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The Politics of Birthing.

 
  

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Nobody's girl
12:43 / 03.06.05
"What do I do?"

"Nothing dear, you're not qualified."

Python wasn't too far off the mark.

Since becoming pregnant I have been astonished at just how political birth and pregnancy is. Pregnancy and birth is a minefield of gender politics, what amazes me the most is that most prospective parents are appallingly underinformed and disempowered about their choices. Not only are the general public underinformed about their choices in pregnancy and birth but it appears that in the quest for an easy life the medical establishment are incredibly reluctant to fully inform patients.

It appears that most parents seem to happily enter into a fully medicalised birth without ever considering that it may not be the best experience for them or their baby because it's what everyone does. Yet we see such worrying signs as the 1 in 5 c-section rate and it doesn't appear to occur to anyone in the establishment that this might be as a result of medical intervention and hospitalisation, the "cascade of interventions" syndrome. Those it does occur to are considered to be less than reputable kooks.

I'm most worried by the disempowerment of women by this over-medicalisation. Birthing is a supremely powerful experience in a woman's life and I believe that by scaring women into a medically managed birth we are stealing that experience from them. I was heartbroken to hear a woman at my ante-natal class express relief that she had been booked in for a c-section because "I don't think I could push" and another woman express envy at this!

I would like to point out that I don't have any problem with necessary medical intervention into birthing and pregnancy. I personally shan't hesitate to protect my health and my baby's health if either appears to be in danger. My problem is with the obvious over-intervention into what for most women is a healthy life event. After all, it just doesn't make sense that 1 in 5 women are unable to give birth normally in developed nations only, does it?

The Association for Improvements in Maternity Services is an excellent resource which has been working to empower prospective parents and The Home Birth Reference Site has comprehensive information for anyone planning home birth in the UK, my favourite part being the "You can't have a home birth because..." page.
 
 
Tryphena Absent
15:30 / 03.06.05
At the age of 17 one of my best friends trained to become a midwife. She said to me "Nina, I never want to have a baby, you have absolutely no idea how many things can go wrong with pregnancy or birth. It's terrifying." She wasn't prone to hysterics. I want everyone to think very, very carefully about a number of factors before they reply to this thread 1)we don't have enough midwives in this country 2)they are overworked 3)there are hundreds of things that can go wrong with childbirth and no one knows which complication you might have. 4)There is not the time nor is it wise to explain to a mother the myriad complications that could arise during or before birth.

I imagine it would be more agonising to spend all that time planning to have your baby at home and then to be rushed to a hospital because it was breech or the cord was round its neck then it would be to simply plan to go the hospital.
 
 
lekvar
19:41 / 03.06.05
I'm inclined to agree with both of you.

When my daughter was born my girlfriend wanted to have a home birth. I insisted that the birth be done at a hospital so that if, heaven forfend, go wrong we would have access to the little machine that goes "ping!" I had no objections to a midwife being the person in charge, but unfortunately the beurocracy of the matter took that option away from us.

Fortunately the birth went as smoothly as a birth possibly could. No thanks to the hospital staff. From the second we walked in the door nurses and doctors were pushing for every possible treatment, medicine and procedure possible, giving us horror stories about how we were seconds away from doom and shooting shocked glances when we refused. I say we because they wouldn't listen to her, but for some ridiculous reason I, the one not giving birth, carried some authority.
Some clarifications-

We live in the US where there is a medicine or a procedure for everything. Being happy, healthy and well-adjusted can only be brought about with expensive prescriptions.

My girlfriend worked in the health insurance industry at the time and has a keen insight into its inner workings and the parasitism that has arisen between the doctors and the insurance companies.

Many of the proceedures that a doctor recommends insure that the birth conforms to their schedule, not the baby's. Inducing labor, dilation drugs, c-section, episiotomies (which are increasingly being called into question), few of these directly benefit the mother to the degree that they are pushed.
 
 
Tom Tit's Tot: A Girl!
22:06 / 03.06.05
At the age of 17 one of my best friends trained to become a midwife. She said to me "Nina, I never want to have a baby, you have absolutely no idea how many things can go wrong with pregnancy or birth. It's terrifying." She wasn't prone to hysterics.

Okay, so your friend at 17 trained, and her opinion somehow shows that a home birth is more dangerous than a hospital birth? Or that every intervention is necessary? Because, if a medical professional said what your friend said, I could see this over-medicalisation arising from health professionals' sense of fear or paranoia.

However, her viewpoint is probably something to do with the fact that all new midwives train in "high risk" cases to begin with, as this is where midwives are most needed. Only later will they be involved with "normal" births, and they will only attend home births after being a hospital midwife for around ten years (UK). No wonder she thought things can always go horribly wrong! How can you know what is "normal" when all you ever experience is the "abnormal"?

Birth isn't that dangerous, actually. In the UK there is one maternal death for every 15,000 births, and 8.2 infant deaths for every 1000 births. (Available on the National Statistics website.)

Also, I think a 17-year-old telling a labouring woman what to do when she herself has never had a child is an example of the sensibility of which NG speaks.

Lekvar makes this point from experience, not hearsay, and experienced this male-oriented approach by the medical community firsthand.

Here's a bit of information. Knowing is half the battle.

"In essence it seems that a woman who is appropriately selected and screened for a home birth is putting herself and her baby at no greater risk than a mother of a similar low-risk profile who is hospital booked and delivered. Home births will probably increase to 4-5% of all maternities in UK during the next decade and this needs preparatory planning." Abstract here.

'In multiparous women, perinatal outcome was significantly better for planned home births than for planned hospital births, with or without control for background variables.' Article here.

Oh, and if that wasn't enough, home birth is as safe as or safer than hospital confinement, with less unnecessary medical intervention.

Read here...

or here...

This one too.

Please look into a topic before posting. While your contribution is appreciated, repeating someting alarmist you once heard from a friend seems uninformed at the best, and if you think that informing a pregnant woman of all that could go wrong with her pregnancy is not something to do, maybe you should take your own advice. Not that NG is not aware of possible complications; but she is exceedingly well-informed.
 
 
Nobody's girl
01:01 / 04.06.05
I insisted that the birth be done at a hospital so that if, heaven forfend, go wrong we would have access to the little machine that goes "ping!"

An understandable precaution.

I'm not too concerned about the prospect of a serious emergency, not because I don't believe bad things could happen to me but because my pregnancy has been normal and I will be attended by more midwives more consistently at home than in hospital. At a home birth in the UK it is policy to send out two midwives to attend the birth- one for me, one for the baby. It is worth pointing out to any Americans that in the UK midwives are degree level healthcare professionals who train as nurses first and it is these people who attend most births in the UK, OB's only attend if a problem arises. If I were to have my baby at the local hospital then I would be sharing my midwives with the other women labouring in the ward and I don't relish the prospect of people banging in and out of the room when I give birth. It has also been noted in studies that women who have a consistent helper during childbirth have an easier time of it. I'm covering all bases and having a doula as well as my two homebirth midwives.

Another interesting point about the relative safety of home vs hospital birth is that it is actually safer to have your first baby at home than subsequent births, despite common wisdom. This is because in a first birth things are unlikely to happen quickly and in subsequent births progress can be alarmingly fast, my mother took 8 hours with her first child, but by her third my wee brother turned up in a breathtaking 2 hours! Obviously, the slower things move the easier it is to forsee difficulties and transfer to a hospital for help.

Plus, considering this is the hospital I would otherwise be birthing in-


And with recent headlines like this,
and this all over the news I believe that a home birth is WAY more safe than a hospital birth!

From the second we walked in the door nurses and doctors were pushing for every possible treatment, medicine and procedure possible, giving us horror stories about how we were seconds away from doom and shooting shocked glances when we refused.

How terrible for you both! I'm very concerned about this, I believe it is an all too common experience and is incredibly undermining to a birthing woman, who is in an extremely vulnerable and impressionable state.

I say we because they wouldn't listen to her, but for some ridiculous reason I, the one not giving birth, carried some authority.

Yeah, I've heard of this and am rather shocked it still occurs. Medical professionals attempting to conspire with fathers to decide what's best for the hysterical woman who couldn't possibly know what's best for herself. Nice.

We live in the US where there is a medicine or a procedure for everything. Being happy, healthy and well-adjusted can only be brought about with expensive prescriptions.

Heh, so I've heard!

Many of the proceedures that a doctor recommends insure that the birth conforms to their schedule, not the baby's. Inducing labor, dilation drugs, c-section, episiotomies (which are increasingly being called into question), few of these directly benefit the mother to the degree that they are pushed.

Another commonly reported problem. My sister-in-law was a single teenage mother in rural Scotland in the seventies and was on sharp end of that attitude. She was induced, which results in much more painful contractions and afterpains, because the doctor wanted to get home early!

Because of organisations like the National Chilbirth Trust and AIMS who I linked to above, women are no longer given routine episiotimies in the UK, thank heavens. Episiotimies are often touted as a good way of preventing perneal problems but fourth degree tears (through the anal muscle- eeek!) are actually more likely after one.
 
 
Tryphena Absent
02:32 / 04.06.05
What do you do if shoulder dystocia occurs during childbirth? How about postpartum haemorrhage? These things aren't detecable before childbirth. I come from a line of women who have incredibly easy births- none of them have taken over 8 hours, on both sides of the family for three generations. There are no miscarriages, no complications during pregnancy, despite this if I was pregnant I'd opt for a hospital birth.I don't think that amount of pain is conducive to comfort anywhere. Don't get me wrong, I'm not saying that I think the number of caesarian sections performed in this country is unquestionable, that each of them needs to be done but I don't frown upon the medicalisation of childbirth because it is dangerous, unpredictable and an immense effort. I would prefer to be away from home and the stresses of it, the washing up and the hoovering, but I think that's a very personal choice.

Also, I think a 17-year-old telling a labouring woman what to do when she herself has never had a child is an example of the sensibility of which NG speaks

She was a student not a midwife and no offense but she was an incredibly capable person, precisely the type of person that I would want telling me what to do in that situation and I speak as a woman capable of birthing a child. Unfortunately that will never happen because at 19 she became a radiological assistant in a cancer ward.
 
 
Tom Tit's Tot: A Girl!
11:43 / 04.06.05
Well, Nina, once again you're basing your fears and your possible birth experience on the comments of one student. Get informed before deciding to commit yourself to hospital, please. Because if you'd done just a little bit of research...

What do you do if shoulder dystocia occurs during childbirth?

"'Shoulder Dystocia' means that the baby's head has been born, but its shoulders are still stuck inside the mother and are not spontaneously born with the next contraction. It is life-threatening for the baby as the baby cannot breathe until its body is delivered - there is no room for it to inflate its lungs - but the cord may be compressed once its head has been born. It is a scenario which can be terrifying for birth attendants as well as the mother, wherever it happens.

All midwives in the UK should be trained in emergency management of shoulder dystocia, and these maneouvres to free the trapped shoulder can be carried out at home as well as in hospital. They include changing the mother's position to one which allows more space for the baby to move through her pelvis, the McRoberts maneouvre where the woman is pushed onto her back and her knees are pushed up high under her armpits, and the midwife using a hand to free the baby's trapped shoulder.

There is only one maneouvre which can be carried out in hospital but not at home, and that is virtually unheard of in the UK - the Zavanelli maneouvre, where the baby's head is pushed back up into the mother's body and the baby is delivered by caesarean section. Because of the time it would take to do this, circumstances where it might save the baby's life are vanishingly rare."


(Just to clarify, the reason it is vanishingly rare is because as shoulder dystocia causes the baby to be unable to inflate it's lungs, time is of the essence. Even in a hospital setting preparing for a c-section, integral to the Zavanelli maneouvre, takes time, which is something the baby just doesn't have. This is why it is vanishingly rare.)

How about postpartum haemorrhage?

"Midwives at home births carry the same drugs which are used to expel the placenta and contract the uterus as would be used in hospital. These include synthetic Oxytocin and Ergometrine, often given in combination as Syntometrine. If these do not control the haemorrhage, the midwife would call an ambulance to transfer you to hospital, and undertake other emergency measures in the meantime, such as giving intravenous fluids and manually compressing your womb.

However, it is significantly less likely that you would have a post-partum haemorrhage after a home birth than after a hospital birth, because the risk of PPH rises with interventions such as assisted delivery and induction of labour, which are only carried out in hospital."


So hospital birth actually increases the possibility of postpartum haemorrhage! How does all this fit in with your deeply inaccurate view of hospital = safer?

(All info available here.)

despite this if I was pregnant I'd opt for a hospital birth.I don't think that amount of pain is conducive to comfort anywhere.

Fair enough. It's entirely your choice what you do with yourself when pregnant. What I take exception to is the sheer depth of misinformation the medical community spreads about home birth, how women are increasingly taking elective c-sections and medical interventions, which in turn increases the likelihood of haemorrhage and further complication.

Just admit to yourself that it's a preference, and has nothing to do with safety apart from the psychological safety you seem to recieve from being in hospital; because that's the only benefit you'll be getting from a hospital birth.
 
 
Tryphena Absent
14:28 / 04.06.05
Tom why do you think I'm being informed by one student of the age of 17? I've read those sources. Do you really think that I'm that uninformed? Can you please have a little bit more respect, take note of words like personal opinion a little more? How about I imagine it would be more agonising to spend all that time planning to have your baby at home and then to be rushed to a hospital. A basic point about my attitude towards childbirth.

I don't understand why you're jumping on me but okay, you generally have to be in hospital in order to have assisted delivery or induction of labour for a variety of reasons, thus being in hospital doesn't increase your risk, having complications before or during childbirth do. Your points are illogical since we appear to be talking about possible complications during home births and most women with complications go to hospital. But I'm not even suggesting that these things are going to happen to many women, I'm not suggesting they're not rare, I'm saying: what if it happened to you?
 
 
Tryphena Absent
14:32 / 04.06.05
I just don't regard myself as a statistic and I don't think that home births provide you with the resources that hospital births do- I want that last choice, I want the operating table readily available to me.
 
 
Tom Tit's Tot: A Girl!
15:26 / 04.06.05
Can you please have a little bit more respect, take note of words like personal opinion a little more?

But the simple fact is that a hospital birth is an option and should not be presented as the standard in birth. Hospital birth increases the chances of: tearing into the anal muscles, haemorrhage, induction (which causes longer and more painful contractions and second stage of labour), infection, etc. A newborn died of MRSA recently, and you're still talking about hospital giving you more options?

I don't understand why you're jumping on me but okay, you generally have to be in hospital in order to have assisted delivery or induction of labour for a variety of reasons, thus being in hospital doesn't increase your risk, having complications before or during childbirth do.

But the system in the UK encourages intervention in birth (although the USA is worse for this) which means that you are more likely to have an unnecessary intervention, and therefore a higher chance of negative knock-on effects like those listed above.

Induction, again, is often preformed unnecessarily. Just because the baby isn't ready to come yet does not mean something is wrong. The hospital can test for fetal distress, but even if the baby is fine, will try to force an induction on some women just because it is past their due date. Induction is painful, invasive, and causes labour to also take longer and be more painful.

I'm "jumping on you" because your response is indicative of the kind of mentality that is fucking boiling my blood right now. My partner is pregnant with our first child, we've both reviewed the information and have chosen to have a home birth. Despite research which is controlled for pre-existing complications and time of travel to the hospital in case of complications, doctors and midwives are hell-bent on trying to convince us to go into hospital. Special appointments have been made so that obstetricians can try to convince us that a hospital birth is required. And, regardless of their paranoia, we've had a marvellously normal pregnancy with a gloriously active baby. Yet conversations still focus on the medical professionals trying to scare us into following procedure, like when we said "But nothing's gone wrong with our birth" and the midwives responding "Nothing's gone wrong yet." That's why I'm so pissed off that statistics, individual and midwife accounts, and scientific evidence don't seem to make a dent in the fear of birth that the medical establishment seems to have instilled in women, yourself included. It makes me sad, and it makes me angry, and it seems so counter-intuitive. Women have been giving birth for quite some time, it's evolutionarily designed to be safe, and yet most women are prepared to hand over all responsibility and allow themselves to be cut open, episiotomied, and forceps delivered without thinking about it, just because doctors say it's okay. Fuck that. The fact that we still do forceps and ventouse extraction of the foetus when it has a 1 in 5 chance of permanent urinary incontinence for the mother, and a high likelihood of head trauma and shoulder dystocia to the baby being delivered is appaling.

It's this attitude that tries it scare, intimidate, and goad women into going against their own wishes. I don't think you're trying to do that here, rather that you have been frightened into accepting the superiority of medical professionals over your own feelings about birth, as so many women have. Your insistence that hospital births present numerous other options? The only options presented are forceps or ventouse (dangerous and less safe than a c-section, as mentioned above) epidural, and caesarian. However, as a c-section takes so much preparation and waiting, being transferred to hospital from home birth does not radically impact the speed with which a c-section can be preformed.

Also, there is the absolutely insane fact that doctors and midwives in hospital are more likely to encourage a woman to give birth lying on her back, which is just fucking stupid. Makes the birth longer, more painful, and, once again, increases the chance of medical intervention.

what if it happened to you?

As for your statement about being transferred to hospital, for some people it may be the case. However my partner and I understand that there are situations in which we may have to transfer to hospital, but as we both dislike hospitals, we'd prefer to have the baby at home. You might find your home stressful, but we find it less stressful than a place where people die regularly, and a place where doctors are more likely to try and pressure us into induction or forceps delivery just because we aren't conforming to a schedule. We accept the possibility of transfer, and would be disappointed if it were the case, but would find having the birth in the hospital from the beginning an even more stressful situation.

I want that last choice, I want the operating table readily available to me.

Like I said above, it is an option if necessary. But if you have a home birth, it's less likely to be necessary, and has a negligible impact upon you in the unfortunate event of complications.
 
 
Tom Tit's Tot: A Girl!
15:31 / 04.06.05
She was a student not a midwife and no offense but she was an incredibly capable person, precisely the type of person that I would want telling me what to do in that situation and I speak as a woman capable of birthing a child.

Incredibly capable people can still be wrong. It happens.

Why would I take offense at your assertion of her capibilities? She was still a 17-year-old student with only experience of high-risk birth situations. Capable or not, her point of view was skewed.

"Telling me what to do" is once again a verbal reinforcement of the idea that women need to be told what to do when giving birth. "Nothing dear, you're not qualified" yet again.
 
 
Nobody's girl
11:57 / 05.06.05
I'm interested in hearing experiences and opinions from other parents on this issue...anyone?
 
 
Tryphena Absent
13:47 / 05.06.05
It was an anecdote.
 
 
illmatic
14:46 / 06.06.05
I don't have time to construct a decent contribtuion today but I'd just like to pimp the work of the friend of mine.

Here's an introduction. He has training in Reichian psychotherapy and became a midwife to see how Reich's concepts worked within the birth process. I'd advise anyone interested in natural birthing to contact him and read some of his pamphlets (unfortunatly not availble online) or send me a PM and I will arrange something.(list of publications here) He regards one of his bigest success as getting some concepts derived from Reichian therapy in usage around the birth process in his hospital. As far as I'm aware it's only him and a couple of other midwives but it's a start. I have heard all manner of horror stories from him about the NHS and the medicalisation of the birth process, where a money/target mentality predominates.

To try and cut through this argument a little bit, I'd say that it need not (certainly should not) be a dichotomy between home/hospital. Talking to Peter does make me think that it's possible for women to have warm, contactful, rewarding birth experiences in a hopsital, it's just unfortunately the exception rather than the rule. And the structure and mentality within the NHS enforces the latter.
 
 
Nobody's girl
15:45 / 06.06.05
What I find interesting about the home birth vs hospital birth debate is the assumption that if you are for one then you are against the other. I have to say I don't believe that is the truth of the matter. I think that just because I have a preference for a birth at home with as little medical intervention as possible does not automatically mean that I hate all modern medical practice, medical professionals and hospitals, yet it appears that this is the inference taken from my preference. I believe this is the inference that medical professionals take from women who state a preference for as little intervention as possible in their birth, and as a result incredibly defensive and resentful attitude towards these women occurs. At least that is my experience, and the experience of many other women- see the websites I have linked to above, the homebirth reference site has a page entitled "you can't have a homebirth because..." which details the various spurious excuses women have been given and AIMS has a page specifically for dealing with healthcare professionals who obstruct your wish to birth at home.
This defensive attitude is an almost huffy response and I have a hard time taking any professionals seriously when they exhibit such a childish attitude to something that is so extremely serious to me.

From a zoological viewpoint I think that birthing in hospital in a healthy normal birth is madness. You'll never see a zookeeper packing up a Panda in labour into the back of a big noisy white van to be tranferred to a brightly fluorescent, strangely smelling, alien environment to give birth heavily drugged and attached to various monitors with needles in the Pandas arm that restrict its movement whilst surrounded by the sounds and smells of other distressed animals in an area full of diseased animals. No, zookepers would never let that happen. Instead, they'd make sure the Panda was healthy and had it's own birthing den in it's enclosure and leave the Panda to get on with birthing on it's own as nature intended, intervening only if absolutely necessary. But suggest the same treatment for a birthing woman- who is after all just another birthing mammal- and suddenly you're a dangerous, irresponsible, anti-establishment hippy out to destroy the NHS!

Aren't we all lucky doctors and nurses can control birthing otherwise we'd surely have died out through irresponsible birthing practice! Oh, hang on a minute...

Yeah, yeah, that was facetious. Look, I'm extremely glad I have the option of birthing with the help of modern medicine if something goes wrong. My problem is the disempowerment of women in the current medical paradigm (OMG I used paradigm in a sentence- kill me!) which is frankly endemic. See most women can give birth without intervention. They really can. Otherwise how the hell did we last so long, eh?

Birthing without intervention is often reported by women as the most empowering experience of their life where they enter a strange form of consciousness many believe is divine. But, the developed world now has this image of childbirth as a frightening and overwhelmingly painful time which we need to "fix"- as though we now view birth from the eyes of the anxious father, not the empowered creating woman. As a result women are terrified and understandbly feel the need to hand over their bodies into the care of the paternalistic medical establishment who will "make it all better, don't you worry your silly little head, dear." It's my theory that this surrender of power is one of the major factors in increased operative (forceps, ventouse) deliveries, epidurals, and c-sections- it is the attitude stated by the woman at my ante-natal class that "I don't think I could push", of course she can't, she's "not qualified"!. This issue really is one of the front lines of gender politics.
 
 
Olulabelle
20:02 / 06.06.05
I am forever amazed at how people seem to think that they can rely on statistics as a sound base for making a judgement. It appears to me to be a fairly ridiculous game.

We all know how statistics can be manipulated and that organisations can and do skew them in order to promote their own cause. The homebirth site (as good as it may be) is as likely to do this as any other organisational body.

In particular things like the following make me extremely angry: Only 4% of babies with home-booked births had Apgar scores below 7 at one minute and 0.6% at five minutes, compared with 9% and 1% of those booked for hospital deliveries. 13% of babies in the home group were resuscitated, usually simply being given a whiff of oxygen, compared with 28% of the hospital group.

Of course the statistics for the hospital births are going to be higher. The Mothers with potentially difficult births who were advised to have their babies in hospital are also included in the hopsital delivery count. Most mothers facing the prospect of potentially difficult births do not opt to have their babies at home because of the risk.

This applies to any home-birth versus hospital-birth comparison statistic.
 
 
Nobody's girl
20:47 / 06.06.05
I am forever amazed at how people seem to think that they can rely on statistics as a sound base for making a judgement. It appears to me to be a fairly ridiculous game.

I agree with you completely on this one. We can play the statistics game 'round and 'round until the end of time and not get anywhere.

We all know how statistics can be manipulated and that organisations can and do skew them in order to promote their own cause. The homebirth site (as good as it may be) is as likely to do this as any other organisational body.

Absolutely, but this argument cuts both ways, doesn't it? We must apply our cynicism to both birth rights organisations and the establishment equally, oughtn't we?

Of course the statistics for the hospital births are going to be higher.

Hmm.. well yes and no actually. Home birth statistics include women who have unplanned emergency home births, so it's not only the low-risk cases that are inculded in the statistics, though I do take your point.

One of the major risks in a hospital birth is much higher chance of infection. As I pointed out above, MRSA is a big problem in hospitals today and it has been known to make it to the maternity ward, hardly a risk factor at a home birth! Of course MRSA only affects those with comprimsed immune systems, unfortunately this includes all the patients in maternity- mothers and newborns alike. Having recently worked in the local hospital I have first hand experience of how appalling the standard of cleaning is and I have to admit this factor definately informed my descision for a home birth.

Personally, I couldn't give a monkeys wherever and however anyone wants to have their baby as long as they aren't forced into a situation they aren't comfortable with either through ignorance or co-ercion. I'm feeling bullied not to have a home birth so I am naturally focussing on that aspect. The opposite situation would be equally awful, no doubt, but if it ever occurs it certainly hasn't been as well documented as the situation I'm currently facing.

What I find interesting is that you're not likely to hear of a woman having her baby at home because she was co-erced and bullied into it by her doctor/midwife/partner or because she thought it was the only place you can have baby, but the opposite situation apppears all too common. Perhaps there's an inbalance, eh?
 
 
Nobody's girl
09:32 / 07.06.05
To clear up a few misunderstandings, I found the comparative study on home births and hospital births on the BMJ website. The study does note that "home birth has become statistically "safer" than hospital birth is not, of course, unexpected, as high risk mothers seldom press for home delivery" this said, "lethal malformation" and "babies of less than 2.5kg" were excluded from the comparison which pretty much excludes the large proportion of high risk babies such as the premature.

Another study I found on the BMJ website did a comparison study on home and hospital births which ought to satisfy your need for fairer comparisons- "controlling for parity and social, medical, and obstetric background". It found that- "There was no relation between the planned place of birth and perinatal outcome in primiparous women when controlling for a favourable or less favourable background. In multiparous women, perinatal outcome was significantly better for planned home births than for planned hospital births, with or without control for background variables." This study was from the Netherlands, however, who are know for a first rate maternity service.

I'm mainly interested in confirming that home birth is at least as safe as a hospital birth, which for healthy women it certainly seems to be. As a result I feel rather frustrated at the amount of prejudice I have experienced from both medical professionals and people I discuss this with.
 
 
nyarlathotep's shoe horn
16:10 / 07.06.05
my 2 cents:

my father was breach, delivered at home by a midwife (c 1937 Montreal). guess it worked out, 'cause he managed to survive to have four kids (one of which types away...) - for my grandmother, it was a very painful experience...

all that aside. The power of birth has been undermined for years, with new technologies taking over. A team of japanese scientists have created an artificial womb. I think it was developed using premature goats. However, the most disturbing aspect of this creation was a spokesman who expressed his fear of the unknown in the womb, and preference for the technology, which allows greater surveillance and control.

eek.

Hormone & gene therapy has been growing in the US, bringing back a subcurrent of the eugenics movement of the 20s (later exported to Nazi Germany). Moreso than trying to screen a child for down's syndrome or any number of other afflictions, we may be screening for height, eye colour, etc...

so much for the acceptance of us as we are.

not to mention in vitro fertilisation.

I think defaulting to the C-section for the sake of convenience of scheduling is pretty atrocious. I'm not sure how widespread this is in hospitals, however, I'm under the impression that there is a greater chance that a C-section will be done before other options are exhausted (given that there's no risk to mother or child).

if the only tool you have is a hammer, everything begins to look like a nail. if the only tool you have is a scalpel...

ta
pablo
 
 
modern maenad
12:51 / 05.07.05
Minor contribution to thread: I found Naomi Woolf's book Misconceptions fantastic on the gender politics of pregnancy, birth and childcare.
 
 
Nobody's girl
00:05 / 06.07.05
Goodness! Reading the Amazon.com customer reviews alone is very interesting, there's quite a debate going on in there!

A Doula reviewing the book made an interesting point-

"She tells women that hospital courses are not adequate or honest (true) but does not tell women that there are literally thousands of independent childbirth education classes held in homes, community centers and yoga studios that do provide the information she seemed unable to locate before her traumatic first birth. Women can seek a Bradley Method (disclosure-I teach Bradley), Birthing From Within, Birthworks, or other natural childbirth class to get balanced viewpoints and better yet - referral lists of wonderful midwives and the (sadly too few and far between) supportive respectful OBs and hospitals."

See, I find that comment interesting. I suspect that Naomi Wolf probably did what most women who've suffered traumatic births do which is surrender themselves and the birth of their child to the medicalised model. I believe that for the birthing mother the medicalised model of birth management is harmfully passive and the medicalised model of pregnancy is very intrusive where every slight deviation from a normal graph is treated like a major catastrophe.

After a whole pregnancy worrying over test results and being treated like an unexploded bomb by her carers your terrified mother is then expected to be the passive bystander in birthing her baby by always deferring to "experts". It's just a recipe for disaster and I suspect it is the reason traumatic births like Naomi Klein's happen.
 
 
Sjaak at the Shoe Shop
09:11 / 06.07.05
Where I live a home birth is still quite common, although a hospital birth is gaining popularity. A C-section is normally done only in case of a medical indication, however this seems to be slowly shifting, following developments in other countries.

To be honest, I do not think there is such a distinct better or worse option here. Every birth is different, just as every person and in particular the mother. I would say a home birth can be more relaxed and intimate - as long as all goes well. In case of complications (even for something relatively 'minor', i.e. something 'simple' as extremely painful contractions) you may wish you decided otherwise.

So with regards to home or hospital I guess it is really down to the medical condition and what you feel comfortable with.
However, I do want to stress that there is quite a chance that things will not go as smoothly as expected(although not necessarily with major consequences giving birth can for example still be extremely painful) I don't care about the exact statistics but there is a reason that not so long ago still a substantial % of women died in child birth (and still do in many places around the world).
(the human birth process did not really keep up with evolution I am afraid)

We have recent personal experience, started off at home but ended up in the hospital anyway, and eventually a C-section was the only option. During pregnancy there were no indications, except that the baby was somewhat larger than average but not exceptionally.
I dont think a Sectio should ever be done without a real medical reason, although quickly performed it is a major operation with serious consequences and a lengthy recovery. Still, parents-to-be should realize that something may go wrong and that a delivery can be very painful event, and if uncomfortable with the thought don't ever hesitate to deliver in the hospital.
 
 
Saturn's nod
21:31 / 03.03.06
I've read and spoken with people from the unassisted childbirth movement, and I thought I would reference some of their works. There is a movement to support the mother's judgement and to encourage her to trust her own knowledge: which perhaps the professionalisation of medicine works counter to. I mean by that it's my perception that the training of medics still includes a lot of encouraging the medic to take the position of 'the knower' and to help the the patient to hand over their self-knowledge. Which perhaps is exactly the opposite to a helpful medical attitude to birthing.

I love Laura Kaplan Shanley's site and Ingrid Bauer's essay Birthpleasure has had an effect on the way I live my life. The points that come from the non-intervention view of birthing seem very important to me and underappreciated in the medicalised view - especially the bizarrities which are representations of birthing in popular media, including fiction.

I'm a biologist by training, so academically "next-door" to medics, and it does seem to me that the medical model works against women learning how to know and trust their bodies. For a start, medical textbooks are heavily gendered: e.g., with women's bodies presented as deviating from the 'normal' male body. The Shanleys' and Bauers work are a vitally necessary corrective to the cultural pressure which drives so much intervention.

An example of a medic who "woke up" to this after her own birthing experiences is Christiane Northrup, an ob/gyn who takes a very wholistic approach, see for example her book "Women's bodies, Women's wisdom": U.K. Amazon, U.S. Amazon. She writes (P430-431 of the edition I have, 'Our cultural inheritance ..." in the chapter 'Pregnancy and giving birth')

"I worked with pregnant women for six years or so and saw that labour and delivery very often go well. Yet we continue to treat the normal proess of birth with hysteria. High anxiety about pregnancy and birth is partly the result of our collective birth trauma - nearly every one of us has unfinished business about her or his own birth that we keep projecting on to pregnant women.

... Fears of death augment the hysteria we bring to childbirth as another aspect of our collective unconscious.

Ironically, most of these deaths and traumas resulted from poor nutrition, overwork and lack of maternal support, not necessarily from lack of sophisticated medical intervention."
She references several articles in support of this from New England J of Medicine, British Medical J, & Clinical Consultation in Obstretics and Gynaecology.

(I want to acknowledge that hysteria is a difficult word in most contexts because of its sexist overtones.)
 
 
Lintila
15:56 / 04.03.06
I have worked at two differnt hospitals in two different states and two different departments. My opinion comes more from my observations then any medical birthing experience.

At my first job I did patient registration. Almost everyday between 4am and 6am about 1-2 women would come in scheduled either for induction or c-section. Now if there is a serious complication that requires the use of either thats fine, but I seriously doubt that that many women had those serious complications. We would also get to talk with a couple of nurses in OB and they would talk about the drs who had scheduled women for inductions because they were going on vacation.

At the second hospital I worked in the Quality Department and input the hospitals incident reports into the computer. This was a frightening job because I got to learn everything that had gone wrong at the hospital and was surrounded by nurses who would then proceed to rant about what was wrong in the hospital. (I never want to have to go to a hospital as a result)

At any rate, not only did this hospital also have a high amount of inductions but there was a documented incident that I got to input where a Dr. harrassed a woman in labor telling her that it was taking to long and if she didnt agree to get a c-section she could just leave. The topper, was that he wasnt even her doctor.

I honestly don't understand why medicine is like this. Is it the masculine factor? They found a way to control this domain of women and so they're taking full advantage of it? I would be interested to see a study between male and female OBGYNS because in both hospitals there were few to no female OBGYNS. This is not to say that women are less arses then men but really to measure the attitude. This would also have to be compared to rural medicine and big city.
 
 
Fritz K Driftwood
22:30 / 29.03.06
One of my sisters (Sara) just gave birth to lovely Ella! Talking to my mom & Sara afterwards, there was quite alot of pressure for her to just get a c-section and get the whole "ordeal" over with. Sara refused and Ella was delivered naturally. One of the reasons that Sara refused is that another sister had had a hard time afterwards with her c-section healing.

Good luck to a doctor that tried to get my brother-in-law to make any decision without Sara's input!

I think that the number of c-sections advocated by doctors is not only due to doctors wanting to save time, but also (at least here in the US) the incredible pressure on them from hospital administrations and insurance companies to cycle the patients thru quickly and (say it with me) SAVE MONEY.
 
 
Dead Megatron
00:52 / 30.03.06
MONEY SAVES!

Incidentally, give my congrats and well wishes to your sister.
 
 
illmatic
07:58 / 30.03.06
*I'm really really sorry for the threadrot - will mod to have my comment removed in a bit*

Megatron: That whole "useless posts" thing? That add no value? You've just done it again. Please do not respond to this in this thread, thereby rotting it further. Send me a PM or something.
 
 
illmatic
08:17 / 30.03.06
In the spirit of adding something positive to the thread ("shut up, Megatron" is arguably positive, but not on topic), I thought I'd add the following tangent.

A step on from "natural childbirth" is "natural breastfeeding" (that is breastfeeding on demand until the child stops of his/her own accord).

There's a very interesting article about that here

Be interested in people's reactions to the article, espcially mothers*. It would appear that breastfeeding delivers an incredbile amount of quantiable health benefits for the child but advocates argue that it lays the foundation for a healthy psyche as well. I can't see how one could measure this but it's something I find of great interest. This dovetails entrely into the work of Wilhelm Reich.

While I'm at it, I should provide a link to info about Jean Liedloff's Continuum Concept while fills out another, accompnaying direction in childcare and nuturing, putting particualr stress on the "in arms phase" - that is, intimate bodily contact and holding in the early months of life. If people are interested in these ideas, we can always expand into seperate threads.

Click here for a Radio 4 Womans Hour article about the Continuum Concept.

*Megatron, that means not you!
 
 
elene
10:38 / 30.03.06
Morrison argues that our distaste for older breastfeeding is not a given - it's purely cultural and has existed only over the past 50 years

The only personal experience of this that I can share is of a four year old boy bullying his mother to give him the breast. I found it very disturbing. He was a very strong and a very aggressive little boy. It seemed wrong, but just about everything about this family seemed wrong, and I can't say whether that was a purely cultural reaction or not. I probably felt too much into it. I think it was just sibling rivalry working itself out. Each child had his or her own way of acquiring mother, and they were all pretty radical.

I don't wish to imply that this is the usual situation. The article claims most children would have self-weaned by four years, and this was not a healthy family. Nevertheless I'm almost certain there's a need to wean between three and four years, if the child shouldn't.

I'm certain that up to a certain point it's very good for the child, I'm less certain it's good for the mother.
 
 
Sax
13:13 / 30.03.06
Firstly, a disclaimer: I am a man and it is unlikely in my lifetime that I will ever give birth, so my opinion frankly counts for very little. However, having experienced childbirth from the business end on two occasions, I do have some personal observations and opinions to offer.

There is a lot of talk of "medicalising" childbirth, and I'm sure there must be instances were overworked and understaffed maternity departments do (probably unintentionally) edge pregnant women towards interventionist practices which they might consider make life easier all round.

But... why shouldn't childbirth be medicalised? It's (very often) an intensely traumatic experience which involves the extraction of an at-least six-pound parasite from within a human body. Now call me a wimpy old bloke who tosses the paracetamol down at the first sign of a sniffle, but that's the sort of thing I'd want medicalising.

Does "natural" always equate to "better"? Would you rather use leaches and maggots on an open wound than an injection and a nice bandage? (That "you" isn't to anyone in particular). Maybe you would. I wouldn't.

Again, personal choice. Perhaps there isn't enough material and information on natural/home births made available to mothers-to-be; obviously there should be.

Some personal stuff now. Both our kids were born in hospital. The pregnancies went perfectly well. The first was a little lazy and needed to be induced after two weeks as there was no sign of him coming naturally. If he hadn't been induced it's quite likely he would have come naturally eventually, however after 42 weeks of pregnancy the placenta starts to deteriorate quite rapidly.

So we went into hospital. It was a long labour and a slow birth; his heartbeat kept dropping. As he was arriving we discovered the umbilical cord was wrapped around his shoulder. Cue rush to the emergency room and lots of flapping about. Lots of medical intervention. Necessary medical intervention.

Baby number two. No problems in pregnancy. Warning that it might be a "big baby". Labour came on naturally, but after a good start nothing. For about twelve hours. A poke around from the doctors and off we were rushing again to the theatre, this time because the baby was transverse (I think that's the phrase; spine-to-spine with the mother rather than spine to belly). Emergency C-section.

So, both times medical intervention was needed without any prior indication. I'm pretty glad we were in hospital for it, because I might not be about to leave work to pick up two babies right now.
 
 
illmatic
17:54 / 30.03.06
BTW: am464, thanks for those links, will read with interest.

Sax: I don't think I can do any better than quote Nobody's Girl's opening post:

I would like to point out that I don't have any problem with necessary medical intervention into birthing and pregnancy. I personally shan't hesitate to protect my health and my baby's health if either appears to be in danger. My problem is with the obvious over-intervention into what for most women is a healthy life event. After all, it just doesn't make sense that 1 in 5 women are unable to give birth normally in developed nations only, does it?

So, I don't think anyone is arguing (particulary not me, because I'll never be more than a nervous onlooker to the event) for a rejection of Western medicine. Rather, people seem to be saying that there exists a power relationship between women and the medical establishment, and women's feelings about, and control over, the birth over the birth are frequently discounted. Obviously, this can be very unpleasant - and, at worse, damaging - when someone is undergoing such a powerful life experience. I have a friend who works in the NHS as a midwife and I'm inclined to agree with this perspective. He has all sorts of horror stories of things done to infelxible rountines, and by rote, with very little feelings and sensitivity for the needs of mother and child. The high rate of C-sections also suggests, to me, that this side of the arguement may have a case.

I suppose the ideal situation would be all the advantages of the contemporary medicine, with women at the centre, fully informed and exercising choice and autonmy, rather than - as is being argued - being made to feel scared and disempowered.
 
 
illmatic
09:47 / 31.03.06
There's a very interesting interview with Wendy Savage - campaigner for womens birthing rights and known for campaining against casereans in today's Guardian. Can't find the link though. Will add later. Apparently the C-rate is now up to one in four!
 
 
illmatic
12:31 / 31.03.06
Here's the link

Interesting article - she doesn't just blame the caserean rate on teh eval medical establishment, she focuses in a lot on womens and families expectations:

I am surprised that Savage homes in on this when I ask her to explain what is causing the rise. "One of the problems," she says, "is that obstetricians don't find it easy to say no when a woman says she wants a caesarean." It's odd to hear the great defender of woman-centred medicine saying doctors should say no to women. "I don't think most women are actually coming in and just saying, 'I want a caesarean', but if they've had a badly managed first birth ending in a caesarean, a lot of women want an elective caesarean the next time. I would say to them, 'It won't be the same the second time around', and in my experience those women can go on to have a vaginal birth."

... this plays a part in shaping the doctors decisions, as it's often backed up by a fear of litagation. It's really worth reading if you're interested in these issues. Advance publicty for her new book Caesarean Birth in Britain.
 
 
Sax
12:39 / 31.03.06
There's also the supposed "too posh to push" syndrome. I'll have a look for some writing on it in a mo.
 
 
Kit-Cat Club
12:16 / 01.04.06
I thought one of the most interesting points in the article was when the journalist suggested that perhaps traumatic experiences during birth made women more inclined to actively want and request caesarean sections:

"Say you were still practising and I came to you telling you that with my first birth I had found it so miserable being in so much pain, being seen by so many indifferent staff, strapped up to so many machines, that I wanted an elective caesarean next time, what would you say?" "I would say, have a home birth," says Savage, looking steelier than ever. "Since your second labour is likely to be much shorter and easier than your first birth. You are rich enough to have an independent midwife at home."

I wonder how many women who have had a difficult first birth would feel easy choosing a home birth second time, and I wonder if Savage understands how hard it is for women who haven't had her kind of childbirth experience to say they found natural birth traumatic rather than empowering. Next to Savage's certainty I feel as if I have let down the side by not taking the correct line: vaginal birth good, caesarean bad.


The whole process of pregnancy, birth and childcare seems to be one of the primary places where women's behaviour and experiences are affected by 'thou shalts' and 'shalt nots' from all sides (I know this is nothing we didn't know already...). Even where someone like Savage is fighting 'for' women, she runs the risk of denying the validity of personal experience - and of telling an individual woman that her choice and her actions are wrong (i.e. both practically wrong and in a sense morally wrong). Everything about pregnancy and birth is so fraught and ethically/morally loaded, it seems counter-productive to me to be prescriptive about the choices of individual women - it reinforces the notion that there is one, definitive, correct way of approaching birth.
 
  

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