Warning: If You Are Pregnant, You Might Not Want To Read This

[lml41981]

Teachers Joined in Birth, Death
Two New Moms Taught Together, Died Days Apart (http://www.philly.com/inquirer/health_science/daily/20070510_Teachers_joined_in_birth__death.html)

In March, the staff, students and parents of Avon Elementary School threw a surprise baby shower for teachers Valerie Scythes and Melissa Farah.
Mere weeks later, both young women were dead.

They died, 15 days apart, after delivering by cesarean section at Underwood Memorial Hospital in Woodbury, Gloucester County. They left behind healthy infants - Isabella Rose Scythes and Grace Melissa Farah.

A combination of the unthinkable and the incredible, the deaths have turned two first-time fathers into widowers, shaken the tiny school and its close-knit borough of Barrington, and left myriad questions about what went wrong.

I cannot imagine how these fathers must feel. G-d, I hope it is just a freak coincidence...but what are the odds? :(

[ellidew]

Wow, that is freak. I haven't read the whole article yet... do they have a cause of death?

eta: Read the article. I'm just sad and sick to my stomach now. I can't imagine the emotion their husbands are feeling and I just feel sad for those babies. It's just awful.

[lml41981]

Wow, that is freak. I haven't read the whole article yet... do they have a cause of death?

From the article...
Scythes, 35, died March 28. The cause is unclear, and final autopsy results are pending, said John Baldante, a Philadelphia lawyer representing the family.

Farah, 28, died April 12 of "shock, due to bleeding and anemia," according to her death certificate. The family's attorney, Todd Miller of Allentown, said he was awaiting an autopsy report.

[jennylou]

I read that last week. Very sad, indeed.

[ignutzz]

I read about this last week too. It's really awful that this happened.

The deaths of the teachers led to a demonstration by birth advocates (http://www.nj.com/news/gloucester/index.ssf?/base/news-2/11794731937810.xml&coll=8) trying to bring attention to NJ's insanely high Cesarean birth rate - 37%.

[jimmysgirl424]

Oh boy...I knew I shouldn't have clicked on this thread, but my curiousity got the best of me. :( My OB has been talking c-section as an almost definite for me.

[jennylou]

Oh boy...I knew I shouldn't have clicked on this thread, but my curiousity got the best of me. :( My OB has been talking c-section as an almost definite for me.


why?

[lml41981]

I read about this last week too. It's really awful that this happened.

The deaths of the teachers led to a demonstration by birth advocates (http://www.nj.com/news/gloucester/index.ssf?/base/news-2/11794731937810.xml&coll=8) trying to bring attention to NJ's insanely high Cesarean birth rate - 37%.
That is about what the DFW Cesarean rate is, IIRC. There's no reason that more than a third of births truly require a Cesarean, and if there is a real reason, then New Jersey has a public health issue on its hands.

Oh boy...I knew I shouldn't have clicked on this thread, but my curiousity got the best of me. :( My OB has been talking c-section as an almost definite for me.
Why on earth would a C-section be an almost definite for you? I'd look into a second opinion. Seriously.

[ignutzz]

That is about what the DFW Cesarean rate is, IIRC. There's no reason that more than a third of births truly require a Cesarean, and if there is a real reason, then New Jersey has a public health issue on its hands.
Frightening!!!! NYC is right up there with them. Some hospitals are in the low 20s while some of our others are at 40 (to be fair, I think the higher rates are due to the NICU level at those particular hospitals).

Why on earth would a C-section be an almost definite for you? I'd look into a second opinion. Seriously.
DEFINITELY!!!

[jimmysgirl424]

why?


Why on earth would a C-section be an almost definite for you? I'd look into a second opinion. Seriously.

Baby is measuring big and my OB says that my pelvis is very small. She thinks even a 7.5 pound baby would be too big for me to push out. :( Its not 100% definite, but the final decision will be made at our last sonogram in a few more weeks. She (my OB) says she's willing to let me try to deliver vaginally but she's concerned that it could end up being for nothing and I'll just need the section anyway.

[Weddings by]

My OB has been talking c-section as an almost definite for me.
Obviously, I don't know your situation, but I want to share mine.

With my first, when I went to my first OB appt., during the exam, she said that I would have no problem delivering a baby. Months later, after I got on state insurance that paid a lot for anything (it was better than private insurances! :eek: ) I suddenly was unable to deliver a baby and would need a C-section. After a couple of such visits, I decided to deliver out of state with my sister's midwife. I had absolutely no issues with delivery. She was born after 20 minutes of pushing, and she weighed 8 1/2 lbs. I later gave birth to a 10+ lb baby.

When a c-section is suggested, I suggest looking at any possible reasons for it, even if they seem...paranoid? (Such as the insurance thing, which was, actually, a widely known issue in that area.) It's just not worth it if it's not necessary, IMO.

Oh...my sister delivered a breech baby at a hospital. The doctors freaked out because they had NEVER had anyone deliver a breech baby there. :eek: Never??? She refused to have a C-section, and it wasn't necessary. I think the baby was around 9 lbs.

My last was breech (the over 10 pounder) and I was told by OBs that I would need a C-section--that was when they thought that the baby wouldn't be more than 8 lbs. We found only one doctor in the entire area willing to deliver a breech baby over 8 lbs, but there is no way that he would have done it at 10 pounds. We had the baby turned before delivery.

********
That is a sad story.

[ignutzz]

Baby is measuring big and my OB says that my pelvis is very small. She thinks even a 7.5 pound baby would be too big for me to push out. :( Its not 100% definite, but the final decision will be made at our last sonogram in a few more weeks. She (my OB) says she's willing to let me try to deliver vaginally but she's concerned that it could end up being for nothing and I'll just need the section anyway.

Pelvises I Have Known and Loved (http://midwiferytoday.com/articles/pelvis.asp)

How big? US can be off by as much as 2lbs either way, especially after the first trimester.

YOU get to make the final decision. YOU, not your Dr. Do some research, talk to other moms, learn about optimal birthing positions, find a doula, get a second opinion. Unless you have TRUE CPD, a cesarean is not a foregone conclusion.

[Sophia]

jimmysgirl, I have to agree. I'm very petite (under 5', small frame) and when I was pg with #1 I raised the possibility of a c-section with my OB because exH was much taller than me, and he's the short one in his family. The OB said that you can't tell beforehand if a pelvis will be big enough or not. I ended up going into labor on my own, progressed beautifully, started pushing, etc, but did eventually have a c-section due to CPD. I chose to have elective c-sections for my other 2. So I'm just saying, that even though I have no regrets about my c-sections and I feel they are actually usually very safe, your OB shouldn't already be planning one out for you.

[ellidew]

I had a c-section because my pelvis is too small to deliver vaginally. It was only determined AFTER i'd labored all day and pushed for 2 hours though with 2 failed epidurals. About a silver dollar was all that was coming through of ds' head. I asked at my last ob appt if there was ANY possible way i could have a baby vaginally by vbac and she said i could try anything i want but that she thinks it will more than likely end the same way. My ds was 7lbs 11oz.

Personally, recovering from a c-section SUCKS. Nearly 7 months later i still get stabbing pains in my lower abdomen, i have itchy numbness, and the incision rubs and gets sore and red. I really don't want to have another cesarean and I'm 90% sure i'll labor through for a vbac. Now, if it doesn't work the 2nd time and we have more children... i'll just have the c-section :) I truly don't understand elective c-sections. :confused:

[Sophia]

I asked at my last ob appt if there was ANY possible way i could have a baby vaginally by vbac and she said i could try anything i want but that she thinks it will more than likely end the same way.

That's pretty much what my OB told me after my first c-section. I chose elective c-section because vbac was very new and I was wary of how safe it was, frankly (this was 1995). FWIW, recovering from a 2nd c-section is a cakewalk compared to a first one or compared to labor.

[jimmysgirl424]

I should have put in my original post that my OB's concerns are actually centered around the baby's size (consistently measures three weeks ahead at every appointment), my pelvic size and also my DH's size. (he is 6'9"). She's afraid that the combination of the three could very well result in c-section. That being said, she is still telling me that she will allow me to try for a vaginal birth first, which I definitely prefer. I don't want to be a new mom recovering from abdominal surgery on top of everything else.

[littlemia]

How awful. I heard that the dance coach at USF died from childbirth complications, too, not very long ago. I just had a baby and one of the few things I didn't worry about was dying.

[ellidew]

jimmysgirl- At my last u/s my ds measured 9+ with a 1lb variance in either direction. So 7.11 is actually out of the range. I don't think u/s is a good reason to have an elective c-section. That's just my personal opinion.

sophia- Good to know it was easier!! I totally don't want one though. Didn't want one the first time either ;)

[wendalah]

Aside from thinking it's a very sad story and odd coincidence, this news item didn't particularly bother me. There are risks in giving birth no matter how you go about it, just like there are risks in traveling by airplane. Most women come out OK.

[ignutzz]

Aside from thinking it's a very sad story and odd coincidence, this news item didn't particularly bother me. There are risks in giving birth no matter how you go about it, just like there are risks in traveling by airplane. Most women come out OK.

Yes, but there is a 3-times greater risk of death from Cesarean-birth (http://www.cmaj.ca/cgi/content/full/176/4/455) than vaginal. Cesareans are a very useful tool when used appropriately (such as the examples in this thread), but the risks involved (http://www.acog.org/from_home/publications/press_releases/nr08-31-06-2.cfm) are not to be taken lightly.

[wendalah]

Right, I'm not planning to have a c-section unless determined necessary, but I'm still not overly concerned about it as the odds are still in my favor I'll be OK if it happens. This is just one of those things I'm choosing not to worry about too much.

[ejs]

Is everyone automatically assuming that these women died because they had c-sections? I don't see the value in jumping to conclusions.

We've all heard stories about complications, including death, from both c-sections and vaginal births, just as we've all heard wonderful, heartwarming tales.

[msnicolea]

Important point, ejs.

[lml41981]

I should have put in my original post that my OB's concerns are actually centered around the baby's size (consistently measures three weeks ahead at every appointment), my pelvic size and also my DH's size. (he is 6'9"). She's afraid that the combination of the three could very well result in c-section. That being said, she is still telling me that she will allow me to try for a vaginal birth first, which I definitely prefer. I don't want to be a new mom recovering from abdominal surgery on top of everything else.
She shouldn't be saying she "will allow" anything. You're the boss, you get to decide what you will and will not do. Her job is to provide you with the facts and allow you the right to make informed consent. I learned that lesson the hard way.

Now that you know the facts that she's using, do your own research... There's time for your pelvis to open up...there are positions you can use even now that can increase your chances at a successful vaginal delivery and positions you can use during labor to open the pelvis and try for proper fetal presentation.
http://www.spinningbabies.com/index.php?option=com_content&task=blogsection&id=4&Itemid=31

[ignutzz]

Is everyone automatically assuming that these women died because they had c-sections? I don't see the value in jumping to conclusions.

I'm not. But I'm not ruling it out or jumping to the alternate conclusion that it was hospital error either.

The discussion of C-b risks came about from the tangent the thread took.

I'm curious though, why should we not consider that their deaths were caused from surgical complications? If we were talking about heart surgery, would you feel differently?

[LittleFredPunkinHead]

I'm curious though, why should we not consider that their deaths were caused from surgical complications? If we were talking about heart surgery, would you feel differently?
Asking someone if they're concluding something is different from telling them not to consider it.

[lml41981]

Is everyone automatically assuming that these women died because they had c-sections? I don't see the value in jumping to conclusions.

We've all heard stories about complications, including death, from both c-sections and vaginal births, just as we've all heard wonderful, heartwarming tales.
No, I'm not assuming they died due to having had c-sections. Actually, my assumption is grave human error on the part of the doctor(s) and medical staff. Hate to say it, but with our country's maternal death rate so low, having two deaths come from the same hospital (even if they transferred to different hospitals, it started it in the same hospital) in such a short span of time would make me seriously reconsider delivering at that hospital.

[Toonces]

No, I'm not assuming they died due to having had c-sections. Actually, my assumption is grave human error on the part of the doctor(s) and medical staff. Hate to say it, but with our country's maternal death rate so low, having two deaths come from the same hospital (even if they transferred to different hospitals, it started it in the same hospital) in such a short span of time would make me seriously reconsider delivering at that hospital.

That was my assumption, too. In this day & age, that's a very bizarre "coincidence".

[Weddings by]

She (my OB) says she's willing to let me try
I hope that you don't feel like people are jumping on you about this. I know that wasn't my intent at all. I just wanted to share my story (which I did before you even posted yours :D) in case it helps you at all. I'm sure that you have a lot of thoughts about the possible c-section, and I'm sorry that you're faced with it. I wasn't overly concerned with the last possible c-section that was mentioned, but I still would not have liked it to have happened. I'm glad that you have an OB who is willing to stick with you and your decision. I hope that you enjoy the rest of your pregnancy...well, sometimes it's better to be miserable for a while before labor so that you want it to be over! :p


I think that it's unlikely that what jimmysgirl's OB meant is that "she'll let her" but rather that she'll stick with her if she tries to deliver vaginally. Some OBs aren't so flexible.


Is everyone automatically assuming that these women died because they had c-sections?

Nope. I haven't even thought about the causes; I just thought it sad for those still alive. :(

[ignutzz]

Asking someone if they're concluding something is different from telling them not to consider it.
You're right. I was trying not to speak in absolutes in my question, which doesn't work since "assuming" is kind of an absolute. :)

So I'll rephrase:
Why shouldn't we assume they died from complications resulting from Cesarean surgery???? It is one idea, out of two immediately probable conclusions (the other being hospital error which is entirely possible), to make based on current reporting. If this were heart surgery, and the patient developed sepsis and died, would we be cautioned against assuming his death was due to the risks of surgery? I do wonder if the kind of surgery (and associated risks) influences a reader's reaction as to what/who is at fault

All of the above aside, I do agree that hospital environment and human factors did likely play a huge part in what happened to these women.


Some OBs aren't so flexible.
The point is, the decision is not up to the OB, flexible or not. Just because a healthcare provider (of any kind) schedules a procedure (of any kind), doesn't mean the patient has to agree to it or show up for it.

[Weddings by]

The point is, the decision is not up to the OB, flexible or not. Just because a healthcare provider (of any kind) schedules a procedure (of any kind), doesn't mean the patient has to agree to it or show up for it.

I'm not arguing with that. In fact, that's essentially the thing that I was saying--that the OB likely isn't telling the patient what the patient may or may not do, but rather what the OB will put up with while attending the patient.

[Sarah]

Please don't let them coerce you or talk you into a c/s for size. It's a really poor reason for a c/s (which is a life saving and wonderful procedure, when necessary).

Read "the thinking woman's guide to a better birth" before you make any decisions, please.

[lml41981]

I'm not arguing with that. In fact, that's essentially the thing that I was saying--that the OB likely isn't telling the patient what the patient may or may not do, but rather what the OB will put up with while attending the patient.
Thing is, if she doesn't want a C-section and the doctor dropped her as a patient, she could still show up at the hospital in labor and someone would have to attend to her care. So, it isn't like a woman has no option if the doctor says, "C-section or else leave my practice. It is just the same as if I were to need an emergency transfer to the hospital during my birth...they have to help me.

I just don't get the "never question the OB's expertise" mindset (and I was in that mindset once). If a doctor says, "You need brain surgery because you might have a cancerous tumor," one would probably schedule a second opinion before agreeing to have one's head cut open, right? So, why not get a second opinion if the OB says, "Your baby might be too big for your pelvis, so a C-section is almost definite for you." Is there a reason we readily accept one major surgery but not others? (of course, emergency c-sections are another matter...I likely wouldn't question a doctor if he said I needed my appendix taken out immediately, either)

I have nothing against C-sections, btw...I think it is great that they are available. I just worry about the misuse of them.

[jennylou]

jimmysgirl - you know, every time someone has had an elective c for size issues around here, the baby isn't such a huge monster after all - just an observation. ;) On the other hand, there are tons and tons of ladies (some who are quite small!) who've delivered vaginally (and good sized babies too!).

Too big is never a valid reason for scheduling a c/s.

I've had both and the vaginal birth was a walk in the park recovery wise compared to the c/s.

[chandy]

jimmysgirl - you know, every time someone has had an elective c for size issues around here, the baby isn't such a huge monster after all - just an observation. ;) On the other hand, there are tons and tons of ladies (some who are quite small!) who've delivered vaginally (and good sized babies too!).

Too big is never a valid reason for scheduling a c/s.

I've had both and the vaginal birth was a walk in the park recovery wise compared to the c/s.

Not me:) At 10 pounds, my son was even bigger than expected. And after the difficulty I had with my daughter's vaginal birth, the c-section recovery was a total breeze. Hopefully you have a trusting relationship with your doctor and can work together to make the decision that is right for you. Only you and your doctor can determine whether your reason is "valid" or not. I just don't want you (or anyone else) to be scared of having a c-section, if that's what it comes down to. Obviously, this case is a horrible tragedy. But I'm certain that it is a very, very rare exception (or it wouldn't be in the news.)

[jennylou]

Not me:) At 10 pounds, my son was even bigger than expected. And after the difficulty I had with my daughter's vaginal birth, the c-section recovery was a total breeze. Hopefully you have a trusting relationship with your doctor and can work together to make the decision that is right for you. Only you and your doctor can determine whether your reason is "valid" or not. I just don't want you (or anyone else) to be scared of having a c-section, if that's what it comes down to. Obviously, this case is a horrible tragedy. But I'm certain that it is a very, very rare exception (or it wouldn't be in the news.)

The WHO says the c/s rate should rest about 15% tops, last I heard, so I'm pretty sure that even if a Dr said it's necessary, some of those aren't.

I'm not saying yours wasn't necessary, you having a prior birth under your belt would know better than someone who has never had a TOL. You're lucky in that your c/s recovery went great - not everyone is so lucky. I know, that for myself, it was months until I felt myself - it's major surgery and sometimes recovery doesn't always go super easy.

[lml41981]

The WHO says the c/s rate should rest about 15% tops, last I heard, so I'm pretty sure that even if a Dr said it's necessary, some of those aren't.
Exactly...some doctors are not exactly honest with their reasons. With the fear of lawsuit, they aren't going to admit that a woman didn't need to undergo surgery because what if there are major complications or death?

It isn't necessarily about providing the absolute best care, but about covering their own asses. I don't think we'll see a drop in the C-section rate until there are more lawsuits relating to the complications of a C-section. Once the C-section lawsuits are more equal to the vaginal birth lawsuits, maybe an OB would be less likely to show preference toward C-sections.

[mpc863]

Exactly...some doctors are not exactly honest with their reasons. With the fear of lawsuit, they aren't going to admit that a woman didn't need to undergo surgery because what if there are major complications or death?

It isn't necessarily about providing the absolute best care, but about covering their own asses. I don't think we'll see a drop in the C-section rate until there are more lawsuits relating to the complications of a C-section. Once the C-section lawsuits are more equal to the vaginal birth lawsuits, maybe an OB would be less likely to show preference toward C-sections.

Honestly, this line of thought scares me. I don't agree that the answer is more lawsuits. Also, how could you prove that complications that result from a c-section would be greater/worse than the complications resulting from a vaginal delivery.

I live in a state where OB/GYNs are no longer delivering babies because of the cost of malpractice insurance. I don't like the idea of advocating more lawsuits to solve the issue of a rising c-section rate.

I agree that a c-section is a major surgery and that it is not something to take lightly. I just get bothered when the proposed solution (IMO) just makes things worse.

[chandy]

Yeah, I'm sure there are some docs out there that push c-sections harder than they need to. But, I'm certain that there are plenty of doctors who truly want what is in the best interest of their patients. That's why I said earlier that you need to have a cooperative and trusting relationship. I truly hope that after 9 months of prenatal care, you would trust your doctor's and your own judgement enough to not be coerced (that may not be the best word I'm looking for...it's late) by people on a message board. And if you don't trust your doctor, then for heaven's sake, find a new one!

Too big is never a valid reason for scheduling a c/s.
Statements like this just seem very black-and-white. I think that a trained and trustworthy medical professional, in cooperation and agreement with her patient, shouldn't need to be told what is and isn't a valid reason for scheduling a c/s.

[artist]

No, I'm not assuming they died due to having had c-sections. Actually, my assumption is grave human error on the part of the doctor(s) and medical staff. Hate to say it, but with our country's maternal death rate so low, having two deaths come from the same hospital (even if they transferred to different hospitals, it started it in the same hospital) in such a short span of time would make me seriously reconsider delivering at that hospital.

That is definitely a very good point.

[lml41981]

I truly hope that after 9 months of prenatal care, you would trust your doctor's and your own judgement enough to not be coerced (that may not be the best word I'm looking for...it's late) by people on a message board. And if you don't trust your doctor, then for heaven's sake, find a new one!
Sometimes you go through the entire 9 months of prenatal care hearing one thing from your doctor (specifically nothing but support for the route you plan to take), but when you're admitted to the hospital you're thrown under the bus and things change. Sometimes the doctor you have during prenatal visits is not the same doctor you have during delivery, despite being the same person.

That, I know from my own personal experience. It isn't always about making sure you're on the same page with your doctor during prenatal care because the doctor can easily flip to a different page and breach the patient's trust during her most vulnerable time. It happened to me.

Also, I agree that too big is never a valid reason for pushing for a C-section. The vaginal muscles stretch. The perineum is just skin...it can tear. Babies will find their way out. Too big plus shoulder dystocia or too big plus CPD, or too big plus other genuine complications...ok, C-section is probably a good idea. But just plain too big is not usually legit (or so I was told by a partner of my former OB, whom I should have used in place of my OB).

mpc, I don't advocate for more lawsuits. I don't advocate for frivilous lawsuits. I do believe that certain lawsuits are worth being filed, though. And I firmly believe our high C-section rate is directly tied to our high lawsuit rate as it relates to vaginal deliveries. Once there are more C-section related lawsuits and fewer vaginal delivery related lawsuits, I believe the pendulum will swing the other way.

[ThreeYell]

I do believe that certain lawsuits are worth being filed, though. And I firmly believe our high C-section rate is directly tied to our high lawsuit rate as it relates to vaginal deliveries. Once there are more C-section related lawsuits and fewer vaginal delivery related lawsuits, I believe the pendulum will swing the other way.

This is something I think about a lot. I'm a lawyer by training so I do believe in the power of lawsuits. A civil suit is how we, as a society, acknowledge that someone has caused pain to another person. The problem is that our society doesn't recognize the pain of a c-section, from the literal pain of recovery to the emotional pain of a bad birth experience and from knowing that future vaginal births are increasingly unlikely. We treat that like it's no big deal and to many women, it is a VERY big deal. The number of c-sections performed in this country is detrimental to women and babies. I'm ready to use whatever tools necessary to change that.

[BTB]

You're lucky in that your c/s recovery went great - not everyone is so lucky.

And conversely, there are women who have vaginal births whose recoveries don't go well. Two years after my vaginal delivery I still have physical and emotional ramifications which have been life-altering. If I'd had a c-section, would I be back to my normal self by now? We'll never know.

Statistically, vaginal birth is safer than c-section with a faster recovery, but while statistics tell you lots about a POPULATION, they tell you nothing about a PERSON. Medical management is an individual decision. Patient-physician trust is shattered too often. But the answer to building more trust is not to sue more, especially since the effects are fantastic so far - midwives' groups are closing too from the cost of insurance, hospitals are shutting down their maternity units, c/s rates are high, 22 states are in "critical" ob/gyn shortage. Yep, clearly, more lawsuits is the answer.

[msnicolea]

I'm all for lawsuits when justified--REALLY justified--but I have to agree with BTB here (pig goes flying by
;-> )--medical lawsuits in this country are absolutely out of control. Sometimes bad things happen--horrible, tragic things that are inexplicable and not the result of malpractice or incompetence.

I wholly agree with the posters who encourage an open dialogue with a trusted provider. I know that when my supposedly-typical vaginal delivery turned into an emergency c-section at the last minute, my strong relationship with my OB/GYN was invaluable.

[Delta]

That, I know from my own personal experience. It isn't always about making sure you're on the same page with your doctor during prenatal care because the doctor can easily flip to a different page and breach the patient's trust during her most vulnerable time. It happened to me.And me too. :mad: :mad: :mad:

When it comes down to it, doctors are trained to look for and manage emergencies, not normal births (as midwives are.) They are also extremely lawsuit-shy, which is understandable in today's litigious society. While they may seem open-minded and attuned to the mother's wishes in the 9 months leading up to birth, when the moment arrives their emergency management instict tends to click on and everything you and she (or he) discussed flies out the window at the smallest sign of trouble, either real or imagined. I can't tell you how many people I know to whom this has happened.

Luckily, I had an excellent perinatologist I was also working with (in addition to my OB) who kept a level head (in contrast to my OB's hyperventilating and transparent manipulation) gave me all of the facts in a calm matter, and trusted me to make my decision. Interestingly, my peri's wife gave birth to their two children at home in their bed. ;)

[jennylou]

I for one am not for more lawsuits. But, generally, I'm not a sue happy type of person. I say if you fall, there's a good chance it's your own fault and not someone else's.

Same with medicine. And life. Sometimes, bad things happen. It's a fact of life - that doesn't mean that there's always someone to blame.

But, I stand behind my statement that the mere fact of being too big without a TOL is not a valid reason for a c/s in a first time mom.

A c/s is a life saving procedure, one that I'm thankful is available. I just think that it's being used far too often. I can recognize that an OB may prefer to do a c/s at the slightest indication of a problem, however, b/c if something does happen and they didn't do the c/s they could be held liable. If they do the c/s - well, they did everything in their power.

[mpc863]

mpc, I don't advocate for more lawsuits. I don't advocate for frivilous lawsuits. I do believe that certain lawsuits are worth being filed, though. And I firmly believe our high C-section rate is directly tied to our high lawsuit rate as it relates to vaginal deliveries. Once there are more C-section related lawsuits and fewer vaginal delivery related lawsuits, I believe the pendulum will swing the other way.

Vaginal deliveries far outnumber c-section deliveries, right (I think I've read 75% vs. 25%)? Wouldn't women have to sue for nearly every c-section in order to achieve your outcome? I don't see why lawsuits related to vaginal deliveries would decline if c-section lawsuits went up. At the point of making a decision to sue, the two events are independent.

I agree that the c-section rates are high but again, i can't agree that more lawsuits are the answer.

[lml41981]

But the answer to building more trust is not to sue more
And, again, I'm not saying that people should sue more. I am for fewer, but warranted lawsuits. I just think that when the number of suits generated by C-section complications outnumbers the number of suits generated by vaginal birth complications, maybe some OBs will reconsider the necessity of the operation.

[msnicolea]

I've been thinking about c-sections and lawsuits this am, after reading through this thread. It would seem to be that since many c-sections happen only after vaginal delivery becomes compromised, then wouldn't that mean that potentially these birth experiences were already riskier than those that proceeded "normally?" I mean, wouldn't it make sense that when someone has an unplanned or unscheduled c-section there is a likelihood that they were at increased risk already? I don't know this to be the case--I'm just typing out loud.

I had a c-section because something went wrong during labor--I would imagine that this means that I was in more "trouble" than someone who had a smooth labor, anb therefore more likely to experience complications during and after a c-section. So maybe the c-section didn't increase the risk, just reflected it?

[wendalah]

But the answer to building more trust is not to sue more, especially since the effects are fantastic so far - midwives' groups are closing too from the cost of insurance, hospitals are shutting down their maternity units, c/s rates are high, 22 states are in "critical" ob/gyn shortage. Yep, clearly, more lawsuits is the answer.


I have to agree with this. I have to say I don't exactly like being handed paperwork that states I waive my right to sue and have to seek third-party mediation instead, as a condition of becoming a new patient under a physician's care. But this is increasingly happening as well (and not just with OBs). More lawsuits are not the answer.

[lml41981]

Vaginal deliveries far outnumber c-section deliveries, right (I think I've read 75% vs. 25%)? Wouldn't women have to sue for nearly every c-section in order to achieve your outcome? I don't see why lawsuits related to vaginal deliveries would decline if c-section lawsuits went up. At the point of making a decision to sue, the two events are independent.

I agree that the c-section rates are high but again, i can't agree that more lawsuits are the answer.
The problem comes when the C-section rates continue to climb. I don't think the day that C-section rates equal or outnumber vaginal delivery rates is that far off. Also, if it is true that a C-section carries three times the risk of a vaginal delivery, then one could probably guess that at a 25% C-section rate, the complication rates are probably pretty similar...but more of those complications come from C-sections.

But, not everyone who has a C-section complication sues...just like not everyone who has a vaginal delivery complication sues. So, that plays into it, as well.

And again, I am not for MORE lawsuits. I want FEWER lawsuits and I want those that are filed to be worthy suits (not that I want people to experience pain, but it is a fact that malpractice occurs). I just think that when the number of suits generated by C-section complications outnumbers the number generated by vaginal delivery complications, the C-section rate will drop.

[ThreeYell]

There's a saying in obstetrics that the only c-section you get sued for is the one you don't perform. I think everyone agrees that OBs are practicing defensive medicine so the question becomes, how do we make them stop? I think legitimate suits for c-sections are one answer. I recently read a story of a woman who sued successfully after her nightmarish c-section and I was so happy that she used the legal system to try to get back at least a little bit of what she lost in that birth.

I think it sucks that lawsuits helped get us here and I get mad at people who file frivilous suits. But something has got to give here. Withholding information from a patient and bullying her into unnecessary surgery is not OK. Women should have recourse when this happens to them. Of course, I think women should educate themselves as much as possible before hand - which I think many posters in this thread have been emphasizing - so their chances of unnecessary surgery are reduced but even the smartest, most educated woman is extremely vulnerable during labor and can get talked into things that are not in her and her baby's best interests.

msnicolea, I think you need to focus on the WHO 15% max necessary c-section rate and the US rate, rapidly approaching 40% in many areas. Undeniably, unless you think the WHO and most other developed countries are full of it, those numbers mean that most of the c-sections in the US aren't really necessary. Yes, some labors are more difficult. I had one of them. My son was in a position that probably 75+ percent of OBs would have said was an automatic section. But I had a midwife and a skilled backup OB who knew how to use forceps to turn my son enough to get him out.

Many OBs just don't have any idea how birth does "normally" proceede. They only know birth with pitocin, an epidural, continuous fetal monitoring, and a woman flat on her back being coached to push with all her might the second she hits 10 centimeters. That's not normal and the "complications" that come up in birth in that model that lead to c-sections are often avoidable if they'd just left the woman alone to birth truly normally in the first place.

[wendalah]

Many OBs just don't have any idea how birth does "normally" proceede. They only know birth with pitocin, an epidural, continuous fetal monitoring, and a woman flat on her back being coached to push with all her might the second she hits 10 centimeters. That's not normal and the "complications" that come up in birth in that model that lead to c-sections are often avoidable if they'd just left the woman alone to birth truly normally in the first place.

I really wish we had some more MDs on this board to comment. I think you are grossly overexaggerating with this statement. I'm not a doctor and even I find this insulting.

[emmjay]

I've been thinking about c-sections and lawsuits this am, after reading through this thread. It would seem to be that since many c-sections happen only after vaginal delivery becomes compromised, then wouldn't that mean that potentially these birth experiences were already riskier than those that proceeded "normally?" I mean, wouldn't it make sense that when someone has an unplanned or unscheduled c-section there is a likelihood that they were at increased risk already? I don't know this to be the case--I'm just typing out loud.

I had a c-section because something went wrong during labor--I would imagine that this means that I was in more "trouble" than someone who had a smooth labor, anb therefore more likely to experience complications during and after a c-section. So maybe the c-section didn't increase the risk, just reflected it?
In my non-expert opinion, a lot of the time people end up with a cesarean because something does go wrong, but the reason something went wrong is because of the way the labor was managed in the first place. As an example, something like getting induced can increase the potential for a cesarean quite a bit. IIRC, the average length of a pregnancy is 41w 1d but lots of women get induced a couple of days after their due date and their bodies aren't ready for labor so they end up with a cesarean. Not that personal experience is a reliable measure of anything, but almost everyone I know who went past their due date got induced a few days later and they all ended up with c-sections.

Of course, I am saying this as a person who went exactly to 41w 1d and had an emergency cesarean due to a true knot in the umbilical cord. For me, a vaginal birth could have been disastrous so I'm pretty grateful that I had the option for a cesarean!

As for the OP, my first inclination is that there was some kind of hospital error but I firmly believe the cesarean rate in the US is way too high.

[msnicolea]

msnicolea, I think you need to focus on the WHO 15% max necessary c-section rate and the US rate, rapidly approaching 40% in many areas. Undeniably, unless you think the WHO and most other developed countries are full of it, those numbers mean that most of the c-sections in the US aren't really necessary. Yes, some labors are more difficult. I had one of them. My son was in a position that probably 75+ percent of OBs would have said was an automatic section. But I had a midwife and a skilled backup OB who knew how to use forceps to turn my son enough to get him out.

Ummmm, I didn't suggest that most c-sections were unavoidable, nor did I scoff at WHO. Not sure where your post is coming from. I am suggesting that complications from c-sections may often be due to the fact that when SOME c-sections occur, there may already be issues, and so the probl;ems aren't ingherently because of the procedure.

I also agree with Wendelah--I think that "stat" is simply made up and based on personal bias--there are many excellent providers who know a lot more about facilitating successful births than any of us do.

Definitely hear what you are saying emmjay--I guess I am talking about medically necessary c-sections, which I had, and not c-sections used as "cop-outs."

I'm glad that you had a succesful vaginal birth, ThreeYell--I did not, and am grateful that my doctor acted as he did.

[BTB]

When it comes down to it, doctors are trained to look for and manage emergencies, not normal births (as midwives are.)

I've noticed that most statements about medical training are made by those who've never been through it. Not to blame them, it started somewhere else. Someone, somewhere said this, and then it seems to get echoed by everyone who's ever read it, a million times over until it's accepted as "fact".

I'm in the midst of learning to deliver babies, and disagree wholeheartedly.

Many OBs just don't have any idea how birth does "normally" proceede.

Also, disagree wholeheartedly.

Maybe my experience is so different from what outsiders believe happens in training because I'm in such a creme de la creme residency program that I'm surrounded by Ivy League geniuses and state-of-the-art training? Um, no. ;) I like my program, and it's certainly respectable, but we're not that special.

Random thought as I read this thread - the US is not alone in this. The c-section rate in some Brazilian hospitals tops 80% - most of those due to elective on-demand sections. I don't know enough about Brazilian medicine to make any intelligent commentary, however - just offering the observation.

[Delta]

I also don't want to put *all* the blame on the doctors. It's up to us as women to educate ourselves and other women (even society at large) who may not have any idea of the risks of medical-model birth today. We've let birth become co-opted by the medical establishment and the only way that is going to change is by speaking up and out.

And it is a true, true shame what is happening to the free-standing birth centers today. I just read this article in the WP (http://www.washingtonpost.com/wp-dyn/content/article/2007/05/17/AR2007051702301.html) about another great one shutting down.

Rikki Lake has produced a documentary called "The Business of Being Born" which chronicles her own homebirths and talks about the childbirth industry. Here is a link (http://www.tribecafilmfestival.org/tixSYS/2007/filmguide/title-detail.php?PageNumber=2&AlphaRange=BB&Category=ALL&FilterVenue=ALL&Day=&Month=&Year=&Genre=ALL&FestProgram=&ShowShorts=&ShowPast=N)to more info (scroll down.)

[ignutzz]

I've been thinking about c-sections and lawsuits this am, after reading through this thread. It would seem to be that since many c-sections happen only after vaginal delivery becomes compromised, then wouldn't that mean that potentially these birth experiences were already riskier than those that proceeded "normally?" I mean, wouldn't it make sense that when someone has an unplanned or unscheduled c-section there is a likelihood that they were at increased risk already? I don't know this to be the case--I'm just typing out loud.
Unless you can rule out iatrogenic causes for a cesarean, no, I don't think you can say that a particular birth was more risky. Until the medical dogma of what "normal" birth is changes, we're going to continue to see a rise in cesarean births.

I had a c-section because something went wrong during labor--I would imagine that this means that I was in more "trouble" than someone who had a smooth labor, anb therefore more likely to experience complications during and after a c-section. So maybe the c-section didn't increase the risk, just reflected it?
I am NOT questioning your need for a cesarean birth, but since you've used yourself as an example, I'm going to run with that. When I hear that something went wrong during a hospital birth, eventually ending with a cesarean birth, I wonder what events/treatments/management led up to that need and how the cesarean could possibly have been prevented if different choices were available, or different policies were in place. Knowing that many of a typical hospital's policies have a potential to create increased risk to Mom and baby, I find it difficult to accept at face value that something went wrong and a cesarean saved the day.

Please, please, please understand though that I am NOT in anyway placing blame, trying to criticize or questioning any of the experiences posted in this thread. These are my general thoughts on a subject that is near and dear to me and I mean absolutely no disrespect to any mother or her experiences.

[Delta]

In my non-expert opinion, a lot of the time people end up with a cesarean because something does go wrong, but the reason something went wrong is because of the way the labor was managed in the first place.This is exactly right.

I've noticed that most statements about medical training are made by those who've never been through it. Not to blame them, it started somewhere else. Someone, somewhere said this, and then it seems to get echoed by everyone who's ever read it, a million times over until it's accepted as "fact".

I'm in the midst of learning to deliver babies, and disagree wholeheartedly. Then how do you explain the disparate c-section rates between FSBC's (after transfer) and hospitals? Why are doctors so quick to induce? Why so many stories of doctors recommending csections for size? The interventions required in hospitals most of the time - even in normal, healthy pregnant women - only set the mother up for more complications down the line.

[ThreeYell]

Sorry, msnicolea, I misunderstood your post. I see what you're saying now WRT complications from c-sections being ones that might have been there all along.

When the vast majority of hospital births do involve epidurals and pitocin and pushing in bed, where are doctors getting all this experience in normal birth? I know some do. I've already met one who did in the birth of my son and I hope I've found another to help me with this one, but honestly, all of them? Even most of them? I don't understand where all that experience is coming from.

[BTB]

Until the medical dogma of what "normal" birth is changes,

Where can I find me some of this "dogma"? 4 years of medical school, and one year of residency nearly completed, and I have yet to be indoctrinated. I'd better hurry!

Then how do you explain the disparate c-section rates between FSBC's (after transfer) and hospitals? Why are doctors so quick to induce? Why so many stories of doctors recommending csections for size? The interventions required in hospitals most of the time - even in normal, healthy pregnant women - only set the mother up for more complications down the line.

I can't speak for all doctors. Some are idiots, it's true. But you can be an idiot, and not have been made an idiot in some systematic way via training.

[msnicolea]

I understand your question, ignuttz, and I don't mind talking about it.

I can only speak from my personal experience which is to say that I had a near-ideal pregnancy (after some false-alarms in the first 2 months). I actively planned for delivery, my DH and I spoke very openly with our doctor, the head of OB/GYN at a teaching hoospital and VERY up-to-speed re: new procedures/medications, etc. . . about what we wanted and needed, and I went into labor on my due date, without initial complication. After about 10 hours, however, the baby had not descended. We decided to keep going, since I was dilating "appropriately" and not in any excessive pain. However, a few hours later, they lost the baby's heartbeat (on the monitor), and that was that. Honestly, I don't think I could have done anything differently--at the point the heartbeat was lost, the doctor said "we need to get him out right now" my DH and I said, "ok"--and off we went. I passed out during the procedure and didn't even get to see my son born--it still breaks my heart a little.

What else could we have done? I truly beliee the c-section saved my son's life and am eternally grateful that I had that option. I actually regret not being prepared for it--I had no intention of having a c-section, assumed I wouldn't need one based on my check-ups and "clear plan of action." And there you have it.

[Delta]

So, BTB, what *are* you learning about birth, then?

[emmjay]

When I hear that something went wrong during a hospital birth, eventually ending with a cesarean birth, I wonder what events/treatments/management led up to that need and how the cesarean could possibly have been prevented if different choices were available, or different policies were in place. Knowing that many of a typical hospital's policies have a potential to create increased risk to Mom and baby, I find it difficult to accept at face value that something went wrong and a cesarean saved the day.

I also had a cesarean that I consider medically necessary. Like I said before, there was a true knot in the cord with my son which happens 1 - 2% of the time and results in a 4x greater risk of stillbirth with a vaginal delivery. That's not to say that things wouldn't have worked out with a vaginal delivery, but I'm pretty glad I had a cesarean based on those statistics. As for my labor, I took a Bradley class and was planning on having NCB. I feel like I was educated on childbirth, and that my OB (who, incidentally, has a c-section rate of less than 15%) was not pushing anything on me and neither was the hospital staff. I felt totally in control of what was going on in terms of the medical decisions being made, and now I have no regrets about what happened.

That said, the women I know IRL who had cesareans (all of them due to being induced) will all say that their cesareans were medically necessary. I don't personally think they were based on what I know about their labor experiences and their knowledge of childbirth beforehand, but that is what they believe.

I agree with you that *in general* most of the time cesareans don't need to happen. But, when it comes to a particular woman's experience, I am not as quick to assume that they didn't need a cesarean as I was before my own childbirth experience. It's like BTB's comment before about applying statistics to individual people - I just can't do it anymore because I know firsthand that there are always exceptions.

[msnicolea]

I should have mentioned, too, that my Ob-Gyn's c-section rate was also less than 15%--I made sure to ask that when we "interviewed" him.

[BTB]

So, BTB, what *are* you learning about birth, then?

Among other things: prenatal care, the anatomy and physiology of birth, the seven cardinal movements of labor, the protection of the perineum, dystocia management, hemorrhage management, assessment and resuscitation (when necessary) of the newborn, laceration repair, and postnatal recovery.

Philosophically the main theme I've gotten is the immense variability in birth. Birth is different for every woman, for each of her pregnancies, even, and any doctor (or mother, for that matter) who thinks she can write out the "birth plan" is fooling herself. Only the baby knows, and the baby's not telling.

It's hard to sum up years' worth of work into a few simple sentences, but that's an attempt.

[ignutzz]

BTB I feel that a refusal to attend breech deliveries, undermining VBAC, induction before true post-dates, and various other policies that sound research has shown to be ineffective at best, is a kind of dogma. Do you plan to learn and attend breech deliveries? Will you not bat an eye when a patient, at 42 wks, refuses an induction? Will you, despite ACOGs reversal, support and encourage VBAC (including after more than one C)? Will you support, encourage and teach multiple labor positions to optimize pain relief and proper baby position? I do not mean, or say, any of this with any malice or snark. I sincerely wonder how traditional medicine is addressing these concerns.

Msnicolea I'm sorry, I didn't mean for you to have to explain your birth. I have no desire to second-guess or pick apart your experience, it turned out well and you are happy and confident in your decisions, rightfully so. I just meant to explain how those words translate in my head and why I can't fully agree with the hypothesis you were making.

ETA: Among other things: prenatal care, the anatomy and physiology of birth, the seven cardinal movements of labor, the protection of the perineum, dystocia management, hemorrhage management, assessment and resuscitation (when necessary) of the newborn, laceration repair, and postnatal recovery.
I'll be learning all of this too, I wonder how differently we'll handle similar situations based on the models of care.

[emmjay]

ignutzz - just as another point, my OB didn't have a problem with me not being induced after my due date (she mentioned it once and when I said I didn't want to, she said she would want to discuss it again if I went past 42 weeks). She doesn't do episiotomies. She said that her role in my son's birth was to step in if something went wrong and that I could do whatever I wanted in terms of positions. At my 6 week postpartum visit she brought up VBAC for the next time and encouraged me to consider it. So, maybe she is the exception to the rule but she is a traditional OB and she was in line with everything I learned in my Bradley class. Well I don't know about breech - that wasn't an issue for me.

[ignutzz]

emmjay I don't think your OB is an exception to the rule. But I don't think there are any hard and fast rules about practitioners. There are midwives disguised as OBs, just as there are MEDwives who might as well be "that" OB. I am speaking in broad general strokes about areas of significant concern among a growing number of women from a range of beliefs "jello" to "earth mother" and back again.

The only absolute about birth is that we need as many options as possible to have the best possible outcomes for all mothers. No two women labor the same way; if we continue to lose practitioners (OB or MW), if we continue to lose birthing options such as VBAC and breech through the closing of birth centers and restrictions on homebirth and/or midwifery practices, we put women at risk because we restrict their available choices.

[BTB]

Ignutzz, I'm not sure where you are attending school, or if that even has to do with your dichotomizing midwifery vs 'medical model' birth. If you think all doctors would answer your questions the same way, or for the same reasons, you're mistaken, and THAT is my point. There is this idea out there that there is a "medical model" all doctors are indoctrinated into and hold dear, and that's simply not true. During medical school, I rotated in obstetrics at a teaching hospital with ob residents that also trained CNMs, and the major differences were in the depth of care, not the manner of it.

[BTB]

But I don't think there are any hard and fast rules about practitioners.

I see we cross-posted - so, nevermind, I see the point's already "broken through". Earlier, when you asked why "doctors" this and why "doctors" that, I thought you were under the impression we were all the same. :)

[ignutzz]

To be clear, I wasn't asking about "doctors," I was asking what YOU, based on the training you've received as a OB, would do in those situations (this goes back to Delta's question about what are you learning, which I saw as more of a philosophical rather than literal query) . How have your personal beliefs about birth been influenced and/or modified by your training, and vice versa.

I can see how some of this thread, including things I've posted, can come across as accusatory and overly critical of Drs, and I'm sorry about that. When I ponder these things, I'm really thinking/talking about the broader picture, far beyond an individual, or individual group, because there are a lot of parts and pieces and confounding factors that are influencing current conditions.

[boilermaker]

I just stumbled upon this thread and haven't read through all the post carefully, so please forgive and correct me if I am missing something. But I want to comment on the c-section comments.

I am not a fan of non-medically necessary c-sections and I bought into the belief that a vaginal delivery is best in pretty much all "normal" cases. I didn't want to be induced early..wanted to wait until I went into labor on my own. I wanted alternate laboring methods vs being stuck in a bed, etc. So I found an OB who followed these practices. What I didn't find was an OB who would trust the instincts of her patient at 9+ months pregnant to do intervention. She was adamant that because I was healthy, it was just my "hormones" talking when I wanted to be induced at 40 weeks. And when I finally went into labor at 41w, 2 days, she was sure that the baby would drop just fine (she never dropped before me going into labor) and all would be fine with a vaginal delivery. But at the end of it all, I ended up with a 9lb 7 oz baby who didn't fit through my pelvis and an injury that 3 months later causes me chronic pain everyday and limits a lot of the activities I use to be able to do no problem. I asked about induction due to size, I asked about a c-sec when it was obvious that she was posterior and not positioned correctly. But that damn crunchy OB insisted that I could deliver vaginally. And when you are in the hospital with your OB, they aren't going to find you a new dr.

So, while generalities are all fine and good, please don't say that inductions and c-section should never be done because of u/s size. Or because a mother is past her due date. I'm proof that the opposite can be just as devastating.

[ThreeYell]

BTB and any other medical professionals, I'm asking this sincerely: given what you've said about your training, why do you think the c-section rate is climbing? And have you seen any move within the profession to question or intervene when a doctor's rate is particularly high? Are there those within the medical community agitating for natural birth?

[ejs]

What are the main concerns people have here? That women are being bullied into c-sections by their OBs? That women aren't educating themselves about birthing children: the progression, the options, etc?

If a woman decides to have a c-section, isn't that her choice? Why is it any different than a woman choosing to have an abortion? Her body, her choice, right?

[thedoorchick]

Yes, it's her choice, but considering the effect on society as a whole in cost of healthcare (and by extension, cost of medical insurance), and considering the effect on hospital policies which ends up negating choice for those who DON'T want a C-section unnecessarily, I think it's worthy of discussion.

[t3h_wookiee]

I really wish we had some more MDs on this board to comment. I think you are grossly overexaggerating with this statement. I'm not a doctor and even I find this insulting.

Around these parts, that is not a gross exaggeration in anyway. At least two hospitals in the metro area have an over 35% Cesarean rate, one of them being 43%! :eek: For the 4 mothers that I have visited in the hospital either during labor or right after birth, what was mentioned is exactly what happened. Many OBs around here don't even give you a choice about episiotimies and continuous fetal monitoring. You're not allowed to walk the halls, or even be out of bed unless it's to go to the bathroom, if you've been laboring longer than 10 hours, or your water has broken. If you want to labor any way other than on your back with feet in stirrups, the nurses scoff at you and tell you that this is how real labor is done (Yes I actually heard a nurse say that...).
If you've labored longer than 18 hours, the already strong pressure for a Cesarean increases dramatically. One mother that I'm friends with said her doctor told her that her baby will (not could in this case, but will!) die if she didn't have one. For that case, it was simply that her labor had lasted 20 hours, and he thought the baby was way too big to deliver vaginally to begin with, so he wanted her to schedule a c-section. Oh, and 2 hours later on her own terms, her healthy baby boy was delivered, not huge, and definitely not in danger. Her over 10 pound estimated boy weighed just 8 pounds, 1 ounce.

So while it may be exaggerated in many parts of the country, in just as many, it's what's true. There's a reason that I plan on doing homebirths for all of my children.

And yeah, I know these are anecdotal stories, but it doesn't make them any less applicable.

[carrie9142]

I am not an MD, but my husband is, so I feel like I can comment on what they learn in med school about birth--not tons. Most of their true, clinical knowledge comes from doing it over and over in residency. Med school seems to be about learning about the zebras whereas residency is about learning horses.

IMO the rise in c/s correlates directly with the rise in lawsuits. If I was a doctor, any sign of trouble would make me want to do a c/s...b/c the alternative is so horrible. What super-crunchy, med free, home-birthing mom is going to say "Oh well. We sure tried to do it med free, didn't we?! Too bad labor stalled and the baby died. But, I am so so glad you listened to me and didn't preform any interventions!!! See you next year!" They are damned if they do and damned if they don't. I know a number of ob/gyns that are no longer willing to do ob work b/c the malpractice insurance and risks are too high.

Doctors are there to be the voice of experience. Sure, you know your body, but they have seen hundreds and thousands of births. They might even know a little bit more about it than you ;) They are the ones qualified to decide what treatment is necessary. Sure, that might come along with a higher c/s rate, but isn't that better than a higher death rate?

Based on that article above, I would have to agree that it was probably either a freak thing or they got ahold of some shitty medical treatment. It does happen in medicine just like any other field. But the stakes are so much higher in medicine. I really hate the criminalization of medicine and doctors. They really do try to do the best for their patients while, yes, covering their own asses.

[t3h_wookiee]

Though what super-crunchy, med free, home-birthing mom would be at a hospital refusing interventions or a Cesarean? If they're at the hospital, it's most likely because of an emergency transfer due to something that went wrong, which would require life-saving interventions.

Sorry, but that part just really rubbed me wrong.

[wendalah]

At least two hospitals in the metro area have an over 35% Cesarean rate, one of them being 43%!

This, plus the anecdotal evidence of four mothers you personally know in one metro area, is evidence to discount the majority of MDs' physiological knowledge of how birth proceeds?

Look, I live in L.A., homebirths and super-crunchiness are a dime a dozen here. I guarantee you I can find four or five home-birthers who had a shit experience. Just saying. I wouldn't take my word on anything home-birth-based, given that kind of report, either.

[ignutzz]

Most of their true, clinical knowledge comes from doing it over and over in residency.
And there in lies the problem.

What super-crunchy, med free, home-birthing mom is going to say "Oh well. We sure tried to do it med free, didn't we?! Too bad labor stalled and the baby died. But, I am so so glad you listened to me and didn't preform any interventions!!! See you next year!"
What a gross misrepresentation of families who choose homebirth. Choosing non-interventive care, be it at home or in a hopsital, is about making clear, informed decisions throughout pregnancy and labor, INCLUDING the decision to ask for/accept/receive assistance. Given a full-term, normal labor, you'd be hard pressed to find any parent who would refuse assistance if difficulties developed.

Sure, that might come along with a higher c/s rate, but isn't that better than a higher death rate?
Maternal death rate in this country has been on an even keel since the early 80s when the cesarean birth rate was closer to the WHO recommendations; increased cesarean birth has not equaled decreased maternal death rate.

[wendalah]

BTW--I don't have any beef with midwives or natural birthing techniques, if that's what someone wants. I just was a little appalled at the turn this thread was taking in regards to medical lawsuits, which I think are already out of control and threatening choice of care providers for those who want an MD to supervise their pregnancy.

[jesvet]

Maternal death rate in this country has been on an even keel since the early 80s when the cesarean birth rate was closer to the WHO recommendations; increased cesarean birth has not equaled decreased maternal death rate.

Out of curiosity, does the same hold for fetal death rate?

Has the increase in c-sections decreased the number of malpractice suits against OB- GYNs? It's getting more and more difficult to find these practitioners even in my urban area, and what a shame that is.

[ignutzz]

Fetal death is defined differently than infant death, so I'm going to assume you mean infant death rate (if not, let me know).

Infant death rates have improved much more than maternal as NICU services continue to advance. There is still a lot of disparity along racial lines however. The mortality rates have been fairly steady since the mid-90s with some subtle fluctuations. You can find all of the info here. (http://www.cdc.gov/nchs/about/major/fetaldth/abfetal.htm)

I don't know about the law stuff.

[lml41981]

What super-crunchy, med free, home-birthing mom is going to say "Oh well. We sure tried to do it med free, didn't we?! Too bad labor stalled and the baby died. But, I am so so glad you listened to me and didn't preform any interventions!!! See you next year!" They are damned if they do and damned if they don't.
Most likely, if there's a complication that needs intervention from an OB, my midwife will catch it before it becomes a life-threatening emergency. There's a reason for this...it is that she is monitoring the entire labor process from start to finish, rather than coming in periodically. She's had one single patient transfer solely to get drugs. The majority of her (very few) transports do not result in C-sections, but are also not emergency transports. Her C-section rate is 3%. No...I didn't forget a zero there. Just 3%. She may not hold the knife, but she has to count it as her rate if her patient ends up with a C-section

Still, every single one of her patients would put aside their preference for no interventions if it meant risking their own life or their baby's (or babies' lives...she does twin homebirths, too) life.

Homebirthing (or even using a FSBC) isn't about shunning MDs. It is about saying, "There's a time and a place for everything. If I remain low-risk, then I do not need a hospital for something that is perfectly natural and normal for the female body to do. If a complication develops, we'll address it appropriately."

Personally, I think that is a highly reasonable and responsible approach to take. We don't rush off to the doctor anytime we get a cold (or we shouldn't!), but if that cold turns to pneumonia...well, yeah, it might be good to see a doctor. Same thing with childbirth.

[ThreeYell]

Has the increase in c-sections decreased the number of malpractice suits against OB- GYNs?

It's an important question, but I don't think we can know the answer yet. Malpractice suits take years to get to resolution. Since the c-section rate has gone up so fast it might take a while to be able to see the results. At the same time, you have states passing tort reform laws and making various moves to make malpractice more transparent so that people can avoid the bad doctors. All those things have got to play a role in how many people are suing successfully.

[carrie9142]

Homebirthing (or even using a FSBC) isn't about shunning MDs. It is about saying, "There's a time and a place for everything. If I remain low-risk, then I do not need a hospital for something that is perfectly natural and normal for the female body to do. If a complication develops, we'll address it appropriately."


Sure. That I agree with. But, that is not really the way the wind is blowing in this thread. Quite a few people have posted about MDs not knowing much about birth, the high rate of c/s, the MDS covering their asses rather than let the woman give birth etc (not you, specifically, Lyndsey)-the tone seems to be more along the lines of doctors don't care about the patients and are only in it for themselves. Which through interactions with my DH and many of our friends, I know is not the case.

I think what you are specifically saying is that you would rather labor somewhere more comfortable, and transfer to a hospital if it becomes necessary. Which is great. My only concern/problem comes from situations where the medical intervention doesn't come in time, and something horrible happens. Sometimes people show up too late and their is nothing the dr. can do-but there is still a good likelihood of them being sued. Question-do doulas/midwives get sued often? Do they have to carry malpractice insurence? I really don't know and am curious.

I realize it is just different strokes for different folks. Me-I like interventions/painkillers/monitoring. Epidural me up! Please watch me at all times to make sure I am ok! But, I am also very, very risk averse and to me-any birth that ends with mom and baby being alive=successful childbirth. I just hate some of the vilification of western medicine or this idea that physicians are just itching to strap you done and cut that baby out!

[Delta]

Quite a few people have posted about MDs not knowing much about birth, the high rate of c/s, the MDS covering their asses rather than let the woman give birth etc (not you, specifically, Lyndsey)-the tone seems to be more along the lines of doctors don't care about the patients and are only in it for themselves.It's not that MDs don't know about birth, it is that the only births they are exposed to are the ones they see in the hospital, which are medically managed (monitors, IV's, cervical checks, epidurals, inductions, etc.) And I certainly do think that doctors care about their patients, but there is absolutely no question that much of the motivation behind their decisions during birth are driven by a (conscious or subconscious) fear of lawsuits, which may or may not be in the best interests of their patient. This observation is not necessarily a criticism of them personally, but of the medicalization of birth as a whole.

[lml41981]

Carrie, they weren't saying that OBs don't know about birth...they were saying many don't know about natural birth. There's a difference. You, yourself, said that your husband didn't learn much about birth in med school and that his knowledge will come from residency. If our hospitals rarely are involved in natural childbirth (defined as not involving labor inducing or augmenting drugs, no pain meds and minimal interventions), then where are the new OBs gaining their knowledge on natural childbirth?

As far as the midwife malpractice question... I think (but don't quote me) that CNMs are required to be covered, but DEMs are not. Most insurance companies don't even write policies for DEMs. One lawsuit and the insurance pool would be wiped out because there aren't enough DEMs to make it cost-effective. This doesn't mean that a DEM is immune to lawsuits, though. It means that she has more at stake and has more of an interest in making sure that her patients are good candidates for a home birth/out-of-hospital birth.

With a birth assisted by a midwife, prenatal care is preventative, not reactive. This hopefully lessens the chance of a patient becoming high risk, but if a patient does become high risk, she is risked out and must transfer care to either a hospital based midwife or an OB. The reason is primarily that a high risk patient will need more specialized care and DEMs are in the business of caring for low-risk patients who will not need the specialized hospital-based care.

As far as your definition of a successful birth...we're going to disagree there, too. My OB threw me under the bus and violated my trust in a deep way. I don't consider her successful at providing care. I'm not saying all OBs would do what she did, but she is single-handedly responsible for my decision to reconsider hospital-based childbirth in a low-risk situation.

[Delta]

Among other things: prenatal care, the anatomy and physiology of birth, the seven cardinal movements of labor, the protection of the perineum, dystocia management, hemorrhage management, assessment and resuscitation (when necessary) of the newborn, laceration repair, and postnatal recovery.

Philosophically the main theme I've gotten is the immense variability in birth. Birth is different for every woman, for each of her pregnancies, even, and any doctor (or mother, for that matter) who thinks she can write out the "birth plan" is fooling herself. Only the baby knows, and the baby's not telling.

It's hard to sum up years' worth of work into a few simple sentences, but that's an attempt.
See, your comment about the 'birth plan' seems so condescending. Women make birth plans (I actually called mine preferences) in order to communicate their wishes to the numerous and shift-changing medical staff that attend the birth of their child. No doubt there are some women who think they can map out the way it's going to go by writing it down, but the women I know who have made one (including myself) did so in order to make sure those attending her birth respected her wishes - basically, to further empower the mothers at a time when she is at her most vulnerable. I see nothing foolish in that.

And when I asked what you were learning about, it was more a philosophical question than technical. It's one thing to learn about birth in a hospital and quite another one to learn under someone like Ina May Gaskin (http://www.inamay.com/) at The Farm (http://www.thefarmmidwives.org/).

[kedzieb]

It's not that MDs don't know about birth, it is that the only births they are exposed to are the ones they see in the hospital, which are medically managed (monitors, IV's, cervical checks, epidurals, inductions, etc.) And I certainly do think that doctors care about their patients, but there is absolutely no question that much of the motivation behind their decisions during birth are driven by a (conscious or subconsious) fear of lawsuits, which may or may not be in the best interests of their patient. This observation is not necessarily a criticism of them personally, but of the medicalization of birth as a whole.


Yes - this makes a lot of sense to me. I think the general breakdown here is whether you believe that childbirth is a medical event. Does every birth need to be considered surgery? Should they mainly take place in hospitals with exceptions for some "easy" births?

To me, I think that in general childbirth is not surgery. It doesn't need to be treated the way a ruptured appendix or gunshot wound does. I think treating childbirth as a natural process that women have been managing - either on their own or with support at home - to complete successfully since the dawn of man makes more sense as a whole. And then in exceptional circumstances - be that things that the mother-to-be desires or her doctor recommends - more intervention should be taken. I think treating all births as surgery sets up an expectation that the patient (mother-to-be) should listen to the doctor's opinion over her own concerns. Which would be perfectly fine if it were a diseased kidney being taken out.

Anyway - I'm not a mother and who knows what I'll decide once I'm pregnant. I'm not saying anything is the wrong choice. I just dislike that a natural part of life is presumed to be harmful to you & requiring medical intervention.

[lml41981]

I think treating all births as surgery sets up an expectation that the patient (mother-to-be) should listen to the doctor's opinion over her own concerns. Which would be perfectly fine if it were a diseased kidney being taken out.
And even if we did treat all births as surgery or possible surgical situations, wouldn't it make sense to get a second opinion before the first cut (in a non-emergent situation)?

I mean, if a doctor says, "You've got kidney disease. We need to put you on the transplant list and operate. In the meantime, you'll be on dialysis X times a week," I'm gonna haul ass to another doctor to repeat all the tests and get a second opinion. And I may even get a third opinion! And, I'm going to find out how long I can live on dialysis or off dialysis before having major complicatios and what the risks of transplant are and what my follow-up care will be like and all of that...

But with childbirth, once you pass the initial interview (if you even do one), it seems like the generally accepted thing is to not question the OB's expertise. The OB knows what the OB is doing and the OB knows what you should be doing, so just shut up and go along with it...

[wendalah]

And when I asked what you were learning about, it was more a philosophical question than technical. It's one thing to learn about birth in a hospital and quite another one to learn under someone like Ina May Gaskin at The Farm.

Well, every woman is different. I'm not knocking Ina May, but I personally have little to zero interest in having someone pissing about in the emotional, spiritual, sexual and cultural aspects of my pregnancy. I'd rather have the person monitoring my care educated in the things BTB described.

I am sure it's valuable to some women, and that is great. But I don't find it useful at all and I don't think it necessarily has to be required learning.

I just dislike that a natural part of life is presumed to be harmful to you & requiring medical intervention.

I don't get the presumption of "harmful" here--aging is also a natural condition which often proceeds without major health concerns. But I don't think we'd have the same negative opinion of senior citizens having concerns about the aging condition and its possible effects on overall health, and seeking preventative or extra medical care as a result.

[kedzieb]

And even if we did treat all births as surgery or possible surgical situations, wouldn't it make sense to get a second opinion before the first cut (in a non-emergent situation)?

I mean, if a doctor says, "You've got kidney disease. We need to put you on the transplant list and operate. In the meantime, you'll be on dialysis X times a week," I'm gonna haul ass to another doctor to repeat all the tests and get a second opinion. And I may even get a third opinion! And, I'm going to find out how long I can live on dialysis or off dialysis before having major complicatios and what the risks of transplant are and what my follow-up care will be like and all of that...

But with childbirth, once you pass the initial interview (if you even do one), it seems like the generally accepted thing is to not question the OB's expertise. The OB knows what the OB is doing and the OB knows what you should be doing, so just shut up and go along with it...

True, but in either case, as long as the doctor is correct that there is actually kidney disease, I'm all for medical intervention. I'm certainly not saying that in some cases doctors aren't necessary or just preferable for some childbirths. I think c-sections are wonderful in certain cases and have saved lives. The same with other practices that are sometimes necessary to help move childbirth along. If it's helping the mother-to-be or will help mitigate some of the danger to the baby, I think we should be happy the options are available.

To me, the main question is why childbirth is considered an event that by default necessitates medical intervention.

[Delta]

Well, every woman is different. I'm not knocking Ina May, but I personally have little to zero interest in having someone pissing about in the emotional, spiritual, sexual and cultural aspects of my pregnancy. I'd rather have the person monitoring my care educated in the things BTB described.
Midwives certainly are educated in those things, and much more. (And I don't go for Ina May's hippy-dippy emotional stuff either. ;) )

[kedzieb]

I don't get the presumption of "harmful" here--aging is also a natural condition which often proceeds without major health concerns. But I don't think we'd have the same negative opinion of senior citizens having concerns about the aging condition and its possible effects on overall health, and seeking preventative or extra medical care as a result.


Yes - and I think pre-natal care is a good comparison to make here. Of course you are going to behave differently and need more care while pregnant than other times. Same as senior citizens would need more care than younger people. But I don't see the comparison to childbirth? When are we telling seniors that their situation necessitates hospitalization?

[GeekGirl]

To me, the main question is why childbirth is considered an event that by default necessitates medical intervention.

Perhaps because of the death rate of mothers and infants before childbirth was considered something worthy of medical intervention?

[lml41981]

True, but in either case, as long as the doctor is correct that there is actually kidney disease, I'm all for medical intervention. I'm certainly not saying that in some cases doctors aren't necessary or just preferable for some childbirths. I think c-sections are wonderful in certain cases and have saved lives. The same with other practices that are sometimes necessary to help move childbirth along. If it's helping the mother-to-be or will help mitigate some of the danger to the baby, I think we should be happy the options are available.

To me, the main question is why childbirth is considered an event that by default necessitates medical intervention.

We don't disagree. At all.

There's a double standard...we're encouraged and told it is prudent to seek a second opinion before undergoing surgery for all non-emergency situations except childbirth. In the case of childbirth, a single OB's opinion seems to be golden and goes unquestioned. Why is that? I have no idea.

[Delta]

And actually, Ina May is most famous for her "Gaskin Maneuver", which even doctors are now being taught in order to deal with shoulder dystocia.

[wendalah]

But I don't see the comparison to childbirth? When are we telling seniors that their situation necessitates hospitalization?


We aren't, and you are correct that prenatal care is more akin to my analogy here. But, I don't see hospitalization as anything more loaded than "All the large, bulky, numerous, etc. equipment and medication we might possibly need in case of emergency is stored in this particular facility, so it makes sense to come here for birth." If you have a healthy, complication-free birth, you aren't kept in the hospital very long.

Midwives certainly are educated in those things, and much more.

Sure, never said they weren't. But you were questioning what BTB learned about birth and she listed a bunch of physiological things that sounded OK to me. Then you said, well, there's a big difference between learning about birth that way and learning about it this way. "This way" isn't worth much in my book--just pointing that out. If it is in yours, then a midwife is probably the route you want and that's fine.

[ignutzz]

I second the sentiments expressed in LML's and Delta's posts about homebirth.

I'd rather have the person monitoring my care educated in the things BTB described.
We ARE educated and trained in the things BTB described. In NYS, the only thing I won't be able to do during a birth is instrumental deliveries (forceps, vacuum, surgery) If I choose to become a CNM, vs CPM, I can also provide well-woman care including prescription privileges. So what exactly do you think a patient/client is missing out on (besides pain meds) if she considers using a midwife?

And, like Delta, I don't go for the otherworldly Ina May stuff either, but her general philosophy is sound.

True, but in either case, as long as the doctor is correct that there is actually kidney disease, I'm all for medical intervention.
The concern is the techniques used to determine if "kidney disease" actually exists. FM doesn't have a great accuracy track record.

[wendalah]

So what exactly do you think a patient/client is missing out on (besides pain meds) if she considers using a midwife?


Who said I thought they were missing out on anything? I myself am one who'd prefer to have an MD overseeing things--personal choice. That's all.

[ignutzz]

Perhaps because of the death rate of mothers and infants before childbirth was considered something worthy of medical intervention?
The death rate of mother and infant shot up 30% when medicine got involved. There was a pretty steep learning curve when birth moved into hospitals, and it wasn't moved there for altruistic reasons.

ETA: wendalah Your previous comment regarding education, or lack thereof, implies (whether you meant it that way or not) that midwives are untrained, or not trained enough, to monitor labor appropriately.

[ejs]

The death rate of mother and infant shot up 30% when medicine got involved. There was a pretty steep learning curve when birth moved into hospitals, and it wasn't moved there for altruistic reasons.

Do you have a link to this info? I'm flabbergasted and would like to learn more about this. Thanks!

[wendalah]

Your previous comment regarding education, or lack thereof, implies (whether you meant it that way or not) that midwives are untrained, or not trained enough, to monitor labor appropriately.


My comment had to do more with the fact that I thought BTB's answer about what she knew about birth was adequate. However, if I do think I am safer under a medical doctor's care--so what?

[ignutzz]

ejs Sure, if you can wait a bit I can gather up the references. The increased death rate was predominantly due to infection. There was little known at the time about aseptic (sterile) technique and care providers were passing around infectious disease. Mother's who were still birthing at home were not exposed to these bacteria so were less likely to contract puerperal fever.

ETA: wendalah I took it as a broader comment, not specific to who you would like to have attend you. I don't care who you choose to have with you as long as it's the right choice for you.

[lml41981]

ejs Sure, if you can wait a bit I can gather up the references. The increased death rate was predominantly due to infection. There was little known at the time about aseptic (sterile) technique and care providers were passing around infectious disease. Mother's who were still birthing at home were not exposed to these bacteria so were less likely to contract puerperal fever.

I'm going to completely steal what my own midwife wrote on another message board, but I'm not going to write her name here for privacy reasons...
In 1843, Dr Oliver Wendell Holmes published his classic essay The Contagiousness of Puerperal Fever (aka. child-bed fever) The essay contained 8 rules for the obstetrician, which included not only handwashing and changes of clothing, but also the avoidance of autopsies if obstetric cases were also being managed. His was a laughingstock and his work was dismissed as being ridiculous. And doctors continued to use ungloved, unwashed hands as they went from patient to patient.. be them living or dead. Semmelweis later in 1861 published his similar studies and observations. His work was also dismissed at the time by his local community. Several years later, it made it's rounds to the wider medical community and was taken seriously and the need for obstetric asepsis was found to be valid.

After that, maternal death rates went down dramatically.

[GeekGirl]

Yes, I'd be curious to see those statistics...it was my assumption that less women die in childbirth now than they did, say, a century ago...but I've never done any research on it, so I'm not an expert by any means.

ETA: Oh, I see your point. I guess it's a matter of perspective...my guess would be many areas of medicine benefitted from doctors figuring out that they should wash their hands, not just obstetrics.

[ejs]

ejs Sure, if you can wait a bit I can gather up the references. The increased death rate was predominantly due to infection. There was little known at the time about aseptic (sterile) technique and care providers were passing around infectious disease. Mother's who were still birthing at home were not exposed to these bacteria so were less likely to contract puerperal fever.
Thanks!

[lml41981]

Yes, I'd be curious to see those statistics...it was my assumption that less women die in childbirth now than they did, say, a century ago...but I've never done any research on it, so I'm not an expert by any means.
Fewer women do die in childbirth now than a century ago. Much of the decrease results from women bearing fewer children, having better health, better nutrition, better access to prenatal care (whether done by a midwife or an OB), better access to emergency care, better hygiene practices, better testing procedures and better technology.

It isn't necessarily the rise in hospital births that led to fewer maternal deaths. And, actually, there may be fewer deaths in general, but now we also have things like MRSA to take into consideration.

[dionysia]

Ok, pardon me if I'm dense, but ignutzz, you basically put the 30% statistic out there to somehow imply that medical intervention in general caused more mothers and infants to die rather than the very specific issue of unsanitary conditions in hospitals in the mid- to late-19th century?

Talk about a red herring.

Di

[moderngal]

wow- wendalah, for someone that calls herself a feminist in some threads, you sure have a patriarchal view of pregnancy and childbirth. I really expected more from you. :rolleyes:

One of the women that died was my friend's son's teacher. The situation is so sad for all those involved. That hospital is under a pretty big investigation now. It doesn't have a good reputation at all, but unfortunately due to the incredibly high cost of malpractice, many of our local maternity wards are closing and women have few, if any, choices in where to deliver. NJ has very strict laws regarding homebirths, so even they aren't always a viable choice. :(

[Delta]

Sure, never said they weren't. But you were questioning what BTB learned about birth and she listed a bunch of physiological things that sounded OK to me. Then you said, well, there's a big difference between learning about birth that way and learning about it this way. "This way" isn't worth much in my book--just pointing that out. If it is in yours, then a midwife is probably the route you want and that's fine.I don't understand what you are saying here. In your comment earlier you made it sound as if midwives are not trained in the things that BTB mentioned. One of the biggest misconceptions (ha! punny) about midwives is that they lack any sort of training and as I and others have explained, that is simply not even close to being true.

And I absolutely would have preferred a homebirth with a midwife, but unfortunately my pregnancy and birth history has pretty much ruled out that possibility.

[Ericka_Jarett]

Interesting article. Weird coincidences that's for sure.

The one doctor mentioned, Dr. Robert Debbs was actually my perinatalogist with Easton.

[BTB]

If our hospitals rarely are involved in natural childbirth (defined as not involving labor inducing or augmenting drugs, no pain meds and minimal interventions), then where are the new OBs gaining their knowledge on natural childbirth?

We have a 72% epidural rate, and deliver an average of 11.4 babies per 24-hr shift. To make that math easy for myself, that's something like 1/4 of 12, or 3 babies per night, born without epidural, and the vast majority of moms who forego epidural tend toward the crunchy overall. Although typically one per night or every other night is a mom who is accidentally birthing naturally, not by plan but because that's what got batted her way, and THAT is a real challenge. I think you learn more about natural birth helping one accidentally crunchy mom through a med-free birth than four planned natural birthers, but that's just my personal opinion.

Luckily I wasn't tossed in without preparation - as a med student, I studied obstetrics at a large inner-city tertiary facility where the epidural rate was less than 40% simply because they're expensive and patients didn't want to pay for them. I'm not saying my experiences are universal, but don't get why others seem to think theirs are. If YOU live in a place where 97.6% of women get an epidural, fine. Or not, depending on your POV. But don't stretch that to "doctors" or "hospitals" in general.

Most of their true, clinical knowledge comes from doing it over and over in residency.
And there in lies the problem.

Ignuttz, this was your response to carrie. Can you expound on that? I'm perplexed why experience would be perceived as a bad thing. IIRC, her comment was on the management of all births, not just complicated ones, but it seems you're interpreting it as the latter. Yes, of course residency has to include training in complicated births, if it didn't who would manage those? But the majority of births are uncomplicated, thus, by definition, that's the majority of what residents see. (and, BTW, yes of course you will have to learn the seven cardinal movements of labor in midwifery school. My original sentence actually said "any one who wants to deliver babies needs to learn..." but then I changed it because it sounded snooty.)

BTW, I'm not in ob residency. I'm in family medicine residency. Thus my bent lies toward prevention, and my own personal philosophy is not far from what wendalah described: let's gather everything we might need in one place, just in case; make it comfortable for moms and observe. We'll be here if we're needed. If you deliver enough babies, you WILL see problems and in ob, there's not much that's "a little bit bad". Things are either pretty ok, or heading south fast. 5% of births encounter genuine problems, that means on average I see one not-so-good birth every other shift. It's certainly often enough to make me want to have everything I'd need to effectively help right there.

[Delta]

Ignuttz, this was your response to carrie. Can you expound on that? I'm perplexed why experience would be perceived as a bad thing. IIRC, her comment was on the management of all births, not just complicated ones, but it seems you're interpreting it as the latter. Yes, of course residency has to include training in complicated births, if it didn't who would manage those? But the majority of births are uncomplicated, thus, by definition, that's the majority of what residents see.It's not the experience that is the 'bad thing', it's the fact that hospital birth with all of its paternalism and technological interventions has come to define birth in America today. The vast majority of hospital births are actually not what I or others in this thread (I would presume) would consider normal birth. Normal birth shouldn't require IV's or fetal strips. So saying that you've seen or attended so many births in a hospital doesn't really mean that you've had experience with normal, minimal intervention birth. Just a sincere question - have you ever seen a (planned) birth occur outside of a hospital in a home, or even a FSBC setting?

[lml41981]

We have a 72% epidural rate, and deliver an average of 11.4 babies per 24-hr shift. To make that math easy for myself, that's something like 1/4 of 12, or 3 babies per night, born without epidural, and the vast majority of moms who forego epidural tend toward the crunchy overall. Although typically one per night or every other night is a mom who is accidentally birthing naturally, not by plan but because that's what got batted her way, and THAT is a real challenge. I think you learn more about natural birth helping one accidentally crunchy mom through a med-free birth than four planned natural birthers, but that's just my personal opinion.

Luckily I wasn't tossed in without preparation - as a med student, I studied obstetrics at a large inner-city tertiary facility where the epidural rate was less than 40% simply because they're expensive and patients didn't want to pay for them. I'm not saying my experiences are universal, but don't get why others seem to think theirs are. If YOU live in a place where 97.6% of women get an epidural, fine. Or not, depending on your POV. But don't stretch that to "doctors" or "hospitals" in general.

How many interventions are done on the 28% who don't have epidurals? Also, how many of that 28% get narcotic pain relief "to take the edge off" or a sedative to "sedate and wait?"

That's something that amused me/irked me after Natalie was born...a nurse said (while cathing me because I had stage fright due to being afraid of the first post-partum pee), "Congratulations on your natural childbirth!" I said, "Thank you, but it wasn't natural. I had two doses of Stadol." Her response was, "Oh, it was natural enough. Around here, if you don't have an epidural you are considered a natural birther. You did something 97% of the other women we tend to can't do." There is nothing natural about being drugged into a stupor, but it amuses me that there's the concept that as long as I didn't take the epi, I had a NCB. Meanwhile, I had all these other not-natural interventions...but it was "natural enough." :p

I've really tried not to generalize all hospitals and all doctors...it is hard not to do, though, when it seems that so few are privileged to attend to a true natural childbirth. Of course, unless they actively seek out the opportunity to be at a home birth or a FSBC birth, I suppose there isn't much opportunity for them to witness a true NCB. And truth be told, I'm not sure I'd want a doctor of any sort at my home birth. I'd be really afraid the doctor would overstep his/her bounds (although I guess if s/he is worried about malpractice insurance issues, I need not worry?)...I'm worried enough having my RN MIL there...

[BTB]

Just to refresh, this is what I said:

Philosophically the main theme I've gotten is the immense variability in birth. Birth is different for every woman, for each of her pregnancies, even, and any doctor (or mother, for that matter) who thinks she can write out the "birth plan" is fooling herself. Only the baby knows, and the baby's not telling.

And this is what you got from it:

See, your comment about the 'birth plan' seems so condescending.

You'll notice the primary subject of the sentence is doctor. The doctor is fooling herself if she thinks she knows the birth plan. And, the mother too. You asked what I *am* learning about birth, and my point in answering you technically was that there is no handed-down birth philosophy. IMO it's as big a mistake to think every birth can or should proceed naturally as it is to think most births can't or shouldn't. That is what I learn, that there is no plan, no preconceived notion. We'll take it as it comes.

So saying that you've seen or attended so many births in a hospital doesn't really mean that you've had experience with normal, minimal intervention birth.

??? I didn't merely say "I've performed so many deliveries in a hospital", I gave our current stats for noninterventional birth. We are fairly comfy for moms of all flavors, but as I said before, we're not special.

Just a sincere question - have you ever seen a (planned) birth occur outside of a hospital in a home, or even a FSBC setting?

Yes. I may even have seen more out-of-hospital births than most thread participants have seen occur in-hospital.

[jennylou]

It seems like this thread has turned into an OB vs a midwife thread.

I for one, love my OB, want to be in the hospital to give birth - but think that the c/s rate is high.

My hospital does have a very high epi rate (90-some percent last I heard). But, thankfully, they still allow vbacs and I had a wonderful vbac, with a great nurse and a great OB - I'm very fortunate that I had that choice available to me. :)

[BTB]

but it amuses me that there's the concept that as long as I didn't take the epi, I had a NCB.

That was one thing one nurse said. *shrug*

I'm afraid I have to bow out of the thread for the next 48 hours. I'll be back, if it's still going on then. I'm not sure why, as again, it seems like people will think what they've already made up their minds to think. My main purpose in posting was to challenge this notion that "doctors do or don't learn this" when spouted by people who don't actually have any accurate idea of what is and isn't taught. And, I've attempted to do that, likely to no avail, anyway.

I'm on duty for 30 consecutive hours starting tomorrow at 7 AM, so it's time for some sleep. I can't wait, 30 hours of no sleep, no food, and rare trips to the john when I simply can't hold it anymore, while missing out on seeing my own family so that I can take care of other people's. All so I can learn how to make people unhappy and ruin their births/hospital stays/whatever. Awesome!

[Delta]

You'll notice the primary subject of the sentence is doctor.You are right, I totally missed that. Yes. I may even have seen more out-of-hospital births than most thread participants have seen occur in-hospital.And wouldn't you agree that they are very different? At least, from the mother's perspective? Well, actually, some FSBC can be more interventionist than others so that comparison is not as good as a hospital birth vs. a homebirth.

BTW - I think women should have whatever birth floats their boat wherever they want to have it! I just think they should be educated and informed and empowered with the knowledge that most likely their bodies CAN birth babies without a lot of technology. But if they want the doctors and epidural and all of that then go for it. I have no problems with that at all. My beef in this thread is with the misconceptions about midwives and the lack of awareness out there about the choices that women have in prenatal care and birth. Although, that awareness is certainly growing and hospitals *are* responding and working on becoming more mother-baby friendly. We can't get lax about it though. ;)

[Delta]

All so I can learn how to make people unhappy and ruin their births/hospital stays/whatever. BTB - Don't take what I am saying personally. I'm sorry. I just get very riled up and frustrated about this topic. :)

[lml41981]

That was one thing one nurse said. *shrug*
<snip>
My main purpose in posting was to challenge this notion that "doctors do or don't learn this" when spouted by people who don't actually have any accurate idea of what is and isn't taught. And, I've attempted to do that, likely to no avail, anyway.


I didn't say that all doctors or nurses thought that...I said it amused me that the concept was there. BUT I will say that I've heard a similar concept from numerous others who are not medical professionals. I've also heard women say, "I didn't have pain medicine, but I did have an epidural and that was awesome because I felt nothing." Umm...well, what do they think an epidural is, exactly? It blocks the pain...

And the ONLY reason I questioned where doctors got knowledge of true NCB is because Carrie posted that doctors don't learn about birth in med school, only in residency...well, if a particular hospital where one does residency doesn't have many patients doing NCB, my question stands...where are they lear