Wednesday, December 26, 2012

The Business of Being Misled


I loved the movie The Business of Being Born after I watched it a few years ago. I mean, I thought it was amazing. I even went to a showing of it up in LA and got to meet and take a photo with Ricki Lake.



I was obsessed and totally convinced that every mom-to-be needed to watch that movie. Hello, we need to know what we're getting into at hospitals! Or even better, opt out of a hospital and give birth at home, because it's (apparently) safer!

It wasn't just the film. But it was a starting point for me. I started reading Ina May's books (for example) and doing all kinds of research on childbirth and on home birth - everything I could get my hands on. I hadn't given birth in a hospital... how was I supposed to know what it's like? That movie played a part in making me fear giving birth in a hospital. Big time. Yes, I knew family and friends that had obviously had babies in hospitals... but I didn't really know what their experiences were like and I came to believe after watching this movie that if they didn't admit to how horrible their birth experience likely was, then it was because they just didn't know how horrible their experience likely was.

If you've read other posts on my blog, then obviously you know that I've changed my tune.

I had to go back to the movie.... I needed to figure out what it was that resonated so vibrantly with me now that made me feel so upset with the film. I decided to watch it again. And take notes. 

I realized what made me feel so upset: I find the film very misleading. And it's misleading about such an intimate topic: childbirth. And once I learned the truth, I almost felt violated for believing so much in this film. So I want to share with all of you the parts of the film that I found to be misleading.

****
  • Two minutes into the film, shortly after a midwife arrives at the home of a woman in labor, this pops up on the screen: "Midwives attend over 70% of births in Europe and Japan. In the United States they attend less than 8%." This comes up in the film more than once - twice in just the first 10 minutes.
It leads you to believe that if you want a birth like other women of developed countries, then you should do it at home with a home birth midwife. It doesn't talk about midwives in hospitals. It just talks about midwives out of hospitals.

So let's talk midwives. This film is obviously very pro-midwife. Which I love because I love the midwifery model of care and have oodles of respect for Certified Nurse Midwives (CNM). But in the US, if you're having a home birth, you are likely not seeing a CNM (you might be, but you are not in the majority if you are).

Yes, in other developed countries, midwives and home birth are very popular. But they are also VERY different from what we have here in the United States

For example, in the Netherlands, the midwife candidate must first be accepted into one of four higher education academies. Each academy follows a strict four-year curriculum and is for full-time students only. Approximately half of the curriculum is practical internships and the other half is studying science-based medicine. Once you graduate and become a professional midwife, you can work either as a midwife who attends home births or who attends hospital births. A home birth midwife in the Netherlands has hospital privileges even if that is not where they primarily work. Low-risk pregnant women have an option of home birth or hospital birth with a midwife but if the woman becomes high-risk or if complications arise during pregnancy, labor or delivery, she is referred (or transferred) to an obstetrician.


In the US, it is very different. There are two main types of midwives in the US: Certified Nurse Midwives (CNM) and direct-entry midwives. Direct-entry midwives refers to Certified Professional Midwives (CPM), Licensed Midwife (LM; which is essentially a CPM that has been licensed to work in a particular state); and, lay midwives (no certification, education or training requirements - technically anyone can call themselves a midwife). 

Though some CNMs attend home births, most work in hospitals - the training and education of a CNM is more similar to the training and education of a midwife in other developed countries. 

Mass majority of home births in the US are attended by some sort of direct-entry midwife (a CPM, LM or lay midwife). The typical route to become a CPM or LM (and most popular route of all currently practicing CPMs and LMs) is the Portfolio Evaluation Process which consists of an apprenticeship program and passing a skills assessment and one written exam. The time length to become a CPM or LM varies on an individual basis. 

If a CNM has current hospital privileges, then she may be able to continue care alongside the hospital staff in the event of a transfer. CPMs and LMs do not have hospital privileges and are legally regulated in only 26 states.

Next...

  • "They're surgeons (obstetricians). They should be doing surgery... they should not be doing normal births." This is a quote made by Elan Vital McAllister. This sentiment has been echoed many, many times by home birth advocates. 
Yes, surgery is one aspect of the job of an obstetrician. It doesn't mean that every OB prefers surgery or even likes surgery. It just means they are able to perform surgery when needed. To lump all obstetricians together like that is wrong. It's ignorant. It's stereotyping. Yes, I'm sure there are going to be some OBs out there who prefer to attend c-sections... there are going to be some who prefer to attend vaginal births. There are also going to be some with awesome bedside manner, some that could use a lesson in TLC, some that would get down on their hands and knees in a delivery room to accommodate a mom in labor, some that only want mom to delivery in one position, some that prefer continuous EFM, some that are good with intermittent EFM or even a doppler, etc.... in any profession you are going to have some good, some bad, some that do it this way, some that do it another way, and some that might seem horrible to you but are precisely what another person prefers. 

This sentiment and skewed view of OBs really tainted my view of OBs. But then... I had my first baby and delivered with the on-call doctor that I'd never met before and she was great to me, as was my nurse... and  I became a doula and saw more OBs in action (even random on-call docs and Laborists).... and I started to hear more about the birth experiences of my sisters and cousins and friends (women I know and trust.... women with no hidden agenda)... the good I was experiencing and hearing was much more than the bad. 

I think it's misleading and a scare tactic to say that OBs are surgeons and should only be doing surgery. A lot of women and a lot of OBs would disagree with that.

Next...

  • This caption pops up on the screen: "The United States has the second worst newborn death rate in the developed world." Then you hear the voice of Eugene Declerq saying "The United States is ranked poorly in terms of infant mortality."
Totally misleading and something I completely fell for when we watched this. Infant mortality is not the correct mortality rate for assessing whether or not childbirth in a country is safe or not. The correct rate to look at is perinatal mortality. Here's the difference: 

Infant mortality refers to the death of a baby within the first year of life. (reference is linked) Infant mortality does not include intrapartum fetal deaths (when a baby dies during labor and delivery). Again, infant mortality refers only to babies born alive that die before they turn one. If a baby dies at 4 days old or 364 days old it will affect the infant mortality rate. So yes, it includes pregnancy and birth-related issues that may later cause a death like birth defects, low birth weight and neonatal hemorrhage but also includes things like accidents, disease, and SIDS… those are all encompassed (and more) in the infant mortality rate. According to the CDC, in the United States, SIDS is actually the leading cause of death of infants 1-12 months of age.

Perinatal mortality refers to death around the time of delivery and includes both fetal deaths (of at least 20 weeks of gestation) and neonatal deaths (death during the first 28 days after live birth – neonatal deaths obviously then determines the neonatal mortality rate). Neonatal mortality is encompassed within perinatal mortality. (reference is linked)

Perinatal mortality is the most accurate way to assess the outcomes of pregnancy and childbirth. 

So, how does the US compare to other countries in this regard? The United States perinatal mortality rate is one of the lowest in the world. Our rate is actually lower than the Netherlands and the UK, surprisingly enough. (reference is linked)

Next...

  • Cara Muhlhahn is the home birth midwife featured in this film. At one point she lists all of her education and training and it sounds awesome. 
She definitely sounds like she is qualified to deliver a baby. She is a CNM. She's been to nursing school and has several years under her belt delivering babies in and out of hospitals. BUT.... did you also know she has had two lawsuits against her? One for a stillborn baby and one for a baby born partially paralyzed both born at home under her care. You can read more about that here. She also does not have hospital privileges and is known for not risking out women and referring them to OB care if they become high risk (breech, twins, etc), even though in the film she talks about how important it is to screen women to make sure they are good candidates for home birth. 

The baby that was partially paralyzed was born in 2003. This film was made in 2008. I found that interesting.

Next...

  • At 27 minutes in, Cara Muhlhahn assists a woman in her water birth... she has her hands in the water and appears to be applying counterpressure presumably to help the woman from tearing... I'm not exactly sure though but in any case, she has her hands down there on the woman's vagina and then helps the mother catch the baby.
What's my issue here? SHE ISN'T WEARING ANY GLOVES!!!!!!!!!! If a midwife or doctor or nurse ever has their hands any where near my vagina and/or my brand new baby, they most certainly will have gloves on. Come ON. So unsanitary.

Can you just imagine if a MALE doctor put his ungloved hand on his patient's vagina? Did this woman in the film give consent to that? Was she aware that it happened? This just blows my mind.

Next...

  • Around 35 minutes in, they discuss c-sections. And basically, we are led to believe that c-sections happen b/c either doctors want to go home for the day or because they are afraid of getting sued. C-sections are "extremely doctor-friendly."  That's their whole spiel on c-sections. How unnecessary and scary they are for women, yet convenient for doctors.
C-sections are also life-saving. And they aren't all scary. There are some beautiful c-section stories out there of women who peacefully birth their babies into this world via cesarean. I know there is a whole slew of people out there who believe that most of the c-sections done in our country are unnecessary c-sections (or "unnecesareans"). I'm sure there have been cases when a c-section has been performed for the wrong reasons - and I'm sure that happens in a lot of developed countries, not just the US. How do we know what's unnecessary and what's not if we don't have the details on each individual case? If they are unnecessary in the moment, then why aren't women saying no to the procedure? If they are only unnecessary in hindsight (in someone's opinion), then how do we know the doctor doesn't feel the same way? How do we know the doctor that performed a c-section isn't thinking "maybe I could have let her labor longer but I was worried about her baby and I truly did what I felt was best in that moment for the health of that baby and mother." Or does it not matter what the doctors thoughts are about it? Once deemed unnecessary by someone - someone that may or may not have any medical expertise in obstetrics - then it becomes the doctors fault and he or she is evil for that potentially unnecessary c-section. The doctor had no good intention in their actions. It was purely out of convenience.

For those who were coerced into a c-section they did not want when there was truly no medical need for it, when labor could have continued on without the mother or baby in danger, then that is horrible. And I don't dismiss those. B/c I know that has happened (and continues to happen). I think sometimes there is more to the story that I don't know, or maybe that even the mother doesn't know - but not always. Sometimes yes, convenience may be the driving factor in a woman getting a c-section. And I do not believe that is OK. At all.

However, I do not believe this overall negative attitude toward c-sections is serving women well. It's filling them with fear and doubt and a sense of failure for those that need c-sections. Empower women with information, such as evidence based practices that have been proven to lower a woman's chances of a c-section. Don't just make sweeping and negative generalizations about c-sections being scary, unnecessary and extremely doctor-friendly. 

Fast forward for a moment to the end of the film when the on-screen producer, Abby Epstein, needs a c-section for her breech, pre-term baby (she says she is about 35-36 weeks pregnant)... what does Ricki Lake say to her afterwards (8 months later) when they are discussing her birth? She so kindly asks "Do you feel cheated? Do you feel like you missed out?"

Nice.

I understand wanting and desiring the birth to go one way, then having it go another and feeling upset about it. It could have been a totally terrifying experience for her and if it was, hopefully she has found a way to sort through that. But this was evidence based care that she received. I don't think she needs someone poking at her to see if she feels like she "missed out," making her feel guilty and insinuating that she was cheated in some way. How about asking "how do you feel about the way that it all happened?"

Abby Epstein then goes on to say that her son "probably would have survived" a vaginal birth... and then talks about how they had a hard time bonding and a hard time breastfeeding. And she thinks this is from the C-section??!!!

The C-section is what is blamed here for her "lack of bonding" and the breastfeeding issues? How about the fact that her baby was in the NICU for a few weeks? How about the fact that her baby was very underweight due to IUGR, weighing only 3 pounds 5 ounces? How about the fact that he was pre-term? Why is the C-section getting the blame for her postpartum issues?? The C-section SAVED her baby. She would not have a child to bond with or breastfeed at all if that baby wouldn't have survived birth - which is completely possible given the state of her baby and his presentation.

Next...

  • What makes homebirth safe? According to Eugene Declerq, outcomes for home birth are very good when "the people there are trained, that there's backup, that they can transfer to the hospital quickly." 
Not sure where he's getting this info because there hasn't been an accurate study of home birth in the US to demonstrate how safe it is or is not. How can he make that statement? There are other studies that have been done in other countries but again, those are different types of midwives with different health care systems. You CANNOT use studies done in other countries to try to demonstrate the safety of home birth in the United States. You're comparing apples to oranges.

There is data on home birth outcomes in US, though. MANA (Midwives Alliance of North America; this is the professional organization for home birth midwives) collected the data from over 27,000 home births between 2004-2007 that took part in a study they organized. But, we have no idea how many babies died or were injured out of those 27,000. They have that information. They intended to release it when they began their study. But they won't release that information now. If home birth was so safe like they say it is, why not share the data to prove it? That was a huge red flag for me when I learned about that. For years they have come up with excuse after excuse for why they haven't released the mortality or morbidity rates, even though they have released every other rate under the sun such as c-section rate, transfer rate, episiotomy rate, etc etc. A low c-section rate means nothing if the perinatal mortality rate is too high! 

(edited to add May 2014: we have the MANA data now and it's not good. Click here to read it. We also have more studies on home birth in the USA, click here to read them)

And also, when Eugene Declerq mentions being "trained" I have to wonder what he means by that? Does he mean the training of a CNM? CM? CPM/LM? Lay midwife? The training varies greatly from one midwife to the next in the US - to which is he referring? You can check out this spreadsheet at the American College of Nurse Midwives website which nicely lays out the different requirements for the different types of midwives or you can go to the NARM website (NARM = North American Registry of Midwives; this is the certifying agency for CPMs and LMs) for more info on becoming a CPM or LM. If you'd like to see an interesting breakdown on the qualifications so you can see just how little it potentially takes in order for one to get the title Certified Professional Midwife or Licensed Midwife, check out this post at the Safer Midwifery for Michigan blog.

Next...

  • "Today in the United States, we know that there is serious increase in minimal neurological problems in children and in attention deficit disorders, in autism, and all these things are increasing at the same period of time that we're increasing all these obstetric interventions," says Marsden Wagner
What a horrible way to try and scare women away from childbirth interventions. No studies or evidence offered to support this nice little scare tactic. This is called correlation (not to be confused with causation). These things could be completely unrelated! Let me explain.... I recently saw a graph representing data for organic food sales compared to autism rates. It clearly showed that the rate of individuals diagnosed with autism increased at the same time and same rate that organic food sales increased. One look at it and one might think "organic food causes autism!!" But can we really assume this is the case? NO. That is exactly what Marsden Wagner is doing. Using correlation and trying to convince people that it means causation. Don't fall for it! This is just a crappy scare tactic based off correlation. Beware the correlations and cherry-picked data, my friends.

This next and final part disgusts me. DISGUSTS me.

  • Michel Odent says this: "With mammals in general, there is immediately after birth, a short period of time which will never happen again and which is critical in mother/baby attachment. Until recently, in order to give birth, a woman, like all mammals, is supposed to release a complex cocktail of love hormones. As soon as baby is born, when mother and baby are together, both of them are under the effect of a sort-of morphine, an opiate, natural morphine endorphins. We know the properties; they create states of dependencies. Addiction. When mother and baby are close to eachother it is the beginning of an attachment." While he says this in the background, you are watching moms/babies shortly after birth at home births. They are over-the-moon with happiness, cuddling their sweet little gooey babies. 
He continues, "But today, most women have babies without releasing this flow of love hormones. I'll just give an example of animal experience. In general, if you disturb the hormonal balance of a female giving birth, it's simple, the mother does not take care of her baby. It's simple, if monkeys give birth by cesarean section, the mother is not interested in her baby. It's simple, easy to detect on an individual level. So you wonder but what about our civilization, what about the future of humanity, if most women have babies without releasing this cocktail of love hormones, can we survive without love?" While he's saying this in the background, you are watching epidurals being placed and c-sections and women who look disconnected from the process. 

Wow. He is reaching pretty far there. Really far. No love cocktail at birth = humanity doomed to try and exist without love. WHAT? Yes, ladies who have had or will have a c-section, you aren't going to feel bonded to your baby. Sorry, but you won't have that "love cocktail" that enables you to feel that bond. We're just like monkeys after all so you probably won't even feel interested in your baby. Moms who have had or will have interventions, please know that if our species stops surviving due to lack of love, it's your fault. For moms who adopted their children and experienced no pregnancy or birth hormones what-so-ever with their adopted child, well, yikes, according to Odent you are pretty much screwed!! All of humanity is!

What a load of nonsense. Horrible, offensive nonsense. 

****

These are my main issues with the film, the things I found to be the most misleading. There were many scare tactics along the way. They clearly want women to take with them the message that if you choose home birth, then you are empowered, you know how you want to do things, you are a go-getter (and it's not just insinuated, there are direct quotes, like this one from Marsden Wagner "If you really want a humanized birth, the best thing to do is to get the hell out of the hospital")... and the rest of us women who choose to give birth in the hospital? We are not empowered, we don't know how we want to do things, we don't desire a humanized birth, we are just willingly poked and prodded when we go to L&D, basically. 

I suppose since it's a documentary it's bound to be biased. Clearly, this film is biased toward scaring women away from hospitals and childbirth interventions.

I remember discussing the film with my cousin a couple years ago. She was not impressed at all by the film and I couldn't understand how that could be possible! We went back and forth about it and just couldn't see eye to eye. I thought, maybe it's b/c she's a little younger than me or something, she just doesn't get it. 

Well, Juls, now I get it. :)


****

I will make an edit soon to add this portion but quickly want to address the maternal mortality. In the film it is brought up about the high rate for maternal mortality in the US. I addressed several issues that I thought probably contribute to our high c-section rate in the US in another blog post. Those factors would also affect the maternal mortality rate. American women are generally not very healthy and this has a huge impact on our maternal mortality rate. According to the CDC, here are the top 5 causes of pregnancy-related deaths in the US:
1. Cardiovascular disease
2. Cardiomyopathy
3. Non-cardiovascular diseases
4. Hemorrhage
5. Infection/sepsis (may be caused by c-section, prolonged rupture of membranes, HIV+ woman, etc etc)







29 comments:

  1. Thank you so much for this fantastic post! I had an almost identical experience to yours with this movie. It came out when I was pregnant with my oldest, and I bought into ALL of it. I desperately wanted to give birth at the local birth center, but my husband didn't feel comfortable with that, so I reluctantly went to the hospital.

    To my shock, I had a fantastic experience, and everyone was completely supportive of my desire not to use pain meds, to breastfeed, to keep my son nearby at all times. I felt rather duped, honestly.

    ReplyDelete
  2. Thank you for this post! I saw BOBB, and was all "meh." But, I've seen many homebirth advocates (online) refer to it as gospel and believe every word is true. I'll admit: it made me nervous about Pitocin. Not so nervous that I would refuse it, but definitely concerned.

    Well, the OB on call gave me Pit augmentation after 12hrs of erratic labor, and he explained everything before he did it and left it to be my choice. I didn't have to take time to consider---if it was going to speed things up and get the babies out faster, while still avoiding a Csection, I was all for it. (Disclaimer: I have no problem with Csections, but I feared having one because I had twins, and I thought a section recovery would be painful and make it difficult to care for my 2 newborns properly.) At any rate, the Pit did the job, got labor on track and PREVENTED a Csection. No cascade of interventions. I did get an epidural, which either had no effect or increased the speed of labor.

    I think I saw BOBB before I was even pregnant, and by the time I got pregnant and had a complicated pregnancy, I thought the movie was pretty much garbage. But that slight fear of Pit remained, until I had it, and found that it was fine. No big deal. Not scary at all.

    ReplyDelete
  3. Thank you so much for this post! I watched BOBB for the first time in 2008 when I was pregnant with my first. I thought it sounded like a load of BS so I poked around online a bit and found out my hunch was correct. Unfortunately I have seen many MANY women talk about this film in terms of "educating yourself" and it outrages me. Keep up the good work!

    ReplyDelete
  4. Thanks for continuing this discussion. I went to see this film as a CPM student. I was sitting with a friend who'd had a C/S with her first. When Michel Odent uttered that nonsense about women who'd had c-sections being unable to love their babies, my blood ran cold. How could they include such drivel?

    It also seemed very dated - the opening scenes with women with the bejesus drugged out of them. Yes. That happened - in the past. But birthing today is, for the most part, much different. Perhaps the pioneers of the natural childbirth movement should be recognized for their influence on childbirth practices in hospitals????

    We're not all being drugged and having babies hauled out of us. So that is good, isn't it?

    Anyway - thank you for contributing your voice and perspective. It is a complicated topic. I don't vilify midwives (even CPMs) though I will acknowledge there is a big need for improvement. And pointing fingers at the 'leadership' organizations (MANA, NARM) is wholly appropriate.

    I think BoBB brings up some valid points - and it also spews utter nonsense. I find it appalling that women cannot go into a hospital and labor and give birth as they wish (ie without meds, supported). This is why they choose OOH options. And often these women are higher-risk. It's absurd. Really. What I witnessed as a student midwife. Whole areas of the state that banned VBACs - so these women gave birth at home. AB-Fricking-surd.

    So is credit due to these women and midwives who had VBACs at home for the turnaround of our local hospitals that now allow VBACs? It is unfortunate that such drastic measures needed to be taken. I can't discount OOH birth entirely - because I believe some positive changes have occurred in the hospital because of it.

    On another note- the showing of BoBB was sold out and every doula, midwife, birth photographer and baby-wearer in the tri-state area was in the crowd. It was a whole lotta preaching to the choir. I didn't see it disseminating the message too far outside the already true-believers.

    ReplyDelete
    Replies
    1. There were a few valid points made... and the end made me cry, again. But overall, I personally found it to be more misleading than "educational."

      I really don't know the history of VBACs to leave any sort of decent comment about them. I don't know if OOH birth had anything to do with certain hospitals changing their policy? I know it is riskier so it makes sense to me that it would be more challenging to find a care provider that would support it.

      Delete
    2. Here is a study on success of vbac after cesearean.

      http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001184

      Basically, risk of uterine rupture is very low for vbac1. However, it can cause death if mother is not in hospital.

      Sincerely,
      Lisa from NY

      Delete
  5. loved this article. i'm unfortunately surrounded by the NCB/homebirth crowd due to my husband's family and they have little to no respect for views other than their own when it comes to pregnancy and childbirth and it is downright scary. i plan on showing this article to my husband when i get pregnant, to at least show him that doctor's are not to be feared. will be following in the future.

    ReplyDelete
  6. Brilliant job. Documentaries are often a double-edge sword, providing an alternate view and uncovering facts, yet highly biased to that view, sometimes so much so as to present those facts in a misleading manor.

    Thanks for your due diligence going through this film and taking notes, uncovering its subterfuge. I wish more people did so with other documentaries.

    ReplyDelete
  7. It's no one's fault, but your own, if you took this documentary as gospel. Of course it's biased. All documentaries are. What people are supposed to do is research and educate themselves and be their own advocate. It seems you're backtracking because you may have previously come across as ignorant. In which case you still are.

    ReplyDelete
    Replies
    1. I deleted my original response in order to edit it since blogger doesn't allow edits (boooooo!).

      I actually didn't take it as "gospel." But it was one thing out of several that played a part in the beliefs I had at a certain point in my life.

      And yes, it's a documentary so yes, of course it's biased - just as I wrote above. What I offered here was a critique of the film. Did I write anything that is a lie or misleading?

      Delete
  8. I absolutely loved this post and I can't wait to read more. The problem I have with BOBB is that it is presented as gospel and truth, and women are urged to watch it and then live it, and babies are dying. Mothers are dying. I don't care how anyone wants to give birth but every homebirth loss that I hear about cuts me to the heart. I can't help but imagine what if one of my beautiful babies died because I followed dogma instead of reality. It sickens me to hear so many women with serious complications urged to homebirth because BOBB said it was okay. As far as I'm concerned, it's a dangerous piece of propaganda. Anyway, thank you for this post. I'm bookmarking it for further use. Tara

    ReplyDelete
  9. Great post! I wanted to add what I hated most about the BOBB. The SCARY hospital music. It was so contrived. I agree with calling it propaganda.

    ReplyDelete
  10. Danielle, Hi. I am Lisa from NY. "Met you" on Skeptic OB post.

    You wrote in your blog "MANA (Midwives Alliance of North America; this is the professional organization for home birth midwives) collected the data from over 27,000 home births between 2004-2007 that took part in a study they organized. But, we have no idea how many babies died or were injured out of those 27,000. They have that information. "

    You mentioned that you might be willing to start a Petition through care2.com. (I'm scared to, but if you do I will forward it to all my friends.)

    Please draft the Petition urging congress to mandate all midwives to report adverse outcomes, and at the same time, passing legislation to protect hospitals from being sued from adverse outcomes due to negligent midwives.

    It is unfair that midwives don't carry insurance, and families can go after hospitals and win, even though had the woman come while in early stages of labor to hospital, the outcome would have been very different for the unborn baby.

    I am so glad that you are defending the rights of unborn babies who can't stand up for themselves. Please keep it up.

    Looking forward to your Petition ASAP, Lisa from NY.

    ReplyDelete
    Replies
    1. Hi Lisa from NY, not sure if/when you'll read this again but can you email me, please? danielle at douladani dot com

      Delete
  11. Btw, the reason I want to protect hospitals is because there are several hospitals that closed in New York.

    We don't need more hospitals closing due to high malpractice insurance due to home birth moms suing.

    ReplyDelete
  12. I definitely experienced SOME of the stuff BOBB was against - I was having a long labor and not progressing. Tired, and losing my will and ability to stay calm, I agreed to having my waters broken to try and move things along. Once that happen we definitely had a cascade of effects that nearly ended in a C-Section. I have no way to really know if that wouldn't have happened if they had left me alone, but I was no longer able to move, it was harder to manage my pain, I ended up on drips of pitocin which made the pain worse, I started having trouble staying relaxed and breathing, and next thing you know it was teams of hysterical nurses rushing in over drops in baby's heart rate and signing a consent form for a C Section.

    However there's a flip side to everything. Even after all that I had not progressed. Until they gave me the epidural to prep for a possible trip to the OR. The initial dose let me relax. And I went from 4 cm to fully dilated in less than an hour after laboring a full day. He was still having trouble, and things were difficult, but our doctor worked really hard at that point to help us avoid surgery, and got him straightened out and everything was eventually fine.

    I think there are lots of truths in BOBB - but I also don't think hospitals and doctors are the enemy. I do think women tend to get rushed, thrown onto drugs, or get interventions they maybe don't "need" as a matter of SOP. But I think the doctors and nurses who work L&D are passionate and really want to do what's best.

    It was hard, my SO completely bought the BOBB propaganda so as we were going through this he was getting angrier and angrier and more convinced they were trying to give me a c section for convenience (it was christmas eve). I pointed out that the doctor was stuck at the hospital till the next day whether I had the baby or not, and if anything it was my fault for agreeing with the initial intervention. But I'm pretty sure he's still angry over it.

    I think if I had a do-over I'd find a middle ground - a birthing center or the like where I'd have more medical backup than at home, with people attending who valued the natural experience just a bit more. But I'm also high risk, so for me a homebirth was out of the question.

    ReplyDelete
    Replies
    1. I know I owe you a reply.... It's hard for me to stay on top of blogging with two little ones :) When I get time to put together a thoughtful response, I will but in the mean time just wanted to say thank you for sharing your story!

      Delete
    2. Thanks again for sharing. I’m curing to know if you had a do-over in the same situation at the hospital, what would you change? Did you feel forced into AROM (having your waters broken)?

      While being home does limit interventions (b/c many are not available), there are certain interventions that are common to home birth midwifery as well. Having your waters broken for example could be offered and done with your consent in either location, home or hospital, if your labor is not progressing. Have you heard of modge blog? For her first birth she planned a home birth. Her water broke at onset of labor, she took castor oil as her midwife instructed, it led her to dehydration which was causing horrible contractions that weren't effective – she wasn't dilating but was having contractions one on top of the next. She ended up transferring and having a c-section after many, many hours. Point is, no matter where you choose to give birth, there are intervention options. Who knows what you would have consented to had you been home, ya know? It sounds like the epidural did the trick for you – you may have transferred and ended up with the same outcome of epidural and vaginal birth. You just never know.

      The movie paints a very horrible picture of hospital births and for women who have never had much hospital experience or have never given birth before, it could definitely scare them away from hospitals. It certainly played a part in my desire for a home birth with our first child (though it was not everything). I hate the insinuation that only those who choose home birth are truly empowered and informed - and other such demeaning insinuations.

      If they were trying to empower women with that film - which is the claim - there are better ways to do so, in my opinion. I found it more fear-instilling than empowering.

      Delete
  13. I'm so glad to see this! Perhaps I'm a little biased, because I used to be a surgery nurse, but I never understood the desire to deliver at home, i.e. away from emergency interventions. I've always believed anyone can deliver a baby during a "normal" birth; but when seconds are all you have before brain damage or death occurs because of an "abnormal" delivery, why would you want to waste those seconds waiting on an ambulance? I've been in situations where we got the call that a baby's life was on the line and we barely had the door to the surgical suite open before the OB dept came crashing thru with the mom. What would have happened had she been at home? It gives me goosebumps. I'll take a delivery in the hospital hooked up to monitors and such any day, because, imo, it's not about me, it's about a safe start for my child's life....perhaps you can even call it my first selfless act, of the many I now make.

    ReplyDelete
  14. The Real BOBB is homebirth midwives refusing or recommending against prenatal screens like GDM and GBBS, ultrasound, genetic screens like Harmony or AFP, epidurals, pain medicines, cesareans for breech, twins, and previous CS. Any of these may require them to risk out the client denying them business. But they promote Brewers diet, massage therapy, acupuncture, acupressure, herbs and moxibustion, rebozo scarf therapy, hypnobirthing or hypnobabies programs, homebirth kits and tubs, AP slings, books by Gaskin and Goer to sell, and anything they can sell for money. Even if a patient transfers to the hospital, some still require payment. Hell they may not even repair your lacerations and just tell you to keep your legs closed or use seaweed. Anything to keep you as a client and not transfer your money, I mean you to the hospital. General OB/GYN routinely consult MFM or infertility docs when they realize they need more expertise. Homebirth midwives, not so much. Like the song says," it's all about the money, money".

    ReplyDelete
  15. Why do doctors sometimes give women asking them about homebirth a hard time? Women on support blogs often rant about how the Backup OB or OB was unsupportive. Aside from the fact that homebirth has more risks, lets look at other reasons. You walk into a business (the OB) and ask for a lab or an ultrasound but tell them I am giving all my business/money to a less trained birth junkie to deliver my baby at home. But if crap hits the fan I want to come to your hospital and help me. Say what? Not get paid for the ante partum care and not have a say in what ante partum care you receive but assume all the risks and malpractice liability?? Ever go to a hairdresser for years then go somewhere else or worse to some else in the same building, then try to go back to that previous hairdresser? So I wasn't good enough for you the first time, but now you need me sentiment. It is condescending. The woo look at OB/GYN as surgeons and only want to goto them if they "need a necessary" CS. OB/GYN look at themselves as primary care takers of women from adolescence to death. OB/GYNs want to take care of you and your pregnancies, and when you go somewhere else for care that they do provide it is an insult. Go have a homebirth but don't include me or come back. You have to be trained in normal birth before you can handle complicated births. Why don't homebirth wannabes understand that? It's like saying you wouldn't trust your architect cousin to build you a dog house because your teenage HS drop neighbor who loves pets wants to build you one. Or like saying you wouldn't want your lawyer brother to represent you in court but rather have your father who watches Law and Order and read through some of your brothers books. I don't get it. The OB/GYN is ready to care for you from birth control, to STI prevention, to irregular periods, to pregnancy, to peri menopause, to bone health, to surgery and hysterectomy and even offer hysterectomy alternatives like Mirena, ablation, and Lysteda, to post menopause and cancer issues. To walk in his/her office and refuse their help until their chosen homebirth midwife craps out and sends you back potentially with fatal consequences and legal ramifications is appalling.

    ReplyDelete
  16. Thanks for this post, I like your take on it and its helpful when going through my own decision. I especially resonated with this part:
    "lll just give an example of animal experience. In general, if you disturb the hormonal balance of a female giving birth, it's simple, the mother does not take care of her baby. It's simple, if monkeys give birth by cesarean section, the mother is not interested in her baby. It's simple, easy to detect on an individual level"

    Because I know that is BS. My mom has bred and raised dogs literally my whole entire life (I came home from the hospital to two litters of puppies) and I have seen both sides of "maternal instinct" I have seen dogs that ended up with c-sections (where from my memory they are completely knocked out) very lovingly care for their pups and I have seen dogs that have had perfect natural births that couldn't be bothered to give two shits about their offspring. It's not that black and white. That bit alone for me puts a different lens on this documentary to me, so I appreciate your including it in your review.

    ReplyDelete
  17. Obsessed with this article and your blog since becoming pregnant! My friends and I watched BOBB when one of our girlfriends was pregnant and jokingly told her we wanted her to have a homebirth and we could all be there and film it. One of my friends since then has always said she would prefer homebirth-she has no education on it outside of that film. I have an Aunt who lost a baby b/c she had it at home. They could not get her to the hospital in time to save her baby and she almost lost her own life. Since becoming pregnant I feel guilty for even joking to my friend that she should have her baby at home, b/c now I can't imagine ever doing it. Yes, my labor can go as smooth as silk, but the what if factor just can't be bypassed for me. I am definitely forwarding this blog to my girlfriends who have been commenting on me seeing an OB instead of midwife. Thank you thank you thank you!

    ReplyDelete
  18. FABULOUS post, will definitely be sharing this.

    ReplyDelete
  19. I am a homebirther myself, watched BOBB when I was pregnant with my first. I enjoyed it, but took it as a spark to educate myself. I still love homebirth but appreciate your conversation. There is no one right way for every pregnant woman or family. I am a doula and have witnessed beautiful births in all settings. I think the most important thing is to not make decisions out of fear. I don't like the "fear" debate on either side. In my work I strive to empower women to make the best educated decisions for themselves. An empowered woman rarely feels regret and is able to overcome many challenges no matter what her birth or postpartum circumstances are.

    ReplyDelete
    Replies
    1. I agree. Not sure if you've read anything else here on my blog, but I wrote a pretty thorough account of why I used to support home birth but no longer do (generally speaking, regarding home birth in our country). In the 4th part of it (http://whatifsandfears.blogspot.com/2014/01/what-drew-me-to-home-birth-and-what_27.html?m=0) I wrote out my feelings on dealing with fears and such, I'll copy and paste it here: " I was told by a birth world friend that my blog was "too negative, too extreme, I was advocating that women live life in fear." But that's not what it was about for me at all. I had so many "what ifs" running through my head when I was in the process of making the decision of where to have our 2nd baby... so much fear that I'd make the wrong choice (and other fears, too)... I had to hash it out. I wanted to make an informed decision. I wanted to feel confident in my choice. This is how my blog earned it's name... it's not about living life in fear or in a constant state of being bogged down by "what ifs." It was about allowing those "what ifs and fears" to guide me to gathering more information so I could feel confident in my choice; feel empowered and well-informed."

      I think it's irresponsible to abandon fear and ignore it completely. But rather to take in those fears and use them to help, not to hinder. What are the fears? What's rational and what isn't? What true, unbiased information out there addresses my fears? Etc etc... Allow them to take a woman further into her research and finding out information so she feels empowered.

      I also agree that there is no one right way for a pregnant woman or family. But the scare tactics and fear mongering and misleading information isn't helping anyone. Women deserve the truth. Not someone's tainted version of the truth. This film was full of misleading information and it doesn't do anyone any favors. While I appreciate that it can inspire women to look at options, it does so in a way that is not truthful. And I do not agree with that.

      Delete
  20. Call me an idiot but I'm confused about two things here. Do you not support breech vaginal birth? And are you completely pro hospital birth? Some of your points seem good but as a Doula, I can't believe you feel that way :(

    ReplyDelete
    Replies
    1. I support breech vaginal birth when it follows evidence-based standards. There are certain evidence-based criteria in order to be considered a good candidate.
      Breech vaginal birth out-of-hospital is not evidence based care.
      Breech vaginal birth for an IUGR baby is not evidence based care.
      Breech vaginal birth for a first time mother is not evidence based care.

      She was not a good candidate. She received evidence based care.

      I am not "completely pro hospital birth." I support home birth when it is a safe option for women. Unfortunately, in the USA, for various reasons home birth is not a safe enough option. I suggest you read my post on Home Birth in the USA for more details: http://whatifsandfears.blogspot.com/2014/05/home-birth-in-usa.html

      Thank you for reading/commenting. :)

      Delete

Related Posts Plugin for WordPress, Blogger...