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Thursday
Oct082009

Maternity Care Advocacy: A Questionable Agenda?

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The following is an excerpt from the article, Saving babies: why c-section is not a dirty word, which appeared in Redbook on October 1, 1996.

 

A QUESTIONABLE AGENDA

No one would argue that natural childbirth advocates intentionally mislead pregnant women by sidestepping the subject of cesareans. In fact, the patient who goes the nurse-midwife route often does so because she already wants to lower the odds of having a cesarean. “We try to give women strategies that will distract them from the pains of labor and counsel them not to request an epidural either too early or in too high a dose - both of which can increase the likelihood of a having a cesarean,” says Deanne Williams, director of professional services for the American College of Nurse Midwives in Washington, D.C. “When a woman is anxious and uncomfortable in labor, she naturally seeks the hospital as a haven, a safe place to be. So early on, we suggest showers, tub baths, walking around the block, back rubs-anything that will distract her from the discomfort fort and keep her home as long as possible so technology is kept away from the natural process of giving birth.”

Laurie Grant, M.D., an obstetrician-gynecologist at Hudson Valley Hospital Medical Center in Peekskill, New York, who uses some of these techniques in her own practice, agrees that they can make labor more comfortable; a woman who walks around during labor, for instance, uses gravity as her ally in bringing the baby down, increases the strength and quality of her contractions, and ultimately hastens labor along. But they won’t stave off a cesarean. “If you’re going to have a C-section, it’ll happen no matter what you do,” she says. Adds Dr. Cole, “C-sections are based on a baby’s or mother’s medical condition, not on the comfort of the mother.”

Certainly many nurse-midwives will call for a cesarean when a routine delivery becomes particularly rocky. What concerns doctors are those practitioners who are so vehemently committed to natural childbirth that they put off suggesting sections to laboring women who really need them. “I know of one woman who purposely had a lay midwife [not a certified nurse-midwife] attend her home birth, and when things started to go wrong they waited too long to come to the hospital,” says Dr. Grant. “They had to medivac the baby to a neonatal intensive care unit.”

Doctors also worry about the messages sages sent by some childbirth education groups, in particular the Bradley Method, that make women suspicious of medical intervention. The American Academy of Husband-.Coached Childbirth, as the Bradley Method is formally called, is a California-based childbirth education group with 1,000 instructors nationwide who endorse natural childbirth without drugs and eschew the routine use of medical intervention during birth. “We attract a different sort of woman than Lamaze instruction, a woman who prefers not to use drugs of any kind during childbirth and who looks for a heavy involvement from her husband as a coach,” says Bradley Method executive director Marjie Hathaway.

According to Hathaway, more than 30,000 women a year attend the Bradley Method’s twelve-week course, based on the teachings of retired Denver obstetrician Robert Bradley. “He started off being a Kansas farm boy, and when went to medical school he wondered why all these women were screaming and yelling during childbirth - he never saw the animals on the farm do that,” explains Hathaway.”So he started applying the same principles of relaxation an abdominal breathing and found out women could give birth naturally almost always, without drugs or intervention.

“We’re not against intervention if it’s done appropriately,” explains Hathaway “but too often it’s done without a medical reason, which can set a up for failure.”

Dr. Flamm argues that routine medical procedures can pick up minor problems before they become major ones. He recalls a woman schooled in the Bradley Method who arrived at the hospital to have her first baby and refused even the simplest medical procedures: “No fetal monitoring, no pelvic exams, nothing. When doctors finally persuaded her to let them listen with a stethoscope, the baby’s heartbeat was horrendous. But still she refused surgery, and the baby died.”

Dr. Grant concurs that her experience with some Bradley graduates is not good. “I have a patient right now who is taking Bradley who won’t let me do a sonogram because they showed her a video-tape in which a doctor said it could be harmful - and that’s never been proven.”

“The health of the baby and the mother are our primary concerns,” counters Hathaway. “But we also think a woman should do whatever she can to avoid major surgery during childbirth if there are questions about her really needing it.”

 

 

Almost every single paragraph has a fallacious statement or sweeping generalization that made my eyes burn from reading. Truth be told, questioning the efficacy of any monopolistic regime, particularly the U.S. medical hegemony, will always be viewed as “a questionable agenda.” It’s a classic case of the emperor walking about naked and a small group of people saying, “Dude, you’re naked.” His supporters work to convince everyone else in the vicinity that he is most certainly not naked or perhaps scramble to justify his nudity with good PR and attempts to discredit those who are staring right at his man-business in disbelief. A few of us point at it.

Meanwhile, the word of the naked emperor trickles out beyond the castle walls and is met with a variety of emotions from those who have a deep-seated need to believe that the power structure in existence is a purely benevolent one or who have been educated in complacency and don’t feel comfortable questioning the emperor’s questionable agenda.

 

 

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Reader Comments (10)

Jill - thanks for posting this piece of journalistic garbage (the Redbook article, not your post). Twice now in 2 days I've seen something that is so ill-informed and agenda-ridden it's made me speechless...

~A

October 8, 2009 | Unregistered CommenterAnne

*Gag* *barf* *puke*

What really got me was :

"He recalls a woman schooled in the Bradley Method who arrived at the hospital to have her first baby and refused even the simplest medical procedures: “No fetal monitoring, no pelvic exams, nothing. When doctors finally persuaded her to let them listen with a stethoscope, the baby’s heartbeat was horrendous. But still she refused surgery, and the baby died."

Thats not the fault of Bradley method or natural birth. No one could force her to have surgery, as well as no one could force her to NOT have surgery. And how do they know the baby would have been saved by cesarean anyway? They don't. Unfortunately babies die. To make sweeping statements and blame the baby's death on natural birth is simply asinine. Talk about grasping for straws.

We don't sidestep cesareans--we try to INFORM women about them, how to lower your risk of having one, and yes sometimes they ARE necessary.

October 8, 2009 | Unregistered Commentermichele

This reminds me - I was going to ask you why the promo for the Expectations Radio piece (and the interview itself) emphasized that you're biased. It's so weird how natural birth advocates have to fess up to being biased, but people whose attitudes and practices fly in the face of evidence, common sense, and human rights don't? Bizarro world.

October 8, 2009 | Unregistered CommenterAmy Romano

Ah, yes, we all know that c-sections are only done for medical reasons and that they are all totally inevitable. This means that the c-section rate will be exactly the same, across time, across geography, across culture, across every medical practice. Yeah, that's happening today-NOT!!

October 8, 2009 | Unregistered Commenterrixa

I think the biggest lies in the article are

“If you’re going to have a C-section, it’ll happen no matter what you do,” she says. Adds Dr. Cole, “C-sections are based on a baby’s or mother’s medical condition, not on the comfort of the mother.”

So it's just a coincidence that women who choose homebirth wouldn't have needed cesareans anyway? If you'll need one no matter what you do, surely hospitals & homebirths would have the same rate?

October 8, 2009 | Unregistered CommenterLisa

wow... that article made me sooooo angry... I found myself talking back to it! It's a shame that so many people believe and rely the type of "information" that perpetuates inaccurate beliefs and sets mothers up for failure. Why can't they see that???

October 8, 2009 | Unregistered CommenterLee-Ann

“I know of one woman..." is probably the best part of this whole article. Because a doctor knowing of one woman who had something bad happen negates all the many many others who didn't. Oh wait...

I get pretty tired of people telling me that birth center & homebirths and/or using a midwife is infinitely more dangerous than a hospital, as if I haven't done any research at all. And using "I know someone who..." as the proof. I want to tell these "helpful" people all about "a woman I know..." that had horrifying experiences at the hospital. Because there are lots of those too! Sheesh.

October 8, 2009 | Unregistered CommenterKelsey

"I was going to ask you why the promo for the Expectations Radio piece (and the interview itself) emphasized that you're biased. It's so weird how natural birth advocates have to fess up to being biased, but people whose attitudes and practices fly in the face of evidence, common sense, and human rights don't? Bizarro world."

TRUTHINESS. (I've felt that apologetic-disclaimer urge in conversation before myself. We should all either knock it off and assume it's a given or insist that our counterparts - whoever they might be - do the same.)

October 8, 2009 | Unregistered CommenterDou-la-la

"I was going to ask you why the promo for the Expectations Radio piece (and the interview itself) emphasized that you're biased. It's so weird how natural birth advocates have to fess up to being biased, but people whose attitudes and practices fly in the face of evidence, common sense, and human rights don't? Bizarro world."

For the record, it was because we wanted to emphasize the point that EVERYONE is biased. No one stands without opinion, and opinions are biased by nature. Everyone comes from somewhere, a product of their experience, including those who advocate intervention.
Sorry if it wasn't more clear. Will attempt to do better next time.

Jill, as usual, I shuddered at this article. One more example of scientific evidence ignored in favor of a familiar and often repeated anecdote ending with "...and the baby died." Makes me want to cry and yell and scream till I'm purple.

October 8, 2009 | Unregistered CommenterKaren

Forget the fact that this article is full of weak journalism, anecdotes and untruths (which it is). Its terrible WRITING. Rambling, unfocused, random sentences strung together in no particular order. I can't believe this was published in an actual national print magazine. The writer should be embarassed. Was there a byline?

October 9, 2009 | Unregistered CommenterMegan
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