The language of natural childbirth: English to English translation

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The most important thing you need to know about the philosophy of natural childbirth is that it is a business. It is a multimillion dollar business that includes trade organizations, public relations people and government lobbyists.

There’s nothing wrong with the fact that natural childbirth is a business. In a capitalist society like ours, when people have an idea, they monetize it. That’s the American way.

Once you understand that natural childbirth is a business, and that midwives, doulas and childbirth educators are the financial beneficiaries, you will never look at their claims the same way again. We understand this about other industries — you would never look to Big Oil for accurate information about solar power — and it makes us better consumers. Women need to bring the same level of skepticism to the claims of the natural childbirth industry as they would bring to the claims of the oil industry.

Once you understand that natural childbirth is a business, you will never look at its claims the same way again.

Toward that end, I’ve created an helpful guide to the language of natural childbirth, an English to English translation of what members of the natural childbirth industry say and what they really mean. Unlike obstetricians who are educated and trained for vaginal birth, C-sections and operative vaginal deliveries, members of the natural childbirth industry can only profit from vaginal birth. That influences their views on the practices of modern obstetrics in the exact same way that the fact that Big Oil can only profit from oil influences their views on solar power.

So without further ado, let’s examine what members of the natural childbirth industry say and what they really mean in reference to their economic interest self-interest.

When they say: Vaginal birth is the standard,
What they really mean is that vaginal birth is the only form of birth they can profit from.

When they say: natural childbirth is better,
What they really mean is we don’t know how to use and therefore cannot profit from the latest life saving obstetric technology.

When they say: Unmedicated birth is healthiest,
What they really mean is we cannot provide epidurals so we cannot profit from them.

When they say: technology interferes with birth
What they really mean is we can’t profit from life saving technology because we don’t know how to use it.

When they say: Epidurals interfere with labor and harm babies,
What they really mean is we make our money by convincing women that they need us to deal with the pain of labor. A technology that safely and effectively abolishes labor pain destroys our business model.

When they say: C-sections are bad,
What they really mean is we can’t profit from C-sections.

When they say: C-sections are more expensive than vaginal births,
What they really mean is we can’t charge for C-sections.

When they say: Electronic fetal monitoring is useless,
What they really mean is electronic fetal monitoring leads to the identification of complications and therefore less profit for us.

When they say: Breech birth is a variation of normal,
What they really mean is C-sections for breech may save lives but they cost the natural childbirth industry money.

When they say: Prenatal screening tests are worthless because they don’t provide a definitive diagnosis,
What they really mean is prenatal screening tests rob of us of patients by identifying women and babies at high risk for pregnancy complications.

When they say: A healthy baby is not all that matters,
What they really mean is we cannot ensure a healthy baby if you follow our recommendations that your baby will be healthy.

These English to English translations represent just a few of the many mistruths, half truths and outright lies promoted by the natural childbirth industry; there are many more. You can figure them out for yourself if you just follow the money. When the natural childbirth industry makes a claim just apply this simple rule:

Does it enhance the profits of the natural childbirth industry?

If it does, you should view the claim with deep skepticism.

But aren’t the claims of obstetricians similar? No they’re not, for one very important reason. Obstetricians profit regardless of whether the birth is a vaginal delivery, a C-section or involves forceps or vaccuum extraction. Obstetricians are usually salaried or receive a global fee for the entirety of prenatal care and childbirth and that fee is unaffected by the use of epidurals or life saving technology. Obstetricians don’t profit by identifying pregnancy complications; often they profit less because the patient needs more time, more appointments and more attention during labor than a patient who has an uncomplicated vaginal delivery.

Obstetricians aren’t saints, but since they are capable of profiting from birth regardless of whether it is an uncomplicated vaginal birth without pain relief, a highly complicated C-section proceeded by every technological innovation ever invented, or anything in between they have no economic incentive to downplay complications, venerate C-sections, or lie about the benefits and risks of epidurals.

In contrast, midwives, doulas and childbirth educators of the natural childbirth industry can only profit from uncomplicated, unmedicated vaginal birth; therefore it is in their economic interest to deny or disregard complications, demonize C-sections, and ignore the excruciating pain of labor and the suffering that it causes.

Listen carefully to the claims of midwives, doulas and childbirth educators; apply the same skepticism that you would apply to any industry; and, above all, follow the money. An obstetrician has no incentive to deprive women of uncomplicated, unmedicated vaginal births. The natural childbirth industry, on the other hand, has a tremendous financial incentive to deprive women and babies of life saving, pain relieving, highly technological care. Who is more likely to tell you the truth about what is safest and healthiest for you and for your baby?

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  • W. X. Wall

    When I was in college, I remember reading in the sociology of medicine about the “medicalization of childbirth” and how childbirth was transformed from a natural process into a disease so that the early organizers of medicine could claim it as their turf. And I nodded in agreement.

    And then I went to med school…

    Call me a Judas but once I learned that before modern obstetrics, childbirth was the leading cause of death for women (in an age when there were plenty of other things that could kill you), I realized the medicalization of childbirth has been a godsend.

    Anyone who tells you childbirth is natural because dogs and cats do it unassisted should talk to an evolutionary biologist. Many of them will tell you that the transfer from walking on all fours to walking on two legs was *the* defining moment of our evolution and that in many ways, our bodies have not still fully evolved to adjust to this advance. That’s why so many of us get back pain (our spines haven’t fully adjusted to a life of being upright). And that’s why birthing is so traumatic for humans: our pelvis had to get narrower since it was now a load-bearing structure holding up the rest of our body, which means it’s harder to push out a baby. That’s even why our babies are so helpless when they’re born compared to other mammals: they are all essentially born “pre-term” because if they get any bigger they wouldn’t come out of a human pelvis at all (witness the massive increase in fetal demise if babies are even a few weeks overdue).

    I suppose we could just let evolution do its thing for another million years, killing off babies that “weren’t meant to live”, along with their mothers who had narrow pelvises and other anatomic variants that were not optimal, until finally we could achieve the same reliable “natural” birth process that quadripedal mammals have. Or we could thank God that he also gave us a brain that allowed us to transcend the brutal process of natural selection that every other animal is subjected to…

    P.S. Actually, we may already be at the optimal point: male pelvises are narrower because they are selected purely for their load-bearing and gait efficiency. Female pelvises have to balance efficient walking and running away from predators with safe childbirth. It may be that evolutionary-wise, we’re already at an optimal point where making the pelvis more amenable to childbirth would have made females less able to flee predators and less energy efficient at walking (and delivering earlier would mean even more helpless neonates with subsequent higher mortality rates). Is higher death rates in childbirth a good evolutionary trade-off for being more mobile? Who cares? Shouldn’t we rather celebrate that thanks to our “natural” brains and their magnificent creations, modern women no longer need to be subjected to that awful trade-off? (Both from the ravages of childbirth and the ravages of hungry lions 🙂

    • Outi

      It’s tragic that in these days the dogs are a bad example for a natural birth. Next time some one uses dogs as an example, you can quote this: http://www.ncbi.nlm.nih.gov/pubmed/20136998
      The conclusion of this study is that in UK, more than 80% of Boston terriers and French bulldogs are born through c-section.

  • sdsures

    Why are you always on about BABIES, Dr Amy? I thought they were just props!

    /satire

  • Ash

    @ fiftyfifty1, @ theadequatemother, @ Dr Kitty–can you please remind me–where’s the best evidence of the NNT of c-sections to prevent surgery for symptomatic pelvic organ prolapse in a woman’s lifetime? Also Dr Kitty (or others), how much NICE has determined in terms of cost–paying for a CS vs a vaginal delivery when comparing the higher rates of pelvic organ prolapse requiring surgery?

    • Laural

      following

    • Daleth

      I’ve seen a few studies… Basic gist: cesarean is protective, especially elective pre-labor cesarean; and especially for moms over 30, because the risks of pelvic floor disorders caused by vaginal delivery goes up with increasing age of the mother.

      Obstet Gynecol. 2006 Jun;107(6):1253-60.

      Parity, mode of delivery, and pelvic floor disorders.

      OBJECTIVE:
      This study aimed to assess the associations between parity, mode of delivery, and pelvic floor disorders.

      METHODS:
      The prevalence of pelvic organ prolapse, stress urinary incontinence, overactive bladder, and anal incontinence was assessed in a random sample of women aged 25-84 years by using the validated Epidemiology of Prolapse and Incontinence Questionnaire. Women were categorized as nulliparous, vaginally parous, or only delivered by cesarean. Adjusted odds ratios and 95% confidence intervals (CIs) for each disorder were calculated with logistic regression, controlling for age, body mass index, and parity.

      RESULTS:
      In the 4,458 respondents the prevalence of each disorder was as follows: 7% prolapse, 15% stress urinary incontinence,
      13% overactive bladder, 25% anal incontinence, and 37% for any one or more pelvic floor disorders. There were no significant
      differences in the prevalence of disorders between the cesarean delivery and nulliparous groups. The adjusted odds of each disorder increased with vaginal parity compared with cesarean delivery: prolapse = 1.82 (95% CI 1.04-3.19), stress urinary incontinence = 1.81 (95% CI 1.25-2.61), overactive bladder = 1.53 (95% CI 1.02-2.29), anal incontinence = 1.72 (95% CI 1.27-2.35), and any one or more pelvic floor disorders = 1.85 (95% CI 1.42-2.41). Number-needed-to-treat analysis revealed that 7 women would have to deliver only by cesarean delivery to prevent one woman from
      having a pelvic floor disorder.

      CONCLUSION:
      The risk of pelvic floor disorders is independently associated with vaginal delivery but not with parity alone. Cesarean delivery has a protective effect, similar to nulliparity, on the development of pelvic
      floor disorders when compared with vaginal delivery.

      Am J Obstet Gynecol. 2012 Oct;207(4):303.e1-7. doi: 10.1016/j.ajog.2012.08.019.
      Epub 2012 Aug 16.

      Risk of surgically managed pelvic floor dysfunction in
      relation to age at first delivery.

      OBJECTIVE:
      The purpose of this study was to compare the risk of surgically treated stress urinary incontinence (SUI) and pelvic organ prolapse (POP) in relation to mode of delivery and age at first childbirth.

      STUDY DESIGN:
      This was a cohort study. Data from the Swedish Medical Birth Register on women with only cesarean delivery (n = 30,880 women) or only vaginal delivery (n = 59,585 women) were compared with the Swedish Patient Register to calculate incidence rates and hazard ratios (95% confidence interval [CI]) for SUI and POP surgery.

      RESULTS:
      In analyses that were stratified by age, vaginal delivery consistently increased the risks of SUI and POP surgery. Among vaginally delivered women who were ≥ 30 years old, incidence rates of POP surgery were 13.8 (95% CI, 12.7-15.1), and for younger women were
      6.4 (95% CI, 6.0-6.8) per 10,000 person-years. Exclusion of
      instrumental vaginal delivery did not alter the conclusions.

      CONCLUSION:
      Increasing age at first delivery increased the risk of subsequent SUI and POP surgery after both vaginal and cesarean delivery.

      Neurourol Urodyn. 2004;23(1):2-6.

      Cesarean section:
      does it really prevent the development of postpartum stress urinary
      incontinence? A prospective study of 363 women one year after their first
      delivery.

      http://www.ncbi.nlm.nih.gov/pubmed/14694448

      AIMS:
      Stress urinary incontinence (SUI) in young women is usually the result of pelvic floor injury during vaginal delivery. Whether cesarean
      section delivery may prevent such injury is questionable. We undertook a prospective study to compare the prevalence of SUI among primiparae 1 year after spontaneous vaginal delivery versus elective cesarean section, or cesarean section performed for obstructed labor.

      METHODS:
      Three hundred and sixty-three consecutive primiparae were recruited immediately after delivery and were followed for 1
      year. Women were asked upon recruitment whether they had ever experienced SUI before pregnancy. Those who had SUI before pregnancy were excluded. Thus, only cases of de novo childbirth-associated SUI were analyzed. Patients were divided into three subgroups according to the mode of delivery: spontaneous vaginal delivery (n = 145), elective cesarean section (n = 118), and cesarean section performed for obstructed labor (n = 100). Patients
      who underwent elective cesarean section were not given a trial of labor. Cesarean sections for obstructed labor were performed at a mean cervical dilatation of 8.7 +/- 1.6 cm and arrest of 184 +/- 24 min. Prevalence, frequency, and severity of postpartum SUI, as well as demographic and obstetric parameters, were analyzed in each subgroup.

      RESULTS:
      The three subgroups were comparable with
      respect to maternal age, weight, and height. Prevalence of postpartum SUI was
      similar after spontaneous vaginal delivery (10.3%)
      and cesarean section performed for obstructed labor (12%). However, SUI was significantly less common following elective cesarean section with no trial of labor (3.4%, P < 0.05). Approximately half of the symptomatic patients in each subgroup reported either moderate or severe symptoms, however, only 15-18% expressed their desire for further evaluation.

      CONCLUSIONS:
      Prevalence of postpartum SUI is similar following spontaneous vaginal delivery and cesarean section performed for obstructed labor. It is quite possible that pelvic floor injury in such cases is already too extensive to be prevented by surgical intervention. Conversely, elective cesarean section, with no trial of labor, was found to be associated with a significantly lower prevalence of postpartum SUI. Whether the prevention of pelvic floor injury should be an indication for elective cesarean section is yet to be established.

      BJOG. 2013 Jan;120(2):152-60. doi: 10.1111/1471-0528.12020. Epub 2012 Nov 2.

      Prevalence and risk factors for pelvic organ prolapse 20 years
      after childbirth: a national cohort study in singleton primiparae after vaginal or caesarean delivery.

      OBJECTIVE:
      To investigate prevalence and risk factors for symptomatic pelvic organ prolapse (sPOP) and sPOP concomitant with urinary incontinence (UI) in women 20 years after one vaginal delivery or one caesarean
      delivery.

      DESIGN:
      Registry-based national cohort study.

      SETTING:
      Women who returned a postal questionnaire in 2008 (response rate 65.2%).

      POPULATION:
      Singleton primiparae with a birth in 1985-88 and no further births (n = 5236).

      METHODS:
      The SWEPOP study used validated questionnaires about sPOP and UI.

      MAIN OUTCOME MEASURES:
      Prevalence rate and risk of sPOP with or without concomitant UI.

      RESULTS:
      Prevalence of sPOP was higher after vaginal delivery compared with caesarean section (14.6 versus 6.3%, odds ratio [OR] 2.55; 95% confidence interval [95% CI] 1.98-3.28) but was not increased after acute compared with elective caesarean section. Episiotomy, vacuum extraction and second-degree or more laceration were not associated with increased risk of sPOP compared with spontaneous vaginal delivery. Symptomatic POP increased 3% (OR 1.03; 95% CI 1.01-1.05) with each unit increase of current BMI and by 3% (OR 1.03; 95% CI 1.02-1.05) for each 100 g increase of infant birthweight. Mothers ≤ 160 cm who delivered a child with birthweight ≥ 4000 g had a doubled prevalence of sPOP compared with short mothers who delivered an infant weighing 10 years more often than women without prolapse.

      CONCLUSION:
      The prevalence of sPOP was doubled after vaginal delivery compared with caesarean section, two decades after one birth.
      Infant birthweight and current BMI were risk factors for sPOP after vaginal delivery.

      • Daleth

        PS sorry for the lack of links, but with the titles you should be able to find these on PubMed.

    • fiftyfifty1

      NNT=8

      • Ash

        Thanks, fiftyfifty1. Source? I can get access to the journal if it’s not on Pubmed or another publicly available source.

        • fiftyfifty1

          There are a bunch of them that get NNT that range from 5-8. Most are based on the Kaiser Permanente dataset. If you search under key terms such as pelvic organ prolapse, pelvic floor, cesarean and Kaiser you will come up with a bunch of them that break it down for different outcomes like urinary incontinence, stool incontinence, POP, and need for surgery as well as risk factors like age, parity, race. The first one that Daleth lists (below) is a good place to start (Obstet Gynecol. 2006 June). It has a NNT=7 for c-section and NNT=5 for *prelabor* CS for the outcome of ANY pelvic floor problem. There is also one based on Swedish data I believe: ncbi.nlm.nih.gov/pubmed/19254581

    • Dr Kitty

      NICE looked at *some* costs when comparing elective CS and vaginal birth. It is rather opaque which costs exactly were considered. I’m afraid all I can do is suggest you read the references for the NICE guidance on CS.

      NICE didn’t consider birth injury related med-mal settlements (often running to 7 figures), for example, and STILL found that when it looked at the figures it had, an elective CS was only £70 more expensive than a vaginal delivery. The NHS is currently paying £100 per delivery in indemnity fees, BTW.

      NICE recommends things that cost more than £70 (many years of statins for someone with a Qrisk of 10% to give one example) with little chance of benefitting the patient concerned ALL THE TIME, which is why it had little choice but to endorse MRCS.

      Once you compare the risks of MRCS and VB, you realise that safety is more or less equal, and what you’re asking women to do is choose between different risks-which is a matter of informed consent and patient autonomy (as confirmed by the recent Supreme Court case v Lanarkshire).

      Economically, you can’t really make a case either, and certainly not if you consider wider issues like the fact that CS recovery takes place while on maternity leave from work, while severe incontinence, pelvic floor physio and POP surgery often mean the woman has to take time off work, affecting productivity and income (and potentially costing the UK taxpayer even more than £70). We’re all supposed to work until we’re 68 now, it can’t be assumed that everyone who needs POP or incontinence surgery is economically inactive…

  • demodocus

    OT: Would an automatic blood pressure monitor read your bp accurately if it is turning your hand the color of blueberries?

    • Sue

      SHould do – it just means that it is pumping up well over your arterial pressure, but it should still be able to detect the correct pressure on its way down (as the cuff deflates).

    • Mattie

      The machine should read it accurately (it will tell you what it is) but if the machine is causing pain which I’d imagine it would if it was that tight then the pain may raise your BP mightn’t it?

    • Dr Kitty

      Is the cuff the right size?
      Is it correctly placed over the artery?
      Has it got fresh batteries?
      Has anyone calibrated or checked it in the last year?

      You can work out if it is accurate for BP yourself, to a certain extent.
      Once the cuff starts deflating you’ll feel your brachial arterial pulse as a “ticking” in your arm, at roughly the point where the machine will detect your systolic BP. When the ticking sensation ends corresponds more or less to your diastolic. It isn’t perfect, but it gives an idea.

      If the machine is registering error messages and pumping up and down in quick succession many times before it finally registers a BP, I’d ignore it.

      Personally, I prefer old fashioned manual sphygmomanometers to the automatic ones.

      My BP is always about 160/110 on the machines. Cue panic at the antenatal clinic! It has never been that high in my life!
      I always get them to double check it manually with a small cuff…surprise, surprise, it’s sitting at 96/60, or somewhere in that region, and everyone can calm down.

      • demodocus

        It was pumping, pausing, pumping, pausing, and pumping again, without deflating much in between. The nurse just admonished me not to move (I had made a small hand gesture) That was the 200 over something reading when I was in labor and something we were always curious about. That nurse seemed a little less competent in general than the others…

        • Ash
        • Dr Kitty

          Yeah…I would have repeated that, and not charted it until I had a second reading similarly high.

          My father genuinely has scary high BP readings (160/100 is best ever, at home, after he’d taken all five of his medications) and the automatic machines give up on him and just put out error messages or numbers incompatible with life.

          My mother checks his BP manually at home before he has his BP check at the GP, just in case they try to send him to hospital (people generally worry he’s going to stroke out in front of them). He’s fine, for a 70 year old man who apparently had a baseline systolic of over 200 for years prior to starting treatment, he has absolutely no health problems and better blood results than most people half his age.

          • demodocus

            Thank you for your answers. I’ll keep it in mind. My dad flat out refuses the machines and wants the manual kind.

      • Outi

        The antenatal clinic in my area is getting rid of the old machines. My blood pressure is always way up when it’s measured with automatic machines and normal when measured with the old ones. Last time they couldn’t find a working unit and told me they are all being replaced. It came to me later: what if there are more people like me and because of this they are getting blood pressure medication?

  • Liz Leyden

    OT- A New Hampshire mom who paid $1,500 for a professional breastfeeding photo session wanted to blow up one photo to poster size for some breastfeeding awareness event. She was outraged when the local Wal Mart refused to print the photo, saying photos that show nipples are against store policy.

    My first question, who pays $1,500 for a professional photo session about breastfeeding? Second, why did the photographer go to Wal Mart to develop the photos? Third, is anyone unaware of breastfeeding?

    http://www.myfoxboston.com/story/29730932/nh-walmart-refuses-to-print-photos-of-women-breastfeeding

    • Roadstergal

      “Oh! I didn’t know mammals made milk for their young! Thank goodness for this oversized, Wal-Mart quality poster! I wonder what else I missed in high school biology.”

      Ah, for the good old days before digital cameras, when any photo showing a bit of nip or the like meant you had to go find a real photo developer, not a chain store. And we didn’t even have Yelp!

      • Anj Fabian

        Solution:

        Have your professional photographer Photoshop the nip slip out of the image.

        • Roadstergal

          I’m guessing it wasn’t as much a nip slip as Topless BF Glory.

    • An Actual Attorney

      Wait, the “professional” photographer went to walmart with her original negatives to develop the pics???

      • Kelly

        That is hilarious. Obviously she is one of those who think they are better than they are. I can’t believe people will pay that much for crappy quality. I love photography and have decent photos of my children but I won’t do it for other people because I have severe limitations. It is truly a hobby for me. Also, all the actual professional photographers I have used, use professional developers. There is a significant difference in quality.

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      • Amy

        The only professionals I have ever used who don’t “develop” their own pics are those who work entirely digitally– and in those cases you get all the digital files!

        • Sue

          It’s proably the “blow up to poster size” bit that she needed the Walmart service for, I’m guessing.

      • Mattie

        I imagine that she already had the photos from the photographer and just wanted it enlarged and went to Walmart for that…or her photographer was more “certified professional” than actual professional

      • CCL (Crazy Cat Lady)

        There’s no way she’s a real professional photographer. I *am* a real professional photographer and the quality of the images shown in the news clip on that link are horrific.

        And real pros? Nope, they don’t use Walmart. Print quality at Walmart is terrible.

    • Fallow

      She had to have done it as a stunt. Anyone who’s paid attention (or knows how to use Google before making relatively large financial decisions) would have known that Wal-Mart has a history of being weird about photographs with any level of “nudity”. That history extends at least back to when I was a teenager, and there weren’t digital cameras around.

      So either she’s very dumb or unobservant, or she pulled a stunt. Possibly all of the above.

    • ArmyChick

      I love this. Hahaha. Proud to live in NH. lol

  • Anna

    I was SO surprised to learn, as I did some research, that in the former days some women never actually delivered their babies, died with them inside((( The baby just couldn’t come out! Please, correct me, Dr. Amy, if I got something wrong. That is “the body designed to bith”. This is so sad when you think about it. And today we have everything to make sure your baby DOES come out and they sniffle at that and stay at home. Mean, evil and selfish people. I wish they could be charged with homicide. Having a new-born daughter it just hurts so much to think about it.

  • Anna

    It freaks me out how they use the word natural all the time. Natural = better in their understanding. Although maternal death, stillborn babies, serious trauma during birth are natural as well, that’s what they forget. A century or two ago “died in childbirth” was a common phrase. Now we have all the life-saving methods, a pregnant woman no longer has to fear that she will not survive birth, as it is extremeley unlikely! But instead of rejoicing in that, they want to go back into the dark ages! Some people are just never content!

    • Amazed

      They don’t forget it, Anna – they say that “some babies aren’t meant to live”.

      My friend’s newborn would have been one of those. She got advice from well-meaning people who think and read that “natural” equals “best” to go to the hospital only when howling in pain as to avoid evil interventions and not lose the helpful comfort of home.

      Long story short, the placenta started detaching. An emergency C-section later, they were both fine. Baby isn’t even in the NICU.

      Yesterday, I looked for information on the placenta detaching. I only made it to the first source. It spelled two courses of action: if the baby is alive, do a C-section NOW. If the baby is already dead… that was where I stopped reading. I didn’t even make it to the information written in English. It just made terribly clear just how much 5 minutes ARE. You have a detaching placenta, and you either have a baby who’s still alive… or one who isn’t already. All in such a short time.

      I guess that according to the natcherel people, this baby wasn’t meant to live. I’m so thrilled that she did!

      • Azuran

        According to the NCB people, your friend probably had an abruption because she did not listen to her body and was suffering from medical intervention. They’d say it wouldn’t have happened at home.

        • Amazed

          She’s a true atheist, at that. As she told me about her fears of the upcoming birth, how she’d like to keep it natural and so on (to her, natural meant vaginal, nothing else), she looked at me and said, “I am scared by all those horror stories I read. But I’ll never get it how anyone can choose to give birth at home. I’ll never do it!”

          Probably even her home would have rejected her. Negative thoughts for negative people, so the negative hospital for you it is!

        • DelphiniumFalcon

          A friend of my mom’s side of the family had and abruption in the late 80s and some neighbors went to help. Just the imagery they described from it was ghastly. They said it was like a sea of blood in the living room and despite knowing how much blood is in the human body it was never more than just a number until then. And this was a rather small abruption. She had planned a hospital birth and wasn’t even in active labor when it happened.

          Luckily she and her son lived but she was in very rough shape for a long time. When it’d come up or when she’d mention it both her and her husband got this very distant look in their eyes like they still couldn’t believe it had happened to them or like it wasn’t real it was so terrifying.

  • meglo91

    Off topic, but I’m looking for help identifying NON baby friendly hospitals in DC. (This makes it sounds like I’m looking for a viper filled pit to give birth in, but I digress.) A few days ago I found out I’m pregnant with a surprise third kid.
    I have given birth twice in baby friendly military hospitals. The last time I was preeclamptic, had a magnesium sulfate drip and couldn’t get out of bed, and was still expected to get up and care for my newborn. I also almost dropped her due to there being no nursery for her to go to when I was nearly delirious after 2.5 days with no sleep. So I don’t want to do that again. I’m in the DC area and will be in the normal civilian system this time. Does anyone have recommendations?

    • Cobalt

      My cousin chose not to deliver at VHC because the maternity tour guide said rooming in was mandatory. She was initially interested in that hospital because they have a great NICU, but it sounded entirely too “baby friendly” if you had a healthy baby. She ended up at one of the Sentara hospitals and loved it (slightly early induction, epidural, nursery on demand, good and respectful breastfeeding support, baby got formula w/o fuss for low blood sugar). This was early last year.

      An aunt delivered at Shady Grove and was happy (spontaneous term labor, epidural, nursery on demand, bottle feeding from the start), but that was ten years ago. Ten years ago, that was normal.

      • anh

        Shady grove has gone baby friendly and it was a goddamned nightmare.
        Sipley still has well baby nursery!

      • Kelly

        I am not up in that area but Sentara hospitals are awesome for labor and delivery. I delivered my second and will be delivering my third there as well. They gave pacifiers, took the baby to the nursery and fed her a bottle so I could sleep and were in general pretty awesome.

    • Cartman36

      The only hospital in my town is “Baby-Friendly”. I’m not looking forward to the crazy. Ill be packing my own formula and pacifiers.

    • An Actual Attorney

      I gave birth at Sibley a few years ago and have a steady stream of friend who have given birth there since. Not baby friendly. Gave me a paci and formula. Kid mostly roomed in, but it worked for me.

      But the “DMV” is big and it may depend on your where your OBs have privileges. Also, if you haven’t, figure out the drive during rush hour. You don’t want to be crossing a bridge over the Potomac in rush, or you might just have that baby on the bridge.

      G’town and GW are both teaching hospitals, with the good and bad that comes with it. G’town is Catholic, and that worries me (I don’t want the Pope weighing in on any choices to be made), but they do have the city NICU. GW has the weird midwife practice, and that makes me not trust the whole OB practice, but that may be unfair.

      I’ve heard bad experiences at Shady Grove, even apart from the new BFHI status apparently.

      Also worth giving a thought to if any jurisdiction makes more sense for you legally. That could affect hospital choice as well.

      In any case, congratulations!!!!

      • Who?

        ‘Shady Grove’ sounds like somewhere out of a gothic novel.

        • An Actual Attorney

          What’s worse, in disparaging comments, it is often referred to as “Shady Grave” — you would think that would have been thought of before they branded it.

          • Gene

            But the Peds ED there is top notch! 🙂

    • Megan

      This article from the WP lists the BFH in DC. It’s almost a year old so may not be completely up to date but hopefully it will be helpful. I second the advice to try the drive in rush hour as part of your decision making process. DC traffic sucks.

      http://www.washingtonpost.com/local/more-us-hospitals-adopting-baby-friendly-policies/2014/09/10/49a86998-34c4-11e4-a723-fa3895a25d02_story.html

    • D/

      Here are the currently BabyFriendly-designated facilities listed by state.
      https://www.babyfriendlyusa.org/find-facilities/designated-facilities–by-state

      It’s worth mentioning that non-designation does not necessarily mean that a facility has not adopted some or all of the Ten Steps (only medically-indicated formula, rooming in, no pacifiers/ artificial nipples, etc).
      http://www.babyfriendlyusa.org/about-us/baby-friendly-hospital-initiative/the-ten-steps

      A telephone interview with the maternal unit’s nurse manager can give you a picture of what a facility’s philosophy is.

      • demodocus

        Damn. My hospital’s on the list. For that matter, half the hospitals in the Cleveland area are on it. 🙁 Fortunately, we had nurses popping in regularly to check on me and the little guy, and he did sleep in a bassinet, not in my bed. Also fortunately, the NICU down the hall is *really* good.

      • Bombshellrisa

        It’s true, the hospital may be trying for the designation and will have adopted all the practices. The hospital I gave birth at is not designated baby friendly, but the LC told me (while rolling her eyes) that they were trying for the designation.

      • KeeperOfTheBooks

        Well, #&!@. It seems that the hospital at which I deliver just got their accreditation. *snarls*
        If you don’t mind, could you give those of us who are stuck using such hospitals a few pointers? Aside from contacting the nurse manager (which I will do), what can we do?
        I had a horrible experience with trying to nurse last time, and the LCs at that hospital were already out of control without the BFH certification. I’m going to bring this up with my (well-respected) OB next time, but what else can I do? Write to someone? Point out that forcing a mother who can’t even stand to do all necessary newborn care is the stupidest damn idea I’ve heard in a long time? (Yes, I’ll refrain from profanity while talking with the people in question.)

        • KBCme

          My second was born in a ‘baby friendly’ hospital. After having the first one not be, it was a bit of a shock how unhelpful the second one was. I had a csection for both and the spinal from teh second csection left my legs numb for quite a few hours afterward and my room had no place for my partner to even lie down! I got a little push back (we don’t have a nursery now…) but I insisted on them taking my baby for a few hours so I could sleep off the spinal and pain meds (and really, what could my numb-legged self DO for my baby safely?) This baby-friendly thing is Mom UN-friendly. I understand having the option to room in for those who want it, but for the love, the idea of being in a hospital is to have some time to RECOVER. Even if it’s just for a day, a baby is not going to be forever scarred by being in the nursery for a few hours.

        • KBCme

          Also, if you know ahead of time that the hospital is mom-unfriendly, make sure you pack bottles and formula if you think you may want to go that route – or even if you want to start with formula until your milk comes in (which, by the way, studies show actually leads to MORE long term success in breastfeeding, so gah.. ). Also pack a pacifier if you intend to use or try (pacifier use has been shown to reduce sids, so not sure why this is on the banned list but whatevs).

          • KeeperOfTheBooks

            That I’ll certainly do. I think a call to management is in order, as well as a chat with my OB. I will say this: the hospital’s website is still claiming to have a fully-staffed nursery available, so maybe some sanity has been exercised in the BFH implementation. Or maybe they haven’t updated their website. :p Either way, both the phone call and the chat will happen.
            It says something rather ridiculous that after reading that last night, I was so high on adrenaline from remembering how awful things were last time that I ended up having to take a sleeping pill to knock myself out. Insane.

          • D/

            Easier for me to say than for you to do, but no worries. Everything wrong about that first experience puts you in a place to be more aware of and better able to clearly (and proactively) express your needs this time.

            This LC’s has faith in you … You’ve got this! 🙂

          • KeeperOfTheBooks

            Yes! I will say that I’m honestly grateful for that experience, because now I at least have an idea of what to expect, and I also have better perspective on things. DD ended up exclusively FF after 4 months, and she’s gorgeous, healthy, and the joy of my life. If another baby gets formula from the start and ends up like DD, I’ll be one very lucky mother.
            You know, it occurs to me–and this is probably something I should try to explain to the hospital–that I would be much more willing to give breastfeeding a try next time if giving it a try wouldn’t mean being berated about it all the time by nursing staff and LCs alike, or made to feel a failure if I give DD formula because my milk, as it did last time, takes ten days to come in.

        • D/

          Hospitals (and the people working in them) are really caught in a terrible position. The pressure from all directions to capture an area’s market share, maximize the payment potential through insurances, stretch every physical resource as far as it can go, and squeeze every last drop of productivity out of the workforce is relentless. On the side of patient care, any facility that is not constantly focused on both providing consistently safe, quality care according to recommended standards of practice and delivering that care in a manner that results in satisfied customers will not survive.

          Baby-Friendly designation is becoming an increasingly sought out and marketable distinction of a facility’s dedication to current recommended standards of practice and quality of care. Baby-Friendly practices do increase exclusive breastfeeding rates (which is a current quality metric in maternity care services), but implemented without individual consideration to patient safety and satisfaction those same practices have will negative results. If you want to catch attention, focus letters to administrators on any safety and patient satisfaction aspects of Baby-Friendly practices that concern you.

          Include in nurse manager interview:
          Physical set-up/ expected degree of rooming in … Is there a staffed nursery? If not, what is the respite care plan for mothers wanting/ needed that degree of assistance? Staffing … What is the typical nurse (and LC): patient ratio? Are their any “restrictions” on formula, bottles, or pacifiers if they are requested?

          Consider an LC interview as well:
          Share your previous experience and what you need to make this experience better. A good LC will want to know, will listen and do everything possible to help you meet your goals (regardless of what those goals are) in a manner that meets your needs. A not good LC can be informed to remove herself from your care completely.

          Unfortunately if the reality of a facility’s set up and staffing makes it unlikely you will have the degree of assistance you will need or want, the option becomes to bring your own help (family/friends) to deal with it. Same for formula/ bottles/ pacifiers.

          There is absolutely nothing about being Baby-Friendly that prevents a facility providing care where babies go to the nursery on their mother’s request (if a nursery exists), get formula/ bottle fed whenever their mother requests, get a pacifier on their mother’s request, etc … What Baby-Friendly designation does require is documentation of those specific maternal requests and of the provision of education related to any “unfriendly” choices a mother might be making. If you find infinitely repeated education to counteract such unfriendliness to be unwanted and meet resistance to requests for one-time education, just mention that part of the HCAPHS survey (which directly affects hospital reimbursement) specifically relates to how nurses treat you.

          “During this hospital stay, how often did nurses treat you with courtesy and respect?
          During this hospital stay, how often did nurses listen carefully to you?”

          http://www.hcahpsonline.org/files/HCAHPS%20V10.0%20Appendix%20A%20-%20HCAHPS%20Mail%20Survey%20Materials%20(English)%20March%202015.pdf

          • KeeperOfTheBooks

            Oooooh, all very good points, and exactly what I was looking for; thanks!
            To clarify: I’m not looking to give the nurses, LCs, etc a hard time. I understand they’re caught between a rock and a hard place. However, I also don’t want to be berated and shamed if I decide not to try breastfeeding, or if I do try, but like last time it doesn’t work out at all.
            For perspective, last time I nursed as much as I could (DD often refused to latch on, probably because there wasn’t anything there) for the first 48 hours, at the end of which she had lost over 10% and needed supplementation. It was a choice of either give her some formula myself, or have her kept at the hospital while I went home and they gave her formula. The LC’s *still* gave me an attitude for “giving in” by giving her formula, even though I pointed out that in my view, having DD and I together at home would be a lot better for any nursing relationship we would have than having her stay in a hospital an hour away from me. I mean, isn’t that some of the point of the BFH initiative, that mom and baby should be together as much as is beneficial for nursing?
            Many thanks again for the tips. I’ll certainly hold off on any letters until I’ve had a chance to chat with nurse management and perhaps a LC.

          • D/

            You’re most welcome.

            To clarify further: If telling me how I’ve screwed up in providing their care is giving me a hard time, I wish every patient would give me a hard time. I’m paid good money and spend way too many of my waking hours doing this to want to be anything other than good at it. I figure the best way to get better is knowing what people need.

            So thanks for your tips too!

          • KeeperOfTheBooks

            Also, it would be *awesome* if this could be made into a post by itself, either here or at the FFF. A lot of moms probably have similar questions and concerns to mine, and would be helped a lot by knowing what to ask of whom and when! I don’t know how Dr. Amy feels about guest posts, but you might try pitching it to her and to the FFF. Can’t hurt, and it might help quite a lot of women out there. Thank you for all that you do! 🙂

          • D/

            You’re sweet and totally just made me lol. It took me more than six months to decide to even comment here and then longer to work through the pros and cons of fessing up to being an LC (and probably wouldn’t have if I hadn’t noticed other LCs already here). Every breastfeeding response I make takes an embarrassing amount of time to decide if I “should”. Just the thought of pitching a guest post idea to Dr Amy would end up being a bit paralytic for me 😉

          • Cobalt

            What would be really great would be if there were more LCs here and on FFF actually LISTENING. There is a real need for honest lactation consultants that give effective, evidence-based, ideology-free advice. Many women want to breastfeed and could do so successfully but need some guidance to get things working smoothly. Some don’t or can’t. They all deserve honesty, compassion, and respect.

            If the goal is a happy, healthy mother and baby, with safety and outcomes over dogma and process, then you’re in the right place.

          • KeeperOfTheBooks

            While I certainly can’t speak for everyone here, I can tell you that I, as someone who tends to get anxiety just thinking about trying to breastfeed again, have always found your posts to be sympathetic, helpful, and not in the least stress-inducing. And believe you me, that is genuinely saying something. I doubt I’m alone in this.
            You seem to have a very good grasp of both the science and the psychology of lactation, and write accordingly. I wish you had a blog or some such so that I could pick your brain a bit further; it seems virtually impossible to find common-sense, non-biased breastfeeding information out there, especially information that isn’t automatically skewed to shame moms who formula feed as lazy/uncaring/ignorant/etc. Seriously, you should consider starting one, or writing a book, or something! 🙂 And please do post here whenever you feel the urge; I, for one, always enjoy and appreciate your posts.
            Lastly, even if you won’t pitch it to Dr. Amy (and for the record, I’ve emailed her in the past and found her nothing but kind and approachable), consider sending that to the FFF. I’m sure her readers would appreciate that sort of concrete information!

          • D/

            Oh my, how very much I appreciate this … and you could not have had better timing!

            Recently I’ve been feeling professionally ineffective to the point of questioning if being an LC— at least in the hospital setting— is even something I can (or should) keep doing. I seldom leave at the end of a shift feeling good about what I was able to do for the collective needs of all the folks I’m supposed to be taking care of. Most days I just don’t feel like a very good lactation consultant anymore, and I’ve never worked a more difficult week than this one. Every day this weekend I could have stopped at some point to cry (with all of the already crying mothers) … but thank goodness not ever stopping for a drink evidently leaves you just dehydrated enough to be unable squeeze up any actual tears 🙁

            I do have a blog that I started a couple of years ago, but it just never turned into much of anything and is pretty sorely neglected at this point. Started feeling a bit embarrassed as I seemed to mostly be just “talking” to myself. I’ll definitely think about resurrecting it … I’ve always liked the idea of one.

            I really do enjoy this particular blog community … smart, funny, “real” people. Thanks for being so welcoming, and thanks again for a much needed pep talk.

          • KeeperOfTheBooks

            It sounds like you’re really overworked. 🙁 I’m sorry.
            When was the last time you had a vacation? Say, a week at least, maybe more like ten days? You sound a bit burned out, and your work is so intense, both emotionally (dealing with miserable, hormonal new moms all day?!) and physically (being on your feet all the time), that I shouldn’t wonder a bit if you were. I ask in part because last year, when DD was about 10 months old, I (a SAHM) was at the point of being in tears at the end of most days, and I couldn’t even quite put my finger on why. Thank goodness for in-laws; DH and I left DD there to be spoiled rotten for ten days while we left for a good long vacation with just the two of us. At the end, I was refreshed, rejuvenated, and excited to see DD, rather than feeling anxious and stressed out of my mind every time she needed something.
            Long story short, you can’t take care of your patients if you don’t take care of yourself.
            If you ever resurrect that blog and don’t mind us reading, please do post the link! I wish to goodness I knew of an online community that was supportive of breastfeeding and offered practical suggestions without shoving it down one’s throat; I’d join it in seconds!
            And yes, if I do say so myself, the blog community here can’t be beat. 😉 Stick around!

          • D/

            Thanks.

            Unfortunately, I’m realizing that there’s no prospects of any end result except overwork with my primary employer. I actually cut my hours back there, and this year I’ve really had to put the brakes on the number of consecutive days I agree to work. I made sure to take a (very much needed) 13 day vacation in June and am, in fact, planning on another in the fall. Yay for vacations! 🙂

            I actually love what I do and working hard … Always have. Not so much loving the idea of never coming close to doing a good job though 🙁 Now I’ve just got to figure out what I’m going to do about it.

          • DelphiniumFalcon

            I think you’re being too hard on yourself when you say you feel like you’re never going to do a good enough job. I think anyone who takes a step back from their job performance, tries to see what’s working and what’s not for their patients/clients, then adjusting their strategy for helping them is a stellar worker.

            That kind of introspection in workers is becoming a very rare thing. I know when I was a manager I tried to hang on to those ones as long as possible and once they graduated out of my department, as they ideally would since I was a trainer and not a permanent manager, to give them a leg up by name dropping to their new managers and making sure they knew who to keep their eyes on for specialty teams and promotions. That kind of worker is an increasingly rare breed it seems.

            It doesn’t always show, but both managers and clients/patients do notice the difference.

          • D/

            Thanks for the kind words. It’s true, no one is any harder on me than myself. My manager is generally complimentary toward me … and offers “you can only do as much as you can do” as comfort. Families are often complimentary (and apologetic) for the time and effort I spend with them.

            It’s also true though that the best I can do Is inadequate for what is needed. It isn’t because my partners and I aren’t good LCs. There’s just not remotely enough of us to go around for the needs. I’m usually pretty testy about the situation … usually more along the lines of my meeting attitude. “We are seriously worrying about exclusive breastfeeding rates when we aren’t even investing 15 or 20 minutes in assistance to ones that are actively asking for help? Seriously, that’s what we’re worrying about? … “. Need to trade all the piti-fulls in and just get back to testy, I think! 😉

          • KeeperOfTheBooks

            I dunno. It seems to me that if you care as much about your patients as you seem to here, and if you care as much about giving them good information without bullying/guilting/shaming them as you do ditto, then you’re probably doing a magnificent job. You can’t fix every problem; you can’t make a mom who has IGT either be able to fully breastfeed or, if she’s swallowed the extreme lactivist stuff, believe that she’s not a terrible failure because she can’t. You can’t wave a magic wand and fix dysfunctional families or crazy administrators. You *can* plant a seed or two that might not blossom into sanity for months or even years, and I bet you do that every day.
            And yes, vacations are AWESOME. Take them! You can love what you do while still getting burned out from doing and caring about it too much.

          • D/

            It’s funny what you can miss when you’re “down in the pit”. A couple years ago after a pretty miserable day I actually ran into 5 different mothers in one grocery store who all chased me down to show me their little buggy riders. Everyone one of them started out with “I know you don’t remember me but … ” Felt pretty silly for bitching all day about nothing making a difference.

            Definite rule for this LC … Only recreational breasts should be acknowledged on vacation 😉

          • KeeperOfTheBooks

            Your last line made me LOL. 😀
            It sounds like you do, as I suspected, make one heck of a difference. I, as a non-medical-professional, prescribe a continued course of vacations and general relaxation whenever possible until your morale improves. 😉 If you like, I can even draw you up a cool-looking prescription you can take to your manager: “Random strangers on the internet say I’m burned out and need more vacation! Guess I’d better take some!”

    • Lawyer jane

      Try checking DCUM – recent maternity experiences come up a lot there. I think some of the Virginia hospitals may be better.

  • demodocus

    No one is going to force you to have pain meds, though everybody had a sigh of relief when I finally asked for some. I didn’t feel pressured by anything but my contractions. My only interventions were the pain meds and the magnesium drip so I wouldn’t have a stroke.

    • Amy M

      I had no pressure about the pain meds either. However, I guess if you go into labor wanting to prove how brave you are by avoiding pain meds, its way easier to blame the hospital staff for pressuring you, than to admit you just didn’t want to feel anymore pain. Now, I think its fine to want to avoid pain–I planned to have an epidural during labor, years before I got pregnant. But clearly, some of the NCB folk view unmedicated labor as test of their mettle.