Increase trust in obstetricians: confront the natural childbirth industry working tirelessly to undermine it

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Oh, the irony!

Yesterday I wrote about the fact that the Childbirth Connection is angered that estimated fetal weights are … gasp! … merely estimates. I cited a recent piece in the NYTimes, When a Big Baby Isn’t So Big. In the comment section, multiple people bewail the loss of trust in obstetricians, apparently without recognizing that it is articles such as the one they are commenting upon that are directly responsible for that loss of trust.

Childbirth lobbying organizations like the Childbirth Connection are front and center in the effort to destroy trust between women and obstetricians.

They fail to see that the premier marketing strategy of the natural childbirth industry (encompassing midwives, doulas, and lobbying organizations like the Childbirth Connection) is the tireless effort to undermine trust in obstetricians. Why? Because the natural childbirth industry is desperate to increase their market share and touting the “experience” of birth only gets them so far. The primary “product” of obstetricians is birth safety and most women want that more than anything else. It is absolutely essential to the natural childbirth industry to inculcate fear and distrust of obstetricians, especially around the issue of safety.

Craig Thompson, professor of marketing at University of Wisconsin wrote about this tactic in Consumer Risk Perceptions in a Community of Reflexive Doubt in the September 2005 Journal of Consumer Research. Thompson marveled at the ability of homebirth advocates to market a “product” by directly defying common sense:

Advocates of natural childbirth seek to inculcate reflexive doubt by countering two commonsense objections to their unorthodox construction of risk: (1) medicalized births would have never gained a cultural foothold if they were so risk laden and (2) the medical profession would not support obstetric practices that place laboring women at risk.

In other words, it is absolutely critical to the natural childbirth industry to convince women that doctors don’t know what they are doing, and willfully and cheerfully risk the lives of women and babies to promote a secret agenda.

It’s difficult to think of a single prominent natural childbirth advocate or organization that does not work assiduously to undermine trust in obstetricians.

Individual tactics may differ of course:

Ina May Gaskin resorts to new-agey nonsense, and animal birth, which she believes, in her absolute cluelessness, to be perfect. Whereas Henci Goer favors cherry picking data, selective interpretation of scientific papers and pandering to privileged Western, white women’s desire to see themselves as “educated.”

Feminist anti-rationalists like Robbie Davis-Floyd deride rationality and insist that women have “other ways of knowing.” Clowns like Jennifer Margulis point to diseases they don’t understand and pretend they are caused by “technology.”

Every homebirth and NCB book, blog and website is predicated on the belief that obstetricians are “surgeons” “untrained in normal birth” who make millions performing unnecessary C-sections in the few moments they have each day between endless rounds of golf. The tremendous successes of modern obstetrics and the fact that nearly 99% of women give birth in hospitals is dismissed as the result of an economic war perpetrated by obstetricians on midwives.

Childbirth lobbying organizations like the Childbirth Connection are front and center in the effort to destroy trust between women and obstetricians. How else to explain the endless iterations of the “Listening to Mothers Survey,” a giant push polling project that desperately seeks evidence that obstetricians are not “listening to mothers” and repeatedly finds that the vast majority of American mothers are very pleased with obstetric care?

The natural childbirth industry eagerly grabs on to new methods for demonizing obstetric care, such as the unproven claims that modern obstetrics causes “traumatic birth,” and the hope that C-section cause long term health problems which have heretofore escaped detection despite the fact that there are tens of millions of adults walking around who were born by C-section and appear no different than those born by vaginal delivery.

NCB and homebirth bloggers pile on with inane accusations like “every day 12 babies are given to the wrong mother.” That makes it sound like there’s an epidemic of women leaving the hospital with the wrong baby, when what it really means (if it is true at all), is that an attendant (and that includes midwives) may bring a baby into the room of the wrong mother and discover her mistake when she checks the ID tags on mother and baby.

What about the spectacular advances in modern obstetrics, dropping the neonatal mortality rate by 90% and the maternal mortality rate by nearly 99% in just 100 years?

That is simply dismissed out of hand, with claims that hospitals actually kill babies, or deliberately cause the medical disasters from which obstetricians thereby appear to rescue babies.

The natural childbirth industry has an “answer” for just about every objection you can name and those “answers” often involve misinformation, and always involve undermining women’s trust in obstetricians.

Of course, the irony of the natural childbirth industry bewailing the very loss of trust between women and obstetricians that they themselves promoted is exceeded by another irony. That irony is the reflexive and unstated reliance of the natural childbirth industry on obstetricians to save the lives of babies and mothers after they’ve taken the advice of the natural childbirth industry and made dangerous decisions.

The backup plan always involves the hospital with the expectation of immediate access to the care of …. you guessed it … obstetricians. Apparently those evil doctors, who should never be trusted, can always be trusted in an emergency.

The next time you read an article based on a press release from the natural childbirth industry, treat it with the same wariness that you would treat an article about solar power based on a press release from Big Oil. Just like it’s always possible that Big Oil is accurately relating derogatory claims about solar power because of a deep and abiding commitment to scientific accuracy, it’s always possible that the natural childbirth industry is accurately relating derogatory claims about obstetricians because of a similar commitment to scientific accuracy.

On the other hand, it could simply be a brazen effort to blacken the reputation of the competition in order to increase market share.

 

Adapted from a piece that first appeared in June 2013.

  • Amazed

    OT: Misplaced trust alert!
    The Intruder just called me to check if I was ready to depart tomorrow if need be. Of course I am! Due date is in 17 days but the OB isn’t inclined to wait until then. Chuffy’s estimated weight 4 days ago was 3,200 kg and he thinks she’ll grow too big (the Intruder’s exact words. I scolded him for insulting Aunty’s Little Treasure, of course.) You see, the Intruder’s plan is to use me to help SIL after they get home. I have no idea what to do, SIL has no idea what to do, Treasure sure as hell has no idea what to do… but the Intruder trusts us! He just has to go back to work. Ancient women wisdom and knowing a woman’s body my ass. No ancestress has come in my dreams to teach me how to support SIL and what to do with the baby. Pretty sure that’s true for SIL as well. Three women who have zero experience. Nada. None.
    I still think we’ll manage. Without scented candles, thank you very much. Even if SIL needs to sacrifice bonding so she could sleep as I carry Treasure around to get her to sleep.

    • The Computer Ate My Nym

      My suggestions:
      1. Keep number to pediatrician handy and don’t be afraid to use it if you see something you don’t like. She or he has heard dumber questions than the one you’re about to ask. I can guarantee that because I heard dumber questions when I was a medical student rotating on pediatrics. I don’t care what your question is. Trust me, it’s not the dumbest one out there.
      2. Keep the number to the OB handy. Same.
      3. Plan on a lot of netflix and chill as well as plenty of naps for the new mom.
      4. Don’t do anything strenuous in terms of cooking or housework.
      5. Feed baby. Takeout is probably not what she wants, but formula or breast is fine.
      6. Crying babies are normal. Crying moms are normal. It will all likely be okay, but see points 1 and 2.
      7. Ignore advice from total strangers if it doesn’t feel right to you. If it’s useful, use it, if it’s not, dump it in the memory hole.

      • Amazed

        Thanks! They all sound like very sensible suggestions. I’ll keep them in mind.

        Their pediatrician is the same who took care of us when we were little. A family friend since Mom was in high school. You can be sure I’ll call her if I hear a peep that I don’t like.

        We must be fed, so cooking is important (for Treasure as well! No matter if her food is breast-cooked or botte-cooked.)! But housework can wait, especially with the fact that I’m going there with my own laptop, aka work. Fingers crossed Little Treasure will be pure gold and sleep well so Aunty can work from time to time!

        • Inmara

          It’s great that your SIL will have help! From my experience- mom needs food and drink fetched to her on a regular basis if she’s tied to couch with a baby latched on her breast. Somebody to hold/look for baby while mom has long shower is akin to heaven on Earth. If you are willing to sacrifice night’s sleep – rocking/bouncing baby to sleep after mom has finished feeding is a huge help because in first days baby may have day and night mixed up and just not willing to fall asleep. I vividly remember the night after we got home from hospital (where I have had 2 hours of sleep in each of 3 consecutive nights); I unlatched baby and said to my husband: Get him to sleep, I’m passing out. Next thing I remember was waking up to unfamiliar silence and husband gloriously reporting that he’s succeeded. From that point on, things got easier.

          • Amazed

            Thanks for your advice, I’ll keep it in mind! And yes, if need be, night sleep will have to go. I go to bed extremely late anyway, so it can as well be baby and awake, instead of work and awake. And perhaps some earplugs if she’s too noisy in the process!

        • Dinolindor

          I would also suggest that if you see something that needs doing and your SIL and baby are engrossed with each other, just do it. Things like cooking or ordering take out, washing dishes, putting in a load of laundry – just make sure it requires zero input from SIL. And the single most amazing thing my mom did for us both times she came to help out with our newborns was staying up with the baby until the midnight-ish feeding. My husband and I went to bed immediately after dinner/evening feed for baby, which was amazing. I got to have some private moments with my best friend and get a few extra hours of sleep all without worrying about our baby.

          • Amazed

            Oh yes, doing things without any input from SIL goes without saying. But I’ll take note on the stay up with the baby thing!

            Thanks for everyone’s suggestions, to this lady of the zero experience they’re very important! Keep giving them please!

            I am thinking of perhaps offering a pump since they don’t plan to have SIL tied to the baby 24 hours a day. As I’ve written already, the plan is to leave Treasure with my dad as soon as she’s old enough (that’s two or three months.) They’ll need the pump if breastfeeding works for them. But I’ll leave that for much later. There is time and for now, SIL is really focused on wanting to breastfeed. I am not giving advice that is both unwanted and, for now, unneeded. And chances are, they’ll come around to this idea all by themselves.

          • An Actual Attorney

            And be willing to change diapers. My mil will take the snuggles, but never is willing to change a diaper. And there are so many diapers.

          • Amazed

            Ah yes, one of the more unpleasant parts of the baby experience! The greatest concern I have right now regarding this is getting past those first few times when I have to place the new diaper RIGHT!

          • An Actual Attorney

            There’s pretty quick feedback so there’s a fast learning curve!
            You know the holes you have to cover, so it’s not too hard. One hint, if it’s a boy variety, point the penis down. Took me a while to learn that.

      • Charybdis

        Congratulations! I bet everyone is excited! Things that I found helpful when DS was a newborn were occasionally the oddball ones. I would suggest:
        1. Keep a basket or small bin of baby stuff in several rooms, so supplies are always on hand. Several diapers, butt paste, wipes, fresh onesies/sleep and play bodysuits, burp rags aka cloth diapers, and several clean, fresh receiving blankets all together in the den/living room, nursery and maybe master bedroom help.

        2. Meconium is STICKY…be prepared to have to work a bit to remove that stuff.

        3. If they live in a cold climate, you might consider a wipe warmer. I had one, as DS was a December baby, and having the chill off the wipes was nice for the both of us.

        4. Have some formula for backup. The ready-to-feed, 2 oz. nursette bottles that come with their own, screw-on nipple caps can be a livesaver. Having some already on hand can be a lifesaver, and the little boxes that have 6-8 of the nursette bottles are under $10.00. You don’t have to get a case or anything, but they are sure nice to have.

        5. Make sure the new mom can get naps and a shower/bath daily. Sounds silly, but sometimes a good nap and a good shower can do wonders to improve one’s mood and outlook.

        6. Babies cry. Sometimes, they cry a LOT. It’s normal. New moms cry. Sometimes, they cry a LOT. It’s normal. But don’t be afraid to step in and call the OB and/or pediatrician. They have heard it all, and then some. It will be okay.

        7. Try and keep a normal rhythm to the day. Meals at roughly mealtimes, things sectioned into mornings, afternoons, evenings and nights. It helps to keep everybody a little more sane, as the new mom time can be endless and stressful because your normal schedule goes out the window.

        8. Beware of the Long, Dark Teatime of the Soul, aka the late afternoon doldrums. Roughly between 3 and 6 pm, everyone is rather out of sorts and it is when things can look especially bleak and patience is in short supply. This is when I felt like going to pieces.

        • demodocus

          i’m not due until june but i’d love some #5 right now

    • KeeperOfTheBooks

      1. Congrats!!!!!!
      2. What everyone else said.
      3. Insofar as getting work done, some babies don’t care what you’re doing as long as they’re held or worn. A friend of whom I am dreadfully jealous, my kid being the keep-me-moving-at-all-times type, got quite a lot of gaming mileage out of her front pack with the latest newborn. Feed kid, change kid, tuck into front pack, Mommy (or Auntie) gets on the computer, kid passes out ’cause full tummy and snuggles, everyone’s happy.
      4. The single nicest thing anyone could have done for me when I had a newborn, sleep aside, was to let me get in a real shower, hair washing included, followed by a full *hot* meal, even if just toast and eggs, without a single interruption. I remember getting that once, and it was utter bliss!
      5. If and ONLY if you feel up to it and actually like cooking, consider putting Treasure in a carrier and whipping up a freezer meal or two. I’d never expect anyone to do this for me, but at the same time, my friends all say that my standard gift of a box of homemade freezer meals of the just-pop-in-the-oven variety (I write out directions on the foil I use to wrap them pre-freeze), not to mention a container or two of cake/brownies/similar treats, is the most awesome new parent gift EVER. As I said though, only an idea, and only if you, like me, find cooking rather relaxing and fun.
      6. Congrats!!!!!!

      • Amazed

        1. Thanks!!!!!!!

        2. I love what everyone said and I’m taking it to heart!

        3. Fingers crossed for a good sleeper! Or at least someone who would let Aunty work! Working while snuggling Treasure, it must be a bliss.

        4. Everyone says so so there must be something to it! I’ll take care to provide her with both shower time (and rose water, I’m buying it for her Friday afternoon, it’s magic for skin and hair) and hot meals.

        5. I am not this much of a cook but I intend to keep her fed. I’ll leave freezer meals to grandmothers. They both live not this far away. Same city, both within half an hour driving time. They won’t let SIL starve… and if they do, I’ll take care to flay my mom alive. Alas, I can’t do it with SIL’s mom. And coconut cookies are something I love making! Perhaps Treasure will love it as well?

        6. Thanks! Thanks! Thaaaaaaanks!!!!!!!!!!

  • J.B.

    I am someone who generally prefers to see a nurse practitioner. Partly because I have had two different mds (one my ob, the second a pediatrician talking about my kid and my parenting) make some pretty negative statements and in one case an incoorrect diagnosis without having all the facts or willingness to consider my input. There are of course jerks in any profession but those had significant consequences. And also reflected the speed of the appointment and need to bill insurance. So the middle road of seeing a nurse practitioner has been better-less speed, more listening. Of course that relies on md backup and that practitioner knowing when (s)he needs to refer!

    • J.B.

      To get back to the post, home birth is not the answer but it is really hard to make medical decisions for yourself and your family without being an expert! Some give and take helps with trust.

  • Brooke

    Some of the biggest advocates of natural childbirth are/were OBs themselves.

    • Azuran

      And they are a minority.
      If you look long enough, you will always find someone who agrees with anything.

    • yentavegan

      ob’s define natural childbirth differently than the anti-hospital pro- home birth acolytes.
      Ob’s definition of natural childbirth includes fetal heart monitoring, an iv lock ( just in case) ,and the laboring mother’s partner to be present . Ob’s do not have a deep abiding faith in normal birth. Mothers who are post date, or laboring for hours on end are not left to suffer through the whims of mother nature. Interventions are the norm because the end goal is a healthy thriving infant and a living mother.

    • Dr Kitty

      Female ones?
      Who have had more than one child?
      Who had anything except easy, low risk pregnancies and textbook deliveries?

      Female obstetricians, when surveyed, often respond that they would prefer to have MRCS themselves.

    • The Bofa on the Sofa

      And Henry Morris is one of the most vocal creationists, with a PhD in hydrodynamical engineering.

      Amazingly, you’d think he’d actually know something about thermodynamics. Yet, he peddles the most thermodynamics nonsense of them all.

    • lilin

      What a perfectly characteristic statement.

      “SOME (How many is some? Two? Three? Four?) of the BIGGEST ADVOCATES (How do you define “bigness” in terms of advocacy? Popularity? Number of articles published? Number of scientific papers published? Enthusiasm?) of NATURAL CHILDBIRTH (What is natural childbirth? Is it with a midwife? Is it medication-free? Is it at home? Is it un-induced?) are/were OBs themselves.”

      In other words, and unspecified number of people who advocated in an unspecified way for an undefined kind of childbirth are or were OBs. This is the kind of statement that cannot be proved wrong because it has no actual definition, which is why Brooke made it.

    • Who?

      Your point?

      A couple of thoughts-even smart, well educated thoughtful people can be wrong. Scientists and those with a science background are used to it and are open to changing their view as better information comes to hand. That’s what smart, thoughtful people do-when they know better, they do better.

      Who doesn’t advocate natural childbirth, so long as mum wants it without feeling pressured into it, mum and baby are apparently fit for it, and there’s help at hand if things don’t go so well naturally?

      What kind of person wouldn’t be far more interested in the opinions of people advocating for healthy, alive mums and babies than for some process.

    • The Bofa on the Sofa

      Hey Brooke, if “some of the biggest advocates” are/were OBs, perhaps you can name three?

      Remember, these are the _biggest_ advocates, not “I know an OB who like this.”

      I can even give you two, I think (correct me if I’m wrong): Biter and Fischbein. Both of whom, of course, have had unethical behavior with patients, so it’s not clear why these would be the examples you want to bring up. You could just as well say that “some of the biggest advocates of natural childbirth are sexual predators.”

      • The Computer Ate My Nym

        Um…J Marion Sims? He probably thought home was a more appropriate place to give birth than a 19th century hospital. Might have been right too. There’s been the occasional change in practice since his time.

        • The Bofa on the Sofa

          Yeah, but this is a challenge for Brooke. As always, folks here know a lot more about it than she does, but it’s a test for her. She is the one who is bluffing.

          • The Computer Ate My Nym

            Oops. Sorry! Yes, I am the nerd that says, “Ooh, ooh, I know!” when the teacher asks a question, any question at all to any student at all.

      • fiftyfifty1

        Hold it, they are BOTH sexual predators?! I thought only Dr. Fischbein (aka Bedside Man) was a sexual predator. Biter’s problem was reckless malpractice resulting in deaths.

        • Amazed

          AFAIK, he isn’t a sexual predator but close. He’s a self-proclaimed hugger. He hugs his patients left and right.

          • The Bofa on the Sofa

            Kind of like Lotso from Toy Story 3.

      • Roadstergal

        And “sexual predators” includes Ina Mae and her ilk as well, so it’s a numerically stronger statement. 😛

      • Bombshellrisa

        Rebecca Wyman, the OB who planned a home birth when she was in residency, her mom is/was a home birth midwife who was “persecuted” into retirement.

    • demodocus

      i heard that there are a couple climatologists who don’t think humans are influencing global warming. There’s a certain neurosurgeon who thinks that the pyramids at Giza are grain silos. There’s always one in every crowd.
      My obs were fine with me trying to have my son without pain meds or anything else, at least until my blood pressure skyrocketed (it bothers them when their patients have strokes), as they were for my mother, who actually succeeded several times.

  • Anna

    It’s too bad that NOT trusting obstetricians has become a fashion. Sort of a marker of being upper middle class, educated and hipster trendy. A well-known woman in my country (not quite a celebrity, but sort of it-girl) who is currently faking a pregnancy and using a surrogate mother (don’t ask how I know it, long story, in two words the world is small) recently dedicated several posts on her blog to the importance of intervention free birth and how difficult it is to find a doctor who would have the right approach and let everything be natural blah-blah-blah, doctors greedy lazy butchers who only want to do cesareans (sorry, Dr. Amy, it was a citation). God, she isn’t even going to give birth! In reality the surrogate mother will have the evil c-section so that the baby gets out as safe as possible. But she writes this crap because it’s trendy and cool! And then she will submit a fake birth story smth like orgasmic birth in a pool surrounded by candles and ethnic music playing in the backgorund. Because she is elite, not one of the stupid crowd and she knows better!

    • The Computer Ate My Nym

      Off topicish, but when I was pregnant I flirted with the idea of having “ethnic music” playing while I was in labor. Specific ethnicity: north-central European. First choice: Nina Hagen’s _Unbeschreiblich Weiblich_.

  • DelphiniumFalcon

    I have one word for those that romanticize animal birth as being natural and beautiful and easy:

    Hyenas.

    I also have a sentence for them:

    Giving birth through pseudo-penis!!!

    Nope!

    Everyone on the Nope Train to Fuck This Shitville!

    • Brooke

      And yet…hyenas survive. By comparison we have it much easier but you wouldn’t think so if you listened to some people.

      • Monkey Professor for a Head

        But how many hyenas would request epidurals if they could?

        • DelphiniumFalcon

          I think they’d skip the epidural and go straight to maternal request c-section. Splits. The clitoris. Open. Estimates of a 10% maternal death rate.

          Hyenas are laughing because we have access to c-sections and yet some humans think c-sections are terrible things to be avoided at all costs. If they had sterile technique and thumbs, I bet hyenas would be all over c-sections.

          • Azuran

            Considering how c-section are actually way less traumatic and have a much quicker recovery in pets than in human, I’m sure they would.

      • Azuran

        And there, you said it. They ‘survive’. Surviving isn’t pretty. Surviving is full of pain and illness and even death. You don’t need 100% of people to survive. You only need enough to survive to produce de next generation. Just because wild animals have it worse does not mean we shouldn’t treat pain.

        And actually, proper analgesia is actually a very important part of veterinary medicine. Pain is recognized as something that should be treated in animals as well.

        • DelphiniumFalcon

          …that’s a rather telling statement actually.

          Midwives think women in labor are less deserving of pain relief than animals when you take what you said into account.

      • DelphiniumFalcon

        Survival of the species isn’t the question here and never has been. It’s the “natural is beautiful and sparkly and knows what’s best” bullshit that gets trotted out.

        We’re just lucky that in some cases we can give nature the middle finger salute when it tries to keep up that survival of the fittest thing on humans.

      • Megan

        The implications of your statement are very ugly. Sure, if we went back to the times before modern obstetrics, enough mothers and babies would survive for the species to continue. But many would die. You only reveal how little you care about individuals and their outcomes by making a statement like that. How much would you care if the species continued but you were the one to lose your baby? How much would your partner (or any of your children left motherless) care that enough mothers survive to propagate the human race if you were one of the ones that died? Would doing things the “natural” way be so important then? It is only by viewing things through the lens of the safety of modern obstetrics that the “natural” process trumps the outcome and seems so lovely. Only the privileged and/or the ignorant can make such a statement.

      • Erin

        Not all of them. When I was a little girl I saw plenty of dead female sheep with little skeleton sheep babies lying inside of them on the hillside. My son and I would have been the human equivalent of that without medical help but then I suppose you probably agree with the Midwife who told me that he didn’t descend not because of my flat pelvis but because I had unprocessed negativity towards being raped and thus my vagina wasn’t on board for a natural birth.

        • DelphiniumFalcon

          What the…

          I can’t even… Just… What?

        • fiftyfifty1

          Wow, what an idiot your MIdwife was. Vaginas are so powerful, that if they don’t want to give birth they can resist against the force of the uterus–the most powerful muscle in the human body. With each uterine contraction, the vagina repels the baby and it can’t even enter the pelvis. Too bad we women can’t use the same magical powers on would-be rapists huh? Every time they try to take a step toward us, the vagina’s magical forces throw them backwards and they fly across the room and hit the wall.

        • Who?

          See, I haven’t even met that midwife but I have both processed and unprocessed negativity towards her.

      • Roadstergal

        Have you considered leasing out the unused space between your ears?

  • Sue

    Latest news scoop: Study confirms that ultrasound estimates of fetal weight significantly more accurate than lay MWs’wild guesses.

    • Who?

      Well what a meeaan!!! thing to say….

      They have many ways of knowing about those who have not yet come earthside.

    • Back in the days before ultrasound, we once had a woman who was somewhat vague about dates, and in early labor. Best guess was 36 Weeks, so the question of EFW was pertinent, as we might try to stop labor if the baby was very small. First, the intern palpated her abdomen. Then the junior resident, then the senior resident, and finally the attending doctor who was on call. Everyone then convened in the corridor. None of the junior doctors really wanted to be the first to volunteer an opinion so finally one respectfully asked the attending, “What do you think, sir?” This doctor, with about 25 years of experience, shrugged, and said, “Five pounds, give or take two pounds either way”.

      That’s how accurate palpation is, even with experience. Ultrasound, with palpation, common sense, and experience, provide better results. Homebirth midwives may not have any of these.

      • Who?

        Are babies like pension funds, in that past performance is not an indicator of future performance?

        Or, in other words, does the size of a previous baby usefully play into the calculation/guesstimate/assessment of the weight of the unborn under discussion?

        • On an average, each subsequent baby is about 200 gm [half a pound] more, but in this case, the woman could not remember when her last period was, nor had she had any antenatal care. Sometimes, for example, a baby may have intrauterine growth retardation and be smaller than previous ones.

          Fortunately, those days are pretty much over. Even if the woman has little or no prenatal care, or has religious reasons not to do ultrasounds in pregnancy [to rule out defects], there are various u/s measurements today which can give us a lot of information even when she is in labor.

          By palpation, in 1980, with my first baby, at term his weight was “somewhere between 3 and 3.5 kilo”, and “don’t worry, you could drive a truck through your pelvis”. He weighed 4.25 kilo, and was delivered, after 2 days’ labor, by C/S. Obstetrics is not an exact science.

          • The Bofa on the Sofa

            On an average, each subsequent baby is about 200 gm [half a pound] more,

            That’s interesting. I am just trying to think…

            Our first was born 6-1 at 37 weeks. Assuming he would have gone to 40, growing 1/2 pound a week, that would put him 7 1/2 lbs full term. Our second was born at 39 1/2 weeks, and was 8 – 2.

            So yeah, 1/2 pound bigger.

            Huh.

          • demodocus

            9 1/3 pounds is not a small kid. ouch

          • demodocus

            Which, if #2 is 1/2 lb bigger than #1, is where I’ll be in 4 1/2 months… meep

          • Who?

            Interesting, thanks for the explanation.

            More information is always better.

  • Medwife

    A good buddy of mine, “elderly primip” with other risk factors, was induced partially for suspected macrosomia between 40 and 41 weeks. Under CNM care at a hospital. She hadn’t wanted to be induced and was trying for a birth without pain medication. She had a nearly 3 day induction, epidural, pushed for FOUR HOURS, episiotomy, and had a 8#14 healthy baby. She read this article and now feels angry with her midwives for being so worried about fetal size. It’s so insidious, how the movement reframes healthy moms and babies into victims.

    • AA

      To clarify–she is angry that the CNMs “tricked” her into being induced instead of waiting for spontaneous labor?

      • Medwife

        Yes. That they caused her a lot of anxiety and scared her into getting induced, because clearly in retrospect she has a perfectly adequate pelvis.

        • CanDoc

          I’m not entirely convinced that a prolonged induction, prolonged second stage, and need for episiotomy clearly demonstrate the adequacy or her pelvis or that her pelvis would have remained so after another week of gestation – including an extra 1/2 pound of baby weight and extra week of placental aging. But a woman with advanced maternal age, “other risk factors”, and suspected macrosomia would be a good candidate for induction at 40-41 weeks because of research clearly demonstrating that induction in that situation a) slightly decreases the risk of stillbirth, and b) slightly decreases the risk of cesarean section. It sounds like she had a really difficult experience and I’m sorry that she didn’t feel satisfied with how it all went… but I wouldn’t assume based on that outcome that if she had just “waited it out” that everything would have been magically fine. Maybe she would have turned up in labour and had a great experience, but maybe she would have ended up with a cesarean section or another type of “bad outcome”.

          • Medwife

            That’s what I was getting at. I should have added /s, I guess without being able to see my eyeroll it didn’t come across. She eked a vaginal birth as it was. If she was my patient and not my buddy I would have probably started talking induction at 39 weeks.

          • Medwife

            Your response was very diplomatic, by the way!

    • fiftyfifty1

      “A good buddy of mine”

      It’s hard to watch, isn’t it? I’ve had 2 friends, one of whom is a very close friend, resist inductions despite being 40+ nullips with IVF babies. All because they wanted to go into labor naturally because they believed it would decrease their chances of needing pain meds. The woo is evil and it takes in a lot of people who really should know better.

      • Medwife

        I was really surprised. She’s a very smart, otherwise rational person. But like so many, after a birth that was pretty traumatic (did I mention the 4 hr 2nd stage and episiotomy?), she has found something or someone to blame other than herself. I think she feels guilty over the epidural, too.This is how the road to home birth starts. And postpartum is such a vulnerable time, too. Man. I think I’ll give her a call!

  • Allie P

    Just in yesterday’s post,.
    Someone parachuted in to accuse Dr T of having “no interest in improving obstetrics”. But when you drill down on that desire, you can see how the NCB movement and obstetrics are at odds.. For me and most people I know, “improving obstetrics” involves more prenatal testing, better management on high risk situations like GD, pre-eclampsia, placental problems, prevention of miscarriage, stillbirth, fetal band syndrome, IUGR, cord prolapse etc etc. For NCB advocates, “improvements” look like making everyone give birth naturally while playing to Enya CDs and burning patchouli in the delivery room. There’s zero common ground.

    • demodocus

      god, not patchouli and Enya! anything but that!! Even I was able to bring a local soloist to sing all my favorites.*
      *True story, but the solos are at church and in his chorale and unpaid. Plus, he’s the father.

    • Bugsy

      Lol…I was so relieved to find my Enya CD after our move a few weeks ago. Not for childbirth, though: to use when I desperately need mommy time in our soaker tub away from the toddler & newborn. 🙂

    • Young CC Prof

      Which is funny, because most actual pregnant women interested in natural childbirth ARE the middle ground. They want a natural birth experience in a nice comfy space, but if necessary, they’ll give it up in hot second for safety.

      • crazy grad mama

        Yup. I belonged to that group, at least until my kid flipped breech and stubbornly refused to turn back. It was really irritating that 99% of the resources on natural birth treated hospital staff like the enemy, because I liked my OB, knew our local hospital was very supportive, and sure as heck wasn’t interested in giving birth at home.

        • Young CC Prof

          Yeah, I remember saying in the early months, something like, “Sure, I want a natural birth in a comfy space. With an operating room down the hall.”

          Then things went wrong, and I wound up with appointments and tests all the time and a c-section at 37 weeks. And you know what? It was beautiful.

          • BeatriceC

            I can’t recall the author of the book, but there was one I read when I was pregnant with my oldest called “The girlfriend’s guide to pregnancy”. It was actually pretty funny, but the line that really struck out at me was when she was talking about all the NCB stuff and she said she really didn’t get all this natural/earth mother stuff, then said “I’m a mother and I live on earth, therefore I’m an earth mother, even if my kid was cut out.”, or something to that effect. I really liked that book.

          • CanDoc

            Oooh, I need to find that one for my waiting room!

          • Kelly

            I know I believed a lot of the woo but once my doctor asked if I wanted an induction, I promptly answered yes. t I would have done anything the doctor suggested because I was going to trust the one who had the education to make those suggestions.

      • Amy

        I was on the Enya/patchouli side myself. But I jettisoned that a few days into labor when it became clear that all the positive thinking and lavender EO in the world wasn’t going to get my baby out safely.

        Kid is now 10. Thank GOD I wasn’t a slave to the woo or who knows if she’d even be alive now. Instead, I’ve got a kid who plays four instruments, does reasonably well in school, writes poetry and short stories, and most importantly is one of the most sensitive empathetic people you will ever meet. But I guess she and I are failures and she lacks magic sparkles because she was delivered via c-section.

        • Nick Sanders

          who knows if she’d even be alive now. Instead, I’ve got a kid who plays four instruments

          If she were my kid, there’s a good chance she wouldn’t be alive. …Nothing to do with woo, I just really value my peace and quiet.

          • Who?

            My son had a brief flirtation with the trombone. We used to send him way out the back, near Bozo the Wonder Neighbour, to practice.

            He later took up the flute. Much better.

          • BeatriceC

            Middle kid plays the Viola. Thankfully he’s past the awful beginner stage and is actually pleasant to listen to these days. The viola is stunningly beautiful if played well, but awful in the beginning. I swear the only worse sound is a beginner oboe (and my sisters and I subjected my parents to that three times over…my older sister was kind enough to play the cello and my youngest sister and brother aren’t into music at all).

          • Haelmoon

            In my family, I am not sure how my parents put up with our learning. Between four kids, we played violin, viola, clarinet, oboe, trumpet, trombone, accordion and organ. We all practiced a lot.
            Now my kids are learning piano, violin and clarinet and I am finally getting around to learning the guitar. Thankfully, we have a large basement that is somewhat sound proofed from the rest of the house!

          • demodocus

            My kid spends far too much time hanging out with the choir; he’s always singing and begging to “play piano!” and “reading” our music.

          • demodocus

            Early evidence, taken by a fellow alto

          • Amy

            Clarinets are pretty bad, too. And you have to be REALLY good before they sound remotely good. Average to above average clarinet players still sound pretty bad.

          • Amy

            Ehh, I play four instruments myself. We jam together a lot.

        • Allie

          Sure, she’s awesome. But think of how much more awesome she’d be if she were born vaginally, without any interventions and breast fed at least until Kindergarten : )
          (Yes, sarcasm)

      • yugaya

        But too often these middle-ground moms are when complications arise too sucked in into dangerous misinformation provided by their dangerously incompetent birth attendant and too far/too late from safe and adequate intervention.

    • Roadstergal

      EFM gives false positives.

      Scientists: Let’s improve our diagnostic tools.

      NCBers: Don’t use EFM.

      Some women don’t make enough milk/don’t want to BF.

      Scientists: Let’s make better milk substitutes.

      NCBers: You’re a bad mom if you don’t EBF.

      Women who breastfeed might be protected against certain types of breast cancer.

      Scientists: Let’s drill down to ensure the effect is really there, analyze it, and see if we can understand this protection so we can better care for all women, BF or not, parous or not, can benefit.

      NCBers: Cancer? Should have BF more.

  • mostlyclueless

    OT but something I’ve been wondering about:

    Allegedly, almost all women can breastfeed, and undersupply is extremely rare, right? Your baby knows exactly how much milk s/he needs and your supply is perfectly regulated for your baby, right?

    Then oversupply doesn’t exist either, right? And moms who think they have an oversupply are actually STARVING their babies. Because their bodies make the exact right amount of milk perfectly regulated to their babies…right?

    • AirPlant

      I actually feel like most of those people assume oversupply to be the norm. Like all women start with enough to feed triplets and regulating the mothers supply is just a matter of working down to enough for one.

      • Commander30

        That would explain why their answer to women who can’t breastfeed is “Get donor milk!” Because apparently there’s just so much to go around and all.

        • AirPlant

          And why they don’t even blink at the idea of breastfeeding twins.

          • BeatriceC

            MrC’s late wife breastfed their twins for a time. I think she wound up combo feeding them for the first year because of supply issues. Anyway, any time I mention something about my massive oversupply, he always says something about how the original MrsC would have been very jealous.

      • BeatriceC

        I would have been happy with only enough to feed triplets. My body thought I’d given birth to a football team. I could lean over and pour out 8-10 oz without even pumping. It was insane, especially with the last one. How much milk did my body think a one pound baby needed?!?!?! Anyway, I had enough pumped and frozen that when my parents took in a foster kid who was FTT at 4 months and was puking up the formula he came with, even if we fed him 1/4 oz at a time, the doctor suggested feeding him some of my extra breastmilk to get us through until morning when we could get to the store and get specialty formula. He tolerated it so well that we decided that I had plenty, so he spent most of the rest of his first year eating what I had stored frozen.

        • AirPlant

          That is amazing! And a bit terrifying! But mostly amazing! The human body is so weird!

    • Zoey

      I had oversupply issues with my youngest and I asked an LC about how to address it, as I was worried about the uncomfortable GI issues it was causing in my daughter. The LC was adamant that I should not to anything to reduce my supply, like block feeding, because my supply would regulate itself eventually (even though my daughter was like 4 months old at the time, so the “need to make milk for triplets” phase should have been over). Instead she recommended that I pump more and freeze / donate the excess.

      Anyway, I ignored her advice and did block feeding until my daughter’s issues resolved.

    • Young CC Prof

      They’ll just say you must have done something wrong, perhaps due to a doctor who “wasn’t educated about breastfeeding.” Too much pumping. Not enough pumping. Letting baby use you as a pacifier. Using an actual pacifier. Occasionally putting baby down to use the bathroom, and the temporary absence of skin contact messed up the hormones. See, there must have been a reason.

    • Amy

      I had oversupply. Donated several gallons of breastmilk. No regrets.

    • Brooke

      According to whom? Undersupply isn’t rare if mothers are not with their babies especially in the begining which is why the first hour of birth and first 6 weeks after birth are so important for getting breastfeeding established. Oversupply isn’t rare either in that some babies love to suckle even if they are not hungry just for comfort, but this nipple stimulation encourages mom to produce more. The idea is that although undersupply isn’t uncommon almost all moms can produce enough milk IF they are given a good start and the right education & support from the very begining. Otherwise they end up trying to play catch up, particularly if as formula companies suggest mom’s “top off” with formula following a feeding and their bodies never learn to produce more during growth spurts or if mom and baby are seperated immediately following birth and for long stretches especially during the first few weeks and months. Additionally many people think they have poor supply when they don’t. Breastpumps are not effective as a baby so many moms freak out if their only pumping a few ounces even though that’s normal. Or they have a doctor who uses the wrong birth chart and tell them their baby is falling in the percentiles when their actually growing normally for a breastfed baby. Some women think softer breasts are a sign of low supply even though that’s normal after the first few months. There are some women to freak themselves out so much being worried about their supply they actually cause themselves to have a low supply from stress.

      • mostlyclueless

        God can you even hear yourself?

      • Azuran

        And nobody is saying breastfeeding support is a bad thing. We are saying that shaming and lying to women who cannot breastfeed or are having ridiculous difficulties about the actual risk/benefit of formula/breastfeeding is wrong.
        Go check out the reality. Even if your claim of ‘almost all moms can produce enough milk IF they are given a good start’ was true, that’s not representative of real life.
        Many mothers will have bad start because of a load of reason and if they want support to achieve BF, they should get it, but if they decide that it’s not for them and want to quit, they should be supported equally.

      • yentavegan

        Lets be honest about milk production/supply. If a mother has the luxury , the economic support, the temperament, the genetic luck of the draw, and the desire to breastfeed every two hours around the clock for 6 months sure she can produce ample milk to sustain her baby. That is a lot of “if’s” and who are we to judge her if that is not an appealing scenario?

      • guest

        I had an oversupply BECAUSE of the breast pump. Tell me again how they are “not as effective.”

      • momofone

        Wow. Given the length of that response, I bet you’re about ready to share your analysis of the PROBIT study and share your statistics about the “ideal” c-section rate. We can’t wait! 🙂

      • Megan

        I think we have bingo!

      • Commander30

        I know I’m a little late to reply to this, buuuuuut…

        My daughter was born vaginally, we had the “sacred hour” with her, one of the first things I did when she was handed to me was to put her to my breast, she roomed in with us at the hospital except during the night (and the nurses still brought her in every couple of hours to feed), and I had six weeks of maternity leave. Somehow I still had a low supply. And I know this because my baby would still be screaming from hunger even after a 30+ minute nursing session. (And I would have loved to have pumped a few ounces. Try a few DROPS for me.) Basically, I knew I had low supply because my baby was hungry. I wasn’t going to waste time waiting to see an lactation consultant and cook up lactation cookies. I gave her formula and she was immediately satisfied.

  • Mel

    Perhaps I am in a dark mood today, but if the NCB industry is so great at what they do, they should be able to convince women of the natural conclusion of their beliefs:

    There is no situation where a laboring woman needs modern medical treatment. No matter what happens, we can handle it at home.

    Now, clearly, the net outcome would be that a) “normal” vaginal births – ie, the ones that turn out fine for mom and baby regardless of the presence, training or absence of an attendant would remain the same and b) “abnormal” births – the ones where anything go wrong would end in far higher levels of maternal and neonatal morbidity and mortality.

    Just like the good ol’ days prior to obstetrics, neonatologists, blood transfusions, antibiotics, and intensive care units.

    • Valerie

      You are hardly exaggerating. One of the childbirth connection’s core principles is that “Most childbearing women are well and healthy and as such have every reason to expect an uncomplicated birth and transition to parenthood and a healthy newborn.” This is misleading and dangerous: health does not always lead to an uncomplicated birth. The fact is that there is no technology to know for sure apriori which births will be uncomplicated, so steps are recommended to reduce risks. That’s the whole point of inductions, CS, etc- it’s to reduce the chance of a poor outcome when known risk-factors crop up. It’s like they have no understanding of the inherent danger of childbirth, even for textbook-conforming pregnancies.

      • The Bofa on the Sofa

        “Most childbearing women are well and healthy and as such have every reason to expect an uncomplicated birth and transition to parenthood and a healthy newborn.” This is misleading and dangerous:

        And it means little to those who have a complicated birth and and non-healthy newborn.

        If my baby dies, that fact that most don’t is no consolation at all.

        • Kesiana

          And for that matter, couldn’t “most” technically mean anywhere from 51% to 99%? It’s not a very helpful descriptor.

      • demodocus

        My mom was young and healthy and her first was an 8th month stillbirth. The twins she had when she was old and overweight and developing a slew of health problems on the other hand were perfectly fine. Couldn’t get to the hospital in time for the first, nice scheduled c-section for the last. anedoctal, sure, but that’s what they use, too

      • Roadstergal

        “Most childbearing women are well and healthy and as such have every reason to expect an uncomplicated birth and transition to parenthood and a healthy newborn.”

        Also, that’s missing:
        -Moms in the developed world are older than any time in history – we don’t generally have kids starting in our teens anymore. First-time moms in their 30s and 40s are increasingly common.
        -Babies are bigger than any time in history. We have excellent nutrition and excellent prenatal care, fewer infectious diseases, and safer water/air, etc. So many of my friends/coworkers are having ~9-11lb babies! A co-worker was showing me a picture of her 11lb newborn – term baby, bald and squalling, just huge.

        • Young CC Prof

          Exactly. Women always had babies in their thirties and sometimes their forties, but they very rarely had FIRST babies at those ages.

          • demodocus

            Well, if I cheated on my husband, I could have had a baby in my 20s, too, lol

        • DelphiniumFalcon

          It’s so crazy how much the advantages in the developed world have changed our body structure. I got to experience how much things have changed in the last 150 years first hand!

          Back when I was seventeen I went to see a concert in the Salt Lake Tabernacle. This was before I had to do more tinkering with my hormones and had my weight end up screwy so I was nearly 5’8″ and somewhere around 145 lbs give or take.

          I wanted to die sitting in those pews. The building was finished in 1867 and people back then must have been tiny. First I could barely squeeze into the rows themselves. Two, once I sat down it became very clear that the angle of the pews were meant for people much shorter than myself and of a more petite build. I felt like a giant sitting there and I’m not really that much taller than the average in Utah. My five foot nothing grandma was very comfortable. I ended up with muscle spasms around my tailbone somehow from wedging myself in so I wouldn’t call off the seat. Yeah the seats were hard wood but I’ve sat on concrete longer than I was sitting in those less and had no problems.

          I’m even directly related to one of the designers and builders of the Tabernacle and I don’t fit in those seats right! Yes there’s about 150 years between him and I but when you take in human history has a whole and how long it usually takes for a change that drastic, that might as well be 150 minutes.

          Edit: Just realized this can’t be tested anymore since the benches were replaced two years after that incident:
          “During the renovations completed in 2007, the original benches were replaced with new oak pews, and legroom was increased from nine to 14 inches.”

    • crazy grad mama

      They kind of take this approach already, with the insistence that high risk pregnancies don’t count toward statistics. Study shows that the safest C-section rate is at least 20%? Oh, that’s because they included all those high-risk women. High out-of-hospital neonatal mortality rates? Oh, don’t worry, home birth is safe for low-risk women. It’s like they have zero understanding of how risk actually works.

      • Valerie

        Also, they think doctors can discriminate with 100% certainty between those births that will wind up with a healthy mother and child and those that will end catastrophically and only recommend interventions with the latter. Obviously the interventions that may have been unnecessary in hindsight were done for reasons other than the health and safety of the mother or baby (eg. convenience or to make money).

        • Amazed

          … and a pink screaming newborn means that an unnecessarian has been committed. The only reason to know that it was a necessarian is a grey limp baby or at least one needing some NICU time.

        • Katie

          And that is why I like to tell my story: I had an easy pregnancy, short labor & small baby, but the last 15 minutes were dicey. The cord was short and didn’t have much Wharton’s Jelly, so once the contractions were close together, his heart rate didn’t come all the way up. It took two doctors – one vacuum, one forceps – and a LOT of cutting to get him out vaginally. The doctor had called for someone from NICU to come down which terrified me, but thankfully he was fine.

    • Amy M

      Really all they have to do is hang out in some developing nation, like Afghanistan for example, where they have very limited access to obstetric technology. Then they can see the natural rates for maternal and perinatal morbidity and mortality. I hope they would not find those rates acceptable.

      These NCB people all come from wealthy nations, where access to healthcare is taken for granted, as is access to other resources like clean water and nourishing food. We privileged people are already starting at a safer point, and even without a birth attendant must have lower rates of morbidity and mortality.

      • Bugsy

        At least from personal experience, the loudest NCB advocate I knew was someone who had little overseas experience, with her husband having pretty much zilch experience with anything other than the miniature bubble in which he was raised. It’s really easy to decry the advancements of modern society when you have never seen first-hand how difficult life for others can be, when you have zero frame of reference for comparison.

        • demodocus

          and apparently never read any books not set in the developed world.

      • Roadstergal

        “Afghanistan doesn’t have sanitation and feminism.”