Alternate Family ArrangementsPoly FamiliesPregnancy & Childbirth

Grounded Midwives

“I want a home birth,” Renee said.  “I’ve hired some midwives.”

In my life, I have felt my anal sphincter clamp shut faster and harder after only three other phrases: “I don’t really like the original Star Wars movies as much as the prequels”; “I had a precognitive vision that we would be together forever, and then today you asked me out—how amazing is that?”; and of course “Wow, honey, that was actually even better than regular sex, but now it’s MY turn.”

Midwives. The very word conjured images of Berkeley hippies in floral skirts wafting into our home on clouds of patchouli. They would speak to Renee with an NPR announcer’s soothing, pastel voice, telling her that the earth mother’s psychic vagina power would get her through the pain. Pain so bad it takes gall stones and broken femurs for women to admit the comparison is kind of close.

We are a science-loving household. We laugh at chiropractors. We get pissed at homeopathy. We may have some anti-vaxers buried in the basement. We do zinc and Claritin when we get colds, not echinacea diffusers and chamomile. We take Vicodin when we have root canals.  We don’t rely on aroma therapy or imagining our pain as a light with a dimmer switch.

We aren’t exactly the midwife types . Or so I thought.

Given how few midwives I’d ever actually met, I knew I was probably being unfair. When it comes to Renee’s health and well-being, however, sometimes my inner Richard Dawkins hulks out.

Because I’m “Uncle Chris” and not a co-parent, certain decisions get made without me, though being a parent/not parent leads to some charming benefits, like being able to say, “I think this one’s a blowout, so you ‘rents have fun”; “I shall wear white today”; or my personal favorite: “Welp, it’s my bedtime. Gotta get my nine hours since I stayed up late last night. Sleep tight.”

But it also means accepting that these are their decisions to make.

I can voice my opinions about things like midwives, of course. It’s not like poly really works if people are running around saying, “I really don’t give a sweet tinselly shit what you think,” so eventually Renee asked me what I thought.

It was a little bit like turning on a fire hose to have a sip of water.

“No way,” I told her. “I want fifty-seven doctors and ten times that many nurses down the hall who will kick open the door action-movie-style at the first sign of trouble. I want syringes with every drug known to science no more than fifty feet away from you so that should you turn purple and begin shooting magma out your ears, the doctor will calmly turn and say ’50 CC’s of antipurplemagmaproponol—stat!’ I want you to have a triple-redundancy epidural line attached to a retinal scan that watches your pupils for pain dilations and ups your drugs at your slightest discomfort. Renee, I want the machine that goes ping!”

But I didn’t get a vote. And at the end of the day, I would have to crack open an ice cold Coke (the ones from Mexico with real cane sugar) and shut the fuck up. My fears that without a doctor there, Tom would rip through Renee’s chest alien-style . . . and then explode, would simply have to take a back seat. And even after I begged to at least do a birthing center as a compromise (because it was a block from the hospital and had a machine with a digital display that spewed out very sciencey-looking readout paper), I ended up watching someone named Lavender set up a birth tub where my dining room table used to be.

We also met a doula named Meadow, and later we met our midwives from a little place here in Oakland called Nova Midwifery. I drank lots of Mexican Cokes and tried not to freak out too much at all the references to “sacred feminine power.”

In fact, I didn’t unclench until one day on our third or fourth meeting with our midwives. I was there, trying to play the supportive partner, and feeling like my science-loving inner Christopher Hitchins was getting bulldozed. I heard repeated references to how important “gut flora” is without actually being told how important it is. Was it going to make Tom have indigestion and be a little cranky for a couple of days? Or was it going to cause him to be a raging psychopath who could never find love? Or would he just explode in an incendiary wave that would take out half a city block? Scope matters when you’re talking about consequences.

Then they started talking about the placenta.

Not if, mind you, but what should be done with the placenta. I sat there trying desperately not to bust out into a few choice lines of Tim Minchin’s Storm while they were calmly discussing encapsulation vs. placenta stew with the apprentice midwife. It was just too much.

“So, is there any science behind this placenta stuff?” I asked, knowing full well there wasn’t, and that I was stirring the pot . . . at best (and at worst, being a class 5 ass). I just wanted to see how ridiculous the answer was going to be.

“Not even a little bit,” the midwife said in a relieved voice.

Wait, what?  Was she . . . maybe . . . as uncomfortable as I was?

I watched the midwife’s eyes flick over to the apprentice—the one who was offering to do the encapsulation. The midwife bit the corner of her bottom lip a little, and then launched into a discussion about how a placebo you believe in has real power even if it is the placebo effect. “If it works, it works—even if everyone knows it’s a placebo.”

I recognized that speech!

That was the same speech I had given a hundred times when I said something just a little too skeptical in front of friends and I was backpedaling to avoid hurting their feelings. Tarot, Reiki, crystals, herbalism, naturopathic doctors—at some point I had said about all of them, “This is fucking bullshit!” and ended up backpedaling the same way the midwife just had. I would retreat into ideas of Rorschach interpretations, or mind over matter in the placebo effect, basically assuaging offense by admitting that some things work even if we don’t always understand why they work–that belief in personal magic and the power of the mind makes them work. It’s a speech that usually cools tempers and gets me an uneasy armistice with the folks who don’t like my skepticism.

Suddenly, I had an ally—a midwife ally who knew this placenta crap was something people believed in, took seriously, would probably get offended about, but had absolutely no science backing it.

And that’s when I realized Renee was going to be in good hands, and after six weeks, I started to unclench.

In fact, besides having a dress code that apparently involved distractingly sexy boots, Nova Midwifery was utterly down to earth. They were codices of APA and CDC guidelines; they could discuss risk factors in statistical terms; they recommended liver and kidney function tests; and they carried around this really neat portable ultrasound device. They took Renee’s blood pressure like every ten minutes.

And the boots thing wasn’t exactly a liability. Just . . . distracting.

There were still moments that earned the archy-est of Spock-arched eyebrows. When they told Renee to induce labor because of a high blood pressure scare, I ended up white-knuckling it in an acupuncturist’s waiting room, where a patient told the receptionist that “people who don’t believe in chiropractic healing are completely full of crap, man.”

But the important part was that Nova weighed the birth plan they knew Renee wanted against the cold, unmerciful science of medical reality and never flinched when it came time to face facts. To be honest, that’s all I really cared about. If Renee could spit out the hellion in a jasmine-scented birth tub with a cry of divine feminine power, fand-diddly-damn-tastic. But I didn’t want midwives with such a rageboner against modern medicine that they would be trying some twig root tea and cleansing incense while a critical second slid by.

There were complications. Tom’s head wasn’t angled right, and we became the “cascade of interventions” you hear about. Renee needed a midwife who could in one moment stand defiantly between her and our utterly obnoxious doctor and say, “Her hips are perfectly wide enough.” But she also needed a midwife who could, an hour later, be gracious enough to defer to modern medicine when it was time to admit that progress had stopped and exhaustion was kicking in. Labor was 80 hours long, and after Renee tried everything—including a vacuum extraction—to get Tom out vaginally, she squeezed the midwife’s hand one more time for luck and mouthed “thank you” before being wheeled off to her c-section.

If there’s anything resembling a take-home message (my editor demands that my meandering, stream-of-consciousness, self-indulgent posts should at least have something resembling a take-home message), it’s this: there really was a doctor who told us, “Well, you have three hours, and then we have to consider alternatives,” like she had literally stepped out of a “Doctors Suck” alternative medicine documentary. And there really are rage-against-the-machine beliefs that “big pharma is a tool of the global health care agenda to mind-control us with fluoride.” But somewhere between those two points, you can find a middle ground with midwives if you look, a middle ground where epidurals are a tool in the toolbox, and c-sections are done as emergencies instead of scheduled before a shift change*—where interventions are not “eschewed failures,” but simply medically prudent steps.

And even a skeptic like me can be comfortable there.

*[Author’s edit- It has been pointed out to me that “scheduled c-sections” is something of a trope in the polemics surrounding the natural childbirth debate. I want to clarify that I was not generalizing with this statement about doctors or c-sections. We really did have a doctor who told us after one hour she would give us “two more” and who then tried to pressure us rather aggressively to have a c-section before the shift change from day to night staff. Alta Bates also offered to schedule our c-section when Renee was still in her first trimester.  I was aware of the stereotype, and my reaction was “Wow, apparently this really is a thing.”  But I absolutely have no experience beyond my own, and I didn’t realize my experience was going to have so much emotive force. I would have been more clear in the original post that it was strictly a personal experience if I had known.  Apologies!]

I suspect that those midwives I fear do exist out there somewhere, wearing Birkenstocks and washing their hair with breakfast ingredients. Maybe they give women enemas of black cohosh when it should be time for a transfer, or do sacred feminine power chants when it should be time for a c-section. But with our midwives, the choice between a natural birth and grounded science became a false dichotomy.

 

In the aftermath, while Renee slept in the recovery room, and William went upstairs with Tom to NICU, I asked Meadow what happened to women who couldn’t push a baby out 200 years ago.

“Usually the baby died,” she said. “If it was the heir to the throne or something, they might kill the mother to get to the baby.  A lot of times, neither one made it.”

I can look across the room and see Renee nursing Tom right now thanks to “modern medicine.”  And I’m so very glad we found the grounded midwives who never, ever thought it was the enemy.

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chrisbrecheen

chrisbrecheen

Chris lives with his girlfriend and her husband in a polyamorous family. On Friday Dec 6th, 2013, the married couple had a darling boy. Not "dad" but so much more than "Uncle Chris" he spends much of his time either trying to figure out the boundaries between parent/not-parent or navigating a world ill equipped to deal with non traditional families. When he's not trying to be a grounded parent, he teaches English as a second language and maintains his own blog about writing (chrisbrecheen.blogspot.com).

69 Comments

  1. January 8, 2014 at 10:48 am —

    We used a doula, and I was worried about similar things, particularly before the second birth when we visited her office in a acupuncture clinic (the first time, she was just the doula on call when we checked in, and we liked her enough to hire her specifically for the second one). However, even though the office had lots of woo stuff around, none of the assistance she gave seemed to be based on woo. She was really there to be another experienced guide for my wife through the process who knew how to give really good massages.

    It worked for us.

    • January 9, 2014 at 6:35 pm —

      Yeah, Renee had about four or five massages from our doula and loved that part a lot. 🙂

  2. deERcountry
    January 8, 2014 at 12:39 pm —

    Yes. We were a low-risk pregnancy that rapidly became a high-risk one in the third trimester. Emergency c-section after a failed induction, but the midwife stayed with us the entire time while the OBGYN popped in and out according to his schedule. My male partner also pointed out that the midwives treated him like he really was equally involved in the process, whereas the OBGYN tended to ignore his questions and focus only on my uterus.

    • January 8, 2014 at 1:12 pm —

      Renee was in labor so long that we went through a couple of doctors (due to scheduling). One of them was just great, and really understood how much we wanted a vaginal birth and for Tom to avoid NICU, but the other was just a nightmare. She was straight out of the Ricky Lake documentary with the pressure to get Renee to a c-section. It was awful.

      I honestly think, in the end, Renee waited through an extra hour of hard labor just so the shift could change again and she wouldn’t have to give the awful doctor the smug satisfaction.

  3. January 8, 2014 at 1:53 pm —

    “and c-sections are done as emergencies instead of scheduled before a shift change”
    That’s actual nonsense and not useful at all.
    I know, there’s much talk about “too many c-sections”, but mostly it’s people not understanding statistics. With certain risk factors (and yes, prolonged labout is one of them) it makes sense to either pre-schedule a c-section or to do it when you note that things are not progressing as they should. An emergency c-section is not only a c-section, it is also an emergency. that means that now there is a considerably higher risk for the woman and the baby.
    I know, the WHO once had this 10% number. Only that the guy who proposed that number had to admit that he pulled that one right out of his ass.
    Humans are exceptionally bad at birthing. We’re getting worse because with better food our babies are getting bigger, too. And we have this novel ideas that every fetus we grow in our wombs should end up as a healthy baby. We have that expectation largely because of c-sections.

    • January 8, 2014 at 3:52 pm —

      One of the reasons I try to stick to my own experiences is that I know many of the issues I’m blogging about are QUITE contentious, and I have no claim to fiat. I can’t really contest your statistics, but I can tell you what happened to us. The hospital offered to schedule a c-section on the day they predicted the due date and even a couple of times after they knew our birth plan, and there was intense pressure from the doctor after only an hour of pushing –long before Renee and Tom started to show signs of there being an infection.

      My experience may have been atypical, but it apparently does happen.

      • January 9, 2014 at 9:57 am —

        Obviously I can’t comment on your experience, but I still think that your framing of c-sections and your characterisation of OB-Gyns is wrong and potentially dangerous.
        There is nothing wrong with offering women c-sections.
        There is nothing wrong with choosing a c-section for no other reason than “I want to”.
        The goal is not a vaginal birth, I can tell you it is very short of marvellous.
        The goal is to have two healthy people in the end who both suffered the least damage possible.
        I’m not saying there aren’t asshole OB-Gyns and nurse-midwives*, during my own reproductive careeer I met some of the best and some of the worst of them, but I find the framing “women vs. Ob-Gyns” a dangerous path to go down.

        *The others come under “irresponsible assholes” anyway

        • January 9, 2014 at 5:55 pm —

          I agree. It seems like one line of my article was seized upon as my philosophy (and the rest of my very pro medicine/science sentiments ignored) when I did, in fact, have a doctor try to schedule a c section before her shift change.

          • January 10, 2014 at 2:56 am

            People who are pro-science can have very faulty notions about individual areas, too. That doesn’t amount to philosophy, it means that you’re wrong on something.
            I know you’re pretty new to this whole pregnancy and childbirth discussion while others here have a bit more experience, so you might not be aware about the myths and tropes surrounding c-sections. You didn’t phrase this one sentences people jumped on as a personal experience, you made a general statement.
            Quite often vaginal birth is hailed as superior to c-sections. Ever heard “too posh to push”? Women who have c-sections are told that they did not really give birth, that they are not really mothers. That they failed. I hope Renee never encounters these bastards.
            There are whole hirarchies made up about who actually really birthed a child, and the more critical it was, the more of an achievemnet it becomes. A woman who managed vaginal delivery after 48 hours is superior to the one who only had 10 hours because she “went through more”. The GODDESS herself is probably the one who had a VBAC3. The woman who has an epidural is only a bit above the c-section. Because apparently pain is good for you, because apples and Eve.
            This causes real and actual harm to women. This causes women to make stupid decisions and endangers them and their babies.
            Nobody denies your experience. As I said, I had my share of assholes, I know they exist. I don’t know if that particular doctor was actually an asshole, or simply said the wrong thing at the wrong time, rubbed you the wrong way or anything else. But that’s no reason to foster harmful stereotypes. People here aren’t attacking you, they’re trying to educate you.

        • January 10, 2014 at 4:04 am —

          I’m not sure why I can’t thread a reply to your most recent reply, but I’ll do so here.

          Listen, I didn’t realize that I was stepping into the middle of some established debate. I had heard about the pushy doctors who schedule c-sections or want to push you into them right away or before shift changes, and when it started actually happening my reaction was basically “Holy crap. They really DO act like that.” That’s what I wrote about. It’s not a “stereotype” in this case–it really, literally happened. I probably could have worded it as a personal experience a little better, but as I said, I didn’t know I was stepping into some ubercontroversial soup so I didn’t know I needed to run the disclaimer flag up high and proud. However, I also think that some of the REACTION to my post has more to do with that controversy than what I wrote, and I’m sorry if my personal experience complicates the narrative of “they don’t really do that,” but in our case, they really, really did.

          • January 10, 2014 at 8:23 am

            There’s a limit to nested comments or we’d be typing in single word lines soon 🙂
            Again, I don’t say this didn’t happen. Nobody said it didn’t happen, so your claim there is a strawman. But I don’t know why it happened. You seem to assume a motive behind the pushy doctor that you cannot know. I actually don’t understand what “schedule before shift change” is supposed to imply. Does it suggest that the doc wants to get the c-section so they can make money? I don’t know, as I said, I come from a different medical system where your doc is usually your doc, yet we have the same c-section rate you folks have.
            So, even if I know the facts, I don’t know the motives, and I’m not going to assume that they’re selfish just because you don’t like what they did.
            As a similar example: I wished doctors would stop prescribing antibiotics for bullshit, yet I don’t assume that the doctors who do so act out of selfish reasons and not out of misguided concern for the patient. And sometimes, even if you really don’t like what they’re saying, they have very good reasons and solid evidence behind what they’re saying.
            Listen, I’m the last person who says that Obestetrics is all fine and dandy everywhere and that we don’t need to fight for better care, but yes, you stepped into a debate and you made some insensitive remarks.

  4. Ammy
    January 8, 2014 at 2:08 pm —

    Not even 200 years ago mate. It still happens today. In Afghanistan, the death rate to women from complications surrounding childbirth is 1 in 4. I have a friend who says, “Your body won’t give you something you can’t handle.” to which I say, “Oh please, evolution is a clumsy beast and my body is just not that smart.”

    • January 8, 2014 at 2:36 pm —

      I wonder, if these people ever read even Jane Austen novels or biographies, what do they think phrases like “died in childbirth” or “had 8 children, 3 of them to grow up into adulthood” actually mean?

  5. Jen K
    January 8, 2014 at 2:08 pm —

    This was 100% marvelous. The only thing I want to know is whether her name was really Lavender.

  6. deERcountry
    January 8, 2014 at 2:57 pm —

    If only it was nonsense — when we were deciding on a OBGYN, the midwives went through the list of one who would even work with a midwife, with comments. Of the 8 at our local hospital, only 2 would ‘let’ a woman labor more than 8 hours before scheduling a c-section. The economic pressures on doctors based in private hospitals to push for c-sections can’t be discounted; the c-section literally cost 3 times more than our hoped-for vaginal birth. Our local public hospital — which only takes referral cases for deliveries — has a 36% c-section rate, compared to the private “Cesar’s Palace” (98%).
    That said, I do agree the risk factors for c-sections are growing, though no-one really has the answer for why. Obesity? Better pre-natal care? Environmental factors? If only we did have a definitive answer.

    • January 8, 2014 at 3:41 pm —

      Well, part of it is liability. Doctors get sued and lose for decisions the patient makes.
      There are also good medical reasons to avoid prolonged labour, and as I said, most of it is statistical risk. 99% of those who get a c-section in a given situation might have done well without it, but unless you know who is the 1% who really needs it, do play Russian Roulette?
      Also, the rate of around 30% seems to be pretty much the same for countries with very different health-care models* such as Germany, the USA, Australia, Italy…
      *The whole approach is completely different in Germany. For one thing, nurse midwives are the people routinely in charge of birth.

    • January 9, 2014 at 5:33 pm —

      Yeah, I think there is probably a reality here between purely ignoble and purely altruistic motivations, and denying that the other ever occurs as a knee jerk is dangerous for either side.

  7. Maya
    January 8, 2014 at 8:08 pm —

    Or maybe the doctor who was encouraging the C saw something that the CPM did not see due to having more experience. Particularly more experience with shit going wrong during a birth. You did, after all, end up with the c-section. Were they pushing inappropriately for a c? Or maybe if you had followed the recommendation you might have saved that long exhausting unproductive labor. I had a similar story and was induced for high BP, 60 hr labor and then a c. My birth plan specified that I didn’t want a C and so no one mentioned it to me for hours and hours of labor and 4 hours of pushing. Finally I brought it up myself and 10 minutes later I was holding my baby. I honestly didn’t know WTF I was talking about when I wrote that birth plan.

    • January 8, 2014 at 8:27 pm —

      I would think it would be a little unusual for a doctor to see such a thing, but fail to mention it to the patient, the doula, the midwife, the husband, me or the next doctor to come on duty. Plus the fact that two different doctors had two WILDLY different respect levels for us trying to get Tom out vaginally. One was basically like “you’ve had three hours….C section!” but after the shift changed, the next doctor was willing to let us keep trying for as long as we wanted as long as Renee’s BP stayed good and Tom’s heart rate didn’t drop too low during contractions. (Eventually they did, and that doctor still told us we could push it a little further before they really recommended a c-section. However, at that point Renee was absolutely exhausted and was still only at minus 2.)

  8. Zarra
    January 8, 2014 at 11:09 pm —

    My OB/GYN has midwives on staff that women can choose to work with during pregnancy and labor. They have to go through a certification and they work with the doctor. I think the midwife will be with you through labor and the doctor will check on you every so often and only be involved with labor if their is a problem. I wouldn’t mind using a midwife from this practice with my next kid because I know that they won’t be into all the woo. (The practice is very science based) But other midwives scare me.

    • January 8, 2014 at 11:19 pm —

      When we first checked in, we were being seen by a hospital midwife. The doctors didn’t start dropping by until Renee went into hard labor. I liked her very much. I think if we hadn’t had our own grounded midwife, she would have been good. The only thing in general is, I think they have shifts just like the doctors and so if your active labor crossed a shift change, you might have to say good-bye to someone you like or get someone you’re not working with as well.

      But I agree with you about other midwives being scary–which is why I was so thrilled about ours.

  9. maya
    January 9, 2014 at 12:43 pm —

    We all have jobs and experience. We rely on that experience to make decisions every day. Someone gave you a recommendation and because you began with an assumption you rejected advice that turned out to be right. It turned out OK, but there was a risk in rejecting that advice that you are dismissing quite casually. Doesn’t it at least seem possible that the doctor made a recommendation for a c based on something other than trying to get to his golf game or whatever it is that you think he was doing? Your midwife was a CPM. Not a nurse. That’s 3 years of a midwife school as opposed to probably 6 years of training to be a CNM. The doctor would have had at least 10 years of training to be and obgyn and supervising a L&D unit and would have seen a lot of difficult births. Isn’t there at least a remote possibility that they were actually making a recommendation to you that you failed to take? You ended up with the treatment that doctor advised. Nothing went wrong, but a long labor is not an ideal situation. A lot of things can go wrong. I think the doc probably said to the next shift – the woman in room 3 has high bp and is getting magnesium the baby is being monitored and is holding on so far. She is set on a vaginal birth. It doesn’t look like it is heading that way, but that’s what she wants. As long as the baby is not in trouble lets stick with it. And that’s a fine way to go because it ended up fine for her and for the baby.

    I’m all for everyone having the birth of their dreams. But doctors are not enemies and a c-section was the correct recommendation in this case.

    • January 9, 2014 at 3:25 pm —

      There are an awful lot of assumptions here for someone who wasn’t there. If you read this article and got the impression that I think doctors are not the enemy, I’m not sure what to say. Nor do I know how to respond if your contention is that all doctors, simply by virtue of being doctors, never pressure people into procedures.

      • January 9, 2014 at 5:28 pm —

        er….ARE the enemy. (No “not”) Oops. That was sort of an important time to double check my reply.

  10. deERcountry
    January 10, 2014 at 3:45 am —

    @Gillell, without wanting to start a flame war, I am going to quibble your response. Yes, c-sections save lives (we’re testimony to that), but c-sections really should be last resort, not the go-to because it’s financially/administratively more appealing for the doctor/medical facility. I also don’t condemn women who think that c-sections are the ‘easier’ choice for taking that option, just think that they’re misinformed — the risk of complications with c-sections really is higher than with a low-risk vaginal birth (again, I’m testimony to that too). The issue of whether or not a woman experiences pain during labor should frankly not be part of the whole vaginal/c-section debate; pain relief FTW every time.

    • January 10, 2014 at 4:53 am —

      Last resort?
      So, let me present an example: breech position: c-section or not?
      Please, give me a definition of “last resort” and some evidence that this is actually safer and better.
      How big does the risk for serious complications have to be before you would codone a scheduled c-section: 1%? 5% 10%
      Yes, c-sections have a slightly increased risk over vaginal delivery in low risk births. Are women allowed to make that decision for themselves? Why do you automatically think that every woman who makes a choice different than your own is “misinformed” and not actually able to weigh the risks and benefits for herself?
      Also “pain relief FTW every time”? If you think that every woman who has a vaginal delivery can GET pain relief, you’re grossly malinformed.
      And yes, you’re pushing the “they only want c-sections because it’s convenient for the doctors” bullshit without presenting actual evidence, as if it was some Big Pharma conspiracy.

  11. deERcountry
    January 10, 2014 at 5:50 am —

    @Gilliell, this is exactly what I was trying to avoid.
    ‘Last resort’ in this case means the other options have been considered and discarded, not that the other options are no longer possible — I admit, this is a case of my wording obviously being interpreted in a way not intended. In many cases the other options are NOT considered. If a woman is told the baby is in the breech position and that manual manipulation may not work/is risky and she decides to go to for a c-section, great. If the doctor tells her “it’s breech, we must do a c-section” without any consultation, it’s a problem. (C-sections are not considered THE standard of care for breech births.)

    If you want ‘evidence’ of physician preference then look in some of the academic literature, like these articles:
    http://bmjopen.bmj.com/content/3/5/e002789.short (Australian study)
    http://www.ncbi.nlm.nih.gov/pubmed/21646928 (indicating US physicians tend to decide on c-sections for more ‘subjective’ than ‘objective’ reasons)
    http://www.biomedcentral.com/content/pdf/1471-2393-13-83.pdf (reasons why TOLAC is still uncommon in California, even though now mandated)
    http://onlinelibrary.wiley.com/doi/10.1111/aogs.12213/abstract (that complications and c-section rates did not correlate across facilities in Finland)
    http://www.who.int/bulletin/volumes/85/10/06-035808/en/ (on China)
    …etc
    I also recommend this article on the ethics of patient choice when it comes to c-sections in the States: http://aquila.usm.edu/ojhe/vol2/iss1/4/

    (And pain relief FTW every time with the proviso “when you can get it”: do I really have to explicitly say that?? That, anyway, is my own personal opinion as I really was just trying to rebut your implication that someone who thinks c-sections should be a considered option must also have ridiculous ideas about “everything should always be the way nature intended.”)

    • January 10, 2014 at 2:06 pm —

      You know what?
      I’m NOT responsible for your shoddy writing. If you use a term that you intend to mean something different, I have no way to know that.
      “indicating US physicians tend to decide on c-sections for more ‘subjective’ than ‘objective’ reasons” This is blatantly false. From the study you yourself linked to:
      “Primary cesarean births accounted for 50% of the increasing cesarean rate. Among primary cesarean deliveries, more subjective indications (nonreassuring fetal status and arrest of dilation) contributed larger proportions than more objective indications (malpresentation, maternal-fetal, and obstetric conditions).”

      “C-sections are not considered THE standard of care for breech births”
      They are in many countries. They are considered standard of care by the midwives in those countries

      Your Australian study concludes that the wealthier the woman, the more likely the c-section. That’s a correlation. You do understand the difference between a correlation and causation, right?

      “do I really have to explicitly say that”
      Can I read your mind?
      “your implication that someone who thinks c-sections should be a considered option must also have ridiculous ideas about “everything should always be the way nature intended.””
      You made that totally up.

      1. We’re only talking about primary c-sections
      2. That those are “more subjective” does not mean “pulled out of their arse and totally not true”

  12. […] feel truly bad for my fellow GP blogger, Chris, for accidentally triggering the landmine that is birthing politics when he was just relating his […]

  13. Maya
    January 10, 2014 at 6:10 pm —

    I’m still feeling like Doc number 1 is getting a bad rap. I’d love to hear her side of it. Alta Bates has the lowest c-section rate of any East Bay hospital. They are known for their natural-birth friendly practices, have one of the highest VBAC rates in the area and one of the lowest low-risk birth c-section rates in the area. The entire reason your family ended up in the hospital instead of at home is that you had a high-risk birth. If your partner was induced for high blood pressure, she was induced for risk of pre-eclampsia. The risk of placental abruption, seizures, anoxic brain injury and actual death are elevated. This is a really serious condition and it’s not like she was happily laboring in a field of wheat with her cervix opening like a flower when some a-hole doctor came along and started shouting C-SECTION out of nowhere. Pre-eclampsia is a life-threatening condition that can develop rapidly. It’s not some crazy thing for a doctor to recommend a c-section for a woman being induced for pre-eclampsia. I also note that the baby was in the NICU. Again, either the whole L&D team knew that the baby was on its way to the NICU for prematurity and even more reason to get the baby out ASAP or the baby had to go to the NICU because the birth was really hard for him. In both of those scenarios the first doc had every reason to recommend a c-section.

    I’m not saying that doctors never make inappropriate recommendations. I’m saying that everything you have written indicates that your family took some chances and that you disregarded some solid advice from Doc number 1. Lucky for you that there were no negative health outcomes for your child and your partner.

    I’m also not saying that training means a person never makes mistakes. I am just pointing out that in this case the person with the most training and experience actually made a recommendation that turned out to be right. Maybe you didn’t like the way she said it, and maybe she gave the impression that it was mostly about her own schedule. But the numbers at Alta Bates indicate that isn’t the way they run their ship. Your partner had a pretty hard birth and if the baby went to the NICU it can’t have been a picnic for him either.

    • January 10, 2014 at 6:53 pm —

      Actually the interventions that happened did so when we heard bellwethers that sounded like medical recommendations instead of just pressure. When we transferred it was because Renee was at 3 cm after 36 hours and needed an epidural to get some sleep. The midwives told us what the numbers were, what the problem was, and made that recommendation (while also telling us about options like breaking Renee’s water or keep trying for a few more hours). When we finally had a c-section it was because we were still at “minus 2” after four hours of pushing and baby’s pulse was starting to cruise toward 160. When we were presented with medical facts of why we should think about a c-section by doctor 2, it was a no brainer. As soon as anyone actually gave us advice and reasoning (instead of than JUST pressure) we were right on board.

      If doctor 1 is getting an unfair rap, then she (“she” BTW–upthread you assumed it was a man) needs to work on her transparency with her patients. She not only didn’t tell anyone else in the room including the nurse or the patient WHY she wanted to push for a c-section, but was also disagreed with by by doctor 2 (who had about twenty years more experience–a fact I only mention since you’ve put a SUCH premium on experience upthread). Doctor 2 told us there was no need to rush the decision, let us keep trying without suggesting an intervention, and then came to us later when there was a medical reason to reconsider, told us the things she was worried about (blood pressure and Tom’s heart rate) and at that point we made the choice in about three seconds of looking at each other and nodding.

      I’m not sure what else to tell you. You really seem to want to exonerate Doc 1, but I don’t think unless you were there, you really could have understood how brusque and pressuring she was. (I later learned she has a bit of a rep for that.) A lot of people have been arm chair quarterbacking Renee’s ever decisions both from “shoulda tried harder” to “shoulda c-sectioned it up sooner!” If that’s all you’re doing then I hope you can respect that it was our decision and we had our reasons for making it. If you would have made different decisions, awesome! I promise I won’t question them. We made our choices as best we could based on what everyone was telling us and Doctor 1 never really gave us a REASON to listen to her. (It’s “her” by the way, upthread you assumed it was a man.)

      Could it have been a huge personality issue and Doc 1 saw something she never mentioned to ANYONE? Of course. Seems a little odd though that she wouldn’t chart it or tell the nurse or ANYTHING, but it’s possible. But for me to know that for sure I would need a telepath and a time machine…and so would you. I can only tell you what happened, and how the doctor pushed without giving us real reasons why and how the second doctor made a recommendation, gave us medical reasons for the recommendation, (and made it sound like a recommendation instead of pressure) and we went with the surgery. But the fact that we ended up needing a c-section is not automatically mean Doc 1 was right to recommend it so early or did so appropriately.

      • January 10, 2014 at 7:19 pm —

        Sorry, I mentioned the woman/man thing twice. I also notice that you got it right in the comment I replied to. Apparently I was feeling extra set-the-record-straight-y while writing my comment.

  14. Silverfeather13
    January 12, 2014 at 2:55 am —

    I also had a great experience with midwives (in a birth center) who were very respectful of what I wanted while at the same time being sure to educate me on the many possible complications that could arise and helping me to create a birth plan that also accounted for them. (My personal experience at the OB’s office was maybe a shadow of your “Doctor 1” – they were very good at telling me what to do, but not very interested in what I wanted. I got a strong sense that they felt entitled to make the decisions they thought were best for me without much explanation, and certainly without my input.)
    I am in complete agreement with the view that medical advances like the c-section and epidurals are wonderful, life saving, pain relieving things that we should be grateful we have in our “toolbox” as you put it. I have also heard enough anecdotal stories about “Doctor 1” scenarios that I believe they happen with far too much regularity. Ultimately, whether she opts for home birth or scheduled c-section, with epidural or without, I think the mother’s wishes should take priority (to the best of everyone’s ability) and she should be making choices with a doctor/CNM that will give her not only their opinion, but medical reasons to back it up. ( I also feel the need to add the caveat that if the woman WANTS to place her care in the medical professional’s hands and let them make all the calls, that is also her choice and should be respected.)
    Thank you for sharing your story… I’m sorry Renee didn’t get to have the birth she wanted, but I’m glad everyone is okay!

    • January 12, 2014 at 2:42 pm —

      Thank you! She’s pretty happy with how it turned out in the end. (Turns out the little buggers are pretty cute.)

      I liked this thing you wrote about your “shadow of Doctor 1”: “they were very good at telling me what to do, but not very interested in what I wanted. I got a strong sense that they felt entitled to make the decisions they thought were best for me without much explanation, and certainly without my input.”

      Exactly! That was exactly the feeling I got.

  15. January 15, 2014 at 1:44 pm —

    Wait! You think it was a good thing that the midwife delayed a necessary C-section by an hour because she had absolutely no idea what was necessary or not?

    She and your family behaved like toddlers: “How do you know!” “You can’t make me.” And, like toddlers, you ended being wrong and having to do it anyway.

    CPMs are not midwives. They are lay people who awarded themselves a bogus credential, recognized nowhere else in the industrialized world. Although there are CPM “schools,” the vast majority of CPMs haven’t been to any midwifery school, just completed a program of unmonitored self study. Whereas ALL other midwives in the industrialized world have a university level degree or a master’s degree in midwifery, the CPM requirements were recently “strengthened” to mandate a high school diploma.

    So the bottom line is that your “midwife” had a grossly inappropriate, utterly ignorant temper tantrum and you are impressed? Please explain why.

    • January 15, 2014 at 2:11 pm —

      Wow. I would need a flow chart in order to explain all the ways this comment is presumptuous, offensive, fallacious, and not even particularly accurate.

      Can we assume that the “please” in your last sentence did not inure me against the rest of your comment, and that I will NOT be explaining a decision that wasn’t yours to make (nor mine if you actually read with any comprehension) to someone so breathtakingly rude? Thanks.

  16. January 15, 2014 at 2:16 pm —

    Instead of obsessing about how you “feel” about the comment, could you please direct yourself to the substance of the comment?

    Why are you impressed with a midwife who contradicted the doctor and was WRONG?

    Did you have any idea that a CPM isn’t a real midwife and may not have had any schooling at all?

    Or do you prefer to discuss how you “feel” about the comment because you wish to divert attention from the fact that you have no rebuttal?

    • January 15, 2014 at 2:20 pm —

      Nope. What I prefer to do is ignore you, and if you can’t figure out the REAL reason why, feel free to tell yourself whatever you like.

  17. January 15, 2014 at 2:28 pm —

    Of course you prefer to ignore me. There you were basking in the glow of your transgressive choice to have a homebirth and I came along and pointed out that what you did, far from being praiseworthy, was nonsensical.

    • January 18, 2014 at 5:33 pm —

      Chris had no choice whatsoever regarding the homebirth. This *could* have been an interesting seque into the reasons why people choose midwives, and doctor-midwife-patient interaction and perhaps some reflection and introspection on what about that midwife made Chris feel better.

  18. January 15, 2014 at 3:47 pm —

    I just have to question whether you might have imagined the pressure to do a c-section before the night staff shift change. My son was born at 1:02 a.m. in a major teaching hospital and I was under no such pressure – and I had been pushing since 10:30 pm at that point. I am unclear as to why it would make a difference to anybody – the day shift went home regardless and on came the night shift.

    • January 15, 2014 at 4:08 pm —

      Well, it’s possible, but six different people got the same impression, including the nurse that worked for the hospital, the doula, the midwife, the husband, the mother, and me. I think what’s probably more likely, if there was indeed a miscommunication, is that the doctor was trying to “prime” us for the POSSIBILITY of a C-section, and said some things that were a little too pushy.

      I mean, Renee’s hips are 44 inches and the baby was pretty small (about 8lbs as it turned out) so telling us her hips weren’t wide enough was kind of head-scratching.

      Also the contrast with the second doctor (the more experienced one) who just kept telling us that we had all the time we wanted until/unless there was a REASON to do a c-section (and that the first doctor was absolutely wrong about the hips thing) was profound.

      So I certainly don’t know for sure what was on Doc 1’s mind, but her behavior certainly gave quite a few people the same impression.

    • January 19, 2014 at 9:25 pm —

      I delivered on a very busy day at my hospital, and they did actually mention that it would be best if I had my c-section before one of the doctors finished their shift. Since no one was coming to relieve them the hospital would have one less doctor on hand.

      I appreciated the honesty.

  19. Sezja
    January 15, 2014 at 4:52 pm —

    Amy, I am a bit disappointed that someone with the education you have cannot seem to give their opinion without ad hominem attacks (calling them a toddler for making a decision for which they have more facts than you do about the situation). Perhaps that’s why you were kicked off your other science-based blog spot. (Personal attacks suck, dont they?) Perhaps its your turn to act like an adult instead of a ‘toddler’, which would include providing an opinion and backing it up with facts rather than denigrating a person’s character. For example, let me rewrite your basic statement, “Midwives are hardly the experts people think them to be, as they sometimes lack even a basic high school degree – http://www.midwife.org/ACNM/files/ccLibraryFiles/Filename/000000001385/CNM%20CM%20CPM%20ComparisonChart%20082511.pdf (a link to requirements for midwifery).” See how you dont need to denigrate the OP, his girlfriend, etc, to still get your point across? Of course, you run the risk of people looking at the qualification list and making their own determination about qualifications and worthiness, but then that’s the point of discussion (each getting to see the others side and making their own decision).

    Look everyone, people are people. Both midwives and obgyn docs have a ton of experience between them. Both, also, are people, which means they are liable to make mistakes. When obgyn docs were first introduced, midwives (rightly) refused to let their patients into hospitals because there was an increased risk of both mother and child dying (hospitals were ridiculously unsanitary until they were forced into regulation decades later). The only reason most births occur today in hospitals is due to the litigation of the American Doctor’s Association (http://www.ourbodiesourselves.org/book/companion.asp?id=21&compID=75). Flipside, docs do have a lot more training now and there are certain situations – like the OP illustrates – that docs just do a whole lot better with than midwives. Ive heard of situations were midwives screwed up, but I’ve also witnessed firsthand docs screwing up (to the tune of, had we listened to their advice I’d be without a father right now, and I thank God my mother – who was forced to sign a ‘i am killing my husband by going against the doc’s decision’ liability waiver – didnt listen to them). Not saying one side is better than the other, but rather, each has their merits and potential fallibility. You get to choose based on the info which risk you want to take.

    Pretty sure thats the whole point of this article – you’ve got Chris denigrating the entire midwife thing and rooting for docs for literally the entire article save for the second to last paragraph – when he then concludes ‘oh hey, maybe midwives do know a thing or two in addition to the docs’.

    • January 15, 2014 at 5:10 pm —

      That was the basic gist, yes. And thank you.

      In my case the credentials of our midwives are in a link in the OP, but knowing that would have required actually reading the article–something it was immediately clear that Amy either didn’t do at all or did so with a spectacular bias already in mind.

  20. January 15, 2014 at 5:03 pm —

    I had a hospital vaginal birth however my Dr was on call but in a different area and I want able to have her deliver my son at first I was a little sad until my hospital have me the most wonderful midwife. She was amazing and it is because of her I didn’t have a awful tear or need to be cut in an area that just shouldn’t be cut (although I do understand sometimes it needs to be done). My midwife messaged me and she was a very calming and a relaxing presence in my labor and delivery room. If I would have had a diving child I would have wanted a midwife with me although still in the hospital….I need drugs to get through that kind of pain! I give major respect to those women who want to deliver a human without any pain meds.
    I am so happy for all of you that “Tom” & “Renee” made it through there ordeal and baby is safely in Mother’s arms when not with Super “Uncle Chris”.

    • January 15, 2014 at 5:16 pm —

      Thanks. The midwife WAS very calming through some tough moments of pain (even through the epidural), so we were very happy she was with us even though her role had changed from the original plan of a home birth.

  21. Lena
    January 17, 2014 at 3:09 pm —

    But…Renee ended up needing a c-section, which means the “nightmare” doctor was right. 80 hours of labor. 4 hours of pushing. That’s fanaticism.

    • January 17, 2014 at 3:13 pm —

      That’s actually a logical fallacy, and I’m surprised it’s come up so often among a group of skeptics. Just because we had a c-section some FOUR hours later (after there actually WERE medical reasons to do so) doesn’t mean that it was correct or appropriate for her to pressure us at the time.

  22. Siri Dennis
    January 18, 2014 at 2:24 pm —

    But she DID end up needing a section, so what was the doctor doing wrong? And the statements ‘wanted a vaginal delivery’ and ‘wanted baby to avoid needing to go to NICU’ are pretty much mutually exclusive in a prolonged labour with an infection setting in. Any obstetrician worth their salt will recommend a section in that case, and what is wrong with seeing the baby safely born before the end of one’s shift? Most patients would be appreciative that their doctor wanted to see them through to the end before clocking off.

    And what did the midwives achieve that was so wonderful? Mum and baby had to endure a failed vaginal delivery, which meant baby had to be yanked back up the birth canal, which likely contributed to the need for a NICU stay. I’m a midwife, but I think you’ve got things exactly the wrong way round here. I think you owe the obstetrician an apology, and the midwives… nothing at all.

    • January 18, 2014 at 2:41 pm —

      There’s some assumption here about time tables that is quite a bit wrong. (The signs of infections were hours later, and we DID go in for a c-section when they showed up.) I wasn’t specific in the article, so I can see why there might be some confusion, but it’s not useful to jump to conclusions.

      • Siri Dennis
        January 18, 2014 at 2:49 pm —

        Not jumping to any conclusions – you specifically stated that the midwife delayed the section by a whole hour, leading to an unnecessary failed attempt at vaginal extraction (in itself stressful for a baby, and means baby has to be stressed further by being pushed back up the birth canal). You also stated your girlfriend’s wish to have a vaginal birth AND avoid a NICU stay; normally the word used would be OR, as sections are much gentler on babies. And this particular baby was put through an awful lot more stress than he needed to, which very likely contributed to his problems.

        • January 18, 2014 at 2:57 pm —

          Actually what I said was that the doctor was “pressuring” us and the midwife told us Renee’s hips were wide enough. (These two events were also hours apart.) Doctor one never made an explicit recommendation, and the midwife never delayed anything.

          When we got an explicit recommendation from the second doctor, we took it immediately.

          • Siri Dennis
            January 18, 2014 at 3:09 pm

            But her hips weren’t wide enough, were they? So the midwife was wrong and the doctor was right on the money. The way you describe it, it sounds as if the baby was put through an awful lot more than he had to, simply because it was more important to prove one particular doctor wrong than to get the little fella out in a timely manner. Did you let dislike of another adult override concern for a brand new baby?

        • Chris
          January 18, 2014 at 3:26 pm —

          No. The complications that led to the c-section had nothing to do with the width of her hips.

  23. Siri Dennis
    January 18, 2014 at 4:09 pm —

    Errm…yes, an 80 hour labour followed by a failed ventouse does mean her hips weren’t wide enough, yes. That’s pretty much one of the definitions of cephalo-pelvic disproportion.

    • January 18, 2014 at 5:09 pm —

      Well, the second doctor (the one who ACTUALLY recommended the C-section explicitly, and who performed us) told us it was not. I’m inclined to go with that diagnosis rather than a midwife who wasn’t there.

  24. Stacy
    January 19, 2014 at 1:29 am —

    The midwives were CPMs…exactly what Dr. Amy said they were. They do not have a degree or midwifery certification that would be recognized in any hospital in the US or any other industrialized nation.

  25. Stacy
    January 19, 2014 at 1:33 am —

    The 4 hours aren’t the point…the 80 hours are. Anyone with any real knowledge of obstetrics and risk knows that the longer the labor the greater the risk of complications to mother and baby – fetal distress, placental retention, post-partum hemorrhage, infection. Guess what – doctors are humans. They have differing medical opinions. That doesn’t mean one is “right” and another is “wrong”. The first doctor was making a very valid recommendation for a C-section that would guarantee the mother’s safety and the baby’s life based on a very inappropriately protracted labor. Just because you liked the second doctor’s recommendation more doesn’t mean it was “right”. Use facts, risks and statistics – not emotion – to evaluate a situation.

  26. Siri Dennis
    January 19, 2014 at 3:51 am —

    So the baby DID come out the right way? Why did you say it was a caesarean then?

    P.s. If the midwife didn’t know that a woman’s external hip measurements say nothing about her internal pelvic dimensions, she don’t know much. Slice and dice it any way you like, that baby was put through a grossly abnormal labour, which probably caused his NICU stay. Not a great start to parenting.

    • January 19, 2014 at 11:29 am —

      Are you seriously referring to vaginal birth as the “right” way? Cesarean is the “wrong” way to you? Wow.

      • Siri Dennis
        January 19, 2014 at 12:32 pm —

        No, it’s just that clearly, as the baby fit through mum’s hips (pelvis, but hey…), clearly he was born vaginally after all. Duh.

      • Siri Dennis
        January 19, 2014 at 12:36 pm —

        Oh, and as to the ‘wrong’ and ‘right’ of it, I’m not the one that put my poor baby through 80 hours of labour, 4 hours of pushing and a failed ventouse! Clearly to these people, there was a right way, and the baby was damn well going to come out vaginally, whatever it took.Me, I’m on the baby’s side in this case…

        • January 19, 2014 at 1:10 pm —

          Non sequitur. You said that vaginal birth was the right way and cesarean the wrong. I’m sorry, but that’s a fucked-up thing to say, but clearly you don’t think so because you won’t even acknowledge that. I think the only side you’re on is your own.

          • Siri Dennis
            January 19, 2014 at 1:25 pm

            No, I mean ‘right’ in terms of this family’s values, not my own. Doesn’t matter to me what you think anyway, but as it happens I think the rightness or wrongness of a birth has nothing to do with whether it’s vaginal or caesarean. It’s what’s right for each woman and baby that matters, not mode of birth per se.

    • January 19, 2014 at 11:41 am —

      This comment makes it clear that you haven’t even read the post–to say nothing of actually bothering to fill in the missing information with accurate facts instead of assumption.

  27. Danielle
    January 20, 2014 at 12:30 pm —

    I want to comment tangentially!
    Gut flora are the microbes that live in your gut. Recently they have been getting a lot of scientific interest interns of how their diversity effects health and weight, which while not totally teased out seems a powerful link based on a) the importance of bacteria to all sorts of biomes and b). The fact that by cell # our bodies are 90% bacteria.

    My understanding is that newborns are born wit to gut flora and then acquire a lot through the birth process because the birth canal is a messy place. This is why in studies on the effect of gut microbes, they use mice delivered by c-section.

    Obviously microbes are also everywhere, so I am sure Tom will pick them up another way, but I would guess that the midwives wanted to fine tune Remee’s microbial community so Tom got inoculated with the best of the best.

    P.S. saw Tom last night and he is adorbs.

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