Women can’t reclaim their agency from doctors by giving it to midwives and lactation consultants

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Where did the natural childbirth and lactivism industries go so wrong?

Why do I receive emails and Facebook messages from desperate women nearly every day detailing their guilt, self-abnegation and torment over “failing” to give birth vaginally or to breastfeed?

Why, when I talk about my forthcoming book with friends and acquaintances, do women years removed from childbearing burst into tears about their struggles?

Yes, it’s true that the philosophies of both natural childbirth and lactivism were created as ways to convince women to remain in the home instead of seeking legal and economic emancipation, and we should never forget that when considering their harmful effects on women. However, their retrograde beginnings were shed (and hidden) when natural childbirth and lactivism reached the mainstream, and the original impetus from both advocates and adherents was strong and resonated deeply. The original goal of the philosophies of natural childbirth and lactivism was to reclaim women’s agency from doctors. Instead of doctors deciding that women should be asleep during birth, deprived of emotional support from partners and subject to unnecessary procedures like shaving and enemas, women insisted that it was their right to decide to be conscious, to be accompanied by partners and to accept or reject procedures based on informed consent. Instead of being convinced to forgo breastfeeding and forced to forgo it due to lack of breastfeeding support, women insisted that it was their right to receive encouragement and support in nourishing their infants in the way they thought best.

In other words, from the 1950’s to the 1970’s, the philosophies of natural childbirth and lactivism were about reclaiming women’s agency from doctors.

The name “Baby Friendly Hospital Initiative” is a deliberate slap in the face to women.

Where did the natural childbirth and lactivism industries go wrong?

Both natural childbirth and lactivism went off the rails when they insisted that the only way women could reclaim their agency from doctors was to hand over that agency to midwives and lactation consultants.

Here’s what childbirth and lactivism would look like if women were in charge of the decision making:

All possible choices would be represented because women have a broad spectrum of needs and desires.
Birth plans would just as readily include maternal request C-sections as unmedicated vaginal births.
Pain relief would have a prominent place in birth plans since most women find they need pain relief.
Women would choose how to feed their infants based on what worked for them, and they would NEVER be shamed for bottlefeeding.
Free formula gifts would be available to those who want them.

In other words, every safe childbirth or feeding decision made by mothers would be respected by professionals and by other mothers, just in the same way that we owe respect to women for whatever decisions they make about who or if to marry, whether or not to have children, and whether or not to work outside the home if they have children.

Decision making would be bottom up: women would make the decisions and inform providers of their choices.

Instead, in the process of women reclaiming their agency from doctors, midwives and lactation consultants swooped in to steal if from them. Within natural childbirth and lactivism, decision making is top down. Midwives, doulas and childbirth educators decide what a “good” or “normal” birth should look like and they force that decision down women’s throats, complete with hectoring and shaming dressed up with the twin lies of being “better for baby” and “evidence based.” Lactation consultants decide how babies should be fed and force that decision down women’s throats, complete with hectoring and shaming dressed up with the twin lies of being “better for baby” and evidence based.”

The Baby Friendly Hospital Initiative (BFHI) is the paradigmatic example of how natural childbirth and lactivism reflect top down decision making and deprive women of their own agency.

The name “Baby Friendly Hospital Initiative” is a deliberate slap in the face to women.

It reflects the professional lactivists’ beliefs that they know better than women what is best for them and their babies, and, it is the apogee of mother shaming.

I am appalled that any hospital allows such an organization anywhere near emotionally fragile new mothers. Political consultants say that when you frame an issue, you own it. The medical community has regrettably allowed an organization of zealots to frame the issue of breastfeeding as “baby friendly” when it may be anything but baby friendly, to explicitly ignore the needs of mothers, and to ratify shaming as an acceptable tactic for manipulating women. Any women who does not breastfeed is branded as not “friendly to” her baby. The medical community has empowered a group of zealots with top down decision making authority over infant feeding. These zealots explicitly deprive women of agency. The assumptions behind the BFHI are that women cannot be trusted to make decisions for their infants, they must be hectored into breastfeeding, any alternative must be made as inconvenient as possible, and that bottlefeeding or combo feeding mothers can and should be deprived of valuable infant formula gifts.

Lactivists rationalize their abysmal and disrespectful treatment of new mothers as “better” for babies … just as midwives justify their insistence on unmedicated birth as a standard by claiming that is is “better” for babies and mothers … just as doctors justified shaving and enemas as “better.”

In every case, women are deprived of agency, purportedly for their own benefit.

Women should understand that standards for birth or infant feeding are efforts at top down decision making that ignore the individual wants and needs of women and babies. Unmedicated vaginal birth is no more “better for babies and mothers” than shaves or enemas. Both reflect the preferences of providers, not the needs of mothers or babies. And the Baby Friendly Hospital Initiative is the most egregious example of depriving women of agency. Its name should be changed immediately to expunge the stench of mother shaming and it’s goals should be modified to reflect the critical role of mothers in determining what is best for them and their babies.

Women can’t reclaim their agency from doctors by ceding it to midwives and lactation consultants. The guilt, self-abnegation and torment of so many mothers reflects that fundamental reality.

  • Lauren

    THANK GOD for this. My only criticism is that you hadn’t written it 7 or 8 weeks ago, when I was in the hospital after my son was born via c-section. We had decided on exclusive formula feeding well beforehand, for a variety of strong, personal reasons, none of which were medical. If you wanted to be a jerk, you could say we chose formula and couldn’t be bothered to even try breastfeeding, because we weren’t going to even try (we saw no reason to). I read a lot of research on both sides, thankfully found this blog, and felt confident about our decision. I battled with doubting family. Hubby battled with outright obnoxious and angry family (and friends!). We stayed strong in our decision and I had no problem scribbling out the 90% of the questions on my intake form that asked exclusively about BF (and nothing about bottle or formula). I wrote in big letters ‘NO LACTATION CONSULTANTS PLEASE!!’
    Our son was born, no LCs came. Free formula was provided.
    It was going well.
    However. ..
    I was teetering on the verge of total depression and anxiety leftover from a hideous pregnancy and 2 previous miscarriages. I was afraid to do anything more than hold our son. Everyone else fed and changed him.
    On a walk through the ward we spotted the door the the BFHI LCs office. It was the only door in the entire wing with any ‘decoration’. Featured heavily was a poster reading: Keep Calm And Refuse Free Formula. An incredibly horrible (and totally inaccurate) article clipped from the Toronto Star, complete wirh highlighted sections, was front and center – it included how formula causes obesity, lukaemia, diabetes….
    Hubby and I were so angry we wanted to tear all that crap down and scrawl “Breastfeeding Bullies!” on the door, but thought that would be petty.
    We ignored it.
    No, HE ignored it.
    It ate me up alive. It slowly eroded my confidence in formula and erased any joy of motherhood I had. It ruined me to the point that one night before my husband returned to sleep in the room I was alone and was forced to feed my son on my own. I sobbed the entire time, moaning ‘I’m not poisoning you! I’m not!” over and over again.
    Not a single nurse, resident, or doctor had shown the slightest derision or judgment over our FF, but all it took was seeing that door to crumble me into pieces. It was so bad I insisted on leaving a day early, against all medical advice.
    And then, for the first weeks that followed, every so often I would be overcome by fear, guilt, and terror and could be found sobbing while feeding my son, crying that I wasn’t poisoning him, desperately terrified that I was.
    It culminated in the evening after several days on yet another formula brand, and my son simply screaming without stopping. He wouldn’t eat, and anything he did manage to swallow he threw up again. He was in pain, he was red-faced and contorted. I was beside myself with panic and horror, crying that I was hurting him with formula.
    My husband took our son out for a walk and called my mother for help. They took him for a long car ride, leaving me at home in my own misery, certain I was poisoning my child, wondering if it was too late to breastfeed (it was).
    Thankfully a good friend with a 3 year old daughter was online, and answered my question of “Do you ever feel like you’re wrecking your child?” with, “Oh honey, all the time.”
    She gave me what I should RIGHTFULLY have gotten from the birth ward nurses — real support and answers about FFing, not just stoic acceptance. Before the BFHI came to Ontario, nurses actually gave out packets of information on BF and FFing, and gave real support to new parents. Combined with cutbacks and a nurse shortage the BFHI has managed to infiltrate and comandeer all aspects of infant feeding in our hospitals. Some cities have now banned free formula on the ‘advice’ of these bullies, making it that much worse for emotionally fragile women, fresh out of the delivery room.
    Every doctor and nurse my son and I have seen for well-baby and post-op visits have confirmed that FFing is fabulous and my son is more than thriving – he is excelling.
    I agree wholeheartedly that this demeaning, hideous, demoralizing ‘initiative’ needs to be thrown out. I can’t imagine what the damage to my own health and sanity would have been if I hadn’t been as confident and informed before entering the hospital, and I cringe to think how awful some other mother’s experiences must have been.

    Thank you for validating the position of mothers (of all new parents) over a group of self-congratulating zealots.

  • AllieFoyle

    This is such a good piece. It’s as reasonable and respectful a position as I’ve even heard articulated on the subject. This is the kind of attitude that women deserve from their care providers, and I hope that things move further in this direction.

  • this could inadvertently be taken as an endorsement of freebirth… I am very depressed over the fact that women like me are terrified of being violated to the point where we cannot trust anyone during childbirth. Midwives pose themselves as the solution but they aren’t. It seems to be a wash if it is better to be unassisted or with a midwife, though both are statistically inferior to hospital birth (as far as safety goes, there does not seem to be any reliable data about subjective measures like respect).

    • Allie P

      talk about throwing the baby out with the bathwater! What “violations” concern you so much? At the OB office where I worked, patients would come in with these multi-page birth plans they printed off the internet refusing all manner of obsolete practices (such as shaving), and practices they are refusing without even knowing what they are, why doctors recommend them, or why they are even refusing them other than this thing on the internet told them it was something they didn’t want (like eye ointment and VitK shots). They come in with these combative, disagreeable attitudes like the docs are out to hurt them and their children. My doctors would sit with the patients and patiently go over these forms filled with fights and fears that the natural childbirth movement TOLD them to argue against and be afraid of. Patients who seemed to have no trouble sitting in brightly lit offices, cafeterias, subway stations, exam rooms, living rooms, and kitchens were suddenly dead set on only giving birth in pitch dark rooms lit with tealights and rocking whale song. They would refuse minor interventions that were suggested to help avoid major ones (like a timely dose of pitocin to improve contractions so as to have a vaginal birth). They weren’t naturally viewing them as “violations.” It’s taught. And even the most caring OB only has you for 30 minutes or so per week, while you have hours every night to get yourself scared and angry and distrustful on the internet.

    • Daleth

      Could you clarify what violations you’re terrified of? And why? I honestly don’t understand, and would like to.

      • AllieFoyle

        I can’t speak for the OP, and I’m not sure about the post being an endorsement of freebirth, but I’ve known the feeling of terror.

        It isn’t fully rational, so if you don’t feel it, I imagine it will be hard to understand. It’s an absolute horror at the thought of being vulnerable, exposed, and in pain; not being able to control what happens, who touches you, what your body does, damage to intimate parts of your body.

        For some people it relates to being very shy or modest, for some it’s a history of trauma related to abuse or assault, others have had a previous upsetting birth experiences, and some people just have a phobia-like fear (tokophobia) the way other people fear snakes or spiders or flying. I think there’s also often the element of not really understanding and feeling comfortable with the process (what will happen when and why and by whom? It can be confusing and frightening to an outsider).

        I felt violated when my child was born, and it didn’t have anything to do with wanting to avoid interventions (I wanted them!). It was probably a mix of my personality, personal history, and what actually happened, and it really turned me into a wreck for a quite a while afterward. It would have been so helpful if people would have had some awareness of the possibility of this happening and I could have had the sort of respectful, individualized approach Dr. Amy advocates in this post.

        These days, thanks to medical advances, most babies and moms come through birth alive and healthy, but lots of moms struggle with pregnancy-related depression and anxiety. Awareness and sensitivity could really make a difference for a vulnerable mom, and by extension, her baby and the rest of the family.

        • Daleth

          You know what, that part I actually do understand. It’s part of the reason I chose an elective c-section. The main reason was fear of complications (especially placental abruption) that could hurt my babies, and for that reason alone I would’ve chosen c-section even if nothing else about the birth experience was different.

          But many other things about the experience were different, in ways that mattered to me. I wasn’t exposed–not like you are when giving birth vaginally, anyway; not even close. My legs were not spread and nobody was touching or looking at me down there. I wasn’t in pain, except for a few mini-contractions that were basically slightly painful braxton-hicks. I didn’t have to have any vaginal exams at all, much less exams done by men I’d never met before. And I knew there wouldn’t be any damage to my lady bits or my continence, because that wasn’t how the babies were getting out.

          Long story short, I didn’t have to spend 10-20-30 hours in pain, exposed, and worrying about my babies, because although I did have to wait about 10 hours for the c-section to start (some time-sensitive emergency cases had to go into the OR’s before me), from prep time to my babies’ birth only took maybe 45-60 minutes. And I had my wits about me the whole time–no loss of self-control–because I wasn’t in pain and because, like virtually all pre-labor c-sections, mine used a spinal block for anesthesia instead of general, so I wasn’t even drugged out much less knocked out.

          For women who are afraid of violations, exposure, loss of self control, etc., I can’t recommend an elective CS strongly enough. Of course, some people are just afraid of operations so that wouldn’t be very reassuring for them, but then again, with childbirth you’re kind of choosing between a rock and a hard place: either an infant much larger than your vaginal canal has to come out that exit in an extremely painful fashion, or you have to get surgery. There is no “unicorns and rainbows” option, so you just have to decide which potential problems scare you more, and go with the least-scary option.

          The part I still don’t understand, though, is choosing something to assuage your fears **even though that choice is more dangerous for your baby.** Homebirth, freebirth–they both multiply your baby’s risk of death or permanent brain injury exponentially. So I guess I don’t understand being so scared of something that you would put your baby in harm’s way in order to avoid it.

          • AllieFoyle

            I agree. That sounds like a much nicer birth experience from my POV too, and I’m glad you were able to choose it. I really wanted a c-section (or at least an epidural!) but no dice. My kids were born before I started reading here, unfortunately. I now know I probably could have had an MRCS if I’d found the right provider, but at the time I didn’t really know what was reasonable or possible.

          • Daleth

            Oh, that’s too bad. At least you know now, if you’re planning any more in the future.

          • Lauren

            You summed up so well what so many of us feel but couldn’t articulate when prying family and friends ask, ‘but why a c-section??! Don’t you want to give birth naturally?’
            Thank you 🙂

          • Daleth

            You’re so welcome!

    • demodocus

      I’m sorry that something so bad happened to you that you cannot trust professionals to be professional. I *hate* being touched by acquaintances much less strangers, but to have a child at all and to give my child the best chance of survival, I “manned up” as my brother would say. Since they all knew, no one patted me or anything. (I know adoption is a possibility, but it’s also intrusive while the authorities decide you’re okay, and I’ve heard it costs more. Plus there is a subtle bias against blind people. If I had a nickel for every time I explain that my husband is competent enough to raise our child, I could afford to adopt and get more IVF.)

  • curiositykeeper

    This is a great article! I am so tired of the depiction of hospital births as being something from the 50s. My hospital birth was wonderful. Lots of agency, hot and cold running nurses, whatever the baby needed, top medical care, pain relief, true caring backed up by science. My choice, without the badgering about what stupid superstitious nonsense that being pedaled to expectant mothers.

    • There is bad and good. I am very happy you had a good experience. I wish everyone did!

  • indigosky

    If a parent starved a child, that would be grounds for the child to be pulled from the family and placed in foster care. But if doctors and nurses do it to a newborn, it’s baby friendly.

    Excuse me while I scream.

  • Maya Markova

    Actually, why isn’t shaving and enema good? I had the impression that it is hygienic. Personally, I wouldn’t like to defecate in the face of the team delivering my baby, and I appreciate their unwillingness to deal with this.

    • Comrade X

      I’m the same, Maya……if I were giving birth vaginally, and there was a choice between 1) inevitably shitting myself and 2) not shitting myself, I would go with 2) every time.

      • Daleth

        And you have hit upon yet another of the hidden perks of pre-labor cesareans. The things no one ever tells you…

      • Inmara

        Here women are advised to buy Microlax enema and do it themselves if they wish so, but it’s not mandatory. And, of course, doing it yourself greatly reduces embarrassment factor.

    • jenny

      Shaving can cause small breaks in the skin, which increases the risk of infection. There’s little benefit, but some risk. I believe the routine enema is no longer done because some patients find it humiliating, and it can be uncomfortable for a woman in labor. According to a 2013 literature review, enemas used to be done because their was a perceived benefit; but there’s just not enough evidence that enemas in labor do anything useful, like reduce infection or make delivery easier. They may, apparently, cause “watery feces” which is a little less hygenic on the delivery table. Generally, in medicine, they try not to use an intervention unless it is useful. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0010611/ I suppose if you wanted to do your own enema before going to the hospital, there’s nothing to stop you.

    • Gozi

      I have had at least 2 nurses tell me stories about how all the enema contents didn’t come out while the patient was on the bedpan or toilet and they end up coming out during the pushing stage. Unpleasant for everyone, highly embarrassing for the patient. I’m not talking about a little bit of soiling either. ..

      On the other side, one would have been helpful before my c-section.

      • Cobalt

        Yeah, if the enema works as expected, nothing happens. If it doesn’t, you run a real risk of spraying very dirty saline at a very inopportune moment. Suddenly solid bowel contents don’t sound so bad.

        I imagine L&D nurses aren’t terribly squeamish though, they have a job with a high baseline level of body fluid exposure.

        • Gozi

          Well I have had some rude nurses, but I am sure they were in the minority. I even had an OB make a rude comment about an unexpected BM.

          • Cobalt

            That’s really unacceptable. If you can’t be sensitive to a vulnerable patient’s needs, and poop bothers you that much, you have no business attending vaginal deliveries. It happens, frequently, and there’s no reason to get juvenile about it.

        • Medwife

          Spraying poopy saline is pretty gross even for L&D.

          Edit to add, I still think we should deal with it without making a woman feel embarrassed. We’d roll with it.

    • Shaving to the skin before surgery has largely been abandoned. That is what all the signs in pre-op areas indicated to me when I still worked in hospitals (this was 5ish years ago so maybe something else happened in the mean time). Electric clippers are used to remove the bulk for mechanical reasons, but the “hygiene” excuse for shaving people with razors has been abandoned. Most data demonstrates that shaving with razors increases the rate of infection (and it makes sense if you think about things like ingrown hair).

      • Sue

        Yep – this is evidence-based. Essentially, it was found that shaving made little skin nicks and left bits of hair that encouraged infection. So, as it tends to do, medicine tested its practices, found evidence for change, and did so.

  • Renee Martin

    Well those zealots that run the BFHI must be smart, they managed to make themselves relevant enough that not only do they get their high fees, they change policy against administrators that oppose it.

    Although anything that actively takes agency away from women, or hurts them, is given a lot of power.

  • Renee Martin

    It was SUPER baby friendly to inform me that there was no night nursery, and I better care for my baby, by a nurse that then left him in his plastic bassinet a few feet further than I could reach. After 36 hours of labor and a CS, I was barely able to breathe fully, let alone pick up a baby. It was SO friendly to be asked where my family and friends were to help? (I lived in Mexico, so they weren’t there hours away in CA!)

    And it was SO baby friendly when I was forced to let him lay there screaming so long (I had to, I couldn’t move), another nurse came and got him, and took him on rounds. Making the nice nurse do her work, plus the work of the nursery (which was open only in the day, wtf?). How friendly!

    This place was SO baby friendly that I rejoiced when my son didn’t come back in the AM, but was in the NICU, because that meant HELP. It meant taking a few days to worry about the state my body was in. It took me days to be able to get up at all, and those days they cared for him I was able to heal. (we knew he would be going to the NICU due to preexisting issues, just not when)

    And I better have healed, because America is SO baby friendly that I had a mere 6 weeks (at 40% pay) to get back to work, to a competitive, all male job where there was a baby boom- by all the mens wives.… They weren’t missing any days, so why should I (in the companies eyes)?

    • Gatita

      Oh god, that sounds so difficult. I’m sorry you had to go through all that.

  • FrederickBPerez

    Your first choice skepticalob Find Here

  • Sue

    Discussion about the move away from twilight birth, shaving and enemas highlights one of the main differences between science-based and non-science-based approaches.

    Science and technology – like most areas of human endeavour – develop over time. As new evidence emerges, or new ways of doing things are tested, life moves forward. This occurs in essentially every area of human endeavour – from health care to communications and transportation, agriculture, engineering and construction – all sorts of areas.

    The pursuit of “natural”, however, be it Paleo, radical NCB or any other area using Naturalistic thinking, ignores the progress of human thought and endeavour.

    Throughout human existance, people have asked “how can we do it better?”. Radical NCB resists doing anything better – it has to be done the way the ideology dictates.

    I imagine many midwives of previous times would be rolling in their graves thinking that there are now ways of saving lives that are being ignored by their modern counterparts in the pursuit of ideology.

    Midwives of the past weren’t practising “normal birth” – they were using whatever skills they had top minimise the impact of “natural”.

    • attitude devant

      So, so true.

    • Allie P

      Alternative medicine that is proved to work is called “medicine.”

    • demodocus

      but humans have been shaving for thousands of years!

  • Allie

    “The medical community has regrettably allowed an organization of zealots to frame the issue of breastfeeding as “baby friendly” when it may be anything but baby friendly, to explicitly ignore the needs of mothers, and to ratify shaming as an acceptable tactic for manipulating women.”
    Not to mention, how is it baby-friendly to let babies go hungry? Thank heavens a sensible nurse suggested we supplement with formula until we got the hang of breastfeeding. And I’ll never forget the instantaneous, restorative effect it had on our baby, who had become increasingly lethargic and yellow.

    • Kq

      Also, how is it baby friendly to let them risk suffocating between an exhausted mother (who may be recovering from surgery) and the bed rail?

    • indigosky

      Yes, because starving a newborn in a vital stage of brain development is the humane thing to do, amirite? God only knows the repercussions of such abuse as a child gets older.

  • KarenJJ

    I want to stand up on my desk at work and shout “YES!!!!”.

    But that would be a bit weird, so I’ll just add a couple of extra exclamation after the ‘YES’ marks to vent my feelings on this.

    • Sue

      That made me smile, Karen. Thanks !!!!

  • This post made me feel so inspired about my lady parts that it makes me want to get ripped so I can swoop in dangling from a helicopter to save parents from “baby-friendly” hospitals.

    “GET IN THE CHOPPER… We have formula.” 🙂

    • DaisyGrrl

      “…and a nursery.”

      *parents dodge interfering lactation consultants and swing into the chopper just as the midwife tries to feed mom placenta smoothie.

      • guest

        Sounds like a good mobile app game!

      • Hahaha yes!

    • Sue

      I’m picturing formula packages landing with tiny parachutes…maybe even delivered by the stork!

      • Yes!

      • Allie P

        I would love a free formula packet at my BFH. Which reminds me, I gotta pack my hospital bags.

  • Daleth

    This is one of your best posts ever.

    • Amy Tuteur, MD

      Thanks!

  • Ellen Mary

    Yasssssssssss!!!! Alternative paternalism sucks. I am just as unlikely to be truly heard by a midwife as an OB. In fact, lately I have found that I am more often supported by OBs than Midwives, as my agency has increased with age and modern OBs are less threatened by a woman with a lot of knowledge about her own care. There are notable exceptions, but there it is.

    • Gatita

      I agree. I’ve seen two CNMs for well-woman care and I found them to be impatient and dismissive of my questions.

      • guest

        My experience with CNMs vs. OBs

        Kid #2 saw the only CNM practice in our region. They encouraged me to forgo induction at 39+5 when my son was having decels on the monitor and sudden increased BP. Was told they absolutely would not offer an epidural to me, I had to ask. I was also “warned” of all the risks of epidurals and how it interfered with breastfeeding etc. I felt very uncomfortable with their recommendations and, most importantly, still don’t understand why they thought avoiding induction was more important than my baby’s life and/or brain cells.

        Kid #3 went back to OB because I found that I didn’t see eye to eye with the CNMs on acceptable risk. Present to hospital at 38+3 (a month ago!) with unexplained bleeding and sudden increased BP. OB immediately says we should deliver, tells me I can get an epidural whenever I want. She also told me that while nothing screamed emergency, there were just too many warning signs. I was incredibly happy with her care.

        Barring some huge paradigm shift, I’ll never use nurse midwife care again. Not worth the risk.

        • Cobalt

          Congrats on the new baby! Glad you got good, safe care and I hope you’re getting some rest after delivering a third!

    • Sue

      I’ve written before about what I call The New Paternalists – who are purveyors of “alternative” remedies, dressed up as choice, but actually delivered as simplistic and directed instructions.

      While conventional health care providers have been encouraged to become less paternalistic – to discuss doubt, become partners in decision-making, and to respect patient choices – the New Paternalists do the opposite. They give you a firm, confident answer, and sell you their “remedy”. But they give you the illusion of choice and personal agency because you are rebelling against Big Medicine.

      I wonder if we have an innate need for a paternalistic approach (especially when we don’t feel well), which is not PC to admit to in our current societies. So, we have to disguise it as rebellion in order to receive simple directions.

      • Roadstergal

        I think some people do indeed prefer the paternalistic approach. I want to see the data, to discuss risk/benefit, to make a choice based on that – but I have friends who just don’t want to think about all that shite, to just be told the best way forward and put it into action. For people like that, I wonder if the loss of the paternalist model in medicine makes them more fearful and less reassured? An alt med person or midwife simply telling them, “This is the right thing to do” would be a relief.

        • Sue

          I suspect that’s right, Roadster. But it’s not currently fashionable to say “I would rather use my judgement to select a good professional and take their advice” – even if you would do that for your car or your legal issues.

  • RMY

    It’s not very friendly to force a baby to be breastfed when the human doing the feeding would really like a break to recover first. It’s rude to let people go hungry.

  • Yes. It was nothing short of shocking to walk into a context where a decision I had made for myself, was not only not respected but that access to that choice was effectively denied. The experience (my first) was incredibly damaging and has left a very bitter taste of what modern maternity care in many contexts (but not all) entails. I will be forever thankful for a second experience that affirmed my right to make such a decision for myself, and the care and respect that was afforded to me during that experience.

  • The Bofa on the Sofa

    OT but gotta post it because I am enraged:

    Just saw this on Respectful Insolance

    http://www.rocket-courier.com/node/141065#.VX111HD3aK0

    An 18 mo dies from an untreated ear infection.

    FUCK FUCK FUCK FUCKING MONSTERS LET THEIR CHILD DIE FROM A FUCKING EAR INFECTION!!!!

    And the ER staff is desperately trying to revive their dead child and she is complaining that they are poking holes in her and pumping her full of chemicals!!!!!!!!

    THEY ARE TRYING TO SAVE THE CHILD THAT YOU KILLED YOU ASSHOLE!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

    FUCK

    • Cobalt

      How in the hell do you just watch a child die? After 3 weeks, it’s obvious the magic water isn’t working.

      They deserve those homicide charges, and to be denied medical care in prison. The father had EMT training, too.

      • The Bofa on the Sofa

        Indeed, after the fever persisted for two weeks, they should have figured out that perhaps their strategy wasn’t working.

        But then again, anyone who can bitch because their child is getting needles put in them while the ER is trying to revive them from the dead can’t be expected to have enough sense to figure out the obvious.

        I agree with you. How can any parent just sit and watch their child die? What monsters.

      • The Computer Ate My Nym

        The mother also did CPR for 30 minutes without bothering to call 911 or anything. I can’t figure out what they could have been thinking.

    • Wut.

      God, I had a monster of an ear infection when I was a teenager and it hurt so much that it turned me into a weeping child. I’ve tolerated broken bones without so much as a whimper and this ear infection had me sobbing into my mom’s lap, and that certainly wasn’t enough to have killed me. As fucking stupid, wrong, and EVIL as it is to let your kid die from something that trivial, what they did amounts to TORTURE in my mind because of the pain that poor baby must have been in. Ugh.

      • Froggggggg

        I know. I had a serious one in my late teens and I still remember it as one of the most painful experiences of my life – and I’ve had quite a lot of painful things happen to me too, and generally have a fairly high pain tolerance. But this… this just beggars belief. That poor baby. It absolutely is torture.

        • It’s such a sharp, piercing, inescapable pain; it’s like a toothache in that it’s a very specific pain we can all identify but have trouble describing. That kid must have been screaming bloody murder *all the time* and they DIDN’T. CARE.

          Ughh. Just the thought of making those “we can’t afford to pay the hospital bills” comments while YOUR CHILD IS CODING. These people are human garbage and the fact that people are responding to this and loving this baby up in death is the only thing keeping me from going full psycho on this shit.

          • Cobalt

            Amoxicillin is cheap. Even in America, it’s available generic for $10 or less pretty much anywhere. Walk in clinic at CVS is $80 uninsured. The low income clinic where I live (which is not available everywhere, I know) will see you for $25 if you’re poor. The Health Dept will see uninsured kids free. Medicaid. Giving a fake name at the ER to steal treatment BEFORE the child develops massive complications (yes, deliberately defrauding the hospital is wrong, but still better than not getting treatment at all).

            Any of these options are cheaper than resuscitation, and your kid gets to LIVE. But it wasn’t really about money. It was about EGO. About being too cool for the “mainstream”.

          • Gatita

            People visit the ER and then ignore the bills all the time. It’s one big reason why healthcare costs for the insured are so high in the U.S.

      • Medwife

        Yes, I had one at age 12 and woke up in the middle of the night literally punching myself in the head, the pain was exquisite. I hate thinking of babies going through that. And for this little girl it was WEEKS.

        How could the parents stand it?

      • Brix

        Yes, I suffered from chronic ear infections into adulthood and it was excruciating. It was like being stabbed in the ear with an ice pick. Absolutely horrible pain. I feel terrible for small children and babies who can’t even really verbalize yet how much pain they are suffering. For an adult (me), at times hydrocodone barely touched the pain. Tylenol or Ibuprofen would have done nothing. This poor baby was likely in torment right up until the point of loss of consciousness. It’s unforgivable.

    • Mel

      That makes me sick. My brother died of an ear infection that went septic due to his immune system being compromised from an nonfunctioning spleen. He was sick for 24hrs. My parents called the pediatrician multiple times and were assured that it was a flu bug that would pass. (Noone knew about his spleen yet. That was found in the autopsy. )

      • The Bofa on the Sofa

        But at least your folks TRIED. These assholes just let her die.

        As was pointed out on Respectful Insolence, note that the guy actually wears glasses, so apparently doctors are good enough for him. But not good enough for their child, nope.

        • Mel

          Oh, I know. My parents have struggled for nearly 30 years with guilt that David died in spite of their (and the EMTs, doctors and nurses) best efforts.
          I can’t imagine just watching a child die and not doing anything to help her.

          • The Bofa on the Sofa

            Note how she still blames doctors. “If they were just trustworthy….”

        • Squillo

          The child was just a prop in the parents’ “natural” lifestyle.

      • Kelly

        That is horrifying. I am so sorry your family had to go through that.

      • Cobalt

        It’s generally reasonable to expect an apparently otherwise healthy child to survive a few days of an ear infection without treatment. An unknown, invisible and very rare health condition is not the parents’ fault, especially when they are actively pursuing care. It’s an absolute tragedy, but not something they could predict or consciously prevent.

        Watching a child slowly suffer for weeks and then die while avoiding treatment is just beyond words.

      • Allie P

        I’m so sorry for your loss.

    • MaineJen

      I have no words for how horrific that article was. “I watched her die,” the mother says…

    • Amazed

      What the actual fuck?

      I am speechless. This poor little kid. These morons!

      “I watched her die?” No, you killed her, you fucking bitch!

      Am I supposed to sympathize with this “loss mother”? Some people are too freaking stupid to be allowed to breed.

      • Cobalt

        The father had EMT training and wore glasses, he was familiar with the benefits of modern medicine. Not stupid, evil.

      • Kq

        Actually, “I watched her die” is perfectly accurate. She “watched.” These parents didn’t intervene, take their sick baby to a doctor, or do ANYTHING but WATCH.

    • Megan

      Ugh. This is infuriating!! It makes me sick! This happened not too far from where I practice and I am only mildly surprised though thoroughly disgusted. We have a large Mennonite population that doesn’t believe in medical intervention and I try my best to combat the lack of education, especially with vaccines and home birth.

    • Guest

      A couple of things here: strep pneumo is usually prevented by a vaccine (Prevnar) that is given at 2mo, 4mo, 6mo, and 18mo. There are some strains that are not covered by the vaccine. In the US, we recommend waiting 48hrs with just “supportive care” (analgesics, etc) for simple ear infections in kids over 2y. This has been a recommendation since 2003. I personally do “watchful waiting” when my kids are over 1y.

      However, this child was likely unvaccinated and would not have qualified for watchful waiting. Of note, Paul Offit just published a book called “Bad Faith” that discusses just this issue (avoiding all conventional medical care in lieu of faith healing). The truly sad thing is that these parents truly believed what they were doing was the best thing for their child. They were fatally wrong.

      • The Bofa on the Sofa

        1) the child was 18 mo, so the policy for 2y is not relevant, and
        2) it was 3 fricking weeks

        So who cares whether they were vaccinated or not, it’s still neglect

        • Guest

          Bofa, you missed the “however”. This child should have received competent medical care immediately (technically, should have received prenatal and routine pediatric care as well). I’ve seen a child die in front of me from strep pneumo meningitis. It’s awful. As far as I’m concerned, these parents should be public ally stoned.

          But AOM doesn’t always call for antibiotics.

          • Sue

            In fairness to Bofa, he is also raging about the mother’s complaints about the hospital resuscitation.

            It’s true that not all ear infections need antibiotics, but we all know that earaches don’t develop into meningitis without a change in clinical condition. This child wasn’t taken to medical care until he’she was essentially dead.

          • Cobalt

            Yeah, giving a kid who is relatively comfortable on acetaminophen a few days to kick the infection on their own is fine, and in many cases the best course.

            Watching a child suffer and deteriorate for weeks with no medical follow-up is neglect AT BEST.

          • Allie P

            If my doc let my kid’s ear infection languish for more than a day or two w/o antibiotics I’d be finding a new doc.

          • The Bofa on the Sofa

            No, not all ear infections need antibiotics, but that is irrelevant to this story. I don’t care if the standard treatment for a 2 yo is watch and wait for 48 hrs. This was not a 2 yo and it was more than 2 weeks.

            And that is irrespective of any vaccines.

      • Box of Salt

        The child *was* unvaccinated, and that’s not all: http://www.rocket-courier.com/node/141065#.VX111HD3aK0

        “Interviews conducted with Christine Delozier on March 24 and March 30 found that her child had been born at home without the use of a midwife and from there on, had never seen a medical doctor, nor did she receive any vaccinations.”

    • DaisyGrrl

      This hurts my head and my heart. I suffered from recurrent ear infections through my mid-teens. I had tubes in my ears for several years (and had to have them manually removed, fun times!). I have permanent hearing loss, tinnitus, and an aversion to anything banana-flavored (yay, antibiotics!).

      BUT, I am alive. My parents might not have liked giving me antibiotics or consenting to surgery to insert the tubes, but they didn’t decide to treat my pain with water. They didn’t watch me get worse over a period of two weeks and watch a RUPTURED ABSCESS drain for FIVE FUCKING DAYS while doing nothing. They didn’t wait until I was most assuredly dead before seeking medical attention.

      These parents deserve to rot in jail. I hope they don’t have any other children but if they do, I hope those children are permanently removed from the family and placed in the care of people who understand the concepts of antibiotics and infection.

    • Sue

      Strep pneumoniae meningitis is now a vaccine preventable disease.

      Tragic stoery.

  • Allie P

    Couldn’t agree more. Just finished reading “Birthing From Within” and the agenda dripping from every page made me sick. Women seeking pain relief in labor were called “weak” and “fearful” and were asked why they had all these fears about their pain and what would help them overcome it? How about not wanting to feel pain in childbirth? For a book that was so focused on a woman’s desires as she transitions from “not mother” to “mother”, why can’t a woman choose to not have the distraction of excruciating pain during those moments? Because I had an epidural, I could concentrate on pushing my baby, looking at my baby, holding my baby. It’s fine if someone else doesn’t want or need that, but I know what I want, and I’m sick of people calling me “weak and fearful” for that.

    • Houston Mom

      You must be made of strong stuff to get through the whole thing. I saw that book on Amazon when I was pregnant. The “Click to See Inside” feature was enough to see that it wasn’t for me. Apparently the first 75 pages are about art and journaling. I just looked at it again and realized they also do classes where you can learn about making birth art, journaling and poetry reading, “exploring assumptions about pain”, tracking and taming birth tigers, footbath rituals, and coyote howling.

      The only book I ended up reading was Epidural without Guilt.

      • Allie P

        I told my crunchy friend I’d read it. I actually kind of liked the birth art thing — I made a little pregnant lady outta clay. My little clay pregnant friend will also be getting an epidural. 😉

      • Allie P

        Also, I approved of the chapter that encouraged to-be dads to rub their wives’ feet. Because sure,why not?

    • I’ve never been pregnant or given birth, but if that does happen, I’m pretty sure I want an epidural if at all possible. Pain sucks. It hurts. I don’t like it. Why would I force myself to go through hours of agony if I don’t have to? And why would it make me weak to say “pain sucks and I’d really rather not, thanks anyways”? I really don’t get it.

  • attitude devant

    I trained in OB in the 80s, and we did the epidurals. At the time, most insurance plans didn’t reimburse for epidural anesthesia because it ‘wasn’t needed.’ Well, feminists pushed, and ACOG pushed and we pushed, and sure enough there started to be epidural coverage in most insurance plans….which meant that the Anesthesia service actually started to be willing to do it, which was fine with me, because this was before the days of continuous dosing and injecting that line every 45 minutes in the middle of the night gets old fast, particularly since as the OB resident I was responsible for dosing up ALL the patients on the floor. I was a really good regionalist though, before this was all over. Anyway, the Medicaid plans didn’t pay at first, which was outrageous (imagine not being able to get pain relief based on your income!) and so that became the next battleground. And again this was framed as a feminist battle, because what is more feminist than making sure that it’s not only rich women who get medical care? And justice prevailed, for once, and pain relief in labor was available to rich and poor alike.

    And now, 30 years later, here we are where women of undeniable privilege insist on birthing under third-world standards as a feminist ideal? Well, if that don’t beat all. I don’t get it and I never will.

    • MaineJen

      Nope…insurance still doesn’t cover epidural anesthesia. >:( But…it was worth every penny. 🙂

      • Kelly

        I am so thankful that mine did both times but even my husband would pay for it out of pocket if we needed to.

      • Cobalt

        That’s not right. It may be true, but it’s not ok.

      • demodocus

        wow, what lunatic decided that was a good idea? Fortunately, mine did, but as Kelly said, we’d have gladly paid too.

      • attitude devant

        Seriously?? What insurance? Where?

    • Inmara

      Hello, I’m from country where labor and associated basic services (including prenatal care) are for free (if you choose government-affiliated doctor and hospital), but epidurals are not. I guess it’s remnant from Soviet era when labor practices where cruel in general, but it pisses me with no end, because most insurance plans don’t cover anything labor-related too (obviously, it’s not feasible for insurance companies and employers who buy insurance). So, if I want epidural it will cost me at least 250 EUR – median monthly salary in country is about 500 EUR. Mine is significantly higher but anyway, I’ll think twice before spending that much, not even to mention women who truly can’t afford such cost. And our politicians whine regularly about low demographics… (to be honest, we have great maternity leave policies, so at least THAT is covered).

    • Renee Martin

      Feminism itself has changed a lot since then. Now its all pushing porn and kink, and centering men in everything. All I gotta say is “Slut Walk”. Barf. It’s no shock this new brigade thinks its feminist.

  • The Bofa on the Sofa

    The medical community has regrettably allowed an organization of zealots to frame the issue of breastfeeding as “baby friendly” when it may be anything but baby friendly, to explicitly ignore the needs of mothers,

    It’s not only that they are ignoring the needs of mothers, but that they beg the question of the needs of the babies themselves.

    For example, I have asked before, what is with the “baby friendly” emphasis on rooming in? Being ALLOWED to room in, sure, I can see that, but why does it matter how many actually do it? What is the difference if 100% of the moms choose to room in and 0%? Which is more baby friendly? I see no difference in the baby friendliness between those two extremes. Yet the BFHI is pushing for rooming in, with no actual benefit of doing so.

    • MegaMechaMeg

      I feel like the rooming in is more a cost justification than anything. Outsourcing infant care to the children’s mothers means that they do not have to pay nurses to do the work and space does not have to be set aside for a nursery.

      • Sarah

        100%

    • EmbraceYourInnerCrone

      I always figured it was “friendlyier”(also safer) to occassionally have someone well rested and not wacked out of their minds from exhaustion and hours of labor, taking care of the baby for a while.
      The idea that if the mother can not care for the baby in the first few hours , the father will, doesn’t really work for me either. What if the father has to go home, after being awake for the whole time in the hospital, and take care of the other children? What if he has to go to work(at least in the U.S. not all jobs will give fathers very much time off, even for the birth of a baby).
      I loved the fact that while I roomed in, I could roll the baby back to the nursery when I needed to so I could sleep.(I had about 8 hours of the shakes after she was born, plus 2 tears and an episiotomy…good times)

      • MegaMechaMeg

        Enforced rooming in immediately after labor seems profoundly disrespectful of the woman imho. Even an easy labor isn’t exactly a walk in the park and who knows how much sleep she has gotten over the past weeks with Braxton Hicks and your run of the mill late pregnancy discomfort. I have no idea why it isnt standard practice to have somebody else take care of the baby until after the woman gets a solid nap in.

        • Cobalt

          I had a short, easy labor and delivered before my usual bedtime. I was still tired, and still wanted the baby watched over by the most qualified babysitters he’ll ever have while I slept.

          • Medwife

            You know, especially if it’s a slow night, we love it when a mom hands over her baby to get some sleep. Everyone thinks l&d is all about babies, but it’s rare that we actually cuddle with any. I mean, they belong to their parents obviously and it’s normal that they are getting baby time, but… it is kinda fun. At least for me. Pregnancy hormones have me falling all over myself for babies.

          • Cobalt

            I would think the babies would be the best part! I got a little push back from the one nurse when my husband told her not to bring the baby back before sunrise, but the charge nurse gave me a wink and a smile. We were already off the “exclusively breastfed” list because he had formula for slight low blood sugar, so I asked them to not even wake me for that.

          • Kelly

            I felt bad because the very pregnant and exhausted nurse came to get our first one but my husband was freaking out over every single noise she made. After five minutes of him thinking she was dying, I called the nurse in and we finally got some sleep. Also, Ambien was my friend. I had not had sleep in over 48 hours but I was so hyped up that I could not sleep.

        • guest

          It really is disrespectful. Almost any other extreme physical exertion is greeted with an insistence that someone rest, that they deserve a rest. But not mothers in “baby friendly” hospitals – no, they should go through what is for many of them the most extreme physical exertion they will ever experience but not deserve any period of rest.

          • Amy M

            How much of that is a holdover from [America’s] Puritan past, that women who have sex should be punished? Even if the women are married—if children result, that woman better be taking care of them, even to the expense of her own health because that’s what you get when you do the nasty. I imagine that few people consciously think that, but old cultures die hard….

          • VeritasLiberat

            Actually, our concept of Puritans as anti-sex is a myth. They were very opposed to adultery, but for married couples sex was considered to be a blessing from God and expected to be engaged in frequently. There was even a case where a man was excommunicated for failing to provide his wife with sex.

            http://thoughtcatalog.com/daniel-hayes/2015/05/puritans/

      • Liz Leyden

        I gave birth at a very popular maternity hospital that pushed rooming-in hard, until exhausted Moms started dropping their babies.

      • Cobalt

        My husband was more tired than I was after my last delivery. He had gotten up early to do the farm chores I couldn’t, put in a full day at work, then sat through labor “ready” for anything. I got up late, did the light work, took a nap, had lunch and went to the doctor and then the hospital have the baby. By our first full night in the hospital, we sent the little guy to the nursery because we were both worn out.

        Birth is tiring. Newborns are exhausting. Pretending otherwise is silly at best, fatal at worst.

      • Allie P

        What if there is no father?

        • guest

          They don’t care. My kids have no father, and I asked during the hospital tour about their policies, and it was still mandatory rooming in, you will share a room even if you have twins and have to therefore find space for three bassinets PLUS your car seat (because they told me I “had” to bring them with me on admission to the hospital for labor). I expressed some doubt about being able to manage all of this if I was alone for my labor, and was dismissed – of course you can do it. Everyone can.

          Luck was on my side if not the hospital, so my mother was with me for labor and birth, and the babies were premature and went to the NICU instead of rooming in with me. The LC tried to tell me I needed to wake myself up several times a night to pump, but I chose to sleep through the night while I could – best decision I ever made (and it had NO effect on my milk production – I had plenty).

          • Elizabeth A

            Guest, there’s a possibility that sleeping through the night *improved* your milk production. Resting helped you recover, and assured that lactation wasn’t (as) complicated by the various effects of physical exhaustion.

            People who have just given birth are often very tired. Very tired people do not have peak physical function.

            I did not wake myself up at night to pump for my preemie either, and even if I had wound up with less milk as a result of that, sleeping would have been a wise choice for me.

            I seriously wonder how much more effective LCs would be if they began with a good meal for mom, and an offer of a few ounces of formula and a chance for mom to nap.

          • guest

            Well, okay, maybe it did have an effect on my production! I don’t know if my babies got some formula during the first two days when I was unable to go down and see them (and no one would come up to tell me what was going on with them), but there was enough for two for sure by the third day after. My hospital was not officially a baby friendly hospital, but it was in NYC, where Bloomberg famously had all the formula in all hospitals locked up. The LC I saw wasn’t pushy, though. She gave me a chart with target production levels by day for pumping for multiples, and I could see that I was over the targets from day one – so I went ahead and slept. I had a c-section to recover from. I didn’t wake up engorged until something like the 8th day, but whatever was coming out of my tits before that was getting turned away from the NICU by day five because they had too much already.

            But a lot of NICU moms struggle, or don’t respond to the pump. It’s hard to say what the exact optimum way to increase milk production for each woman is. No one should ever feel bad about formula. I switched to it at 6 months because I wanted my freedom back. But given the insanity that is newborn twins and single parenthood, I will pat myself on the back forever for being able to recognize that what I should sleep while I had the chance.

        • EmbraceYourInnerCrone

          Exactly ! What if you are a single mom what if your partner has to work or is deployed (I was active duty Navy when I gave birth) what if you are stationed or live someplace thousands of miles from family and don t know anyone there. What if your family can t afford to come visit when the baby is born. Baby friendly my ass

          • Bombshellrisa

            Exactly.
            The baby friendly hospital I delivered my ds at had a pamphlet they hand out about what to pack in your hospital bag and said to make sure to have a support person able to spend the night at the hospital while you recover, I asked what I would do if my husband had to go home and attend to dd or had to work. The PA (words can’t express how much I hated her condescending attitude) sighed and said that this should be part of my birth plan, that is what responsible people do. She then said that the bassinet had wheels and the bathrooms were big enough to accommodate it while I went to the bathroom or took a shower. They didn’t want the baby left “unattended” for me to do those things if I didn’t have a support person. They also didn’t have a nursery so I could do those things. If I hadn’t have gone into labor at 35 weeks and barely made it to this hospital, I would have delivered at the main branch that is unfriendly to babies complete with a nursery and formula friendly nurses.

      • Gatita

        What if there’s no father? What if there’s no family locally? The whole thing is obscene.

        ETA: I see people below beat me to this point.

    • Rosalind Dalefield

      Rooming-in should be a choice. I was distraught when they took my first baby to the nursery against my will, but a mother should also have the choice of having the baby taken to the nursery if she wants.

    • Sue

      Besides, rooming in is “unnatural”. Many cultures have either the maternal grandmother or some other helpful person (the original meaning of “doula”) to take the baby off the mother;s hands for a while so she can sleep.

      Leaving a newborn with an exhausted mother is neither baby-friendly nor mother-friendly, AND unnatural.

    • Allie P

      What “rooming in” achieves practically is that kind nurses end up wheeling as many babies as they can into the nursing station to give exhausted moms a chance to sleep.

  • Amy

    “Here’s what childbirth and lactivism would look like if women were in charge of the decision making” Something is missing from this assertion. Aren’t women the ones who spearheaded midwifery and lactivisism?

    • MLE

      Individual women vs organizations with a specific agenda?

    • Amy Tuteur, MD

      When I say “if women were in charge,” I mean each woman in charge of making a decision for herself, NOT one woman making decisions for other women.

      • Amy

        I totally understand that you mean individual women. It’s just that the zealots look to tear your work apart.

        • Sue

          maybe “in charge of the decision-making FOR THEIR OWN BIRTHS”

    • Allie P

      oh, there are plenty of men who drink the NCB koolaid (Michel Odent, etc.) plus, most OBs these days are women!

  • guest

    Right on target. I was appalled in junior high school when we were shown a human birth video that included an episiotomy and the teacher told us it was routine and that women didn’t even feel it. I think the whole class was appalled. So when years later I learned that no, it’s NOT routinely necessary but doctors did used to think so, the whole “reclaim women’s power” aspect of birth was appealing, because yeah: the medical industry has made mistakes. But now it’s all so muddled – how do I know which hospital procedures are and aren’t necessary? Who do I trust to help me figure out what’s best for ME? I erred on the side of doctors because I’d rather have an unnecessary procedure or intervention than a dead or injured mom or baby, but if you don’t know when to speak up to yourself you can be made miserable – and sometimes be seriously hurt.

    Honestly, I think the biggest problem is that health care providers are understaffed, across the board. How can a doctor or nurse help me, specifically ME, when they have only so many minutes to attend to each patient? They can’t. They have procedures to maximize health outcomes, but no time for feelings or comfort measures – or adequate explanations.

    So women gravitate toward midwives and doulas and LCs who give them the time and individual attention we want (if you can afford it) and they claim to be offering empowerment and freedom, but much of the time they’re not.

    It kind of does make you want to go the unassisted childbirth route! Terrifying.

    • FormerPhysicist

      I always felt like I had enough time from my OBs. And my current Gyn is awesome. But I do understand you.

      • guest

        Sometimes things work out, definitely. But I gave birth in a big city hospital – attention from nurses, in particular, was hard to get. But my roommate had great difficulty getting attention from a doctor. She was a diabetic (not GB, but pre-existing diabetes) and was concerned that she had been given the wrong meds because they weren’t what she was used to. It took a day and a half for a doctor to speak to her about it. I don’t think anyone meant to neglect her, but she needed individual attention and no one had the time to give it. My point isn’t to criticize the doctors and nurses themselves, but the system that demands they take on a high caseload to be more “efficient.”

    • Allie P

      I get plenty of time fro my OB. All I hear are horror stories about the midwives who don’t come or sit in a corner and knit or transfer you to the hospital and charge full price. This idea that the midwives are somehow better at this than doctors is kinda…. off.

      • guest

        It is standard practice in the hospital I went to to check a laboring woman into a birthing room, hook her up to monitors, and then you won’t see your OB or midwife until those monitors indicate a problem. Nurses will come in only if called. I’m sure some people love this, but there was very poor communication to me how it worked and when to call for assistance.

        • Allie P

          I’m talking about global care, not just labor experience. I didn’t need my doctor sitting with me for hours while I was in labor.

  • MegaMechaMeg

    What makes me craziest about the BFHI honestly is not the tactics, but the emphasis on universal percentages. If, for example, it were an opt-in kind of situation where Mothers could choose to go down the “Breastfeeding Friendly” path with the rooming in and the verboten supplementation and lack of formula swag and that population was the basis of the certification that would be one thing, but forcing all mothers to go down a single path with the expectation that they all will of course want to exclusively breastfeed for as long as possible just feels like insanity. There are seriously only two accepted food types that it is considered healthy to feed a baby, I don’t feel like asking for two or three treatment plans for post partum mothers is asking for the moon. If I, as a rational adult woman, decide a path in an informed and educated manner, then I feel like my wishes should be respected and I shouldn’t have to be railroaded in the interest of somebody else’s numbers.