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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.
I'm not fooled by Ricki Lake. And I'm not fooled by stats either. There is a problem with how birth is approached in North America.
I don't think Lake & Epstein have set out to fool anyone. I think they've set out to promote conscious choices and empowerment. And whether your logic or Lake's logic is flawed, what I know to be true from my own direct experiences with hospital births and home births for many friends and myself: is that there is a gross lack of respect for the innate knowledge of women during their birthing process. And that lack of respect is leaving unnecessary emotional scars on women and babies.
To quote you from your own website: "Psychological methods of pain relief have come to be known as "natural childbirth." They were formulated in the 1950s as part of a larger effort to wrest control of childbirth from the medical establishment and give it back to women."
Amy, I respect your medical training and your clear commitment to help women have a healthy birth, but are you serious with that comment? Those "psychological methods" weren't "formulated in the 50's." They're rooted female history. Women have been deep breathing and crouching and surrounding themselves with loving caregivers for a mighty long time.
There are outright lies, and outright brilliance on both sides of this cultural conversation. I'm certainly interested in the data source for perinatal mortality where midwives are used more often.
On a different track, let me ask you this: What do you think about the rising amount of scheduled C-Sections?
Respectfully,
Danielle
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.
In order to understand how “the business of being born” and women’s lack of empowerment as regards our health has come to this we must acknowledge the context within which women live their sexual and reproductive lives.
It starts with menarche, the first step on the continuum of becoming a sexual, fertile woman capable of reproduction. Yet for 50 years we have treated fertility like a scourge, an enemy to tame in service to our sexual lives. We make it go away; we induce infertility in young women with drugs at ever younger ages, often before their menstrual cycles (and their fertility) have fully matured on the grounds that menstruation itself is irrelevant and unnecessary for a girl to experience. Yet it is becoming ever clearer that healthy ovulatory menstruation is the foundation on which women's health and well-being must rest to ensure a healthy and long life.
Now menstrual suppression- induced by continuous-use oral contraceptives - is being marketed to women in magazines and TV as a lifestyle choice, including ads directed at men so that they can "sell" their partners on the idea of no periods. If we treat the menstrual cycle with such dismissive distain, is it any wonder that other physiological milestones like natural childbirth become just another female bodily function unworthy of our mindful attention or experience?
Think about it, the female body is open to manipulation at every turn. We choose artificiality against authenticity in a myriad of ways. Take your pick: fake food, fake breasts, numbed-out smile lines and wrinkles, fake lips, fake orgasms, fake cycles.
As women we lose our connection to our bodies with every inauthentic choice we make. And the deeper the disconnect we feel, the more likely we are to reject the next natural process our bodies and our lives offer up. It takes conscious effort to reject the "solutions" offered to us. It takes vigilance, intelligence and determination to read, research, and ask questions so that we can make our own informed choices. It isn't easy. And I do acknowledge that not all intervention is bad or unworthy of our support. Must it must be chosen by us, not foisted upon us.
To create empowered women’s health and wellness we must start at the beginning. To do this we must honour menarche, teach girls and women how the menstrual cycle actually works and how it supports our reproductive and, just as importantly, our general health. Once learned it cannot be unlearned. When we understand and appreciate how the food we eat, drugs we take, exercise and sleep we get, thoughts we think, sex we have and love we share connects us to our bodies we will understand what health and wellness truly is.
We are our bodies, they are us. Our bodies are not separate from our psyches. My vision is for women to know and trust what their bodies can do and were meant to do from menarche through menopause and beyond, and to find a way to live as harmoniously as possible – in our authentic bodies – amidst the wealth of choice and opportunity modern life has to offer.
These numbers seem unlikely, but not impossible with just the information available. If you want to truly show that these numbers are contradictory, please provide data that shows that the number of vaginal births is greater than 7.5% or the percentage of total births attended by a certified nurse midwife is greater than 0.75%.
It would also be nice if you actually posted a reference for your facts and if Danielle were to discover the source the film used for its reference (especially to discover if either source had assumptions that were not presented here).
Present statistics that show that some options are so dangerous that they ought not be considered, that is a useful contribution to the discussion. Do not, as you seem to be trying to do below, make it look like you did not really try to understand the point that was being made in the first place.
"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.
Thank you Erika and Amy for your rigor with stat-comparison.
Correct: I would never make such a preposterous claim that natural childbirth is painless, or that home birth is without risks.
What we're not cleary discussing is the current, widespread opinions and practices that are stripping women of empowering and informed choices and options.
What if...what if it were part of the medical conversation that giving birth was one of the most natural and empowering processes that a woman can experience (with or without pain management interventions?) Of course, keeping mothers and babies alive and healthy is THE fundamental issue - and stats are golden in this regard. But what about the "other" issues, the hard-to-measure outcomes that relate to the health of a woman's psyche? That affect an infant's developing psyche?
Next to survival itself, attitude and consciousness is everything. Medical stats only tell half the story. The other half of the story that involves women's power in terms of pregnancy and birth, is rampant with lies and mistruths.
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.
Birth is not painless but I take exception to the use of the word "agonizing". Agony means "extreme mental or physical suffering", a word that I believe can only be used subjectively. 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.
Several months ago I heard a male OBCYN use this word while being interviewed about current issues in maternity care. When asked about the use of epidurals he blithely said, with a smirk on his face, that many women come in thinking they won't have one "but then the agony sets in" and they change their minds. I've no problem with women choosing pain relief. This is a decision we must each make for ourselves. I have a great problem with this kind of thoughtless, smug communication when it comes to any issue related to women's health.
And here's one more thought. I heard a science sociologist, Brian Wynne (CBC Radio Ideas), who studies how scientific information is delivered or communicated to the public (science and society) say that the key message he'd give is that scientists need to be more humble about what they think they know. As a long-time sexual and reproductive health advocate, I believe this comment speaks volumes about what has transpired in women's health and continues to transpire. We would all do well to step back and reconsider many of the assumptions we make about the value of drugs, technology and procedures to the health and well-being of women.
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.
Childbirth is a subjective experience. No one can tell me what I felt or didnt' feel, or any woman for that matter. And "agonizing" just ain't the word that first comes to mind for most of us about giving birth.
It is my opinion, and I stand by it, that claiming that labour and childbirth is "agonizing" is no more accurate, non-judgemental or reflective of the breadth of women's experience than insisting that labour and childbirth is or can be "painless".
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.
Pain is subjective...different people have different, uh "pain thresholds." And like Laura, I know many women who would not describe there labour as agonizing (and I'm one of them, so I guess your fact is not really a fact any longer.)
And Amy, choosing not to have birthing interventions does not mean that someone is uninformed. My God, the arrogance of that perspective is just...saddening.
Regardless...we can end this discussion with a sliver of common ground: the physical health of the mother and child is the paramount priority.
To those of you are replying to "Dr" Tuteur, sadly you are wasting your time. She is so wrapped up in her OPINION that she refuses to see the "other side of the fence' Her ignorant generalizations reveal her arrogance.
Pathetic
1. Women need to be educated about what happens to their bodies during pregnancy, labor and delivery. They need to know that the discomfort and pain is the body's way of preparing and getting ready. What's happening is normal not something that needs to be treated.
2. Women need to be made aware of the options available to them for medical care (doctors, midwives, doulas, etc.).
3. Doctors need to take a not so one sided view of pregnancy and labor and be willing to offer their patients a well-rounded perspective.
4. Hospital staff needs to be trained to assist women through labor naturally. I realize that not all staff are alike and my hospital may have been a unique situation but I just have issue with being asked if I want an epi and not being offered anything else. I also realize I have my husband and others have birth partners but it would be nice to have hospital staff educated to take on the task.
I think everyone involved in the birthing process of a healty pregnancy needs to have the mindset of - My sole purpose is to support this woman in whatever she needs so that her body can do its job.
I used hypnosis for my 2nd birth after a traumatic cesarean and it was amazing. I have since gone onto teach Hypnobabies to other moms and see them let go of their fears and look forward to their births. Educating them about their options and giving them tools to feel confident and comfortable during birth is so important. http://enjoybirth.wordpress.com/2008/05/05/hypn...
I wish all moms knew about how hypnosis can help them to get over their fears and have more comfortable births.
"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.
Fact: While natural childbirth is a social contruct with a problematic racist history rooted, women of color are also midwives and advocates of homebirth (see International Center for Traditional Childbearing).
Fact: At any time in US history, there has never been soundproof evidence than birth with midwives at home was more dangerous than birth with physicians in hospitals and in fact in the early 20th century leader of the campaign to eliminate midwifery Dr. J. Whitridge Williams (author of Williams Obstetrics) said so. He, like you, did not base his efforts on facts but on his personal interest in increasing the wealth and prestige of his profession.