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Tuesday
Jun162009

Watch It, Sister! Your Words Might Get a Little Twisted

My (super-reader turned) friend sent me an e-mail this morning (from class—tsk, tsk!) about a reply to a comment I had left on a Huffington Post post about coerced cesareans. She said something to the effect of liking what I said on that HuffPo post and thought the attack was interesting. I had to ask her what she was talking about. I replied to a post a few months ago and checked back a few times to see if a discussion had started but it hadn’t. Unfortunately, comments are closed so she couldn’t reply, but she sent me a link to the post.

 

Here’s what I said:

If you replace the word “abortion” with the words “cesarean section” or “induction” in the Missouri House of Reps bill, parts of it are very interesting.

 

The physician performing or inducing the (cesarean section or induction) or a qualified professional must: …

 

(3) Explain that coercing a pregnant woman to get (a cesarean section or induction) is illegal and she is free to withhold or withdraw her consent to the (cesarean section or induction) anytime without fear of losing treatment and assistance benefits

 

Women are coerced into unnecessary cesareans and inductions everyday by physicians and hospital midwives who downplay the risks of the procedures and grossly exaggerate the risks of vaginal birth and vaginal birth after a previous cesarean.

 

Abortions and cesareans are not the same obviously. While there are spontaneous abortions, there are no spontaneous cesareans. Yet both are medical procedures that will end a pregnancy— one with a dead fetus and one with a live baby. Vaginal birth is not a medical procedure, however. It is a spontaneously occurring event. Maybe it should be illegal to misinform pregnant women of the risks of vaginal birth, thereby coercing them into unnecessary procedures.

 

These new abortion laws want to show women how alive their fetus is and that they are about to kill it by consenting to treatment. When pushing unnecessary cesareans and inductions, doctors shower women with tales of how they are about to kill or maim their baby by giving birth vaginally unless they consent to treatment.

 

Here is the reply:

I am with you on the main points, but since when are midwives known for “downplaying the risks of procedures and grossly exaggerating the risks of vaginal births”? “Midwives coerce women into unnecessary cesareans and inductions everyday?” Really? Midwives by definition are the guardians of normal, and practice exactly the opposite of each of these statements. Perhaps you are witnessing situations where a hospital-based midwife is compelled to adhere to certain protocols called for by her back-up OB, which, if she did not, would not even be able to practice there, thus forcing all birthing women at that facility to have only the “choice” of an OB. This is a problem better addressed by lifting the restrictive nature of back-up relationships (a litigation/malpractice insurance driven problem) so that the midwife may practice more freely within her established scope-of-practice of midwifery. Throwing midwives in the same boat with physicians, as the driving force of the problem, alienates an enormous pool of the very like minds you are trying to gain support from. Watch it it sister!

 

 

If I could reply on the now-closed thread, here’s what I would write:

 

Perhaps you are witnessing situations where a hospital-based midwife is compelled to adhere to certain protocols called for by her back-up OB, which, if she did not, would not even be able to practice there, thus forcing all birthing women at that facility to have only the “choice” of an OB. This is a problem better addressed by lifting the restrictive nature of back-up relationships (a litigation/malpractice insurance driven problem) so that the midwife may practice more freely within her established scope-of-practice of midwifery.

 

YES!

 

 

So, the last two sentences are interesting.

Throwing midwives in the same boat with physicians, as the driving force of the problem, alienates an enormous pool of the very like minds you are trying to gain support from. Watch it it sister!

 

There are a few things about this that are worth addressing to me. The first thing the friend who sent me the link pointed out was that not all doctors are hard-core cesarean pushers and not all institutional midwives are able to guard normal birth. We both know. A CNM recommended my (refused) cesarean over the phone after returning from vacation to find a late-term ultrasound showing macrosomia then dumped me in the care of a doctor. My friend who sent me the link was induced by a midwife for her “big baby” at 37 weeks. Needless to say, her son was in the NICU and she was very angry about the non-judicious use of technology. Our stories are not uncommon for the very reasons that the commenter mentioned. I’ve never thought of this caveat as an indictment of midwifery in general but rather a assessment of the current intervention-heavy state of institutional maternity care. If I had simply written “doctors,” this wouldn’t have come up. I’m glad that it did.

 

Really, what I should have written was “some doctors and some hospital midwives,” which was the mistake that my friend pointed out to me.

 

I’m seeing that the what-kind-of-midwife-are-you issue is pretty touchy. I’ve had multiple personal experiences in care with both institutional and home birth midwives, but I don’t know if they are relevant they are to this comment. What I gather from this is that some institutional midwives find it offensive to be referred to in the same clause as physicians. Like the commenter said, some midwives are more bound to hospital protocol than others. This must be incredibly frustrating to work in one of these hospitals where the normalcy of birth and the autonomy of midwives are not respected.

 

I was one of many who heard “midwife” while pregnant the first time and did not make any effort to get to know my midwife or learn about her philosophy, or more importantly, how her practice was extremely limited by the institution. I just assumed that she trusted in birth but she played the dead baby card as well as any doctor that followed her in trying to strong-arm me into a c-section. However, I never generalized the experience to “all hospital midwives” or “all midwives.” To me, it’s always been about the two women involved in the midwife-client relationship and the communication between them. On the same token, many women have great relationships with their doctors, talk openly with them throughout their pregnancies and understand well in advance of labor what concessions they might have to make to give birth in that institution.

 

Rather than go on and on about how I love midwives (see ENTIRE BLOG for that), I want to wonder aloud if it’s actually offensive to say that some midwives are scared of birth, too. Some midwives are terrified of big babies. Some midwives encourage their patients to have unnecessary interventions based on their own fears. I don’t think it’s about type of midwife as it is about knowing your midwife. As much as I advocate for midwives and midwifery care and I also encourage women to ask questions liberally, get to know their care provider and their philosophy and find a new one if the fit isn’t right. I think that was what was at the crux of this commenter’s bone to pick— the mere implication that midwives could have anything to do with any coerced cesarean.

 

I also realized that, the longer I’m on the Internet, the more I’ll have to get used to having to clarify unclear statements, finding my words over-generalized and being warned to “watch it, sister!”

 

 

 

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Reader Comments (8)

I agree with you, there is no blanket -All midwives- or -All doctors- but there is a general amount of 'hospital midwives' practice closer to OB's like you said. My c-section and first child was with a hospital CNM who passed me onto a doc after my water had been broken a certain number of hours per protocal. My second was a Home VBAC with a CNM who did not have a supervising doc. I was reading an old Smithsonian Magazine on the history of the seatbelt (April 2009 'Buckle up and Behave') and I found this great quote that applies to most hospital birthing.
"the idea that humans have an inborn tolerance for risk-meaning that as people are made to feel less vulerable, they tend to take more chances. The feeling of greater security temps us." Meaning that often unsafe care is given (too much pictosin, cytotec etc) with the feeling of that if it gets bad she can just get a c-section. If c-sections are not avalible for carelessness more effort might be made to keep the mother and baby safe and labor unfooled around with.

June 16, 2009 | Unregistered Commenterbriome

I think it's important, too, to realize that not all CNMs follow nor believe in the midwifery model of care. Some CNMs are simply L&D nurses who are taking "the next step up" and becoming a midwife for financial or other reasons, rather than loving to help women during pregnancy and committing to safeguard normal birth. I would suspect that it is these who are the majority of the OB-like midwives, but I have no way of knowing for sure.

June 16, 2009 | Unregistered CommenterKathy

I agree with the above comments completely.

You might have the most midwife OB there is. He follows normal birth to a tee. And you might have a CNM that has more medicated births than other OB in the hospital. The important thing is to get to know your caregiver. They are all differnt! Don't think that if you get a midwife, they are completely pro natural birth or if you get a doctor they are completely pro medical birth.

June 16, 2009 | Unregistered CommenterKayce

So basically what it boils down to is that there are human beings (OB's, CNMS, lay midwives) delivering other human beings. They ALL come with a history and a birth philosophy. ( Most CNM's take a pay cut when the become CNM's from staff nursing BTW. Staff nursing tends to be the most lucrative positions). Yes, know your care provider. Talk to them. Understand what is going on. Ask questions. Honestly, the women reading these birthing blogs are in the vast minority. Most mom's will go ahead with whatever the OB or midwife tells them. If there are no squeaky wheels, there will not be any oil.

June 16, 2009 | Unregistered CommenterReality Rounds

It's hard because if I'm going to give people one piece of advice that they'll use, I want it to be "get a midwife". But yet there's no guarantee that this care will be any better, and I worry that it if they end up with a "hands-tied" or interventionist midwife, they'll be less likely to question it because "she's a midwife". I will definitely say that anyone who thinks all midwives are the "guardians of normal" needs a wake-up call. I have seen too many midwives who order up the pit, break the water, and push the epidural. It is, indeed, all about *your* provider - not some general class of providers.

June 16, 2009 | Unregistered CommenterRebecca

Every one of these comments is so interesting. I can see how it would be a really touchy subject. I knew there was privileging and marginalization of different groups among midwives but I've never really sat down and asked any of my friends about it. Perhaps now I shall.

Briome, the seatbelt analogy is great. Would you drive differently if you didn't have seltbelts? If your kids were in the front seat without a seatbelt? That's food for thought.

Thanks all.

June 16, 2009 | Registered CommenterJill

My non-hospital based midwife would send me to the hospital in a heartbeat if my baby was breech.

June 20, 2009 | Unregistered CommenterJen

Jen, it's good you know that now instead of at 36 weeks or something. Tell that kid he/she only has another month or so of somersaults. Actually, I think another two weeks before people starting thinking "what if?" We did moxabustion and burned the heck out of my pinky toes and my last baby flipped at 34 or 35 weeks. Whew.

June 20, 2009 | Registered CommenterJill
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