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Tuesday, October 25, 2011

Everything in moderation - even birth advocacy?

I have always stood firmly in the middle when it comes to birth advocacy. I am not in the "trust birth!" camp, because I feel that birth can still be predictably unpredictable; our bodies, for all their wonderment, can still betray us and so, sometimes, can our births. I am not a person who believes that every doppler and every ultrasound is bad, nor do I believe that birth is "an accident waiting to happen." I also don't agree with the mantra "Just trust your doctor!", because being burned by doing so is probably what leads many women to seek a home birth (or at the very least, an alternative birth experience) in the first place.

Yesterday I read three articles that stuck in my brain - one, about the Australian midwife Lisa Barrett whom the 10 Centimeters blog lambasted for her seemingly reckless midwifery; one written by labor and delivery nurses on how to have a "natural hospital birth," and one from none other than The sOB about The Navelgazing Midwife's transition out of the NCB community. (That one was especially bizarre, most of us agreed.)

If what the writers over at 10 Centimeters are saying is true, Lisa Barrett has had four baby deaths on her hands recently, two of which occurred very close together. I haven't read much on the subject, but I agree that something sounds weird about that. I question those who align themselves with her, simply because overall her attitude sounds very cavalier, almost. The Navelgazing Midwife commented about the situation and further distanced herself from the "NCB crowd," something I can understand - because it seems like The NgM was very judicious in her practice and someone I respected for her cautious approach to bringing babies into the world (something that has drawn both praise and criticism).

As far as Barrett's behavior, I don't know what to say - I wasn't there. If it's true, then I don't know how birth advocates can support her. I get the feeling that it's very easy to blame the mother (for hiring her), in some bizarre way, blame the baby (because, admittedly, some babies die anyway, right?) - instead of blaming a cowboy-type attitude of the birth attendant (which you see in hospitals, too). I've often wondered how women can not intervene and tell the obviously whacked midwife not to get the F out of the way because I'm calling 911 whether you like it or not, but again, I wasn't there. I wasn't inside mom's head to understand what she was thinking, or even if she really had time to think. The words "I trusted her" come to mind, much like they do for many women in hospital births who feel helpless, powerless to question the authority of a doctor who might be behaving in much the same way, only in the opposite direction. I am not saying no cesarean is every unnecessary, but you do have to step back and question for a moment why 1 in 3 babies are born this way.

On the other hand is the article written by two labor and delivery nurses - who give pointers on how to have a great natural birth while in the hospital. Yeah, that's all well and good, but perhaps the realist in me is coming out. The first one on the list is to "plan your birth," whether you write it out officially or not. That's a good idea, in theory, but as most people will tell you, not all births work out the way we want them to. There's a Catch 22 there, though, because for some women having a "plan" doesn't change the outcome - how many times have we heard that having a birth plan is almost a guaranteed cesarean? Is it because mom's plan is too rigid? Or because her physician sees it as an attack on his knowledge and authority?

That's where the idea of "finding a physician you can trust!" comes in. This is true; but for some, it's harder than others. Some go through multiple physicians and still can't find one who doesn't see birth as potentially catastrophic. What if you're living in a remote area and have one doctor to choose from? Then what?

Other points on the list include "asking for the right nurse" and "bringing your own doula." As they put it,
“There are some nurses who cannot stand to hear a woman screaming and it kills the nurse NOT to put in an epidural." 
Oh, I'm sure it "kills her." Perhaps. And then there are those who just want you to STFU and stop your whining already because you're being a royal pain just by allowing yourself to be in pain, like these:
"There is good reason for birthing couples to be wary. Our hospital epidural rates run over 90% and in most hospitals, over 95%. The nurses in general not only do not know how to support a laboring women, but have no desire to do so. They would scramble to take other patients first, leaving the "natural" moms for whoever was "unlucky" enough to not be at the board first. They sabotage natural childbirth at every turn ("There's no need for this suffering you know--they don't give out medals for this," and on and on). I saw moms thwarted at every turn--no help, no support, no suggestions until moms finally begged for the epidural and the nurses responded with comments like "See--now you'll know better than to try this next time." I helped where I could, but couldn't take every mom wanting a natural childbirth. (Read the entire article here.)
As far as the doula part, they say, "...doulas can do the things we'd love to but can't." Well, that may be true, to a point. But there are lots of hospitals and doctors who don't like doulas, don't want them anywhere near the patient, and don't consider them a help but rather a hindrance.

One that really stuck out was "Be prepared to follow hospital procedure." Then that basically means, be prepared to surrender your rights in some cases, and have a far less chance of getting the birth you want. I guess this is one of the parts that makes me a moderate - while I know you're there for help should you need it, I also realize that much of the hospital's crap policies and procedures make that desired natural hospital birth next to impossible.

The article asks, "What keeps women from having a great birth experience?" The nurses say it's the idea that women are not accepting enough of themselves, and often blame themselves when things don't turn out perfectly.
“We tend to be pretty controlling beings. Having a baby is a rare situation for us [as individuals] because we’re not used to the lack control. For most women, this is their first experience in a hospital or in any real pain.”

That idea of control sticks with me, somehow. I do think that women should be permitted to exercise control during their labors - to a point. You should be able to control some aspects, but if the true need for cesarean arises, you have to surrender some of that control to the physician, unless you plan on doing one on yourself.

It's when sometimes over-the-top advocates over-analyze the experiences of others and tell them what could have been different, what you should have done, this that and the other that I start to be glad I'm sort of sitting on the outside of the advocacy circle, sort of like watching the debacle unfold while sitting on the curb. I think we've all done it, and sometimes it's quite clear what happened and where things went downhill. Sometimes it isn't, though. I've had at least three people feel the need to almost justify their experiences - prefaced with a "I know it's basically everything you disapprove of" - and this makes me bristle. Disapprove? As if I am somehow the Final Judge of All That Is Holy and Right concerning your birth. Not. Although, in explaining the situation, I've realized there is often a lot more going on behind the scenes than I know, and can often understand their position. And sometimes I don't agree (like my neighbor who likely had two births unnecessarily over-managed simply because it was a holiday) but crap, I'm not going to say anything. What business is it of mine? Not my body, not my baby, not my doctor, not my anything. And likewise, I will use my somewhat crazy birth experiences to inform others that yes, there is an alternative. You can still think I'm nuts, but that's your problem.

It's important to be very careful when questioning the experiences of others. There's a fine line between coming off as a know-it-all and basically telling them they're dumb for doing it by the book and simply, respectfully, informing them of their various choices when it comes to birth. I know after having my VBAC and second cesarean that things could have been different - it was after this last birth that I read that "breech and nuchal cord are not necessarily cause for cesarean." Yeah, that doesn't really help me after the fact, though. And who the hell am I to force my doctor to deliver a baby in a manner that he hasn't been skilled in since I was probably a child? No thanks.

One thing I simply cannot stand is the idea that all natural birth advocates are the same: the group at 10 Centimeters does this, as does The sOB. Surprisingly, she had a change of heart about The Navelgazing Midwife after hearing that Barb was leaving the midwifery community because of her disagreement over their somewhat radical views. Strangely, she is now almost aligning herself with Barb.

I was once lambasted in the comments section of The sOB for a post I did on gullibility and the "Trust your doctor!" ideology.  Someone questioned my idea that because it comes from a doctor's mouth, it must be right and true, and asked "How can we stop this?"

I guess this is just another way in which I am a moderate: blindly, completely trusting your doctor is often not a fool-proof way to have a great birth. Neither is throwing all caution and reason three sheets to the wind. There has to be middle ground. I try to be realistic but not scary and ridiculous; I find that some like to practice "fear-based obstetrics" in both directions: there has to be more to the argument than "all birth is dangerous" or "home birth/unassisted birth is the only true option." Many women have been betrayed by their bodies during the birth process; just as many have been betrayed by overzealous midwives who want them to have a natural, intervention-free birth seemingly at any cost; by nurses who sabotage their efforts to have a "safe," natural birth in a hospital; by doctors who knowingly put them at increased risk to either get it over with already or teach them a lesson. By lumping all natural birth advocates together, by shunning those who disagree, or by aligning ourselves on the extreme ends of either spectrum, we are ignoring - and doing a great disservice to - all of those who land somewhere in the middle.

Related posts:
What the "other side" is saying about NCB literature
A bitter birth nerd
He's your have to listen to him
My doctor will tell me everything! Part 1
The myth of the emergency c-section
Birth faith


The Deranged Housewife said...

Here is the link I mentioned above about advice from labor and delivery nurses:

kristine said...

I think this is a fantastic article. My son was injured while being born at a birth center. Would I make the same choices again? Oh, hell no. Our experience really shattered a lot of the ideals that we had been told from the natural birth community. That being said. I do think this new NB trend is a HUGE wake up call to Doctors and Hospital. Before giving birth, the idea of a C-section was horrible to me. After having a completely organic, natural birth experience that has left my adorable little boy with a life long disabily, I would happily have a C-section not the first sign of a possible problem. We are a living example of what happens when you don't. There are much worse things than C-sections. Thanks for the fair, non-extremist post!

Deena Blumenfeld RYT, RPYT, LCCE said...

Amen to this! I wrote a similar post recently on the same subject.

As a childbirth educator, I see all flavors of mamas come through my door. I want to be able to support them in their choices, not force an agenda upon them. I get a ton of flack from others in my field who believe we should only be teaching... well, essentially anti-hospital messages. I can't and won't do that. I am not anti- anything. I am for doing what's right for your body, your baby and your family.

Nurse Lochia said...
This comment has been removed by the author.
Nurse Lochia said...
This comment has been removed by the author.
Nurse Lochia said...

Ok, figured it out...thought you were referencing my blog but I see there is a 10 centimeter blog, much different than mine. (helps if I would have actually clicked on the link lol)

The Deranged Housewife said...

Nurse Lochia, Sorry! You know what, I added you to my blog roll and then read the "other" article - and got totally confused and took you off. LOL Then I realized, wait a minute, these are two different blogs! and added you back. So confusing! Your name is a riot, BTW. :P

I did post the link to the LIsa Barrett story, didn't I? Now I can't remember.

The Deranged Housewife said...

I should also add that, while I think the post at 10 Centimeters brings up valid points, the comments are often lead back to rather snarky writers who often come off like a clone of Dr. Amy. No moderation there; they almost sound like the very people they're attacking. :/

Anonymous said...

Lisa Barrett and Dr. Amy are two sides of the same coin. Their rigid ideas and not listening to the valid concerns of 'the other side' have set back the progress made in different providers and philosophies had made in working together.
Dr. Amy and her minions and Lisa Barrett and her super fans are a small minority of women who are concerned about the quality of maternity care but they are far, far away the loudest and most media worthy. Those of us who want skilled AND compassionate care for women and their babies are far and away the majority but we get shouted down by both sides and ignored by the media. It is time that we, who don't believe childbirth is a medical procedure nor all about the woman's right to her experience need to stop letting the big mouths have all the say. I think, for the most part, we are the 'nice' women. You know the ones who don't make waves, who don't get up in anyone's face, who don't carry signs. We just quietly support our friends, real and online, and family and are the peacemakers. It's time to stop trying to make peace between the Dr. Amy's and Lisa Barrets of the world but to become a voice of our own.

Whoz Your Doula said...

well said!

Anonymous said...

This is why I read your blog. :O)