A healthy baby is not all that matters? Who ever said it was?


It’s getting ever more difficult for homebirth and natural childbirth advocates to defend safety claims. It’s pretty obvious that hospital birth is safer than homebirth and it’s pretty obvious that unmedicated childbirth is not safer, healthier or better in any way that childbirth with pain relief and interventions.

To camouflage their retreated on the safety issue, homebirth and natural childbirth advocates have conjured a straw man.

There is an entire medical specialty based on the assumption that there is more to childbirth than a healthy baby; it’s called obstetric anesthesia.

Milli Hill has been leading the charge in the UK. She thinks that she has discovered a deep, important, essential truth about childbirth:

… [A] healthy baby is not ALL that matters.

This article might push your buttons so before we go on I want to ask you to stay calm, grab a cuppa and keep your wig on. I need to be very very clear, because I know from experience that talking about this issue can cause an outcry. So please listen carefully. The following sentence is crucial:

When a woman gives birth, a healthy baby is absolutely completely and utterly the most important thing.

Got that? OK – do not adjust your wig, there’s more…

It is not ALL that matters.

Two things – just to repeat: a healthy baby is the most important thing, AND it is not all that matters.

Duh! Who ever said otherwise.

I own a lot of obstetrics textbooks, and I’ve read thousands of obstetrics papers, and never once have I seen anyone claim that so long as a baby is healthy it is acceptable to treat women shabbily.

Indeed, there is an entire medical specialty based on the assumption that there is more to childbirth than a healthy baby; it’s called obstetric anesthesia. A woman’s experience of pain is critical and attending to her desire for pain relief is a basic requirement for ethical obstetric care.

Oh, wait. According to natural childbirth and homebirth advocates, a woman’s experience of pain IS irrelevant. And that leads to some surprising “reasoning” on the part of proponents of “natural” birth.

Women matter too. When we tell women that a healthy baby is all that matters we often silence them. We say, or at least we very strongly imply, that their feelings do not matter, and that even though the birth may have left them feeling hurt, shocked or even violated, they should not complain because their baby is healthy and this is the only important thing.

Yes, when we tell women, as Grantly Dick-Read did, and as Lamaze and other natural childbirth organizations still do, that their pain is “good” pain, or “pain with a purpose,” we very strongly imply that their pain doesn’t matter. When we tell women as midwifery charlatan Ina May Gaskin claims that the excruciating pain of childbirth isn’t pain at all, just “surges,” we very strongly imply that how they experience childbirth is irrelevant. When we tell them, like quack Debra Pascali-Bonaro does that excruciating pain of childbirth isn’t merely a figment of their imagination, but is actually orgasmic, we very strongly imply not only that their pain is of no concern, but that they are gullible idiots to boot.

It is difficult for me to imagine a practice that more effectively silences women on their experience of childbirth than the entire natural childbirth movement.

According to Hill:

Too often women who say they care about the details of their baby’s birth day are accused of wanting an ‘experience’, as if it is selfish to care about how their baby is born, how they feel or how they are treated. But, as the saying goes, ‘when a baby is born, so is a mother’. If a mother feels broken, dispirited, depressed or traumatised, how will this affect her baby? Is this healthy?

That’s right. Too often women who choose pain relief in labor are made to feel as if they have failed. Too often women are told that if their baby did not transit their vagina, they haven’t really given birth. Too often women who choose C-sections to avoid the potential for vaginal tearing, future sexual difficulties or future incontinence are labeled “too posh to push.”

But Hill and her compatriots could care less about that.

Birth matters. To be respected, to be treated with dignity, to be in control of what happens to our bodies. To really feel the power of bringing a new life into the world – no matter whether in theatre or at home in a birth pool – why is it so wrong for women to want this?

It’s not wrong to want any of it, and no one, least of all obstetricians, ever said it was. What’s wrong is being willing to compromise safety to achieve it. What’s wrong is asserting without any evidence whatsoever that interventions and pain relief in labor hurt women and babies in an effort to chivvy women into opting for natural childbirth. What’s wrong is an entire group of medical professionals, midwives, promoting one form of birth, “normal birth,” above others.

How, pray tell, does discouraging epidurals promote women’s control over what happens to their bodies? How is a midwife delaying calling the anesthesiologist compatible with treating women with dignity? How does the relentless emphasis on unmedicated vaginal birth help women “to really feel the power of bringing a new life into the world – no matter whether in theatre or at home in a birth pool’? It doesn’t, of course.

Hill fails to see the irony when she insists:

What we do know is that many women DO care about what happens to them when they have their baby, but that they find it hard to talk about these feelings in a culture which persistently tells them that they really shouldn’t, and that what goes on in the delivery room is always acceptable as long as everyone survives.

The reality is that women DO care about what happens to them when they have a baby, but they find it hard to talk about these feeling in a natural childbirth culture which persistently tells them that what goes on in the delivery room is always acceptable as long as women refuse interventions, reject pain relief, and push their baby out their vagina.

Hill concludes:

A healthy baby is the most important thing, and it is not all that matters.

Respect, consent, choice, dignity – all that matters too.

If Hill and her compatriots really believe that they’d demand an end to promoting “normal birth.” They’d insist that a timely epidural is the right of every woman in labor. They’d favor giving every woman the option of a Cesarean by choice. And, as an added bonus, they’d stop the relentless campaigns to promote breastfeeding whether it is the right choice for the mother or not.

But that’s not what Hill and other natural childbirth advocates believe. They want respect for THEIR choices, not the choices of women who choose differently.

A healthy baby is not all that matters. Obstetricians have always recognized this. It’s time for natural childbirth and homebirth advocates to recognize that women’s experience of pain in childbirth matters. It’s time for them to recognize that sexual function after childbirth matters. It’s time for them to recognize that preventing incontinence matters.

It’s time for natural childbirth advocates to stop promoting “normal birth” and start promoting whatever women choose, whether they approve those choices or not.

426 Responses to “A healthy baby is not all that matters? Who ever said it was?”

  1. Morose57
    March 19, 2015 at 10:51 am #

    I’m just going to say, I came across the original article and loved it. I didn’t notice it was from a natural birth advocate. I have had two devastating c sections and both OBs have completely disregarded my feelings about it before, during and after the procedures. Both drs on multiple occasions have said to me “all that matters is a healthy baby.” I am glad you read many obstetrical textbooks but you obviously have not been in or part of many c sections being performed or conversations about c sections between mothers and drs. During my last c-section as I laid waiting for my baby to be cut out of me, my OB and others in the room were laughing and joking about women who eat the placentas. I’m sorry but I don’t feel like that was an appropriate conversation as I waited to meet my baby. I wish more than anything to have had vaginal births and if I truly couldn’t to have had more mother centered c sections. The author of the original article is spot on. you claim that obstetricians know that a healthy baby is not all that matters. Obviously you never met mine.

    • Amazed
      March 19, 2015 at 11:20 am #

      Because you have been part of many c-sections? Mighty two?

      How old are you? My mother’s age, if the 57 is an indicator. How many years have you obsessed over your c-sections?

      It takes a special kind of stupid to tell an obstetrician that she has not participated in many c-sections while you took part in whole two – your own. That tells me all I need to know about you. You’re an idiot. And you know, you could have had the thing you wish more than anything. You could have gone out into the wood to pop your kids out, dead or alive, or die trying to.

      • Morose57
        March 19, 2015 at 12:25 pm #

        I apologize, I did not realize that the author is an OB. I only read the response to the original article. I stumbled upon this post while searching for the original piece. No I am not 57. I am 32 years old and my second c section was recent. No need to be nasty. I am currently trying to deal with my feelings over my birth experiences. I felt the need to post on this because in my experience, my OBs have said that a healthy baby is all that matters and this author is claiming that “a healthy baby is not all that matters. obstetricians have always recognized this.” I am just stating that is not true especially in my own experiences with two different OBs. I age ee with the original article that while a healthy baby is the most important thing, I count too. What good am I as a mother sitting here with postpartum depression to my healthy baby? Maybe my c section was necessary maybe it wasn’t. i don’t know. What I do know is, postpartum care counts and the birth experience women have matters to our overall well being as well – c section or vaginal.

        • Amazed
          March 19, 2015 at 1:14 pm #

          Wow! You’re extremely polite to someone who was downright nasty. It really irks me when I see someone close to their 60s still lamenting the loss of their vaginal births (we’ve seen them on this site and I’ve met two such ladies in real life), so it automatically turns my NASTY button on. I apologize.

          Since the people commenting the way you did usually parachute straight fron NCBers sites and are well versed who Dr Amy is and ready to disparage her since she let her licebse lapsed, it really didn’t occur to me that you might not know. I apologize for that, too.

          I hope you come to peace with your c-sections. They happened and there were indications that showed that there might be a problem. Yes, they probably weren’t necessarry but you took the wise way, the way of caution. Because something MIGHT have happened. One never knows and that’s one of the moments when one’s children are at their most vulnerable. Your baby wasn’t cut out of you but born. You listened to the doctor’s reasoning, made up your mind, went to the hospital, underwent a procedure that led to your child coming into the world – could you really be more involved? Because “I wasn’t taking part, I wasn’t there, it was just pain that I could not control” is a common refrain of vaginal birth.

          Try to think of the pros: you won’t suffer the complications related to vaginal childbirth. Fecal incontinence is a problem linked to vaginal birth alone. I repeat the conversation my mom had with her doctor soon after her second vaginal, all natural childbirth (that almost killed her, she saw the tunnel of light and everything): “One day, you’ll sneeze and you’ll piss yoursellf.” She was like, “You mean, like now? Because that’s what’s beeh happening for weeks.” But that was a problem related mostly to pregnancy. Her being on the verge of fecal incontinence and getting worse with aging is a direct result of vaginal childbirths.

          • Morose57
            March 19, 2015 at 4:25 pm #

            Thank you. I know if I had a vaginal birth it could have went badly as well however saying a vaginal birth went bad is much more acceptable then to say I am disappointed and upset over a c section. No one tells women to get over a bad vaginal birth however women who have cs are told this all the time. Anyway thank you for your kind words. You did make me feel a little better for now. Also what are NCBers?

          • Amazed
            March 19, 2015 at 4:36 pm #

            NCB – Natural Childbirth. Here, we use it when we talk about the most ardent ones, those who deny that modern medicine have any role in childbirth and think that doctors are only there to get them. They repeat “Women have given birth for thousands of years and we’re still here!” “Trust Nature!” “Trust Birth!” One of them actually wrote that when her baby died in the hospital after her homebirth went south, that proved that “babies died in the hospital, as well!”

            You seem to have friends who are not crunchy enough. In crunchy circles, blaming women for feeling bad about their vaginal birth runs rampant. And “At least you have a healthy baby!” is a phrase I’ve heard often enough in real life about women who were left shell-shocked after their vaginal births. After all, that’s “a woman’s battle” and woe on thise who don’t behave like good little soldiers. Women who desire a c-section are labeled vain, uncaring about their babies and only caring about maintaining a tight vagina. It really goes both ways and it’s a shame because new mothers need support and… err, sleep, not judgment.

            Pay no attention to what people are telling you. I don’t doubt they mean well but the road to hell… If you need to share, find someone qualified. Those people aren’t helping.

          • Morose57
            March 20, 2015 at 7:18 am #

            I am not in a crunchy area at all. I have been told actually the opposite that I am lucky to have an intact vagina! Elected c sections are common here as well. Thank you for sharing that quote. It is very true. I cried when I read it and am going to try and keep it in mind when I feel down about my experiences!

          • Amazed
            March 20, 2015 at 12:24 pm #

            Do try. And don’t forget that when all cofounders are taken out of the equation, elective c-sections have the very best outcomes for babies. Your children have all the brain cells nature intended them to have thanks to your decision to take the road of caution.

          • Bombshellrisa
            March 19, 2015 at 5:17 pm #

            NCBers “natural childbirthers”

        • AllieFoyle
          March 19, 2015 at 1:16 pm #

          I think we all agree here that the well-being of the mother is important and her providers should be professional and considerate, but I’m not really sure what you’re upset about or what you think you missed. Vaginal birth was humiliating, frightening, and excruciatingly painful for me. I didn’t choose it and I certainly didn’t feel like an active participant. You actually had a choice and chose the c-section! I understand regret and I’m sorry it wasn’t a great experience for you, but you’re wrong if you think vaginal birth is a wonderful, empowering experience for everyone.

          • Morose57
            March 19, 2015 at 4:21 pm #

            I get that everyone has different birth ideas and experiences and some people would prefer c sections others vaginal births. I understands vaginal births aren’t all unicorns and rainbows. What upsets me is that it is ok for you to feel the way you do about your vaginal birth but when I talk about how I feel about my cs I am told I should t feel that way because I have a healthy baby and that’s what matters. I doubt people tell you that you shouldn’t have felt humiliated and frightened and that you are over reacting to the pain of your vaginal brith. No one says how dare you for wishing you had a cs instead. I was just pointing out that the original article this author wrote about validated my feelings about my cs and that many OBs do push the idea that all that matters is a healthy baby which does make women who feel bad about their birth experiences feel guilty and adds to depression.

          • AllieFoyle
            March 19, 2015 at 4:49 pm #

            I’m not sure why you think people are ok with being upset about a vaginal birth and not a c-section. In my experience, it is the opposite. There are lots of websites and books and magazine articles about how a woman may grieve or be disappointed about a c-section, but almost nothing about what I experienced. I was so damaged that I had to see specialists and eventually have surgery, but no one was really very nice about it or cared particularly about my feelings. The whole thing is too upsetting and embarrassing to discuss with anyone in real life except my husband, and he just can’t, won’t. My therapist didn’t really get it and I could tell it made her uncomfortable. There’s no comfortable way to express distress about something so personal and private and embarrassing, especially when it’s something you’re supposed to want and think of as a wonderful thing.

          • toni
            March 19, 2015 at 8:07 pm #

            I think in general IRL it is split.. but on this particular site it does seem that there is a lot more sympathy for people who had bad vaginal births and would have preferred c-section than there is for anyone who was dismayed by their CS and wished they could have had a VB.for them it’s all ‘just be grateful you had the opportunity to have a life saving surgery’ etc. which i think is not so much different to telling someone traumatized by a VB they should be grateful they didn’t have surgery and their baby is fine. it’s unhelpful and could drive people into NCB clutches. I see no harm in acknowledging their right to feel disappointed that they didn’t get to do it the ol’ fashioned way when that’s what they expected. that’s not the same as saying c-sections are bad and you should wallow in your sadness forever (or until your VBAC). it seems to be pretty common for women to be told to just suck it up and be thankful when it comes to anything birth/motherhood related. sorry if this was hard to read, my boy is climbing all over me

          • Morose57
            March 20, 2015 at 7:09 am #

            I guess it does go both ways and people are not very empathic to negative feelings about birth experiences either vaginal or c section however I did end up on this site because this author pulled apart the original article which discussed the need for person centered cs and the importance of the mothers experience during birth. IRL I have not heard negativity given to my friends or family who complained about things during their vaginal births. Usually those conversations become a sharing of birth stories. When I discuss my c section though I do get a lot of well your lucky or be happy you have a healthy baby or I should be grateful etc. so I did assume it was more one sided. I do not live in a crunchy area though.

          • toni
            March 20, 2015 at 11:26 am #

            part of it might be them trying to put it into perspective for you.. they are probably not intending to demean but it’s hard not to feel shitty when your feelings are dismissed. i would just not talk about it with people you are close to unless you know they will be non-judgmental and just listen.


            if you scroll down there is a list of therapists specialising in birth trauma in texas. there is one in houston, but as you say you have trouble finding childcare maybe you could email some of them and see if they do skype therapy sessions.

          • Morose57
            March 20, 2015 at 2:09 pm #

            Thank you for this list. I am not in Texas but I did find someone in the state directory nearby where I live and she takes my insurance! I called and left a message. Waiting to hear back from her. Thank you again for this link!

          • Amazed
            March 20, 2015 at 4:00 pm #

            Good luck! Kiss your kids, put your intact vagina to good use, use all the help you can find and remember, it will get better. Don’t forget the quote Doula Dani coined out!

          • toni
            March 20, 2015 at 6:03 pm #

            Yay I’m so glad. good luck with everything.
            i don’t know where I got the idea you lived in texas from lol

          • Amazed
            March 20, 2015 at 6:42 pm #

            Lucky you. I don’t live in crunchy area either (actually, I don’t live in the USA at all. Long story, I found this site after a preventable homebirth death made it to the news here and alerted me that there WERE people who wanted to give birth at home) but the little personal exposure of crunchy that I have had me rolling my eyes. Cheer up. Just imagine: you are able to breastfeed or nor, use a stroller or not, grab your chance for a child-free evening or not, give a bar of chocolate from time to time without most of the moms around telling you without actually telling you that You. Were. Not. Doing. It. The. Only. Right. Way.

          • Bombshellrisa
            March 19, 2015 at 4:54 pm #

            “doubt people tell you that you shouldn’t have felt humiliated and frightened and that you are over reacting to the pain of your vaginal brith. No one says how dare you for wishing you had a cs instead.”
            No, really, they do. I was sitting on an ice pack to try and soothe my stitches and crying because I was upset that the birth went the way it did and I got a lot of “but you got to give birth naturally” and “at least you didn’t have a c-section”. Labor and birth are processes that have became safer thanks to obstetrics but the experience still is life changing and often traumatic. Not to mention the pressure to look beautiful during pregnancy (look at all pregnancy photographers now), have a perfectly decorated nursery, have a birth plan, a freezer full of meals made before you go into labor, look beautiful during labor and delivery so you will be able to share yor birth pics and then on top of that have a beautiful birth, then go onto breastfed until the baby weans itself and then make all it’s foods from non GMO organic fruits and veggies. All while getting your post baby figure back and taking care of your home and other child and partner. It’s a lot of pressure and a lot to live up to. And any deviation from that feels like a failure. And we tend to replay our defeats. Give yourself a break, I will bet that you are an amazing mom. Especially since you are shouldering the majority of the care of two kids and not having help. I hope you can find the help you need.

        • Guesteleh
          March 19, 2015 at 1:29 pm #

          Everyone has a right to respectful care and I’m sorry you didn’t get it. Re: CS vs. vaginal birth, I want to share a story: I know a woman who planned an all natural homebirth that turned out to be horrifically painful. She was deeply shaken by the experience and thought she’d failed somehow. She decided on a second homebirth as a do-over, encouraged by her midwife who told her that second births are always less painful. But this birth was even more painful than the first, so bad that she went unconscious during labor and didn’t want to hold her baby after he was born because she didn’t feel any love or joy, she just wanted that thing that caused her so much pain away from her. It was only after those two terrible experiences that she realized that the idealized version of birth is largely due to luck, there is no one right way to bring a baby into the world, and even an all natural vaginal birth can fall far short of ideal.

        • Bombshellrisa
          March 19, 2015 at 1:33 pm #

          It hasn’t been long since the last time you gave birth, have you been in for a well woman exam since your postpartum? I experienced crippling depression during my pregnancies. I was anxious and overwhelmed after. I have no doubt what you went through has traumatized you, but I think with the depression you might have something more serious going on, and should really see your doctor.

          • Morose57
            March 19, 2015 at 4:33 pm #

            my baby is 8 months old. I haven’t been back to the dr. I know I should but I can’t bring myself to go back. I went for my incision to be checked but did not go to my 6 week appointment. I need to find a new dr and I have a lot of anxiety about it now. However I am taking Zoloft that my OB has called in for me.

          • Bombshellrisa
            March 19, 2015 at 4:40 pm #

            Can’t blame you, plus having two little ones makes things complicated when you need to talk something out with a doctor. How long have you been on the Zoloft? Some of what you are talking about could be side effects that come and go with that.
            What made you miss your six week appointment? Was it just scheduling or something else?
            There are psychiatrists who specialize in mental health in pregnant women ans those who are in the first year after a birth, it might be extremely helpful to you having a doctor like that.

          • Morose57
            March 20, 2015 at 7:00 am #

            I have been on Zoloft since about 3 months postpartum so around October. Before then I was crying daily and just couldn’t handle that I had another c section. I was pretty much devastated at that point. I didn’t go to my 6 week appt because I couldn’t bring myself to go. Just the thought of going back to my OBs office made me choke up. I was so angry at him and upset at how dismissive he was when I had my incision checked. I will look into a different dr for meds. I was breastfeeding at the time that I was given the Zoloft and seemed to be the best option.

    • Daleth
      March 19, 2015 at 11:24 am #

      Morose, I’m sorry you had unpleasant birth experiences. Many women have vaginal births that are just as unpleasant. It’s unfortunate.

      Just so you know, Dr. Tuteur (the author of this blog) is an OB-gyn so she has not just “read many obstetrical textbooks” but has attended many thousands of births and performed hundreds if not thousands of c-sections. (She has also delivered four kids of her own.) So she actually has “been in or part of many c sections being performed or conversations about c sections between mothers and doctors.”

      • Amazed
        March 19, 2015 at 11:45 am #

        I’d say a good part of the unpleasantness of her birth experiences was probably of her own making. Did you notice the language she used? “For my baby to be cut out of me”. How could anyone with this mindset have a “cutting” that is even moderately satisfying?

        • Guesteleh
          March 19, 2015 at 12:11 pm #

          That’s not fair. The OBs shouldn’t have been snarking on placenta eaters during the procedure. That’s just shitty practice and she has a legitimate reason to be upset about that.

          • Amazed
            March 19, 2015 at 12:46 pm #

            Yes, of course! No one says that there aren’t obstetricians with bad manners. Not even bad bedside manners. Just bad manners. It’s seeing her child’s birth as “cutting out of her” that doesn’t sit well with me.

          • Morose57
            March 19, 2015 at 12:54 pm #

            I am not the only woman to feel this way. Many do. Are you a woman? Have you experienced a c section? To me and many others that is what it felt like. It is cold. Your laying on a table. You can’t move. You can’t see your baby being born. You can’t hold them after. Yes I had my babies cut out of me. What else would you like me to say happened? They were surgically taken out of my body while I laid there.

          • Amazed
            March 19, 2015 at 1:17 pm #

            You are not the only woman to feel this way. Far from that. But those who tend to feel this way years after the fact (as I thought was the case with you) are generally those who spent their pregnancy absolutely sure that they wouldn’t need a c-section, c-section was evil, and when it happened, it was the end of the world.

          • Dr Kitty
            March 19, 2015 at 1:32 pm #

            My experience of a CS was very different.
            Laughing and joking with the anaesthetist and OBs, covered with a nice warm blanket, my husband taking pictures of my daughter being lifted out of my abdomen, and my baby being immediately lifted over the screen and into my arms for a cuddle.

            Your CS experience sounds horrible…
            But it is not a description of every CS, any more than a description of a traumatic vaginal birth with a PPH is a description of every vaginal birth.

            I’m pregnant with #2 at present, my experience of a lovely, positive CS means that the last thing I want is a VBAC.

            In some ways a CS is something that is done to you and a VB is something that you do yourself…but ascribing value judgements to the processes themselves is unhelpful.

          • Montserrat Blanco
            March 19, 2015 at 6:10 pm #

            I had a C-Section 6 months ago. I am sorry you had a bad experience.

            My baby was born prematurely. Very prematurely. Believe us, when someone says “a healthy baby is all that matters”, yes, I agree it is not the only thing that matters, but the truth is, if your baby was not healthy, you would discover it is the only thing that matters.

          • Morose57
            March 20, 2015 at 7:24 am #

            Yes a healthy baby is the most important thing! I really don’t disregard that at all. I am grateful I have healthy and healthy babies but I am disappointed about their births. I am sorry you went through the experience of having a premie. That must have been very difficult. I do not mean to disregard the importance of having a healthy child.

          • The Computer Ate My Nym
            March 20, 2015 at 12:59 pm #

            I’ve had a c-section. Actually, I could move during the c-section, which was a problem because it meant that the OBs were in such a rush that they didn’t wait for the epidural to kick in completely. I figured that the pain nerves were under and no one else seemed concerned so I just…didn’t. Move, that is.

            I would have liked to peek over the curtain and see the baby being born, but the OBs weren’t too keen on that idea for some reason. Something about seeing all the wiggly internal bits and fainting. I think I would have found it cool, but there wasn’t really time to argue (see above.)

            I wasn’t the first to hold my baby, it’s true, but my partner brought her over while I was still being stitched up so that didn’t seem like a big deal either. Mostly I was just happy to have heard her healthy cry when she was born and know that she was alive.

            A healthy baby isn’t all that matters, but if you don’t come out of it with a healthy baby nothing else does.

          • The Bofa on the Sofa
            March 20, 2015 at 2:07 pm #

            A healthy baby isn’t all that matters, but if you don’t come out of it with a healthy baby nothing else does.

            That’s it right there.

        • Morose57
          March 19, 2015 at 12:33 pm #

          my baby was being cut out of me as I laid there being an inactive participant in her birth. I get you don’t like my wording but that is how I feel as well as many other women who have also have had their babies cut out of them. I honestly do think if c-sections were more mother centered we would feel more apart of our babies births.

          • toni
            March 19, 2015 at 12:54 pm #

            I’m sorry you feel like you missed out on something and I’ll admit I think I might feel a tinge of sadness if I could have only had c-sections but bear in mind that a lot of women have horrible experiences with vaginal births too. Birth is a big ordeal either way. Maybe just try to change your perspective a little bit… yes you had a baby cut out of you, you were opened up and had your child pulled out through your belly and you’re still alive! That’s pretty badass if you think about it. Maybe a therapist could help you work through your emotions and get you feeling, if not happy, at least more accepting of how your kids were born. The doctor’s joking around may have been trying to make the delivery less stressful for you.. or maybe they were just being insensitive I don’t know. Either way please don’t let that put a dampener on your child’s birthday. My doctor said some pretty weird things when he delivered my son, he asked my husband after the birth if i ‘looked all right’ down there to him amongst other odd comments :/ but that didn’t stop it being one of the best days of my life.

          • Morose57
            March 19, 2015 at 1:17 pm #

            Thank you. when I feel overwhelmed and saddened by my experiences I like to read some articles I found that I feel validate my feelings. Most of the time when I talk about how I feel with people I know who have not had c sections I am told “all that matters is a healthy baby” and “to get over it”. Which is why I was googlingb for the original article and found this response to it. I was a bit hasty commenting here though.

          • Ash
            March 19, 2015 at 1:28 pm #


            I do think that therapy would be a good idea for you. Sometimes therapy can be useful to get past something that’s “stuck” in our minds, and I would recommend the same to a woman who was dwelling upon her experience during vaginal birth as well.


            Perhaps you could make a suggestion to Patient Relations at your hospital?

          • Morose57
            March 19, 2015 at 4:39 pm #

            You are right I probably should go to therapy and I know I need to. Unfortunately right now I do not have childcare so that I can go. My husband works long hours and I stay home with my kids. We don’t have anyone to help and at this point can not afford co pays and a babysitter. The link you posted is great. I wish mine were like that. Thank you. I should write a letter to the hospital encouraging these types of practices.

          • demodocus' spouse
            March 19, 2015 at 6:59 pm #

            We take our toddler, but I can see how taking 2 along, especially when one is 4, would be problematic. Could you talk to a rabbi or a pastor or someone like that? Sometimes they can help.

          • KeeperOfTheBooks
            March 19, 2015 at 10:24 pm #

            Seriously, you should. If you’re in the US, which I get the impression from your phrasing/spelling that you are, then the rather tiresome fact is that hospitals are a big business, and they like happy customers because happy customers mean repeat business. Writing a professional, courteous letter explaining what you experienced and how unprofessional you considered it, along with a brief suggestion (like the link) of how they could correct these behaviors might be a bit of a wakeup call for someone. In any case, they’re unlikely to change what they’re doing if they don’t hear from people who don’t like those sorts of shenanigans; they’re likely to assume that no one minds. (Or, in the case of management not in the OR, they’re unaware of what’s going on.) This also might be rather helpful for you on an emotional level.

          • Morose57
            March 20, 2015 at 6:53 am #

            Yes I am in the US. Writing a letter is a great idea and I am planning on doing so. Actually talking about it on this site has helped tremendously as well. So although this wasn’t the exact forum to put this all out there, I am feeling a lot better about everything today. Is this a uk based website? I honestly just thought I was commenting on a blog not in a forum. I wasn’t expecting such a reaction to what I wrote!

          • demodocus' spouse
            March 20, 2015 at 1:14 pm #

            Dr. T worked at Harvard’s hospital, and I think still lives in that general area, ‘though she does have a lot of UK commentators. It’s a blog full of talkative followers.
            I’m glad folks here have been helpful for you, and please, keep coming around!

          • KeeperOfTheBooks
            March 20, 2015 at 1:21 pm #

            Nope, it’s a US-based blog, but it has a fair number of readers/commenters from the UK, so I added that caveat in case you weren’t in the US. 🙂
            The comment box here is very active by just about any blog’s standards, and there are a lot of interesting people here. I’m glad writing about it helped you! Stick around!

          • Amazed
            March 20, 2015 at 11:23 pm #

            You should have seen the vaccine posts. We literally crashed the site. Over 2000 comments on a single post, and down the site went. Dr Amy had to remove the comments, so we’d have, you know, a site.

          • Morose57
            March 21, 2015 at 9:49 am #

            Wow lol. I am on babycenter a lot and vaccine posts always get a lot of traction! People are crazy. My kids are fully vaccinated as am I

          • Amazed
            March 21, 2015 at 1:11 pm #

            We did do a little overloading. Yours truly posted the story of the two children dying from SSPE years after catching measles from the same sourse at least 3 times. In fact, each time an anti-vaxxer came in howling, “What do you care whether I vaccinate my kids if YOUR vaccines are so effective?” I explained that actually, chickenpox won’t be a mild disease to me since I’m 30ish years older to receive it (they don’t vaccinate adults here) and received a reply that basically stated that while it was sad that I couldn’t get the vaccine, my death and death of others might be just part of the price we pay for the right to stay free or something like that. People ARE crazy.

          • Amazed
            March 19, 2015 at 1:31 pm #

            Well, you should get over it. The thing is, sometimes people cannot do it alone. Certainly not on will. I really doubt that telling you to get over it is helpful. We don’t tell people with broken arm to get over it, do we?

            Have you considered therapy?

          • demodocus' spouse
            March 19, 2015 at 6:44 pm #

            I’m sorry your docs gave you such a hard time, especially the unprofessional joking around. NOT how a professional should behave. Did you file a complaint?

          • Amazed
            March 19, 2015 at 1:24 pm #

            Insensitive. The doctors, I mean. Really, if you would not bring it at your dinner table, why would you bring it where a patient can hear you? It’s a specific thing.

            It doesn’t take much to think that not everyone is comfortable with such conversations. Just bad manners. I wonder whether they had a patient retch if they were particularly graphic in their description.

          • The Bofa on the Sofa
            March 19, 2015 at 1:26 pm #

            my baby was being cut out of me as I laid there being an inactive participant in her birth.

            So what’s wrong with that? I guess I don’t understand.

          • Bombshellrisa
            March 19, 2015 at 1:30 pm #

            What I wished for, being able to rest while I gave birth to a baby. I guess some people really want to experience the farting, pooping and peeing that accompanies vaginal birth. Not to mention the vomiting and dry heaves as you push your baby out. And not being able to stop pushing

          • toni
            March 19, 2015 at 1:55 pm #

            that’s a little scaremongering. not everyone loses control like that. also enemas are still available if not popular anymore.

          • Bombshellrisa
            March 19, 2015 at 2:17 pm #

            Not really. It’s pretty common. When women talk about being inactive participants, they forget there is an up side to that. For women who are survivors of childhood sexual abuse, losing control of your bladder or bowels makes the experience that much worse.

          • demodocus' spouse
            March 19, 2015 at 5:22 pm #

            I didn’t get nauseas, but I pooped. (a nice nurse immediately whisked the evidence away)

          • Bombshellrisa
            March 19, 2015 at 5:44 pm #

            I was surprised when I didn’t get nauseated (only because I have seen so many women get nauseated during labor) but you bet I pooped and the first labor I couldn’t control my bladder.

          • AllieFoyle
            March 19, 2015 at 5:24 pm #

            Why is it scaremongering? I think it’s just being realistic about things that can and often do happen that no one wants to talk about. There are a lot of downsides to vaginal birth that no one talks about. I think some moms who are upset with their c-sections might feel better knowing that vaginal births can be pretty awful sometimes.

          • Bombshellrisa
            March 19, 2015 at 5:46 pm #

            I find that there is a huge glossing over of the unpleasant parts of vaginal birth. I didn’t like having a resident and students at the first birth, but I might not have minded if it had been a c-section.

          • KeeperOfTheBooks
            March 19, 2015 at 10:20 pm #

            Quite. I’m not sure how I’d feel about a student at a vaginal birth–perhaps I’ll find out one day–but I didn’t mind in the least having the anesthesiology student attending my C-section. She was just observing, as it was her first day, and was terribly nervous. If anything, *I* was reassuring *her*–she seemed very worried that she was intruding, and I really didn’t mind her there at all.

          • toni
            March 19, 2015 at 10:36 pm #

            I had one female resident there standing about six feet from the bed. i didn’t mind at all.. she was really nice. I wouldn’t have liked a room full of people just standing around though. i would have allowed it if asked but.. still

          • toni
            March 19, 2015 at 8:39 pm #

            I agree with that.. a lot of people make out like natural childbirth is all sunshine and c-sections are omgscary but i think some go way over the top the other way too. Painting a picture like all women are writhing around in agony, breaking wind uncontrollably with feces and urine flying all over the place. I peed twice.. in the lavatory. i never lost control of that stuff and I doubt I’m that much of a rarity. I accept that it happens to a lot women that they have a bm when they push the baby out.. though tbh i find it a little hard to believe it’s the vast majority because surely the odds of needing to go at the exact same time that the baby is ready to come out are kinda small(?) But in any case, the baby’s head putting pressure on your rectum and squeezing a bit of poop out as it descends (which from what i gather is all that usually happens) doesn’t sound so bad whereas this image of someone pissing and shitting all over their bed and retching all at the same time sounds horrific and i just can’t believe it happens that much. and anyway, not to bang on about it but there is a pretty simple solution to it and i am puzzled as to why enemas have fallen so much out of favour when for so many expectant mothers pooping in front of the medical staff is one of their biggest fears about the delivery.

          • Cobalt
            March 19, 2015 at 9:33 pm #

            Enema don’t always help with that, and they introduce the risk of spraying dirty saline instead of pushing out a solid mass. Poop happens, that’s part of why there’s a nurse right next to the doctor. It’s maybe embarrassing if you’re aware it, but I can’t imagine there’s anyone who delivers babies everyday that is going to be worried about it.

            And there is no birth without some mess, some violation of the body. The baby has to get from inside to outside, and there’s no zipper.

          • toni
            March 19, 2015 at 10:10 pm #

            yeah i guess if you got one too close to the delivery! that would probably be even worse lol. but in most cases they must work pretty well.. they wouldn’t have been used routinely for so long otherwise right. they’re still pretty routine in indian hospitals and afaik women are glad to have them

          • Medwife
            March 20, 2015 at 12:29 am #

            It’s ritual. Unless mom is constipated it doesn’t help. Women still pass feces when they push even after an enema. Sometimes things are done because they’ve always been done.

          • toni
            March 20, 2015 at 6:13 pm #

            ok well i suppose i should take your word from it given your username lol. i don’t really see how it’s possible though, they realllly clean you out so unless it’s done way too far in advance of delivery, or not enough solution is used, or i guess if you were eating a lot beforehand, i don’t see how your colon would have time to fill up again (doesn’t your digestive system slow waaay down during labour as well?). i had mine i’d say about 8 hrs before and i didn’t need to go for at least another 24 hrs after the birth. i had barely eatn anything that week though and i had used a glycerin suppository before i went to the hospital too. sorry about TMI

          • Bombshellrisa
            March 19, 2015 at 1:27 pm #

            I absolutely longed for a c-section. Vaginal birth was painful, scary, and I felt completely powerless during and after. Especially when I felt myself tearing and I couldn’t do anything about it. I think that the idea of being an active participant in either birth scenario is over played, we are at the mercy of what our body can and cannot do during labor and birth. We can’t control anything, although I tight maybe choosing HOW I gave birth would feel like control.
            How would you propose to make a c-section “mother centered”. I feel like c-sections are very mother centered, in that they give you a chance to have a live baby.

          • Guesteleh
            March 19, 2015 at 1:33 pm #

            Talking to the mother, explaining the procedure step by step, telling her what’s coming next, some praise (You did such a great job of growing this kid, and you’ll be meeting him in just a few minutes!), carry the baby where mother can see him immediately after he’s born unless there’s a compelling medical need. Don’t gossip with the staff as though you’re peforming tree surgery instead of operating on someone who’s conscious and can hear every word.

          • Bombshellrisa
            March 19, 2015 at 1:35 pm #

            Good suggestions, I really would like to scream at the surgical staff who career for this woman. They sound like the worst examples of what people think happens in an OR.

          • fiftyfifty1
            March 19, 2015 at 3:26 pm #

            I very much see your point. And I think these suggestions would be welcomed by most women.
            I do realize I am probably an outlier. But I would not want any of these things. I certainly don’t need any praise. It would feel false to me. I didn’t care about seeing the baby right away. And I welcomed the “tree surgery” chatter.

          • KeeperOfTheBooks
            March 19, 2015 at 10:17 pm #

            To be fair, I had what I considered a very parent-friendly C-section. Loved it, I might add.
            In comparison to Morose57’s, my OB was very warm and kind as he helped me get ready for the CS, which I had because DD was transverse breech. He checked to make sure DD hadn’t flipped position as we walked to the OR–basically, the last minute. He, I, the nurses and the anesthesiologist all chatted while I got prepped. DH and I were part of the ongoing conversation the whole time. The nurses were the epitome of kindness, gentleness, and helpfulness. The OB explained what was going on during the whole time, and invited DH to take as many pics as he wanted. After DD came out and was briefly checked and she’d demonstrated that she had *no* trouble breathing (ahh, those furious newborn shrieks!) she was put on my chest to nurse while I was sewn up. The only time she was removed for the next several hours was a) when I was transferred from the OR table to a bed (DH held her), b) when they needed to check my bleeding in recovery (ditto), and c) when the pediatrician did a quick examination. It was a really beautiful birth. Of course, if DD had to go to the NICU for breathing issues or what have you, we’d have still been happy with everything, but it was icing on the cake that I could get in lots of snuggles then. 🙂
            Short version: kindness and courtesy on the part of caregivers can go a looooong way to helping a patient to have a positive overall experience. A CS was not my first choice by any stretch, but it was still a beautiful birth. I don’t think I’d have that impression if I was treated dismissively or disrespectfully.

          • Morose57
            March 20, 2015 at 7:31 am #

            You seems to have had a wonderful experience during your cs. My baby did have breathing issues she was born so she did spend 4 days in the NICU. I didn’t get to see her till after being in recovery for 6 hours. I am sure that her being taken immediately added to my negativity about my cs on top of the poor behavior of my dr during my cs.

          • fiftyfifty1
            March 20, 2015 at 7:53 am #

            Wow, 4 days in the NICU. That would be stressful for any new mom. Did they know why she had breathing problems? I’m glad she is OK now. You must have been very worried.

          • Morose57
            March 20, 2015 at 8:00 am #

            she had fluid in her lungs when she was born and had to go on a Cpap machine. She is fine now.

          • KeeperOfTheBooks
            March 22, 2015 at 11:16 pm #

            I have no doubt! I’m glad she was somewhere where she could receive good care, but that must have been terribly rough on you. As I said, I imagine that if DD had had to go to the NICU, I’d have understood, but I would have been sad not to have had that opportunity for snuggles.

    • Amy Tuteur, MD
      March 19, 2015 at 11:46 am #

      How many women have you met who thought just like you, who wish more than anything to have a vaginal birth, and then have that vaginally born baby die?

      I’ve met (on the internet and real life) more than a few, and I can tell you from experience that a mother wailing for and apologizing to a dead baby that might have lived with a C-section is far, far, worse than the disappointment of a having a C-section.

      • Morose57
        March 19, 2015 at 12:44 pm #

        I am sorry that I did not realize you were a dr when I posted my first comment. My first c section I had because on my due date I did not drop yet and had yet to dialate. my OB was the only delivering dr in the practice and was going on vacation. I was told I could either go for a 48 hour induction that most likely would end up in a c section or go right to a c section. The other option was to wait but I would most likely have a dr I never met deliver me via c section. At the time I was young, terrified and believed my OB that I was going to have a c section no matter what so I scheduled the c section for the end of that week. He did not even check if I made any progress five days later. My second section the OB I saw said he was willing to do a VBAC but around 35 weeks started changing his tune and around 37 weeks decided he would not let me have a trial of labor claiming the baby was too big. She was 6lbs 10oz. At that point it was too late to switch drs. Yes are there times when c sections are absolutely necessary. I don’t believe mine were.

        • toni
          March 19, 2015 at 1:10 pm #

          was this many years ago? I can’t imagine that scheduling an unrequested c-section for no other reason than it’s bang on 40 weeks would fly these days. but you mentioned they were talking about eating placentas in the operating room which i think is a relatively recent fad…

          • Morose57
            March 19, 2015 at 1:19 pm #

            No my first was 4 years ago and my second was this past July. It was during my Past July one they were laughing and discussing eating placentas. Also they were not talking to me or my husband. Just amongst themselves on the other side of the curtain.

          • Guesteleh
            March 19, 2015 at 1:21 pm #

            Very definitely not a new fad. Been reading about placenta eating for at least ten years if not more. But I’m in Crunchylandia, so.

          • Roadstergal
            March 20, 2015 at 2:17 pm #

            I remember reading about it in the Straight Dope back when I lived in Evanston in the ’80s, and I went to the site and realized, yes, I wasn’t mis-remembering:

            Although I didn’t quite have the same perspective at the time I do now on homebirth and Mothering magazine.

        • Cobalt
          March 19, 2015 at 1:30 pm #

          Just to demonstrate perspective, I have a friend who had both of her kids by purely elective cesarean. She wanted to avoid the inherent violence of vaginal birth, and describes her cesareans as her children being lifted into the world, instead of shoved.

          You might have preferred a vaginal delivery, you might or might not have had a successful one in different circumstances or with a different doctor. You did, however, choose a very safe way to bring your children into the world even if you were young and afraid and unprepared. You made a solid, safe decision based on the information and options available, and that’s the absolute BEST any mother can do.

        • Cobalt
          March 19, 2015 at 1:44 pm #

          It is also true that an induction on a first time mother with a thick, closed cervix is likely to end in a cesarean. Not as likely to end in emergency cesarean as waiting for labor beyond 40 weeks, though. Your first cesarean MIGHT not have been necessary, but it might have been, and you avoided needing an emergency cesarean and the extra risks to the baby of being overdue.

          • toni
            March 19, 2015 at 1:57 pm #

            you mean past 41 weeks? if it were 40 weeks surely they would be recommending everyone gets induced by then

          • Cobalt
            March 19, 2015 at 2:17 pm #

            There’s a few factors that come into play:

            The longer you are pregnant past 39 weeks:
            the less likely you are to spontaneously go into labor/greater need for induction
            the bigger the baby gets, with attendant risks/greater need for cesarean
            the more likely the placenta is to fail/greater need for emergency cesarean

            After 40 weeks, the stillbirth rate goes up rather quickly. Offering induction at 40 weeks is becoming more common, and offering it to everyone would probably reduce the cesarean rate.

        • fiftyfifty1
          March 19, 2015 at 3:13 pm #

          If your OB did not tell you ahead of time that he had vacation scheduled for around your due date that is very unfair! If he had told you with a few months of warning you could have found another practice. It sounds important to you that you be attended by someone you already knew well. Of course not all women feel this way, but those who do deserve to know ahead of time if at all possible.
          (On the other hand, if you did know about his schedule, but chose to stay with him and did not want to accept any substitute, and were not willing to try an induction, then that is your own choice.)

          • Morose57
            March 19, 2015 at 4:03 pm #

            I did not know he had a scheduled vacation. He told me on my due date giving me my options. He also made it sound like I was having a c section no matter what even if I waited. my due date was on a Monday. My c-section was that Friday. he was going on vacation Saturday.

          • fiftyfifty1
            March 19, 2015 at 6:03 pm #

            He should have given you more warning. Sure, sometimes emergencies come up, but this sounds like he had it scheduled so could have warned you.
            From a medical perspective, I can totally get behind his recommendation to have the baby out by 41 weeks, because that’s when the stillbirth risk goes up (actually it starts going up at 39 weeks, but it really goes up at 41 weeks). And I can understand his prediction that your induction would likely have lasted a long time (48 hours is quite possible) and maybe ended in CS anyway. This is especially true if a woman has the sort of pelvis where a baby doesn’t “drop” in the last weeks. Still, it sounds as if you wish you had gone for the induction anyway, just to give it a try? Even if it had ended is CS?
            For what it’s worth, I am a woman who had a very difficult vaginal birth. I elected to have a CS for the second due to my extensive pelvic floor damage. I do realize that my being the one fully in control of the decision to have the CS made it easy for me to see the CS in a positive light. I guess it didn’t feel passive to me because I actively chose it. (obviously, my ideal scenario would have been 2 straightforward non-damaging easy vag births, but that isn’t a choice any of us gets to make. Sometimes the only choice we get is the choice to make the best out of a bad situation).

        • Jocelyn
          March 19, 2015 at 7:52 pm #

          Hi Morose! I just want to say welcome, and I’m sorry about your bad experiences.

          • Morose57
            March 20, 2015 at 7:39 am #

            Thank you!

  2. Heather
    June 5, 2014 at 5:32 pm #

    “I own a lot of obstetrics textbooks, and I’ve read thousands of obstetrics papers, and never once have I seen anyone claim that so long as a baby is healthy it is acceptable to treat women shabbily.”
    You should have just stopped there. How many women in your country have a “natural” child birth? US has a 32% c/section rate and if you’re anything like Canada, the epidural rate is 80% or more. Women who comply with whatever non-evidence based intervention the hospital staff want to use are treated well. Those who question are demeaned, ridiculed and ignored. THEY are the ones treated shabbily when they enter the medical system. Since you haven’t stepped foot in an OB unit in over 30 years, I’ll vouch for my own statement – as a labour and delivery nurse. I think you’re slipping Amy. This post makes no sense.

    • Stacy48918
      June 5, 2014 at 6:06 pm #

      “How many women in your country have a “natural” child birth? ”
      Why does this matter? Why is this the goal?

      I am pregnant with my 3rd child. After 2 “natural” births I can emphatically say I DO NOT WANT a natural birth with this one.

      Why do you presume to know better than the laboring moms themselves?

      • deafgimp
        June 8, 2014 at 9:48 am #

        I misread “Why is this the goal” as “Why, are they goats?” and sadly, both seemed to fit.

    • toni
      June 5, 2014 at 6:23 pm #

      80% of women don’t care to feel the pain of childbirth, the horror! I had a natural birth in the hospital a year ago and was not treated at all shabbily. In fact I was a little embarrassed at how they acted impressed with me for not needing an epi.. they were very encouraging. I sensed no negativity at all.

      As for the c section rate it’s been mentioned here before that many of those are elective repeats for women who don’t want to risk ruptures or are due to active herpes and HIV which are more common in North America than Northern Europe for example. And more black women = more complications. The chance of a healthy woman with a vertex baby and no previous caesareans is much lower than 32% but you must know that if you’re an L&D nurse..

    • Bombshellrisa
      June 5, 2014 at 6:32 pm #

      Just being a labor and delivery nurse doesn’t mean you aren’t hopelessly neck deep in woo. I at one point trained to be a home birth midwife. I was a doula. When I gave birth the first time, I had a nurse that sounded just like you. She wouldn’t make the call for me to get an epidural, instead told me I should want to do right by my baby and not “cave in” and “take drugs”. She wanted me walking, bouncing on the birth ball, standing in the shower, getting counter pressure. I was ridiculed and ignored and I was in the worst pain of my life. I wish I could have requested a c section. I wish I could have had one with my son, but labor went too quickly even for me to get pain medicine. I could care less about “natural birth”, I hope your opinions don’t affect the care you give your patients and I hope you NEVER value natural over interventions for those in your care.

      • Stacy48918
        June 5, 2014 at 6:34 pm #

        ” I had a nurse that sounded just like you. She wouldn’t make the call for me to get an epidural, instead told me I should want to do right by my baby and not “cave in” and “take drugs”. ”

        I already know what I’ll say if my nurse acts like this – “Get. Out. I’d like a new nurse please.”

    • The Bofa, Being of the Sofa
      June 5, 2014 at 6:45 pm #

      How many women in your country have a “natural” child birth?

      Who cares?

      • Roadstergal
        March 20, 2015 at 2:22 pm #

        From reading this site, it seems the answer is “More than wanted them.”

    • Daleth
      March 19, 2015 at 11:25 am #

      Heather, what do you think “evidence based” means? The incontrovertible evidence is that epidurals make labor as close to painless as possible. That’s why so many women choose them when given the option.

  3. Tara
    June 3, 2014 at 10:21 am #

    I sometimes read the Facebook group but don’t want to join due to having too many friends and family caught up in the woo. I noticed a posting about a Utah homebirth death and I have more information. If anyone wants to put is over there, that could be helpful.


  4. Christy Renee' Younce Rach
    June 2, 2014 at 2:05 am #

    Well said, Dr. Amy!

  5. Deena Chamlee
    May 30, 2014 at 8:55 am #

    I disagree every woman NEEDS AN EPIDURAL. If they want it after discussing risk and benefits by anethesia all well and good and if not all well and good. It is her choice. As far as witch hunts. Witch and bad outcomes is related to poor or no education. It is not related to a well educated graduate prepared provider. Because it has been proven those providers have excellent outcomes.

    • AllieFoyle
      May 30, 2014 at 9:08 am #

      Who ever said every woman needs an epidural?

      ??? on the other stuff. It’s completely irrelevant and doesn’t even make sense.

      • The Bofa, Being of the Sofa
        May 30, 2014 at 9:12 am #

        I know what she’s going to say. By saying that epidural is a “right” she is implying that everyone should do it.

        To which I say, of course not. That does not suggest it in the least. Think of a simple example: everyone in the US has the right to …. stand on their driveway on one foot and sing the theme from Charlie Brown.

        Does that mean that everyone has to do it? Of course not. But it is their right.

      • Deena Chamlee
        May 30, 2014 at 9:23 am #

        I read Amy’s post incorrectly. It says a timely epidural is everyones right. So sorry you are correct. Witches correlation to midwifery has existed since the 14th century. Burning them at the stake or arresting midwives for dead babies began in the late 19th century to today. So what I am saying is the time has come for midwives to be educated. And educated based on outcome data. Inhospital graduate prepared midwives have excellent outcomes, can offer pain relief and are integrated into the system. So why continue searching for any other system for midwifery when it already exist. And witch hunts dont exist but bad outcomes do.

        • Young CC Prof
          May 30, 2014 at 10:25 am #

          Every woman should have the opportunity to get an epidural. If she decides not to, or if it is medically a bad choice for her, that’s fine. However, if she asks for one and doesn’t get one within a reasonable period of time, she has received substandard care.

        • VeritasLiberat
          May 30, 2014 at 8:57 pm #

          Your timeline is off. Witch hunting more or less stopped in the early 18th century. Here’s some fascinating history. The phenomena of the witch hunt was a lot more complex than most people realize.

        • Daleth
          March 19, 2015 at 11:30 am #

          Deena, I am a Pagan and practicing witch so I know more than most about the Burning Times and consider it to be one of the great abominations in human history. So to me it is especially OBNOXIOUS and OFFENSIVE for you to compare arresting a midwife for causing a baby’s death to witch hunts.

          Hundreds of thousands and possibly millions of people, most of them women, were slaughtered in the most gruesome ways in Europe and America because they were either healers, psychics, crotchety old ladies or totally innocent outcasts and scapegoats. How on EARTH does that REMOTELY compare to arresting an incompetent midwife for negligently or recklessly causing a baby’s death?!

    • Stacy48918
      May 30, 2014 at 11:07 am #

      You need to go back and read the studies. Even with a CNM homebirth in the US had a higher neonatal mortality than hospital birth. Low risk moms attended by midwives at home in the Netherlands are more likely to have their baby die than high risk moms attended by OBs in the Netherlands.

      Poor care providers (ie everyone but CNMs) kill babies too but the location matters too.

  6. Beth S
    May 29, 2014 at 10:55 pm #

    See it’s the Mommy shaming that gets to me with this whole post. I’ve done it both ways, natural, unmedicated, unplanned homebirth and ECS, medicated hospital birth. Guess which one made me feel more powerful? The one where my DH got to stand at my head, and point the camera at me (Not at the hooha never there) and I got to be conscious for the first day of my child’s life! Sure it was necessary because my little squatter (thanks to whoever down there made that up I’m stealing it as it’s how I felt this whole pregnancy) spent most of her time in my womb standing on my bladder, but to me the live baby, conscious mother thing was a whole heck of a lot more important that having an experience. I love the fact that Dr. Amy gives mothers information about their choices weather she agrees with them or not, she’s doing good work and trying to make sure more babies don’t die because mother’s are either being shamed or left uneducated about the choices they’re making for their bodies.

    • Jessica S.
      May 29, 2014 at 11:55 pm #

      Haha… I’m quite sure I’m not the first to ever use that term, but I will say that I’m happy to discover other people who feel that way while pregnant! I’m a giant baby when I’m put out and that’s ALL pregnancy is! 😉 I honestly prefer the chaos of a newborn to being pregnant, at least then I have my body to myself. Of course, I’ve yet to care for a newborn (and recover from a CS, unless she has other precipitous plans) with a 3.5 year old in tow so ask me again in two months: I may have changed me tune. 🙂

      • Beth S
        May 30, 2014 at 7:36 am #

        It’s a lot of extra work, I just went through the same thing and as much as I love my four year old, right now she’s going through a little evil monster stage. I was lucky, my Mom, stepdad and stepson were all able to help me with ODD but I still came out of the hospital just glad to not be pregnant. I hate pregnancy, love the baby don’t get me wrong, but if I could’ve gotten the baby without having to deal with nine months of hyperemesis, six weeks of partial bed rest, and pain I’d have done it in a heartbeat.

      • Mac Sherbert
        May 31, 2014 at 3:37 pm #

        Oh, but if you breastfeed you just might find that even after delivery your body isn’t yours. At least it was that way for me…demanding little things newborns.

  7. witches
    May 29, 2014 at 3:17 pm #

    Sadism and enjoyment of watching pain in others seems to correlate to this post. I hear midwives crying in their own defense in modern day: It is just a witch hunt! But has the killing of babies been occurring since the 14th century? Harrowing thought I may add.

    It is 1585 in Bullingham Germany, Ama Hausman, a midwife, is burned at the stake for killing babies. The judge believes a tide of sadism is overtaking Germany. Before her death she exclaims: the devil has been my lover and the babies were sacrificed to him.


    Wikipedia: Walpurga Hausmännin (died 1587) was an Austrian midwife executed for witchcraft, vampirism and child murderer. The confession she made under torture exemplifies the classical relationship between witch and devil later commonly used in several witch trials.

    This case will be listed here simply because since the accusation and confession of serial murder of infants by midwives is a common occurrence throughout history, thus, the possibility of her guilt in these crimes is quite plausible


    Midwives kill baby girls in India

    Posted on February 10, 2014 by Sarah

    On infanticide in India:

    “There are about 535,000 traditional birth attendants in Bihar for a population of 100 million. In several districts of the state, [the researcher] found that each midwife killed as many as 5 newborn girls a month. The study, released in 1995, was in a formal exercise, but [the researchers] believe that “if anything, the survey underestimated infanticide.”

    An organization called Adithi, founded by Vigia Srinivasan, did the research.
    Miriam Jordan “Brief Lives” Wall Street Journal, May 9, 2000

    Midwife scandal kills 46 babies every week

    UP to 2,392 baby deaths – that is 46 every week – are being linked to lack of proper care in Britain’s ­overstretched maternity units. A Sunday Express investigation reveals ­avoidable factors such as staff ­shortages, lack of training, faulty equipment and poor leadership, are a key factor in as many as 40 per cent of the 6,070 babies that die in Britain each year.

    By: Lucy JohnstonPublished: Sun, May 22, 2011

    “Midwives are under increasing pressure because their numbers haven’t caught up with the rising birth rate and increasingly complex health needs of women. I am very concerned. This situation needs to be addressed as a ­matter of urgency.”

    Alarmingly our inquiries show up to a ­quarter of women are left alone during labour and sent home without support or advice on feeding their baby. 46 deaths a week have been linked to a lack of good care in maternity units Our investigation follows a recent study which showed 14 NHS trusts have shockingly high baby death rates which have soared to twice the national average.

    Last month a report in The Lancet revealed Britain ranked 33rd in the developed world for stillborn babies with 11 delivered every day.

    ThE Sunday Express has uncovered a catalogue of harrowing cases where mothers and babies have died or suffered harm due to lack of care. These include a mother who gave birth in a waiting room because there was no bed available for her.

    • pj
      May 29, 2014 at 4:13 pm #

      To be fair, I don’t think you can blame midwives for a wider culture of misogyny that values boys over girls (which is not to excuse the individuals who carried out these barbaric acts), and you definitely can’t blame them for inadequate resources in the NHS. Midwives can be fantastic when they are well-trained and regulated.

    • Medwife
      May 29, 2014 at 5:27 pm #

      This is crazy talk.

      • KarenJJ
        May 29, 2014 at 7:24 pm #

        I have never met a midwife that I would call a sociopath, but what if there was a Harold Shipman type amongst midwives? How long would it take MANA to stop them (or even any other College of Midwives)? It’s an interesting thought exercise and I hope it isn’t actually happening.

        • KarenJJ
          May 29, 2014 at 11:03 pm #

          I should add, however, that I’ve had my doubts about Lisa Barrett for a while.

          • Trixie
            May 31, 2014 at 9:08 am #

            Christy Collins?

          • Karen in SC
            June 3, 2014 at 10:36 am #

            Brenda Scarpino has a count of 8 or 9.

        • Bombshellrisa
          May 31, 2014 at 10:00 am #

          And the Utah midwife who said they would have to cut off her hands to get her to stop practicing midwifery

    • Certified Hamster Midwife
      May 29, 2014 at 7:31 pm #


  8. OldTimeRN
    May 28, 2014 at 10:18 pm #

    What do think the perfect birth experience for woman with the desire or hopes of having one? I ask this for 2 reasons. One being a mother myself and compare my experience and 2 as a maternity nurse who is sometimes perplexed as to where this is all heading. But I want and really try to make my moms feel like they’ve had a great birth experience. But sometimes there just isn’t pleasing people.

    From my own nursing opinion I feel these woman with so many expectations are setting themselves up for disappointment and failure and ultimately will be blaming others(nurses) when things don’t go as planned. Wouldn’t it be better to relax? Go with the flow and enjoy your baby? You can read all the blogs and message boards you like, but your baby didn’t.

    • Mishimoo
      May 29, 2014 at 12:27 am #

      What I wanted from my experience was a healthy baby with a minimum of fuss in a safe environment. I also wanted a vaginal birth, because I’m allergic to some painkillers, resistant to other painkillers and anaesthetics; and didn’t want to end up in surgery without functioning pain relief. I expected I’d need an emergency caeserean, made peace with it, and ended up with vaginal deliveries. There were some complications with them, but what made all of the deliveries really positive experiences for me was feeling safe despite hating hospitals. The OR was literally seconds away, my CNMs had loads of experience and were part of a very professional team, there were always great Ob/Gyns on shift, and it was just really peaceful.

    • KarenJJ
      May 29, 2014 at 1:43 am #

      What I wanted was to feel positive about birth and not end up with PND and being angry at everyone (and especially doctors) for having an unnecesearean like my mum did. To be honest I would probably have been better off with counselling or similar prior to giving birth, but I didn’t think of that option and instead tried NCB things instead. Luckily the NCB thing I did was a hypnobirthing class (basically relaxation) and very luckily the midwife that ran it – although very pro-NCB/Ina May – was sensible enough to tell me to trust the medical professionals.

      That was probably the main thing I really needed to hear. I heartily wish more NCB educators were saying it to women.

    • Kupo
      May 29, 2014 at 1:57 am #

      My first birth experience (26+ hrs) flashed by so quickly between the pain that my abiding memory is via PTSD. My second birth experience (dunno hours but mere minutes in hospital before crowning) was over so quickly I never had my epidural.

      In summary, for my next experience I should liken it to air travel – get over as fast as possible, as safely as possible…and show me the exit signs.

    • Staceyjw
      May 29, 2014 at 2:50 am #

      After a healthy baby without brain damage, and no issues for me, I wanted to avoid labor and delivery altogether. I find it barbaric. I wanted an MCRS and if not, an epidural upon arrival. I didn’t know much about NCB then, all I knew was that I didn’t want it!

      I also really wanted as little pain as possible (who doesn’t?), but even more vitally, I didn’t want that pain to be in my vagina. I have had surgery, and knew I could get through that type of pain in my abdomen, even though it would likely be more intense and longer lasting. Labor itself didn’t really worry me, it was transition and delivery I was concerned about.

      Pushing a 6-9# baby (average) through a 10 cm hole? Totally, horrifically, absurd IMO. I dreaded the possibility of having my vulva or clit torn up, and tearing to where you need freaking stitches? Horrible, just horrible. Makes me want to close my legs forever just thinking about it.

      I never got my MCRS.
      My first OB screwed me over on the MCRS. I did get a CS, but it was only after a 36 hr labor, including 4 hours of pushing. I didn’t care- there was ZERO PAIN, I got my epi first right after I was admitted. I was having contractions hours before I got to the hospital, but they never hurt a bit. They put me on the monitor and couldn’t belive I didn’t feel the ctx. I do not know why. Luck I guess?

      With my second kid I planned an ECRS. My new OB was (is) AMAZING, and really respects a womans choice, full stop. Then I had a complicated pregnancy and baby was born at 33 weeks, while in another city without my beloved OB! I was pestered, pressured very strongly, tricked really, into having a VBAC by the out of town hospital staff. After a litte pit, and an attempt at an epi (unsuccessful), I slept a few hours and woke up with my baby coming out. Literally. 14 minutes after I woke up, she was born, in 4 painless pushes. Very lucky for the docs it went well…

      If I have another baby, I will have a VBAC if the baby is early, and a CS if its full term. I have the same awesome OB and I know she will respect me, while always doing the right thing, I wish we could clone her!

      People romanticize birth because if they didn’t it would be too horrible to bear. I swear if this was a mens issue, it would have made it easy and painless centuries ago. Hell, it would have been the driving force that developed medicine in the first place! I believe epidurals, spinals, and CS are amazing gifts from science.

      • staceyjw
        May 29, 2014 at 3:01 am #

        The entire experience ended up being so much better than I could have envisioned. The suites were nicer than my own bedroom, the nurses and support staff was so helpful and polite, and the food was fantastic! Both places had jacuzzi tubs and all the amenities. It was great!

        The first place didn’t have a night nursery, so that was pretty unpleasant, but it ended up OK anyway. Both kids went rifght to the NICU anyway.
        (Also, I wanted a hospital with a level 3 NICU, and with a nursery.)

    • lawyer jane
      May 29, 2014 at 9:39 am #

      I don’t know exactly what I wanted, except for that I had an instinctive aversion to a c-section because the thought of surgery scared me. Although now that I’ve read about the horrible tearing and damage that can happen with vaginal birth, surgery seems preferable to that!

      I can tell you what I DID want – or maybe just assume, to my detriment: that my chosen medical professionals were in fact competent experts and that their medical decisions were geared towards maximizing health baby/healthy mom. That turned out not to be true, to my subsequent distress — unbeknowest to me, my trendy hosptial-based midwives were much more woo-infected than I had realized.

    • yentavegan
      May 29, 2014 at 12:24 pm #

      Those of us who have already labored and given birth do the next generation of mothers-to-be a great disservice when we set them up for a “perfect” birth experience. Those of us who have had non-painful labors, contractions that did not stress the baby’s heart, perineums that stretched without tearing, pushes that expelled a lively vigorous newborn we are delusional if we think that some how our purity of thought and our ability to tap into the ancient “mammma” vibe had an impact on our birthing experience. Ladies, it is a crap shoot, it is luck of the genetic draw….

    • KeeperOfTheBooks
      March 19, 2015 at 10:40 pm #

      Some people, as you say, will never be really happy with anything.
      For me, though, providing baby and I are fine and my caregivers are good at what they do…I want to be treated with kindness and warmth by the staff. I don’t have family in the area who can do that for me. After I had DD, even though it was a lovely birth, I was very, very fragile emotionally, partly due to the hormones, I’m sure, and partly due to all the issues I’d had with my own childhood coming up whenever I looked at DD and wondered how I could ever be a good mom to her. The delivery room nurses were so kind and warm; they helped me start nursing without being at all pushy, and kept reassuring me about how well DD and I were doing. One of the L&D patient care techs was particularly sweet. She insisted that I go take a shower, and she’d take care of DD. By the time I got out of the shower, I had a clean gown waiting for me, a clean bed with plumped pillows all arranged juuust right, my water glass refilled with cold ice water, and a baby whose diaper was changed and who was expressing an interest in food. All I had to do was get into my deliciously clean bed, have my baby handed to me, assent to the snack the tech offered to get me, and snuggle DD some more. It was one of the nicest things anyone’s ever done for me; I can honestly say I never before had someone take care of me when I wasn’t feeling well, and that made it seem even more awesome.

  9. Captain Obvious
    May 28, 2014 at 10:11 pm #

    Other perspective of same article.


  10. Guest, forgot my login again
    May 28, 2014 at 8:08 pm #

    OT, but just wanted to let you know that one of the picture links (“Around The Web”) at the bottom of this post inks to an anti-vaccine article: http://thepeopleschemist.com/reasons-dont-vaccinate-children-vaccine-supporters-shouldnt-give/

    I don’t know if you have any control over what comes up in the links, but if you do, you might want to look into it.

    • Certified Hamster Midwife
      May 29, 2014 at 11:08 am #

      Unfortunately, those links are the price of having a “free” comments system.

  11. Tone Leo
    May 28, 2014 at 7:13 pm #

    I wonder where she finds this statistics? It does not match with anything I’ve studied or experienced in my 10 years of delivering babies. Statistics are not better than the person reading them, though…

    • Young CC Prof
      May 28, 2014 at 7:52 pm #

      Which statistics are you referring to? I didn’t see any in this post.

      • Tone Leo
        May 29, 2014 at 6:44 am #

        Perhaps not statistics in this text, but there are no references to her statements. If you claim to be a doctor, and claim that medicalized births are safer than the unmedicalized ones, you should refer to research and statistics. She might have done that elsewhere, idk, i have a hard time reading this, because it hurts to see professionals scare and manipulate women. That is treating women shabbily. Its a lie that all births are hazardious without medication, and I’m curious how she can claim so. Its a fact that every woman is different, and every birth is different. Its true that few women have the health and normal pregnancy to birth at home. In some cases, medicine is absolutely necessary. In some cases cesareans are the safest option. But it should be used with a critical sense. I’m happy to live in a country where women are treated as normal until they are not. I’m happy to live in a country where gynecologists and midwifes work together for the best possible outcome. I’m happy that i live in a country where being frightened of law suits doesn’t affect my standards, and where doctors get the same paycheck and workhours no matter how i birth and time of the day it happens. WHO has some good guidelines. I’m just in shock,I guess, stumbeling into this blog and see the universe turned inside out. But I guess thats the beauty of a blog – anyone can say their opinion, which of course everyone is entitled to.

        • Young CC Prof
          May 29, 2014 at 7:56 am #

          To put this post in context, she regularly writes about women who attempted home birth despite risk factors that made them entirely unsuited to it, or irresponsible providers who ignored or failed to recognize clear signs of a problem, and the disasters that ensued. Essentially, people who put the goal of natural birth ABOVE health and safety.

          And the US health system is diverse, many times doctors are paid on salary and work approximately the same hours regardless of how or when their patients give birth. Doesn’t affect the c-section rate much. There are countries where medical malpractice lawsuits are practically nonexistent that have c-section rates just as high as here.

          Other posts do have statistics, keep reading.

        • Guesteleh
          May 29, 2014 at 11:15 am #

          Amy doesn’t object to birth without interventions, what she objects to is a philosophy that encourages women to avoid interventions at the cost of safety. She’s also a strong believer in the right of women to access effective pain relief in labor and she’s angry that natural childbirth advocates exaggerate the risks of pain meds to scare women away from using them.

        • moto_librarian
          May 29, 2014 at 11:23 am #

          I don’t really understand what you mean by referring to “women being treated as normal until they’re not.” How exactly does that differ from the United States? Do you not perform standard screening tests for gestational diabetes or Group B strep? Do you not take a woman’s blood pressure and dip her urine for protein if the numbers are high? Do you not refer a woman to specialist care when she becomes high risk?

          Nowhere does Dr. Amy say that births without medication are “hazardous.” The point that she is making is that natural childbirth advocates claim that a woman’s experience is important, but they are pushing for all women to give birth according to their narrative. They lie about the risks of pain medication (epidurals do NOT drug the baby), refuse to acknowledge when situations become risky (high risk situations are described as “variations of normal”), and generally shame any woman for having pain relief or (gasp) a c-section.

        • Renee
          May 29, 2014 at 1:34 pm #

          WOW, you have no clue about this blog at all. Please go on with your groundless assumptions, don’t bother to actually read the blog….

          IMO, as an American-
          Lawsuits get a bad rap.
          Why do lawsuits happen? Because horrible stuff happens, often due to negligence or short cuts. While some are unfair, most ending in judgement are not. Some of those unfair ones, like an OB sued even though it wasn’t really their fault, because that is the only way the kid will get money for its care. Both these suits (not the majority), and legit ones may be less frequent if the USA had a way to help those that had disasters. We have no such social system for this, no health care for all to cover a damaged baby. Thus, lawsuits are vitally important when bad things happen. No one else will help you, if you don’t get a pay out, you are on your own. This makes people that may have been legitimately hurt, sue, even when they would rather not.

          Fear of lawsuits also has an enormous upside- more careful docs, that aren’t going to wait until a tragedy happens to act. With the push for NCB and “wait it out”, law suits help ensure OBs don’t wait it out until disasters happen. I would rather a unneeded CS than a dead or damaged baby because the OB figured it would be fine. If you don’t like this, you can always say NO to the CS.

          USA has LOTS of issues, but quality maternity care is not one of them. I cannot think of any other place I would prefer to have a baby. Well, maybe Singapore.

        • MaineJen
          May 29, 2014 at 3:52 pm #

          “i have a hard time reading this”
          No kidding.

        • S
          May 29, 2014 at 5:50 pm #

          “Its a lie that all births are hazardious without medication…” Of course it is! Where did you see this? I think you’ve misunderstood this post.

        • Jessica S.
          May 29, 2014 at 10:20 pm #

          Yeah, I think you need to read more of Dr. Amy’s post before you jump to such conclusions. You’ll find that, for the most part, everything that you’ve stated as the opposite of what she believes is actually what she promotes.

        • Stacy48918
          May 30, 2014 at 11:13 am #

          so in other words you read one post in complete isolation and felt you just had to parachute in and tell Dr Amy she’s wrong wrong wrong?

          Do you think yourself “educated” on birth?

          One cannot write about every study in every post. You might take the time to familiarize yourself with the blog before making yourself look so ridiculous.

  12. Adelaide GP
    May 28, 2014 at 5:58 pm #

    This woman reminds me of Jen Kamel from Dr Amy’s recent post, where she railed against people getting their medical information from lay peoples blogs, at the same time as writing ” VBAC facts”. No insight and a broken irony metre! Thanks for highlighting the ongoing inconsistencies and hypocrisies of NCB “logic”. Great post!

  13. Allie P
    May 28, 2014 at 5:04 pm #

    It’s also an issue of “misinformed consent.” You’d better believe there’d be fewer women who make the “choice” of having natural childbirth if they weren’t force-fed lies about how horrible it is for their baby or for them. Women are initially misled into thinking they are better people for having natural childbirth, and then every other excuse springs from there. Once you let go of the myth that pain relief is a failure, a moral failing, or unhealthy, all the other arguments are bullshit. I’ve seen women insist on having “natural childbirth” who would never DREAM of having “natural root canals.” If you drill down on their reasoning, a small percentage will cite medical/allergy/etc issues. Most will tell you they think it could be bad for their labor and the baby. “Labor at home as long as possible” “stalled labor caused my epidural” “babies born drugged” and other myths prevail in the mainstream.

    • yentavegan
      May 28, 2014 at 5:16 pm #

      oh yes Allie P. I bought into the propaganda that there was something superior to giving birth w/o an epidural. As if that was an achievement on par with getting a bachelor’s degree or something. I feel like a fraud for propagating that mindset.

      • Karen in SC
        May 28, 2014 at 6:33 pm #

        Me, too. I know better now.

  14. Anna T
    May 28, 2014 at 4:32 pm #

    I’ll confess I’m a little confused about the “whatever women choose” stance, and the elective Cesareans. I mean, this blog is dedicated to promoting the absolute safest form of childbirth. If a woman has no medical indication for a Cesarean, doesn’t that mean that vaginal birth is the safest option for her and the baby? Of course she has the right to choose a Cesarean, but shouldn’t she be informed that statistically, vaginal birth is safer, especially if we take possible future births into account?

    I realize that vaginal birth comes with some complications that don’t exist in a Cesarean. But so does a Cesarean come with complications – and, I believe, graver ones – that do not exist in a vaginal birth. I did experience tearing during my first birth. The sewing up was probably worse than the pushing. But I honestly don’t think that, from a medical point of view, it can be compared with the consequences of a C-section. If I had had a C-section, my risk factor for all subsequent births would be automatically higher.

    Also, I don’t want to be contrary, but ultimately it’s all about choice. It’s not about encouraging or discouraging epidurals. It’s about giving women the right tools and knowledge to choose. For me, not getting an epidural did indeed promote control over my body. It meant I was able to be mobile and upright, could shower and use the bathroom without assistance, and could assume the birthing position I felt most comfortable in.

    However, while I was standing under a jet of warm water and happily saying to myself, “this isn’t nearly as painful as I feared it would be”, a woman across the hall was screaming for an epidural. I remember it vividly, she sounded like a wounded animal. “NOW, give it to me NOW”… it was terrible, and I sure hope she got that epidural fast.

    Every birth is different. My sister in law often says, “I don’t know how you did it naturally, I never could have”, to which I reply that she can’t compare apples to oranges; she can’t compare having the baby out in three pushes to having the baby out in three hours, with the aid of forceps. There is a place for natural birth, and there is a place for pain relief and interventions. As long as any of this is done safely, and the mother’s wishes were considered, I believe we’re doing well.

    • MaineJen
      May 28, 2014 at 4:38 pm #

      If every choice is valid, then why are women routinely counseled to “put off getting pain relief as long as possible, labor at home for as long as possible?” As if getting pain relief is something to be avoided at all costs. For me, trying to give birth without pain relief made me feel OUT of control. My body started pushing for me. All I could do was curl up and wail. Once I had my pain under control, I got my personality back, got back in control of myself. As you said, every experience is different, but I don’t like the trend in the childbirth classes toward telling women to avoid pain relief if they can. That does not always make for an easier birth experience.

      • Paloma
        May 28, 2014 at 5:45 pm #

        The putting off pain relief must come from the NCB movement. In my hospital, epidurals are done at 2-3 cm of dilation and kept until the delivery has ended. And every woman in labour is admitted and put in a delivery room to stay with a member of the family throughout the dilation. Pain really depends on the person. The other day we had a mom come in at 10PM who had been working all day and didn’t even feel the contractions, she was done delivering in less than an hour. And a couple hours before her a woman was screaming and having contractions so painful that she couldn’t even walk or move. She got her epidural and went back to being a rational human being and having a perfectly normal delivery. It really depends a lot on the person. Trying to say that everyone should do exactly the same is ridiculous since we are not clones of one another 😉

      • CanDoc
        May 28, 2014 at 10:13 pm #

        Partly because some women, especially with their first baby, attend labor and delivery over and over and over and over again with cramps that they’re SURE is active labour, and then they feel pelvic pressure and they’re SURE the baby is about to fall out… but actually they’re 1 cm dilated, not in labour, and you watch them for 4 hours and nothing happens besides an occasional mild cramp. This wastes resources and, for women who can be counselled and triaged over the phone, is unnecessary. Our cutoff for whether to advise most moms if they should come into labor and delivery if they think they’re in labour is, “Do you feel like you need something to help with the pain or a nurse to help coach you through?”

        • Anna T
          May 29, 2014 at 1:09 am #

          Yes, exactly! I remember I started having contractions the first time… they are 5 minutes apart! Let’s rush to the hospital! Quick quick quick!.. And as soon as I was there, *of course* it turned out I’m only 1.5 cm, and it all stopped pretty soon. I was offered an induction but preferred to go home to wait it out. Turned out I had more than 24 hours from then and until the baby was born.

          Also, with an epidural you can’t walk (at least here walking epidurals haven’t been introduced yet), and being mobile and upright promotes contractions. So I do see sense in not administering epidurals too early. However, obviously this consideration flies out of the window if the mother is in excessive pain.

          • Mer
            May 29, 2014 at 8:06 pm #

            Actually, there was a study (maybe more than one?) that showed that mobility and position don’t really affect labor nearly as much as common knowledge says. I’m afraid that I don’t know exactly which post it was that I read that has the info, because it was in the comments. Perhaps one of the other commenters would remember and could link to it.

          • theadequatemother
            May 30, 2014 at 12:12 pm #

            We actually have good quality randomized trials that address this question of “can you give an epidural too early.” The answer is that epidurals should be given when the woman thinks she needs one. Epidurals given on demand (median dilation 2 cm, median pain score 8/10) resulted in shorter labours (by 90 min), no inc c/s risk, no inc instrumental delivery risk compared to epidurals that were only given on demand if 4 cm was reached (that group of women also had median dilation of 2 cm at first request for analgesia).

    • Jessica S.
      May 28, 2014 at 4:44 pm #

      I believe there is a small trade off with c-section: a little safer for baby than for mom. The reverse is true for vaginal delivery. This is assumed that it takes place in a hospital. (Obviously the CS would.) But I don’t think the difference is huge. I expect that other, more qualified, people will answer about the CS, b/c I learned this from reading the doctors who comment here! 🙂 My response is based on foggy memory of what they’ve said.

    • Guesteleh
      May 28, 2014 at 4:49 pm #

      Given how many women have a history of sexual abuse, maternal request CS should absolutely be on the table as an option, especially since nowadays most women stop after two children. There are increased medical risks from CS but there are women for whom vaginal birth is emotionally intolerable. They should have the option for CS with no guilt or shame.

      • Anna T
        May 29, 2014 at 2:50 am #

        I realize this is a complicated issue, and I’m not condemning anyone for their birth choices, but consider this…

        One woman chooses home birth because giving birth in a hospital is emotionally intolerable for her. She just plain hates hospitals, gets all shaky and sweaty as soon as she steps into one. So we say she’s irresponsible because she took an unnecessary risk.

        Another women chooses a Cesarean because vaginal birth is emotionally intolerable for her, or because of fears, or because she wants the full control and predictability of a C-section. She took an unnecessary risk, too.

        Until it is proven that C-section, a surgical procedure, is as safe or safer (for *healthy, low-risk* mothers) than vaginal birth, a physiological process, I will continue to have very strong reservations about elective Cesareans.

        Also, in your society perhaps women stop after two children. In mine there are fewer families with less than five. A neighbour of mine had five C-sections. The first and second were perhaps as or almost as safe as vaginal births. But the fifth? I doubt it.

        Of course here we come to another problem – that women who can only have C-sections are still facing social pressure to have many children, regardless of their health.

        • May 29, 2014 at 4:04 am #

          C-section is slightly more risky for mothers and slightly less risky for babies than vaginal birth for healthy, low-risk mothers. We already know that.

          Because the differences are so slight, we let women make their own informed decisions. If someone wants a large family, then yes, she shouldn’t have a MRCS on her first. But if she’s quite sure she wants to stop at one or two children, the complication rate is still extremely low and in the range of vaginal delivery.

          If women in your society are pressured to have large families, against their will or even if it will damage their health, you have much bigger issues than whether to ‘allow’ MRCS or not. You have to get people to recognize that a woman’s body is her own, and she gets to decide how many kids she wants, and when, and how she wants them to be born. Your reservations about MRCS are, quite frankly, irrelevant. That is a choice between a woman and her doctor. Your input into her decision is not requested, required, or probably wanted. What do you plan to do, ban MRCS?

          The reason homebirth and MRCS are not comparable is that their outcomes are not comparable. It’s as simple as that. Homebirth kills both women and babies who did not have to die, while CS does not.

          • Anna T
            May 29, 2014 at 8:35 am #

            I was not comparing the risk of home birth to the risk of C-section, statistically. I was commenting on principle. As in, shouldn’t mothers be encouraged to do things in the safest possible way (whether it means more or less interventions than they might like).

            I do not think MRCS should be banned. Women should have a choice, ultimately. I do believe, however, that doctors should strongly caution women against choosing surgery over a physiological process when there is no medical indication to do so. I know of several doctors in Israel who have declared they personally will not perform MRCS because they believe that by doing so, they are violating their commitment of “do no harm”.

            I should have chosen my words more carefully. What I meant to say is that the norm in our society is to have a larger family than is considered average in the Western world. So naturally women tend to want, and to have, more children than if they had lived in a society where one or two children is the norm. We don’t live in a vacuum, after all, and what’s normal where one lives does influence one’s choices, for better or worse. This does not mean Orthodox Jews won’t or don’t use birth control or limit the size of their family. Having 5 children when you might have had 12 is also limiting one’s family size, and quite significantly.

            However, I think women, again, should be very strongly cautioned against opting for multiple C-sections. The desire to have a large family is no excuse to risk one’s health and perhaps life, especially if there are already children at home who need their mother alive and well.

          • The Bofa, Being of the Sofa
            May 29, 2014 at 9:14 am #

            hat doctors should strongly caution women against choosing surgery over a physiological process when there is no medical indication to do so.

            But what about non-medical reasons? Assuming that there is no difference between outcomes for intervention and non-intervention, I tend to agree with you that you don’t resort to intervention for no reason. However, why does it have to be a medical reason? Why can’t it be an issue of convenience, for example? That is still a reason. Given that there is no downside, why shouldn’t it be good enough?

            We aren’t choosing CS based on a flip of a coin. In every case, there is a reason as to why it is chosen. Why should that be considered wrong?

          • Anna T
            May 29, 2014 at 9:29 am #

            It’s not about wrong or right, it’s about risks vs. benefits. If a woman requests a Cesarean, shouldn’t doctors at least ask why? Perhaps she is facing some fears which can be dealt with by counseling. Perhaps it’s an issue of immediate convenience, but she hasn’t thought out the long-term implications.

            Another of my sisters-in-law (I have several) lately told me that her baby is, so far, breech, and that her doctor recommends trying to turn it. She was really put out by that and said, “I’d rather not, I heard it can hurt. I’d rather have a C-section and be done with it.”

            I gently told her, “this is your choice, of course… and I realize right now you are only thinking about this baby – but have you ever considered how many you would like to have?”

            She was startled. She genuinely didn’t think about that, because when you’re in late pregnancy, it’s hard to think about having MORE babies after this one. But the fact is that she’s Orthodox Jewish, young, and this is only her second. So she does have her reproductive future to consider.

            Luckily, the baby later flipped on her own.

          • The Bofa, Being of the Sofa
            May 29, 2014 at 9:33 am #

            If a woman requests a Cesarean, shouldn’t doctors at least ask why?

            Do you think they don’t?

          • AllieFoyle
            May 29, 2014 at 10:30 am #

            If a woman requests a Cesarean, shouldn’t doctors at least ask why? Perhaps she is facing some fears which can be dealt with by counseling. Perhaps it’s an issue of immediate convenience, but she hasn’t thought out the long-term implications

            Sure, the doctor and patient should have a conversation, but the point shouldn’t be to brush aside the woman’s concerns or fears and convince her to have a vaginal delivery. There are perfectly legitimate reasons why a well-informed woman might choose a c-section.

          • fiftyfifty1
            May 29, 2014 at 11:03 am #

            “She was startled. She genuinely didn’t think about that, because when you’re in late pregnancy, it’s hard to think about having MORE babies after this one.”

            If her OB did not counsel her about the risks of having a scarred uterus when one plans a large family, s/he was certainly remiss. True informed consent includes both the risks and the benefits.

            Turning a baby can indeed be painful. But a bigger concern is that an attempt to turn the baby sometimes results in an abruption and the baby dying. It may be a very small risk, but it’s a real risk. For that reason, my cousin turned her OB down when he offered it. She knew she only wanted 2 babies. At the time of the c-section they discovered that she wouldn’t have been successful anyway: the had a bicornate (heart-shaped) uterus and the baby had a short cord. Her OB told her “you made the right decision”. Now, for a woman like your sister who plans a large family due to religious and social factors, the equation will be different. She may be willing to accept the slightly increased risk to this baby of an attempted version to decrease risk to later babies of a ruptured c-section scar.

          • Amazed
            May 29, 2014 at 11:10 am #

            “It’s not about wrong or right, it’s about risks vs. benefits. If a woman
            requests a Cesarean, shouldn’t doctors at least ask why?”

            No. “Personal factors” should be enough.

            You aren’t going into my head to peel the details of the pitiful story of the young neighbour who tried to rape me when I was too young to realize that his attack was a sexual one. Not you and not any OB. You aren’t entitled to my past. You have to give me the pros and cons and let me make my decision. Presumably, I am a woman grown and might not want to chase counseling or any other therapy for the sole reason of giving birth vaginally.

          • fiftyfifty1
            May 29, 2014 at 11:44 am #

            ” If a woman requests a Cesarean, shouldn’t doctors at least ask why?”

            Do you seriously think they don’t already?
            My ideal would be that all women would get presented with the risks and benefits of both planned c-section AND vaginal birth. A woman would make her choice, and at that point the doctor would ask why, to ensure that her choice really is in line with her personal goals and that she is understanding the factors involved. If there was a big mismatch or an obvious lack of understanding, then they would talk more.

            “I choose vaginal birth” “Why?” “Because I’m young and I may want a large family” “Great, makes sense”.
            “I choose a c-section” “Why?” “Because a vaginal birth seems emotionally traumatizing to me, and I plan a small family anyway”. “Fine. And you’re pretty sure that having good pain control with an epidural or talking to our counselor wouldn’t change that, right?” “Right.” “Great, makes sense.”

            “I choose a c-section” “Why?” “Because I’m GBS positive, and that’s too risky for the baby, so I’m doing it even though I might want a big family”. “Well actually we should talk more. Because the antibiotics we give in labor to women who are GBS positive are very effective in nearly eliminating the risk. Here are the extra precautions we would take…”
            “I choose vaginal birth” “Why?” “Because even though I am a 40 year old first time mom who only plans one baby, I really want to experience vaginal birth if possible”. “Great. But since statistically you are at a higher risk of needing a c-section during labor, let’s talk about how we will know if that turns out to be the case and what our options would be at that point”.

            Pie in the sky? Maybe, maybe not.

          • Amy M
            May 29, 2014 at 10:04 am #

            Also, if the doctor is doing his/her job right, all the risks/benefits of the Csection should be explained to the patients, including long-term ones. Anna T keeps mentioning that multiple Csections aren’t ideal if one wants a large family—true, but any doctor worth her salt will tell that to the patient and let the patient decide which factors weigh more heavily. (This is, as Bofa says, assuming there is no difference in outcomes for intervention v. non-intervention—-a purely elective Csection.) If the doctor leaves that out, I’d say that is not fully informed consent.

          • fiftyfifty1
            May 29, 2014 at 11:15 am #

            “As in, shouldn’t mothers be encouraged to do things in the safest possible way ”

            Safer for whom? For the mother, or for this baby, or for theoretical future babies?

            Let’s take a mom who plans only one child. A planned c-section at 39 weeks may increase her risk of death ever so slightly, but the decrease in risk of death to her infant is many multiples that of her increased risk. In other words, in places where 1 baby is common (China, Italy, some social circles here in the U.S. etc) it results in fewer deaths overall to plan c-sections. Now a woman shouldn’t be forced into it of course, but it should be offered.

            Obviously the equation is different if you are planning 3 or 4 or 5.

          • May 29, 2014 at 12:53 pm #

            So you think doctor’s should caution women about an extremely safe surgery when it is approximately as safe as a physiological process. That violates informed consent procedures- you have to tell people the truth, and the truth is that MRCS is on par with vaginal birth in terms of safety and outcome especially for only a few births. And it’s not like grand multiparas aren’t at risk for major complications as well- it’s not healthy for any woman to have 12 kids, but you don’t see people urging doctors to caution women not to do so.

            Yes, women should be cautioned against having multiple CS’s. The thing is, they already are. No one talks about MRCS without finding out the woman’s plans for her family size and taking that into consideration when talking about the option. So basically, you want doctors to … do something they already do.

            People should generally be counseled to do things in the safest way possible, yes. The thing is, especially if you plan a small family, planned CS and vaginal birth are both the safest way possible. They have very different benefits and drawbacks, but at the end of the day, they wind up with a healthy pair (mother and infant) at pretty much the same rate. Why, then, do you think MRCS should be actively discouraged?

          • Jessica S.
            May 29, 2014 at 11:41 pm #

            Actually, having a very large family in and of itself is very risky and those women should also consider their existing children, if you’re going to term it that way.

        • AllieFoyle
          May 29, 2014 at 10:22 am #

          Another women chooses a Cesarean because vaginal birth is emotionally intolerable for her, or because of fears, or because she wants the full control and predictability of a C-section. She took an unnecessary risk, too.

          No. Homebirth is significantly more risky for the baby than hospital birth, and many women are mislead or deceived about the risk involved. C-sections are at least as safe as vaginal birth for the baby–probably safer. Maternal risk is a series of trade-offs. You just can’t state that c-section is riskier than vaginal birth for an individual woman–it depends on which variables you look at and how much you weight them, as well as individual characteristics and values.

          I think if you don’t have experience with having been assaulted, sexually or otherwise, it will be difficult to understand just what horror the process of vaginal birth can be for another woman. The nature and location of the pain, the exposure, the loss of control over your body while other people are touching it can be absolutely intolerable. If you’ve never been assaulted, violated, and in fear then you will probably not get it. Nor will you understand the anger, shame, and depression that follow. Add a difficult, complicated delivery and then a pelvic floor injury and the series of embarrassing and invasive exams and future surgeries that necessitates and consider the effect it might have on a woman.

          An uncomplicated, complication-free delivery is not ever guaranteed. Pain relief is not guaranteed. In fact, nothing is guaranteed in a vaginal birth. Women should know that MRCS is an option, and their providers should discuss it with them in the knowledge that, for some women, even in the absence of risk factors, it can absolutely be the best choice.

        • Jessica S.
          May 29, 2014 at 11:36 pm #

          But your neighbor had 5 CS. And I assume, God willing, she’s still alive? I’m not trying to suggest that everyone plan on have 5+ CS. But the point is, she must not be hearing from her doctors that she shouldn’t keep getting pregnant (maybe they do say that now, I don’t know) and I suspect that not all of those CS were surprises? Maybe 5 is only half is what she really wanted. I’m not about to label what *I* think is a large family (on particularly trying days, I think one is plenty – and I’m usually being generous to my adorable terror of a three year old, b/c he’s already here!) the same as I think MRCS shouldn’t be panned as a bad choice – for a large majority of women, it isn’t.

    • DiomedesV
      May 28, 2014 at 4:50 pm #

      Other readers here can give you the exact stats on this, but a scheduled C-section is much safer for the baby involved. That is one reason why they are so common in parts of China (e.g., Shanghai), where families are restricted to 1 or 2 children.

      They do come with more risk for the mother, but those risks are very small when the woman is healthy and desires only 2 children.

      I requested a C-section because I have had chronic pelvic pain all of my adult life, for reasons that I still don’t understand. In the last few years, it has mostly gone away, but before it had, I was very worried that a vaginal labor would further damage my pelvic floor. My doctor (and the insurance company, thank goodness) agreed with me and I was granted a MRCS.

      I agree that it can be difficult for women to weigh these options
      without counseling. At the time, I was certain that 2 kids was all I
      wanted. Now I am not so sure, so you could say that my initial reasons were overshadowed by changing circumstances.

      But in the end it didn’t matter because my baby was transverse from 30 weeks on. The surgeon discovered that I have a uterine anomaly that was probably responsible for the transverse lie. The uterine anomaly and the incision required to get the baby out, effectively rule out any future vaginal labor. In retrospect, we were both very lucky to be alive in the US now, where a C/S is absolutely routine surgery. And I may still only have 2 children. It’s hard to predict the future.

      • Jessica S.
        May 28, 2014 at 9:00 pm #

        Do they do a different incision for a transverse lie? Was that uncomfortable carrying like that? I imagine that would be awkward!

        • DiomedesV
          May 28, 2014 at 9:37 pm #

          I have what I believe is called a J incision. Or it’s a T. I’m not sure. Also, apparently the lower section of the uterus was poorly developed. I’m not an OB, so I don’t completely understand the details. I was told that I was never a good candidate for a vaginal labor, as the baby would not have engaged.

          I don’t think it was more uncomfortable than the last stages of pregnancy generally are. But apparently anyone with OB experience could tell the baby was transverse just by looking at me. Like, from across the room.

          • Jessica S.
            May 29, 2014 at 8:57 pm #


    • Allie P
      May 28, 2014 at 5:06 pm #

      The numbers for morbidity from CS are so low that it’s a perfectly safe alternative. Just as having an epidural OR NOT in the hospital is also six of one, half dozen of the other. This blog is only about telling the truth about so called “choices” that are lies (such as tying yourself into knots over breastfeeding) and actually measurably dangerous (like refusing diabetes screening, GB+ antibiotics; and the practice of homebirth).

    • fiftyfifty1
      May 28, 2014 at 5:08 pm #

      ” If a woman has no medical indication for a Cesarean, doesn’t that mean that vaginal birth is the safest option for her and the baby?”
      That’s a complicated question. Fifty years ago the answer was clear cut-a c-section without a hard medical indication would have been foolish. At that time, C-sections were much riskier than they are now. And 50 years ago women were also more likely to be successful with a vaginal birth (because they tended to be younger) and more likely to want a larger family.
      But things have really changed. C-sections are much safer (because of regional rather than general anesthesia, advances in surgical technique, and understanding of how to prevent lung clots). At the same time, a womans’ chance of having a failed attempt at vaginal birth have increased, and the riskiest kind of c-section is an emergency one in the middle of labor.
      So now, for selected women, it really can make sense medically to opt for a maternal-request c-section. I chose one myself for my second birth after sustaining pelvic floor damage with my first. My OB and I sat down and went over the risks of CS at length. I was sure I wanted a small family. I was past 35 so was unlikely to change my mind. I had no history of blood clotting problems. I understood that the risk to me was a tiny bit higher in the days right after birth, but that was offset by the risk of doing even more damage to my pelvic floor. I am already going to need surgery for my pelvic organ prolapse. My pelvic floor surgeon warned me that the worse the damage gets, the more complicated and risky the repair gets. I’m glad I had the choice.

    • yentavegan
      May 28, 2014 at 5:11 pm #

      I think some of the statistics showing that c/sec’s are associated with maternal health complications are b/c women with pre-existing health problems are also getting higher rates of c/sec’s.

      • Anna T
        May 29, 2014 at 2:39 am #

        OK, so aren’t there any studies that focus specifically on elective Cesareans? Such as, take two groups of healthy women, one has vaginal births, the other elective Cesareans (for no medical reason whatsoever), and see how they compare? If there is no such study I think there should be.

        • Young CC Prof
          May 29, 2014 at 7:28 am #

          There really aren’t, and it would be incredibly difficult to do such a study. For one thing, it would have to be HUGE. In order to study serious morbidity in healthy pregnant women, you’d need a sample well into the thousands depending on how serious morbidity is defined. To have a chance of detecting a difference in mortality, I think you’d need to recruit every low-risk first birth in the USA for a couple years!

          Then, you have to essentially randomize them to c-section for no reason vs attempted vaginal birth. How many women would consent to that? Probably even fewer than the number who currently get true MRCS.

          They HAVE tried to look at women having scheduled primary c-sections for reasons that don’t carry a serious risk of complications in and of themselves. (With c-sections for placenta previa, for example, hemorrhage is much more common.)

          One study looked at first time mothers, 1,000 having a scheduled c-section for a breech baby, and 30,000 planning vaginal birth. Some of the planned vaginal births ended in CS, but that’s the honest way to do it. There was no difference in maternal outcomes, but the sample size was too small to measure the rate of serious complications in low risk women.

          Based on the literature overall, a collection of imperfect but interesting studies, it appears that if you only have one child, MRCS and attempted vaginal birth really are six of one half a dozen of the other. If you want two, there’s a slight advantage to attempted vaginal birth, but not much. If you want a big family, that’s a different matter entirely.

          • Guesteleh
            May 29, 2014 at 12:56 pm #

            What about countries like Brazil and China where a large percentage of women opt for CS? Of course, it would be hard to extrapolate from that given all of the differences between populations but it would still be interesting to study.

          • Young CC Prof
            May 29, 2014 at 5:26 pm #

            I don’t trust statistics from China. Their government has a well-documented history of lying.

            Brazil, now, that might be interesting.

          • Certified Hamster Midwife
            May 29, 2014 at 7:29 pm #

            I do at least find it plausible that c-sections are popular in China, because future births aren’t much of an issue there.

          • Young CC Prof
            May 29, 2014 at 7:42 pm #

            Oh, I believe they have many c-sections, I just wouldn’t believe their morbidity and mortality data.

        • MaineJen
          May 29, 2014 at 4:18 pm #

          I think you’ll find that the number of women having c sections for “no medical reason whatsoever” is very small. Even c sections that are listed as “elective” often have medical indications associated with them; if I understand correctly, ‘elective’ only means that it is a scheduled procedure and not an emergency. An “elective” section could be performed for breech presentation, for example. Absolutely medically indicated, but technically elective.

    • Amy Tuteur, MD
      May 28, 2014 at 5:12 pm #

      This blog is NOT devoted to the absolute safest form of childbirth. This blog is devoted to providing women with scientifically accurate information so they can make informed choices. Part of providing accurate information is debunking the false claims about the safety of homebirth, refusing interventions, refusing C-sections, etc.

    • Elizabeth A
      May 28, 2014 at 10:14 pm #

      I am totally unconvinced that the consequences of a vaginal birth ate always gping to be preferable to the consequences of a c-section, althpugh that was what I believd when my son was born.

      I had assorted tearing, retained placenta and pph fromy vaginal delivery. When I had my daughter, 2.5 years later, I had a c/s, and had a MUCH easier recovery. It took me longer, post c/s to get back to jogging, but far less to get back to sitting without pain, walking around, and doing things around the house. I also lost less blood.

      Future births aren’t really an issue for me, but I was told at the time I was a good candidate for vbac, and no one seemed to think a third or fourth baby would be a problem.

      • Anna T
        May 29, 2014 at 1:06 am #

        No, definitely not every vaginal birth is better than a Cesarean. I guess if the pushing stage, say, is extremely long and excruciating and hard on the baby, and emergency use of forceps is required, and the mother’s pelvic floor is permanently damaged, then perhaps in retrospect a Cesarean would have been better. But surely an uncomplicated, quick vaginal birth is better than a Cesarean (from a medical point of view)? And if a mother has no indication for a Cesarean, and every chance to have an uncomplicated delivery, how can a doctor in good conscience *not* advise her against a Cesarean? The choice should be hers, but I don’t think elective C-sections should be encouraged.

        Please keep in mind I’m talking about cases when there is absolutely NO medical reason to perform a C-section, not about “grey areas” such as many of the commenters here have described.

        • Elizabeth A
          May 29, 2014 at 8:06 am #

          Of course an uncomplicated vaginal birth is better than a c/s. Do you have a crystal ball that predicts which births will turn out that way?

          In a case where there’s no medical indication in advance for c-section, doctors who won’t do MRCS are telling the patients who request those procedures to roll the dice – trade the risks of elective c/s on a weekday morning for the risks of labor, whenever labor occurs and however it goes. That second set of risks includes the potential for an emergent c/s delayed because of staffing or respurce issues. If you poke around, you can find a few women who had c/s wihithout anesthesia, because the baby was dying and the ana was too far away.

          If a patient knows the risks of elective c/s on a weekday morning, it’s reasonable for her to prefer those risks to other risks, and for her doctor to respect her preferences.

          • Anna T
            May 29, 2014 at 8:20 am #

            No, of course we can’t know in advance how a birth will turn out. But if there is nothing indicating beforehand that something might go wrong, and the mother is healthy and low-risk, I still maintain that vaginal birth is the medically preferable option.

            Of course I realize we live in Lifeville, where we make the best choices depending on all the circumstances. It would have been better for me not to miss any prenatal appointments, but I was forced to miss some, due to circumstances. It would be better for our family to switch to all whole-grain and organic, but we can’t do this because of budget reasons. Similarly, I understand some women choose elective Cesareans, for various reasons, even though they probably could have had vaginal births. However, I don’t think doctors should support this as a trend.

          • Elizabeth A
            May 29, 2014 at 8:45 am #

            I don’t know what percentage of moms have totally uncomplicated vaginal deliveries that don’t hurt all that much and are easy to recover from, but the historical evidence (read your Old Testament) is “not that many.” We often don’t *get* a warning flag that something will go wrong.

            Vaginal birth is not an end in itself. It’s not a good thing unless it’s evaluated in the context of outcomes – does it result in healthy babies and healthy mothers as often as the alternatives? The big trend that I see in medicine is consideration for patient concerns, including those concerns that aren’t strictly medical. That’s a good trend.

            Your argument wouldn’t piss me off so much if I hadn’t heard exactly the same case made against prophylactic mastectomies.

          • Anna T
            May 29, 2014 at 9:20 am #

            If labor hurts more than the mother is willing or able to tolerate, why, that is what epidurals are for. The labor pain, in itself, can be avoided or minimized without a C-section.

            No, vaginal birth is most definitely not an end in itself. I’m looking at all this in context of the woman’s long-term health. But then, again, I come from a place where people have large families.

            My SIL fought tooth and nail to have vaginal delivery for breech, and succeeded. Why was it so important to her? Because it was her first, and she was at the beginning of her childbearing years, and thought she’ll want at least 4 children – and she was also told that, because of a certain condition (sorry, can’t remember which) she’s very likely to have breech again. So she figured that for her, once a C-section will always be a C-section, and she didn’t want that.

            For a 40-year-old woman with breech, a C-section would probably be the preferable option. So it all depends on the circumstances.

          • The Bofa, Being of the Sofa
            May 29, 2014 at 9:32 am #

            For a 40-year-old woman with breech, a C-section would probably be the preferable option. So it all depends on the circumstances.

            Yes, it depends on the circumstances.

            So why are you trying to restrict women’s choices, like an MRCS, which are made based on THEIR circumstances?

          • staceyjw
            May 29, 2014 at 11:53 am #

            I preferred to have pain in the ab area, then in the vaginal area.
            I preferred the known recovery for CS than an unknown one for VB.
            CS pain is also taken seriously, where post VB pain is not, so the odds of being really in pain aren’t that much worse with a CS.
            I had already had a serious surgery, and knew this would be something I could manage, but the unknowns of labor, who knows?
            There is no guarantee of an epidural working (my second one did not get working in time).
            THERE ARE NO GUARANTEES, I wanted to make the choice that was right for ME.

            Two opposite stories here:
            DS 1, I was denied an MCRS at the last minute. I am sure you would have been happy my OB was not supportive when it mattered! I was a 32 yr old, low risk mom, zero health issues, no complications. My family history told me VB would not end well, but I didn’t get to make this choice.
            Instead, I got a 36 hour labor, 4 hours of pushing, a baby that never desended, and a CS ANYWAY. But now, it came on top of the long labor and pushing. Recovery was painful for 2 days, but after that it was a breeze. My Ob apologized for not respecting my choice and denying me.

            Second baby, I had pretty serious issues, possibly directly related to the ridiculous amount of unproductive pushing. Nearly lost my girl at 19 weeks. Got a cerclage, weekly shots, monitored constantly, etc. Still, she was born early. I ended up with a preemie VBAC, which went well. No pain, even without a working epidural, 4 pushes, no issues. Great! But my choice was not respected at that hospital. MY OB was respectful of my desire for an ECRS, but this place was not.
            I was happy with the end result, but their attitude was pretty bad. I don’t complain because I did get the perfect, painless VB. But who could have known? Especially after the last horrible try?

          • theadequatemother
            May 30, 2014 at 12:03 pm #

            “If labor hurts more than the mother is willing or able to tolerate, why,
            that is what epidurals are for. The labor pain, in itself, can be
            avoided or minimized without a C-section.”

            IMO, as an anesthesiologist, I agree epidurals are a solution to labour pain. But they are NOT a perfect solution.

            First pass success (getting the woman comfortable) is only 90%. We can get to 98% but that’s with replacing catheters and fiddling…potentially getting a second anesthesiologist. That could take an hour or more. An hour or more to adequate pain relief for SEVERE pain shouldn’t be considered acceptable.

            There are also access issues in many health systems and also depending on the size of the hospital. The anesthesiologist may be unavailable. Some centers have a culture where women are pushed to delay the epidural (coming from RNs and Midwives and physicians). Some labours progress too quickly for an epidural to be placed. Sometimes emergency procedures are required before an epidural can be placed or topped up…its lovely to be called to a room to top up an epidural for emergency forceps to find the forceps are already in use.

            Some women can’t have epidurals because of medical concerns.

            Fear of pain in childbirth is a reasonable fear. It is not a kind of pain that is well treated. It is not a kind of pain for which there are super great options. It is not a kind of pain that is quickly treated/ treated urgently in some centers.

            In short, there are no guarantees that when you show up at the hospital in sig labour pain that it will be treated promptly, or treated adequately or in some cases treated at all.

          • Busbus
            May 30, 2014 at 12:20 pm #

            Theadequatemother, I just wanted to say that I always enjoy your posts and point of view as an anesthesiologist. It’s very interesting to hear about your job and experiences. Thank you!

          • Jessica S.
            May 30, 2014 at 10:45 pm #

            I totally agree!!

          • Dr Kitty
            May 30, 2014 at 12:34 pm #

            If your sister was planning four kids, all of them were frank breech and she had four breech VBs she has a fairly good chance of experiencing an adverse event (cord prolapse, head entrapment, emergency CS).

            Number of planned breech CS to prevent one neonatal death is 110.

            The risk of neonatal death or significant maternal morbidity for four elective CS is lower than for four breech VBs.

            I’m not sure I understand your SIL’s reasoning.

          • Guestll
            May 31, 2014 at 1:17 am #

            Willing or able to tolerate? That is what epidurals are for? Yeah, let me tell you about my first and only, born posterior, 8.8 lbs, and me with a narrow pelvis. Let me tell you about the failed epidural, the one they couldn’t get right for love nor money. Listen, please, as I explain in detail what it felt like — like I was being ripped apart by two hot, huge, metal claws, one around each hip, pulling them apart, slowly, slowly…then brutally jammed back together again, only the pieces, they didn’t fit so well, so…jammed in crooked. Lather, rinse, repeat, for two and a half hours, interspersed with periodic vomiting, until a hand slides in me at the end in an effort to spare my flesh and free her shoulders…now another hand, shoulders freed, flesh torn, burning, jammed back together again, crooked.

            Where was my crystal ball when I needed it??

          • staceyjw
            May 29, 2014 at 11:40 am #

            Anna- If you really think docs shouldn’t support MCRS, you are a part of the problem.

            It is MY BODY, and if its medically reasonable, its MY CHOICE. Making a woman have a VB because you think VB is better (not even true) is unreasonable. As long as there is true informed consent, the risks are a pretty even trade off. Why shouldn’t I get to make this choice? Why should an OB refuse to support me? There is no medical rational for denial of MCRS, just like there is none to deny NCB or use of an epidural.

            There are lots of times in labor/delivery where one choice might be slightly better than another, and mom chooses the lesser option for her own needs. VBA2C is a good example. A mom may choose this, even though it will be somewhat riskier than a repeat CS, but she wants a big family, so its worth it. Or, a mom choose to go unmedicated, even though it has been proven to up the odds of PTSD pretty significantly, because she hates pain meds and fears needles.

            What about the moms that want a VB, and would have a better chance at getting one with pitocin, choosing to refuse it? How about when they refuse any interventions up until it becomes an emergency? Do you think an OB should stop supporting her, and just go ahead with intercventions anyway? How is this different?

            There are many reasons for MCRS, though IMO the reason is irrelevant. I can name a bunch of them you may have never even considered, but the big ones are history of sexual abuse/rape (1 in 6 or more woman, experience this, right #YesAllWoman), desire to maintain the current function of their vaginas for their own sexual needs, fear of labor (you can avoid a CS because you fear it, but not a VB?), desire to avoid pain in the vaginal area trading it for ab pain (don’t laugh, this was me), avoid serious pelvic floor issues, the list goes on and on.

            This is what respecting patient choice is all about. As long as the dangers aren’t overwhelming, there is no reason not to support what a woman wants. Hell, often OBs will support womens choices even when they have more dangerous consequences!

            I will let others explain why MCRS isn’t an inferior choice. I just wanted you to think of this perspective.

          • Something From Nothing
            May 29, 2014 at 12:25 pm #

            So you think a paternalistic medical system is best, where we tell women what they should do and not respect the choice of maternal request caesarean with informed choice? Seriously? I’m so sick of people saying we should respect women’s choices, except…..

          • The Bofa, Being of the Sofa
            May 29, 2014 at 12:27 pm #

            But she had such a great story about how the doctor respected her sister’s (or whomever) wish for a vaginal breech. Wasn’t that great?

          • AllieFoyle
            May 29, 2014 at 12:57 pm #

            Exactly. I’m sick of the argument about large families. Most women these days will have small families. Why deny them a perfectly valid option because a few women will choose to have large families? I really resent having my ability to perform as a brood mare preserved over my autonomy and quality of life.

          • Mac Sherbert
            May 29, 2014 at 3:00 pm #

            And some of us poor souls couldn’t be brood mares even, if we wanted to!!

            Try fighting infertility… I’m not risking this baby it may be the only one I have! (Not that I really think any baby should be risked, but it really hits home when it may be your only one!)

          • The Bofa, Being of the Sofa
            May 29, 2014 at 4:15 pm #

            I was thinking that as well. I know a surprising number of people who have gone to very extreme extents to even have a baby in the first place. They aren’t having big families, even given the “surprise pregnancy after struggling with infertility for years” possibilities (I know someone like that – fought for years, had twins by IVF, and then got pregnant accidentally right after. Now…they have three. No, no big family there; and they were relatively young with their second pregnancy).

            Why should the long term effects on a big family have any bearing on them? Shit, from my perspective, it makes more sense to do the c-section just to not take any chances with the baby they have.

          • KeeperOfTheBooks
            March 19, 2015 at 10:55 pm #

            Indeed. The about-how-many-kids conversation is one that any OB worth the name ought to have with a patient when discussing whether she wants to delivery via CS or vaginally. DH and I aren’t the norm in that we do want a big family, but I’d think it just as irresponsible of my OB to not verify with me that we’d like a bigger family, and so, all other things being equal, let’s give a VBAC a shot next time as it would be for another OB to tell the patient who wants two kids that she really needs to try for the VBAC to increase the number of kids she could potentially safely have.
            ETA: I’m an idiot, and didn’t realize this post is 10 months old. Ok, time for bed… *facepalm*

          • Jessica S.
            May 29, 2014 at 11:12 pm #

            Why not? If there’s evidence to show that the trade off is negligible and if the patient desires a small family (even then, having three or four CS is not unheard by any means and if I understand correctly, an elective prelabor CS is safer than a rushed or emergency one in mid labor), why not? I’d agree with you if CS was much more risky in any scenario, but that’s not how I understand it to be. I don’t know that you’d see a surge in women choosing it, but they should absolutely be given the choice, fully informed of course, but an option nonetheless.

        • The Bofa, Being of the Sofa
          May 29, 2014 at 9:09 am #

          But surely an uncomplicated, quick vaginal birth is better than a Cesarean (from a medical point of view)?

          How likely is that, though?

          Basically, this is a gambler’s fallacy. As I’ve said before, blackjack is a real easy game. All you have to do is bet big when you have 21, and bet small, or not at all, on those hands where you don’t/

          That’s basically what you are suggesting here.

        • moto_librarian
          May 29, 2014 at 10:04 am #

          The problem is that you only know how the delivery went in retrospect. I delivered two small babies vaginally (6 lbs., 4 oz., and 6 lbs., 15 oz., respectively), and at 36, I have already done a stint in pelvic floor rehab and I am having issues with bowel incontinence. I can’t even begin to describe how embarrassing this is for me, and I know it’s not likely going to get better as I age. Very few providers talk about just how common pelvic floor problems are. My husband asked me a couple of days ago that if I had known about the potential for these issues, would I have preferred a c-section? I don’t know, but it would have been nice to be made aware of it.

          • Amy M
            May 29, 2014 at 10:11 am #

            Yes, I went for vaginal delivery of my twins because I was able to, and I was afraid of a painful and difficult recovery from a C section. I have no idea how recovery from surgery would have been—maybe it would have really sucked, maybe it would have been tolerable. What I do know is that the vaginal delivery led to a bad PPH which led to a very uncomfortable recovery. Suffering the effects of blood loss for months, while dealing with newborn twins may not have been any better than dealing with surgical recovery, which likely would have been bad only for a few weeks, if that. On the other hand, I didn’t have much tearing, or a big scar with adhesions, so who knows? Each woman has to make the decision that seems best with the information she has at the time, which hopefully includes all the possible risks/benefits from the doctor (and this is assuming we are not talking about an emergency situation.)

          • moto_librarian
            May 29, 2014 at 11:10 am #

            Recovery from a pph is a bitch, isn’t it? I had one after my first delivery, and very nearly got a transfusion. I felt unwell for a good six weeks. It was bad enough dealing with one baby; I can’t imagine recovering from one with twins!

          • Amy M
            May 29, 2014 at 11:24 am #

            Yep–I also narrowly avoided transfusion. When I went to a routine doctor appt 3mos after the boys were born, they found I was still pretty anemic. I figured I was always exhausted and foggy because I was sleep-deprived with new babies, but it seems it was much worse than it should/could have been, had I gone home from the hospital with more blood.

        • fiftyfifty1
          May 29, 2014 at 10:44 am #

          “And if a mother has no indication for a Cesarean, and every chance to have an uncomplicated delivery,”

          The problem is that people overestimate that “every chance of having an uncomplicated delivery”. For a first time mother, the chance of needing an unplanned, mid-labor c-section is already 15%. It’s substantially higher than that for older first time mothers. Emergency c-sections carry much more risk for both mom and baby than planned c-sections. And then there are the women who do go on to deliver vaginally. Pelvic floor damage is a real risk even in women who at the time seem to have “every chance” of having a straightforward vaginal birth. There are some known risk factors (estimated large baby, Asian heritage, short perineal body) but most women who have damage don’t have any of these risk factors. I had none of those risks myself.

          A large study at Kaiser in California showed that of every 8 women who give birth vaginally (rather than have a pre-labor planned c-section) 1 of these women will need surgery for pelvic organ prolapse that would have been avoided. Surgery for POP is a much bigger deal surgery wise than a c-section, and has a big failure rate. Basically, once your pelvic floor is messed up, it ain’t never going to be normal again.

          So if a first time mother can look at her odds and say “If I choose to try for a vaginal birth, I may get an uncomplicated birth with no damage, and yes that might be ideal. But I might also be in the 15% who end up with an emergency C-section or one of the 12% who will need pelvic repair surgery later in my life, which will often fail anyway leaving me still incontinent. That’s a 27% chance total of outcomes I really do not want. And it is substantially higher if I am over 35”.

          Really it makes good medical sense to offer women who want small families elective C-sections as one of their options.

          • The Bofa, Being of the Sofa
            May 29, 2014 at 10:50 am #

            A large study at Kaiser in California showed that of every 8 women who give birth vaginally (rather than have a pre-labor planned c-section) 1 of these women will need surgery for pelvic organ prolapse that would have been avoided

            So a 15% chance of a c-section, and a 12.5% chance of pelvic organ collapse surgery.

            Wow, the tradeoff is even closer than expected!

          • fiftyfifty1
            May 29, 2014 at 12:06 pm #

            “pelvic organ collapse [sic] ”

            LOL. Yes, that is what it feels like to me.

          • Renee
            May 29, 2014 at 1:42 pm #

            Woah, thats awful. I never knew.

          • fiftyfifty1
            May 29, 2014 at 3:58 pm #

            “Wow, the tradeoff is even closer than expected!”

            And then add to that the fact that a scheduled c-section at 39 weeks improves fetal outcomes in 2 ways:
            1. prevents birth trauma (asphyxia, brachial plexus injury etc)
            2. Prevents the stillbirths that are bound to occur between 39 weeks and whenever a woman happens to go into labor (although of course this aspect could also be accomplished by induction at 39 weeks).

          • theadequatemother
            May 29, 2014 at 11:34 am #

            If I had known that prior to having my first (just how good cs are at preventing pelvic floor problems), if I had been properly counselled on the risks and benefits of both a MRCS and a TOL, I would feel much better about things right now. I might have chosen the TOL anyway….who knows with certainty?

            I have straight forward vaginal births. The first was outlet vacuum for worsening decels. The second was precipitous.

            I have chronic pelvic pain from a rectocele.

            I have to periodically empty the poop out of my rectocele by inserting a finger into my vagina.

            I can no longer run without peeing myself. I used to love running. Now I look for any excuse NOT to go.

            I can no longer ski without peeing myself. I used to love skiing. Now I worry about what will happen, how bad it will be, how many bathroom breaks I’m going to need.

            I used to love road biking. Now I can ride my bike without rubbing of tissue at the outlet of my vaginal. Rubbing so bad that after an hour bike ride, it stings when I pee WORSE than after childbirth. That’s right. I’ve rubbed my protruding vaginal tissue raw.

            I’m not going to go into details but sexual function? The phrase makes me laugh. What function?

            If I had had a crystal ball, I would have chosen an MRCS. If I had been properly counselled, at least I would be able to own my choice. As it stands, I feel that the medical establishment and insurers that encourage vaginal birth are liars who don’t care about women.

          • AllieFoyle
            May 29, 2014 at 11:47 am #

            I’m so sorry. You are definitely not alone in this. It’s a shame and disgrace that women aren’t told about this beforehand, but it’s also terrible how these concerns are shrugged off afterward.

            Vaginal birth=checkmark in the plus column. Complications that destroy your quality of life=few answers, no one cares.

            Fwiw, I recommend looking into surgery. I had it and don’t regret it, though it was not a pleasant experience and caused other problems. Vaginal birth, otoh, I regret very much.

          • fiftyfifty1
            May 29, 2014 at 11:56 am #

            “I have to periodically empty the poop out of my rectocele by inserting a finger into my vagina.”

            Yes, I hate when I have to do that. And my only other option is to keep my stool so soft that that doesn’t happen. But then I have fecal leakage! There seems to be no happy medium in my case.

          • carr528
            May 29, 2014 at 4:04 pm #

            My four c-sections seem REALLY easy in comparison. I can’t even imagine going through all of those problems. (insert hug emoticon here)

          • DiomedesV
            May 29, 2014 at 4:14 pm #

            I am very, very sorry to hear that you’ve had these difficulties. And it can be very hard to get good medical advice with respect to pelvic floor problems. Are you satisfied with your doctors’ care on this issue? Have you considered seeing someone else?

            I have not had these severe problems, but my experience with pelvic floor pain has been that doctor’s vary widely in their interest, competence, and willingness to address these issues. I had to visit several doctors before I found one that took me seriously.

          • araikwao
            May 29, 2014 at 5:07 pm #

            That’s horrid, and it’s just not what anyone expects (or should) as a young, healthy person. I’m so sorry it happened, and isn’t being addressed. Second opinion, maybe?

          • Jessica S.
            May 29, 2014 at 11:02 pm #

            How horrible. It makes me even more angry that MRCS are scoffed at – and that vaginal births are pushed without any consideration that a woman might not want her important parts messed up. My important parts are VERY important to me and I’ll be damned if anyone is going to tell me that’s selfish and vain.

          • S
            May 29, 2014 at 3:14 pm #

            I really appreciate this discussion and your comments in particular. I’m a couple weeks from giving birth and trying to gather information before my next OB visit. She says i have a short perineum and will likely tear again. First was a controlled third-degree — attending OB directed it off to the side — without any resulting bowel problems (a little numbness, not a concern). I’m worried the next one might come barreling out before anyone can intervene.

          • fiftyfifty1
            May 29, 2014 at 3:53 pm #

            I sometimes wonder if the pendulum has swung too far toward anti-epis. It is true that many women can avoid an epis and will not tear. But it’s also true that a mediolateral (angled sideways) epis can keep the tearing away from the anus entirely. The issue is that mediolateral episiotomies go into the “meat” of the vulva which has a fair number of nerves. So getting one can be a more painful and longer recovery and have more numbness than a midline epis or tears that go straight back which hurt less but get into anal sphincter territory. My guess is that your OB is as motivated as you are to help you avoid a 3rd and 4th degree tear. Has she talked to you about options yet?

          • DiomedesV
            May 29, 2014 at 4:14 pm #

            I thought that labors without epidural anesthesia were more likely to result in 3rd and 4th degree tears. Is that wrong?

          • S
            May 29, 2014 at 4:29 pm #

            Ack, i literally just came across something that mentioned this (that epidurals are associated with severe tearing) — it’s buried in my history now. I assumed the finding had to do with malpositioned babies causing a lot of pain.

          • May 29, 2014 at 4:54 pm #

            This is from Google Scholar- sorry if not everything is accessible or is hidden behind paywalls.




            From this (very cursory) glance over some of the literature, it looks like epidurals aren’t associated with perineal tears at all. I didn’t see anything suggesting a protective effect either, but I didn’t look very hard.

          • S
            May 29, 2014 at 6:22 pm #

            I have no idea if what i saw was a robust finding or not.

            I also saw a Norwegian study in which slowed delivery of the head was associated with less tearing.

          • DiomedesV
            May 29, 2014 at 5:23 pm #

            That makes sense.

          • Jocelyn
            May 29, 2014 at 6:34 pm #

            That would totally fit with my experience with my first baby – very severe pain from 1 cm on. Epidural at 5 cm. Forceps assisted delivery at 10 cm, due to malpositioning.

          • S
            May 29, 2014 at 4:27 pm #

            I asked what could be done to prevent damage next time, and she said their standard practice would be what was done last time (which, by the way, i am quite content with) — to redirect the tear around or alongside the anal area instead of into it.

            I mentioned my concern about a faster birth — my son was born in 20 minutes of “pushing”, and i couldn’t feel a thing, so i’m not sure if i was even actively pushing — and she said a quick second stage is better than a longer one because the tissues get less battered.

            I confess to being not very assertive with doctors. With my mental health history i’m afraid of being judged as attention-seeking, and also i just forget stuff (like that i have occasional bowel issues anyway and had experienced brief episodes of incontinence before i ever got pregnant!). My OB is an excellent communicator and a nonjudgmental listener — but that’s just how i habitually interact with providers. My husband is coming to my next appointment with me to help keep the conversation on track.

          • DiomedesV
            May 29, 2014 at 5:26 pm #

            I think it’s a very good idea to have your husband come. My husband did the same. The day of the C/S, my mother also advocated for me. It was awesome. Of course, she likes to remind me of how awesome it was, but that’s OK.

          • Jocelyn
            May 29, 2014 at 4:13 pm #

            “I’m worried the next one might come barreling out before anyone can intervene.” Not to scare you, but that’s pretty much exactly what happened with my second. I did tear, and it was a bit worse than my first baby, but it’s all healed up now. Best of luck to you!

          • Jessica S.
            May 29, 2014 at 10:54 pm #

            I swear, fifty, you’re like a walking encyclopedia! I love it! 😀

        • jbennett4579
          May 29, 2014 at 12:20 pm #

          Informed consent is not happening often enough. Birth, in all its many forms, carries risk. Benefits and risks can be communicated properly, when an actual choice needs to be made, without attaching guilt to a particular choice. Just clear and honest communication. Epidurals (as well as any other intervention including surgery) should always be an option. What we crunchies rarely explain properly is that most damage resulting from vaginal birth occurs due to coached pushing (telling a woman forcefully and urgently how and when to push). Coached pushing is necessary in most epidural births (though when an epidural works 100% perfectly, she can feel just enough to respond to the contraction and push accordingly). Coached pushing may also be necessary in a non-epidural births if it helps the baby to be born 10 or 20 minutes quicker. But that’s not always necessary and so laying off when there’s no urgency can reduce tearing. Pushing is a very intense sensation but if given the right kind of non-anxious encouragement, women can and do push their babies out gently without damage. I’ve had two drug-free births myself: one with coached pushing (3rd degree tear — thank God for the OB who sewed me up and I had a great recovery), and one without any coaching (no tears, even though I had torn before). If more practitioners of all types understood this reality and how to help achieve it, we’d be much better off.

          • yentavegan
            May 29, 2014 at 12:32 pm #

            How do you know that most of the pelvic floor damage is done because of forced/coached pushing? That belief is woo. Perhaps your experience of a 3rd d

          • jbennett4579
            May 29, 2014 at 12:42 pm #

            Both of my babies’ heads pressed against my perenium and as far as I know, both births were governed by the laws of physics, so that leads me to look at other factors. I’m open to reading studies which prove what I’ve observed is unfounded.

          • Guesteleh
            May 29, 2014 at 12:50 pm #

            It’s not surprising that your second birth was the one where you didn’t tear. In general, second births tend to be easier than first births. It probably didn’t have anything to do with whether or not you were coached.

            Also, you are misinformed about epidurals. Most women are not totally numbed out and even if they are, you can turn down the epidural dose to facilitate pushing. I was able to feel my son moving down the birth canal and out of my body but with only mild pain. And I didn’t tear.

          • AllieFoyle
            May 29, 2014 at 12:50 pm #

            It’s difficult to draw conclusions in any given situation because of confounding factors. First vs. subsequent births? Large/malpositioned baby leading to both the need for directed pushing and increased chance of tearing/damage?

            The idea that pelvic damage can be prevented by specific birth practices is another lie that does women a disservice.

          • jbennett4579
            May 29, 2014 at 12:58 pm #

            Yes, multips are better pushers so of course that was a factor. My first baby was 6 lbs. 5 oz. and anterior. My second baby was 6 lbs. 7 oz. with a nuchal hand, so you may be able to better understand my personal belief. It doesn’t mean any other woman has to forgo coached pushing or an epidural or anything else she wants. It doesn’t mean I’m right and everyone else is wrong. It just means that I have observed an interestingly strong connection and whenever I can, I will help to preserve a woman’s ability to push with her body if that’s what SHE wants and can reasonably achieve.

          • AllieFoyle
            May 29, 2014 at 1:02 pm #

            No, it’s not that multips are better pushers, it’s that the tissues were often already stretched (and damaged) in previous births.

          • jbennett4579
            May 29, 2014 at 1:17 pm #

            The uterus helps, too.

          • moto_librarian
            May 29, 2014 at 1:15 pm #

            So you’re advising women about how to push with n=2. Are you a doula?

          • jbennett4579
            May 29, 2014 at 1:17 pm #

            I’m not advising anyone to do anything. I’m supporting mothers’ choices. Yes, I’m a doula.

          • Renee
            May 29, 2014 at 1:40 pm #

            Of course she is a doula.

            No one is unsupportive. If you don’t want coached pushing, just say so. If you do, fine.

            I wanted it. I couldn’t feel the contractions well enough even without an epidural. I also liked that the OB was able to control the delivery helping to keep baby from bursting out to quickly.

          • AllieFoyle
            May 29, 2014 at 1:44 pm #

            I don’t have anything against doulas in theory, but they shouldn’t be advising women of things that aren’t true.

          • jbennett4579
            May 29, 2014 at 1:51 pm #

            “If you don’t want coached pushing, just say so.” If only that were easy to do at the most vulnerable time in your life. Providers don’t walk in and ask, “And how will we be pushing today?” They just coach, and it’s not right for everyone. I’m glad you got what you wanted and needed. It’s my job as a doula to guide women to find that, not advise anyone of what they should be doing.

          • moto_librarian
            May 29, 2014 at 2:21 pm #

            It’s not your role to “guide women.” Your job is to support what she has already decided upon. I’ll bet that you are out of scope in your practice.

          • jbennett4579
            May 30, 2014 at 8:19 am #

            You’d like us all to be muted robots who don’t share our own experiences. I do not share my experience in order to project it onto anyone else or to imply that my experience is anything but mine. I do not guide decision-making. I guide them to reach their goals, whatever those goals might be.

          • The Bofa, Being of the Sofa
            May 30, 2014 at 9:10 am #

            I do not guide decision-making.

            But you were the one who is making assertions about coached pushing causing tears! If you are telling people that, then you are guiding their decision making. With falsehoods.

          • jbennett4579
            May 30, 2014 at 11:22 pm #

            I have learned something and that is that coached pushing may not increase the risk of tearing! I also learned from the same study that it may increase the risk of damage to the bladder and therefore it is not considered a best practice. So maybe we’ve all learned a thing or two. I think you believe that all doulas give their clients false information when we are actually focused on something more important and that is building supportive relationships that in many cases last beyond the birth. I’ve found this to be true especially if there was a Cesarean birth or a vaginal birth that was traumatic for the mother.

          • The Bofa, Being of the Sofa
            May 31, 2014 at 12:11 am #

            I think you believe that all doulas give their clients false information

            Not in the least. For example, I think Doula Dani, who is a regular here, is a wonderful person who doesn’t fill her clients head full of made up nonsense.

            But I am wondering, now that you have learned how wrong you were, does it make you wonder what else you believe and are teaching in your childbirth classes might be bullshit as well?

            By the way, it makes me wonder: who taught you that supposed information in the first place?

          • Bombshellrisa
            May 30, 2014 at 11:02 pm #

            Aren’t you also a child birth educator with a blog that shares in great deal the birth of your second child? And then has a bunch of entries about “why you should attend child birth classes” and “why to hire a doul. If you share AT ALL your personal experience during your classes or when a women is making a birth plan, you are guiding decision making.

          • Bombshellrisa
            May 29, 2014 at 2:51 pm #

            But that is what the birth plan is for, right?
            I gave birth recently and was asked if I wanted to be coached.

          • jbennett4579
            May 30, 2014 at 8:26 am #

            Would be nice if birth plans were taken seriously.

          • The Bofa, Being of the Sofa
            May 30, 2014 at 9:09 am #

            Depends on the birth plan.

            Sometimes, shit happens that is out of everyone’s control. In those cases, there are things that need to be done without any consultation of any birth plan.

            Do you have evidence that birth plans are being routinely ignored without cause?

          • jbennett4579
            May 30, 2014 at 11:13 pm #

            Birth plans (preferences) are more of a communication exercise for the family and their purpose is served during prenatal visits. The question really is whether the practice is set up to routinely support those choices unless a different need arises.

          • The Bofa, Being of the Sofa
            May 30, 2014 at 11:58 pm #

            You didn’t answer the question.

          • Bombshellrisa
            May 30, 2014 at 12:27 pm #

            It’s one thing to request no coached pushing, it’s quite another to list all kinds of ridiculous things that you want to have happen when it’s out of anyone’s control. My OB call a birth plan “the birth wishes list” (birth plans are a standard part of the 36 week visit) and that is very wise indeed.

          • fiftyfifty1
            May 29, 2014 at 3:38 pm #

            Actually, research does NOT show that coached pushing increases tears at all (systematic review by Prins et al). On the other hand, research shows that delivering squatting IS associated with worse tears. Also delivering sitting on a birthing stool causes both increased labial lacerations and increased blood loss. Are you at least informing your clients about this important research?

            A lot of the dogma of NCB is false information. And you are propagating it.

          • PrimaryCareDoc
            May 29, 2014 at 3:54 pm #

            Of course she’s not. She’s going to use her vast experience giving birth to 2 children, because it suits her narrative.

          • jbennett4579
            May 29, 2014 at 9:50 pm #

            I’ll take a look at that study. Would also like to see one which shows improved outcomes with lithotomy position (which is the what most women who are being coached are in).

          • Jessica S.
            May 29, 2014 at 10:52 pm #

            But they aren’t literally flat on their backs, right? It may not be squatting or whatever (take note of what fiftyfifty said about those other positions and their association to tears) but it’s more of a reclined position.

          • jbennett4579
            May 30, 2014 at 8:25 am #

            “take note of what fiftyfifty said about those other positions and their association to tears”

            The studies she refers to (I think, unless she provides a link to a different one), says this: “The authors (Gupta et al., 2009) cautioned that due to methodological flaws in several studies, the findings of the review should be interpreted with caution. Moreover, the authors concluded that due to deleterious maternal and/or fetal effects of non-supine positions, women should be encouraged to give birth in the position they find most comfortable.”

          • The Bofa, Being of the Sofa
            May 30, 2014 at 9:07 am #

            “The authors (Gupta et al., 2009) cautioned that due to methodological flaws in several studies, the findings of the review should be interpreted with caution. Moreover, the authors concluded that due to deleterious maternal and/or fetal effects of non-supine positions, women should be encouraged to give birth in the position they find most comfortable.”

            Yeah. So how does that support your assertion about coaching causing tears?

          • jbennett4579
            May 30, 2014 at 11:11 pm #

            It doesn’t. We went off on a side discussion about positions.

          • Jessica S.
            May 30, 2014 at 10:36 pm #

            Ok, I’m fine with interpreting with caution – I won’t paint with a broad brush based on flawed observations.

            “due to deleterious maternal and/or fetal effects of non-supine positions”

            So they’re saying non-supine positions could be harmful to the woman and fetus? Or am I reading that wrong? I realize they go on to say that women should give birth in the position most comfortable to them, but still, I’m thinking if non-supine positions could have deleterious effects, I’m fine on my back. But of course, the authors did just state not to trust their review too much, so…what do I know!? 🙂

          • jbennett4579
            May 30, 2014 at 8:12 am #

            The Prins study concluded that there was no difference in perineal lacerations due to coached vs. non-coached. I know you think all of us only admit what supports our own beliefs but I actually do take the studies seriously and don’t think it’s OK to cherry pick, so I appreciate the opportunity to expand my understanding. Please do also acknowledge that findings indicate damage to bladder function in the coached pushing group and for that reason, coached pushing is not considered a best practice according to this paper. The study also notes coached pushing shortens 2nd stage considerably but the clinical value of that is not clear. Bottom line: “Given the wide prevalence of the use of the Valsalva pushing technique, further rigorous research needs to be undertaken before it can be recommended.”

          • AllieFoyle
            May 29, 2014 at 1:35 pm #

            It doesn’t mean any other woman has to forgo coached pushing or an epidural or anything else she wants

            Does anyone want coached pushing? I mean, probably some people do, but in general you can’t do anything to prevent many of the situations that require coached pushing.

            I think women are sometimes wrongly encouraged to go without epidurals so that they can control their pushing better and avoid tearing somehow, and also are sometimes blamed for the damage when it does occur for having done something “wrong” during labor, i.e. pushing too hard, not pushing hard enough, getting an epidural, being in the wrong position, etc.

            The truth is that MANY women will have tearing, no matter what happens. This tendency toward doctor-blaming/mother-blaming postmortems to place the blame on specific details misses the point: birth itself can cause damage no matter what you do.

          • jbennett4579
            May 29, 2014 at 1:46 pm #

            I agree with you that no one should be made to feel they did something wrong postmortem. If she chose an epidural, that was the right choice. If she asked for more time and space to figure out pushing, I salute her. Birth is what it is. The language I use is, “Sometimes, women experience…”. Everyone’s experience is their own.

          • AllieFoyle
            May 29, 2014 at 2:01 pm #

            That’s fine, so long as “sometimes, women experience” is not followed by a generalization that isn’t backed up by evidence and may unnecessarily influence her to do or not do something that isn’t in her best interest.

          • An Actual Attorney
            May 29, 2014 at 10:50 pm #

            I’ll nitpick. No one feels anything postmortem.

          • jbennett4579
            May 30, 2014 at 11:25 pm #

            Maybe they feel sad because their attorney is a jerk and it happens to be during the postpartum period.

          • jbennett4579
            May 31, 2014 at 8:32 am #


          • moto_librarian
            May 29, 2014 at 2:19 pm #

            For me, having an epidural the second time around was intended to give me control over my pushing. The likely cause of the cervical laceration during my first was because I was unable to control the urge to push.

          • MaineJen
            May 29, 2014 at 4:03 pm #

            So you’ve taken your N of 2 and extrapolated that to advise everyone else? Come on.

          • PrimaryCareDoc
            May 29, 2014 at 4:18 pm #

            But it’s an “interestingly strong correlation!” (with an n of 2. Screw all the real research that says otherwise.)

          • theadequatemother
            May 29, 2014 at 2:08 pm #

            “The idea that pelvic damage can be prevented by specific birth practices is another lie that does women a disservice.”

            Prelabour cs is preventative.

          • AllieFoyle
            May 29, 2014 at 2:10 pm #

            Oh yeah, you got me there. 😉

          • S
            May 29, 2014 at 12:56 pm #

            First birth is a risk factor for severe tear. Much less likely in subsequent births. I’ve been spending a good amount of my spare time these past few days searching on this subject, so can comb through my recent history and get back to you in a few hours with some citations. =)

          • S
            May 29, 2014 at 4:04 pm #

            Bah, most of my search was done on the laptop, which doesn’t save history, but here are a couple links.

            This is a book chapter summarizing some of the research. Relevant bits:
            – Women with previous sphincter injury and no resulting symptoms have only a 5% chance of sustaining new injury or developing new symptoms (page 272-3).
            – Perineal massage has been found to be somewhat protective against tearing _in primiparous women only (page 273; Shipman et al. 1997, Labrecque et al. 1999)
            – Coached versus delayed pushing was found to have no effect on third- and fourth-degree tears (page 273; Fraser et al. 2000).

            Here is a link to the Labrecque studyreferenced above: http://www.ncbi.nlm.nih.gov/pubmed/10076134
            And the Fraser study:

            Baghestan et al. “Risk of recurrence and subsequent delivery after obstetric anal sphincter injuries.”
            “Adjusted odds ratios of the recurrence of OASIS in women with a history of OASIS [obstetric anal sphincter injuries] in the first, and in both the first and second deliveries, were 4.2…and 10.6… respectively, relative to women without a history of OASIS.”

            I have NO background in research, so please feel free to weigh in with comments. I have a vested interest in understanding my odds here! =)

          • Jessica S.
            May 29, 2014 at 10:43 pm #

            I think that it’s important for you to cite something about the difference of coached/non-coached pushing in regards to tearing before you make claims about practitioners needing to know more.

          • PrimaryCareDoc
            May 29, 2014 at 12:44 pm #

            Lemme guess- your coached birth with the tear was your first birth and the non tearing birth was your second.

            But that has NOTHING to do with it, right? Had to be the coaching that caused the tear.

          • Guest
            May 29, 2014 at 12:53 pm #

            You are correct, doc! I completely understand that multips are more efficient pushers. Isn’t it true that women are more likely to tear the second time if the tore the first? So my risk was higher the second time, yet I didn’t tear.

          • S
            May 29, 2014 at 12:58 pm #

            If i understand correctly, your risk of severe tear was higher than baseline for a woman giving birth for the second time. However, your risk of tearing the second time was lower than your risk of tearing the first time, by virtue of it being your second birth.

          • S
            May 29, 2014 at 3:52 pm #

            I don’t think i worded the above comment very well.

            Because you tore severely the first time, you were more likely to tear during your second birth than a multipara who had not torn the first time.

            However, the vast majority of women who experience a severe tear in their first birth do NOT tear severely the second time around. (I’m putting together a comment with some links.)

          • jbennett4579
            May 29, 2014 at 12:54 pm #

            You are correct, doc! I completely understand that multips are more efficient pushers. Isn’t it true that women are more likely to tear the second time if there was a previous tear? So my risk was higher the second time.

          • PrimaryCareDoc
            May 29, 2014 at 12:56 pm #

            No, that’s not true.

          • moto_librarian
            May 29, 2014 at 1:05 pm #

            I call bullshit. If you can’t cite an actual study to prove that coached pushing is the cause of pelvic floor problems, keep your speculation to yourself. My first birth (unmedicated) resulted in a cervical laceration and 2nd degree tear because I could not control the force with which I pushed because of the intensity of the urge. I had a 2nd degree tear with my second (epidural) only because he had distress at the end that necessitated a quick and very forceful push to deliver him immediately.

          • Jocelyn
            May 29, 2014 at 4:08 pm #

            Hmmmm. I tore worse with my unmedicated, non-coached-pushing baby than I did with my epidural, coached-pushing one. There was no urgency with the epidural. There was with the unmedicated baby, because it hurt like hell. Soooo…my experience is opposite of what you’re saying.

          • MaineJen
            May 29, 2014 at 4:22 pm #

            Absolutely. With the epidural i was hearing a lot of “Okay, push harder now…now ease off a bit…okay, one big one…” Do you think I would have had that amount of control if I were howling in pain? Doubt it.

          • Jessica S.
            May 29, 2014 at 10:39 pm #

            Do you have any sources to back up the coached/non-coached theory?

          • Busbus
            May 30, 2014 at 9:40 am #

            Another anecdote: I had two unmedicated births, no coached pushing either time. I had a 2nd degree tear with my first. I was in so much pain at the time that I put everything I had into pushing her out just so this could end. Who knows, had I had an epidural and been able to go slower, maybe the tear could have been prevented…? (Coached pushing or not.) I had a 1st degree tear with my second baby, and again—no coached pushing. Maybe it was positioning, first baby vs. second, … Who knows.

            That’s why we need studies, not anecdotes!

          • Busbus
            May 30, 2014 at 9:43 am #

            Also, how exactly do we define where coached pushing starts? At my second labor, the midwives did tell me that I needed to push more effectively, gave me instructions on how to do that and sort of cheered me on during the contractions. Is that already coached pushing? Half-coached pushing…?

          • Irène Delse
            May 30, 2014 at 10:12 am #

            Or is it one of those things that are bad if practiced in a hospital, especially if at the behest of doctors, but good if it’s done by independent midwives? Coached pushing is “depriving women of autonomy”, but midwives “empower” a woman to push when they say so?
            Hmm. I wonder why that is. /Snark.

      • Guest
        May 29, 2014 at 7:35 pm #

        I think every woman should be given the option to section if that’s what she wants after she’s been well informed of her options. I had a very large baby and I was so relieved when they sectioned. I did not want to be scarred and incontinent and I believe I should be allowed to make that choice and not have it imposed on me.

    • LibrarianSarah
      May 29, 2014 at 9:53 am #

      From what I understand, a maternal request c-section is more risky for the mother but less for the baby not more risky for both. While I don’t think any women should be forced to make the choice to put herself at risk for the sake of her child, I also think that those who make that choice should be commended for their sacrifice instead of derided as “too posh to push.”

    • Something From Nothing
      May 29, 2014 at 12:18 pm #

      For healthy women planning three babies or less, elective caesarean is safer for mom and baby than planned vaginal delivery, hands down.

  15. Jessica S.
    May 28, 2014 at 3:13 pm #

    “According to Hill: Too often women who say they care about the details of their baby’s birth day are accused of wanting an ‘experience’, as if it is selfish to care about how their baby is born, how they feel or how they are treated. But, as the saying goes, ‘when a baby is born, so is a mother’. If a mother feels broken, dispirited, depressed or traumatised, how will this affect her baby? Is this healthy?”

    I don’t know, I agree with how Dr. Amy frames it – that things like full range of choice for delivery method, access to timely and effective pain relief, etc. matter very much, and thank heavens we live in a day and age where a healthy baby and healthy mom is ‘and/also’ situation and not an ‘either/or’.

    But as far as this quote from Hill goes, I’m not buying *her* redefinition of “experience”. Unless she’s willing to embrace those options Dr. Amy laid out, to set aside ideology for a “big tent”, then she *is* potentially sacrificing baby’s health for mom’s experience – assuming the “choice” and “respect” and blah, blah, blah means what I think it does: Natural Childbirth Dogma. (The funny thing is, it promises a beautiful experience for mom but in reality could make it way worse than what a typical (demonized) hospital birth offers!) Especially if she’s talking about home birth – in that case, she’s right that a healthy baby is not all that matters but wrong when she asserts it’s the Most Important Thing.

    Lastly, the whole idea of a mother being born, too – this is true. But, absent some horrendous, rights-violating hospital delivery, what happens on the day the baby is born is a drop in the hat compared to the rest of the baby’s life. So much like how a baby is born matters little (except for healthy outcome!) compared to the entirety of their life, so does my own birth experience mean little to my identity, my role as mother. (I understand this may be VERY easy for me to say, b/c my one delivery experience was not unpleasant. So please know I’m not saying everyone should get over their hurts. Not at all. It should be dealt with respectfully and perhaps professionally. Trust me, I’m familiar with professional help. I’m a big fan! Ha!)

    • Young CC Prof
      May 28, 2014 at 3:24 pm #

      I say this a lot: According to MANA’s own data, the incidence of hemorrhage was much higher at home birth. PPH, even if it stops on its own before it becomes life-threatening, is a recipe for a lousy childbirth experience and a truly miserable postpartum period.

  16. The Computer Ate My Nym
    May 28, 2014 at 3:04 pm #

    I’ll admit it: a healthy baby was not my first priority in childbirth. No, my first priority was surviving. A healthy baby was a very close second. Coming through without major physical damage gets third place and no intolerable pain fourth. After that, we’re starting to get into “wouldn’t it be nice if…” territory. I don’t mind not getting those.

    • Young CC Prof
      May 28, 2014 at 3:21 pm #

      Yeah, that’s pretty much how I feel too. First priority is mother surviving, then baby surviving. Although I personally place “avoiding serious injury to baby” third, ahead of “avoiding serious injury to mother.” (Perhaps it’s because catastrophic brain damage isn’t the kind of maternal injury that jumps to mind? Although I know women have suffered strokes around childbirth.)

      Of course, another person might arrange those top priorities a bit differently.

      • The Computer Ate My Nym
        May 28, 2014 at 3:27 pm #

        Good point. Brain damage to the baby outweighs the vast majority of bad things that could happen to the mother, short of death or catastrophic maternal brain injury, which, unfortunately, can and does occur occasionally. Baby’s brain came above, for example, continued urinary continence for me, but urinary continence was still important.

  17. Dr Kitty
    May 28, 2014 at 2:58 pm #

    I may have been a little too blunt and forthright filling in a questionnaire our local health Trusts are sending to seek opinions on making Midwives the lead professionals for low risk pregnancies.

    In particular the question. “How can we progress Midwives as being the initial professional women see in their pregnancy ” got short shrift from me.

    As a GP, that is currently my job, I do it damn well, and it can involve conversations about whether or not the pregnancy is even going to continue. or where to have the baby because of previous bad experiences, I don’t think Midwives want to get involved in giving advice about how to access abortion services, nor to hear honest feedback about their colleagues’ previous cock-ups.

    • Medwife
      May 28, 2014 at 3:50 pm #

      US certified nurse-midwives have that discussion all the time. I never assume a newly pregnant patient desires to continue her pregnancy. In some states CNMs are also abortion providers (the medical variety, not surgical). I can’t imagine doing my job without my OB though. That’s not where I’m going with this post.

      • DiomedesV
        May 28, 2014 at 4:53 pm #

        I believe Dr. Kitty works in Ireland. Perhaps the social dynamics make a conversation about termination with a midwife more difficult?

        • Medwife
          May 28, 2014 at 5:08 pm #

          Oh, there are places in the US where it would be at least as difficult to talk abortion. But US cnms I guess are more likely to do GYN, which I love- women’s health is so much more than pregnancy. If you live in a place in my country that is not Texas or like Texas, you can have that conversation with a midwife as well as with an MD.

        • Dr Kitty
          May 28, 2014 at 5:29 pm #

          Right… Northern Ireland, which is its own special circle of oddness.

          I have no objection to MWs being lead in low risk pregnancies
          1) If the plan is for the pregnancy to progress
          2) If someone (and why not the GP who provides cradle to grave care and is likely to know the woman and her circumstances well) has determined that she IS low risk and WANTS midwifery led care.

          GPs see their patients on average six times a year here.
          Why shouldn’t I be the first port of call when two lines appear?
          I know their entire medical history, their social circumstances and often can predict whether it is being greeted as good news or not.
          Midwives here. DON’T provide well woman or Gyn care, their involvement stops at 21 days post partum,, and they won’t have access to the same notes I will.

          Not least because being seen by a midwife in an antenatal clinic may let your friends and neighbours know you are pregnant, but going to see your GP doesn’t.
          Which means a lot in a small lace where arranging an abortion is hugely taboo.

          • Montserrat Blanco
            May 28, 2014 at 6:39 pm #

            When I was living in England I had my Pap test with the midwife at the GP practice. It sounds like it works different in different places. I would be happier having that conversation with my GP and not with a midwife I have just seen once though.

          • Medwife
            May 28, 2014 at 8:27 pm #

            It makes far more sense in your system for you to be the primary provider, I agree 100%.

  18. Guest
    May 28, 2014 at 2:17 pm #

    YES!!!! Thank you, thank you. Every word of it.

  19. theadequatemother
    May 28, 2014 at 1:29 pm #

    Favorite post this year. Thank you.

  20. NoLongerCrunching
    May 28, 2014 at 1:14 pm #

    Can we stop using the word “interventions”? That’s an NCB word. The word should be treatment.

    • me
      May 28, 2014 at 3:29 pm #

      IDK… to me “treatment” suggests that a problem already exists, has been identified/diagnosed, and we are, well, treating it. Interventions seems more appropriate since we are intervening in order to attempt to prevent the problem from occurring (or we are intervening to see if we can catch a problem before it becomes an emergency). It sometimes goes by another name: preventative medicine.

      Yes, sometimes the intervention and treatment are one in the same, but often intervening is simply monitoring and testing to identify issues that may need actual treatment. For example: A c-section is an intervention that is also treatment for many issues. EFM is an intervention that doesn’t actually treat anything, it just helps us identify problems that may then require treatment.

      I’m okay with the word interventions. We could simply call it “medical care” tho…. that would cover it.

      • The Bofa, Being of the Sofa
        May 28, 2014 at 3:37 pm #

        EFM is an intervention that doesn’t actually treat anything

        We’ve had this discussion before. I don’t even think EFM should be considered an “intervention.” It’s monitoring. It’s no more of an intervention than taking a blood pressure.

        • Amy M
          May 28, 2014 at 3:46 pm #

          I agree, but I think the hardcore NCBers view taking a blood pressure as an intervention.

          • me
            May 28, 2014 at 4:14 pm #

            True. But changing what we call it won’t change the view. I look at it this way: having your cholesterol checked is an intervention. Having a colonoscopy is an intervention. Having an HIV test is an intervention. Heck, stepping on a scale is an intervention. Some people will always avoid these things (denial? preferring to be left in the dark? thinking if they don’t know about it, it can’t hurt them? IDK, that’s above my pay grade). But most people understand that these sorts of interventions give them information that they can use to make logical, rational decisions that can help their health and happiness (often in major ways). They don’t regard these interventions as some horrible thing to be avoided at all costs. How it came to be that way in childbearing I don’t know. But calling prenatal care and the care one receives in L&D “treatment” may be more off-putting to many people.

            As a layperson, I never regarded my pregnancies as diseases or conditions requiring “treatment”. Quite the contrary, I took much better care of my pregnant self than I ever did before: I paid attention to nutrition, I exercised, I quit smoking, quit drinking, and cut my caffeine intake, I got more sleep, and drank more water. I felt fantastic. I was also very fortunate to have easy, comfortable pregnancies, free from complications. You would have been hard pressed to convince me that I was in need of medical “treatment”. Preventative care? Interventions? Sure. “Treatment”? For what, exactly?

            Now this is admittedly a naive way to look at it (my normal, happy pregnancy could have turned into a serious condition at any point), but being young, never having had any real medical issues prior, and being over the moon at the prospect of motherhood, well, I certainly felt like I didn’t have any disease or disorder. No, hardcore NCBers won’t want any medical care, no matter how basic and harmless. But suddenly calling things like cholesterol tests and HIV tests “treatment” makes no sense. We don’t need to change the English language to take the negativity away from the terminology.

          • The Bofa, Being of the Sofa
            May 28, 2014 at 4:15 pm #

            having your cholesterol checked is an intervention.

            Not according to the definition you provided above.

          • me
            May 28, 2014 at 4:20 pm #

            You now know your numbers. You can identify whether or not there is an issue that requires further intervention or possibly treatment. That improves your situation over being left in the dark. Is that not, in your opinion, an improvement?

          • Jessica S.
            May 28, 2014 at 5:19 pm #

            I understand what you’re saying about not wanting your pregnancy to be viewed as a disease or disorder. Someone here, on another post, used a phrase that stuck with me, (and I hope I’m remembering it right) about pregnancy being a normal condition to be in, but that’s it’s still an altered physiological state. So things are going to be done to you during pregnancy that wouldn’t be otherwise. That’s such an obvious statement it almost sounds patronizing, but I don’t mean it that way. 🙂

            I think Bofa’s use of “monitoring” to me is closest to what most of basic prenatal care is about. It may be a pain to do the screening or diagnostic tests (believe me, I just did the three-hour GD for the first time – didn’t have to do it with out first – even though my hunch and my doctor’s was that it was just another big baby, like my son. I was so peeved at first, but as I read up on GD and learned some about it here, I realized it was the wise choice – undiagnosed GD is not good for baby, or mom.) but it’s more a form of monitoring that intervention. The intervention is what you decide to do in light of the results of monitoring.

            Of course, it won’t matter much to NCB faithfuls what it’s called – they’ll say it’s unnecessary!

          • me
            May 28, 2014 at 6:02 pm #

            I didn’t find your comment patronizing at all. Yes things will be done during your pregnancy that wouldn’t be done otherwise. Those things are interventions. It’s not a four letter word. Interventions are not bad. They do run the risk of telling you stuff you might rather not hear, but it is always better to know (at least IMO). And, just like any other aspect of healthcare, if you feel all that strongly about a particular intervention, you can refuse it. There is no need to change the terminology tho.

            “Of course, it won’t matter much to NCB faithfuls what it’s called – they’ll say it’s unnecessary!”

            That’s kind of what I was getting at – calling it “treatment” when you aren’t actually treating anything is pointless. And would actually give the hard-core NCB’s more to wail about (“I’m not sick! I don’t need treatment!)…

          • Jessica S.
            May 28, 2014 at 9:10 pm #

            I see your point! 🙂

          • Amy M
            May 28, 2014 at 8:16 pm #

            See I required big time medical intervention to even get pregnant (IVF) and then went on to have a complicated pregnancy with a 4wk hospital stay before the babies were even born. Their birth was actually the most “normal” thing about it, though it was chock-full of medical interventions/treatments/whatever you want to call it. So from my point of view, pregnancy was a total freak state to be in, and you better believe I wanted any/all medical care necessary to see to it that my babies and I came through unscathed. So I guess my point is that personal semantics often comes down to individual experience.

          • me
            May 28, 2014 at 8:56 pm #

            I get what you’re saying. I guess I look at it this way: all treatments are “interventions” (actions taken to improve your situation) but not all interventions are “treatments”. Some interventions are tests or monitoring or screening. Some interventions are preventative medicine or precautions. And, of course, some are treatments.

            None of them are “good” or “bad”. They can give more information. They can enhance safety. They can fix problems. Changing the terminology and calling everything doctors or (real) midwives do “treatment” won’t change anything, in fact, it could make things worse. As I said, many (most?) healthy young women with uncomplicated pregnancies don’t regard themselves as someone with a disease or disorder that requires “treatment”.

            And interventions are important – those yearly tests you have give your HCPs a “baseline” and they can spot trends or sudden changes. The routine prenatal care does the same thing. A single BP reading isn’t particularly useful (unless it’s really out there in either direction). But seeing what’s normal for you and watching changes can reveal problems. Is there any “improvement” in your situation in finding out your GBS neg? I’d argue yes – if anything it gives you peace of mind that if you have a quick labor (not enough time for the abx) your child won’t be subjected to more invasive interventions (or be at risk).

            All I’m saying is interventions are not some scary thing to be afraid of. Maybe we need to start pointing out that these routine screenings ARE interventions, and they are nothing to get in a twist about. And like I said, if there is something you really don’t want done, you always have the option to refuse. You may not like the reaction, you may have to find a new provider (hey, vaccines are interventions, some peds won’t accept unvax kids), but you do have the right to refuse.

            Sorry if I’m rambling. I just see no point in calling something anything other than what it is. It just doesn’t seem helpful or productive.

          • SarahSD
            May 28, 2014 at 7:20 pm #

            Right – it counts as an intervention if you believe, as many NCBers do, that thoughts and feelings are part of a mysterious causal mechanism of labor. In this view, not only can the knowledge gained from monitoring lead to more interventive interventions (in a “cascade”), as well as the act of monitoring itself as an instance which might upset the laboring woman (leading to complications, leading to interventions). Nearly every problem can become the medical establishment’s fault.
            SarahSD (can’t sign in at the moment)

        • me
          May 28, 2014 at 3:57 pm #

          It is “intervening” in the sense that it wouldn’t happen if there wasn’t a medical provider there to do it. I’d say all prenatal care (everything from BP checks to urine checks to the GTT and ultrasounds) is “intervention”. By definition “interventions” are “actions taken to improve a situation”. They aren’t necessarily the same as “treatment” (tho there can be overlap, as I indicated above). Whether one chooses to “consider” it an intervention or not doesn’t really change the meaning of the word.

          Now, we definitely should work on making sure “intervention” is not a four letter word. I think part of that is pointing out that these things (EFM, checking BP, checking glucose levels) ARE interventions. Many women considering “intervention-free” childbirth would never consider “intervention-free” prenatal care: that would basically be no care whatsoever because prenatal care (routine prenatal care, that is) is by definition “intervention”.

          • The Bofa, Being of the Sofa
            May 28, 2014 at 4:14 pm #

            By definition “interventions” are “actions taken to improve a situation”

            But that just proves the point. EFM is not done to improve the situation. It is done to determine the state of the situation, to determine whether it needs to be improved or not.

            It is monitoring, or assessment. Intervention is the action in response to finding out that the situation needs improvement. Taking your temperature is not an intervention. Giving you an aspirin if you have a fever is.

          • me
            May 28, 2014 at 4:18 pm #

            Doesn’t monitoring improve the situation in that now we know (one way or the other) what’s going on? If the choice is monitor and know (or at least have a really good idea) vs don’t monitor and have no idea…. well, yeah, monitoring improves the situation.

            An aspirin is treatment for your headache. Taking your temperature to see if you also have a fever (which may be cause for more concern than simply having a headache) is intervention. Taking your temp doesn’t treat your fever (as aspirin treats your headache), but it does improve the situation – you now know whether or not there are other symptoms.

            Semantics, yes, but I love a good semantics argument 🙂

          • The Bofa, Being of the Sofa
            May 28, 2014 at 4:38 pm #

            Doesn’t monitoring improve the situation in that now we know

            Only if you act upon them.

            If I take your temperature and discover you have a fever, but do nothing about it, have I improved your situation at all?

          • me
            May 28, 2014 at 5:57 pm #

            Depends on if you find any value in knowing.

            Let me ask you this: Do you get your cholesterol checked every couple of years or so? Why/why not? If you do get tested, you must see some benefit in it, or you wouldn’t bother, right? Why waste your time and money getting tested, if you are see no benefit in knowing your stats?

            I suppose that, no, if you don’t intend on doing anything about a test result, there is little/no point (benefit/improvement for you situation) in taking the test. And maybe that’s why some people eschew medical care altogether. Just because some people choose not to act on negative test results by proceeding with further intervention and/or treatment doesn’t mean those tests are somehow not interventions.

          • fiftyfifty1
            May 28, 2014 at 10:06 pm #

            “Semantics, yes, but I love a good semantics argument :)”

            Medicine already has standardized terms for most of the ideas you are talking about. No need to argue semantics 🙂

            The reason you are taking the term “intervention” seriously is because NCB has intentionally created and propagated this terminology to demonize OB care. When ideas as different as screening, primary prevention and treatment all get collapsed under the term “interventions” it’s a sign that some Newspeak is going on.

          • me
            May 29, 2014 at 8:16 am #

            I see your point. At the same time the word intervention literally means “taking action(s) to improve one’s situation”. That’s not a bad thing (and certainly doesn’t deserve to be demonized).

            Let’s put it this way: All squares are rectangles, but not every rectangle is a square. Let’s suppose there is some radical group that has decided to demonize most rectangles; they think rectangles are bad and unnecessary, unless those rectangles also happen to be squares (and sometimes even then!). If we decide we are going to just start calling all rectangles squares, first we are being intellectually dishonest – not every rectangle is a square. Second, we are legitimizing the notion that rectangles that don’t happen to be squares are inherently “bad”. Let’s take back the rectangle. Let’s stand up for the poor, maligned rectangle. Let’s talk about how rectangles are important and helpful and useful *even if they don’t happen to be squares*. I know I wouldn’t want to live in a world without rectangles.

            Now replace “rectangles” with “interventions” and “squares” with “treatments” and you’ll see where I’m coming from 🙂

          • fiftyfifty1
            May 29, 2014 at 9:44 am #

            “the word intervention literally means “taking action(s) to improve one’s situation”. That’s not a bad thing (and certainly doesn’t deserve to be demonized).”

            Oh come now. As someone who claims to love a good semantics argument, surely you can do better than that.

            Yes, you Googled “intervention” and saw that one meaning was “taking action to improve ones situation”. But you must also have seen that that is not the only way the word is used. More commonly the word is used with a connotation of interference. For example Google example #1 and #2 are “They are plants that grow naturally without human intervention” and “The administration was reported to be considering military intervention”. Neither of those examples make an intervention sound very positive at all, do they? Intervention comes from the Latin word intervenire “to come between, interrupt”. Not very positive. NCB chose this word on purpose to replace other more benign words because it suited their agenda of making everything OBs do seem like an invasion or like being shoved off the path towards a natural utopian outcome.

            And then without thinking of how we have been manipulated, we sit around and discuss how yes we agree that screening for diabetes or monitoring of fetal wellbeing during labor are really “interventions” after all.

          • me
            May 29, 2014 at 2:10 pm #

            Before I had kids the word “intervention” meant trying to convince a loved one struggling with an addiction to get help. Not exactly negative. In fact, quite fitting with the definition I’ve been citing (I mean, we aren’t plants and we aren’t countries, are we?) – taking action (in this case, confronting) to try to improve someone’s situation (to convince that person to get help for their addiction) is a good thing.

            Yes, interference can sound negative. But it certainly doesn’t have to be. Especially when you look at the fact that the intention is to *improve* the situation.

            The medical definition (per Merriam Webster) specifically states that the goal of intervention is to “prevent harm or improve functioning”.

            So some women think about meddling mother-in-laws when they hear the word “intervention”… That doesn’t mean they are interpreting the word correctly when used in a medical context. I guess I go back to my original response to NoLongerCrunching and ask, why don’t we just call it “medical care”? That covers it, without any potentially negative connotation and without reducing ourselves to referring to rectangles as squares simply because some people don’t like the idea of rectangles.

          • fiftyfifty1
            May 29, 2014 at 3:02 pm #

            Do you seriously think that an addiction intervention has connotations that are anything other than rather grim? Sure, sign me up for that next weekend and cancel the picnic and the massage I had planned, an intervention sounds way more fun!

            You’ve fallen right into the hands of NCB by arguing that everything from blood pressure checks, to glucose checks to EFM are “interventions”. And now you try to say that the word has (or ought to have if you are “interpreting the word correctly”) a good connotation? Um no. Laughable.

          • me
            May 30, 2014 at 9:32 am #

            “Do you seriously think that an addiction intervention has connotations that are anything other than rather grim?”

            Of course it’s serious. Of course it’s grim. You are, quite literally, trying to help someone save their own life. Fun? No. But if one of your family members or close friends was in the midst of a horrible addiction and you were watching them go down that downward spiral, would you say, ‘gee that intervention thingy doesn’t sound like much fun, let’s plan a picnic or go for a mani-pedi instead!’

            And certainly the person being confronted won’t find it “fun”. In fact, they will likely see it as “interference” or “meddling” and may get quite enraged when they are confronted. But, if it works, and they do get help, it may well turn their whole life around, and that would certainly change the way they regard the intervention.

            “You’ve fallen right into the hands of NCB by arguing that everything from blood pressure checks, to glucose checks to EFM are “interventions”.”

            What are they then? Treatments (as was earlier proposed)? What do they treat, exactly? If you don’t think BP checks, GTT, and/or EFM improve one’s situation (IOW you think they have no benefits), why bother doing it? What would be the point? Shits and giggles? If they have no benefits and do not improve one’s situation, that renders them the much decried “unnecessary intervention” (you know, the type NCB advocates are actually opposed to, when you get down to brass tacks), and they become not only optional, but superfluous.

            Intervene comes from the Latin inter (between) + venire (to come). That’s it. To come between. Could be positive, could be negative, depending on the context and how one chooses to interpret it. The term medical intervention has an additional attribute of, not only “coming between”, but “for the purpose of preventing harm or improving functioning”. So, yes, that is a good connotation.

            As I mentioned above, if you start talking with NCB advocates about interventions, and point out that there are MANY safe, non-invasive interventions that provide tremendous benefit, that’s when they add the adjective “unnecessary”. It’s not that they think all intervention is bad, per se, they just oppose “unnecessary” ones. And that’s where it gets interesting. IDK about you, but most NCB advocates I’ve encountered are absolutely fanatical about vehicle restraints. They would prostitute themselves on a street corner in order to afford a car set that allows little precious to remain rear-facing until kindergarten and in a five point harness until 8th grade. They will downsize their home in order to afford a vehicle large enough to accommodate multiple behemoth car seats so all their little preciouses can be thus restrained. But using vehicle restraints is an intervention. And most often it is completely unnecessary. The trouble is, you only know it is necessary/unnecessary in retrospect. Much like childbirth interventions. The absolute risk of getting into an accident (and one serious enough for the restraints to even come into play) is extremely small for any given trip. Even one’s lifetime risk is fairly low. But dare suggest to a NCB advocate that forgoing the “unnecessary” interventions of childbirth is no different than being unrestrained in a vehicle. Good luck with that, lol.

            Anyway. I know this is long, but I do have a point. sure, there is negative connotation to the word “intervention”. We will simply have to agree to disagree on whether or not their SHOULD be a negative connotation. However, you seem to want to avoid the negative connotation by using a different word. Okay. “Treatment” is intellectually dishonest. Not all interventions are treatments. I think we’ve established that. “Medical care” (akin to calling rectangles “four sided polygons with four 90 degree angles”) is at least accurate. BUT (and you knew there was a “but”) it’s not the “intervention” they oppose. It’s the “unnecessary intervention” they oppose (never mind it’s only unnecessary in retrospect). So you will end up with a new term: Unnecessary medical care. Whatever you call it, if they think it’s unnecessary they will find a way to make it negative.

            A rose by any other name….

          • fiftyfifty1
            May 30, 2014 at 10:20 am #

            “A rose by any other name….”
            So now you are arguing that semantics DON’T matter? That’s a major about face for you. But okay, we all have the right to change our minds. I disagree though. And NCB certainly thinks semantics matter. Why else would they do things like rename labor pains “surges”? I suspect for the same reason that they have renamed “monitoring” with a word that means “come between”.

          • me
            May 30, 2014 at 10:36 am #

            I said I enjoy arguing semantics. I also said that no matter what you call it, the hardcore NCBer will find a way to twist it and make it negative (just as you pointed out, they will find a way to twist/rename other things to suit their own beliefs). Those are not mutually exclusive statements.

            And they could just as easily rename monitoring that they don’t want/agree with “unnecessary monitoring” with the same result as calling all forms of monitoring, screening, testing, prevention, precaution, and treatment that they don’t want/agree with “unnecessary interventions”.

            Trouble is, they are, strictly speaking, correct. The term “unnecessary” aside, all those things ARE “interventions”. And trying to deny that makes one look rather foolish. Those actions certainly meet the definition of the word. What needs to change is the perception. To intervene (to come between) could be negative (I’m coming between you and your much desired Jamaican vacation). Or it could be positive (I’m coming between you and that hungry bear over there). Medical providers believe (and rightfully so) that they are coming between women and ‘hungry bears’. The NCB advocates think medical providers are coming between women and ‘Jamaican vacations’. That’s where the disconnect lies. Instead of changing the terminology (which won’t work anyway, not with people so bent on bastardizing the terminology to suit their own needs) focus on getting women to understand that it is the hungry bear, not the doctor, who doesn’t care about their plans for a Jamaican vacation.

            How best to do that? I wish I knew. Seems similar to the challenge in changing perceptions on cesarean births. A difficult, uphill battle, to be sure. But one worth trying.

          • me
            May 30, 2014 at 11:24 am #

            Wanted to add a thought – you say we should call things like BP checks, GTT, and EFM “monitoring”. Okay. But as someone who seems desperate to avoid any terminology with a negative connotation, how wise do you think it is to call those things “monitoring”? There term monitoring has negative connotation:

            The government has been monitoring our phone calls.

            My creepy next door neighbor is monitoring my comings and goings.

            My abusive boyfriend monitors my facebook page.

            Do any of those statements give you the warm fuzzies? Not me.

          • Young CC Prof
            May 30, 2014 at 11:27 am #

            But a computer has a monitor, and I like computers, so it must be a good word.

          • me
            May 30, 2014 at 2:13 pm #


          • Stacy48918
            May 30, 2014 at 11:40 am #

            Oh good grief.

            So now we have to find a term with no negative connotations?

            There are diagnostics, monitoring and treatment. When I check a dystocic bitch’s calcium that’s a diagnostic not an “intervention”. When I give her calcium gluconate that’s a treatment. When I recheck the fetal HR that’s monitoring.

            Its no different in human medicine except that NCB types have their own word. Those of us actually practicing medicine don’t use that term. You have been misled.

          • me
            May 30, 2014 at 2:12 pm #

            “Oh good grief.

            So now we have to find a term with no negative connotations?”

            My thoughts exactly!

            “Those of us actually practicing medicine don’t use that term. You have been misled.”

            No one in medicine uses the term “intervention”? Interesting…

            Then why does a quick google scholar search of “childbirth interventions” reveal over 82000 results (okay some of them aren’t actual medical journals, but many are)? Why does a search of “medical interventions” give over 2 million results?

            Cuz no one practicing medicine has evah used that word. The NCBers made it up dammit! (despite the fact that it is derived from Latin – a language spoken long before there was any sort of NCB “movement” and became part of the English language in the early 15th Century, again long before the NCB movement came into being, but hey, who needs pesky facts right?)

          • fiftyfifty1
            May 30, 2014 at 11:57 am #

            No, only EFM is monitoring. BP checks and GTT are screening. Or if you don’t want to use medical terminology at all you can say “checking” as in “We are checking to make sure your blood pressure is nice and low” or “Let’s check to make sure you don’t have diabetes”.

          • me
            May 30, 2014 at 2:15 pm #

            Okay. I totally agree with you. They are not, however “treatments”, correct? You could collectively call them interventions, or medical care, or health care, or you could avoid grouping them at all and refer to each category by its own unique subset. But they still aren’t “treatments”. That was kinda my point.

            I’m glad we agree.

  21. Amy Tuteur, MD
    May 28, 2014 at 1:05 pm #

    Milli Hill responds:

    • Renee
      May 28, 2014 at 1:26 pm #

      I hope she reads this-
      Milli Hill- Quit making a straw man, no one ever said the only thing that matters is a healthy baby. I find it ridiculous that the culture of NCB even plays this game with experience, when they spend all of their time working to deflect and deny moms choices that are not in line with their ideologies. From accessible pain relief in labor, to “social” induction and Maternal request CS, you can be sure your NCM MW will not respect your needs. They don’t see those things as a need, so you aren’t allowed to either.
      So, quit it. Just, quit it.

      My OBs cared more about my wishes and my comfort than any NCB MW ever would. Just do this little experiment and see what you think would happen- Mom wants a MRCS, and is healthy enough that this is medically acceptable. What do you think the NCB crowd and an “normal birth” worshipping MW would do? I know what my OB did- they went over all the possible consequences, gave me informed consent, and let MW choose what to do.
      NCB MWs are always delaying pain relief, downplaying moms complaints, and basically ignoring anything that doesn’t fit into their paradigm of “natural vaginal unmedicated, birth”.

      GUESS WHAT? MOST MOMS DO NOT WANT AN NCB! When epidurals are easily accessible, most want them. So you are doing everyone a great disservice, and causing much PTSD, by denying pain relief or pushing it off until its too late.

    • LibrarianSarah
      May 28, 2014 at 1:31 pm #

      I wouldn’t call that a “response.” It’s more of a “I know that you are but what am I.”

      • Young CC Prof
        May 28, 2014 at 2:00 pm #

        Yeah, I’m disappointed. I was hoping for an actual counterpoint, that would have been interesting.

        • Karen in SC
          May 28, 2014 at 2:09 pm #

          Come on CCP, there’s never an “actual counterpoint.” I can’t remember any at all. Can you?

    • Carrie Looney
      May 28, 2014 at 1:43 pm #

      Way to 100% avoid actually addressing said criticisms.

  22. attitude devant
    May 28, 2014 at 12:24 pm #

    An old motto for the American College of Obstetricians and Gynecologists was “Childbirth in Safety with Dignity.” That always summed it up for me.

    • moto_librarian
      May 28, 2014 at 2:23 pm #

      Why did they change the motto? This strikes me as exactly the right thing!

      • May 28, 2014 at 2:45 pm #

        I’m guessing because ACOG is about more than just childbirth now…

    • araikwao
      May 28, 2014 at 5:00 pm #

      Oh wow, that summarises exactly why (I think) I want to do obstetrics!

  23. Ellen Mary
    May 28, 2014 at 12:12 pm #

    Listening to women is crucial, but don’t assume they all want an Epidural. When I arrived at the hospital, I was tired & after arranging childcare & being hooked up to the monitors I wanted a nap on the monitors before getting down to business. I was convinced to start low dose Pit & told I could sleep through that. I think we all know I could not. So I will always wonder a little bit how things would have gone if I had just been listened to . . .

    • attitude devant
      May 28, 2014 at 12:23 pm #

      No offense or anything, Ellen Mary, but “a nap on the monitors”? What does that even mean? I recently had a woman stave off starting pitocin at 8 cm for eight hours (I only wish I were kidding!) so it’s not like I’m a clock watcher, but if you wanted a nap maybe you could have dropped the kids off wherever they were going and taken one before coming to the hospital? No offense or anything, but if you were not in active why did you even go in?

      • Ellen Mary
        May 28, 2014 at 12:26 pm #

        I went in because my water had been broken for nearly 12 hours. I had been contracting every 5 minutes for up to a minute during the night (hence no sleep) before I had to arrange childcare & pack. I was at 2 cm. Maybe I should not have gone in? I had never had my water break prior to onset before so I went in because I was worried about the baby.

        • Ellen Mary
          May 28, 2014 at 12:29 pm #

          And I would not have been able to sleep off the monitors, because I would have stayed awake doing kick counts?

          • attitude devant
            May 28, 2014 at 1:31 pm #

            As a former very tired mommy, I understand. Yes, you were right to go in. (but I still think they were right to encourage you to get your labor started.

          • Jessica S.
            May 28, 2014 at 5:27 pm #

            Yeah, b/c if I recall correctly, isn’t there a time frame of sorts from when your water breaks? I vaguely remember the doctors saying something about 18 hours or a day or something. Or maybe they were saying 24hr limit on Pitocin? Both may be true.

          • Busbus
            May 29, 2014 at 12:52 am #

            I have a question about pit and pain. I’m not trying to discount anyone’s experience. I do wonder, though, of there is any actual research on if contractions are more painful with pit than without? It seems to me that there could be two reasons for this belief that actually have nothing to do with the pit.
            First, with the pit, the contractions speed up and you become more dilated – as you would have anyway (hopefully), eventually. Stronger, more advanced labor = more pain. But, given that it starts after the pit was given, it could seem that they pit is at fault, when in fact it’s just further advanced labor. My non-pit labor certainly hurt more at 4 cm than at 2, and a hell of a lot more at 8 cm, and, unimaginably, even worse at 10 and during pushing.
            Second, it could be that women with obstructed labor are in more pain, and also are more likely to need pitocin.

            Does anybody know if there is research on this?

          • staceyjw
            May 29, 2014 at 3:22 am #

            I don’t know about research but here is a theory I heard (don’t know if there is anything behind it).

            You are likely to be having no, few, or ineffective, contractions, or weaker, irregular and erratic ones, if you need pit. These are not as painful as the effective ones that you will get with the pit.

            I do think it may make them more intense, but I am not sure if this is true, or happens all the time.

          • me
            May 29, 2014 at 9:34 am #

            I only have my own n=3 study 😉 But I did find my induced labor far more painful at a much earlier stage. At 3 cm I was experiencing a level of pain that I did not experience until transition in my spontaneous labors. I think part of it is the lack of a gradual build-up. With my unmed labors the ctx started slowly and built up, sometimes even easing up/backing off at points before progressing. Kind of like the difference between jumping into a body of cold water all at once vs wading in slowly. It’s not that the water is any colder, but having that time to adjust to it was helpful in my perception of the pain. Pushing was just as painful all three times, despite an epidural with the induction and no epidurals with the subsequent deliveries (I think I got a bum epidural).

          • Jessica S.
            May 29, 2014 at 9:08 pm #

            I’ve only had the one labor experience so far (and expecting to skip it entirely this time, since baby 2.0 is already a giant like her brother was!), but I don’t remember when they started the Pitocin – if it was before or after my epidural. So I’m a lousy case study. But one thing I do remember was how I was still able to feel the contractions, by the end of the day (they started the pit in the AM).

        • attitude devant
          May 28, 2014 at 12:39 pm #

          Oh I see. I’m afraid I would’ve encouraged the pit too. 12 hours ruptured, a multip, and still not progressing in spite of regular contractions: that’s what pit is made for. I’m all for seeing if labor ensues, but labor was not ensuing.

        • Renee
          May 28, 2014 at 1:28 pm #

          No, you did the right thing.
          And the doc also did the right thing getting you on the pit.
          Sometimes we just do not get what we want.

    • Isramommy
      May 28, 2014 at 1:28 pm #

      Well, if you had accepted some form of pain relief you certainly could’ve gotten some rest.

      • Ellen Mary
        May 28, 2014 at 3:39 pm #

        I accepted (nay demanded) pain relief . . . Later when my baby had responded poorly to Ctx & I was told I wouldn’t be getting out of bed. It was super great, but not better than having a labor out of bed.

    • Mac Sherbert
      May 28, 2014 at 1:49 pm #

      I guess it depends on how you respond to the Pit…it didn’t do much for me!

      I went in right away after my water broke because I was already at 3cm and the baby was high…They let me rest all night about 8 hours after which they really really encouraged me to start the Pic. So, I don’t think it’s unusual that after 12 hours they were anxious for your labor to progress.

      I certainly understand about wanting to sleep. I couldn’t sleep because of the monitors and finally just asked the nurse to give me something to help me sleep!

    • yentavegan
      May 28, 2014 at 3:02 pm #

      Please Don’t beat yourself up for listening to the doctors about starting Pit. You had already been in labor for 12 plus hours and the contractions had hit a glitch. The Pit drip was given to get the contractions coordinated, not to bring pain or to rush things along.

  24. lola
    May 28, 2014 at 12:11 pm #

    I think this message definitely bears repeating. I’ve never been judged so harshly, both online and in real life as when I’ve shared that I had a maternal request c-section. As an experiment, I even emailed Offbeat Mama (I think it’s Offbeat Families now), and asked if they would accept a birth story contribution about someone who had a maternal request c-section, and it was denied. When it was pointed out that they had no positive c-section stories, the replied that they did – and shared links where having a c-section was a tragedy on level of the baby dying. I think more people need to hear the message in the above blog post.

    • Jacob Wrestled (Danielle G.)
      May 28, 2014 at 12:16 pm #

      Given the fact that many women have c-sections, it’s a travesty that it is an unspoken rule that women cannot discuss their positive experiences, and not invite ridicule. At most, you’re allowed to say, “I had one, it was medically necessary, and it wasn’t too bad.”

      • Paloma
        May 28, 2014 at 3:35 pm #

        One of the beauty bloggers I follow just had an elective C-section and did a blogpost on her experience, which was incredibly positive. She got SO much hate for speaking out, it was outraging. Little by little, hopefully things will start to change 🙂

        • The Bofa, Being of the Sofa
          May 28, 2014 at 3:46 pm #

          The most important thing for people to do is to keep telling their stories. The hate that shows up in these cases is not very becoming, and really reveals the dark side of the movement.

          • Paloma
            May 29, 2014 at 1:23 pm #

            Really I think the whole NCB idea is disrespectful to mothers, especially to adoptive mothers. Are you really telling me that a mother who hasn’t carried their child (and obviously, no passing through her vagina) is less of a mother? Really, it’s incredible not that many people speak up and say how ridiculous it is to claim something even remotely close to that.

          • An Actual Attorney
            May 29, 2014 at 10:44 pm #

            And to lesbian mothers. My wife is as much a mother as I am. I gestated the Actual Kid. Totally irrelevant to his relationship with either of us.

            But I see this is sooooo much of the mainstream mommy culture. Even people who would swear to you up and down that they are gay-positive. If kiddo didn’t come out of your cooch, you don’t belong.

        • Jessica S.
          May 28, 2014 at 5:30 pm #

          It blows my mind, really, how pervasive is the idea that a baby should come from a vagina unless mom or baby is in a life-threatening situation. And in that case, you better damn well feel sad that your vagina failed you!!

        • Carrie Looney
          May 28, 2014 at 10:55 pm #


          • Paloma
            May 29, 2014 at 1:14 am #

            http://www.thesmallthingsblog.com/2013/12/his-arrival-what-c-section-is-like-and/ Most of the negative comments have gone away now (thankfully) and a lot of people have shown support, but in the beginning it was so sad to see those people questioning everything!

          • R T
            May 29, 2014 at 2:46 am #

            She said the baby was breech. That’s not a maternal requested elective csection. It was a medically indicated csection for a breech position!

          • The Bofa, Being of the Sofa
            May 29, 2014 at 9:19 am #

            Oh, but don’t you know? You can have a vaginal breech delivery!

            To which I say, I know. My MIL had two of them (my wife was her only baby that wasn’t breech). And you know what she says? IT WAS AWFUL!!!!!! Don’t do it!!!!!

            So when our first was breech, my wife jumped at the chance to have a c-section. She would not have tried a VB even if the doctor would have offered.

          • Mac Sherbert
            May 29, 2014 at 5:08 pm #

            Exactly Bofa!! Just because something can be done doesn’t mean it should or that it is preferable.

            My MIL also had a breech baby. Her first (early only 5 lbs.) and they both almost died. She says her two other births of 9 and 10 lbs. were much easier.

            So many of the older women I’ve talked to that delivered breech babies say it was awful. My neighbor said she begged for a c-section, but was told by the nurse that they didn’t do those for convenience. Not only that they often talk about how the babies are beat up. One lady my husband works with was told not to hold her baby for a week due to the bruising (a footling breech)!

          • Paloma
            May 29, 2014 at 11:51 am #

            It was an elective, since it was programmed and planned (not urgent). I never said it was maternal request 🙂

          • R T
            May 29, 2014 at 8:01 pm #

            I still don’t think that would be listed as an elective csection. It’s near impossible to find an OB who would be willing to attend a breech vaginal birth in the US! It’s not elective if it’s medically indicated.

          • Paloma
            May 30, 2014 at 1:11 am #

            In my hospital it would. Electives are those that are programmed, whatever the indication might be, and urgent is the one that is performed on the spot, whatever the indication might be. Even if it technically is the same procedure the don’t go exactly the same, since in one you can take your time and the other one tends to be rushed. I don’t know whether this is considered like that in the US, but in my hospital we use it to differentiate urgent vs programmed. For example, a breech birth that comes in on the programmed day and has a c-section performed is elective, but a breech that comes in because the started labour (who also gets a c-section) would be urgent. Type of procedure is one thing, medical indication for the procedure is another (at least for my hospital).

    • May 28, 2014 at 2:49 pm #

      This needs to change – thank-you for trying to contribute to the change that needs to happen. It’s not an easy road.

  25. Amy M
    May 28, 2014 at 12:05 pm #

    Hill said it herself: “Respect, consent, choice, dignity – all that matters too.” I don’t think anyone here would disagree with that, as long as safety is taken into account first. People who are actively fighting the Creeping Woo maybe can use Hill’s very words against her and her ilk.

    If all Hill and co care about are unmedicated vaginal births, then they should just say so, like this: “A healthy baby is not all that matters. That a mother gives birth without pain relief or medical intervention is of the utmost importance (to us) and we will do our damnedest to convince everyone of that, because if we say it enough, maybe it will be true. For women who will have no other achievements other than what orifice their children emerged from, and how much they can martyr themselves in raising said children, this is paramount.”

    Of course those of us in the real world recognize that a healthy baby AND a healthy mother–which includes mental health, are the most important things. To achieve those ends, safe obstetric practices that are done with informed consent, respect, dignity and as much choice as possible are the way to go.

  26. Elizabeth Yirak
    May 28, 2014 at 12:01 pm #

    Thank you for this. My first birth went horribly different from what I had planned and I felt so guilty for failing to have the perfect birth I’d been told I had to have. I’ve had people shame me for not trying hard enough to avoid a c-section and not trying hard enough to have a VBAC. I’ve been shamed for being unable to breastfeed. The people who shame are the same ones who claim that they only want women to have a wonderful experience. How is shaming them for how they birthed their children going to make us want to know their way of doing things? Thankfully, it was this shaming that pushed me away from the woo 🙂

  27. Are you nuts
    May 28, 2014 at 12:01 pm #

    Here are my childbirth priorities:
    1. Healthy baby
    Distant but still very important 2. A pelvic floor that works
    Distant but less important 3. A pleasant birth experience (whatever that means)

    • Young CC Prof
      May 28, 2014 at 12:13 pm #

      Also, on the pleasant experience chart, I would note that being seriously afraid for your life or the child’s life, or being utterly overwhelmed by pain with no opportunity for pain relief, or something else that might cause PTSD is a different sort of bad experience than, say, the lights being too bright, or not having a window in your hospital room, or one provider being rude.

    • Amy M
      May 28, 2014 at 12:23 pm #

      I would say the birth of my children was fairly pleasant, at least up to the pushing phase. I wasn’t in excruciating pain for a while, so after initial check in, my husband and I were largely left alone, to hang out. We talked, I tried to rest some. When they wanted to intervene some, it was very clearly explained to me and I was given time to decide what I wanted to do (pit augmentation or Csection.) When the pain increased, I asked for an epidural and was promptly given it. The vast majority of the labor was pretty boring, just waiting around to dilate.

      Pushing sucked, even with an epidural, it hurt, but I imagine it would have been much worse wo/one. Overall, I was respected and treated kindly and with dignity. I don’t think I could have asked for more, all things considered.

      • Are you nuts
        May 28, 2014 at 1:18 pm #

        I just realized “whatever that means” sounds sort of sarcastic and it’s not meant to. Just an acknowledgement that there are many ways to have a pleasant birth experience in my book. Maybe it’s natural labor that’s “not that bad,” or an epidural that lets me sleep for a few hours, or a non-emergency c-section that goes well.

        • Amy M
          May 28, 2014 at 2:14 pm #

          I didn’t see it as sarcastic at all! I saw it as subjective, and put what it means to me. 🙂

  28. Irène Delse
    May 28, 2014 at 11:57 am #

    Even if homebirth really guaranteed a better experience, it’s disingenuous to say “a healthy baby is not all that matters” when the safety record of homebirth is so bad. It seems to imply that the difference in safety for the baby is small enough to be offset by the added convenience, and that homebirth has no added risk for mothers. But that’s simply not true. Before emphasizing the supposed psychological benefits of what they sell, they might try and work on making it safer for both their clients and the clients’ babies. At least that would be the responsible thing to do.

  29. May 28, 2014 at 11:48 am #

    To respect women is to respect their right to make a medical decision and their right to adequate and unbiased information with respect to that decision. Bravo – well written. Of note, of those who truly seem to get “birth trauma”, as opposed to those wanting to profit from it – they take a similar stance to what you have taken here.

  30. May 28, 2014 at 11:44 am #

    This choice, respect and dignity line is bullshit unless it also respects women who chose pain relief, interventions and c-sections. Bravo, Dr. Amy.

    • The Bofa, Being of the Sofa
      May 28, 2014 at 11:59 am #

      As someone very wise has said many times, “Empowerment is manifested in the ability to make choices, in not in the choices that made.”

    • Renee
      May 28, 2014 at 1:31 pm #

      Don’t ya know that they ONLY moms that deserve choice, respect and dignity are those that want an NCB and are willing to die trying?

  31. moto_librarian
    May 28, 2014 at 11:19 am #

    You know who did not (and still does not) want to hear about how I felt about my first birth experience? Natural childbirth advocates. If you stray from the narrative in which unmedicated vaginal birth is an empowering, transcendent experience, there is no place for your feelings about your birth. I have been told that my complications were not life threatening ( they were), that I would not have died if I had been at home (I would not have survived transport at the rate I was losing blood), that my failure to prepare adequately caused me to have so much pain, etc. In other words, everything about my experience has been devalued by this group of people. The hypocrisy is astounding.

    • Mac Sherbert
      May 28, 2014 at 11:31 am #

      It is like they lack the ability to understand that your experience and someone else’s experience may not be the same. They can’t seem to understand that the way one person experiences pain is different from someone else.

      For example, when I was in labor my nurse had to do a procedure. The entire time she apologized I’m so sorry, etc. I didn’t find it to be that bad, but she informed me most women cried. Later my OB came in to check me. She later apologized because she thought I had an epidural when I didn’t. “You acted like you had an epidural.”

      Now just because I could be at 5 cm and 80% effaced with little pain doesn’t mean I discount the agonizing pain my best friend said she had at 2 cm. Actually, whenever she tells me about how painful it was and that she didn’t get her epidural until she was about to deliver I get really angry. I don’t say well you know there is no way you were hurting that bad because it wasn’t that way for me.

      • Anj Fabian
        May 28, 2014 at 11:45 am #

        My experience was like the chest waxing scene from The 40 Year Old Virgin.

        warning, pain, cursing, apology

        Plus the scene may have a lot in common with childbirth in general…

        • MaineJen
          May 28, 2014 at 4:54 pm #

          If I am ever in labor again (not likely) I’m going to scream “Kelly Clarkson!!” and see who gets it. 🙂

          • Happy Sheep
            May 28, 2014 at 6:35 pm #

            I actually said that during early labor with my second
            My husband and the student nurse laughed, the head nurse just looked at me, which made it funnier.

      • Renee
        May 28, 2014 at 1:37 pm #

        It’s not that they lack the ability to know people experience things differently, its that they simply don’t think any other experience is worthy of consideration. They have a preconceived notion of what childbirth ought to be like, and anything out of that is inferior, even awful. NCB is a very limited worldview.

      • araikwao
        May 28, 2014 at 5:14 pm #

        …yes, and presumably you don’t also consider yourself superior and stronger for not being in agony at the same point your friend was. NCB is just one giant attribution error: “things went well for me because of my inherent awesomeness, and badly for you because you are not awesome/educated/prepared”. Nothing to do with luck of the draw, or variation between individual experiences.

        • Mac Sherbert
          May 28, 2014 at 7:14 pm #

          Hardly superior…I went on to need to need a c-section and she managed a VB. (sarcasm)

          And you are quiet right it’s the attitude of superiority that really irks me about NCB.

    • Jacob Wrestled (Danielle G.)
      May 28, 2014 at 12:00 pm #

      Both sides sometimes shame women for making choices that reflect their feelings, philosophies, and perceived needs. But the natural childbirth camp are the pros at this activity. They view natural childbirth as inherently empowering, and so make the mistake of thinking that they can speak for what women “need” and would want, if only they were enlightened. So in trying to empower women, they just co-opt everyone’s voices and experience.

      Two anecdotes that illustrate this point:

      When I asked my OB about some aspect of pain management, my lead in made it sound a bit like I wanted to go natural. Her response to this was to grab a stool, sit down, give me eye contact, and prepare to listen to what I was about to say.

      When my husband mentioned to a coworker, whose wife teachers natural childbirth classes, that we were planning to request an epidural for me, said, “Well, that’s a fine option if you want to poison your baby!” (My husband was tired of statements like that by this late point, and replied with, “Sir, we believe in science in our house!” HA!)

      Guess who I found more pressuring? These are just anecdotes of course, but they do illustrate a trend I perceived for natural childbirth people always to bypass what made me feel safe or happy for an argument than ran, “But your baby will be healthier if you forgo pain relief. You DO want a healthy baby, don’t you?”

      • Amy M
        May 28, 2014 at 12:13 pm #

        The thing is, childbirth as an activity, isn’t really empowering. What power does it bestow? It may make a woman FEEL powerful because she did something physically difficult, but she has no more power at the end than she did at the beginning, unless you count the power of being a parent over a child. Which the father has now too, only he didn’t have to go through childbirth to get it.

        Getting the right to vote is empowering, because now the new voter has a voice where she didn’t previously, and she was entirely dependent on the voices of others. If anything, a woman is fairly DISempowered during childbirth, since she can’t do much…if she was at home and the house started burning down, she would barely have the power to get herself out, let alone help anyone else…she becomes pretty much entirely dependent on whatever care provider/s are around.

        I think a lot of these NCB women do not know what “empowerment” actually means.

        • The Bofa, Being of the Sofa
          May 28, 2014 at 12:55 pm #

          If anything, a woman is fairly DISempowered during childbirth, since she can’t do much..

          One of the things that caught my eye in the statement was about they wanted to “be in control.”

          It seems to me that the things that can be controlled are things like, when to go into labour, if it is done early, and pain management. But once things get going, how much control does anyone really have?

          “Let’s quit this shit and do a c-section” is control. “I’ll just wait it out and try to push through it” is not controlling anything.

          • Jacob Wrestled (Danielle G.)
            May 28, 2014 at 1:52 pm #

            Yes. Natural childbirth provides “control” in the sense that it purports to remove doctors and hospitals [NCB translation: men and institutions] from room, and includes mothers and “sympathetic women.” Secondarily, we might say that it focuses on the laboring mother’s ability to facilitate the birth and manage her own pain.

            Without that narrative, all you get is a woman alone with some other women, trying to succeed at self-hypnosis.

        • Jessica S.
          May 28, 2014 at 5:36 pm #

          This is TOTALLY my personal feelings, which I admit are probably in the minority of women who have

          • InvisibleDragon
            May 28, 2014 at 8:13 pm #

            I understand entirely; the feeling of being hijacked. That would be why I only have one. Heh. “Squatter.” Wish I’d thought of that.

          • Jessica S.
            May 28, 2014 at 9:16 pm #

            I also like to describe a rainy day stuck inside with my 3.5 year old as a hostage situation involving terrorists. Or one very small terrorist. 😉

          • InvisibleDragon
            May 29, 2014 at 11:47 am #

            Aw, crumbs. I missed that one too. Altho, I do refer to picking up a package at the post office as a “hostage situation”.

          • Amy M
            May 28, 2014 at 8:25 pm #

            I’ve only been pregnant once, and it was interesting, but then got wicked uncomfortable by the 3rd trimester. Then downright scary as well as boring, as my squatters attempted break out early a few times, landing me in the hospital for several weeks. (Scary=worrying about preemies, Boring=literally seeing the same 4 walls for 4wks, mostly by myself as everyone else had life to get on with). Definitely one advantage of having twins—I don’t have to go through pregnancy again, already got the 2 kids we wanted. But I don’t think it is at all unusual to hate being pregnant….I know plenty of women who were puking throughout, or had some other issue that made them thankful when it was over and they had the baby safe and sound and OUT.

          • Jessica S.
            May 28, 2014 at 9:15 pm #

            I don’t know if I could handle being in the hospital for 4 weeks, but then again, if it were for my baby (or babies, in your case!) I guess I’d suck it up. But I’d complain royally the whole time to my poor husband. 😉

          • Amy M
            May 29, 2014 at 8:50 am #

            Ha! I did my share of complaining. I kept a livejournal at the time and when I could get online (it was very spotty), I would update my friends, and entertain myself by coming up with a new synonym for “jail” every time. So I had posts from the pokey, the clink, etc. I considered scratching a tally on the wall, but I didn’t want to deface hospital property.

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