, inflated baby weight and severely engorged breasts.

Awww, how generous of Katie to concede that epidurals “have their place,” as if it is up to the midwife to decide whether a patient “needs” an epidural.

Katie, too, is censorious. It seems to be an occupational hazard for midwifesplainers:

I was presenting a different point of few not trying to educate anyone. Group think seems to be the norm here and if they don’t like the message, some here attack the messenger. I have no time for that kind of nonsense…

But, like Rob, she’s having trouble sticking the flounce. She too has continued her midwifesplainin’ days after she threatened to leave.

I wish I could report that Rob and Katie have had their eyes opened by the discussions here, but midwifesplainers never listen to anyone but themselves and the colleagues who agree with them. But let’s see if I can convey to them and their midwifesplainin’ colleagues the depth and breadth of their obnoxiousness.

Rob and Katie, it is not your right, your prerogative or your job to substitute what YOU think women are feeling from what THEY are actually feeling. It is unethical to imagine, as you clearly do, that you are a gatekeeper for access to pain relief. How dare you pretend that you know better than women themselves what they are experiencing? Who, exactly, do you think you are??!!

Oh, right. You are midwives, so you think that entitles you to midwifesplain’ obstetrics to obstetricians, breastfeeding to people who have actually read the scientific literature that you can’t be bothered to read, and women’s pain levels to the women themselves. If anyone should be ashamed, it is you.

  • Cara

    Are these practices common? I had midwives for my pregnancy in Ontario. They are certified nurse midwives. They had no problem with pain relief, supported hospital birth (although they do home and birth centre births too). My primary MW worked with my psychiatrist and perinatal psychiatrist (I have bipolar 1). When my water broke 5 weeks early, my MW transferred my care to an OB. They and the nurses worked seamlessly together. My MW was very supportive of the continuous fetal monitoring, antibiotics, and pitocin I received. She encouraged me to consider an epi early because I was suffering and totally supported my choice to get one. After an easy delivery of a 7.5 lb baby, who was fine except for low blood sugar, she encouraged me to supplement with formula,while still helping me learn to breastfeed. When baby was slow to regain birth weight she had me on a strict feeding schedule with formula and referred me to a pediatrician for input. It was such a wonderful experience that combined the midwifery model of care wotj evidence based medicine. I know I just one person, but I find the things you write about to be so out there.

    • DaisyGrrl

      I’m so glad you had a great experience with your midwife! Your experience describes my dream of how all RMs in Ontario should behave. Unfortunately, the woo has crept in and taken firm hold. A note, Ontario midwives are usually not nurses. The requirement for registration is an undergraduate degree in midwifery (not saying it’s inadequate, just clarifying requirements).

      I am also in Ontario, and know of a midwife in my city who travels to the US to teach lay midwives how to deliver breach babies (stupid and dangerous). Also, a midwifery practice popular with my friends has actively discouraged and lied about epidural analgesia, delayed conveying epidural requests to the anesthesiologist on duty, and failed to have mandated informed consent conversations with patients at 41 weeks (the College requires midwives to explain the increased risk of stillbirth for pregnancies that go past 41 weeks, even if no OB consult is required until 42 weeks). Oh, and they push breastfeeding very hard.
      Thus, I have friends who believe that epidurals cause c-sections and drug the baby, who endured hours of labour pain without effective pain relief after requesting it, and (worst of all) who believe that going past 41 weeks does not increase the risk of stillbirth at all.

      • Cara

        Terrifying. And the demand is so high I think many women will take any midwifery practice who can take them as a patient. I do know of one practice that is as you say. My friend went to one appointment and was presented with their view of how birth “should” be, including the recommendation that ultrasounds aren’t needed and might harm the baby. So of course she ran far far away to a competent practice. Incidentally her ultrasound tech spotted a problem that if not caught then, almost certainly would have resulted in fetal death. But my thought was that they were some kind of lunatic fringe. I didn’t feel the need to interview my MW as I knew her work, but if I ever meet with an unknown quantity I certainly will ask many questions. Thanks for replying.

  • BabyCatcher

    It seems that many midwives love to warn their patients about wicked doctors and hospitals. They feel it necessary to save women from the medical community. They will spend excessive time and energy ensuring that every vagina-bearing human being understands that physicians and hospitals are evil and are only interested in raking in the $$ and any intervention that is suggested to a woman is only for their own personal gain on some level. They find it necessary to let out the secret that c-sections are only done to ensure the physician won’t miss a tee-time or essential beauty sleep. They find it necessary to enlighten pregnant women that when a physician recommends an intervention or advises against an alternate plan of care they are only trying to instill fear in order to persuade. I find this particularly interesting, isn’t this form of brainwashing exactly what these midwives are accusing the physicians of? It’s very frustrating….OH, and did I mention, I AM a midwife? There are midwives that push the very agenda represented above…epidurals are evil, real women give birth sans drugs. Does that truly represent supporting women? In my practice if you want an epidural-by all means have an epidural the very moment you possibly can. If you want to give birth without medications-you go girl! I’ll be right there with you helping you through every contraction. If you change your mind part way through-no judgement, I’ll rush to the phone to call anesthesia. When you do birth that baby unmedicated, I’ll be the first to high-five you because you rock! If you get the epidural, I’ll be the first to high-five you because you rock! But, be assured that if there is any point in your labor, regardless of circumstances, that I am concerned even in the least for you and/or your baby, I will tell you so and I will never lie to instill fear. If you feel fear based on what I tell you-you probably should feel fear but I’m going to be right there explaining everything to you while simultaneously intervening to the best of my ability and that may include calling my back up physician that will come in and help me care for you without question, without delay and without any shaming of either of us whatsoever. So, to the fear-mongering midwives of the world….KNOCK IT OFF! You’re giving the rest of us a bad name!

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  • Bertrande

    1. “Parachuted in” to the conversation: I love it! Such an accurate and also hilarious description. 2. Midwifesplainin’ as a form of mansplaining. Interesting how mansplaining in this context intersects with midwifery.

    • sdsures

      Is there such a thing as “womansplaining”?

      • Bertrande

        I think, as it is something men do all the time to women, it makes more sense to call it ‘mansplaining’ even if a woman is doing it. It’s s communication style that is also called paternalism. A woman can use paternalistic rhetoric, but it’s still paternal. It’s kind of strange to gender words!

        • sdsures

          English doesn’t have gender. Many other languages, including French, German and Russian, do.

          • Bertrande

            Theoretically, as in, feminist theory, it does. Linguistically, as you say, it doesn’t.

  • Guest

    I love this site. After my first emergency C section, day three my midwife forgot to give me my pain relief, then when I asked her for it because I was in agony moving around, denied not giving it to me and advised she could ‘give me another’ in four hours. Luckily my OB visited me about 20 mins later and I told him and he kicked her arse over it. What a sanctimonious cow. The only good mids were either the young girls that had worked country hospitals or the much older ones. My only downside after my c section was that some of the midwives were exactly as you had explained above and mainly because in their mind I hadn’t birthed properly.

  • Allie P

    My friend recently told me she’ll be trying for a VBAC with the “Midwives of GW.” GW? So far, so good, right? They’re at a university hospital, they’re CNMs, sounds great. Right? Then I went to the website, where they are heavily promoting a video called “Mama Sherpas” in which the GW Midwives are at rallies “normalizing” birth and demonizing doctors and prominently featuring a woman who talks about getting “revenge” on her provider for making her get a c-section, and saying they won’t stop until they’ve “normalized” birth for every woman in the country. I’m aghast and have no idea what to say for her. She almost died in her attempt to have a “normal” birth last time and now I’m afraid that these midwives are promoting ideology over safety.

    • FormerPhysicist

      OMG. Good luck to her.

    • anh

      That practice is really strange. On one hand they risk people out really easily. So that’s good. But I’ve heard anecdotes of them dumping patients late in their third trimester. And unlike my awesome CNM practice in DC who worked with mds these women just kind of dump you.
      These midwives also require you hire a doula. I love doulas, but this requirement makes it financially difficult for lots of women. They also enforce a strict diet.
      Weirdest thing about this hospital, the postpartum women share the same ward with labouring women. I want to visit my friend there when I was six months postpartum. Hearing labouring women in agony was REALLY upsetting

      • Ash

        Must be pretty easy to discharge patients from this practice–patient says they ate bread? Bye bye!

      • Allie P

        Thank you so much for your perspective. I don’t like the idea of my friend getting “dumped” and neither does her husband. He’s so nervous about all of this.

      • An Actual Attorney

        The practice is really weird. I don’t know why the obs put up with it. They also suggest no prenatal vitamins. How is that ok?

        • Ash

          IMHO, it’d be a nightmare to be one of healthcare providers consulting with this practice. For GW midwives, how can you promote their model of service as superior when you eliminate the 99% of women that eat bread, rice, potatoes and (gasp) corns syrup and sugar?

          I take Yelp with a grain of salt, but these are gems:

          “She grilled me on my lifestyle, exercise, what I want out of the
          pregnancy, how educated I was on pregnancy, natural birth, etc. I was
          definitely squirming and hoping I was going to make the cut. My husband
          actually found it pretty funny since I’m normally pretty confident and
          stubborn but Whitney owned me.”

          “She then went through my medical history with me, and determined that I
          should reconsider natural childbirth. Why? I’ve had my appendix out, and
          two nights ago, I slept on my neck wrong and it was hurting. Yeah. She
          said, and I quote here, “What happens if your neck hurts while you’re
          trying to give birth?””

          ” Whitney Pinger is an intense personality, and after my first
          appointment with her, I left feeling like, “whoa–I really do not want
          to disappoint her.””

          “They don’t want to waste spots in their program for people who, on the
          day of the climb, are going to opt for the helicopter, which will be
          their right. They want to reserve the coveted spots in their program for
          people committed to the climb. “

        • Dr Kitty

          For women with high BMI, family hx of Spina bifida, women with epilepsy or diabetes it really, really isn’t.

          For some of us off the shelf prenatals have less than 10% of the recommended level of folic acid.

          Ladies, some of you, like me, will need high dose folic acid.
          5mg a day.
          If you’re not sure whether you do, ask your Dr.

          Unless you want to take 13 OTC folic acid tablets a day, I strongly recommend getting a prescription from your Dr as soon as you plan to conceive.

          Neural tubes are important- take it from someone with a defective one!

          • sdsures

            Amen (I have hydrocephalus, but that was due to premature birth and brain bleed rather than neural tube defect).

    • Ash

      RRRRRGH Hulk rage upon this CNM practice! Their “about us” statement is very odd. Enrolling in a practice. Interesting. “Be committed to natural birth,” ok so women have to play by your rules about whatever “natural” means.

      “Acknowledge the risk inherent in birth”….is this supposed to mean that pregnant women going to this practice should have a higher tolerance of uncertainty? WTF kind of practice says “hey clients, before choosing us, ‘acknowledge the risk’!

      “Be committed to waiting for labor to begin on its own” Great, go ahead and dump all potential induction cases on your OBGYN colleagues. That’s real nice.

      This is NOT collaborative care!

      • posting under a different name

        Yeah, the lack of collaboration is what really bothered me in the end. I wanted a plan for dealing with my BP, which was creeping up although not in the pre-eclampsia range. They basically wouldn’t discuss it with me, so when I spiked and had to be induced, it was much scarier than it needed to be if I had had a plan and some understanding of how things might go. FWIW I believe they do advise patients not to go past 2 weeks late. But the “acknowledge the risk inherent in birth” REALLY bothered me in retrospect after my experience. What I understand it to mean now is that being committed to natural birth means taking some risks that would not be taken by a “regular” OB because you value natural birth so much. I wish they had explained this in more detail to me before I signed up.

    • moto_librarian

      I decided to peruse the webpage for the CNM practice that delivered my babies, and I’m a bit surprised to see that it has changed a good bit. At the time that I delivered, I remember a statement to the effect that it is your birth, and they are there to support whatever you need (including anesthesia). That’s gone now, along with the woman who was my primary CNM with both pregnancies. It has been replaced with a bunch of claptrap about how their c-section and induction rates are low because they don’t “interfere” with the process. That’s bullshit. The reason that their rates are so low is because they transfer over complex patients to OB.

      We aren’t planning on having anymore children, but if we were, I don’t think I would go back to this practice again. I also don’t feel confident that I can give a blanket recommendation to friends who are pregnant. This really bothers me.

    • sdsures

      *cringe*

    • posting under a different name

      The GW midwives have some very good providers – but I would never go back to them because of one terrible provider. They tried to stop me from getting an epidural and then had the gall, after the birth, to tell me “you made the right choice to get the epidural when you did.” They suggested that I lie about my BP spike that happened when I was in their office for a checkup (it was to something like 160/110, can’t remember exactly, but high) and then when I didn’t want to, they sent me to WALK over to the hospital to check myself in, where one of the sane midwives made the call to induce me. (It was July and almost 100 degrees out.) The kicker is that they didn’t believe I was in labor, and wouldn’t let me call my doula. So I sat there alone, in pain, until I finally said, “epidural time!” I think the head midwife was mad that I got induced, or just didn’t have any experience with induced labor. On the other hand, I did avoid a c-section (at no risk to my baby because I was ultimately able to push him out faster than they could have done a c when the OB on rotation called it.). But you can’t chose, and the fact that they prioritized a “normal birth” over the health of me & my baby really upsets me to this day. I did not really understand what I was getting into.

      • posting under a different name

        But I just wanted to add for Allie P – despite my crappy experience, the Wisdom GW Midwives are basically competent medical providers. They are not crazy and undeducated like the DEM midwives sometimess discussed here. I don’t think you should worry too much about your friend as long as she is reasonable herself (e.g doesn’t insist on going 3 weeks post dates). They are not crazy – they will do all the normal prenatal tests, will recommend induction if you go 1 or 2 weeks past the due date, and will recommend an epidural after 24 hours of labor. There really is only one nutty midwife there as far as I can tell.

  • Emma

    I missed Rob and Katie’s comments the first time around, but I really am disgusted that they think that they are better arbiters of the pain a woman is feeling than the woman herself. I am in the UK and have come across the notion from midwives that they know better than you do. Community midwives attend your home after birth and the withering looks I got every time I mentioned that I had an epidural and forceps with my first daughter. Not to mention, with my second child, being pestered by them and having them insist on attending my home despite the fact that I was receiving consultant led antenatal care elsewhere. (I should say this was after I attended my GP for an injection and the receptionist decided to pass my details on to them).

    As for epidurals though I resent the notion that I was brainwashed. The first time around I was all about natural birth, I gave birth in hospital, but I am ashamed to say had bought into the propaganda about no drugs etc and had no intention of having an epidural going in. I was induced and when I reached the labour ward I was screaming and thrashing in pain. The two midwives attending had no intention of ordering an epidural and only did so after the consultant insisted.

    As for breastfeeding I did everything you were not supposed to do, underwired bras, topping up with formula to get some sleep in the early months. The only thing that hindered me was a nursing policy in the hospital not to remove a canula, despite it not being used, just in case it may be needed in the 3 days I was in there.

  • Allie

    “That would probably be because birth interventions DON’T have any impact on women’s ability to breastfeed.”
    Actually, getting those pesky stitches in my clitoral artery, if such can be considered an “intervention,” ate up the so-called “golden hour” and the little nugget slept for damn near two full days after that, but I went on to breastfeed for 23 months instead of dying, so all-in-all, I’d call it a win : )

    • An Actual Attorney

      “those pesky stitches in my clitoral artery” — AAHHHHH! That’s a sentence I wish I could unread.

      • sdsures

        *clenches ALL THE THINGS* I hope you’re on the mend.

    • Samantha06

      OMG! You poor thing!!!! I hope you had LOTS of pain medication!!!

  • Mishimoo

    OT: Wish me luck, I snuggled and kissed a 5 month old before I found out that he’d recently been exposed to a kid with chickenpox. My youngest is due for that vaccine on Monday and I have been meaning to get it for ages (I know, it’s my own fault if I get sick) because I didn’t catch it as a kid and missed out on the vaccine as my parents were antivax at the time. Calling my doctor in the morning and hoping that they’re open.

    • fiftyfifty1

      Good luck!

    • Amazed

      Good luck!

    • sdsures

      Good luck!

    • Guesteleh

      You may not remember getting chicken pox as a kid but you were almost certainly exposed to the virus and likely have antibodies. You may want to have a titer drawn and tested–it would be reassuring if you discover you’re already immune. This was my experience when a coworker had a shingles outbreak and we all had to have titers to make sure we were immune. I had no memory of getting chicken pox but I had the antibodies. Good luck!

      • Mishimoo

        Thanks, I was hoping for that but unfortunately I had my titres done and I don’t have immunity to chickenpox. I meant to go and get the shot once I’d weaned the youngest but then life happened and now I’m regretting not making more of an effort. Have to call back tomorrow because they’re swamped with only 1 doctor, 1 nurse, and 1 receptionist and a flood of New Years injuries.

        • Samantha06

          I hope everything is ok!

    • araikwao

      Oh no… Hope all goes well for you, and keep us posted

    • Mishimoo

      Update: The 5 month old hasn’t come out in spots yet. As long as he doesn’t develop lesions in the next few days, we should be okay.

      I’m still going to get my varicella vaccination as soon as possible, and hope that the airconditioning at my doctor’s surgery will be fixed quickly. They’ve had to halt vaccinations as it’s too hot without the airconditioning to safely open the fridges because they’d lose all the vaccines.

      I really hope that the 5 month old doesn’t catch chickenpox, he’s very small and I’m scared that it would make him rather sick.

  • SporkParade

    While we are all respecting women’s medical preferences here, I have a question for the practitioners. What happens if a woman is scheduled for a C-section, but her platelet level is below the level where an epidural can be given (I assume spinals have the same restrictions as epidurals)? I just barely made the threshold last time, and I’m trying to figure out which is worse if they fall too low next time: C-section or vaginal delivery.

    • General anesthesia is an option, even if not the preferred one. It is true that GA does mean that more of the anesthetic reaches the baby, but there are several factors to consider.

      One, it takes barely two or three minutes to get the baby out, after the initial incision. Most of the time in the operation is spent closing after the birth. Anesthesia is begun literally at the latest possible minute, to keep the effect on the baby minimal. (There are also maternal risks for GA, but no more than any other surgery.)

      Two, when GA is used, the pediatric team is prepared in the event the baby is a bit sleepy, so they aren’t caught unawares and can act immediately.

      BTW, all three of my children were born by C/S with GA, without complications.

      • Cobalt

        I had GA for a hernia repair. LOVED IT! I was awake, then I was awake later. No weird opiate symptoms, no perceptual changes, no memories of feeling doped.

      • theadequatemother

        Studies of elective cs under SAB or ga show richly the same maternal risks. Most of the dangers that are attributed to ga cs occur during emergent situations.

    • The Computer Ate My Nym

      Pregnancy related thrombocytopenia (assuming that’s what it was) doesn’t necessarily recur but it often does. So you may not have a problem, but it’s better to think of the options ahead of time (as you are, of course). General anesthesia or regional (for vaginal delivery if you go that route) are options. If your platelets are borderline for epidural, the c-section itself should be no problem (there’s a higher platelet threshold for epidural because it’s a big needle in the spine where you don’t want ANY bleeding rather than a relatively low risk space like the abdominal cavity where minor oozing can be tolerated). I’ve occasionally heard anesthesiologists express willingness to give spinal anesthesia when epidural is out because the needle is smaller, but I’m not sure of the details. Might be worth looking into.

    • theadequatemother

      Different anesthesiology practitioners have different platelet thresholds. If you schedule a repeat cs then they can check your plates prior and maybe pulse steroids to improve the count to let you have regional anesthesia. If ou got for vaginal you will have to take what comes. Even with a ga cs th pain control will be better than an unmedicated vaginal or vaginal wih nitrous and or fentanyl.

      • SporkParade

        That’s exactly what I wanted to know, thank you. I believe my hospital actually has a threshold of 100 as department policy. Although I’m still scared of intubation and general anesthesia. 🙂

        • Cobalt

          I had GA for surgery and was really happy with it, but I am really afraid of epidurals so went without painkillers for my deliveries. This is why options matter!

          I was really scared going into surgery, but it was actually really easy from my perspective. The intubation and everything was after I was knocked out, so I just was gone and then woke up later with a little voice hoarseness. I didn’t have any nausea from the meds, but I know that varies wildly from person to person. I would strongly consider GA if I am ever pregnant again and planning a cesarean.

  • Maria

    I was late to the orgy of nonsense that was Rob’s commentary, and everyone responded better than I could have, but I missed out on Katie. I hate feeding the egos of the parachuters, but I may need to read up on how my epiduralized vaginal birth and my c-section affected my breastfeeding relationships with my two girls…oh wait, they didn’t.

  • Brix

    Rob can suck it!!! Until the day science allows HIM to become pregnant and experience pregnancy and birth he needs to STFU with his stupid ass opinions with regard to whether pain relief is appropriate during childbirth!!! I don’t care what stupid classes he’s taken that give him the false confidence of his knowledge of the birth experience! He has NO effing medical degree and NO effing UTERUS!!! He’s not even an effing MIDWIFE!!! He’s a STUDENT!! So eff off, you fracking wanker!! I don’t need ANYONE, most ESPECIALLY a man to tell me what’s right for my fracking pain!!! Of all the arrogant, egotistical, self-satisfied, smug, ignorant sanctimonious ABSOLUTE HUBRIS!!! Who the HELL does he think he is?!?!!

    • Sue

      You are right, but one shouldn’t even need to experience severe pain to have empathy for those who do. I have never had a heart attack or a broken leg, but I don’t deny patients effective pain relief on that basis!

      Smugness and hubris describe so many of these Dunning-Kruger sufferers.

    • just me

      Yeah, and these types always claim that women are somehow misled or conditioned into thinking they need pain relief. I think the opposite is true–with all the natural birth, “you can do it!” crap out there, women think hey maybe it won’t be so bad. Then they’re like holy shit this hurts way worse than anything. Horrible cramps x 1000.

    • toofargone

      I’m with you there. I just want to grab him by the balls and say “oh, you are just brainwashed by the media into thinking this is painful. I mean how many times on TV do you see a guy getting kicked in his junk doubled over in pain. In third world countries men kicked in the balls don’t wince at all. It’s more natural just to take it like a man and naturally let the pain subside, after all its only temporary pain. The pain that’s all in your head I mean.”

    • theadequatemother

      Given the current climate at midwifery training programs his sanctimonious bs is probably what got him a spot in the class.

      • Brix

        You’re probably right.

  • Kq

    If just one person – anyone – had actually addressed, rather than just acknowledged, my fears about it, I would have had a much better birth. My cs was uncomplicated, but I was so scared I had an anxiety attack. Half the terror was about being awake during surgery. I wonder what it would have been like if c section wasn’t some terrible, inferior outcome – this scary specter to be avoided at all costs. This thing so awful that total strangers have no problem telling you your birth, your child, your ability to mother – that YOU are damaged. Knowledge is how I deal with fear. I was not terrified during other surgeries and procedures – ones without the bizarre social baggage of birth. It really does bother me.

    • Meredith

      I had a scheduled csection for my 3rd birth after two very scary vaginal births with my first two. At the (new to me) hospital, the woman giving the tour to our group didn’t even tell us what would happen or where to go if we needed a csection. Finally, I raised my hand and asked her about the csection procedure, where to check in, etc… and she said they would tell me all that in the unfortunate event I needed one but they would do everything they could to prevent it. I told her my csection was already planned and as far as I was concerned not unfortunate. She asked me why?! Like that was any of her business. This was my 3rd kid, but what a horrible thing to hear for the first time moms on the tour. And for the record, my csection was the best birthing experience out of all 3. I was able to ask my doctor for the ins and outs on the c-section and the check in procedures, etc.. but I’m sure new moms would have left that tour thinking a c-section was the worst thing that could happen to them. My doctor even wrote a letter to the hospital enraged about that guide.

    • fiftyfifty1

      Kq, when you say address, do you mean try to debunk the myths surrounding it? Or do you mean come up with a concrete plan (meds, support, therapy etc) to try to decrease the anxiety? I think that as a doctor, if this were one of my patients, I would try to do both perhaps (depending on what was needed). But there can be a fine line between trying to debunk a person’s fears and invalidating a person’s fears. I guess I’m asking if your doc had said “I understand you are afraid, but I think your fears are misplaced because xyz” would that have been helpful or not? Or what would have been helpful?

      • Kq

        Yes. A concrete plan and debunking would have helped – as would being talked thro through the procedure in advance.

        • Cobalt

          That’s what I would want if I was planning a c-section.

          • Dr Kitty

            Maybe Dr T or one of the anaesthetists would do a “no scare mongering” post about what actually happens before, during and after a CS.

          • Cobalt

            That would be excellent. What does it feel like? What really happens? What makes it safe?

          • TwinMom

            Yes. My husband is an anesthesiologist and it was priceless to me, my relatives, and my girlfriends when he walked us through the procedure, the things we could or would feel, etc. What was normal to feel and what was not. Priceless. Fear of the unknown is quite powerful, and I think people can do quite well emotionally so long as they know what to expect.

          • theadequatemother

            I have a post on just that topic on my blog

          • sdsures

            Yes, please! Maybe include (or do separate posts) about the different things that might come up ie needing vacuum, forceps, etc. if a TOL is done.

        • EastCoaster

          I think talking through a procedure in detail helps my fears significantly. I have incredible procedure-related anxiety and really the only thing that helps (aside from mountains of Ativan, of course) is knowing exactly what will happen and when. No glossing over details, no minimizing the unpleasant parts.

          I had to have a trans-bronc lung biopsy a couple of years ago and I was so thankful for the respiratory therapist who took the time to tell me exactly how the procedure worked. It made things so much easier for me.

        • sdsures

          “I think talking through a procedure in detail helps my fears significantly.”

          Me, too. This extends to all kinds of medical procedures.

    • sdsures

      *hugs* Anxiety totally sucks.

  • GiddyUpGo123

    OT: My hospital did not offer epidurals. We could request an “intrathecal,” but woe to us who didn’t time it exactly right, because once it was worn off the only other option was nubain, which I can tell you from personal experience does absolutely nothing. The intrathecal worked great, while it was working, but I asked for it too soon both times so got to do all the pushing stuff totally sans-meds, which believe me was not my preference. I asked but was never given a straight answer about why the hospital didn’t offer epidurals, and I gathered that it had something to do with not having the budget to have an anesthesiologist on staff who could do them … but WTF? Is this outside of the norm for most hospitals, or is it common? I don’t live in a huge town (12,000+ population) but we do have a decent sized hospital.

    • just me

      Was this in the US????

      • GiddyUpGo123

        Yep, Northern California.

        • just me

          Whoa. Shocked here in northern/central coast california. That’s crazy.

    • Therese

      Um, doesn’t an anesthesiologist have to do intrathecals as well?

      • GiddyUpGo123

        Yeah, and of course they have to have one for c-sections too. But I got the idea that epidurals were different somehow, either because of scheduling or training or whatever, and now that I’m typing that all outloud it sounds completely wackadoo, so I guess I really have no idea and am even more confused than ever ….

        • Sue

          They often do a spinal for the surgery and epidural for the post-surgical pain-relief – just involves putting the end of the catheter in different anatomical spaces.

    • fiftyfifty1

      I trained at a hospital in a large city in the midwest that also offered intrathecals (ITN) instead of epidurals.They did not routinely offer epidurals until ~2004. Here are some random thoughts about it:

      ITN is easier and faster to place. It was promoted in the 1990s as a way that smaller hospitals without an anesthesiologist on site 24/7 could give fairly effective pain relief (although at our hospital, they were all placed by anesthesiologists anyway).

      Part of the push was a desire to cater to NCB ideology. Women typically have some mobility, even to the point of walking, and also are not “tied to the bed (gasp!)” by the tube. Some of this ideology was coming from the patients at the time, but some of it sadly was also coming from a few people within the faculty.

      ITN just isn’t as effective. Our hospital eventually did a study of it and found that women said it was less effective and were less satisfied than with epidural. It turned out that a lot of women said that they valued mobility before they were ever in labor, but once they were in labor, they didn’t actually value mobility but instead wanted effective pain relief.

      ITN is helpful for contractions but typically pretty worthless for pushing/perineal pain. It can even make perineal pain worse. I eventually did an away rotation at a hospital where epidurals were freely offered (and frequently accepted), and boy is it a dream to stitch up a tear with an epidural on board vs ITN or nothing! You still typically need to use a local (lidocaine) but the epidural helps SO MUCH!

      ITN does need to be timed right. The med mixture can be varied somewhat to make it last longer, but it still eventually runs out. A second shot of it can be given.

      Between the study that came back saying ITN wasn’t as effective and women voting with their feet, our hospital eventually adopted epidurals. By 2003, when I delivered there, they were already available but typically “only if the ITN failed”. So I got ITN (which indeed did fail) and then an epidural. Soon after they decided to go straight to epidural unless a woman really wants ITN and asks for it (rare).

      • GiddyUpGo123

        Thank you for your reply. I think part of the partial answer I did get at the hospital had something to do with not having an anesthesiologist on site around the clock, and I do recall having to wait a very long time for mine because I asked for it after he had already gone home for the day, and they had to call someone in to do it. But I never understood why they couldn’t just call him in to do an epidural if he was going to come in and do the intrathecal anyway.

        I would not be at all surprised to learn that not offering epidurals had something to do with NCB ideology because our community is *very* crunchy with lots of people here homebirthing and refusing vaccines.

        After the first experience and knowing that the intrathecal just didn’t work very well, I considered delivering in another hospital but the nearest one is about 45 minutes away and the thought of delivering in a car alongside the road was way more terrifying than the thought of not being able to have an epidural, plus I really liked my OB and didn’t want to switch. I imagine one of the reasons why the hospital still hangs on to their no-epidural policy is because they have a captive audience … switching to a hospital 45 minutes away is probably viewed as problematic by a lot of people, and it’s not like the hospital offers *no* pain relief at all.

  • Samantha06

    Katie- If you’re still reading, this should make you feel much better about labor interventions and breastfeeding!

    http://www.gomerblog.com/2013/08/new-study-shows-fathers-breastmilk-improve-babies-intelligence-over-mothers-breastmilk/

  • Sue

    Why is it that we think the pain of labor should be endured? Didn’t these people ever have painful periods as a teenager? Dysmenorrhoea is natural and physiological too – but can hurt like hell for some young women. Are they cowards if they take Tylenol or NSAIDs?

  • The Computer Ate My Nym

    Very little of the drugs given in an epidural get into the bloodstream, much less into the fetus. That’s one of the advantages of epidurals over, say, general anesthesia given for a home birth turned stat c-section or IV/IM narcotics (which midwives do sometimes give). I’ve seen a few dozen babies born to women with epidurals. They were all wide awake at birth.

    C-sections don’t prevent breast feeding. Breast feeding isn’t all that significant anyway, but a c-section won’t stop you from doing it if you want to. The papers I’ve seen on the subject don’t even universally conclude that c-section is associated with a lower rate of breast feeding.

    • Kq

      My anecdotal evidence – had a cs and missed the first 2 hours of bonding tome – after an epidural AND narcotics, and the boy latched the first time he tried and nursed without the slightest problem until he self weaned at 11 months.

    • Meredith

      I had two vaginal births and one c-section. My milk came in faster after the c-section than with the vaginal births, probably because I lost less blood in a controlled setting versus the hemorrhaging of the first two. Either way, the notion that breastfeeding and bonding is compromised did not hold true with my births.

  • just me

    “It may not be safer”

    Then why the hell would anyone promote it?

    I’d like to see Rob get a “natural” root canal.

    • kt

      Why do a root canal in the first place? It’s more natural to leave it as doing anything to the tooth is unnatural… 🙂

      • Lauren

        No no no, a root canal is an unwanted, medical intervention! If you think you need one you have clearly been brainwashed by the tooth media, and if your dentist recommends one — well he’s just in the pocket of Big Oral Care. In fact, I bet he’s on Crest’s payroll, the shill.

      • Young CC Prof

        Hey, some infected teeth fall out naturally on their own. Dentists CLAIM that the infection can spread into the bloodstream and cause serious illness, but that’s just scaremongering! Trust teeth!

        • Trixie

          Clearly you’re not current with the work of Weston A Price, eugenicist dentist. Can I offer you a raw cream and bear fat smoothie?

          • Cobalt

            Is that the guy that says that (wildly paraphrasing here) breast fed babies become more beautiful adults because the superior nutrition improves the shape of the skull and jaws?

        • Mariana Baca

          You think you are joking, but really, there are woo infested people who think cavities can heal on their own.

      • just me

        Good point…tooth decay is a natural process. Our ancestors did just fine letting their teeth fall out naturally or having them pulled with no pain relief so we should too.

    • wookie130

      I think out of any of Rob’s remarks, this is the one that left me with my mouth literally hanging open. As far as childbirth is concerned, it positively floored me that he would still claim that natural birth was still “better” for the mother and baby, even though it may not be safer. How was this statement even remotely logical? If you want to sound completely insane, apparently this is the route you take.

  • Mishimoo

    I wouldn’t be alive without a caesarian. No ifs, no buts, no maybes. Please, do tell me how pushing a 9lb 15oz baby through an android pelvis during a placental abruption would have been “healthier, more empowering, superior, and far better for mum and baby.”

    • Sarah

      Because you wouldn’t have had a scar on your abdomen, obviously. Being a pretty corpse is preferable to being alive but not having a bikini body.

      • Mishimoo

        I was the baby – the quote from the ob/gyn that talked my parents into having the caesarean was a shocked: “I have never seen a live baby come out of that much blood!”

        • Sarah

          Ah yes, I entered this world via EMCS too. So far I appear to have survived the experience without overt damage to gut flora, and I was even ebf’d too…

          • Mishimoo

            Depending on who you ask, I was breastfed for between 6 weeks to 6 months and then put straight onto cows milk even though safe formula was available.

            I do have health issues, but only woo-addicted fools would blame them on the EMCS and milk, as current research points towards a genetic basis.

          • Sarah

            It was probably vaccination that did it.

      • An Actual Attorney

        My cs scar, hidden under my pubes, is not what keeps me out of a bikini,

        • Dr Kitty

          I’m covered in scars and I’ve been known to wear bikinis. Not that any bikini I wear is cut in such a way that you could see my CS scar.

          I’m perfectly happy for people to see my scars.
          They don’t make me uncomfortable, I’m happy with the results of my surgeries, I have no reason to cover up.

          It’s a really good test for unpleasant people. Anyone who asks rude questions isn’t worth my time.

          • Sarah

            Apologies, I hope my post didn’t imply that you shouldn’t wear whatever you want, or that scars ought to be hiddden away.

          • Dr Kitty

            Oh Sarah, no apology necessary!
            I know that’s not how you think.

          • Empliau

            I have quite a noticeable scar on my face, and I consider myself free to lie about it to anyone who enquires about it rudely. One of my favorites is that I got it in a fencing duel.

          • Empliau

            And I did not mean to upvote my own comment – clicked by mistake, and can’t get Disqus to take it off!

        • Sarah

          Ha! I don’t even have one, so not sure what my excuse is.

        • wookie130

          After two separate and fairly recent childbirths (the last being only 4 months ago…my kids are 17 months apart) via c-section, the scar is seriously the least of my cosmetic worries. I’m actually a bit more self-conscious of how large my behind has become post-pregnancy. Ha!!

    • MidtownParent

      We’ve lost several babies before birth (none during labor or because of labor). There is a measure of strength that you find when you know you have faced the single worst thing that can happen to a parent and survived it. I would trade all of that strength and empowerment in a heartbeat, if it meant I had my live, healthy babies back.

      • Mishimoo

        I am so very sorry for your losses, that is honestly one of my greatest fears. My first pregnancy ended at 10 weeks and I would have done anything to avoid it, I imagine that it would have been so much worse for you.

        Edited to add: That’s why, as weird as it sounds, labour is my favourite time of pregnancy. I’m right there in the hospital where we can be saved and it would be much harder for a complication to go unnoticed.

      • Brix

        I’m so so sorry. No one should have to experience the loss of their child. And even worse, children.

  • demodocus’ spouse

    Rob’s winking face just put extra emphasis on the truthiness of his statements.

    • CanDoc

      Oh truthiness, how you light our way.

  • sdsures

    Is this the first time NCB commentors have been awarded their very own post? How “impressive”.

  • Allie P

    “it is healthier, more empowering, superior and it’s far better for mum and baby.”

    Citation, please. It was not “healthier” for me to go post dates and wind up with a c-section when a timely dose of cervadil could fix my problem pronto. I in no way felt disempowered or “inferior” in my epidural-assisted childbirth.

    It’s only “inferior” if you decide there’s a better or worse way to give birth, which is a little like deciding, for everyone, if there’s a better or worse way to get to work without taking into account that some people live down the street from their job, some live across town, and some live on an entirely different landmass, with various and sundry transportation options, life situations, and weather conditions available to them. I was not the woman in the birthing suite next to me, I had not had her pregnancy or her baby, so our options and choices were not the same.

    I think the NCB need to make up their minds. Was it better or worse for my breastfeeding chances that I have a medical induction or that I wait for the inevitable emergency c-section? Speaking of which, my friend with an emergency csection breastfed for 20 months. So maybe it had nothing to do with manner of birth and everything to do with a variety of other factors?

    • moto_librarian

      This was my reply to Rob in response to his ludicrous assertion:

      “No, no it is NOT “healthier, more empowering, super and far better for mum and baby.” I never felt more disempowered in my life than when I was giving birth “naturally.” The pain of pushing was an indescribable agony. I just wanted it to be over. This was with the support of a fabulous nurse-midwife and L&D nurse who urged me to push in different positions, drink between contractions, and only have intermittent EFM. It was still horrible because for the vast majority of women, labor is excruciatingly painful. You are lying when you claim that it is better in any way. Because I was unable to control my pushing, I suffered a cervical laceration, 2nd degree tear, and massive pph that almost resulted in a blood transfusion. My midwife called for help immediately, but I still had to endure the manual examination of my uterus without pain medication. Once I finally received from fentanyl, the worst was over and I was wheeled back to the OR so the attending OB could repair my cervix. He did a good job – I was able to carry a second child to term without any problems – but my recovery was long and painful. We almost didn’t have a second child because the birth experience was so terrifying and awful.”

    • Sarah

      Shhh! Postdates induction absolutely does not reduce the chance of an emergency section! If it did, that would mean the whole cascade of interventions thing was a fairytale…

  • Sarah

    Which post/s was this on? I missed all the fun.

  • You know what doesn’t “feel right” to me, the denial of access to information on the choices available, the risks and benefits associated with each and the ability of women to freely choose what best meets their needs for themselves. It feels terribly wrong to drone on about the risks of “intervention” and at the same time ignore the “benefits” of same intervention. The risks to breastfeeding might be swamped by the benefit of potentially avoiding post part depression (see Society for Obstetric Anesthesia and Perinatology, August 2014, Volume 119, No. 2, “Epidural Labour Anesthesia is Associated with a Decreased Risk of Postpartum Depression: A Prospective Cohort Study”, Ding et. al). It feels terribly wrong to subject women to delivery processes that they clearly object to after being informed of the risks and benefits of the option, and then for those women to have no recourse and no large lobby groups advocating on their behalf – there’s is outcry when a woman is subjected to an “unwanted cesarean” and crickets when its an “unwanted vaginal delivery”. It feels wrong to pass judgement on other women who make different choices that best meet their needs. It feels wrong to tell another woman what to do with her body. It feels wrong to not support other women when they most need to be supported – when they are making difficult choices. It simply feels wrong to declare “you aren’t trying hard enough” when knowing that every mother gives it her all to do the best for her family….instilling feelings of failure and inadequacy at a time when a mother is just starting out seems terribly cruel, just as instilling feelings of superiority and triumph for things beyond her control seems to discount the accomplishments that come as a result of a woman’s hard work.

    • nervoussubject

      That phrase, “unwanted vaginal delivery,” should be used a lot more. Nobody would say a woman should be forced to do something with her vagina that she does not want to… unless it’s childbirth. It’s horrifying that woman can be forced into a vaginal delivery when they would prefer a c-section.

      A maternal request c-section should be available to any woman who wants one. That would be empowering.

  • Woolworth

    I am a UK midwife working in a hospital setting. Granted, things work different to the US but I do not know that any of my midwifery colleagues would ‘deny’ any woman an epidural if that is what she requested, regardless of what her birth plan specifies. If a woman at home or in a midwife led birth centre wants pain relief in addition to what can be offered, she is transported to the appropriate setting. It is not my role to try to assess or quantify another person’s pain and make a decision about their pain relief. I firmly feel that my job is to support and facilitate the choices that are made when feeling the pain (not when 12/40).The problem often lies with the availability of an anaesthetist. In the middle of the night when one anaesthetist is allocated to a Labour Ward and is required for an emergency CS, there is inevitably a wait for an epidural. Not ideal but certainly not because of some twisted ideology on the part of the midwife.

    • moto_librarian

      Then you are not part of the problem, Woolworth! CNMs delivered both of my sons, and I received great care from them. The issue with some midwives is that they are blinded by ideology, and will actively try to prevent a woman from getting pain relief, either by failing to put in orders or by lying about the risks.

    • Sarah

      It happened to me. The problem wasn’t anaesthetist availability- when finally called, he got there in 5 minutes. It was the midwife who decided, for whatever reason, not to contact him. I have experienced some superb care from midwives in the UK, but I have also experienced what Amy describes.

      • Woolworth

        Don’t understand the logic behind not contacting the anaesthetist. If you have chosen to give birth in a hospital setting it is either because you are high risk and have been advised to, or because you want access to the facilities a hospital has to offer. What does the midwife gain by delaying contacting the anaesthetist? Nobody keeps a tally on who achieves the most epidural free number of births.There is no ‘Midwife of the month’ award. The only thing I wrote in my birth plan was, ‘if I ask for an epidural it means I want one’. I did ask for one, with both of my children. Loved them. The only person with the capacity to decide on pain relief is the person experiencing the pain. Simple.

        • Sarah

          I have no idea why she did it. I only know that she did, and by the time I complained she didn’t work for that Trust anymore.

        • moto_librarian

          When I was pregnant with my first child and discussing the birth plan, my primary midwife told me that she had epidurals with both of her children, and that if I had a long labor that was not progressing, she would offer one to me. I was planning on trying for a natural birth (which I “achieved” at great physical cost), but it was reassuring to know that my decisions would be supported.

        • CanDoc

          Thanks for sharing your perspective, @Woolworth. It is an important reminder that not “all” members of Group X (midwives, doulas, doctors, whatever) can be painted with the same brush.

    • SporkParade

      Maybe they wouldn’t deny an epidural, but would they try to convince a woman not to get one? And would they give inaccurate or unsupported statements (as Katie did) in order to pressure the woman out of it? A woman in labor is in a very vulnerable position. She shouldn’t need to fight for accurate information from her care providers, let alone fight them for adequate pain relief.

  • Dr Kitty

    Rob insisted we were “twisting” his words, but seemed completely unwilling to clarify what he meant by his more offensive remarks, which is the mark of someone who either can’t defend their position because they know it isn’t defensible, or won’t defend their position because they don’t have the knowledge or skill to do so.

    • fiftyfifty1

      Whenever I say something and no matter what I say, I want those around me to express strong agreement and treat me like a hero.

      If that doesn’t happen it must be that you are “twisting my words”.

      • Amazed

        He was the only one who got me to resort to vulgarity (I think). My post to him was much more expressive before I edited it. I still see red at the thought of a man explaining to me how healthier and empowering pushing the endurance of my “down there” equipment when men are so concerned about their own down there equipment!

        I want him to pass a kidney stone through said equipment. Then, he can come back and argue.

        • MidtownParent

          I actually think it would be more effective for him to have to watch his wife writhe in pain, beg for relief, and try to explain to her why HE thinks she shouldn’t have pain relief. Or to have an actual crisis happen to his wife or baby during labor. I would never wish bad things to happen to innocent people, but it’s usually something that extreme that finally makes people like him “get it.”

          • anh

            Truth. I’ve been with my husband for nine years and the only time I’ve seen him completely horrified and paralysed with fear was when I was screaming and begging for an epidural. He says it’s one of the worst things he’s ever gone through

          • MidtownParent

            People seriously discount the effect of L&D, especially a bad L&D, on fathers. They sometimes walk away as wounded as the mom, and there is no one there for them.

          • moto_librarian

            I’ve said it here before, but one of my greatest regrets about natural childbirth was the impact that it had on my husband. He had already been widowed once, and when I began hemorrhaging, he was terrified. I was screaming and writhing during the manual exam, which almost certainly added to his anxiety. He was a Navy medic who I have rarely seen shaken by much of anything, but this did.

          • Mishimoo

            This! One of my friends would love to have more kids, but he never wants to “put my wife through that again” simply because it was such a traumatic birth, and he’s still carrying the pain of thinking they’d lost the baby and he was about to lose his wife. These things should not be happening, not in this day and age when we have the technology to do so much better.

          • Kq

            The first time I got pregnant, I asked my husband if he had any opinions on pain relief. He looked at me like I’d gone insane and said, “why would you want pain when there’s drugs for that?” He later said more than once that he had no desire to watch me suffer and was glad I wanted an epidural.

            During labor the epidural stopped working. They kept topping up the dose with no effect. My husband checked and noticed the catheter had come out of my back, and the medicine wad literally running out on the bed. He ran into the hall and physically dragged a nurse in. He said later it was the worst part of the experience for him – watching me suffer when there was something that could be done about it and nobody was helping. He’ll always be my hero for that.

          • toni

            Your husband sounds ace.
            Also.. you met penn and teller!!?

          • Kq

            I did! They hang out in the lobby after every show they do and meet everyone who wants to meet them!

          • toni

            did you see them in Las Vegas?

          • Kq

            They did a show in Oregon in November

          • Dr Kitty

            Yeah, as I posted in that thread, I don’t think Rob has had the experience to watching the love of his life in the throes of an unmedicated labour.

            I have a feeling he would find it difficult to watch.
            Or maybe he wouldn’t, and would still feel able to judge her if she failed to find it empowering and asked for an epidural.

            My husband knows he has exactly two jobs if I ever go into labour before my scheduled RCS and am unable to advocate for myself.
            1) “we need an anaesthetist in here, she wants an epidural as soon as possible”
            2) “we do not want a VBAC, please get a theatre set up for a section, now”.

            He also knows that if he meets any resistance he is to start taking down names and NMC numbers.

          • toni

            are you having another baby?

          • Dr Kitty

            Still early days, but yes.

          • Amazed

            Congratulations! I wish you all the best.

          • toni

            congrats! i’m early days too, six weeks I think.

          • Mishimoo

            Congratulations! Hope everything goes well.

          • Amazed

            Best wishes to you too!

          • Mishimoo

            Yay! Congratulations and all the best.

        • MLE

          I used the f word on Katie, first time in 3.5 years of commenting. Being an American, it was the media that made me think that’s ok to do, I’m sure.

          • Amazed

            Yeah, it was the media, no doubt.

            This chick was amazing in an evil way. Soooo patronizing.

          • Samantha06

            She seemed to enjoy being passive-aggressive..

        • Guesteleh

          Ha, you are pretty restrained if it’s just this once. These parachuters inevitably get me to pound ASSHOLE on my keyboard with my forehead, especially the ones who are passive aggressive.

          • Amazed

            I actually did write about him not being qualified to argue on the pain a woman feels because he’s the proud owner of a pendant down there.

    • lilin

      My favorite was when he said that midwives are trained to handle complicated labors – and a doctor from the UK dropped in to say, no, actually, doctors are trained to handle it.

      Then he said that specialty midwives did and they were fantastic. And the doctor said that, according to guidelines they shouldn’t. And asked what “fantastic” meant in terms of numbers.

      And then he said something like “this place is poison.” My point is, can someone get Rob a poetry grant so he can do less damage?

      • Sarah

        To be fair, I did have a fantastic midwife when my forced natural birth got complicated after I was denied adequate pain relief, and I couldn’t have done it without her help. But it was the obstetrician who was in charge.

        • Guest

          There are fantastic CNMs out there. It’s the magical thinking, risk taking and ideological driven ones who taint the profession for the rest of us.

          • Guest

            ETA…and yes, alongside every good CNM there IS an OB and alongside an OB IS a Medwife who realizes her limits.

      • Guest

        I believe Rob may have mentioned those midwives ‘specializing’ in HBAC. All I could think was how does one get specialized in VBAC? There are guidelines for candidates, contraindications and management. Every provider has access to such information, so are the ‘specialized’ midwives equipped with xray uterine integrity vision or can they time travel to an equipped OR from a woman’s living to safely deliver a baby? I don’t think Rob had any idea how foolish or woo swept he appeared.

        Fair enough complicated or High Risk women can be comanaged by CNMs with OB’s. The problem is having the right working relationship and the knowledge to what high risk is or when things are getting complicated.

        • Dr Kitty

          RCOG doesn’t support HBAC or VBAC in birth centres and Rob should know that.
          Anyone in the UK who has a HBAC is doing so against medical advice.

          Yes MWs in the UK attend VBACs, which are supposed to have CEFM, and immediate access to an operating theatre and an OB on site.

          The RCOG guidance on OVD remarks on the paucity of evidence for the use of ventouse in birth centres ( a single retrospective study) and therefore does not support the use of ventouse or forceps in midwife led birth centres.

          But it’s much more fun to cite anecdotes of special midwives with fantastic results without any evidence to support that claim.

          • Roadstergal

            My UK friend is planning an HBAC with the second she’s working on, delivery in water, just like her friend’s midwife-attended ‘healing’ HBAC. The midwives certainly aren’t selling it as AMA. Everything I hear from her that she gets from the midwives makes me angry. The evil of inductions and epidurals, uncaring OBs who only know how to cut, unneccesareans, hospital-acquired infections, all of the squares on the bingo card…

          • Dr Kitty

            NHS MWs or independent?
            If it was IMWs it wouldn’t surprise me in the least.
            If they are NHS MWs, that is BAD.

          • Roadstergal

            Good question – I had been assuming it was all NHS, but her friend might have been delivered by independent midwives, I don’t know either way. All the woo-selling to my friend is NHS MW.

  • This sort of stupidity almost makes me want to go back to work. I feel rather ashamed to be in the same profession as these two idiots. Women deserve better.

    • MidtownParent

      It actually reminds me of why I never want to work L&D. You never know when the patient who bought into this nonsense is going to come in, and then blame everyone except the woo-pushers when something doesn’t go “as planned.”

      • Samantha06

        Oh absolutely! And they do blame it all on us, like we “did this to them” or some stupid crap like that. They’re really pissed off at themselves but will never admit it.

  • MidtownParent

    Dear Rob: Many women don’t find thrashing around in unmanaged pain for hours on end, or vomiting/peeing/pooping on themselves in front of other people “empowering.”

    • sdsures

      I’ve experienced all of those things outside the realm of childbirth. It was NOT empowering.

    • Sarah

      Yeah, those are all fairly niche preferences normally. I’m not about to shade people who enjoy pain and pooing in company, all consenting adults etc, but the mainstream perspective is to not find any of those things particularly positive…

  • Guesteleh

    What got to me about Katie was she kept insisting that epidurals make babies sleepy even after several posters posted papers demonstrating that’s not the case. Also the snotty comment to NoLongerCrunching about never having seen an undrugged baby. Not quite to the asshole level of that sanctimommy who parachuted in here about a month ago but close.

    • moto_librarian

      She couldn’t show any evidence of course, but that didn’t stop her. I loved how theadequatemother schooled her ass.

      • Amazed

        When I see posts explaining how interventions hurt breasfeeding relationship and then resorting to anecdotes to support it, I am sorely tempted to give the example with my almost dying of a PPH mother, my exclusively powdered milk fed (before her milk came in as she started to recover) brother and our clearly superior genes. I mean, my mom’s body knew it was supposed to nurse her baby and remembered it all through the PPH and the recovery from it, my brother’s brains knew that powdered milk was just a second best until he could be breastfed, so he immediately tackled latching and drawing milk out, and those losers who had difficulties brought it upon themselves. It’s all in the genes, darling. I am so sorry you got the stupid ones.

        I swear, I am not far away from the day I’ll actually write that. For now, only the thought that they MIGHT take me seriously stops me.

    • Smoochagator

      I had two completely unmedicated labors, with two very alert babies. And then I had an induction with an epidural placed at 4cm, and a very alert baby. Anecdotal evidence: epidurals do not drug babies, thank you very much.

      Also, I experienced the “birth high” after all three births, so let me be clear: I am never, ever EVER going back to childbirth without pain relief. There’s no reason to.

    • CanDoc

      I had a heavily drugged and sleepy baby who breastfeed for 3 years and 2 days. I would have taken a lot more drugs if I thought it would have helped me wean him sooner.

      • Amy M

        Mine weren’t drugged, because epidurals don’t drug babies, but they were sleepy due to being a little premature. I wonder how many poor new moms are told that their new 36-38wkers that are a little sleepy is down to epidural use? How awful would that be? After 2 weeks, of eating and growing, my babies were more alert….I know that’s typical of late pre-term, so I wasn’t worried, but I bet jerks like Kate jump all over that one. Nothing like a group of exhausted and scared new mothers handed to you on a platter, to shame.

        • Young CC Prof

          Excessive sleepiness in a newborn can also be a sign of a serious medical problem. Attributing it to an imaginary cause may dangerously delay diagnosis.

        • anotheramy

          Interestingly, In my work experience, babies born post dates resemble those near-term preemies in terms of sleepiness and early developmental milestones. Another (albeit less serious) reason to be skeptical about NCB claims that waiting for baby to be born spontaneously is best.

  • MidtownParent

    This is one reason CERTIFIED NURSE MIDWIVES are the only way to go if one wants a midwife. Any CNM was a registered nurse first, and one of the primary things a nurse is taught is to let patients rate their own pain, not to do it for them. We’re also taught to educate and advocate for our patients, but respect their right to personal autonomy. I’ve yet to see those principles clearly practiced by other “midwives,” especially unlicensed ones.

    • fiftyfifty1

      But Katie IS an RN, and Rob is a midwife student in the UK. I agree that having formal nursing training is better than not, but these 2 cases prove that even formal training cannot guarantee compassion, competence of freedom from woo.

      • Samantha06

        Do we know for sure she is an RN? Some of the things she said really made me wonder..

    • SporkParade

      Do UK and Australian midwives not start out as RNs? Midwives in Israel need at least a year working as RNs in the hospital setting to even apply for midwife education.

      • MidtownParent

        I don’t know about other countries, so I can’t speak to that. My experience with U.S.-based “midwives” who aren’t CNMs has been universally negative. And while not all U.S. RN’s are good, there are many, many more good ones than bad ones.

      • 40 years ago, when I studied midwifery in the UK, yes, all midwives were registered nurses as well. Since then, it seems that most, if not all British midwives are now direct-entry, although their course of study is far more comprehensive than US direct entry midwives.

        • Guest

          Do you think not having become RNs first detracts from the experience gained from a nursing background (ie Med/Surg) for DEMs in the UK?

          • Definitely. Apart from anything else, not all pregnant women are in the best of health, and midwife-led models of care require that the midwives know when to bring in the MD.

          • Guest

            Thank you. I have often wondered this when trying to understand the Midwifery Model in the UK with Midwives providing care without the breadth of nursing experience. There seems to be such a comparison of UK midwives and US CNMs, but it seems an inapproproate comparison without the nursing model and with the majority of bedside care provided by RNs in the US and CNMs as the primary provider. This is not to say all US CNMs have an extensive nursing background, but the foundation and theory is there. I know several CNMs who went to nursing school on their path become CNMs, but see a difference in the practice of experienced RNs that eventually moved onto Advanced Practice/CNM. It seems difficult to address the health needs of pregnant (and nonpregnant) women without the foundation of generalized nursing.

          • Dr Kitty

            Or when the MD isn’t required.
            Pregnancy is associated with DVT, developing varicose veins and lower platelet counts.

            I have had a midwife insist a patient see me to rule out a DVT, because she had varicose veins and platelets of 146 (lower limit of normal 150) and MW felt that lower platelets would make a clot more likely.

            The lady in question had varicose veins since her first pregnancy, which were no worse than usual, no calf pain, redness or swelling, or, in fact any signs or symptoms of DVT, and I’m perfectly happy with that level of platelets as long as we keep an eye it doesn’t drop.

            So I got to say, “situation normal for pregnancy, don’t worry about it” to an anxious, tearful, terrified woman.

            A little knowledge is a dangerous thing, and midwives could do with a little bit more basic physiology education about non reproductive systems.

          • Sarah

            True, and this is more and more common as we become older, fatter and more capable of surviving to bear children when suffering the type of illnesses and long term conditions that would’ve killed us as children only a couple of decades ago.

        • anh

          Antigonos, is it wrong I imagine you like one of the gals from Call The Midwife?

          • Can’t really answer you because I’ve never seen the program — but I doubt it. I was only in the UK for a year, and three months on the district. Midwifery in Israel, where I’ve been since 1976, is very different from the way it’s managed in the UK.

        • Isramommy

          “most, if not all British midwives are now direct-entry”

          I find this horrifying. I can’t imagine giving birth with a midwife who wasn’t also a nurse.

          • Apparently the vetting criteria for homebirth have also been relaxed since my time — back then primigravidas were not allowed to deliver at home, now they are, and I think other standards have been changed as well.

      • Sue

        Australian midwifery has always been a post-graduate specialisation in nursing, until recently. There is now a direct pathway into midwifery training – a three-year bachelor of midwifery degree.

        My concern about this pathway is that it would be very difficult to accumulate a lot of experience of sick patients and complications in a practice population of mainly healthy young women. Having a background of working in medical and surgical wards, kids and emergency definitely makes you a better clinician pre-specialisation – whether you are a nurse, doctor or in a paramedical profession.

        • KarenJJ

          I’m against the idea of direct entry midwifery because for a lot of “young, healthy” women it is their first ongoing contact with a medical professional and all sorts of odd symptoms get picked up on that weren’t known previously (I was undiagnosed with an immune system issue and was picked up with anaemia of chronic disease and a friend’s first pregnancy she had undiagnosed Graves disease and was picked up with heart irregularities).

    • moto_librarian

      I think that you are generally right about this, but I was surprised at some of the things that my CNMs posted on their FB page. They were generally evidence-based, but once in awhile, something from Ina May or some other nonsense would pop up. I had to leave the group when I got tired of arguing with patients who were anti-vaxx (Some of them were pissed that the CNMs strongly advocated for both Hep B and Vitamin K).

    • CrownedMedwife

      Yes and no. When choosing midwifery care, CNMs are the only way to go. Unfortunately, they aren’t always the way to go. CNMs are not exempt from falling for the woo and that fact makes it impossible to carte blanche recommend CNM care across the board. I wish it wasn’t so, but it is true. There can be vast differences in management style and practice philosophies, which really shouldn’t exist if we’re all correctly and consistently reviewing the research and practicing according to guidelines without bias. Alas, there are midwives and medwives, but there isn’t a easy way for woman to know the difference.

      • demodocus’ spouse

        Yeah, I know a certified nurse who’s studying to be a midwife, and she’s got a fair dose of woo in her. Sigh. She periodically posts articles about the joys of waterbirth and such on FB.

        • Guest

          It’s a shame how the students can be swept into that. I remember once meeting with a woman contemplating a transfer to our practice. While discussing labor options, including hydrotherapy in active labor, she asked whether that included waterbirth. Naturally, I said no, birth occurs on land. She asked why she couldn’t have a waterbirth. She just looked at me perplexed when I informed her of the risks of waterbirth, lack of evidence supporting its safety and professional guidelines prohibiting its practice. While I believe she appreciated my honesty, I think she was thoroughly confused why other providers and social media purported the safety and benefits of waterbirth. It took a bit to keep myself from saying “WOO! It’s because of the WOO!”.

    • Liz Leyden

      Unfortunately, too many RNs don’t take patient pain reports seriously, especially if the patient is taking narcotics. Apparently, asking for pain meds when they’re due is “drug-seeking behavior.”

      • Samantha06

        I have to disagree with you on that. Where I work, it’s taken very seriously and patients are medicated appropriately

  • Oceanblue

    Well, I didn’t want to breastfeed, so I guess that epidural I got was perfectly fine, am I right? 😉 But seriously…I know what pain is, I was quite the daredevil as a child and got myself into all sorts of accidents and lots of injuries and several hospital stays. I have had my appendix out and surgery on my knee as well. So they can kiss my rear end if they don’t think I know what pain feels like.

    • Sarah

      Yeah, I think the bigger question is why I’d give a tiny shit if an epidural would make breastfeeding more difficult.

  • fiftyfifty1

    It’s difficult to decide which one is harder to stomach: plain midwifesplaining (e.g. Katie)or midwifesplaining + mansplaining (e.g. Rob).

    I must say, however, that the combo-‘splaining is more amusing. Listening to Rob go on about what he is sure he would want (if only he had a uterus!!) is golden.

    • The Bofa on the Sofa

      I saw a graphic the other day about “what men would do if they were women” and “what women would do if they were men.” I don’t know (nor care) if it was serious, but that has been in my head since Rob’s “if I were a woman” comment.

      I don’t even remember all of the graphic, but I remember this part. What men would do if they were women? Most common answer: Play with their boobs.

      The end.

      • Roadstergal

        I’m sure that the #1 answer _really_ was “Give birth to a big-headed baby with no pain relief,” but it got lost in the notes.

        (I’ve told my husband more than once that if I had a penis, I’d never get anything done. Not even sexually – the whole package is just so much fun to play around with! (Much like I sometimes give in and play with my boobs).)

        I do not judge myself competent to tell any man that it doesn’t _actually_ hurt to get kicked in the balls.

        • Mishimoo

          But it’s a good pain! It lets you know that everything is there and all of the nerves are working just fine.

        • The Bofa on the Sofa

          (I’ve told my husband more than once that if I had a penis, I’d never
          get anything done. Not even sexually – the whole package is just so much
          fun to play around with!

          You just have to know how to multi-task.

          Although you need to remember that it is also self-limiting to an extent.

    • moto_librarian

      Kidney stones are quite awful, but I rather hope he gets to pass a very large one soon, au natural.

      • Dr Kitty

        I think I’ve told this story before.
        Patient comes to see me for a sick line after having been in hospital with renal colic. His wife is with him.

        He says “It was awful doc, even worse than that time I got shot! Thank God for morphine, eh!”

        His wife says, “Remember that time I had kidney stones when I was pregnant and they wouldn’t let me have the good painkillers? It was almost as bad as labour”.

        He looks horrified “You mean labour was worse? We have four kids!”

        Wife rolls eyes.

        • Dr Kitty

          Just in case Rob is still reading.

          Getting shot is preferable to medicated renal colic is preferable to unmedicated renal colic is preferable to labour pain.

          But labour pain is “empowering”, apparently, so, you know, actually “superior”.

    • Young CC Prof

      Some men are great obstetricians. You don’t need to have a uterus to be an expert on them. Many of the anesthesiologists who do epidurals and discuss the subtleties of technique and advantages and disadvantages are men.

      HOWEVER, I cannot deal with anyone without a uterus claiming that pain relief in childbirth is silly or unnecessary.

      • moto_librarian

        There was a male midwife in training when I was pregnant with my second. I saw him for one of my prenatal visits, and he was quite compassionate and good. Rob needs to stop pontificating about what women ought to do, and instead focus on what they want and need during labor.

      • MidtownParent

        One of the best male OB/GYNs I ever knew said he was glad not to have a uterus because he saw the pain they cause. His assumption was that the owner of the uterus knew best how much pain it was causing. I’ve actually seen female OB/GYNs with far less sense than this.

        • demodocus’ spouse

          I hear you. I saw a few different OBs in the practice, and the female was the one I didn’t want to see again. Partly a minor personality conflict, but largely because her perfume made me feel queasy. She sees pregnant ladies all day long, some pregnant ladies develop painfully good senses of smell, she probably runs across a few a week at least. *Why* would you wear perfume? (or perfumed hand sanitizer, extra smelly shampoo, etc)

          • me

            She may not realize. The pregnant nose can be so fickle, and unless someone has said something to her about it, she may have no idea. I know perfume never bothered me, but the smell of Pampers baby wipes became god-awful! It was like, how on earth did they find the one fragrance that smells worse than toddler shit???!!

          • demodocus’ spouse

            *all* scented things were bugging me. And cooking meats. Sigh. Better now.

          • Dr Kitty

            My husband smelt “off” to me when I was pregnant with my daughter and I only found him bearable to be around if he wore a specific cologne. He smells perfectly fine normally BTW, I was just a bit weird.

            I survived much of that pregnancy by wearing a strong smelling solid perfume I liked on my wrist and sniffing it if I got overwhelmed by whatever odour was going on around me. Green Tea was a winner. Using alcohol hand sanitizer a lot helped too.

            The produce and meat aisles in the supermarket were my least favourite places.
            Being in the vicinity of onions, garlic, raw meat and aged cheese made me vomit more than once.

      • SporkParade

        I adore my male OB/GYN. I really, really hope I am done having kids before he retires. There’s a limit to how far woo can sell here, but it nonetheless goes further than I am happy with.

      • sdsures

        I had to have a colposcopy under sedation because of my primary vaginismus, because I have never been able to have a Pap smear done successfully. I asked for the colposcopy so we could be sure nothing was wrong that might be overlooked by not being able to have a Pap done regularly. (Everything is fine.)

        We did still try whilst I was conscious, before setting a date for the procedure, to use a speculum, but it just didn’t work. I don’t know how many of the readers here are familiar with vaginismus, but it has a psychological as well as physiological component. Suffice it to say that trying to use a speculum on me caused me to have a severe panic attack: screaming crying, the works.

        Both the gynaecologist and the registrar were male. My husband was allowed to stay with me during the attempt. Neither of the doctors ever tried to dictate what I ought to be feeling. Both of them were very kind and sensitive and did NOT try to do the awake procedure on me again. I had the procedure done under sedation, and all is well.

        • toni

          I have it too. I feel ya <3

          • sdsures

            I’m lucky my husband is very understanding. We’re making slow progress.

        • Mel

          I have vaginismus as well. I can get through pelvic exams, but I need to be able to focus on deep, even breathing and actively relaxing my PC muscles or I get stabbing vaginal pain.

          Thankfully, my doctors have always been excellent support. In fact, one of my docs took the time to teach me the correct medical/anatomical terms to explain to different doctors the different positioning of my vagina – which makes a huge difference since when a spec is inserted as for a more normal vaginal opening it hits the PC muscles dead on and starts a spasm. That was a huge relief to me as a youngish co-ed who was worried about changing doctors.

          • sdsures

            I think my uterus might be oriented slightly forward – that’s all I remember from the exam report.

    • Allie P

      My male OB is fond of saying that if men gave birth, there’d be no such thing as NCB, pain relief in childbirth would be universal, and all manner of birth control would be fully covered by all insurances. Because misogyny.

      • me

        Yup. And abortion would be a sacrament.

  • moto_librarian

    Poor Katie got the vapors when one of our regular commenters stated that her hospital has a 98% epidural rate. She simply could not fathom why this would be the case. Rob is equally perturbed by epidurals and c-sections, and seems to think that these are related to moral failings in the American populace. Here’s a newsflash for both Katie and Rob: many women in Australia and the UK would love to have better access to epidural anesthesia, but they are stymied both by a lack of anesthesiologists and by midwives who are more interested in promoting vapid ideology that is unsupported by fact. Katie even has the gall to suggest that that active management of the third stage may cause breast feeding failures, while failing to acknowledge that a mother who dies due to a massive pph will definitely not establish a breasteeding relationship with her infant.

    Katie says she is not currently practicing, and Rob is still a student. I sincerely hope that neither of them attends to laboring women.

    • Guest

      Just attended two births, both grandmultips and a few former homebirths, both received their first ever epidurals, both thrilled to bits about effective pain management, both proceeded to have uneventful births and healthy babies. I assume both, according to Rob, must have just been watching too much TV. After all, why else, according to Rob, would a woman choose to get an epidural? Won’t address Katie, I’m sure she has swooned by now.