Apparently her patients are happy and the births she works on have good health outcomes. Nonetheless, the hospital pressured her to more than double her rate of c-sections. LAmom has the story.
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June 25th, 2005 at 10:44 am
“the main concern reiterated several times was an overall practice attitude rather than any individual case.”?
Of course. They can’t deal with it on an individual basis, because that would require forcing ten percent of her patients to get C-sections. She should’ve sent these people her case list (identifying info deleted) and asked them to tell her which of them should have gotten C-sections. Thing is, they HAVE to deal with it on an individual basis in order to be fair, because that’s how she does things. SHE doesn’t take patients in 20 at a time and say, “Now I’m going to look at all your medical information, and the four with the most risk will have C-sections.” She deals with them qualitatively, not quantitatively, and so should the hospital. Her patients happen to have a lower rate of C-sections because fewer of them need C-sections, and she does not share other doctors’ deplorable habit of doing C-sections because it’s more convenient for THEM.
This has all the logic of a police department being sued for sex discrimination because all the rape cases under investigation are cases of women being raped. Or a complaint that Pepsi-Co does not serve enough Coca-Cola drinkers. Or a teacher giving an F to a student with a score of 90% because it was the lowest score in the class. Or someone saying that politically conservative women don’t account for enough of abortions.
This woman is a specialist. People come to her because they DON’T want C-sections. It is pure, malevolent stupidity to try to make all groups of life conform to average percentages. A group of honors students does not fit a standard bell curve. A group of women who really want to give birth naturally, and want it enough to seek out a specialist, do not fit the standard community who want a live baby and don’t care as much how it gets there.
This comment was written by Kyra.Report this comment to the moderators
June 25th, 2005 at 11:50 am
C-sections are more profitable for all concerned.
This makes me wonder what the critics’ motivation is here.
This comment was written by Susan.Report this comment to the moderators
June 25th, 2005 at 2:13 pm
Did y’all read the entire story?
This comment was written by mythago.Report this comment to the moderators
June 25th, 2005 at 4:19 pm
Amp,
What the hospital is telling the MD is to not keep her C/S rate artificially low (based on personal philosophy) in a high risk population. It’s not so much that the hospital cares about/objects to the MD’s philosophy; their main concern is exposure to lawsuits.
This comment was written by ema.Report this comment to the moderators
June 25th, 2005 at 5:13 pm
I’m not about to jump on a bandwagon to support this md either without knowing some facts, which I probably will never know unless I study obstetrics. I’m skittish of natural birth at almost all costs- a silly philosophy when we consider that so many women used to die in childbirth, and still do. To say an old phrase differently than it’s usually said- women have been dying in childbirth for centuries. We’re lucky that we don’t risk our lives with every pregnancy anymore and I think that natural childbirth extremists forget that sometimes. I can think of about a dozen women who would probably be dead now if it weren’t for doctors who intervened “unaturally”.
This comment was written by Elena.Report this comment to the moderators
June 25th, 2005 at 5:24 pm
No-one is arguing that intervention where it is medically necessary should be prevented. Intervention, when not necessary, for profit, out of ignorance or so we don’t miss the golf club dinner is less easy to justify.
Dr Sandland would be very welcome in the UK where all and sundry are trying to get our rate of C-sections DOWN!
Major surgery, with its attendant risks, and premature delivery of an infant less than fully developed are not things any sane person would advise just because “we have the technology”.
This comment was written by maureen.Report this comment to the moderators
June 25th, 2005 at 7:27 pm
I’m rather skepticle of c-section needs in the US as well. At this point c-section is used almost as a ‘get ‘er done’ option, and many women aren’t aware that if they accept it the first go around, chances are they will be forced from there on out. In my case I was given the ‘choice’ for this pregnancy to either accept c-section (prior to any physical examination even), or potentially not be covered if I try for v-bac. It’s big business, after all. Given the multi-thousand dollar difference between a c-section delivery and a natural one, I think doctors are a bit too eager to go down that road, and wanting to pawn it off on potential lawsuits.
This comment was written by Kim (basement variety!).Report this comment to the moderators
June 25th, 2005 at 8:12 pm
Ema- What’s your basis for calling this doctor’s patients a ‘high risk population’? Surely if that were the issue, she would have been warned about particular ‘high-risk’ patients for whom vaginal delivery was inappropriate. Given that the instruction was to raise her c-sec percentage generally, rather than with reference to ‘high-risk’ patients, I really don’t believe that this is an issue.
Mythago- What, in your reading, is in the whole story that would change anyone’s reading of the situation? I’ve read the whole thing and I can’t figure it out.
This comment was written by LizardBreath.Report this comment to the moderators
June 25th, 2005 at 8:29 pm
As one who has delivered around 6,000 babies, I’d like to make a few point.
1. We get paid around $1,800 for 9 months of care and a vaginal delivery… $2,100 if it is a c-section. (not enough to fuel the profit motive theory)
2. If a doc gets sued, the hospital ALWAYS gets sued with them because they have deeper pockets and have the duty the insure that docs aren’t doing weird things.
3. There is a direct cause/effect between malpractice lawsuits and
c-section rates. If you ever have a bad baby…. they lawyers always claim “things would have only been different if only the doctor had preformed a c-section sooner”.
4. VBAC’s will becomes a historical footnote due to malpractice.
5. Six countries now allow for elective c-section as part of their national health insurance benefits.
well……. that’s enough for now
This comment was written by Doktor.Report this comment to the moderators
June 25th, 2005 at 9:14 pm
Doktor,
Thanks for chiming in, it’s interesting to hear from someone with a different perspective. I can’t say, however, that I agree with the practice of forced vbac without even so much as a medical examination. Statistics that I’ve read give a 70% success rate of normal vaginal birth, post c-section, with the rest, barring extremely rare problems being normal c-section deliveries. I don’t think that the risk of malpractice, if the statistics I’ve read are a good rule of thumb, is enough to warrant cutting a person open versus at the very least attempting a vaginal birth.
I -definitely- can see, and agree with a need for more caution to be exercised with vbac; hospital delivery, shorter labor allowance and planned c-section if upon thorough examination the need for c-section can be pre-established as a medical condition, beyond that of ’she’s had one before’.
It’s a very frustrating thing as a grown woman to have what in essence is economics determine whether I will have to go under anesthesia and cut open, versus have a chance at what most likely would be a normal, healthy vaginal delivery.
This comment was written by Kim (basement variety!).Report this comment to the moderators
June 26th, 2005 at 9:02 am
Greed might not be motivating doctors, but the article pretty much says it is motivating hospitals:
Other times, especially when the unit was overrun with laboring moms, she said, there was pressure from department heads to speed up labor or consider a c-section.
“Quite a lot of c-sections are being done for so-called failure to progress,”? Dr. Sandland said. “If you haven’t progressed in a couple of hours, a c-section’s waiting. There’s certainly a pressure to keep patients moving on through.”?
And why do you want them to keep “moving on through”? Because you need to keep the fancy OB ward, which you have been enticing pregnant women to use (in competition with other hospitals, birthing centers and midwives in the area), by advertising that they can have the “birthing experience they choose”, full.
That letter they sent to Dr. Sandland is a joke. She is delivering babies with a birth weight “above average.” (!) Undoubtedly the reason the birth weights are “above average” has to do with the fact that Sandland rarely induces labor and allows babies to be warn when they are ready, as opposed to scheduling them around her golf games and vacations and weekends, for that matter. Ditto as to the gestational ages being “above average.” The reason birthweights and gestational ages average as they do is that doctor almost routinely induce pregnant women, artificially lowering the “average” birth weight and gestational age.
Sorry, Elena, but I can’t agree that there are all of these women who would be dead without doctors helping them deliver. Women say this about their labors and deliveries quite often because of the traumas which result from having been (usually unnecessarily) induced and from having their labors and deliveries mismanaged in all sorts of ways. Then once the doctors and staff people have created the emergency, women are frightened into having c-sections, told they are in danger, their babies are in danger. Well, yeah, this may be true, but it is danger the hospital staff itself has put them in! I could tell countless numbers of stories of botched labors and deliveries which put the lives of women and their babies at risk or which killed them.
Women didn’t die by the droves in times past because they needed the help of doctors and the medical establishment. They died because they were in poor health to begin with, because they birthed in unsanitary conditions, because they developed infections. In this day and age, women are more likely to *encounter* unsanitary conditions and to develop infections when they birth in hospitals than in their own homes! Actually, they have been more likely to die of infections for this reason in the past as well. Thousands of women died from childbed fever, for example, in the 1800s and before because doctors didn’t know they had to wash their hands between deliveries, or, say, after they touched someone who was really sick or dead and before they strolled in to deliver a baby.
I know of nobody who is “pressured” to have natural births by anybody, but I know of many, many, many women who have been pressured to birth in hospitals, pressured to allow their labors to be induced, pressured to have episiotomies, pressured to have anesthetic, pressured to allow all sorts of procedures to be done to themselves and their babies. The women who birthed with Dr. Sandland undoubtedly chose her, more often than not, because they wanted both the experience of a midwife-attended birth (as Sandland says, she wanted to be a midwife with an “MD” after her name, go HER) and the safety of a hospital setting. Now they will have neither thanks to a male-dominated patriarchal birthing establishment which cares first and foremost about covering its ass and making sure its own policies are honored.
Women who want a woman-centered birthing experience ought to do what I and thousands and millions of other women have done for millennia with great success: they ought to birth at home with midwives. I hope Sandland continues to practice as a midwife, sets up her own birthing center, continues to make the health and well-being of her pregnant patients and their babies her highest priority, and I hope she writes about her experience, that it gets a lot of publicity, and that increased pressure is brought to bear on hospitals and doctors for their anti-woman practices and procedures.
Heart
This comment was written by Cheryl Lindsey Seelhoff.http://www.gentlespirit.com/margins
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June 26th, 2005 at 9:31 am
One more thing. Mythago was probably making reference to mothers requesting c-sections. Number one, it’s unlikely mothers interested in Dr. Sandland attending their birth would be all about c-sections. Number two, we need to go a little bit deeper, yanno. The reason a lot of pregnant mothers request c-sections is, they are really scared of the pain of labor and delivery. And why are they scared? Because they hear so many women tell about their horrendous labor and delivery experiences, most of which were made horrendous by doctors. And most of which began with the really *bad* decision to induce labor in a woman. Induction is a HUGE problem. First of all, induced labors are really, really painful labors, far more painful than labors which come on in their own good time. Second of all, induced labors often go on and on and on and on interminably, because how much medicine to be given to any individual woman is always a crap shoot, so the doctors give not so much and the labor goes on and on, and the woman gets exhausted, and then either she is begging for a c-section because of weariness and pain or she is bumping up against hospital rules about duration of labor. OR the doctors administer TOO much medicine in the course of induction and the woman is IMMEDIATELy vaulted into extreme pain and dangerously powerful, uncontrollable uterine contractions (with the risk that the uterus can even be ruptured). So then she might be given medications to *slow down* her labor (!) because it is dangerous and risky, so now after all that pain she’s back to a lot of pain but not unbearable pain, and this time it goes on and on, so HELL yeah, bring on the c-section. Not to mention in all of this inducing effort the doctors and nurses are creating all sorts of high drama via endless monitoring of both the baby and the mom and she is on the edge of the labor bed in fear wondering, is the heartbeat okay, is the baby okay, why did they say that, what does that mean.
So yeah. That’s traumatic. That is a horrible, painful birth experience and mothers can believe they “almost died,” or they “would have died.” And they come out of the hospital needing to talk about it and women here that stuff and they think, “Fuck this, I’m having a c-section!” And who can blame them!
When the reality is, you know what? Birth can, does and most often will occur peacefully and beautifully and pleasurably as a continuation of the process which began right where the birth takes place: in a woman’s own bed, in her own room, in her own home. With her partner right there holding her. And a midwife who really is most interested in supporting her. Pregnancy is not a disease any more than menstruating every month is a disease. Birth is not a medical crisis; it is the culmination of the work a woman’s body has been doing in creating a child. Really, the treatment of pregnant and laboring woman in the United States is a horror story, despite how hard feminists have worked to change things.
Heart
This comment was written by Cheryl Lindsey Seelhoff.Report this comment to the moderators
June 27th, 2005 at 6:33 am
The notion that 40 weeks is the duration of a normal pregnancy is backed up by no more studies than the notion that a person’s normal temperature is 98.6 F or 37 C — which is to say, exactly one study. I am currently pg (7 months minus a few days) and I participate in pg chat boards and am shocked at the number of babies who are “taken” between 36 and 39 weeks — in order to avoid what risk I can’t even begin to imagine. So the “average” age at which birth is taking place is probably even earlier than 40 weeks — no wonder Dr. Sandman’s babies are bigger!
I was “threatened” with induction with my second child (that’s about what it amounted to) if I went more than 2 days late and my OB prophylactically called a perinatologist to back him up so I couldn’t disagree (and spoke to my husband the entire time I was there in order to get him to pressure me as well). I went into labor normally anyway, and they still “enhanced” with the same drug used to induce, and everything said about induction is absolutely true. It makes the experience miserable, even the l&d nurse told me that. So of course you need an epidural. Which means you can’t move around or push as effectively. So of course you are likely to push for longer and end up needing forceps. It’s so predicable that I can’t blame women for staying at home and waiting until they are practically crowning to come to the hospital.
And oh yeah, I did a VBAC. It even included pitocin. And here I am to talk about it. VBACs are unsafe if a hospital isn’t committed to making them safe. That about sums it up, along with everything else: how can the hospital cut its costs and still delude women into thinking that they are looking out for their best interests. Usually, it’s by offering them “nicely appointed luxurious” birthing suites. However, that’s just a smokescreen. The real answer is, they aren’t. Not by a long shot. The c-section rate went up way before the so-called “malpractice crisis.” That too is a bogus explanation.
This comment was written by Barbara.Report this comment to the moderators
June 27th, 2005 at 6:56 am
Heart & Barbara: YIKES!! What terrifying information, but so good that you’re passing it on as it’s vital for women to know these things.
Thanks.
This comment was written by Crys T.Report this comment to the moderators
June 27th, 2005 at 7:59 am
How fast things change! My best friend nearly died 8 years ago because the hospital was pressuring the doctors to “go natural”, and now a doctor who has a high natural birth ratio is being pressured to do more C-sections.
I think modern medicine has done a lot to make childbirth overall safer for women and babies, but there is still risk involved. (I’m sure the OBs out there will concur.) The insurance companies are the villains here, and the doctors don’t have much of a leg to stand on because they need to be insured to keep practicing medicine. Which is why there is such a shortage of OB/GYNs in some areas, and why there is starting to be a shortage of pediatricians, too.
This comment was written by Lee.Report this comment to the moderators
June 27th, 2005 at 8:14 am
Lee, your friend might nearly have died from a VBAC but the overall incidence of complications from VBACs is less than from cesareans. The complication rate for VBAC is higher than it needs to be because of the other types of interventions that are being done — in particular, induction via pitocin and cervical ripening. There is simply no philosophy of “leaving well enough alone” in the world of mainstream obstetrics. Here is a summary of the evidence:
“The majority of studies report that in the rare event of a uterine rupture, if the labor was carefully monitored, the birth attendant was trained to attend VBAC births, and if the medical response was rapid, mothers and babies do well. The focus should be on improving the quality of care for women who want a VBAC, not on discouraging them because of negative outcomes publicized in high profile medical malpractice law suits.
“The Society of Obstetricians and Gynaecologists state that “maternal uterine rupture with haemorrhage and fetal compromise, or even death, occurs with an incidence of 0.1percent [1/1000].” In other words 1 per 1,000 uterine ruptures, not 1 per 1000 trials of labor.
“In a recent Swiss study of 17,613 planned hospital VBACs, the uterine rupture rate was .40% (4/1000). There were no maternal deaths, and 5 babies died as a direct result of a uterine rupture.
“The same study compared outcomes for women who planned an elective repeat cesarean and women who planned a VBAC. The rate of uterine rupture was 0.40%for planned VBACs and 0.32% for planned elective repeat operations. However, all other maternal and newborn complications (hysterectomy, complications from blood clots, infections, and neonatal transfer to ICU) were higher for women who had an elective repeat cesarean.
“Dr. Bruce L. Flamm, an eminent researcher on VBACs cautioned that if US physicians were to discourage women from planning VBACs and to adopt a policy of elective repeat cesareans, it “would mean performing an additional 100,000 cesareans every year. It is unlikely this huge number of operations could be performed without many serious complications and perhaps even some maternal deaths.”
The link, a little dated, is here: http://www.abcbirth.com/hVBAC.html
This comment was written by Barbara.Report this comment to the moderators
June 27th, 2005 at 9:26 am
I would heartily *disagree* that modern medicine has made birth safer for women and their babies. What has made birth safer for women and their babies is women steadfastly resisting the intrusions and interventions of modern medicine, demanding the right to birth in their own way, and holding modern medicine’s feet to the fire with respect to the way it has violated pregnant and birthing women in an ongoing way for centuries. What has made birth safer for women and their babies is women educating ourselves about pregnancy and birth and about our own overall health. The risks doctors insure themselves against are far and away risks which are the creation of male-centered medicine.
Heart
This comment was written by Cheryl Lindsey Seelhoff.Report this comment to the moderators
June 27th, 2005 at 9:56 am
Modern medicine has made SOME births safer. Those for which c-section is clearly needed — where the head cannot fit through the pelvis, for instance. Some (but not all) breech births are much more difficult and dangerous without c-section. But there are hospital practices that are unsafe and not conducive to a faster, less complicated birth experience:
1. No eating and drinking allowed (makes you dehydrated and exhausted and unable to participate as effectively).
2. Giving IVs (especially in advance of an epidural, where they force it in, or because you’re not allowed to eat and drink!) (can raise blood pressure and dilute electrolytes and various other complications)
3. Requiring a so-called lithotomy position for delivery, for convenience of the doctor (This, as well as other “anti-gravity” measures (like requiring a woman to lie in bed) prolongs labor by working against gravity and makes it impossible to push effectively and leads to an increased incidence of forceps birth)
4. Episiotomy (greatly increases the number of postnatal sexual and urinary complications due to scarring and related issues)
5. Induction (doesn’t work well if less than 2cm dilated, which leads to protracted, ineffective and extremely painful labor)
This comment was written by Barbara.Report this comment to the moderators
June 27th, 2005 at 11:03 am
Barbara, my friend did not have a VBAC. This was with her first pregnancy and her first child. The baby’s position was not optimal (it was breech), plus the head looked a little large to pass through the pelvis when they did a detailed sonogram, so the doctor wanted to do a C-section. However, when the doctor did whatever it was she had to do to get the operating room prepped for a non-emergency C-section, the word came back that a C-section was not medically necessary and the doctor should proceed with a vaginal delivery. After about 3 more hours of labor, the doctor tried again, but was told that my friend needed to have been in labor for 36 hours before they would consider allowing a non-emergency C-section. During this entire time, unbeknownst to the doctor, my friend had developed a small tear in the placenta, which was quietly bleeding away. It was not until my friend’s vitals started ringing alarm bells that they were able to rush her in to surgery.
I agree that hospitals are not automatically superior places to give birth, but already being in the hospital when things start to go wrong is usually way better than not being there.
This comment was written by Lee.Report this comment to the moderators
June 27th, 2005 at 11:43 am
Cheryl:
I don’t buy it that you have never known anyone to be pressured into natural birth. Just about all women in this country who try to educate themselves a little about giving birth are pressured into doing it without any relief for the pain and many are made to feel like failures if they do take something for pain or end up having c-sections. My friend just had a baby and was extremely dissapointed at not having a “positive birth experience” because she had an emergency c-section. I told her she was a hero, and she was. There was all this dogma at her “birthing center” that tainted her son’s birth.
You’ll all excuse me for actually diferring to the expertise of obstetricians. I know enough about pregnancy and labor of my dogs to know that it is indeed a dangerous and vulnerable time, and there’s no way in heck anyone will ever convince me that having a baby at home is the safest way or pleasurable (like labor pains are “discomfort”?). I understand that midwives are in the habit of sending high risk pregnancies to the hospital, confirmed by the article that appeared in salon a few weeks ago. The pregnant woman ended up in the hospital because she couldn’t deal with the jumpy midwife who had to abdicate quickly to all signs of possible problems because she wasn’t prepared to deal with them herself. The same article implied that midwives success rate has to t
This comment was written by Elena.Report this comment to the moderators
June 27th, 2005 at 11:45 am
Argh, I think I need to avoid this thread. These are issues I try to put in the back of my head because I currently am ‘that woman’. The one being forced into c-section regardless of my body. The most offensive day for me in my pregnancy thus far was getting the phonecall, prior to any physical examination (just the urine test confirming my pregnancy) by one of the office managers saying I needed to agree to c-section before they would even start my prenatal care.
*sigh* so…….stressful…… :(
This comment was written by Kim (basement variety!).Report this comment to the moderators
June 27th, 2005 at 12:01 pm
Kim, it doesn’t matter what you agreed to. You can revoke your agreement once you start labor. There’s not a damn thing they can do to you legally and they sure as hell can’t abandon you.
Elena, I was extremely disappointed that I had a c-section with my first daughter and it wasn’t because I was brainwashed by natural childbirth advocates. It’s natural to be disappointed even if you know, rationally, that a c-section was necessary (as I did, and I immediately agreed to it). I subsequently had a vaginal delivery (f’ed up as it was see above post) and there is nothing like it. Your friend’s feelings are valid and they shouldn’t be pooh poohed or blamed on overzealous childbirth coaches. One of the reasons these people may seem to be so strident is because they know what they are up against in the way of nurses and doctors who start trying to strong arm you into accepting all kinds of intervention as soon as you walk in the door. You have to be pretty tough and committed to resist.
This comment was written by Barbara.Report this comment to the moderators
June 27th, 2005 at 12:03 pm
Barbara;
They aren’t letting me get to labor. We have to pre-schedule a c-section date, so I don’t accidentally go into labor.
This comment was written by Kim (basement variety!).Report this comment to the moderators
June 27th, 2005 at 12:15 pm
Kim, I think it’s a no-win for you, unless you manage to switch doctors. But since it’s likely the insurance company that’s forcing the whole C-section decision, changing doctors might not fix things, either.
A close friend with 4 kids kept trying to have her children by vaginal delivery, and every single time she ended up having a C-section. Her first child was breech and she was in the military at the time, so hello, C-section! She felt very frustrated that with each subsequent kid, the doctors would all tell her, “Oh yes, VBAC, no problem!” and then whisk her off to the operating room when she showed up in labor. So at least your doctor is being up front with you!
This comment was written by Lee.Report this comment to the moderators
June 27th, 2005 at 12:51 pm
Kim, I assume from what you say that you’ve had a previous C-section? Is there any chance of finding a doctor who’ll support a vaginal birth for you? I have a friend who pretty much lost her chance to have a VBAC because the hospital she was delivering at didn’t have an anaesthesiologist available 24/7.
This comment was written by Ledasmom.Believe me, doctors can be jerky even about non-VBAC births if they disagree with your choices. My (back-up) obstetrician dropped me during my last pregnancy because I was planning a homebirth and wouldn’t have the dating ultrasound (there was literally one day that I could have gotten pregnant. Can’t date much better than that).
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June 27th, 2005 at 12:58 pm
Kim, I would try to switch doctors. Let me put this as gently as possible. A doctor who bases treatment on predetermined ideas that advance his benefit rather than yours isn’t really “treating” YOU, and whatever personal connection you have formed isn’t really that significant. He is engaging in paint by numbers medicine and if there is an alternative I would try to find it. It may not be possible. But you can always reassure yourself that you tried.
And no, to whoever said it above, health insurance companies are not pushing this, not by a longshot.
This comment was written by Barbara.Report this comment to the moderators
June 27th, 2005 at 3:44 pm
If a woman wants a C-section and knows both the risks and benefits, to her and/or to the baby, she deserves to be able to have one.
And has anyone else noticed the all-natural obsession? No preservatices in drinks, even though you really can’t taste the difference? Pianos made entirely out of high quality wood despite the fact that wood shifts according to the season, thereore making the pianos difficult to tune? Alternatice medicine that has not been proven because of the belief that because it is natural, it can’t hurt you? (Don’t get me wrong. I strongly support alternative adn traditional medicine alike. Anything that WORKS.) In other words, everything that is natural is better than anything “unnatural.”
But let’s not forget that everything at the very core is natural. Everything is made up of all the basic NATURAL elements.
Even more to the point, arsenic is natural, too. But it sure as hell aint any good for you.
Just thought I’d throw that in.
This comment was written by Lucio.Report this comment to the moderators
June 28th, 2005 at 8:51 am
I agree, and probably so does everyone else here.
What this thread is about, however, is the completely opposite case; hospitals in effect trying to force unneeded c-sections on women who don’t want one. As I’m sure you agree, women should have their choice respected in either direction. Right?
This comment was written by Ampersand.Report this comment to the moderators
June 28th, 2005 at 8:52 am
Barbara, I was the one who mentioned the insurance companies. It’s not just certain close-minded doctors who discourage VBACs, it’s also the the health insurance companies and, more importantly, the malpractice insurance companies. If either the health insurance company or the doctor’s malpractice insurance company says that they will not cover VBACs, the doctor who is willing to assist a patient who wants a VBAC has to choose between being covered in case of a lawsuit or not. The ob/gyn practice I use asks patients choosing VBACs to sign a liability waiver statement; this may not be an option in some states.
This comment was written by Lee.Report this comment to the moderators
June 28th, 2005 at 9:02 am
Lucio, there are many times has a seemingly harmless intervention turned out in fact to be harmful. Most doctors won’t approve of things like dying one’s hair, taking various types of medication (including that which is clearly needed) during pregnancy, yet they endorse all of their own interventions without too much thought.
So the desire for “natural” childbirth is an acknowledgement of several important principles: First, doctors don’t really know to what extent all of these drugs affect babies. It’s probably not that much, but all interventions carry risks, and if you don’t need it you shouldn’t accept the risk associated with it.
Second, it’s a shift in –yes, let’s just say it — the power between the birthing woman and the doctor, an acknowledgement that nature designed MOST women to be capable of experiencing childbirth without all kinds of surgically and medically based interventions. I don’t give a rat’s ass if that makes OBs feel useless during most births, or even worse, if it means that they can’t have the kinds of fun that doctors have when they use needles, knives and other medical gizmos.
Lee, provide just one example of a health or malpractice insurer that is insisting that a physician not provide a VBAC. I am not saying you are wrong but I work with these insurers day in and day out and I don’t know of any.
This comment was written by Barbara.Report this comment to the moderators
June 28th, 2005 at 9:11 am
P.S. The real catalyst for the “no VBAC” movement was the updated ACOG guidelines that require hospitals to have 24/7 anesthesia coverage in order for VBACs to be considered safe. Most of the horror stories occur in facilities that aren’t able to get an anesthetist in to help quickly enough. I happen to think that this is probably a sign that there are lots of other types of care that are provided at a substandard level of care (God forbid that you would have a traumatic injury requiring urgent surgery at such a facility) but it’s a bigger problem for pregnant women because they are more numerous. Most of these hospitals are either rural or smaller community facilities, although the attitude appears to be spreading.
This comment was written by Barbara.Report this comment to the moderators
June 28th, 2005 at 9:58 am
Barbara, I can’t list specific companies because I never needed VBAC myself, I just know what my ob/gyn practice does and the reason for it they gave me. It could be that the ACOG guidelines are the real reason and they just thought it was simpler to say it was the insurance companies.
This comment was written by Lee.Report this comment to the moderators
June 28th, 2005 at 11:06 am
I am disgusted by the anti-doctor bias on this thread. If I were to believe everything written here, I’d believe doctors and nurses were out to hurt me and my baby all because that way they get more money, or else get to go golfing sooner. Or something else- how do these anti-obstetric people explain their belief that medical professionals have bad intentions? The irony is that the natural birth movement or whatever it calls itself is just as full of bullies and prejudice as they accuse the medical profession of being. Now it’s not enough to give birth in extreme pain without relief, you have to do it without a doctor, no backup and at home. Otherwise, you’ve bought into the medical profession’s pack of lies. Motherhood as martyrdom, indeed.
I am all for educating oneself about childbirth, and for taking a little control, but advocating for patients to distrust their doctors is disastrous. It is also unethical, in my opinion.
This comment was written by Elena.Report this comment to the moderators
June 28th, 2005 at 11:21 am
Elena, I do trust my doctors and I sincerely believe that they (there are two) believe that they are doing their best. However, there are too many studies that show that there are many routine obstetric and obstetric related practices that are not only not evidence-based, but that are actually contradicted by evidence based studies. To list a few: routine episiotomy (a form of genital mutilation that becomes apparent if you’ve had one); no eating and drinking during labor on the off chance you might need general anesthesia; and the notion that c-sections are “safe enough” which is equated with being as safe as vaginal birth. Other risks are downplayed (like the risks and consequences of epidural and induction). You can be as disgusted as you want to be but there is no reason why women should not be aware that many standard obstetric practices are questionable. If that’s viewed as anti-doctor bias then so be it.
This comment was written by Barbara.Report this comment to the moderators
June 28th, 2005 at 11:22 am
Thank you, Elena. It also is insulting to women who had c-sections as a medical necessity, and Cheryl, if you are going to make claims about modern medicine being “anti-woman” or not working to prolong and enrichen the lives of many, many people, please provide some statistical backup to show how quality (modern medicine) health-care has increased pre-natal or post-natal death, or made women’s lives worse.
Of course I agree that no woman should be forced to have section against her will, but the attitude “you must have a baby via natural means instead of c-section, or else you aren’t as mother as the mothers who go through vaginal birth” is bigoted. Besides, the “natural” argument kind of sucks. Humans are part of nature by virtue of being biological organisms, so please drop the “but’s that not natural!” arguments. Human nature is to be inventive and think up new solutions.
This comment was written by Tuomas.Report this comment to the moderators
June 28th, 2005 at 11:32 am
Vaginal birth, btw, is safer on the average, but in some cases c-section is simply better and safer. And yes, women do die on complications arising during child-birth, if it is a safe, wonderful experience for many it doen’t mean that it is the best, or even viable option for some women.
It does seem, though, that american hospitals are unnecessarily pushing for more c-sections, for unmedical reasons. This is far from good medicine or scientific, rational approach. What needs to be done is evaluate women on invidual basis taking into account the differences between inviduals.
This comment was written by Tuomas.Report this comment to the moderators
June 28th, 2005 at 11:47 am
Ampersand,
No woman should be forced to have a C-section.
Bean,
And show me just how drink preservatives are so unhealthy that do drink them is a wish to die. Show me that by attacking someone who had done nothing to harm you that you are so much more in the right than I am.
I rest my case. Thank you for proving my point.
This comment was written by Lucio.Report this comment to the moderators
June 28th, 2005 at 12:22 pm
Tuomas, basically I agree with you, but if you look at what happened to medical care from the 1950s forward until women began demanding better treatment, I think it is possible to make an argument that medical care was, if not anti-female, suffused with with the arrogant belief that medically imposed procedures were in almost all cases superior to natural processes. Women were actively discouraged from breastfeeding (my mother and my mother-in-law, who gave birth in two very different places in the country, are both adamant that this was in fact the case). Women were in some cases actually strapped to delivery tables and forced to lie down. Husbands and any other personal helper were banished from the delivery room. Babies were not permitted to room with their mothers.
And finally, they were and in some places are still routinely subject to episiotomies on the theory that a “natural” tear would always be worse than a surgical cut. Can you imagine an entire profession ignoring study after study showing that a surgical incision with a high risk of sexual and urinary dysfunction was almost always unnecessary if the recipients of the incision were male? What does that say about the value placed on female sexuality?
So, yes, the situation has improved considerably since the early 1970s, when women basically rebelled. But all too often, the changes have been cosmetic only — the nicely appointed birthing suite — while there is still a core belief that medical intervention is best in spite of evidence to the contrary.
P.S. I had a c-section because my baby needed for me to have one done. I would have smacked anyone who tried to make me feel guilty. But that doesn’t mean doctors don’t have a responsibility to ensure that interventions are necessary, even if no woman should be made to feel guilty for accepting an intervention that was portrayed as necessary, falsely or not.
This comment was written by Barbara.Report this comment to the moderators
June 28th, 2005 at 12:39 pm
Frankly, I won’t listen to anyone talk to me about the evils of the mecical profession. I have a chronic illness, and by that time two years ago, which changed my life, I had kept it a secret for almost two years. By that time, my condition was one of the most severe that my doctor had ever seen. They promoted a “less invasive” meothd of treating me, but also, they gave me the option of surgery, which was likely to be “more efective,” i.e. faster, and continue with medication after that. That was all they said. No one told me, “Have surgery or you will never be treated.” Nor did they throw the “natural-ness” of the former option in my face. I loved my doctor and regret never having had the chance just to thank him.
I chose the surgery. Iwas thirteen at the time-yes, I will be sixteen in Sept.-moving on with a busy life, in constant pain, and was simply not going to put up with that crap anymore. Besides, I had already tried numerous “less invasive strategies,” and they didn’t work as well as I wanted them to. I have NO PROBLEM with anyone who chose to go that course, but it just wasn’t right for me. But I know someone who thought it was-and she was my mother. She was so angry that I had not gone with the “better” option that she refused to speak to me the day of my sugery and for some time the next day. I had “shamed” her. Now, I have to take the birth control pill to avoid having periods because they make me sick. Plus, I just find them inconvenient, and I don’t want to get pregnant, thank you very much, but that is not the point. So please do not bash me for thinking my menses is a disease, because in my case, it is.
Personally, I can’t wait to have a hysterectomy, and some other changes, because I am transgender. Am I less supportive of the rights on women because I don’t entirely want to be one?
Once again, don’t get me wrong. Every woman has the right to decide how, when, and where she delivers, to have medical staff that support her, to be informed and given a balanced view, and so forth. We all have that right in whatever health care we get. I commend those who support that. What infuriates me is those comments by people who pass judgment on those who, for whatever reason, chose not to take the “natural” route with out knowing about their situation, and shooting their mouths off about the people who refuse to promote only those interventions that fir within their “natural” doctrine.
As for the actual story, like Elena, I refuse to comment abotu this M.D. or her situation, because I simply do not have all the facts, and lately, I have become so distrustful of most of my news-some of which are actually propaganda-sources that being informed has become that much harder.
This comment was written by Lucio.Report this comment to the moderators
June 28th, 2005 at 1:04 pm
Interesting to come back to this today. I don’t think anyone is pressing for no c-sections at all, but come on, are you folks saying you don’t believe me when I talk about the phone call I received? Are you saying that is responsible medicine that is respectful of women? It’s a reality for me three months from now, and it’s frightening and overwhelming in the sense that my medical choices are so out of my hands.
Because I don’t want to have more stress, I’ve chosen the path of least resistance, but I did attempt to put up a struggle in the beginning to basically no avail. They said they would send me off with a recommendation of VBAC performers, which are few and far between in Portland. It also would likely affect my insurance because prior to ANY PHYSICAL CONSULTATION AT ALL THEY WERE STATING I NEEDED SURGERY. Their diagnosis was based on the fact that I had a c-section with my first daughter.
So anyways, excuse my lack of complete confidence that the Doctors only have MY CHILD AND MY BEST INTERESTS at heart. This is why I need to avoid this thread.
This comment was written by Kim (basement variety!).Report this comment to the moderators
June 28th, 2005 at 1:08 pm
You’re transgender, and you still see no reason to be a little, I dunno, wary of the medical profession? None whatsoever? No problem with people like John Money, say? No problem with the earlier versions of the HBSOC, or with the current one? Never encountered a therapist, counsellor, doctor, or surgeon who sees a transgender patient as a collection of stereotypes and nothing else? Never been billed, but not treated? Never been excluded from demographic healthcare? Never been treated to negligence, ignorance, or heuristic bullshit from a healthcare-provider? Never had trouble getting a gynecological exam or STD test? Never had a doctor insist–just to take a common example–that every ftm absolutely must have a hysterectomy at the earliest possible opportunity?
Wow. Lucky you.
This comment was written by piny.Report this comment to the moderators
June 28th, 2005 at 1:21 pm
Piny, I’m fifteen, not even out yet, and nowhere near the gay community. (That is rural America for you.) Not to mention that the scenario I was discussing doesn’t so much as creep into that issue. So, actually, yes, I have no problems. And did I ever once say that there is nothing wrong with some aspects and definitely a few more people within the medical profession? Read the next to last paragraph. No, I did not say anything of the sort, and I would appreciate it if you did not treat me in such a condscending manner that you think I am just stupid and unaware of the issues with my own community and self and that I am simply laissez-faire when in comes to action.
This comment was written by Lucio.Report this comment to the moderators
June 28th, 2005 at 1:26 pm
Kim,
This comment was written by Lucio.If you want a VBAC, then have one. Do you feel in danger by not having a C-section? Is VBAC really what you want? Do you have the means and support to change doctors or maybe put up just a little more of a fight? You should! Most of the medical profession, I think, is a real blessing. I have never once-yet-encountered an asshole doctor, except for this one whoel clinic that refused anyone under the age of 18 to be alone in frigging doctor’s office to talk to the nurse. I lied to the nurse that day, because my mom was in the room and I did not trust her.
But that is not what this is about. I just don’t think it would be wise for ANYONE to push away possible allies-in traditional or alternative medicine. If it works, or feels good, do it.
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June 28th, 2005 at 1:59 pm
Lucio,
Piny is your community. He speaks from experience, not patronization. As for ‘just have it’, it’s not as easy as all that. It’s expensive (additional costs due to additional caution), and my insurance is Oregon Health Plan because I’m a student. You’re viewing this from a limited perspective of not dealing with beauracracy, as well as disregarding the fact that stress and a huge all out battle and worries over money is the last thing that a pregnant woman wants to have facing them down 3 months prior to delivery.
And while I appreciate your contribution to the thread, and I know you’re going to hate hearing it, your 15 years ‘never once yet encountered’ analogy is lacking in practical experience both overall, and economically. People aren’t pushing away allies, but instead questioning motives, and this is an absolutely legitimate thing, and I can tell you that from first hand knowledge and experience in this particular topic.
Barbara;
You suggested I consider trying to push harder for VBAC as well - I had considered it - went through a few months of agonizing the decision and then realised that due to me being high risk for c-section anyways my health and the babies health would be far better off with me accepting the situation and not letting this stress play a huge factor through the pregnancy which could cause problems of its own. I weighed my options and came up with this decision for a few reasons: 1) my mother and grandmother both had c-sections at a time when they were less common 2) I’ve had a c-section before 3) I have an anterior placenta with this baby which at times can end up blocking the birth canal.
I can say that it’s definitely colored my view of the birthing process and business though.
This comment was written by Kim (basement variety!).Report this comment to the moderators
June 28th, 2005 at 2:06 pm
Why you had a c-section previously says alot about whether you’ll need one again, and if it’s likely you’ll end up having a c-section anyway, then you are almost certainly making the right decision. There’s never any way to know for sure and you shouldn’t beat yourself up about it or carry added stress that you definitely don’t need.
This comment was written by Barbara.Report this comment to the moderators
June 28th, 2005 at 2:07 pm
Piny,
I am sorry about that last comment. I should not have said anything without really knowing.
And Kim,
No, I do not hate hearing that I have limited life experience in some areas. I know that I do, and I just have to say I am damn lucky that I live in a state as great as New Hampshire. Plus, the last thing I wanted to do was attack anyone who did have a sucky doctor. But I do think that there are some, as Elena said, “natural childbirth extremists” here on this blog that I really wonder about.
Ot maybe I just misunderstood some of the people’s posts here. If so, sorry for that, too.
This comment was written by Lucio.Report this comment to the moderators
June 28th, 2005 at 2:16 pm
This thread is full of women who have said, “I was forced into a surgical procedure I did not want which may not have been necessary,” and some women who have said, “I was forced into a surgical procedure I did not want which was almost certainly not necessary,” and many, many other woman who have said, “I have encountered a great deal of pressure to undergo this surgical procedure I don’t want regardless of its necessity.” And then, of course, there’s the story of the doctor who was fired for having lower c-section rates, with no attention paid to the health of the mothers in her care.
So, yes, coming onto this thread and acting as though the people commenting about fear, mistrust, and episiotomy studies have some spurious blame-the-evil-doctors hair up their butts is indicative of some pretty serious bias and lack of awareness.
These women are not a bunch of orthorexic hippies with a fear of sterile needles. Technology is not the problem, nor is it what anti-unnecessary-c-section people are afraid of. Nor is this an issue of a few bad apples, individual doctors who insist on c-sections for a few patients who don’t need them. It’s an industry-wide problem, involving institutional pressure on most if not all women, that has resulted in a higher likelihood of c-sections for all women. “The medical profession,” in other words, does not refer to physicians as opposed to osteopaths, or to obstetricians as opposed to midwives. It refers to the professional conflict of interest between treating individual patients well and upholding a generalized, profit-driven standard that cheats them.
You will encounter this conflict as you transition and as you live your life as someone with a new medical condition–your available treatment options are affected by it, the information that informs your choices is affected by it, and the doctors who treat you will be no less vulnerable to it. Of course this doesn’t mean that milk thistle is a substitute for regular blood tests, any more than this termination means that the AMA is a worthless entity. But this is not the same thing as refusing to drink pasteurized juice out of a vague phobia of “preservatives.”
This comment was written by piny.Report this comment to the moderators
June 28th, 2005 at 2:23 pm
But this is not the same thing as refusing to drink pasteurized juice out of a vague phobia of “preservatives.”?
I know that. I was talking abouta general trend toward a dislike of anything considered unnatural.
This comment was written by Lucio.Report this comment to the moderators
June 28th, 2005 at 2:24 pm
>>Piny,
I am sorry about that last comment. I should not have said anything without really knowing.>>
Oh, look, an escalatory cross-post!
Don’t feel bad. There’s really no way you would know. And I get royally pissed off, too, with people who insist that surgery=mutilation, testosterone=dangerous drugs, or my lesbian therapist=John Money. Plus, I’m trying to break the habit of outing myself to people just to win arguments.
And I don’t want to sound patronizing even _as_ a transperson–I’ve encountered that myself, too, particularly around medical issues.
It’s just–this isn’t like how John Travolta’s kid got botulism because Travolta refused to allow anti-bacterial soap to touch the household produce. Unnecessary VBAC’s are something that most women deal with at least as a threat, along with a host of other reproductive horrors. It’s true that there are some crackpots who think that we’d all be better off treating clinical depression with dandelion tea, and that no one should ever give birth in a hospital, but they’re a small minority.
This comment was written by piny.Report this comment to the moderators
June 28th, 2005 at 2:26 pm
Make that “delivery-room horrors.” I don’t want to sound like I think pregnancy is a disease.
This comment was written by piny.Report this comment to the moderators
June 28th, 2005 at 2:39 pm
Tuomos, Elena (and others): a couple of books for your libraries, if you really are interested in answers to the questions you’ve posed and responses to the challenges you’ve issued:
MalePractice: How Doctors Manipulate Women, by Robert Mendelsohn, M.D.
Also, Confessions of a Medical Heretic and How to Raise Healthy Children in Spite of Your Pediatrician by the same author, who was incidentally the chair of the American College of Pediatricians before his death.
The Hidden Malpractice: How American Medicine Treats Women as Patients and Professionals by Gena Corea.
Witches, Midwives and Nurses: A History of Women Healers
by Barbara Ehrenreich & Deirdre English
How the alliance of the Christian church and patirarchal medicine deliberately and systematically suppressed female healers and the harm to women as a people
Gyn/Ecology: The Metaethics of Radical Feminism by Mary Daly, Chapter 7, “American Gynecology: Gynocide by the Holy Ghosts of Medicine and Therapy”
And if you read those and want more, I can provide you with titles.
Heart
This comment was written by Cheryl Lindsey Seelhoff.Report this comment to the moderators
June 28th, 2005 at 2:55 pm
Wow, Piny, I was very wrong about you. Thank you very much for clearing that up, and I think I’m really going to enjoy blogging with you.
Anyway…this is a bit off-topic, but I saw the website, LAmom, and I’m glad that at least she is a liberal pro-life person. I am pro-choice, obviously, but I am more than happy to work with anyone who generally considers themselves liberal. I think it is partly because I trust them not to have paid them to completely spin the story, like the Bush Administration does!
This comment was written by Lucio.Report this comment to the moderators
June 28th, 2005 at 3:34 pm
Heart,
Thanks, I’ll check my local library for those (or, I’ll put a note to do that in the autumn when the wonderful summer has ended). I try to keep an open mind. A random thought occured to me (and I’m surprised I might have such “Marxist Feminist” thoughts, or judge yourself, here comes): I am a big proponent of consevative medicine (not on conservative-liberal axis, but conservative-invasive axis), like using surgery only as last resort, avoiding strong medications etc. preferring instead to empasize rest, healthy life habits and less dangerous medication.And could it be, that in America where medicine indeed is male- and market-dominated, and thus is probably dominated by ideas of aggressivity, penetration, invasiveness, competition and dominance,unlike scandinavian countries for example, where medicine is more equal field of men and women and society-driven, and less invasive, more passive and caring procedures are preferred? (Disclaimer: I absolutely refuse to believe that men are necessarily more aggressive, and women more nurturing, but such is the way people are raised in many [almost all] cultures, thus “masculinity” is paired aggressiveness and dominance, and “feminity” with passivity).
Some other thoughts on the issue (some have been mentioned by others): I see several motives why doctors would prefer more technology-oriented or “unnatural” procedures.
1) Some patients believe that the more expensive and complicated a procedure is, the better, thus creating market-demand for more involved procedures (this would include, “look our hospital makes many c-sections, we’re not like some cheapskate hospitals that don’t”) Of course, this is FAR from truth, as more complicated procedures usually risk more complications (for example, many patients would like to have total anesthesia for even small operations, but knowing that the risk of compilications a responsible doctor would advice against it.)
2) More money involved. This is obvious.
3) Gaining experience on these operations. Again, very irresponsible to use some patients as practise dummies when not medically warranted.
4) Using average percentages, to justify doing operations just to keep up with supposed quotas. This is faulty logic.
Some years ago, on my health economics class I encountered a hypothesis: Privatized healthcare (where the patient pays) has a natural incentive to over-treat patients, while public health care (where the government or similar organization pays) has a natural incentive to under-treat. On public health care, I must point out that the nurses/doctors aren’t actually the ones who manage the finances, so I’m not sure if this theory works so well on that system.
But the issue I had with your comments is, in a nutshell; methinks you paint modern medicine with too big brush. Scandinavian countries are world leaders on many health issues, especially women’s and children’s health. And we do use and trust modern medicine a lot (this is one contributing factor), however, it is more tailored to meet the needs of patients and society. Also, more equality on many issues is also a positive contributing factor. (Disclaimer, I’m not saying this as “our system is perfect”, of course there are many problems that Scandinavian countries face in terms of equality and healthcare.)
This comment was written by Tuomas.Report this comment to the moderators
June 28th, 2005 at 3:41 pm
Of course my long post was a bit off-topic, maybe. But the point is: Unnecessary surgery is an antithesis of doctor’s ethics and a doctor who does that is not only unethical, but in fact incompetent. Necessary surgery is not.
This comment was written by Tuomas.(and typo fix: empathisize, not empasize)
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June 28th, 2005 at 4:33 pm
Amp, I thought the thread was about a hospital not wanting an OB who had a low rate of C-sections. That is a different question than “forcing women to have C-sections.”
I started off my first pregnancy wanting to ‘go natural,’ being highly suspicious of the medical profession, and learning about the natural-birthing movement. And anyone who claims that childbirth is only painful, scary and dangerous because doctors made it so is welcome to kiss my *entire* ass.
I got very tired of bad science and scare tactics and distortions. I was injuring my eyeballs rolling them at people who said “You have an OB…instead of a *midwife?!?!” And don’t even get me started on the outdated insistence on what “hospital practices” are always like. There was the midwife who called me a sheep because I preferred to give birth at the local hospital’s comfortable, nurturing birthing center instead of my cramped high-rise apartment (you know, “at home”).
This comment was written by mythago.Report this comment to the moderators
June 28th, 2005 at 5:03 pm
>>Amp, I thought the thread was about a hospital not wanting an OB who had a low rate of C-sections. That is a different question than “forcing women to have C-sections.”?>>
Didn’t we just have several discussions about how allowing pharmacists to refuse to prescribe birth control results in fewer options for women? And how there’s no reason to believe that there will always be BC-prescribing pharmacists available nearby or at all?
They aren’t being operated on at gunpoint, sure, but this certainly makes it more difficult for them to find doctors who prefer alternative means.
This comment was written by piny.Report this comment to the moderators
June 28th, 2005 at 5:12 pm
piny, that’s yet a third discussion, and one which I agree is an effect of this doctor resigning. It’s not the same as the hospital “forcing women to have C-sections.”
tuomas, the public/private split seems backwards to me. If you know the public fund will pay for whatever treatment you bill, that’s an incentive to overtreat; whereas if your private insurance company kicks back to the doctor if they limit the number of procedures ordered, that’s an invitation to undertreat. In other words, it depends on the incentive structure.
This comment was written by mythago.Report this comment to the moderators
June 28th, 2005 at 5:25 pm
> Amp, I thought the thread was about a hospital not wanting an OB who had a low rate of C-sections. That is a different question than “forcing women to have C-sections.”?
It isn’t a _very_ different question, surely? Ultimately, for most women, the decision as to whether she will have a c-section is in her doctor’s hands. If the doctor says that it’s medically necessary, most of us don’t have the training or knowledge to disagree. You let the doctor do what she says is necessary, and thank providence that you live in the 21st century with modern medical care. If it wasn’t really imperative in your case, you’d never know.
So if you would strongly prefer not to have a c-section (just as a purely personal, one-person choice, not trying to oppress anyone else), your only way to act on that preference is to select a practicioner who assures you that she will treat a c-section as something to be resorted to only when absolutely necessary, and will try other options first. If such practitioners aren’t allowed to practice, then there is no way to act on that preference.
I’m sure the natural childbirthing community can be hideously annoying — most communities can — but their annoyingness isn’t the issue in this case. No one here is trying to keep anyone from getting a c-section who wants one, or from working with an interventionist practicioner who wants to. We are (or I am) regretting that the hospital has shut down a low intervention option for those women that wanted it, and has done so with no obvious medical justification.
This comment was written by LizardBreath.Report this comment to the moderators
June 28th, 2005 at 5:30 pm
There is a difference between deliberately attempting to force women to undergo surgery, and a decision in the interests of avoiding malpractice which has the side effect of limiting women’s choices at that hospital. Neither is good. But they are not identical.
I’m sure the natural childbirthing community can be hideously annoying … most communities can … but their annoyingness isn’t the issue in this case.
It seems rather lopsided to say that discussion of the evils of medical birthing practices are relevant, but similar discussion of ‘natural alternatives’ is not–especially when part of the debate is whether the physician’s low C-section rate is good medical practice.
This comment was written by mythago.Report this comment to the moderators
June 28th, 2005 at 5:34 pm
Mythago:
Yes, the “rule of thumb” is quite invalid because it depends on too many things. But public health care system wants to undertreat, assuming it is a homogenous organization, as there is no clear profit for the system.
Absolutely, this was my objection to the rule (sort of).
Never thought it that way. But you are right.
This comment was written by Tuomas.Report this comment to the moderators
June 28th, 2005 at 5:56 pm
mythago, there is almost no way to avoid institutional medical imperatives unless you are willing to forego all organized medical treatment. Midwives must be backed up by physicians and all physicians must have access to hospitals. I participated in a disciplinary hearing in which a physician was nearly kicked off her medical staff for not requiring the midwives she backed to require more of their patients to be referred for c-sections. So this post really struck a chord with me.
I had a c-section, no one will convince me that all natural all the time is an appropriate attitude, but I do not accept that the possible risk of a malpractice suit is a valid justification for ignoring the results of studies on the actual risks in specific patient populations of undergoing — or foregoing — a given treatment. And when the specific treatment being pushed happens to coincide with the convenience and economic interests of the OB, the anesthesiologist, and the hospital, well yes, call me suspicious.
This comment was written by Barbara.Report this comment to the moderators
June 28th, 2005 at 6:00 pm
>It seems rather lopsided to say that discussion of the evils of medical birthing practices are relevant, but similar discussion of ‘natural alternatives’ is not”“especially when part of the debate is whether the physician’s low C-section rate is good medical practice.
Well, personal annoyingness hasn’t got a _lot_ to do with figuring out what is good medical practice (What would the argument look like? Dr. Sandland should have been censured because whiny hippies who talk about the magicalness of birth irritate me?)
What I see as the central questions are: Is Dr. Sandland’s c-section rate compatible with good medical practice? If it is, how can the hospital be regarded as being justified in instructing her to change her mode of practice to one that produced no better results medically, and was contrary to what her patients wanted?
To the first question: we’re all working off a newspaper story that’s clearly sympathetic to her — maybe she was committing malpractice right and left, and North Carolina is littered with the injured children that resulted. If that’s true, certainly what the hospital did is justified. If the article is reliable, though, her results were as good as any other doctor’s. There’s nothing intrinsically improbable about that — while I haven’t looked at the stats in awhile, entire countries have had c-section rates close to 10%, with outcomes as good or better than those in the US.
To the second question: If that’s the case — her methods aren’t unprecedented, and have reliably produced good results, they’re just unconventional by North Carolina standards — then I can’t see another way to look at what the hospital did than to consider it an unacceptable infringement on her autonomy and that of her patients. The malpractice suit fear, in light of a decade of past good results and happy patients, seems entirely misplaced.
This comment was written by LizardBreath.Report this comment to the moderators
June 28th, 2005 at 6:29 pm
What I see as the central questions are: Is Dr. Sandland’s c-section rate compatible with good medical practice?
Exactly. The issue about ‘natural childbirth’ isn’t whether it’s merely irritating, but whether it’s good medical practice. I don’t see how a medical approach rooted in the idea that any pain, fear or danger from childbirth is largely due to doctors is good medical practice.
I don’t agree that the hospital is ‘misplaced’ in its concern about malpractice; you could argue that they should look at factors other than the numbers. We don’t know from the article. I’d bet money that I know exactly what the hospital’s legal department was imagining: having a hospital administrator on the witness stand, facing the question “So you *knew* this doctor was extremely reluctant to perform C-sections because she thought of herself as a midwife with OB credentials?” Or “So isn’t it true that you let this unorthodox medical practice continue because many patients thought it was ‘healthier’ and that brought in money for your hospital?”
As you say, I don’t think we have enough information to be sure what was really going on here. Maybe the hospital had concerns about her practice other than the 10% rate. Maybe she is a great doctor who was the victim of paranoia about malpractice. Can’t tell from the article.
This comment was written by mythago.Report this comment to the moderators
June 28th, 2005 at 7:44 pm
>I don’t see how a medical approach rooted in the idea that any pain, fear or danger from childbirth is largely due to doctors is good medical practice.
Attributing this attitude to Dr. Sandland, or to anyone else, because they’re concerned about the rate of unnecessary c-sections is unwarranted, don’t you think? I, for example, think that the rate of c-sections in this country is unnecessarily high, but I certainly wouldn’t say that labor pain can be blamed exclusively on doctors, nor that modern medicine doesn’t save many lives in child birth. You’ve erected a straw man here.
With respect to malpractice: taking the article at face value, the hospital couldn’t find any particular cases to second-guess her on as cases where she should have done a C-sec and didn’t. It doesn’t sound as though her methods were particularly unorthodox on a case-by-case basis. I can see why an administrator would think just what you describe, but in the absence of any evidence suggesting that Dr. Sandland was any more likely to commit malpractice or to be sued than any other doctor, their decision looks illegitimately cautious to me — they don’t appear to be at any genuinely greater risk of a big judgment from her than from any other doctor. It’s the hospital’s money, they can make decisions with it, but I can, and do, disapprove.
>Maybe the hospital had concerns about her practice other than the 10% rate.
Anything’s possible.
>Maybe she is a great doctor who was the victim of paranoia about malpractice.
But this looks more likely.
This comment was written by LizardBreath.Report this comment to the moderators
June 28th, 2005 at 8:32 pm
Mythago;
Two things, first, the whole good medical practice really needs to be tempered with remembering it’s invasive surgery we’re talking about here. I’m far less worried about the whole ‘natural’ element, and more affronted and boggled at the idea of giving carte blanche permission to doctors and hospitals to say ‘you get a c-section’, without so much as a physical because of a prior surgery. It also takes away a patients rights of informed consent with regards to reliable insurance.
Second, this concept matters very little to someone that isn’t thinking about litigation, but instead just a healthy child-birthing experience, that is suddenly faced with bodily autonomy being something people discuss around you, and not with you.
This comment was written by Kim (basement variety!).Report this comment to the moderators
June 28th, 2005 at 11:32 pm
>>I’d bet money that I know exactly what the hospital’s legal department was imagining: having a hospital administrator on the witness stand, facing the question “So you *knew* this doctor was extremely reluctant to perform C-sections because she thought of herself as a midwife with OB credentials?”? Or “So isn’t it true that you let this unorthodox medical practice continue because many patients thought it was ‘healthier’ and that brought in money for your hospital?”?>>
Considering the publicity and the potential for complications from c-sections, their decision could cause the exact same problem in reverse for any other obstetrician at the hospital. “Bring your c-section rate into line with our averages, or lose your surgical privileges,” is pretty good evidence for someone trying to prove she was given an unnecessary c-section, don’t you think?
This comment was written by piny.Report this comment to the moderators
June 28th, 2005 at 11:33 pm
You’ve erected a straw man here.
Uh, no. If you scroll up, at least one poster has criticized the hospital’s decision on that very basis.
But this looks more likely.
How so? Because we don’t like the hospital’s decision? As you’ve already said: we don’t have much information, other than Dr. Sandland’s resignation and the article’s discussion of how doctors lean towards C-sections, sometimes out of fear of litigation and sometimes because their patients want them. I’m not willing to tag one as ‘possible’ and the other ‘more likely’ based on one sympathetic news article that has little information from the people involved.
but in the absence of any evidence suggesting that Dr. Sandland was any more likely to commit malpractice or to be sued than any other doctor, their decision looks illegitimately cautious to me
I’ll repeat myself: the issue is not that Dr. Sandland is more dangerous than another doctor, although perhaps the hospital administration thought she was. The issue is that if there were a lawsuit, the hospital administrators would have to explain why they knew about yet did nothing to intervene in her disinclination to do C-sections, and why they permitted a maverick physician to make choices not in tune with standard medical practice.
Perhaps their concern was overblown–but I doubt that, as some posters have suggested, it was motivated by greed or a sinister desire to meddle in the natural process of childbirth.
Kim, did I miss the part where women were not even given a prior physical for non-emergency C-sections in that article?
This comment was written by mythago.Report this comment to the moderators
June 28th, 2005 at 11:40 pm
“Bring your c-section rate into line with our averages, or lose your surgical privileges,”? is pretty good evidence for someone trying to prove she was given an unnecessary c-section, don’t you think?
Do you think that doctors are often sued for performing an unnecessary C-section? Unless the child is damaged, it’s going to be very hard to show that the doctor should have let the birth proceed vaginally and everything would have turned out better.
Look, I’m not rah-rah about C-sections or the hospital’s decision; but knowing about how doctors think about medical malpractice, their decision doesn’t look sinister. It’s possible it was a stupid decision. (It’s possible something else is going on.) We don’t, IMO, have enough information to throw stones either way.
This comment was written by mythago.Report this comment to the moderators
June 28th, 2005 at 11:47 pm
Ahh, I was referring to my situation, Mythago. Which is part of how the whole forced c-section issue came up. I had commented on this being (as I understand it) pretty common in Portland, and definitely the case with me. The conversation seemed to be trending a bit to ‘well doctor’s wouldn’t do it if it wasn’t a necessity’, which unfortunately just isn’t the case, from my personal experience.
This comment was written by Kim (basement variety!).Report this comment to the moderators
June 29th, 2005 at 5:37 am
Mythago: I don’t see how a medical approach rooted in the idea that any pain, fear or danger from childbirth is largely due to doctors is good medical practice
Lizardbreath: You’ve erected a straw man here.
Mythago: Uh, no. If you scroll up, at least one poster has criticized the hospital’s decision on that very basis.
If you’re referring to me, I haven’t done that at all. I have said that the risks doctors insure themselves against are risks they have created by their own practice and policies. I’ve also said that doctors and hospitals are not the ones who have made childbirth safer for women, in general, *women* have made childbirth safer for women.
And you (and others) have certainly created and argued against straw men consistently here, from the first time someone came in shouting about all those women who bully other women to have natural births. From the time someone started arguing with all the invisible people here who are touting all-natural-all-the-time-is-the-highest-good — which nobody here has said or inferred or hinted at even once.
Which is why I’m not bothering to engage besides suggesting a few of a huge list of books which could be read on the subject. I am not interested in arguing points I’ve never made or refuting positions nobody is taking, just because somebody wants to vent their spleen because once somebody they know got her feelings hurt when the suggestion was made that natural birth might be a good thing. Which made her the forever-phantom-bully invoked in these arguments.
I have also never said there was no pain in childbirth or that doctors created all of the pain in childbirth. I’ve barely talked about that issue at all.
I am just wanting to clarify what I *did* say in the event someone thinks she is arguing against what I said, or responding to it, or something. What I see here is you, Mythago, and others, arguing against positions nobody has taking, tilting at windmills. That is pretty much what always goes down in this kind of discussion, so useless.
Heart
This comment was written by Cheryl Lindsey Seelhoff.Report this comment to the moderators
June 29th, 2005 at 5:59 am
>knowing about how doctors think about medical malpractice, their decision doesn’t look sinister. It’s possible it was a stupid decision.
Does it have to be sinister for it to be a very bad, lousy, messed-up decision that should be publicly commented on with disapproval in the hopes that similar decisions are made differently in the future? I doubt the hospital has a fiendish plan to come after innocent healthy women with scalpels — you’re probably right that they think they’re covering their ass from malpractice liability. They appear, however, to be doing so stupidly, and in a way that insures that at least some women who don’t want c-sections, and who don’t actually need c-sections, will nonetheless get them. I strongly disapprove.
And on the strawman point — the only person whose medical practices we’re talking about here are Dr. Sandland’s. In the absence of any indication that _she_ believes that doctors are the devil and childbirth would be a mystical pain-free experience if laboring women would just click their heels together and think about dolphins, saying that such beliefs are bad medical practice is a strawman.
This comment was written by LizardBreath.Report this comment to the moderators
June 29th, 2005 at 6:36 am
>>I am not interested in arguing points I’ve never made or refuting positions nobody is taking, just because somebody wants to vent their spleen because once somebody they know got her feelings hurt when the suggestion was made that natural birth might be a good thing. Which made her the forever-phantom-bully invoked in these arguments.>>
Actually, Mythago’s experience was firsthand, and the things said to her were much more unpleasant and most definitely grounds for taking offense.
So you might want to read what other people have really said about what they’ve really been through before you start squealing about strawmen.
This comment was written by piny.Report this comment to the moderators
June 29th, 2005 at 6:41 am
Well, sure, if were were talking about how natural childbirth advocates should be politer. In the context of whether the doctor in the story practices medicine responsibly and with good outcomes, attributing the beliefs of the most extreme natural childbirth advocates to her (particularly given that she sections 1/10th of her patients) is a strawman.
This comment was written by LizardBreath.Report this comment to the moderators
June 29th, 2005 at 6:51 am
> If you know the public fund will pay for whatever treatment you bill, that’s an incentive to overtreat
Mythago, that’s assuming that the decision on treatment are taken entirely and exclusively by the patient. You can’t just go up and ask your doctor or state hospital to provide you with anything you want. It has to be justified because it’s about spending taxpayers’ money, it’s about using limited public resources, not clogging up the system, etc. In the absence of widespread corruption and fraud, any moderately efficient public healthcare system such as the one Tuomas was talking about will tend to avoid unnecessary procedures much more than a private hospital where it’s only your own money that counts.
In terms of elective c-section, that’s a different story of course, no matter if the system is public or private, any woman must have the right to choose that option even when it’s not considered strictly ‘necessary’ for her health or the baby’s. I definitely agree c-sections shouldn’t be pressured or forced, but like you said there can be too much of a tendency to idealise ‘natural’ childbirth.
(Also, assuming the decision is well-informed, there is another reason for elective c-section aside from the legitimate desire to avoid pain and risks: the desire to avoid stretching and tearing and other disruptions to a woman’s sex life after birth. I hope that no one thinks it’s a taboo or a frivolous reason.)
This comment was written by noodles.Report this comment to the moderators
June 29th, 2005 at 7:25 am
Cheryl, I didn’t read mythago’s comment as a straw man, I also got the impression you were indeed attributing the painful aspects of childbirth to hospital delivery - you said most women who choose c-sections are traumatised by horror stories like those you described in hospitals, and those are the “horrible, painful experiences”, then you said the reality is that “birth can, does and most often will occur peacefully and beautifully and pleasurably as a continuation of the process which began right where the birth takes place: in a woman’s own bed, in her own room, in her own home. With her partner right there holding her. And a midwife who really is most interested in supporting her.”
That does sound like an idealised view where pain is not even factored in. I have never seen that scenario (without any drugs?) except in films.
In the past, especially if you were poor, giving birth at home was the only option, not some ideal. Now there are more options, and I don’t think it’s realistic to treat it as a matter of horrible hospital delivery vs. beautiful home birth.
I don’t believe in one-size-fits-all solutions and I think it’s definitely a good thing for women to be more confident about pregnancy and childbirth and to avoid excessive medicalisation of it, but it won’t be a pleasant, peaceful and beautiful experience just because we want it to be. Especially if you’re supposed to do without any medication for the sake of doing it the ‘natural’ way.
This comment was written by noodles.Report this comment to the moderators
June 29th, 2005 at 8:27 am
Mythago, that’s assuming that the decision on treatment are taken entirely and exclusively by the patient.
I wasn’t making that assumption. That’s why I noted that there are competing forces; it’s not as simple as private = good care and public = bad (or vice versa).
Which is why I’m not bothering to engage besides suggesting a few of a huge list of books which could be read on the subject.
You did engage, actually. It’s rather dishonest of you to disavow your own words, post a counterattack and then claim you’re “not engaging”. “The reason a lot of pregnant mothers request c-sections is, they are really scared of the pain of labor and delivery. And why are they scared? Because they hear so many women tell about their horrendous labor and delivery experiences, most of which were made horrendous by doctors. ” That’s you, not a strawman. (I particularly liked the attack on doctors for not washing their hands back in the 19th century. Midwives didn’t know about germ theory, either. It was a male doctor, btw, who introduced the practice.)
Does it have to be sinister for it to be a very bad, lousy, messed-up decision that should be publicly commented on with disapproval in the hopes that similar decisions are made differently in the future?
Nope. But it would be nice to have a little more information before decidint that the doctor is clearly a shining beacon of good medical practice and the hospital administrators are merely stupid.
This comment was written by mythago.Report this comment to the moderators
June 29th, 2005 at 8:34 am
Hmm. I’m pretty comfortable with saying that if, as represented by the article, the doctor does not have an elevated rate of maternal or neonatal mortality or morbidity over the decade she has been practicing at this hospital with this c-secton rate, then the hospital administrators are making a bad decision, and holding in abeyance the possibility that she’s leaving a trail of mutilated children behind her until anything at all that suggests that might be the case comes out.
There’s no evidence whatsover suggesting that there’s anything wrong with the doctor’s practices, other than that her c-section rate would be more conventional in some other countries that have childbirth statistics as good or better than ours than it is here..
This comment was written by LizardBreath.Report this comment to the moderators
June 29th, 2005 at 8:45 am
There’s no evidence whatsover suggesting that there’s anything wrong with the doctor’s practices
There’s very little evidence at all. We know what she has said, and we know that the hospital felt her C-section rate was too low. There was also concern, apparently, over birth weights and over shoulder dystocia from vaginal breech births. (I know fancy terms like “shoulder dystocia” because I read about them in my trial lawyer magazines. People sue over these things.)
So yes, there’s a whole underlying debate over C-sections and whether women are over-surguried and why this doctor’s rate was low–was she sensibly avoiding unnecessary surgery? was she avoiding *necessary* surgery and has been lucky so far? is she just in that gray area where you might or mighn’t do a C-section in some cases and if it turned out OK then you don’t know if it would have been different?
That’s where the information is lacking.
This comment was written by mythago.Report this comment to the moderators
June 29th, 2005 at 9:02 am
>shoulder dystocia
Heavens, that is a big word. It’s also a word that’s entirely absent from the linked newspaper article. The hospital threatened to watch her number of *collarbone fractures*, a common event in vaginal deliveries, that almost always requires no treatment, and that people don’t sue over. If there’s another article suggesting that the hospital had some basis for concerns over her shoulder dystocia rate, I’d appreciate a link. Likewise with the birth weights — higher average birthweight, cited in the hospital’s letter, shouldn’t be cause for concern. Higher rates of macrosomic babies would be, but there’s no indication that Dr. Sandland had such a higher rate.
>was she avoiding *necessary* surgery and has been lucky so far?
For a decade?
This comment was written by LizardBreath.Report this comment to the moderators
June 29th, 2005 at 9:10 am
I can’t believe someone’s midwife called her a sheep for not wanting to have a baby at home. Was it Mythago? Yikes.
This comment was written by Elena.Report this comment to the moderators
June 29th, 2005 at 9:14 am
A lot of doctors would never attempt a vaginal birth for any baby in a breech position, even though some breech positions are more dangerous than others. This was the fact that stood out for me in the article as a likely concern of the hospital, and dystocia is nothing to underplay.
In closed network systems that keep close tabs on such things, the optimal rate of c-section is thought to be between 10 and 15% of births, depending on the patient population. Many Latina immigrants, for instance, cannot do a VBAC because Latin American doctors don’t do low transverse (horizontal) c-sections, so I imagine that the c-section rate for them would be higher.
I am sensitive to concerns of malpractice, but the kind of knee-jerk reaction we are seeing is a form of litigation psychosis. On the chance that 1/10,000 patients (at most) might sue in a given scenario, ALL WOMEN are being subjected to an incredibly personal form of coercion regarding a major life event. This truly is to let lawyers practice medicine — and it isn’t true that doctors won’t get sued if they do a c-section, there will always be some way to claim that the doctor screwed up — didn’t monitor enough beforehand and take the baby earlier, etc. The real problem is that parents with injured and sick infants have no safety net to fall back on to obtain expensive care, UNLESS they can prove that the doctor or hospital is at fault. This isn’t fair to doctors, but it sure as hell is a lot less fair to patients, and forcing all patients to pay for it in the form of irrational and coerced medical care makes it even less fair.
This comment was written by Barbara.Report this comment to the moderators
June 29th, 2005 at 9:14 am
The hospital threatened to watch her number of *collarbone fractures*, a common event in vaginal deliveries, that almost always requires no treatment, and that people don’t sue over.
Then why is the hospital watching them? As a pretext? Probably more because they are concerned about OTHER problems (e.g., shoulder dystocia) that may lead to lawsuits.
For a decade?
You deeply misunderestimate doctors’ paranoia about malpractice.
We have the doctors’ own comments, two letters from the hospital, and a bunch of comments from outside experts. I’m perfectly willing to believe the hospital fucked up. I’m not willing to believe that the article is a neutral summary of all the pertinent facts.
Elena, it wasn’t *my* midwife, but yeah. To be more accurate, she made bleating noises.
This comment was written by mythago.Report this comment to the moderators
June 29th, 2005 at 9:26 am
At this point we’re just going around in circles. Sure, if there are unreported facts that indicate Dr.Sandland is a danger to her patients, the hospital did the right thing. If the facts are as reported, they were stupidly paranoid, and took a valuable treatment option away from patients in their area. Until I see any facts suggesting the first is true, I’m going to assume the second. (And I simply don’t know what to say about the argument that the hospital’s threat to monitor collarbone fractures indicates that they were concerned about shoulder dystocia.)
This comment was written by LizardBreath.Report this comment to the moderators
June 29th, 2005 at 10:06 am
piny, quoting me, Cheryl/Heart: I am not interested in arguing points I’ve never made or refuting positions nobody is taking, just because somebody wants to vent their spleen because once somebody they know got her feelings hurt when the suggestion was made that natural birth might be a good thing. Which made her the forever-phantom-bully invoked in these arguments.
piny Actually, Mythago’s experience was firsthand, and the things said to her were much more unpleasant and most definitely grounds for taking offense.
So you might want to read what other people have really said about what they’ve really been through before you start squealing about strawmen.
Let’s take a look at what Mythago said about her own experience:
Mythago: got very tired of bad science and scare tactics and distortions. I was injuring my eyeballs rolling them at people who said “You have an OB…instead of a *midwife?!?!”? And don’t even get me started on the outdated insistence on what “hospital practices”? are always like. There was the midwife who called me a sheep because I preferred to give birth at the local hospital’s comfortable, nurturing birthing center instead of my cramped high-rise apartment (you know, “at home”?).
I am not seeing the “unpleasantness” and “cause for offense” in asking a woman why she’s chosen an OB instead of a midwife. That is a question which might well be asked sincerely and honestly, including by women who are pregnant or thinking about getting pregnant and hence, are making that decision themselves. The talk about the “bad science” and “distortions” and “outdated insistence about what ‘hospital practices’ are” don’t seem to me to be statemenst about unpleasantness or offensiveness; those are judgments Mythago made about whatever she heard or read based on her own opinions and views. As to the midwife who called Mythago a sheep, Mythago, don’t lie: Did some midwife say straight up to you, “Mythago, you are a sheep because you won’t birth at home!” Or did she just refer to the way pregnant and birthing women are herded sheep-like in the direction of obstetricians, hospitals, medications, interventions and so on, something you took personally and which you are now reporting as her attacking you by calling you a sheep. Come on.
I don’t know who first started ranting on about all of these bullies who advocate for natural birth, but it’s about then that I began to lose interest. The real bullies, you know, are women who have birthed naturally, have birthed at home, midwives; the real bullies aren’t the hospitals and doctors and entire medical establishment that regulates, or attempts to regulate, the pregnancy, labor, delivery and postpartum process from beginning to end with real consequences to the women and babies it is regulating. The real bullies are those women who birth naturally and their midwives and doulas who believe in it and speak up about their own experiences. How dare they. The very idea that they should suggest there are alternatives to patriarchal medicine. I like what someone said about that, maybe Kim, that advocates for natural birth HAVE to speak up; they DO, to be heard above the din of hospitals and drug companies and formula companies and all of the various mouthpieces for patriarchal medicine who are interested in controlling the process of pregnancy and labor and delivery, not only out of a profit motive, not only because heteropatriarchy likes to control women, but also for more nefarious reasons. The policing of women’s reproductive capacities includes refusing abortions, includes controls on birth control, includes the “harvesting” and selling of women’s eggs and bodies in surrogacy. So it is in women’s best interests that at least SOME of us continue to assert that these are OUR bodies, we will get pregnant, or not, we will discuss that with y’all or not, we will seek your advice or not, we will ignore it, or not, we will birth wherever we damn well please, and if we want anything from you, we’ll tell you about it. And when we hear young pregnant women lining up and cutting checks to hospitals, obstetricians and drug companies, we want to make sure they’ve considered the alternatives. That’s not being a bully, that’s being a feminist, but if somebody wants to call that bullying, be my guest, let the “bullying” continue, because it is no such thing.
noodles: Cheryl, I didn’t read mythago’s comment as a straw man, I also got the impression you were indeed attributing the painful aspects of childbirth to hospital delivery - you said most women who choose c-sections are traumatised by horror stories like those you described in hospitals, and those are the “horrible, painful experiences”?, then you said the reality is that “birth can, does and most often will occur peacefully and beautifully and pleasurably as a continuation of the process which began right where the birth takes place: in a woman’s own bed, in her own room, in her own home. With her partner right there holding her. And a midwife who really is most interested in supporting her.”?
That does sound like an idealised view where pain is not even factored in.
How so? I didn’t say one word about pain– I think the pain of labor and delivery and postpartum is a complicated discussion, would require many posts to discuss, but birth being pleasurable, beautiful and peaceful says nothing at all about it being painless. And that is also not an idealization– that’s the way it really *is*, the majority of time, for those of us who birth at home.
And I stand by everything I said there. Women *have* and *do* hear horror stories about birth, all of the time, most of the time from women who have birthed in hospitals with OBs. Those horror stories are the result of specific medical practices, of interventions and hospital policies and regulations which have *caused* the practices, and yes, indeed, the *pain*. Which says nothing about the natural and predictable pain that accompanies childbirth. I am talking there about the pain that hospitals and doctors and their policies cause or inflict in the course of attending laboring and birthing women (even when the women don’t realize, as they usually don’t, that the interventions and practices and policies are what caused the pain to be so unbearable.)
Noodles: I have never seen that scenario (without any drugs?) except in films.
How many births have you attended? How many times have you given birth? How many home births, as opposed to hospital births, have you attended?
Noodles: In the past, especially if you were poor, giving birth at home was the only option, not some ideal. Now there are more options, and I don’t think it’s realistic to treat it as a matter of horrible hospital delivery vs. beautiful home birth.
And that is not how I have treated it at all. I have talked about home birth as a beautiful option to hospital birth (which most here are defending), because it is.
Noodles: I don’t believe in one-size-fits-all solutions and I think it’s definitely a good thing for women to be more confident about pregnancy and childbirth and to avoid excessive medicalisation of it, but it won’t be a pleasant, peaceful and beautiful experience just because we want it to be. Especially if you’re supposed to do without any medication for the sake of doing it the ‘natural’ way.
And this is exactly what I mean by straw man arguments. Maybe somebody else argued the above and I didn’t see it, I haven’t read really, really carefully, but I don’t see anyone here advocating for one-size-fits-all solutions or for doing something the “natural” way for it’s own sake. Nobody has said any such thing here. As to the idea that home birth won’t be pleasant, peaceful and beautiful just because we want it to be– that just strikes me as a very odd thing to say. For one thing, I think that is a foregone conclusion. Most of us know that we don’t always get what we want. But why is it *so* important to communicate that we might not get the birth experience we want at home? Isn’t it at least *as* true, and of course I believe *more* true, that we will not get the birth experience we want in hospitals just because we want it. And one reason for that is, it’s not going to be up to us. As women have said in this thread, and as I have experienced personally (I have given birth 11 times, all babies are still alive, the first seven were birthed in hospitals, the last four were at home), I could write *books*, much less threads, much less posts, about ALL of the things that were done to me and to my babies against my will in hospitals and to the hundreds of similar stories I have heard from other women who have birthed in hospitals, or witnessed myself, even when doctors and hospitals agreed they’d do it my (or their) way, signed off on birthing plans and you name it. A lot of the time you don’t find out what was done to you without your consent until AFTER the fact, and lots of times you never really find out at all. You just are wheeled away from the hospital reeling over your horrible birth experience not even understanding that it was horrible because of what was DONE to you. And you don’t realize this fully until you HAVE a child outside the hospital and see the tremendous difference between *that* experience and hospital birth.
Mythago quoting me, Heart which is why I’m not bothering to engage besides suggesting a few of a huge list of books which could be read on the subject.
Mythago: You did engage, actually. It’s rather dishonest of you to disavow your own words, post a counterattack and then claim you’re “not engaging”?.
Oh, come on, Mythago. What I *meant* was I haven’t been engaging in the ongoing back and forth, in other words, I haven’t involved myself much in this thread, although I would have if there wasn’t so much arguing with what nobody has ever said.
Mythago: (I particularly liked the attack on doctors for not washing their hands back in the 19th century. Midwives didn’t know about germ theory, either. It was a male doctor, btw, who introduced the practice.)
True, midwives didn’t know about germ theory, but it was FAR less an issue, because they delivered women one at a time in their own HOMES. Not in filthy hospitals where and when nobody knew about germ theory! When a woman was in labor, the midwife went to her and stayed there with her in her hom until the baby was born. She wasn’t attending to multiple laboring women in an unsanitary ward full of them while popping in and out to, say, treat someone’s tuberculosis or gangrene or other infection or to take a look at a corpse or to bandage someone’s gaping, bleeding wound or whatever. All she did was attend births. There weren’t cars, she didn’t zip from home to home, she cared for each woman, in that woman’s home, for as long as it took, which *tremendously* reduced the risk of infection to moms AND babies. A woman’s own surroundings are what her body is accustomed to, familiar with. There is much less risk in such surroundings. Even now, with understanding of germs and sanitation, hospitals are hotbeds of infection and for this reason many patients, not only birthing women, are STILL sent home quickly whenever possible. The longer they are in the hospital, the greater the risk of exposure to infection. At home, again, there is MUCH less risk.
And for what it’s worth, it is still the same with midwives. They come to your home when you ask them to and they stay with you until the baby is born, even if it’s 24 hours or more.
As to a male doctor coming up with germ theory, *of course* it was a male doctor, hello. Women weren’t even ALLOWED to go to medical school or to BECOME doctors until the early part of the 20th century in the United States and Europe. Women who are kept out of colleges and universities because they are women aren’t going to be making too many scientific discoveries (although if they do, and some did, a man will have received the credit). But tell you what, had women been allowed to practice medicine, go to medical school, they would sure as hell, I bet you a million bucks, have applied themselves to what was happening to birthing women in hospitals.
Mythago: There’s very little evidence at all. We know what she has said, and we know that the hospital felt her C-section rate was too low. There was also concern, apparently, over birth weights and over shoulder dystocia from vaginal breech births. (I know fancy terms like “shoulder dystocia”? because I read about them in my trial lawyer magazines. People sue over these things.)
And if we are going to accuse one another of “dishonesty,” which I think is not a good thing to do, but since you did it, here is where I will hear your accusation and raise you better one as follows. The “concern” over the birth weights was that they were too high. That is a CRAZY thing to be “concerned” about, unless she was routinely delivering 11- or 12-pound babies which I *doubt*. Low birth weights are a huge concern and associated with high infant mortality. But *higher* birth weights are a GOOD thing, which is what makes that hospital’s letter so incredible. The goal with pregnant women is always to ensure that they birth when their babies are big enough. Which *happens*, as has already been said, when doctors wait until babies are ready to be born instead of inducing labor to keep their schedules tidy.
As to “soldier dystocia,” I don’t recall reading what was said in that letter, but I do know that (1) it is a VERY rare situation; (2) midwives are trained to deliver babies with shoulder dystocia whereas MD’s usually are NOT. I have two friends who have birthed soldier dystocia babies at home with midwives — one weighing nearly 12 pounds — and there was no problem. Doctors are taught “shoulder dystocia = c-section.” Midwives are taught, “Shoulder dystocia = get mother onto her hands and knees with one leg up and …. , OR, put one hand on the baby’s back and one on the baby’s chest in kind of a praying position, thumbs outside the mom, and gently rotate the baby,” OR a bunch of other maneuvers which midwives use successfully. It’s the same thing with breach births: doctors are taught that breach = c-section. Midwives are taught breach = external version, rotating the breach baby into the head-down position, something I experienced with my ninth, successfully, late in pregnancy, and she was born head down just fine at home. (And one thing we haven’t even touched on is all the things doctors do c-sections for just because they aren’t taught less invasive ways to address the problem, again, something midwives ARE taught.)
And as to choosing a hospital over a high rise apartment, my 10th was born in the back seat of our car. It was sweet, very pleasurable (though not painless, none of my births has been), beautiful, and in no way would I have preferred to have birthed him in the hospital, even though he was born in an 80s model Pontiac, hardly plush surroundings. My 11th was born when I was still living in a very humble double-wide on acreage out in the country, and when I say humble, I mean humble. But it, too, was a beautiful, pleasurable experience in SO many ways.
Heart
This comment was written by Cheryl Lindsey Seelhoff.Report this comment to the moderators
June 29th, 2005 at 10:19 am
And tell you what, up until the time midwifery was outlawed and pregnancy and birth were medicalized, women were *not* dying, in droves, of childbed fever. That was a direct result of the medicalization of pregnancy and birth.
Heart
This comment was written by Cheryl Lindsey Seelhoff.Report this comment to the moderators
June 29th, 2005 at 10:22 am
>>As to the midwife who called Mythago a sheep, Mythago, don’t lie: Did some midwife say straight up to you, “Mythago, you are a sheep because you won’t birth at home!”? Or did she just refer to the way pregnant and birthing women are herded sheep-like in the direction of obstetricians, hospitals, medications, interventions and so on, something you took personally and which you are now reporting as her attacking you by calling you a sheep. Come on.>>
I know it’s a long thread, Heart, but do try to keep up:
Mythago, #83:>>Elena, it wasn’t *my* midwife, but yeah. To be more accurate, she made bleating noises. >>
And you’re certainly making up for your lack of engagement in the back and forth now, aren’t you? I’ll be back to read the rest of The Poisonwood Bible later.
This comment was written by piny.Report this comment to the moderators
June 29th, 2005 at 10:37 am
Depends, I suppose, what you consider to merit the word “droves”. I’m glad you and your friends have had good childbirth experiences (or quite a lot of them, in your case), but complications sometimes do occur. And who the hell cares whether Louis Pasteur was a man or a woman (not me, and was Marie Curie a “token”, btw, seems insulting to imply that she was)? What matters is the theory saves lives.
But I may be wasting my energy here. Clearly you have vested much in your conspiracy theory of modern medicine=killing women, and doctors=greedy bastards who want to kill women out of sheer fun, and science=anti-female religion or something. Any and all evidence of contrary will probably be considered as biased because of male dominance on field of science (which fields? Women are doing great in science…)
Disclaimer: I am not dissing your choices in life, or midwifery, but this ridiculous bias does annoy the hell out of me.
This comment was written by Tuomas.Report this comment to the moderators
June 29th, 2005 at 10:47 am
Yeah, piny, I made up for my not engaging, because there is *way* too much misinformation in this thread about a subject of great importance to women and to those who are allies to women.
As to “keeping up,” Mythago and I cross posted. She posted 10 minutes before I did, while I was still penning the Poisonwood Bible. But what she says just ratchets my level of suspicion up a notch. Now we have someone telling Mythago that her midwife made “bleating noises.” I find that hard to believe, but if it did happen, I am betting it happened in some generic way, in the course of a general conversation, and Mythago’s friend took it personally, and here Mythago is suggesting that a midwife straight up told her friend she was a sheep complete with bleating noises. You will excuse my unwillingness to suspend disbelief I’m sure.
And that leaves to offend Mythago only women asking her why she was using an OB instead of a midwife, as opposed to having had to suffer all of this seriousness and offense at the hands of women who advocate for natural or home birth. Right?
And I think it’s pretty lame, given all that I have taken the time to post here, to respond with insults because you can’t come up with anything substantive, or more, or better, or anything at all. This is a topic of serious concern to all women, and to all feminists. I hate seeing so much misinformation and so little real understanding of the situation as it exists on profeminists boards.
Heart
This comment was written by Cheryl Lindsey Seelhoff.Report this comment to the moderators
June 29th, 2005 at 11:09 am
What? No, your totally unsubstantiated refusal to take Mythago at her word is _not_ a good reason to dispatch all her complaints with, “Whatever. Moving on.” Calling her a liar doesn’t make her one. I don’t have to excuse your calling her a liar, and I will not.
Furthermore, Mythago did not say that natural birth advocates asked her why she wasn’t using a midwife instead of an OB–they asked her in an extremely rude way and then proceeded to rudely disparage her choices. That’s like the difference between asking, in a nonjudgmental way, why a woman does not breastfeed and behaving as though she might as well be giving her child toilet water cut with Drano. It’s like the difference between talking about all-natural foods and throwing a shit-fit when you see a woman giving her toddler Juicy Juice. Any sane reading of her descriptions–one not based on a self-serving need to cut them apart because you can’t deal with an experience that doesn’t jibe with yours–would yield that interpretation: she was insulted.
You know what else is a serious concern to women, and to their reproductive choices? Cliquish, judgmental bullshit like yours.
This comment was written by piny.Report this comment to the moderators
June 29th, 2005 at 11:10 am
>>And if we are going to accuse one another of “dishonesty,”? which I think is not a good thing to do, but since you did it, here is where I will hear your accusation and raise you better one as follows.>>
Also? This is chutzpah defined.
This comment was written by piny.Report this comment to the moderators
June 29th, 2005 at 11:19 am
Tuomos, I did want to say, in partial response to your earlier post, that I have been talking here about medicine in the the United States, not in Norway or Sweden or Finland, countries which have the lowest rates of both infant and maternal mortality in the world. As does Canada. All of the above are, like, in the top 10 nations. The United States, for all of its wealth and resources, is way down, not in the top 10, not even in the top 20, if I’m not mistaken. Which is serious. Which is something for Americans to think deeply about. I am betting a lot of what I have said here does not hold true in Norway, Sweden, Finland, even Canada.
Tuomos quoting me, Heart: And tell you what, up until the time midwifery was outlawed and pregnancy and birth were medicalized, women were *not* dying, in droves, of childbed fever. That was a direct result of the medicalization of pregnancy and birth.
Tuomos Depends, I suppose, what you consider to merit the word “droves”?.
Puerperal, or childbed fever was the greatest killer of women in the 1700s and 1800s. One in 4-5 birthing women died of it. Mary Wollstonecraft died of it.
From an article which I will link to:
“…in ancient and medieval times, mortality from puerperal sepsis was apparently relatively low, as women generally gave birth at home.
“The 17th century saw the establishment of “lying-in”? hospitals in many European cities. While these institutions were, in some ways, an advance … in particular, by relieving obstructed labour with forceps or intrauterine manipulation … the crowding of patients, frequent vaginal examinations and the use of contaminated instruments, dressings and
bedlinen spread infection in an era when there was no knowledge of antisepsis.
“The first recorded epidemic of puerperal fever occurred at the Hôtel Dieu in Paris in 1646. Subsequently, maternity hospitals all over Europe and North America reported intermittent outbreaks, and even between epidemics the death rate from sepsis reached one woman in four or five of those giving birth.5
” …in Vienna, Dr Ignaz Semmelweis, a native of Hungary, was beginning a life-long obsession with finding the cause of, and preventing, puerperal fever.
In 1844, Semmelweis was appointed assistant lecturer in the First Obstetric Division of the Vienna Lying-In Hospital, the division in which medical students received their training. He was appalled by the division’s high mortality rate from puerperal fever … 16% of all women giving birth in the years 1841″“1843. In contrast, in the Second Division, where midwives or midwifery students did the deliveries, the mortality rate from the fever was much lower, at about 2%. Semmelweis also noted that puerperal sepsis was rare in women who gave birth before arriving at the hospital.6,11
“…Semmelweis began experimenting with various cleansing agents and, from May 1847, ordered that all doctors and students working in the First Division wash their hands in chlorinated lime solution before starting ward work, and later before each vaginal examination. The results were extraordinary … the mortality rate from puerperal fever in the division fell from 18% in May 1847 to less than 3% in June”“November of the same year.11″
http://www.mja.com.au/public/issues/177_11_021202/dec10354_fm.pdf
I’m glad you and your friends have had good childbirth experiences (or quite a lot of them, in your case), but complications sometimes do occur.
It isn’t just me and my friends, it’s millions of women throughout the ages, throughout the world who have birthed at home, with midwives.
And who the hell cares whether Louis Pasteur was a man or a woman (not me, and was Marie Curie a “token”?, btw, seems insulting to imply that she was)? What matters is the theory saves lives.
Well, evidently Mythago cared which is why she posted that Semmelweis was a man, evidently as evidence that some male scientists and doctors have done good things for women (something I have never disputed and wouldn’t dispute.) But I can’t get too excited that a male doctor discovered a solution to thousands of deaths which male medicine caused in the first place. You know?
And these are feminist boards. It *matters* that male doctors’ practices killed women. It *matters* that women couldn’t BE doctors and address these women’s issues. It mattesr that women couldn’t BE scientists. And it isn’t going to do to say that a man discovered germ theory without ALSO reminding those reading that only a man *could* have because women were kept out of those disciplines.
Clearly you have vested much in your conspiracy theory of modern medicine=killing women, and doctors=greedy bastards who want to kill women out of sheer fun, and science=anti-female religion or something. Any and all evidence of contrary will probably be considered as biased because of male dominance on field of science (which fields? Women are doing great in science…)
Disclaimer: I am not dissing your choices in life, or midwifery, but this ridiculous bias does annoy the hell out of me.
It’s about history, Tuomas. It’s about what patriarchal medicine and science have in fact done to women through the ages. I am quite sure they never sat down and conspired to kill women and hurt women– as is almost always true of the way women are hurt under male supremacy, the damage was caused because women were marginalized, were kept out of the equation, because the perspectives were male perspectives, and were perspectives which celebrated male dominance over women. Meaning women were hurt and killed in droves and nobody meant it to happen. It happened because women were a subjugated underclass and were not valued in certain ways or were not valued at all. And that’s not about any “conspiracy” theory– that’s about history which is readily available for anyone to brush up on, which is why I posted that list of books.
Heart
This comment was written by Cheryl Lindsey Seelhoff.Report this comment to the moderators
June 29th, 2005 at 11:26 am
Cheryl;
I don’t think there is anything wrong in asking a woman about her choices, but I do think the tone taken by the mid-wife Mythago described was extremely inappropriate. I’d have been hard pressed in not telling the mid-wife to go diddle herself. It was a patronizing, disrespectful and unprofessional.
I think we all can agree that respecting a womans bodily processes and her choices are at the core of this issue, and that treating the woman as ‘a patient’ instead of an individual should be important to both doctors and midwives.
Come on Tuomas, that’s not at all what Cheryl said or implied. While she has staunch beliefs in birth and midwifery, you’re taking what she said and twisting it around in a really spiteful way.
This comment was written by Kim (basement variety!).Report this comment to the moderators
June 29th, 2005 at 11:43 am
The issue of maternal mortality is very complicated. Here is an article regarding the downward trend of maternal mortality from the 1930s forward, if you are truly interested.
http://www.ajcn.org/cgi/reprint/72/1/241S
“The beginning of the sudden improvement in
maternal mortality was in 1937 (Figure 1). In the first few years,
it was almost entirely due to the introduction of sulfonamides
and later penicillin, and this applied to other countries as well. If
the decline is plotted on a logarithmic scale, you get a straight
line. Richard Doll (personal communication, 1993) remarked
that this showed that the decline was not due to one factor but to
many. The factors that may have been responsible were, first,
sulfonamide and penicillin for infection; second, ergometrine
use to reduce postpartum hemorrhage; third, universal blood
transfusion; and fourth, much better cooperation and better medical
education and so on.”
The article talks in some detail about disastrous medical innovations, and how physician assisted births were associated with a higher maternal death rate from about 1870 through the 1920s (as exemplified by the fact that during that time period, upper class women were at greater risk of death than the working class, a complete inversion of the traditional state of affairs, the difference being attributable to access to physicians).
It was other developments — really, antibiotics and the ability to manage postnatal bleeding, along with the standardization of healthy practices through better education, that caused the steep decline in the maternal death rate from around 1935 onward. (It was pretty steady between 1890 and 1935.)
It’s also useful to keep in mind that a large component of OB-Gyn training and practice is surgery. I dated a surgeon for a long time. Surgeons love doing surgery (probably overall a good thing) but the downside for women giving birth is the impulse to find a surgical solution for just about any complexity. Some Ob/Gyns are starting to do versions now, so the cause is not hopeless, but depending on where you live you are swimming upstream in trying to change the focus of ob-gyns. And overall, they simply discount the importance to many women of giving birth vaginally.
Tuomas, it’s not a conspiracy theory. The experience of women on this score is remarkably consistent. I don’t talk excessively about patriarchal medicine, it usually doesn’t help, but medicine has often in the past and is even now often very — let’s say dismissive, if not exploitive — of women. The mother of a friend of mine woke up after giving birth and was told by her physician that he had tied her tubes because five children was enough for anyone. This was in 1965. That’s an extreme example, but it reflects an attitude that is chilling and not that uncommon (even if a practice as extreme as that was uncommon). Fear of litigation is just the latest justification, it’s just plain hard for doctors to cede control. Everything about their training demands that they assume control.
My biggest fear is, as Cheryl says, that I can talk until I am blue in the face but my OBs won’t listen to what I want once I walk into THEIR territory, even though they are very agreeable to doing a VBAC for now (I already did one — I am a tough nut to crack on the subject).
This comment was written by Barbara.Report this comment to the moderators
June 29th, 2005 at 11:48 am
Cheryl, Thank you for your response, here is mine:
Yes, I do realize we are indeed talking about health-care in America, and I too am baffled by the (by statistics at least, not to bash american doctors, there are societal factors…) low quality of American health-care. However, your accusations were aimed at modern health care as bad and anti-woman, and anti-child instead of midwifery which is supposedly superior. And the thing is… Scandinavian countries are big on modern health care. There is much distrust here against alternative medicines, and much trust toward doctors. And/but we are in the top 10. Consistently. So I think it is relevant to the question: Is the treatment that doctors give bad for you? (As there are some differences in american medicine and scandinavian ones, mostly minor ones about proper treatment in specific cases, the field of science is essentially same and many study books, anatomic pictorials etc. are from America. Germany is also big on study books…)
History of medicine is indeed filled with shameful stuff. I would not be the one to dispute, that perhaps in 1700 or 1800, or early 1900 the field was, what we would define as quackery and horrid treatments today. It is a very dynamic field of science and is constantly evolving, mostly towards being better. And I do agree with you that medicine may indeed have considered women as not important, and has had bizarre anti-woman, and racial biases. But for the love God, times have changed!
I mostly disagree with your solutions on the issue. I think you are too quick to dismiss modern medicine. What I would like to see, as an outside observer of course (but one whose probably primary concern among social issues is indeed health care), not polarization, or gender separation on the health care in America to pro- and antiwoman, or scientific and “natural”, but instead reclaiming the field of medicine from law-suit based medicine, or unwarrantedly surgical and demanding better health care from the powers that are. I see absolutely no reason to dismiss the field of medicine simply because it has indeed been very much influenced by patriarchal values in the past, and probably still is to a lesser extent. (Btw, did you see the comment I jokingly referred as “Marxist/Feminist”). But I do think that some of your concerns about american hospitals/doctors are valid. but you are seeing it, IMHO, too much in black and white terms.
This comment was written by Tuomas.Report this comment to the moderators
June 29th, 2005 at 11:49 am
Piny: Post please, paste from my words, where I called *anyone*, including Mythago, a liar. You won’t be able to. Because it didn’t happen. Meaning if anyone is “lieing”, it’s you. Mythago accused me of dishonesty and I responded to *that* accusation.
Piny: Furthermore, Mythago did not say that natural birth advocates asked her why she wasn’t using a midwife instead of an OB”“they asked her in an extremely rude way and then proceeded to rudely disparage her choices.
Here again are Mythago’s words:
Mythago: got very tired of bad science and scare tactics and distortions. I was injuring my eyeballs rolling them at people who said “You have an OB…instead of a *midwife?!?!”? And don’t even get me started on the outdated insistence on what “hospital practices”? are always like. There was the midwife who called me a sheep because I preferred to give birth at the local hospital’s comfortable, nurturing birthing center instead of my cramped high-rise apartment (you know, “at home”?).
Where is the “very rude way” part? And where did those people “rudely disparage” her choices? I think Mythago’s eyeball rolling was, arguably, as rude?
And I see here that it *was* Mythago who was called a sheep, complete with bleating noises, just not by her own midwife. I do have to take Mythago at her word — I was being facetious and smart-alecky when I said “don’t lie,” — but for the record, in all of my years around midwives and doulas, I have not seen anything like this, and that’s a lot of years, 33. Mythago also appears to be someone who can take good care of herself, I’m pretty sure she stands up for herself quite well, and in view of all the eye-rolling, possibly the midwife got pissed off and said some things she should not have.
And I could also post quite the lengthy list of horrendously offensive statements made by OBs and gynecologists to their patients, you know? Not to mention statements like, “If you don’t [do what they say] your baby will DIE.” When it isn’t remotely true. I could even talk about the ones who molest or rape their patients, for that matter, like this idiot out here where I live has just been found to have done, and lots of them, too, omething midwives just don’t do and never have, you know? I realize that patriarchal medicine is a sacred cow. Dr. Mendelsohn who wrote the books I posted up there referred to medical books as sacred texts, doctors as priests in vestments, hospitals as sacred in that that IS how highly they are regarded. While there *are* good doctors and there *is* good medicine, patriarchal medicine *has* in fact hurt women, and particularly birthing women. And sacred cow or no, that is something it is important for people to know about and change.
piny: That’s like the difference between asking, in a nonjudgmental way, why a woman does not breastfeed and behaving as though she might as well be giving her child toilet water cut with Drano. It’s like the difference between talking about all-natural foods and throwing a shit-fit when you see a woman giving her toddler Juicy Juice. Any sane reading of her descriptions”“one not based on a self-serving need to cut them apart because you can’t deal with an experience that doesn’t jibe with yours”“would yield that interpretation: she was insulted.
Yes, she was insulted. As, I’m sure, were women on the other end of the eye-rolling and all of the insulting language around natural birth and home birth and midwifery. I think some insults rise to the level of more than insults, though, I think some rise to the level of the oppression and subjugation of birthing and laboring women and their babies, and those are the insults I’ve described in my posts, and *none* of them are to be found in that paragraph there which you just wrote. It’s as though to be a judgmental woman (because male doctors, men, period are not judgmental, they are discerning, they are thinking critically and so on), is the worst possible offense. Never mind *real* offenses, the ones that injure, hurt or kill women or their children or deprive them of the birth experiences they want and have paid for; let’s focus on all those judgmental women talking about natural birth and home birth and midwives! Um, no. If it takes women being loud and strident and judgmental and even “cliqueish” and chutzpah’d as can be, such that it gets people talking and arguing and finally beginning, even against their will, to understand history and all that has happened to women in our history, at the hands of men, then I think that’s what it takes. So we’re judgmental sometimes. So someone gets offended or insulted. So what. Women are getting hurt every single minute of every day by doctors, my medicine, in real ways, nd that’s what is at issue in this thread.
Heart
This comment was written by Cheryl Lindsey Seelhoff.Report this comment to the moderators
June 29th, 2005 at 11:58 am
Barbara, cross-posted with you and I agree your concerns are valid on:
This seems to me a classic case of paternalistic, authoritarian and outright arrogant doctor. Study of medicine (in scandinavia at least) values a more cooperative approach, mainly because it seems to be more effective. Again, it seems to me that this is an issue in your (more) anti-woman culture affecting the field of medicine towards being biased, and thus NOT in the best interests of the patient which is the definition of good medicine. I am sorry if I’m getting off-topic with this, or nit-picky, but I cannot idly stand by watch a field of study that is about helping people getting painted in a negative light by these blanket statements.
This comment was written by Tuomas.Report this comment to the moderators
June 29th, 2005 at 12:04 pm
Kim (Basement Variety!):
Um, seeing this and my relevant comment I have to agree, it was snarky, straw-mannish and probably didn’t come across too well.
This comment was written by Tuomas.Cheryl: I apologize for that post, I’ll try to be more respectful in the future.
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June 29th, 2005 at 12:11 pm
Cheryl - How so? I didn’t say one word about pain”“ I think the pain of labor and delivery and postpartum is a complicated discussion, would require many posts to discuss, but birth being pleasurable, beautiful and peaceful says nothing at all about it being painless.
It is a matter of points of view. I cannot picture anything described as pleasurable, beautiful and peaceful, and picture extreme physical pain and discomfort in it.
It’s precisely the fact you described home birth without making any references to pain, after having talked hospital births as stories of pain and horror, that gave me the impression it is a very idealised view.
And that is also not an idealization”“ that’s the way it really *is*, the majority of time, for those of us who birth at home.
All right, then, again, I guess it’s different points of view, different experiences and preferences, and different notions of pleasure and pain.
I am glad it was such a beautiful experience for you and all the women you know that had home births. I just have my doubts it would be so for most women.
Now like Tuomas I’m not American so we’re speaking from different backgrounds here. I don’t have this experience of hospital care as a nasty, horrible thing with frantic rhythms and disregard for patients esp. pregnant women. Quite the contrary. (NB: I’m not saying I believe the US has horrible hospital care! I don’t think so, but I don’t have direct experience of it, I am just referring to the examples of ‘horror stories’ you mentioned, which of course can happen anywhere). Also, home birth was the done thing in my grandma’s times, in rural Spain. Out of necessity, not out of choice, or as a luxury (now women who *choose* to have home births - rather than have it happen unexpectedly, which is still more frequent - are wealthy people who can afford personal midwives and private assistance and so on. And of course, at a stone’s throw from the nearest city hospital so in case anything goes wrong they have that option too. Quite different from my grandma’s times again). Midwives were great, indeed, still, there are things that midwives alone couldn’t do. My grandma gave birth to seven children at home, two of which died for lack of care that today *is* the *basic* standard in any hospital. One was a premature twin - only the other one survived. They had hot water bottles to keep them warm, as home-made incubators… that is one reason I do tend to view medical progress as a good thing. Not horror stories of frantic hospitals and over-medicalisation and unnecessary procedures and awful episiotomies, of course I do agree those shouldn’t happen. But basic, decent medical assistance, I do view as a Very Good Thing.
So my view is biased that way. The fact those two babies died was entirely “natural” and “predictable” by the standards of care of her times and environment. Even without that kind of misfortune which used to be far more common than today, of course, yes, the pain itself is predictable and natural. I just think it’s a good thing that today we have the means to at least reduce all kinds of predictable and natural pain. I don’t see why ‘natural’ has to mean “good” when it comes to pain. To me, it doesn’t.
And this is exactly what I mean by straw man arguments. Maybe somebody else argued the above and I didn’t see it, I haven’t read really, really carefully, but I don’t see anyone here advocating for one-size-fits-all solutions or for doing something the “natural”? way for it’s own sake. Nobody has said any such thing here.
Nobody was putting up that straw man either. I was not attributing that “one-size-fits-all” view specifically to you or anybody else here, I only wanted to make it clear that I personally am not here to make any statements about what is *the* best option. I don’t think there is one, I think it depends entirely on a woman’s choice and her individual situation, health, finances, etc. I am only responding to what I personally see as a rather extreme black-and-white view of things that has home birth at one end as the ideal thing and hospital care on the other as the cause of all wrongs and even of pain itself. I am not telling anyone what to do, I am perfectly happy for everyone to make that kind of choice individually, of course. I simply have objections to the notion of “natural” as the best thing, and to the consequences of demonising other options. I also strongly disagree with the notion that medicine has not dramatically improved things for women giving birth and for their babies, because that is not my reality, in the world I grew up in.
This comment was written by noodles.Report this comment to the moderators
June 29th, 2005 at 12:13 pm
I mean, honestly. “If you don’t stop breastfeeding, your baby will, or even might DIE.” That is “judgmental.” And especially when it is spoken by someone with the authority to report a woman to child protection services, as recently has happened to women who refused c-sections.
I was told I had to stop breastfeeding because my child had jaundice. I knew this was bullshit. My babies always had newborn jaundice, they recovered nicely, and lots of breastfeeding HELPED their recovery. And of course 10 years later or so, we get the revelation: “Breastfeeding does NOT aggravate newborn jaundice.” Well, I knew *that*. Which is why I ignored my doctor when he told me my baby would “die” if I didn’t put her under the bili lights.
But that’s the kind of “judgmentalism” which concerns me– judgmentalism with teeth and issuing from the mouths of those with money, and power, and prestige in American society, people who can do real harm to women.
“Judgmentalism” in the form of women judging the likes of the above? I don’t think it’s judgmentalism at all. I think it’s a public service.
And yeah, Kim, the midwife should not have behaved like an asshat, I do actually agree.
Tuomas, one reason there is faith in medicine in your country might be that your country IS so progressive overall and its policies and laws so much more egalitarian and even favorable to women. That isn’t so in the U.S. and especially under Bush’s reign of terror, where women are losing their rights over their bodies steadily and daily, very scary.
Fwiw, I’m not so much about most alternative medicine, either? I don’t really understand midwifery or home or natural birth to be about alternative medicine. I am glad hospitals and doctors are around for broken limbs and big, bleeding gashes, and some diseases, and yes, for the times when a birthing woman really does need help. I am not opposed, iow, to doctors and hospitals. I just think that far and away, they are not woman-friendly or woman-centered, particularly, again, in the U.S.
Heart
This comment was written by Cheryl Lindsey Seelhoff.Report this comment to the moderators
June 29th, 2005 at 12:14 pm
>>Piny: Post please, paste from my words, where I called *anyone*, including Mythago, a liar. You won’t be able to. Because it didn’t happen. Meaning if anyone is “lieing”?, it’s you. Mythago accused me of dishonesty and I responded to *that* accusation.>>
Oh, here we fucking go again. Do you have a macro for this? You should consider it.
This is what you said:
>>But what she says just ratchets my level of suspicion up a notch. Now we have someone telling Mythago that her midwife made “bleating noises.”? I find that hard to believe, but if it did happen, I am betting it happened in some generic way, in the course of a general conversation, and Mythago’s friend took it personally, and here Mythago is suggesting that a midwife straight up told her friend she was a sheep complete with bleating noises. You will excuse my unwillingness to suspend disbelief I’m sure.>>
Now, it’s absolutely true that nowhere in this post did you call her a liar _using those exact words_, but objecting to what I said on those grounds is pretty fucking disingenuous.
Oh, look, I just didn’t call you a liar!
So let’s look at the section I quote above. You say that you’re suspicious of what she’s saying. Then you say, “I find [what she just said happened] hard to believe, but if it did happen, [it must have happened in a completely different context than the one she's implying].” Then you reiterate that you don’t believe what she’s saying. It’s sensible to assume that Mythago can read the words she’s typing, and there’s no reason to believe that she doesn’t know what impression she’s creating, so it’s purposeful on her part. You’re accusing her of lying, telling untruths, misrepresenting facts, misleading all of us, and so on. Call it whatever you like, but it is, too, calling her a liar.
Also, just so we’re clear, it’s not a second-hand report. This is what she says happened–not her midwife, but a midwife speaking directly to her:
>>There was the midwife who called me a sheep because I preferred to give birth at the local hospital’s comfortable, nurturing birthing center instead of my cramped high-rise apartment (you know, “at home”?).>>
This comment was written by piny.Report this comment to the moderators
June 29th, 2005 at 12:27 pm
Noodles: It is a matter of points of view. I cannot picture anything described as pleasurable, beautiful and peaceful, and picture extreme physical pain and discomfort in it.
Well, but I didn’t say anything about “extreme” physical pain or discomfort. I have had pain with my births, some more than others, but I wouldn’t describe it as extreme, in part because it wasn’t just pain– was part and parcel of something very beautiful– the birth of my children. Something long-awaited and anticipated and much desired. I think extreme pain more often accompanies births in hospitals, not only because of interventions, but also because of the way women must be removed from their familiar surroundings, are surrounded by strangers and strange procedures, and are made to be afraid ahead of time. Managing the pain of birth is mostly a matter of a woman being able to relax and feel safe and that’s not how it is for most women entering hospitals. They may feel “safe” in that they are in the hospital, but very fearful about what is going to happen to them, again, in large part because of what they have heard from other women.
But think about it: sports involves both discomfort, sometimes extreme pain, but also really exultant, good, happy, positive feelings, right? A personal best in running or lifting, say, training for and finally running a marathon, climbing a mountain — all of these involve discomfort and extreme pain at different points, but are nevertheless, in the end, often beautiful, pleasurable and peaceful. I mean, they don’t call the moment of birth a “mountaintop experience” for nothing! Yes, there might have been pain and discomfort, heck, frostbite, extreme cold, lots of fear along the way but when you get to the top, whoa, it was *so* worth it, the pain and discomfort are just not the most important thing. And the same can be true of birth.
As to your grandmother’s experience, agreed– there are times when moms have to be transported. Here in the U.S. midwives who birth at home always transport for twins or multiple births, largely because, as you say, twins often need extra attention from doctors that midwives aren’t qualified to provide.
Heart
This comment was written by Cheryl Lindsey Seelhoff.Report this comment to the moderators
June 29th, 2005 at 12:29 pm
Piny, I responded to all of that in posts 96 and 102. Try to keep up.
Heart
This comment was written by Cheryl Lindsey Seelhoff.Report this comment to the moderators
June 29th, 2005 at 12:38 pm
Cheryl:
Hmm. It seems to me that we have basically agreed on the issue all along, but it did take some straightening out misconceptions on both sides. With this, I don’t think it’s necessary for me to argue with you anymore. But, of course scandinavian health-care isn’t perfectly egalitarian either (if there would be a discussion on that, I’d be sure to throw in some studies and personal experiences from women here, but, off-topic and I’m lazy). :)
This comment was written by Tuomas.Report this comment to the moderators
June 29th, 2005 at 12:40 pm
[ftr, you're complaining that I didn't read a post that couldn't possibly have been available to read while I was writing. Moving on:]
>>And I see here that it *was* Mythago who was called a sheep, complete with bleating noises, just not by her own midwife. I do have to take Mythago at her word … I was being facetious and smart-alecky when I said “don’t lie,”? … but for the record, in all of my years around midwives and doulas, I have not seen anything like this, and that’s a lot of years, 33. Mythago also appears to be someone who can take good care of herself, I’m pretty sure she stands up for herself quite well, and in view of all the eye-rolling, possibly the midwife got pissed off and said some things she should not have.>>
Whoops, you’re right. I should have acknowledged that you re-read and took back the accusation that she was lying.
Sorry.
Instead, you switched to saying that (a) Mythago’s experience cannot possibly have any relation to the experiences of women as a whole, (b) she brought it on herself, what with the refusal to uncritically accept rhetoric she saw as inflammatory, inaccurate, and bullying, and (c) well, she should be able to withstand all the pressure and guilt-tripping, anyway.
Yeah, that’s much better.
This comment was written by piny.Report this comment to the moderators
June 29th, 2005 at 12:57 pm
but very fearful about what is going to happen to them, again, in large part because of what they have heard from other women.
I don’t know what y’all talked about when you were pregnant, but among every single woman I’ve talked to facing her first birth, the questions were not “What horrible things did they do to you in the hospital?” but “How bad did it HURT?!”
The only women I’ve ever had ask me fearful questions like “do they not let you drink water?” or “do you have to lie on your back?” were those who had been told these things by some “natural birth” person.
Cheryl can re-engage and say that she’s never heard those things in all her years, and I’m sure she hasn’t, because she’d sail right by them and not notice their bias neatly matches hers.
But perhaps it would be more helpful to women to stop the scare tactics (doctors will make your birth awful!) and making us doubt pretty much *everything* you say when you give out bad, outdated or unscientific advice. When a midwife tells me that hospitals will always be mean to you and make you give birth on your back, I’m that much less likely to listen to anything she has to say about C-sections.
This comment was written by mythago.Report this comment to the moderators
June 29th, 2005 at 1:07 pm
Cheryl, just very quickly because my dial-up connection is threatening to die, but at what point do you believe an MD should be involved in a birth? Not at home vs. in hospital, or vaginal vs. C-section, but in prenatal and postpartum care? Because I agree the woman should have control over what she would prefer to happen, but I also think that it is too easy to go the other way and rely solely on the midwife for the stuff that modern medicine does so well. Are most midwives not adverse to referrals if things don’t seem to be going well, like pre-eclympsia (sp?).
This comment was written by Lee.Report this comment to the moderators
June 29th, 2005 at 2:43 pm
And I suppose, Mythago, that the biases of the women you’re citing to don’t match your own. In fact, I published a magazine for 13 years, a big focus of which was conception, pregnancy, labor and delivery, birth, home birth, post partum, and a lot of what I know comes from the work I did then, including with columnists and freelance writers as well as just women who wrote to me, many, many. I heard from all sides, from your side as well as my side and all the sides around and outside of and in between.
And nothing I’ve posted here has been outdated, unscientific or bad advice. I think a *lot* of what you (and others) have posted here has been all or some of the above in addition to wrong and wrong headed. And you’ve neatly sidestepped all sorts of stuff that has soundly refuted pretty much everything you’ve had to say. So anyway.
Lee, in Washington — and I think this is the standard of care in the United States pretty generally, though I couldn’t swear to that — midwives who attend home births work closely with OBs who have agreed to step in if there is a need. I relied on my midwife to refer me when she felt she needed to. You agree at the beginning that if there are undiagnosed twins, persistent breach (meaning external version doesn’t turn the baby successfully), transverse lie (the baby lies across the cervix, neither head nor bottom down) or other unusual presentations (like a foot or hand presenting), or problems like placenta previa (the placenta threatens to deliver before the baby) or placenta abrutio (the placenta detaches from the wall of the uterus before birth, and a few other things, you will be transported to the hospital and one of the doctors who backs up your midwife will attend your birth alongside your midwife.
Midwives don’t typically attend women who are actually high risk, not talking now about “high risk” as the medical establishment understands it but by the lights of midwives. But in general, diabetes, heart disease, high blood pressure, and a few other chronic health conditions would mean midwives would likely not agree to attend a woman’s birth. So those are not usually going to be problems for midwife attended births.
Midwives handle late stage labor issues a little differently. They might be inclined to watch pre-eclampsia closely and not to send the woman off to the hospital as quickly as a doctor would. Broken amniotic sack is not cause for immediate induction and/or c-section. Women whose waters have broken can stay home and wait until labor begins without being induced. But where there are signs of real difficulty, midwives refer. One real benefit of midwife-attended home birth is, the midwives really knows her patients well, the patient she’s only her own midwife with rare exceptions, and hence, the midwife quickly picks up on whatever might be going wrong. Also, most midwives deliver all of their patients’ kids, so they become familiar with a woman’s own idiosyncratic patterns, i.e., some women’s pregnancies are 42 weeks, some 40, some are 38, some are 36 and that is normal for that woman (whereas doctors insist that pregnancy should be 40 weeks view anything earlier as premature and medicate-able or an emergency or as “late” requiring induction. Argh.
So, the short of it is, yes, midwives rely on doctors for back-up. :-)
It’s frustrating to me. Years and years ago in my magazine I published an article about how home birth became legal. One way it became legal was, doctors courageously defied hospitals and the medical establishment, generally. I published the sweetest story, maybe I have it at home and can post it, about a male doctor who was captured by home birth when he attended a birth on a nearby farm. From that time on, he attended home births, defying hospital rules. Over time, all of his peers and colleagues turned against him, dogged him, did all they could to undermine him, and finally he left being a doctor and became a carpenter. But he still attended home births. And his work and others in the organization he was part of persisted and eventually home birth became legal in his state.
Here I see that it’s as though none of that happened. Once again we’ve got a progressive, woman-centered doctor dogged and harrassed for helping women to birth in the way they choose. We’ve just lost so much. Very discouraging.
Heart
This comment was written by Cheryl Lindsey Seelhoff.Report this comment to the moderators
June 29th, 2005 at 2:48 pm
Ugh, sorry for this insane paragraph– I just don’t have the time to edit as I should. Here it is cleaned up.
***
One real benefit of midwife-attended home birth is, the midwife really knows her patients well, the patient sees only her own midwife, with rare exceptions, and hence, the midwife quickly picks up on whatever might be going wrong. Also, most midwives deliver all of their patients’ kids, so they become familiar with a woman’s own idiosyncratic patterns, i.e., some women’s pregnancies are 42 weeks, some 40, some are 38, some are 36 and that is normal for that woman (whereas doctors insist that pregnancy should be 40 weeks view and view anything earlier as premature and medicate-able or as an emergency or as “late”? requiring induction. Argh.)
***
Heart
This comment was written by Cheryl Lindsey Seelhoff.Report this comment to the moderators
June 29th, 2005 at 2:57 pm
Here is the link about a mother jailed for murder for refusing a c-section:
http://www.usatoday.com/news/nation/2004-03-17-mother-charged_x.htm
So you jail women who refuse c-sections, fire doctors who don’t do them enough, teach medical students to do c-sections in all sorts of situations, including when there are good alternatives, and then tell women they can come to the hospital and have the birth experience they choose. Right.
Heart
This comment was written by Cheryl Lindsey Seelhoff.Report this comment to the moderators
June 29th, 2005 at 3:23 pm
Cheryl: I would and did describe it as extreme pain and discomfort. I can’t see how it can be considered ordinary pain and discomfort. No comparison with any sport makes sense to me. Definitely not climbing, which is about effort, not pain (unless something goes bad).
You picked an interesting analogy there, it so exemplifies how our respective views of childbirth differ. Both in terms of physical pain involved - and we’re never going to agree on that! the more you talk about it the more idyllic and unrealistic it sounds to me - and most of all in terms of the idea of childbirth as achievement.
Say I didn’t manage to climb a peak I’d set out to climb, it would be natural for me to feel it was a failure, and that I could have done something this way instead of that way. I wouldn’t need to beat myself over it, but I could still think, damn, well I’ll train harder/plan better/wait for better weather conditions next time. OTOH, climbing is not a means to another end; it is the end, in itself. The whole thing is about the experience. It lasts hours, days. The journey is itself the goal. Not just getting to the top. Otherwise no one would climb and we’d all just take helicopters.
Wheareas for a pregnant woman who may even start out wanting a home birth and then either has to or chooses to go to hospital (c-section or not), I believe it would be truly horrible for her to feel that she has “failed” in not having a natural birth (as in the example someone above was making). I cannot see it as a kind of achievement. I personally don’t share that kind of focus on the act of childbirth itself because I honestly do not think it is that important in itself. I see it simply as a means to an end. To me the point is not the delivery as ‘experience’, but the wellbeing of the woman and of the child. So I really don’t think it makes any difference whatsoever how it happens and where, c-section, vaginal birth, hospital, home, whatever, who cares as long as the kid and the woman are fine and suffer as least as possible?
If I can plan it, if I feel and know that drugs and doctors are going to ease my peace of mind, then you bet I want drugs and doctors, and no amount of eulogising on the beauty of home birth is gonna cut it. I don’t care if someone else thinks I’m giving up on some peak that I should climb, it’s my decision to take, not theirs, and pregnant women could really do with less “this is the right way to do it” advice from all sides. It can all get a bit too much.
Some will feel more at ease at home, some will feel more at ease in hospitals. Some will want epidurals and drugs, some will want to do without. Some will want a vaginal birth unless absolutely impossible, some will want a c-section at all costs. What should matter, I believe, is that each woman is properly informed in realistic terms so that they can take the decision that makes them feel at ease on their own terms, not some supposed ideal, and that everything goes fine (a lot of which is of course like anything in life beyond the control of both doctors, midwives, partners etc. and the woman herself).
As to your grandmother’s experience, agreed”“ there are times when moms have to be transported. Here in the U.S. midwives who birth at home always transport for twins or multiple births, largely because, as you say, twins often need extra attention from doctors that midwives aren’t qualified to provide.
Yeah, but that wasn’t my point really. That works the same in Europe too, today, it’s a big step ahead from my grandma’s times - that was the point. The progress and increased availability of medical care even in (formerly) poorer rural areas. That medical care has allowed more children to survive and more women to go through childbirth with less risks and less pain. I don’t believe that can be denied.
Can I just ask two quick questions, you don’t have to reply but I’m genuinely curious:
This comment was written by noodles.- When you talk of home births, do you mean completely drug-free?
- Do you think women who opt for c-sections because they want to avoid stretching and tearing and the consequences on their sex life are also just being scared by horror stories (like you said of the ones who opt for c-sections to avoid the pain)?
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June 29th, 2005 at 3:28 pm
.And nothing I’ve posted here has been outdated, unscientific or bad advice. I think a *lot* of what you (and others) have posted here has been all or some of the above in addition to wrong and wrong headed. And you’ve neatly sidestepped all sorts of stuff that has soundly refuted pretty much everything you’ve had to say
It must be nice to live in a world where “I say so” is a refutation of all other facts and everyone else’s contrary experience. It is precisely attitudes like yours that led me to back away from the ‘alternative birth’ movement.
My ‘biases’ are towards actual facts instead of scare tactics, and focusing on what is really best for the woman–not on presenting an idealized birth experience and insisting it’s one size fits all. Not to mention candy-coating any discomfort or pain in childbirth and palming it off on ‘fear’ and ‘doctors,’ as though any woman who doesn’t have a Venus of Willendorf experience has nobody but herself and her choice of birthing assistant to blame for it.
And I am always amazed that some advocates of alternative birth really dis themselves: they don’t see, or don’t care to see, the absolutely profound effect they have had on the medical establishment. Do you think that hospitals had birthing centers 40 years ago? That women were encouraged to walk during birth, to have their partners present, or to keep their children in their room instead of in a nursery? That episiotomies are no longer considered safer than tearing? All that happened because women challenged doctors and made them listen.
But I guess it’s harder to scare women with horror stories about what the bad doctors will do to you if you admit that, yeah, we taught those doctors a few things and made them do things better.
This comment was written by mythago.Report this comment to the moderators
June 29th, 2005 at 3:31 pm
Years and years ago in my magazine I published an article about how home birth became legal. One way it became legal was, doctors courageously defied hospitals and the medical establishment, generally.
Now I’m going to sound dumb but I gotta ask: what do you mean “make legal”? It was illegal? Seriously? Illegal for women to have births at home (which sounds insane) or for doctors to attend (even more insane)?
I’d never heard of anything like that. How did it work?
This comment was written by noodles.Report this comment to the moderators
June 29th, 2005 at 4:22 pm
I not only SEE the “absolutely profound effect” advocates of alternative birth had on the medical establishment, Mythago, I *participated* in creating those effects, in all the ways you list and several more. And I am proud of that and talk about it all the time. But what I know *because* of my participation is that we can *lose* what we’ve gained, what we’ve won. And what I also know is that not enough has changed. And that there are people who don’t care about change, who would turn back the clock if they could and who are actively trying to do that. And what I also know — firsthand, not scare tactics, I have lived this and I have witnessed it with my friends, daughters-in-law in the births of my grandchildren, and others — is that women are STILL mistreated and violated during their births, that they are STILL not having the birth experiences they would like to have. We have barely scratched the surface of that part of this discussion, and I don’t have time to get into it. But in all sorts of ways, doctors do indeed intervene in ways which *cause* pain for women or *worsen* their pain. Nobody wants to talk about that. There is this idea that doctors have spared you, or other women, all of this pain, or that c-sections spare women pain or problems with their bodies, when in fact, that is just not true, for so many reasons.
Noodles, my mountain example was not about “achievement,” it was about the way pain and discomfort can coexist with pleasure and peace and wonderful experiences, about the way people who are working towards something, looking forward to it, often take a philosophical perspective towards the pain that might be involved. You may not think mountain climbers experience pain– I think that they do. And discomfort as well. And I also think that just as the journey is integral to the experience of getting to the top of the mountain, the same is true, for many women, as to pregnancy and birth. There are some women who love being pregnant but hate being moms. Or who love giving birth but hate being pregnant. Or who hate giving birth and being pregnant but love motherhood. So some women have babies as much for the journey of the pregnancy as for having the child at the end of it all. And there’s tons I could say about that. Well, there’s so, so much here that is important, so just know that for everything I write, I’m leaving out reams of stuff that I don’t have time to write. I mean, I am a gardener, and I experience plenty of pain gardening– I get sore muscles, I brush up against nettles, I scratch my hands and arms and legs, I get sunburned, I get exhausted, but when I’m done, I’m sure not thinking about all of that, I’m enjoying my garden. I do really think that pain and discomfort are part and parcel of many of the things people do which they very much value, find beautiful, peaceful and so on.
Despite the villainizing of advocates for natural and home birth which is ongoing in this thread — and I think it really sucks and should stop — advocates for home and natural birth do not, ime, suggest that if it doesn’t happen, that equals “failure.” A woman whose heart is dead set on a certain experience who doesn’t have that experience may feel as though she has failed, but that isn’t because of some trip home or natural birthing mothers have laid on her, that’s because she has suffered a disappointment and wishes things had gone better. Home and natural birthing people IME faithfully warn women that things don’t always go as planned, that it isn’t the end of the world if they don’t, they urge women to create Plans A, B and C so that they *don’t* get their hearts set on something that might not be possible, and in my experience, they offer tons of wise and seasoned encouragement that *includes* the ongoing reminder that we can never predict how these things will go, and that no birthing mom is ever a failure.
I don’t agree that medical care has allowed more women to go through birth without pain. I just don’t. I think medical care has improved infant mortality and maternal mortality in some ways, for some women and their kids, but has also caused lots of damage to women and their kids as well. Some of what appears to be improvements in infant and maternal mortality has to do do with the availability of birth control and abortion and with the fact that women actually *can* decide whether or not to become pregnant now, and how and when. In your grandmother’s day women and babies became sick or died more often in part because women didn’t have that choice– there was no birth control or ineffective birth control, the babies just came, whether the mom was healthy or not, no matter what the circumstances were, in the dead of winter when babies were born into the cold and couldn’t be kept warm enough, all sorts of things.
You think I have idealized birth, but you know what, I have given birth 11 times. I have attended friends’ a number of friends’ home births as well. I know very well what giving birth is all about. I asked this before and you didn’t answer, but how many births have you attended? Have you ever given birth yourself?
I think you have accepted the medicalized version of birth, this idea that birth is like a sickness to “treat” and a medical emergency to be survived and endured rather than a natural process — sorry, but pregnancy and birth *are* a natural, physiological processes, they are not illnesses, women’s bodies are made for them — and if that is your view, then of *course* you are going to think highly of all sorts of interventions. But those interventions *cost* women. C-sections result in lengthy and painful post-partum periods requiring lots of bed rest. A c-section is major surgery with all of the risks of major surgery as follows (and more) (and this is *information* , though Mythago, you probably will call it “scare tactics”):
***
Risks for the Baby
Premature birth. If the due date was not accurately calculated, the baby could be delivered too early.
Breathing problems. Babies born by cesarean are more likely to develop breathing problems such as transient tachypnea (abnormally fast breathing during the first few days after birth).
Low Apgar scores. Babies born by cesarean sometimes have low Apgar scores. The low score can be an effect of the anesthesia and cesarean birth, or the baby may have been in distress to begin with. Or perhaps the baby was not stimulated as he or she would have been by vaginal birth.
Fetal injury. Although rare, the surgeon can accidentally nick the baby while making the uterine incision.
Risks for the Mother
Infection. The uterus or nearby pelvic organs, such as the bladder or kidneys, can become infected.
Increased blood loss. Blood loss on the average is about twice as much with cesarean birth as with vaginal birth. However, blood transfusions are rarely needed during a cesarean.
Decreased bowel function. The bowel sometimes slows down for several days after surgery, resulting in distention, bloating and discomfort.
Respiratory complications. General anesthesia can sometimes lead to pneumonia.
Longer hospital stay and recovery time. Three to five days in the hospital is the common length of stay, whereas it is less than one to three days for a vaginal birth.
Reactions to anesthesia. The mother’s health could be endangered by unexpected responses (such as blood pressure that drops quickly) to anesthesia or other medications during the surgery.
Risk of additional surgeries. For example, hysterectomy, bladder repair, etc.
You can get blood clots in the legs, pelvic organs or lungs.
Your bowel or bladder can be injured.
http://www.pregnancy-info.net/c-section_complications.html
Medications to relieve pain during labor often don’t. Often, they are given late in the labor process when most of the hard work has already been done by the mother. Sometimes they have to be withheld because they slow down labor too much (usually because they were given too early, meaning a longer overall labor). Usually, I’d say, not enough medication is given to actually eliminate the pain of labor and birth. The mother still feels plenty. And I could say *so* much more, but I just don’t have time.
Noodles: - When you talk of home births, do you mean completely drug-free?
Yes. Midwives can’t prescribe drugs, though they do bring methergen in case of hemorrhage after birth (stops it immediately) and they bring topical anesthetic in case there is tearing (which there rarely is; midwives are skilled at helping women to deliver without tearing.)
Noodles: - Do you think women who opt for c-sections because they want to avoid stretching and tearing and the consequences on their sex life are also just being scared by horror stories (like you said of the ones who opt for c-sections to avoid the pain)?
Yes. Because (1) there is no need for a woman to tear while birthing, as I’ve already said– just takes an attentive midwife; it is induction of labor and the way it intensifies contractions which is more likely to cause tearing; (2) I don’t get what you mean by “stretching.” Women stretch to give birth and then they return to their pre-stretched condition. Women who do not return to their pre-stretched condition usually don’t because they tore (having to do with induction or attendants not attending properly or thoughtfully or carefully) or because their babies were birthed way too quickly (goes along with tearing) which is most often a function,*again* of having been induced. Tearing and stretching are *not* usually part of births attended by skilled midwives and so there is no reason to be concerned about consequences on the sex life. (And beyond that, for what it’s worth, not all women have heterosexual sex or the kind of sex that being “stretched out” would problematize.)
Heart
This comment was written by Cheryl Lindsey Seelhoff.Report this comment to the moderators
June 29th, 2005 at 4:24 pm
Now I’m going to sound dumb but I gotta ask: what do you mean “make legal”?? It was illegal? Seriously? Illegal for women to have births at home (which sounds insane) or for doctors to attend (even more insane)?
I’d never heard of anything like that. How did it work?
Yes, it was straight up illegal for women to birth except in hospitals. And even after it was made legal, it remained unavailable to most women because insurance companies wouldn’t cover the cost of the births unless they occurred in the hospital.
Heart
This comment was written by Cheryl Lindsey Seelhoff.Report this comment to the moderators
June 29th, 2005 at 4:33 pm
There is this idea that doctors have spared you, or other women, all of this pain
If you can tell me where I said such a thing, I’ll give you a dollar.
I don’t think doctors are gods. I don’t think midwives are goddesses, either. Sorry.
This comment was written by mythago.Report this comment to the moderators
June 29th, 2005 at 4:43 pm
noodles, it’s still illegal in some states for some health professionals to attend births at home.
As for everyone getting what they want, well, it’s nice to think that there is a happy medium — to have the possibility of required intervention if needed in a setting that halfway feels like home, with supportive attendants. Very few in a hospital setting feel compelled to do that for you. They are just too focused on their own needs, schedules, and so on. When did I finally realize this? Maybe it was when the l&d nurse was only coming in to see me in order to yell at me for screwing up the fetal monitor or maybe it was when the doctor refused to let me squat anymore while pushing, for his own convenience, or maybe it was when I realized that I had been mutilated by forceps and episiotomy that I probably never would have needed if I hadn’t been pressured into an induction. But, hey, I’ve got the most delicate c-section scar you can imagine (even my new OB commented on what good work it was).
As for the risk of sexual dysfunction — first, the pelvic floor gets weakened through pregnancy itself, and a c-section doesn’t change that, and can cause its own host of related issues (prolapse, weakened uterus). Second, if I am an example, the damage was clearly caused by the intervention of episiotomy and nothing else. Most natural tears heal well and don’t cause scarring, unlike mine. Third, I hope you don’t assume that vaginal expansion during the birthing process inevitably causes reduced sexual function. It doesn’t.
Your view that how one gives birth should be unimportant is your view. I respect it, but I don’t share it for myself. I do care. I think Cheryl is overstating the benefit of a home birth, but women shouldn’t have to give birth at home in order for their their needs to be met, their wishes respected, and their feelings validated.
This comment was written by Barbara.Report this comment to the moderators
June 29th, 2005 at 5:08 pm
but women shouldn’t have to give birth at home in order for their their needs to be met, their wishes respected, and their feelings validated
I couldn’t agree more.
I will, however, tell you that part of the doctors’ malpractice fears is that they will be punished for agreeing with the patient.
“But she didn’t want a C-section.”
“You’re the DOCTOR. You’re the expert. She was a laboring woman in pain who didn’t have your medical knowledge. How could you go along with her decision instead of doing what you knew to be the medically-appropriate thing?
This comment was written by mythago.Report this comment to the moderators
June 29th, 2005 at 7:09 pm
I think you have accepted the medicalized version of birth, this idea that birth is like a sickness to “treat”? and a medical emergency to be survived and endured rather than a natural process … sorry, but pregnancy and birth *are* a natural, physiological processes, they are not illnesses, women’s bodies are made for them … and if that is your view, then of *course* you are going to think highly of all sorts of interventions.
Now that is a straw man, Cheryl. “If that is your view” - no it isn’t. I didn’t say or imply that.
Like I said, I am not interested in advocating any “right” way for anybody. I’m for freedom of choice on everything. I respect all individual choices - that doesn’t mean I have to embrace them personally for *myself*, to respect them when *others* take them. Precisely because women’s bodies are made for them. Not for doctors, not for midwives, not for natural birth advocates, either. Each woman’s informed choice is her own and she has a right not to be pressured or scared or judged, either way, from any side. I guess we all agree there.
What I have trouble with is preaching, which seems to be what you’re doing here. It comes across very strongly that way, Cheryl.
Just because I don’t personally share *your* notion of giving birth as some beautiful pleasant experience where pain is negligible, you have to tell me I have been brainwashed into “accepting the medicalised version of birth”. That’s a bit of a Tom Cruise thing to say, you know, him and his powerful antidepressant vitamins…
(NB: absolutely no childbirth-depression comparisons intended, nor between natural childbirth advocates and Scientologists, not even close. Just between that black/white binary kind of reasoning. Like, to someone vehemently committed to convincing others that drugs are bad, all you need to do to become a supporter of the most business-driven and prescription-happy form of psychiatry is to dare suggest that perhaps sometimes pills are useful if you’re suicidal. God forbid!! Have this orange juice instead, woman!)
Now, I am glad you had your children without any help from chemistry or surgery and that you were happy with it. I did not say you were a fool for doing that. How could I? I am not you, I cannot and do not feel any desire to tell you what you should do. I also did not say that no one should do what you did. I am only speaking my own mind on my own choices, what I consider good for me, and might not be good for someone else, because I do not believe there is a universal “best” here.
For myself, I do appreciate the options of avoiding or reducing pain, as well as risks and complications.
I do not appreciate people considering my own capacity to choose for myself impaired because of making a different choice than they did.
The pain is what can be reduced by drugs. Pain itself doesn’t make childbirth an illness, no. But natural childbirth pain doesn’t make that pain any less painful.
Between “childbirth is an illness” (which I did not say or imply even remotely and obviously do not believe) and “childbirth is a pleasant peaceful experience whose pain is secondary and comparable to that you experience in gardening”, there’s a whole range of things that are actually within reality. My idea of reality at least. Everything is relative.
What isn’t relative but fact is that women who have access to modern health care are having less trouble with pregnancy and childbirth than women who didn’t, in the past, or still don’t, today. Globally. Less children die as a result of better health care. Less malnourished children are born when mothers have access to modern health care. No one needs to be an apologist of the kind of problems you criticise in the way a particular medical system may work, to acknowledge that.
This comment was written by noodles.Report this comment to the moderators
June 29th, 2005 at 7:25 pm
Your view that how one gives birth should be unimportant is your view. I respect it, but I don’t share it for myself. I do care. I think Cheryl is overstating the benefit of a home birth, but women shouldn’t have to give birth at home in order for their their needs to be met, their wishes respected, and their feelings validated.
Barbara, I absolutely agree, you summed up my point in a nutshell.
And yes, that was my view only, of course, I appreciate you respecting it!
(anyway that “the how is not important” was above all in relation to the wellbeing of mother and child. In itself, it is of course important to make the choice one feels comfortable with, but in the end it really doesn’t *define* you as a mother and it doesn’t matter as much as baby and mother being healthy).
I am sorry to hear you had that kind of nasty experiences. I can even barely picture that kind of thing.
I hope you don’t assume that vaginal expansion during the birthing process inevitably causes reduced sexual function. It doesn’t.
No, but I know women who had trouble getting back into shape, so to speak, especially after multiple births. It never went back to the way it was before.
This comment was written by noodles.Report this comment to the moderators
June 29th, 2005 at 7:47 pm
Cheryl, thanks for the replies to the two questions - and on the illegal thing too, I really had no idea it used to be like that.
On the sex thing again - well… I imagined you’d consider that concern unnecessary and paranoid. But it’s not necessarily true that for women who do not “return to their pre-stretched condition” it has to be because of particular complications or effects of hospital intervention that skilled midwives can avoid. For one thing, the baby can simply be big and take longer to deliver. There is no 100% returning to pre-birth conditions anyway, is it?
And beyond that, for what it’s worth, not all women have heterosexual sex or the kind of sex that being “stretched out”? would problematize.
Well yes, but knowing that is no use to women who do have that concern in the first place. Even heterosexual women do not only have vaginal sex, still, you know, it’s nice to know it’s there and hasn’t turned into the Channel Tunnel to steal a certain Julie’s words.
This comment was written by noodles.Report this comment to the moderators
June 30th, 2005 at 11:02 am
Cheryl, thanks for answering my question. Since both of my pregnancies were considered high-risk, I had a high degree of medical monitoring and never really considered home births. I asked because the media usually only covers the awful outcomes. One of my former neighbors had 4 kids, all at home, and her mother, who was a nurse-practitioner, was also her midwife. However, within hours of the birth, she always went to the hospital to get the baby and herself checked out and make sure the postpartum stuff all went OK. On the other hand, my friend’s sister-in-law had a midwife who I think must have been unlicensed or something, because despite some clear warning signs that things were not going well, she never saw a doctor and the baby died within a week of birth. (I think this one was written up in the Chicago Tribune.)
This comment was written by Lee.Report this comment to the moderators
June 30th, 2005 at 12:42 pm
noodles, unfortunately, I don’t think my experience was atypical. Even as of two or three years ago, something like 70% of first-time mothers were still being subjected to episiotomies in many parts of the country. That’s why ACOG and others keep publishing studies, because the failure to change this practice is truly inexplicable.
I have no doubt even a “normal” birth has complications. But so does a c-section, and the studies are pretty much consistent that the complications of the latter outstrip the incidence of complications for the former.
I could go on and on why the typical birth experience is harder on women physically than it needs to be, but with respect to damage to the vagina there are two things that are key: failure to do Kegel exercises and otherwise prepare the perineum for the experience, and the insistence in many settings that the pushing phase should be conducted with a level of exertion that is normally reserved for olympic events (i.e., forced, fast paced breathing accompanied by active rather than “instinctive” pushing, the latter being exacerbated by epidurals and forced lithotomy positioning that requires the woman to work against gravity).
This comment was written by Barbara.Report this comment to the moderators
July 2nd, 2005 at 1:57 pm
Arrgghhhh… where to start?
“First of all, induced labors are really, really painful labors, far more painful than labors which come on in their own good time.”?
This is not correct. Studies have shown that women who are induced are no more likely to request an epidural than women who enter the hospital with spontaneous labor.
“Second of all, induced labors often go on and on and on and on interminably, because how much medicine to be given to any individual woman is always a crap shoot, so the doctors give not so much and the labor goes on and on, and the woman gets exhausted, and then either she is begging for a c-section because of weariness and pain or she is bumping up against hospital rules about duration of labor.”?
This is not correct. You need to understand that there are two types of induction. The first type of induction is one where there is a medical need such as hypertension or preeclampsia. In these inductions, it is imperative for the doctor to proceed with the induction regardless of the state of the cervix. This is when prolongation of the pregnancy outweighs the risk of c-section from a failed induction.
The second type of induction is the “elective induction”. Studies have shown that in a private hospital (not a teaching hospital) that women who are electively induced have a lower c-section rate than if they in turn labor spontaneously. Also, labor is 30% shorter in duration.
“When the reality is, you know what? Birth can, does and most often will occur peacefully and beautifully and pleasurably as a continuation of the process which began right where the birth takes place: in a woman’s own bed, in her own room, in her own home.”?
The key word is “most often”. For every story that you can quote about a horrific hospital delivery….. I can tell you as story of women brought into the hospital after laboring for three days at home with a midwife and the baby dies in the NICU due to sepsis. Or a midwife who allows a patient to push for six hours straight and then brings the patient the hospital where the doctor on call has to perform an emergency c-section for fetal distress. And then there are the cases of placenta abruption or cord prolapse which are brought in by ambulance only to find the infant stillbirth on arrival.
“The c-section rate went up way before the so-called “malpractice crisis.”? That too is a bogus explanation.”?
There is a direct correlation between the c-section rate in United States and the number of malpractice suits.
For example, last night a doctor was involved in a difficult delivery and the family was insistent on a vaginal delivery. This was a normal, natural non-induced labor. The baby was in a persistent occiput transverse position. The doctor offered a c-section and the patient\family refused. After three hours of pushing, the baby was low enough that the doctor could rotate the head using forceps and then finish the delivery with a vacuum extractor. The baby weighed 9 lbs. 6 oz. The family was very happy.
Now, if this baby develops any type of seizure activity, developmental delay or any other type of problems that might be related to the delivery, for the next 18 years, there will be a line of attorneys drooling at the opportunity to sue this physician.
“She (the doctor) was wrong to allow the patient to push for over two hours”
“She should have known the baby was too big”
“The doctor should never do a combined forceps/vacuum extractor delivery”?
…. and on and on and on……
“The majority of studies report that in the rare event of a uterine rupture, if the labor was carefully monitored, the birth attendant was trained to attend VBAC births, and if the medical response was rapid, mothers and babies do well. The focus should be on improving the quality of care for women who want a VBAC, not on discouraging them because of negative outcomes publicized in high profile medical malpractice law suits.”?
This is very easy for someone to say if they are not the ones that are being sued. In my state, the largest insurer of physicians has recently stated that if the doctor is sued for a VBAC delivery it will not be covered. The other insurance company covering physicians state that for them to defend a bad VBAC delivery the following must have occurred.
1. There had to have been in-house anesthesia dedicated to the patient for the duration of her labor. This means an anesthesiologist would have to be on the unit, with no other duties, other than being available one patient.
2. There had to have been an in-house OR team dedicated to the patient for the duration of her labor.
3. There had to have been a dedicated OR suite setup and dedicated to the patient for the duration of her labor.
4. There had to have been an obstetrician in-house and immediately available to the patient for the duration of her labor.
Then if all of these things occurred and there was a bad outcome, the insurance company would defend the doctor. I used to love doing VBAC’s and never had a bad outcome although I did observe bad outcomes of other physicians. It finally came down to the fact that the risk was too much for me to accept. Every time I did a VBAC delivery, I was putting at risk everything that I owned and had saved for the future of my family. VBAC’s became a thing of the past when they became the 3rd most common reason for a malpractice lawsuit. As physicians, most of us believe the patient should be able to accept whichever risks they feel appropriate. This is America and people have the right to make own decisions. The problem comes in the doctor gets sued because the patient made the wrong decision.
“The hospital threatened to watch her number of *collarbone fractures*, a common event in vaginal deliveries, that almost always requires no treatment, and that people don’t sue over.”?
This is wrong. A fractured clavicle is not a common event (4 per 1000 deliveries in a teaching hospital).
“The real problem is that parents with injured and sick infants have no safety net to fall back on to obtain expensive care, UNLESS they can prove that the doctor or hospital is at fault.”?
This is a very true statement because all malpractice is about the money. A recent study in West Virginia asked the question, “If you ever were to become wealthy, how would it occur?” The answers were 1. Through inheritance 2. Win the lottery 3. Win a malpractice case.
“?Low birth weights are a huge concern and associated with high infant mortality. But *higher* birth weights are a GOOD thing, which is what makes that hospital’s letter so incredible. The goal with pregnant women is always to ensure that they birth when their babies are big enough.”?
This comment was written by Doktor.Higher birth rates are a good thing if you’re comparing a 4 pound baby with a 7 pound baby. It is not a good thing if you’re comparing a 7 pound baby with a 9 pound baby. A 9 pound baby is not healthier than a 7 pound baby… it is just a more difficult delivery for the mother and baby with an increased risk of trauma to the mother’s birth canal and trauma to the baby.
“I have two friends who have birthed soldier dystocia babies at home with midwives … one weighing nearly 12 pounds … and there was no problem.”?
Defending this statement is like saying my four-year-old child once ran across a busy street and made it safety to the other side so therefore it is safe for all four-year old children to cross a busy street. Anecdotal stories mean nothing.
“Midwives are trained to deliver babies with shoulder dystocia whereas MD’s usually are NOT.”?
Give me a break! This statement is just is just silly.
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July 2nd, 2005 at 2:42 pm
Nah, you give me a break, Doc. Anecdotal stories mean nothing to YOU. But they mean everything to women because as against patriarchal medicine, and those trained under male supremacy, and those whose biggest concern is being sued, those are the stories that matter to US. Those “anecdotal stories” represent *our lives*, they are the stories patriarchal medicine *does not publish* and does not *value*.
And I think what you’ve posted there is damn silly– MOST of it. And wrong. And for every “study” you cite to I could do you one better. And I could refute, at length, everything you’ve said up there. I might if I decide it’s worth it to me; for now, you’ve represented patriarchal medicine well, as you’ve been trained to do. Which doesn’t mean that anything you have had to say is true, or especially, that any of it reflects women’s reality.
Heart
This comment was written by Cheryl Lindsey Seelhoff.Report this comment to the moderators
July 2nd, 2005 at 4:08 pm
Not to pick on Doktor too much, but not everyone agrees with him/her that it’s fear of malpractice that’s most likely to prevent obstetricians from providing women the full spectrum of choices they deserve when birthing :
http://www.citizen.org/pressroom/release.cfm?ID=1805
*
A University of California-San Francisco (UCSF) study of New York doctors found that the main reason doctors cease providing obstetrics care is advancing age.UCSF researchers studied the effect of liability premiums on doctors’ behavior, the only such study trying to show such causation that we know of. The study, of New York state physicians during the mid-1980s insurance crisis, found no association between malpractice premiums and doctors’ decisions to quit.[5] The study did find that the decrease in doctors practicing obstetrics was associated with the length of time since receiving a medical license in New York. This relationship “very likely represents the phenomenon of physicians retiring from practice or curtailing obstetrics as they age.”?[6]
*
Obstetricians frequently cut back their practice as they advance in years.As doctors become more financially secure, and as the child-bearing years of their patient population pass, many obstetricians give up the demands of delivering babies in favor of concentrating on the gynecological needs of their patients. For example, in 2000, 18.7 percent of Georgia’s OB/GYNs were between 40 and 44 years old, but only 11.1 percent of OB/GYNs were 50-54 years old ““ a decrease of about 40 percent.[7]
*
This comment was written by alsis39.A North Carolina survey found that the main reasons doctors decreased their obstetrics patients were unrelated to fear of lawsuits.The authors note that while some providers whose obstetrical patient volume had decreased cited fear of lawsuits as a factor, “…[T]his was not the overwhelming reason for stopping or planning to stop deliveries.The strain and inconvenience of the practice and problems with burnout also were issues.”?[8]
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July 2nd, 2005 at 6:29 pm
Since more women are in medical school than men and at this point about 30% of all Ob’s are women….. who will you scapegoat when you don’t have the “patriarchal medicine” to go after…. the matriarchal medicne?
This comment was written by Doktor.Report this comment to the moderators
July 2nd, 2005 at 6:51 pm
alsis, that doesn’t really address the C-sections out of a fear of malpractice issue.
Oh, dear, Doktor, you really had me supporting you up until that last post. And I’m a lawyer.
Which doesn’t mean that anything you have had to say is true, or especially, that any of it reflects women’s reality.
I might say the same to you, Cheryl. If anecdotes are truth, then it’s ludicrous of you to say that those supporting your point of view are clearly true but any women whose experience is different is merely brainwashed by the patriarchal medical establishment.
This comment was written by mythago.Report this comment to the moderators
July 2nd, 2005 at 8:22 pm
Actually I think it is fear of malpractice suits that make doctors choose C-sections.
In South Florida:
The fear that drives them to perform c-sections on four out of 10 mothers is delivering a baby with brain damage. Obstetricians once believed that sparing babies the trauma of passing through the birth canal would drastically cut the rate of cerebral palsy and mental retardation. More recent studies have proven that brain disorders are rarely related to childbirth, and that the surge in cesarean deliveries has not diminished the incidence of cerebral palsy.
Obstetricians know of the studies, yet they also know how easily jurors can be swayed by testimony from “medical experts” who’ll say that if the doctor had only done a c-section, the baby would have been fine.
From the ACOG
# According to the Delta Democrat Times, 324 Mississippi physicians stopped delivering babies in the last decade. Only 10% of family physicians deliver babies.
# In the ACOG practice change survey, 86.2% of responding Nevada ob-gyns indicated that they have changed their practices, with 27.59% dropping obstetrics.
# As of October 2002, according to Clark County, Nevada OB-GYN Society, only 80 private practice physicians, 14 HMO physicians, and 12 residents are doing deliveries, totaling 106 doctors. With an estimated 23,000 deliveries expected in Nevada in 2003, each physician will have to deliver 216 babies.
# According to the Star-Ledger, “An obstetrician with a good history — maybe just one dismissed lawsuit — can expect to pay about $45,000 for $1 million in coverage. Rates rise if the physician faces several lawsuits, regardless of whether the physician has been found liable in those cases.”
# The president of the New Jersey Hospital Association says that rising medical liability premiums are a “wake-up call” that the state may lose doctors. Hospital premiums have risen 250% over the last three years, and 65% of facilities report that they are losing physicians due to liability insurance costs.
# In the ACOG practice change survey, 67% of responding New York ob-gyns indicated that they have changed their practices, with 19.28% dropping obstetrics.
# In 2000, there was a total of $633 million in medical liability payouts in New York State, far and away the highest in the country, and 80% more than the state with the second highest total.
# One-quarter of respondents to an informal ACOG poll of Pennsylvania ob-gyns say they have stopped or are planning to stop the practice of obstetrics. 80% of medical students who come to the state for a world-class education choose to practice elsewhere, according to the Pennsylvania State Medical Society.
# On April 24, 2002, Methodist Hospital in South Philadelphia announced that it would stop delivering babies due to the rising costs of medical liability insurance. The labor and delivery ward closed on June 30, leaving that area of the city without a maternity ward. Methodist Hospital has been delivering babies since its founding in 1892.
So, when there is a shortage of doctors to sue, will midwives become the next targets? Because nothing bad ever just happens, there has to be someone to take the blame and pay the bills.
Midwives earn on average $41,500 to $52,000 annually, topping out at $65,000, according to the University of Missouri Career Center–less than half of the $133,450 earned by obstetricians, according to the Bureau of Labor Statistics. The insurance plan endorsed by the American College of Nurse-Midwives costs from $7,000 to $32,000 per year, depending on experience, education and location. New York, and Florida are two of the priciest states to practice.
The doctors and hospitals go out of business because they can’t afford the insurance. Next it will be midwives who can’t afford to practice.
Doctors are not evil people out to cause women pain. They are just folks trying to work within a system that makes it hard or impossible for them to do their jobs in as good a fashion as they would like. Midwives are not saintly creatures who magically make child birth pain free and safe.
The problem isn’t the medical community, it is the folks who sue right and left with some strange idea that it’s free money they deserve because something bad happened. Sometimes bad things just happen. Sometimes it is no ones fault.
This comment was written by mousehounde.Report this comment to the moderators
July 2nd, 2005 at 9:46 pm
Obstetricians know of the studies, yet they also know how easily jurors can be swayed by testimony from “medical experts”? who’ll say that if the doctor had only done a c-section, the baby would have been fine.
Interesting use of quotes, given that those ‘medical experts’ have to be, um, medical experts. Not that doctors themselves would hire their own medical experts to contradict that, either.
The medical malpractice crisis isn’t anything like doctors believe it is–but they’re paranoid, and they’re convinced they’d get sued, and it only takes one time in court to convince them that it’s better to cut Mom open than pay her millions of dollars later.
By the way, the line about how frivolous lawsuits are lottery tickets driving up insurance rates is crap. Insurance companies are very happy you believe it, but as a plaintiff’s lawyer, I get pretty fucking tired of telling some people that they should accept reasonable settlements–because they’ve heard all these stories about “an injury is a lottery ticket” and they want to know where their million bucks went.
This comment was written by mythago.Report this comment to the moderators
July 2nd, 2005 at 9:54 pm
The problem isn’t the medical community, it is the folks who sue right and left with some strange idea that it’s free money they deserve because something bad happened. Sometimes bad things just happen. Sometimes it is no ones fault.
Actually, if you believe P.C., the problem is neither of these things. It’s the insurance companies:
http://www.citizen.org/congress/civjus/medmal/articles.cfm?ID=8101
“Suing right and left,” isn’t actually all that common. Hikes in malpractice rates have more to do with insurers passing on costs to doctors to make up for tanked investments in the aftermath of the internet bubble bursting– And less to do with some supposed gigantic upsurge in patients suing by the truckload.
It’s interesting that this impression you give, Mythago, thrives all over the U.S., amongst citizens of many political stripes. As with the brouhaha about the supposed imminent bankruptcy of Social Security, “Welfare Queens,” and so on, it points out the degree to which the center political discourse regarding social issues has continued to shift more and more to the right, toward favoritism to corporations and against that of the individual.
I was unable to find any direct corolation between the prevalence of Caesarians and fear of malpractice at P.C. (Though I didn’t have unlimited time to search, either.) But I don’t think it’s out of the question that Caesarians, like other medical procedures, may simply be serving as a convenient excuse for insurers to jerk around both doctors and patients. If you’re curious, here is one of the press releases that P.C. issued regarding Caesarians:
http://www.citizen.org/publications/release.cfm?ID=6930
This comment was written by alsis39.Report this comment to the moderators
July 2nd, 2005 at 9:57 pm
My comments should have been adressed to mousehounde, not Mythago. My apologies. :o
This comment was written by alsis39.Report this comment to the moderators
July 3rd, 2005 at 11:53 am
Me, Cheryl: Which doesn’t mean that anything you have had to say is true, or especially, that any of it reflects women’s reality.
Mythago: I might say the same to you, Cheryl. If anecdotes are truth, then it’s ludicrous of you to say that those supporting your point of view are clearly true but any women whose experience is different is merely brainwashed by the patriarchal medical establishment.
Uh, Mythago, who said anecdotes are “truth”? Not me. And you know, it seems like frequently argue with me over points I never made and things I never said. And I wish you would stop doing that.
The good Doktor said that anecdotal stories “mean nothing.” In response, I didn’t say that anecdotal stories are “truth” — mine, yours, his anybody’s. I said that anecdotal stories mean *everything* to the women whose lives are the stories. They do not “mean nothing.” Women’s stories are women’s stories; they matter. They are a picture of our realities. And yes, our stories differ.
I went on to say that he represented patriarchal medicine well, which diddn’t mean that what he had to say was true or reflected women’s reality. Which had nothing to do with whether or not anecdotal stories are “true.”
The truth is, I could demolish that post Doktor wrote there, honestly. And I still might. But it’s the 3rd of July and everybody comes to my house on the 4th; hence, I have to decide if it’s worth my time. And one thing that discourages me *is* your habit, Mythago, of responding to my posts as though I said things I never said. I don’t have the energy to straighten it all out time and time again.
Heart
This comment was written by Cheryl Lindsey Seelhoff.Report this comment to the moderators
July 3rd, 2005 at 1:10 pm
And one thing that discourages me *is* your habit, Mythago, of responding to my posts as though I said things I never said.
Boy howdy, I’ll sign up for that club. You can be President if I can be Treasurer. (Always go for the money, momma said.)
This comment was written by Robert.Report this comment to the moderators
July 3rd, 2005 at 5:17 pm
alsis39 said:
alsis39, thank you very much for the links. I would have bet money that it was high awards in malpractice suits that were driving up insurance costs. I appreciate you taking the time to point those cites out to me.
I went poking around and found : this
Data from the Physician Insurers Association of America indicates that in 2003 almost as many lawsuit claims were closed out (through settlement or jury verdict) against ob-gyns as against internists–992 and 1100. But ob-gyns comprise a much smaller segment (about 5 percent) of the total physician population than internists (about 17 percent.)
The American College of Obstetrics and Gynecology says 75 percent of its members have been sued at least once. In 2003, the organization surveyed a portion of its membership and found that, as a result of lawsuits or the fear of lawsuits and high medical liability insurance costs, 22 percent of respondents reduced the number of high-risk obstetric patients they accepted, 15 percent stopped doing vaginal deliveries for pregnancies subsequent to a Caesarian section and 14 percent stopped practicing obstetrics altogether, but kept their gynecology patients.
—–
In an effort to avoid being sued, obstetricians are increasingly delivering babies by Caesarian section, if fetal monitoring shows the slightest abnormality. But the increased C-section rate in the United States–now at 26 percent of all live births, according to the National Center for Health Statistics–has not reduced neo-natal mortality or the occurrence of cerebral palsy, a birth outcome that has prompted many of the lawsuits.
So, it seems like regardless of whether malpractice suit awards are raising cost of insurance [seeing as how they account for only 2% of overall health costs] the costs are rising. And the fear of being sued does cause an increase in c sections. One site I found said that while insurance costs across the board had risen 15%. For OBGYNs and internists the costs had risen 22 - 33% respectively.
In Dade County Florida the cost of malpractice insurance for OBGYNs can be as high as $277,000 per year, with the average being $195,000. It won’t be long and everyone who wants to have a baby will have to travel to Oklahoma, with average malpractice insurance costs of $17,000, because that’s where all the doctors will be. :D
I have learned a whole bunch of stuff I never knew on this thread. Thank you for posting it, Ampersand.
This comment was written by mousehounde.Report this comment to the moderators
July 3rd, 2005 at 5:55 pm
Bean said:
Ummm, yes? Because if you don’t know why something is happening, you can’t fix it.
This comment was written by mousehounde.Report this comment to the moderators
July 3rd, 2005 at 7:53 pm
:o No prob, mousehounde. You know the old joke/proverb: “I’m only smart now because I’ve been stupid before.” :D
I have learned a whole bunch of stuff I never knew on this thread. Thank you for posting it, Ampersand.
Me, too.
This comment was written by alsis39.Report this comment to the moderators
July 3rd, 2005 at 9:12 pm
To mousehounde
“More recent studies have proven that brain disorders are rarely related to childbirth, and that the surge in cesarean deliveries has not diminished the incidence of cerebral palsy.”
That is true but it doesn’t stop a suit from being brought or sway a jury. In my experience, a malpractice case in more about emotion than fact and when they bring a child with CP into the court room and play a scripted video about “The Day in the Life of _____”, the facts become overwhelmed by the emotion of the moment. Does anyone really believe that the normal person of the street can be made to understand the complexities of acid-base balance, fetal monitoring and the role of cytokines in intra uterine infection in 5-7 days to the point that they can decide a case? Is a state worker at the DMV or a retired aircraft mechanic really constitute a jury of my peers?
“Next it will be midwives who can’t afford to practice.”
Sadly, this has already happened in OKC where the one free standing midwife clinic closed after 1 lawsuit raised the malpractice rates to the point they couln’t work.
“It won’t be long and everyone who wants to have a baby will have to travel to Oklahoma, with average malpractice insurance costs of $17,000,”
I wish this were true but as a practicing doc in Oklahoma City, I can tell you that for Ob’s the cost of malpractice is around $85,000 this year. $17,000 may be true if you average in the family practice docs.
——–
I understand the value of anecdotal experiences for the individual but do you really want a doctor to practice medicine based on ancedotal stories?
This comment was written by Doktor.Do want a doc to say ” I have delivered babies vaginally that weighed close to 12 pounds without any problems”
or
“The risk of birth trauma to a baby who weighs over 10 pounds is 25% if it is born vaginally?”
Now if this were Las Vegas… I would love to have 3 to 1 odds in my favor but in obstetrics, injurying 1 big baby out of 4… is unacceptable, IMHO.
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July 4th, 2005 at 9:36 am
And you know, it seems like frequently argue with me over points I never made and things I never said.
Eerie! I was thinking the same thing about your posts.
And yes, our stories differ.
That’s *not* what you originally said. When you talk about “women’s stories” and “women’s reality” as oppoosed to “patriarchal medicine,” you sure as hell aren’t saying our stories differ: you’re saying there’s a single reality for women (all women).
You also keep talking about how you won’t engage (but then you do) and how you don’t have the energy to argue (right after you post a response). If it’s not worth your time, then walk away. Insisting you could win the argument easily if you chose, but you simply don’t have time or energy just at the moment, convinces no one.
So, it seems like regardless of whether malpractice suit awards are raising cost of insurance [seeing as how they account for only 2% of overall health costs] the costs are rising. And the fear of being sued does cause an increase in c sections.
Exactly. I wish doctors would take a hard look at their insurers and how those rates are set.
This comment was written by mythago.Report this comment to the moderators
July 4th, 2005 at 9:36 am
doh! bad tag. [Fixed! --Amp]
This comment was written by mythago.Report this comment to the moderators
July 4th, 2005 at 1:45 pm
Medicine is a weird profession….. I ponder this today after after delivering a drop-in patient who tested + for cocaine.
It is the only job I can think of that you are forced to work against your will, for free but then can be sued if anything goes wrong.
Musings from the front line on the 4th of July…….
This comment was written by Doktor.Report this comment to the moderators
July 4th, 2005 at 6:58 pm
Gee Doktor, at least you are honest enough to admit that you let lawyers dictate your medical practice.
And as for induced labor being more painful, maybe you can talk to the l&d nurse who told me that yes, indeedy, in her experience women going through induced labors tend to have shorter but harder labors. On average. Mine was 27 hours anyway. Of course she didn’t go to MEDICAL SCHOOL which, I guess means her experience counts for naught.
And if you don’t like working for free find something else to do. People respect doctors for a reason and it isn’t because they make boatloads of money.
This comment was written by Barbara.Report this comment to the moderators
July 4th, 2005 at 7:56 pm
More seriously, even if it is understandable, a doctor who is motivated by factors that are extraneous to medical evidence is not earning his or her patient’s trust, and it won’t take long for patients to understand this. Doctors should think long and hard before they succumb to this particular temptation.
This comment was written by Barbara.Report this comment to the moderators
July 4th, 2005 at 9:24 pm
Gee Doktor, at least you are honest enough to admit that you let lawyers dictate your medical practice.
In the same way that you let lawyers dictate how you drive your car.
I’m not sure how encouraging doctors to ignore rational incentives is going to be productive for anyone in the long run.
This comment was written by Robert.Report this comment to the moderators
July 5th, 2005 at 6:30 am
Robert, the analogy isn’t even close. And the incentives here are rational only if you consider the scientific evidence in opposition to a knee-jerk insistence on doing c-sections to be irrelevant. Or, as I suggested above, if you consider good individually determined patient care to be a subsidiary goal of the medical profession. Either way, it gives patients one less reason to trust their doctors and doctors should realize that it matters what incentives they consider important and listen to, and if it isn’t those incentives that flow out of the best interests of their patients, they don’t deserve the trust they crave and sometimes try to demand from their patients.
But then, I’m someone who is pretty sure I was bullied into an induced labor so that my obstetrician could get away for a holiday weekend without having me hanging me over his head.
Imagine a doctor saying, “well, I have big plans for the 4th of July weekend so you are going to have to buck it up and be induced.” Or, in this context, “I’m afraid that you will be one of the 1/1000 (or whatever) patients who has a bad outcome and sue me and it will look a lot better in court for me to insist that you have a c-section even though I know that all the evidence shows a much higher rate of complications for a c-section than a vaginal birth. Sorry, but it works best for me if all the risk is on your head instead of mine.”
I don’t mean to flog a dead horse, but if doctors want to play those games they had best be prepared for some fairly nasty consequences.
This comment was written by Barbara.Report this comment to the moderators
July 5th, 2005 at 6:58 am
Re: induced labor. Both of mine were induced (for hypertension). My first labor was 7 hours from start of drip to cutting the cord, my second was 4.5 hours. However, my cousin was induced at 42 weeks with both of hers, and both of hers were >36 hours. Like everything else to do with labor, I think induction is highly individualistic.
This comment was written by Lee.Report this comment to the moderators
July 5th, 2005 at 8:03 am
And the incentives here are rational only if you consider the scientific evidence in opposition to a knee-jerk insistence on doing c-sections to be irrelevant.
Barbara, incentives are rational if the payoff or penalty actually exists. Being afraid that subterranean demons are going to consume you if you venture into a cave is an example of a non-rational incentive (unless you are in a horror movie).
Being afraid that a lawsuit is going to take your house or quintuple your malpractice insurance premium if you don’t perform a C-section is rational if those lawsuits are a realistic prospect. The fact that some people, not sitting on a jury, think those lawsuits are based on bad science is not material to the rationality of the incentive.
Your position seems to be essentially that if doctors want to have their patients’ trust, they must ignore the economic reality of lawsuits against them. I do not believe it is productive (or realistic) to expect people to ignore enormous economic incentives.
This comment was written by Robert.Report this comment to the moderators
July 5th, 2005 at 8:19 am
No, my position is that doctors are being, and are willing to be, manipulated by insurance companies and are way to eager to dump a lot of externalities on their patients — you know, those people whose welfare they are supposed to assure — based on soggy economic rationales that don’t hold up under scrutiny. That, and not being willing to take the forefront in addressing the only “real” insurance crisis that exists in America: lack of access to needed care for the very sick and disabled among us.
The fact that many OBs cling to clearly discredited l&d practices does not help their cause in my book.
This comment was written by Barbara.Report this comment to the moderators
July 5th, 2005 at 10:58 am
OK, Barbara. What do you want doctors to do? In concrete terms, not abstracts like “put the interests of the patient first”.
This comment was written by Robert.Report this comment to the moderators
July 5th, 2005 at 11:11 am
Yes, but, Barbara, in many states you can’t practice medicine (even if you have a valid license) unless you also have malpractice insurance. If I were a doctor and my insurance company told me that my performing a particular procedure would lead to a spectactular rate increase, I would have to choose between raising my rates - which would lead to a loss of patients because their health insurance companies wouldn’t cover my full fee; performing the procedure anyway and maybe not being able to pay my staff or my mortgage; joining a group practice (if I had a solo practice); or leaving the profession altogether. My son’s pediatricians closed up their practice with only 6 weeks notice because their malpractice insurance had gotten too high - and the practice had only been sued twice in 10 years.
I agree that there are still plenty of old-school and/or patriarchal OBs out there, but there also many doctors who are using tremendous amounts of time and energy to fight the insurance companies for everyone’s benefit. We just don’t hear about it unless they go out on strike or do something really spectacular that gains media attention.
This comment was written by Lee.Report this comment to the moderators
July 5th, 2005 at 11:22 am
1. Not lie to their patients about why they propose to undertake a course of treatment. Like my doctor did to me.
2. Not push women into induction, c-sections or other interventions that are not supported by evidence (or in inappropriate circumstances).
3. Think 120 times before they conclude that malpractice is an adequate excuse for not assessing the circumstances of an individual patient and advocating a course of action that is known, on average, to be riskier than its alternatives.
4. Advocate for better obstetric care (like 24/7 anesthesia) that would actually make all deliveries safer.
5. Consider reviewing the experience of Virginia and Florida no-fault birth injury compensation funds to see if, indeed, there is a better way to address ALL birth injuries so that parents and children in distress are not required to prove that their obstetrician was at fault before they are eligible for care.
6. Explore more effective disciplinary processes when a doctor’s malpractice history reaches a certain level — like Massachusetts currently does.
7. In short, understand that there is a critical and unmet need for care by children who suffer from congenital/birth injuries, and not expect their patients to bear all of the costs of these injuries, whether in the form of inferior care (like coerced c-sections) and whether fault based or not, but especially not if they are fault based.
This comment was written by Barbara.Report this comment to the moderators
July 5th, 2005 at 12:38 pm
Adding on to Barbara’s list:
8. Push for state-enforced caps on malpractice premiums, rather than caps on damages caused by a scant handful of negligent doctors.
This comment was written by alsis39.Report this comment to the moderators
July 5th, 2005 at 3:17 pm
Lee, very often malpractice rates are driven by the insurers experience as a whole. Sometimes this is mandated by state law, which effectively prohibits individual underwriting. Individualized underwriting would allow differentiation that rewards good risks. But there are two real issues here that would go a long way to reducing the so-called malpractice insurance crisis, and that would, incidentally, make medicine better and fairer for everyone:
1. More effective oversight of health care providers by competent and reasonably funded state boards.
2. Universal access to health care for sick people regardless whether their doctor was at fault.
Organized medicine has opposed any form of these changes with tooth and nail, so yeah, my sympathy is pretty limited. For doctors, it seems as if it’s all take and no give when it comes to “reforming” malpractice. Much better that patients just suffer their ill health in silence regardless of need or fault.
This comment was written by Barbara.Report this comment to the moderators
July 5th, 2005 at 10:24 pm
It is so hard to regulate bad docs. As head of a QA committee, I can tell you that when we try to regulate or remove incompetent doctors several things happen….
1. They bring in their own lawyers and usually use the ploy, “these doctors (the ones on the committee) are in direct competition with my client and therefore can’t be considered as unbiased.” Then they find some other squirrel doc as their “expert witness”, so the incompetent doc gets to continue practice.
2. The incompetent doc resigns from the hospital just before their privileges get yanked so they don’t have to report it to the next hospital they apply at.
3. The incompetent doc just disappears and goes to some other state.
We try to police our own practice but everyone has got “rights” and some lawyer to defend them……..
This comment was written by Doktor.Report this comment to the moderators
July 6th, 2005 at 12:43 am
Doktor,
While I appreciate the contribution you’re making to the thread from a professional perspective, I do have to say that you come off as a bit easy on the amount of needless c-sections than might be comfortable. It took me a great deal of courage to really confront my own doctor on whether or not there was a genuine need for me to have a c-section, and what her stance is on the VBAC issue and amount of c-sections occurring. I was, however, pleasantly surprised in that she didn’t seem to write off my concerns as meaningless, which is sort of how you have appeared (to me) in a few of your posts. I got particularly frustrated with the comment you made about the idea of medicine being part of a patriarchal system.
Here was a synopsis of her response to me:
(nutshell)I tend to feel as a physician that my hands are tied due litigation concerns that the overall practice has, with regards to VBAC’s. I don’t, however, agree with the use of c-section as a catch-all response to women who have had c-sections before. Their are many cases, such as breach birth or lowered heart rate, where the chances of repeat are slim and a woman can likely have a perfectly healthy VBAC. In those cases, I talk to the woman about her options and my opinion that she could likely have a successful VBAC, if she chose to investigate what options were available to her more thoroughly. (/nutshell)
She then went on to explain to me why she considered me a ‘triple’ risk:
1) General physical structure, with a familial pattern of non-progressing long-time labor (grandmother labored for 80 hours with my mother and 72 with my uncle) and my mother labored for 30 hours with my brother and then had a c-section for him, and consequently a c-section for me.
2) Previous c-section myself after an unproductive labor (was induced and had HORRIBLE back labor for 15 hours, btw).
3) Have anterior placenta this pregnancy which has a heightened chance of getting in the way during labor if I were to attempt a vbac.
She stated that the triple risk made her comfortable and confident that a second c-section is the right choice for me.
Knowing that she doesn’t just accept without question the notion that c-sections are just swell, no matter what, I felt a lot better in the diagnosis that chances are I’d end up back on the operating table anyways if I gave it a second go.
I think there is not only room, but absolute need for questioning with regards to the use of c-section in the manner that we do in the US by both doctors and patients.
This comment was written by Kim (basement variety!).Report this comment to the moderators
July 6th, 2005 at 6:36 am
Doktor, I am not talking about QA committees and so on. These play a role, certainly, and they can certainly be misused (though having defended a few doctors in these types of settings I can tell you that they are also misused by the complainants, not just the defendants). I am talking about an agency that has resources and authority to investigate medical professionals and to mandate solutions, to escape litigation and accusations of conflicts of interest. In Massachusetts, when a doctor settles or goes to verdict on three malpractice cases, the Board of Registration in Medicine investigates not just those cases but the doctor’s entire practice, and makes recommendations (or not — sometimes things do happen as a result of random bad luck).
With regard to moving from state to state — this is something I know a lot about. Again, professional societies (of all stripes, not just physicians) are so jealous of their turf that they resist any kind of centralized credentialing and disciplinary reporting that would help to build an accurate and complete picture of the doctor’s practice patterns and make it more difficult for bad doctors to evade detection.
What you are describing is also a pattern of non-compliance with the HCQIA — which mandates the reporting as an “adverse action” of any physician that resigns in lieu of a full blown disciplinary hearing. It’s no secret that hospitals don’t like reporting. However, hospitals (and other participants) were handed antitrust immunity in a trade off to make information more available to other credentialing bodies. They asked for and received the protection, and now seem to consider the whole process optional, depending on what’s most convenient for them. Meanwhile, other institutions can’t get information that they are entitled to think would be available.
Professional societies and health care providers also resist making any quality or peer review data public, or even available to credentialing bodies who don’t plan to disseminate it publicly, again stifling the dissemination of information that would allow other hospitals and potential patients to steer clear of bad doctors. Now, I am divided on whether or not a doctor’s malpractice history should be easily accessible to the public. The “raw score” is so simplistic that it is nearly impossible to interpret it correctly without a lot more knowledge. However, I do not accept that such information should be withheld simply to protect professionals, which is essentially how the system works now.
Saying that “it’s hard to deal with bad doctors” is just not enough. There’s a context of professional privilege that keeps those difficulties firmly in place as a form of professional self-protection that is simply unavailable to any other professional group.
This comment was written by Barbara.Report this comment to the moderators
July 6th, 2005 at 6:44 am
Barbara, while I agree with your points, I do have to take issue with your use of “so-called” when referring to the malpractice insurance crisis. This is a very real issue in Maryland, where the state legislature was forced to examine some ugly budgetary issues in the last session (Maryland’s legislature is only in session for 90 days, so it’s kinda crunched legislatively) in order to make sure that almost a third of the doctors in the state would be able to continue to practice. It’s a very real issue in New Jersey, where there is a huge shortage of the “high risk” specialists. It’s becoming an issue in Florida. Based on Doktor’s posts, Oklahoma is not far behind. Doctors do need to pound on their professional organizations about universal health care and malpractice insurance, but most of the doctors I know already work 50-60 hours a week, so where would the time come from to do this? IMO, there is a huge disconnect between the AMA and its members on these and other issues.
This comment was written by Lee.Report this comment to the moderators
July 6th, 2005 at 7:25 am
Hey, I’ve lived in or near Maryland for more than 20 years — I have a pretty good grasp on what’s happening there and the “solution” was to raise health insurance costs via taxes (retrospective taxes at that) in order to placate a highly organized professional lobby. Do you really accept that 1/3 of doctors practicing in Maryland would simply “leave” in a short period of time? Somehow, I just don’t see the JHU and UM faculty practice doctors pulling up stakes and moving away or closing their doors. Or the well-heeled physician practices that operate in Bethesda/Chevy Chase. The truth is, Maryland is particularly vulnerable to hard core lobbying by health care groups because, especially in Baltimore, the provision of health care services makes up a huge percentage of the economic activity that occurs in the state, which has had a difficult time attracting different kinds of business. Partly because of the high cost of health insurance. Which is itself the result of the clout that hospitals in particular have over the pricing of hospital services. A really vicious cycle exists in Maryland. And if you live here then you no doubt saw the WaPo article on the unbelievably inept system of professional discipline that exists in each of the three jurisdictions that make up Metro D.C., including Maryland.
You see, Lee, somehow, even though they work 50-60 hours a week Maryland doctors and their lobbyists found time to lobby for relief for themselves alone but just can never seem to find the time to advocate for a long-term fix that would help others. And you know what, nearly anybody who lives in Maryland lives close enough to Delaware, Virginia, D.C., Pennsylvania, West Virginia or New Jersey to find a doctor. And I would be grateful if my husband ONLY worked 50-60 hourse per week. The truth is, lots of people work that hard.
I’m sorry to be snarky, but time and priorities are always up for grabs, it’s never easy to make progress, and, frankly, it’s only a crisis if you have a laser focus on what the doctors are telling you.
This comment was written by Barbara.Report this comment to the moderators
July 6th, 2005 at 7:52 am
Lee, here is a link to an article that discusses the proportion of the crisis:
http://www.washingtonpost.com/ac2/wp-dyn/A15752-2003Sep15?language=printer
Choice quotes:
“A study released last week about Maryland, where medical groups have warned about a “crisis” caused by rising malpractice premiums, reached similar conclusions. Researchers from Public Citizen Health Research Group analyzed government data and found that the number of malpractice claims filed per physician declined significantly between 1996 and 2002, as did the amount paid by insurers to cover claims. And while some groups have warned about an “exodus” of physicians, the number of doctors in the state actually increased between 1996 and 2002, according to the advocacy group.”
“‘What the latest GAO report shows is that the threat about access to health care is largely overblown,’ said Maryann Napoli, deputy director of the New York-based Center for Medical Consumers. “It’s interesting that [organized medicine] always zeroes in on pregnant women every time there’s a so-called crisis.”
This comment was written by Barbara.Report this comment to the moderators
July 6th, 2005 at 8:05 am
And another link about the distribution of doctors by state:
http://www.citizen.org/documents/FCT-Why_Doctors_Practice_Where_04-05-04.pdf
Maryland is one of the states with the highest number of physicians per capita, and ranks second after Alaska in the average income earned by a doctor.
It’s a big subject, but the scarcity of doctors in the U.S. only really exists in rural communities, and the reason for the scarcity can only be very tangentially related to malpractice premiums. For the same reasons that rural areas in general have experienced depopulation, they have experienced shortages of doctors and dentists, who have the luxury of locating almost anywhere. My in-laws live in a rural area, and I have seen this phenomenon first hand.
The scarcity of primary care physicians, if it exists, is the result of payment and education policies that reward specialists and those who train them.
This comment was written by Barbara.Report this comment to the moderators
July 6th, 2005 at 8:19 am
Barbara, thank you for those links. I hadn’t seen those articles. Most of the doctors I know on a personal level practice in Michigan, which is a whole different ball of wax.
This comment was written by Lee.Report this comment to the moderators
July 6th, 2005 at 8:21 am
But it also makes me wonder, if the number of malpractice claims is going down and the amount of claims is going down, and the number of doctors is urban areas is increasing, why malpractice insurance premiums are increasing so rapidly.
This comment was written by Lee.Report this comment to the moderators
July 6th, 2005 at 8:30 am
Lee, it’s called a bear market. Insurers, especially p&l insurers (and life insurers too) price their policies with the expectation that they will earn returns from investing “unearned” premiums, and the market has been very difficult over the last five years. In addition, there is also something called the insurance underwriting cycle that is usually about 7 years in duration — it’s difficult to predict underwriting experience with precision and there tends to be under/over pricing trends that are then adjusted for over time. Making up an underpricing trend during a bear market when market returns are lower than average results in a spike in prices that is much higher than would normally be expected by claims experience.
You don’t see this in health or auto insurance, where the rate of unearned premiums is actually much lower — basically, they have a much lower profit margin because their payouts are continuous.
This comment was written by Barbara.Report this comment to the moderators
July 6th, 2005 at 8:34 am
Barbara, thank you for that lucid explanation. Usually explanations of insurance policy start looking like time travel theory! :)
This comment was written by Lee.Report this comment to the moderators
July 6th, 2005 at 8:38 am
Doktor, my state bar journal has pages every month of disciplinary actions taken against lawyers by the State Bar. If even lawyers can’t so easily escape discipline by their own professional board, why are you doctors having so much trouble?
Lee, this is a flatly partisan link, but here are reasons other than malpractice suits that doctors are getting screwed by their insurers.
This comment was written by mythago.Report this comment to the moderators
July 6th, 2005 at 8:38 am
hm, link didn’t show:
Summary of NBER report
This comment was written by mythago.Report this comment to the moderators
July 6th, 2005 at 8:48 am
Mythago, thanks for that link. Is it still true that the top 5 earning firms in the U.S. are insurance companies?
This comment was written by Lee.Report this comment to the moderators
July 6th, 2005 at 9:13 am
mythago, the snarky answer is that lawyers are so used to arguing and pointing fingers that it’s in their blood and the fact that the other guy is also a lawyer is just another detail. But the real answer is that there are two types of disciplinary problems. The first is incompetence and the second is misconduct (lying, cheating and stealing). In the case of physicians or lawyers, out and out fraud or stealing or sexual abuse or whatever is somewhat easier to deal with, overall, but the real problem with physician discipline is policing professional incompetence, and this requires one set of professionals to make judgments about the practices of another, and doctors just don’t want to do it. Plus, there is a real culture of self-protection — clearly played out in the extent to which known drug abusing doctors are permitted to continue practicing for years in many communities, because “it would be tragic for someone’s investment in their career to go down the tubes.” This is what I mean when I say that professional disciplinary action is primarily for the protection of the professional, and not his patients. Until this changes, there will be no way to improve the situation.
This comment was written by Barbara.Report this comment to the moderators
July 6th, 2005 at 12:17 pm
Bean, if you are referring to me, I don’t think it’s entirely the insurance companies’ fault that there are more C-sections, and I don’t think unnecessary C-sections are a good thing. I was trying to point out that it isn’t just due to doctors and hospitals being paternalistic or misogynist, that even very good and thoughtful doctors have to pay attention to what the health insurers and the malpractice insurers are saying, because it impacts their jobs. I also think that many doctors and hospitals are trying to practice medicine the best way they can, and that many patients would benefit tremendously by being informed consumers and being willing to talk to their health practitioners about what is happening. I have indeed stood up to my doctor and to my health insurance company when necessary. Sometimes I won, sometimes I lost. If I was coming off as complaining about evil insurance companies, it was probably because I was responding to what I thought were unnecessarily fierce attempts to pin it all on an evil doctor or an evil hospital.
This comment was written by Lee.Report this comment to the moderators
July 6th, 2005 at 5:16 pm
There are a few people in here who seem to want to believe that the fault entirely lays on insurance companies, never the doctors.
If you’re referring to me, this is crap.
The state of malpractice premiums has more to do with insurance companies than doctors. The decision to do prophylactic C-sections has more to do with doctors than insurance companies.
mythago, the snarky answer is that lawyers are so used to arguing and pointing fingers that it’s in their blood and the fact that the other guy is also a lawyer is just another detail.
But Doktor attributes these doctors escaping discipline in part to their clever lawyers (apparently, medical boards investigating misconduct only hire stupid lawyers). You’d think that lawyers themselves would be even more likely to get a hired gun to get them out of trouble.
You’re entirely right that it has more to do with the culture. Lawyers are protective of the profession, but we’re more than happy to attack one another. Doctors, not so much.
This comment was written by mythago.Report this comment to the moderators
July 6th, 2005 at 9:36 pm
bean, why is it automatically “passing the buck” to introduce another factor into the equation ? If an institution is a possible factor in a bad situation, how does it profit the discussion to not point out this possible factor ? I don’t consider that “passing the buck.” I consider it introducing a factor that was previously not visible.
This comment was written by alsis39.Report this comment to the moderators
July 7th, 2005 at 6:25 am
Alsis39, many states have tried to mandate malpractice premium price controls and the net effect is that malpractice insurers leave the state. This happened in West Virginia. It’s happened for other types of insurance as well (esp. automobile and homeowners). Over time, if a line of business really can’t be sustained profitably, there’s nothing that can make an insurer continue to take a loss in it or write new policies. The problem in health care is that we have neither free nor regulated markets. A totally free market would be insane, but imperfect regulation doesn’t introduce enough sanity to solve the problems. But for doctors to ask for regulatory relief in the pricing of malpractice premiums and to ignore the devastating financial impact that lack of access to affordable medical care has for their patients and oppose solutions on that score — Well, I’m sure by now you know where my sympathies lie. There’s an insurance crisis alright, but it has nothing to do with malpractice.
This comment was written by Barbara.Report this comment to the moderators
July 7th, 2005 at 10:06 am
bean, I never said that doctors shouldn’t be blamed. In fact, I posted what I did in response to Doktor’s trying to blame malpractice-happy jurors, et al for his dilemna. Furthermore, the insurance industry is largely headed by men, just as the medical industry is. It’s not as if one is more patriarchal than the other.
Barbara, maybe the solution is for the state to step in and run the insurance business. Not that I expect this to happen anytime soon, but the uneasy hybrid model you describe doesn’t seem to be doing anyone any good– except the CEOs and the bad doctors, of course. :(
This comment was written by alsis39.Report this comment to the moderators
July 7th, 2005 at 11:23 am
Whew. :o
This comment was written by alsis39.Report this comment to the moderators
July 7th, 2005 at 11:53 pm
The GAO report reminds of the old line “there are liars, damned liars, and statisticians.
The Post article stated, “In Pennsylvania and West Virginia, for example, two of 19 states designated by the AMA as being in a “full-blown liability crisis,” the number of doctors per capita has actually increased in the past six years, according to the GAO.
In Pennsylvania, despite reports of physician departures, the number of physicians per capita in the state has increased slightly during the past 6 years.
The truth is…….
Between 2002 and 2003, 24 OB/GYNs left the state due to malpractice concerns; however, the state’s population of women age 18 to 40 fell by 18,000 during the same time period.”
So, Ob docs did leave the state but the Ob population decreased as well so that the net result was anlooked like an increase in Ob docs per capita.
That is a little different flavor than the original story.
This comment was written by Doktor.Numbers can be used to support either side of any argument according to my old stats professor.
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July 9th, 2005 at 12:36 pm
Maybe they left “due to malpractice concerns” in the sense that the practice of obstetrics was already becoming marginal given the population drop. In any event, there was no verification of their reasons for leaving. In West Virginia, the medical society couldn’t really say how many were leaving for malpractice concerns. Pennsylvania has one of the oldest average age populations in the country (it’s where I grew up). I would never say that it makes me happy that a good doctor would leave practice for any extraneous reason, but the point is, the departure of a small number of physicians is not a public health threat, and as the GAO report also pointed out, many of these communities have always had difficulty recruiting and retaining physicians due to a variety of factors. It also pointed out the steps that hospitals, in particular, were taking to ameliorate the situation for doctors.
Other studies have shown that doctors who “leave obstetrics” often do so as their patients age and they no longer want to maintain an OB lifestyle. This happened with my first obstetrician. He stopped delivering babies around the time of my first pg.
And the most recent study, of course, shows that malpractice payouts have remained flat even as premiums have escalated. I tried to explain above why that could happen in the absence of “skyrocketing” malpractice verdicts.
I have a doctor client who told me how unnerving it was to be sued (she’s an oncologist), and how betrayed she felt when her patient alleged that she had been mistreated. She lives in a state with one of those “pre-adjudication” panels that actually works — it’s so rare for someone to win a malpractice case if the panel declares in the doctor’s favor that it usually decides the case. The doctor’s care was considered appropriate, so that was the end of it. But her reaction shows that, at some level, doctors just don’t like being questioned — everything about their training puts them in command of those around them and they find it upsetting and disorienting to be challenged. I honestly believe that this fuels the belief that malpractice is a crisis as much as any financial issue does.
This comment was written by Barbara.Report this comment to the moderators
August 9th, 2005 at 5:11 am
Well–it certainly has been interesting that my battle with the hospital has generated so much discussion–I guess some good came out of it.
Just to put a rest to some concerns: I would have LOVED for the entire peer review process to be reviewed by an outside source—because they would find nothing. the concerns stated in the letter were the only concerns—higher birth weights, longer gestation and lower C. Section rates and one or two more clavicle fractures a year.
I DID ask about the birth weights and reviewed ALL my records. There was no higher incidence of macrosomia and everybody was delivered by 41 weeks–there were none over 42 weeks.
there were no brachial plexus injuries. There were no encephalopathy.
i did not walk around criticizing everybody–I was in solo and just did my own thing–live and let live philosophy. I knew I wouldn’t last long if I was openly critical. Actually most of the OB were very nice and we would chat quite often. this process was started by a couple of OB who had enough clout to “get ‘er done”
I demanded an independent review and got it–the reviewer finding no fault with my care. I asked for an apology letter and got one but it was very carefully worded “……so sorry that you found this process so stressful….you have always been and continue to remain in good standing….”
I did not leave to hide form anything. I did not have any lawyers sitting beside me because I knew that the peer review process is protected by WAY bigger governmental machines than I can handle.
My malpractice rate was 40K a year in a crisis state–because my record was clean-and I don’t have nay suits pending.
Life goes on—only with 14 year old girls on their second child down here in Mississippi—so I have new frontiers to try and conquer–.. I am getting very involved in programs at the school to foster a sense of self-worth.
One girl at a time.
This comment was written by H. Sandland.Report this comment to the moderators
August 9th, 2005 at 11:01 am
Wow, H. Sandland. Those girls in Mississippi are lucky to have you.
This comment was written by Lee.Report this comment to the moderators
August 9th, 2005 at 8:13 pm
But her reaction shows that, at some level, doctors just don’t like being questioned … everything about their training puts them in command of those around them and they find it upsetting and disorienting to be challenged. I honestly believe that this fuels the belief that malpractice is a crisis as much as any financial issue does.
Bingo.
I recall reading an article, quoting a professor at a medical school who didn’t believe there was a ‘malpractice crisis.’ His students simply refused to believe it, even in the face of statistics showing they were getting screwed by their insurers. Having a patient sue feels like a betrayal and an attempt to say “You are a bad doctor.”
This comment was written by mythago.Report this comment to the moderators
August 10th, 2005 at 4:19 am
oh yes–I DID say to the reporter at the time that I TRULY did NOT believe that doctors are saying “ooo–more bucks for me if I section her” OR “geez-I had a tee time of 5 pm—let’s get this over with”
I really DON’t think the rise in C Section is financially driven–I DO think there is a difference in one’s approach to labor.
MANY times I hear “I had a C. Section with my first because I was on the drip all day and I didn’t dilate” THIS DRIVES ME CRAZY!!!
#1. I can never let on to the patient what I think about that because in truth I really wasn’t there and don’t want to open taht can of worms
2. the indication was failed induction—not CPD as is coded
If a patient opts for induction at 41 weeks–becasue ACOG says I have to OFFER and induction then priming the cervix is “a good thing” I prefer the use of a Foley catheter placed in the cervix –a quick strip on the monitor and let the patient go home. Many times she comes in during the night in good labor and I don’t need to use any Pitocin. I also encourage ambulation–which was NOT being done when I first got to Wilmington.
I also offer breast pump or encourage nipple stimulation instead of pitocin.
I don’t put too much weight in the push for 2 hurs rule–never did!
If there is progress and the mother is not tired –she can push longer. If she has an epidural, I don’t “make her push at 10 cm”–let her sleep and the uterus do the lioness’ share of the work–she can spend 3 hurs pushing ineffectively or 2 hours sleeping and one hour pushing effectively–all the same to me.
I am also VERY comfortable with forceps if it looks like intervention is needed. Even “natural” childbirth can lead to EXHAUSTED mothers who can easily be delivered with forceps. I give them the choice– but if the head is low I certainly tell them my preference. I think it helps to tell them I had a forceps with my first after 5 hours of pushing.
I have seen 4th year residents who haven’t go the first CLUE how to put on forceps—needless tosay they will not be comfortable with this option when they are out in private practice—so it’s either push it out–and they won’t let them go past 2 hours or C. Section.
During my17 years I have delivered at least 150 breeches and have had no problems with any of them—I wasn’t cited for any breech deliveries. I have certainly had to c. Section some of them but over 90% deliver vaginally. It is very sad to me that the ACOG has mandated C. Section. Again you have residents who are in awe at a vaginal breech delivery–they’ve never seen one–make no wonder they are scared of them.
Overall I wonder about the exposure to different ways of thinking. If youget a whole town all trained in that town–everybody will be walking the same path. That’s OK as long as you don’t mind some people walking a different way down the same path–we’re all going to the same place. Some are more tolerant than others and some will be downright against anything outside uniformity.
This comment was written by H. Sandland.Report this comment to the moderators
October 28th, 2005 at 7:26 am
To respond to a previous poster’s comments about women dying in childbirth, just FYI, depending on which study you look at, women who have a cesarean have a 2-6 times higher risk of dying during childbirth compared to women birthing vaginally.
In many cases, the problems that arise during labor are actually CAUSED by the medical interventions. Add to that that OBs are not trained (and mostly don’t bother seeking out on their own) in ways to get babies born vaginally.
Midwives are the gatekeepers of normal birth and always have been. You get equal or better outcomes with much less interventions.
-Barbara
This comment was written by Barbara.Report this comment to the moderators
October 30th, 2005 at 1:35 pm
Midwives are the gatekeepers of normal birth and always have been
Just as private schools always have better outcomes than public schools, and for the same reason.
Nice dig at women who required medical intervention in their, oh, I guess you would call them “abnormal” births, though.
This comment was written by mythago.Report this comment to the moderators
October 30th, 2005 at 7:53 pm
Okay, just fyi, the post just previous to Mythago’s by someone named Barbara was a different person from previous posts that were mine — I don’t add my name at the end of the post. I thought the post was okay up to the last paragraph. I have never used a midwife, my position is that women shouldn’t have to use a midwife to have a birth experience that is accompanied by only as much intervention as is genuinely useful.
This comment was written by Barbara.Report this comment to the moderators