DISQUS

Danielle:

"choosing not to have birthing interventions does not mean that someone is uninformed. My God, the arrogance of that perspective is just…saddening."

Please do not distort what I have said. I did not say that choosing to forgo interventions means that a woman is uninformed. What I said is:

"The majority of American women want pain medication in labor, they want the routine use of technology and they want, above all, to have a healthy baby. American obstetricians are working to meet those needs. A minority of women don’t want pain medication in labor and don’t want any interventions. That is their right, but obstetricians know that those women do not understand the risks of childbirth (they grossly underestimate them) and do not understand that supposed risks of technology (they grossly overestimate them). Therefore, they are not making informed decisions."

"Natural" childbirth advocates generally do not understand the risks of childbirth and do not understand the fact that the risks of technology are far less. They like to tell themselves and each other that they are making the superior choice, but they are not. The decisions to forgo pain medication or the decision to forgo interventions is a personal preference, like the decision to prefer vanilla to chocolate. "Natural" childbirth is not better, safer, healthier or superior in any way to childbirth with medication and interventions. The only people who appear to be unaware of this fact are "natural" childbirth advocates.

These are factual statements. In order to show that they are not facts you would need to provide scientific data to the contrary. Merely claiming that you don't like the attitude of someone who informs you of these facts tells us about your opinion, but not whether you are correct.

Homebirth advocacy is based on mistruths, half truths and outright deceptions. Please do not unwittingly pass along these mistruths and deceptions. Please check to see if they are actually true, before repeating them.

"It is my opinion, and I stand by it"

It is not an opinion issue; it is a factual issue. The fact is that labor has been described as agonizing in every time, place and culture. In tests of various pain rating systems, labor is usually described as having the most severe pain rating.

The description of pain is subjective, but pain itself is not subjective. It is a particular sensation that takes place by transmission of nerve signals from specific receptors to the brain. If you chop off someone's leg without anesthesia, they will feel severe pain, unless they have an underlying nerve deficit. No one would dare suggest that the pain was "subjective". Similarly, uterine contractions, cervical dilatation and stretching of the perineum all cause severe pain for the majority of women. That pain is not "subjective" either.

It is not a coincidence that only women's pain is described as "subjective", deserved, in their imagination, or the result of poor preparation. That's is often the way that women's pain has been historically described by men. It is not a coincidence that everyone agreed that labor was agonizingly painful until a bunch of middle aged white men told women that "real" women did not feel pain in labor. It is ironic in the extreme that some women, against all evidence, have adopted this view that labor pain is merely subjective.

Women's feelings of severe pain in labor are real, authentic, and biologically based. Respect for women demands that we acknowledge that pain, not minimize it, and certainly not take the word of a bunch of middle aged white men for what women are "supposed" to feel in labor.

"In other words, a woman may call her birth experience agonizing but to make a categorical statement that birth is considered "agonizing" across time, place and culture" is an exaggeration and an overstatement. Such a statement is the kind of thing that creates a "cultural construct" which inevitably, eventually, will be deconstructed."

No, birth has been considered agonizing across time, place and culture!!! This is not a matter of personal opinion. It is irrefutable fact. The ideas of birth as empowering, painless, pleasurable (??) ARE the social constructs. They never existed before the mid 20th century (when white men made most of them up), and only in Western countries and only among white, relatively well educated, relatively well off women.

A deeply entrenched, but rarely appreciated legacy of sexism is the idea that while men's pain is real, women's pain is in their head, or punishment for some imagined sin, or the result of not being properly "prepared"; in other words, while the pain of men is real, the pain of women is always construed as the fault of women. We need to get past that legacy of sexism and acknowledge that women's pain is real.

The pain of childbirth is agonizing for most women, across all contemporary cultures and they are not afraid to describe it as such. The overwhelming majority of women WANT pain medication in labor, and why shouldn't they? When pain is considered empowering for men, we can talk about it being empowering for women. Until then, there is no virtue in enduring it. If women don't want pain medication in labor, that's fine, but it is no more empowering that forgoing novocaine for root canal. It is a personal preference, nothing more.

"What we’re not cleary discussing is the current, widespread opinions and practices that are stripping women of empowering and informed choices and options."

As I said above, the entire health care system has massive room for improvement in the way that it treats all patients. However, there is really no evidence that women are being stripped of "empowering and informed choices and options".

First of all, the American public has made it clear that its top priority is the birth of a healthy baby to a healthy mother. The current malpractice climate reflects the American belief that a baby must be born healthy or the doctor should be punished by being sued. Doctors have gotten the message.

Second, contrary to the assertions of homebirth advocates, most women are very pleased with the current state of maternity care. Consider the Listening to Mothers Survey II, conducted by the Childbirth Connection (an "natural" childbirth advocacy organization). The survey demonstrates a large disconnect between what the Childbirth Connection defines as a good birth, and what mothers themselves have to say.

According to the report:
"Mothers generally gave high ratings to the quality of the United States health care system and even higher ratings to the quality of maternity care in the U.S. Their opinions about the impact of the malpractice environment on maternity care, however, recongnized concerns. Large proportions felt that malpractice pressures led to increased charges and unnecessary tests and cesareans, and caused providers to stop offering maternity services. On the other hand, most felt that the malpractice environment caused providers to take better care of their patients.

By law ... women are entitled to full informed consent or informed refusal before expriencing any test or treatment. Most mothers stated that they had fully understood that they had a right to full and complete information ... and to accept or refuse any offered care...

A small proportion of mothers reported experiencing pressure froma health professional to have labor induction (11%), epidural anesthesia (7%) and cesarean section (9%)... Despite the very broad array of interventions presented and experienced ... just a small proportion (10%) had refused anything ..."
So, despite the belief of the people from the Childbirth Connection that women had experienced "unnecessary" interventions, women were overwhelmingly pleased with their care, understood that they had the right to complete information, yet rarely refused recommended or offered treatments or interventions.

Third, most women do not consider pain empowering nor should they. Most women do not consider forgoing technology empowering, either. Unmedicated childbirth is hardly an achievement. Women are no longer uneducated, passive individuals. They are doctors, lawyers, physicists and programmers. They control their own lives; they invent technology, and they use technology to improve their quality of life the same way that men do. They bring those same abilities and attitudes to childbirth. I find it interesting that no one EVER counsels men to refuse pain medication for any reason. No one ever counsels men that using technology is disempowering. Yet somehow women are supposed to be "empowered" by passively accepting whatever happens under the guise that it is "natural".

Childbirth is natural, but it is also INHERENTLY dangerous. Homebirth advocates don't appear to understand this because they look at the current low rates of neonatal and maternal mortality and assume that these occur in spite of technology. The low rates of neonatal and maternal mortality occur BECAUSE OF the widespread, routine use of technology in pregnancy and childbirth.

Human reproduction naturally involves a high rate of "wastage". Women are born with millions of eggs that will never be used. Men produces billions of sperm that will never fertilize an egg. Established pregnancies have a natural miscarriage rate of approximately 20%. The natural rate of neonatal mortality is in the range of 7% and the natural rate of maternal mortality is approximately 1%. Each year modern obstetrics saves over 200,000 American babies and more than 39,000 American women who would otherwise have died. Obstetricians do this EACH and EVERY year by routinely using modern technology.

The bottom line is that obstetrics is preventive medicine. The tests, procedures and C-sections are like wearing a seatbelt. Would your baby die if you didn't buckle her into a carseat and drove to the grocery store. No, of course not, but we buckle our children into carseats because, in the event of an accident, being buckled dramatically decreases the risk of injury. Would the babies of the many women who have C-sections definitely die without the C-section. No, of course not, but obstetricians knowlingly and deliberately perform C-sections the might not have been necessary in retrospect because we know that in the event of signs of distress, a C-section dramatically decreases the risk that baby will suffer injury or death.

The majority of American women want pain medication in labor, they want the routine use of technology and they want, above all, to have a healthy baby. American obstetricians are working to meet those needs. A minority of women don't want pain medication in labor and don't want any interventions. That is their right, but obstetricians know that those women do not understand the risks of childbirth (they grossly underestimate them) and do not understand that supposed risks of technology (they grossly overestimate them). Therefore, they are not making informed decisions.

According to the American College of Nurse Midwives Annual Report:

"In 2005, the most recent year for which data are
available, CNMs attended more than 306,000 births, or
11.2 percent of all vaginal births."

According to the CDC, in 2005 there were 4,138,349 births. That means that midwives cared for 7.4% of all women giving birth in that year.

"They’re rooted female history."

No, they're not. That's just one of the many made up claims of homebirth advocacy. Indeed, since I wrote about the rise of the "natural" childbirth ideology in the 1950's, I've learned a lot more about the inception of the "natural" childbirth ideology in the 1930's.

The acknowledged father of "natural" childbirth, Grantly Dick-Read, was profoundly influenced by the eugenics movement. Dick-Read wrote about the problem of "race suicide" that was going to occur because white women of the "better" classes were more concerned about economic and political emancipation than about having lots of children. The world was going to be overrun with the children of the lower classes. He thought that educated white women were less likely to have children because of the pain, so they should be convinced that the pain was in their heads. (See Ornella Moscucci, Holistic obstetrics: the origins of "natural childbirth" in Britain, PMJ 2003;79:168-173 .)

It is very important to understand that Grantly Dick-Read fabricated his principle claim, that "primitive" women had painless childbirths and that white women of the "better" classes had pain because of fear. He was following in the tradition of many Victorian doctors who believed that "primitive" women (read women of color) were hypersexualized, had painless labors and understood that their principle role was to have children. In contrast, educated white women were likely to have "shriveled ovaries", "hysteria" (believed to originate in the uterus) and painful labors. (See ,The Race of Hysteria: "Overcivilization" and the "Savage" Woman in Late Nineteenth-Century Obstetrics and Gynecology, Laura Briggs, American Quarterly, Vol. 52, No. 2 June 2000; and Patricia Jasen, Race, Culture, and the Colonization of Childbirth in Northern Canada, Social History of Medicine 1997 10(3):383-400.)

All the originators of the philosophy of "natural" childbirth were men. Dick-Read, Lamaze, LeBoyer, Bradley, etc. all counseled that the pain was essentially in women's head. The MADE IT UP. Labor is considered agonizing across all times, places and cultures. Women in indigeneous societies do NOT have painless labors.

The ideology of "natural" childbirth is a cultural construct adopted by Western, white women who are relatively well educated (high school, a little college) and relatively well off. It is basically scorned among women of color, women of non-Western cultures, women of low economic means and professional women. The ideology of "natural" childbirth did not exist until a bunch of middle aged men made it up in the 1930's-1950's.

"I think they’ve set out to promote conscious choices and empowerment."

Women cannot make conscious choices and be empowered when they are fed mistruths, half truths and outright lies. There's a lot that could be improved about the way all patients are treated (not just white women, and not particularly white women). However, homebirth advocates resort to misrepresenting the safety of modern obstetrics instead of addressing the real issues. In the US, modern obstetrics has lowered the neonatal mortality rate 90% and the maternal mortality rate 99% in the last 100 years. Midwifery has lowered the neonatal mortality rate by 0% and the maternal mortality rate by 0%. The ONLY countries that have low neonatal and maternal mortality rates are countries where modern obstetrics is practiced.

Homebirth midwifery is dangerous. All the existing scientific evidence indicates that homebirth increases the risk of neonatal death. Even the widely quoted Johnson and Daviss paper actually shows that homebirth with a direct entry midwife in 2000 had almost TRIPLE the neonatal death rate for low risk women in the hospital in 2000. You won't find that information in the paper. The authors (Johnson is the former Director of Research for the Midwives Alliance of North America; Daviss, his wife, is a homebirth midwife) conveniently left that out. Instead, they tried to fool people by comparing homebirth in 2000 with a bunch of out of date papers about hospital birth extending back to 1969. The most recent US statistics (2003-2004) show that homebirth with a direct entry midwife is the most dangerous form of PLANNED birth in the US. The neonatal mortality rate is triple that of low risk hospital birth in the same years.

Homebirth advocacy is made up of mistruths, half truths and outright lies. I've discussed only a small number of them above. The bottom line is that women cannot make informed decisions when they are being misinformed.

APPALLING FACT: Infant mortality is the WRONG statistic for evaluating obstetric care because it includes deaths from birth to one year. The correct statistic is perinatal mortality. According to the 2006 World Health Organization report on perinatal mortality, the US has one of the lowest rates in the world, lower than Denmark, the UK and the Netherlands.

APPALLING FACT: Your claim about midwifery is utterly absurd. You said, "In the US, midwives attend about 1% of births (in the rest of the world, it is about 70-80%.)"

In the US, certified nurse midwives attend approximately 10% of vaginal deliveries. Direct entry (lay) midwives attend less than 0.25% of births. There are other countries that utilize midwives more often (the UK, the Netherlands) and they have HIGHER perinatal mortality.

Ricki Lake bases her advocacy of homebirth on mistruths, half truths and outright lies. Don't let her fool you.