Story about the "free birthers." Anyone read it?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I am not a freebirther but I did have three homebirths with certified nurse-midwives and a hospital less than 10 minutes away.

I do think though that it's important to recognize as well the risks to women and babies both*from* the hospital. Some non-zero number of babies are born still due directly to medical interventions/malpractice. And a much larger than necessary number of women are harmed --many permanently -- or even killed by medical malpractice as well. One of the reasons that maternal mortality is so much higher in the US than in other developed countries is that women become secondary to babies in the labor and delivery process. Like so many of the PP upthread -- you cast aspersions and yes, hatred towards women who choose to freebirth (and/or homebirth) and accuse them of caring about their experiences more than their babies' lives, but there are very real risks to modern obstetric practices.

Women die *because* of medical practices -- and malpractice and not always for lack of them. In fact, half the maternal deaths are preventable! That's not about how dangerous childbirth is inherently -- it's how screwed up and flawed our obstetric system is.

Yes, a live mother and baby at the end of the process is absolutely the goal, but the mother should not have to sacrifice her own physical well-being because of the laser focus on delivering her baby rather than keeping her safe and comfortable throughout the process.

See this story just published today in the NY Times:

https://www.nytimes.com/2018/11/16/opinion/sunday/maternal-mortality-rates.html?action=click&module=Opinion&pgtype=Homepage

And of course this landmark series from ProPublica earlier this year:

https://www.propublica.org/series/lost-mothers

So instead of hating on freebirthers, maybe you could be a little more critical of our truly poor healthcare system and try to imagine why women would object to being part of that system. It's not a choice I would make -- but it's also not appropriate IMO to dismiss all concerns about the medical system as whacko.

Completely illogical. The women who died in those stories needed more medical care, not less.

If by “more care” you mean “the most basic care available” then yes, they needed more care.

Because what’s really happening in Westernized countries is obstetrics providers (OBs and midwives) becoming too dependent on technology ($$$$$) to tell them if something is wrong. Modern women dying of 16th century childbirth killers is making them wake up to the fact that we’ve reached the point of over-dependence on technology to the exclusion of basic medical care. More isn’t always better.

I read through all the Lost Mother stories and have been following these articles on maternal mortality. Most of the deaths and near deaths detailed there were from complications that are treatable, but the providers missed something they would have picked up on had they paid more attention to the new mom’s symptoms instead of dismissing everything but a beeping monitor or a positive lab result. The miraculous medical advance California started implementing to reduce deaths from severe postpartum hemorrhage? Crash carts to weigh bloody pads on a scale rather than the old method of care, which was to assume a woman was bleeding normally until she started going into shock. Oh, and reducing elective inductions and c-sections to reduce the risk of severe postpartum hemorrhage happening in the first place. Novel approach medical community!

And doctors are generally hugely dismissive of the risks associated with the technology they use, believing that if something is life-saving in some circumstances it must be harmless when applied to everyone, even healthy people. It’s not! Especially not when you are getting the stellar combination of ultra-technology + minimum basic care.

Can't you even see the contradictions? You first write, that OBs are "too dependent on technology" and then you acknolege the proven efforts to reduce mortality (crash carts and other techniques to ACCESS technology). There is some role for reducing c-sections, but again, that's STILL dependent on modern technology to monitor the labor. And I don't believe there is any evidence about inductions increasing maternal mortality -- the research I've seen indicates the reverse.

Women need MORE and BETTER medical care. Not less.

I wrote that inductions increase the risk of severe postpartum hemorrhage, which is more likely to kill you in the modern U.S. than the non-severe kind that sometimes happens after spontaneous labor for which the treatment is usually one or two shots of pitocin (both kinds of hemorrhage are extremely dangerous in under-resourced areas where hospitals don't typically have supplies of pitocin or blood banks).

Here are some articles that make a strong or significant association between induction and severe postpartum hemorrhage:

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0054858
https://www.sciencedirect.com/science/article/pii/S0002937810000220
https://www.sciencedirect.com/science/article/pii/S0002937810010264
https://europepmc.org/abstract/med/21366123
https://www.tandfonline.com/doi/abs/10.3109/00016349.2010.514324
https://obgyn.onlinelibrary.wiley.com/doi/abs/10.1111/j.1600-0412.2011.01298.x
https://link.springer.com/article/10.1007/s00404-015-3725-y

Also, extra high-tech monitoring during labor does not reduce the need for c-sections, in fact, continuous fetal monitoring has been shown in study after study to do nothing but increase intervention without improving outcomes at all. What California did to reduce c-sections was to train nurses to provide more one on one labor support to the mom, to urge doctors to exercise patience during labor (and gave them tools for how to know when it is appropriate to intervene, to minimize errors of judgment) and to use intermittent rather than continuous fetal monitoring for low-risk patients.

So yes, more attentive, personalized, low-tech care combined with judicious use of technology is what is needed as demonstrated by California reducing maternal mortality by half with these simple measures… and if you do that stuff at baseline then you won’t need as much of the high-tech care, and those resources can be focused on those who need them the most.

Once again, you completely miss the point. Women die because they don't get the high tech care they need, FFS! Women get induced due to conditions that will hurt them or hurt their babies. Just waiting it out does not actually improve infant or maternal health. https://www.washingtonpost.com/national/health-science/should-pregnant-women-be-induced-at-39-weeks/2016/06/27/e1bb9d16-27fe-11e6-b989-4e5479715b54_story.html?utm_term=.f08fbe2960d9

The problem is that high-risk women are being ignored and not getting the advanced medical care they need. Particularly women of color.

There’s actually a mountain of evidence that a lot of the things they induce for don’t improve outcomes.
http://www.childbirthconnection.org/giving-birth/labor-induction/research-evidence/research-and-evidence-q-a/common-reasons-given.html

At the end of the day, a 55% reduction in maternal mortality in the span of a few years by implementing a low-tech/low-intervention care model pretty much speaks for itself.

This exactly. Listen up, people.

[Anonymous]

I think a lot of posters actually are arguing the same points. Yes, births in the US have become overmedicalized. Is freebirthing the answer? No.

[Anonymous]

Anonymous wrote:I think a lot of posters actually are arguing the same points. Yes, births in the US have become overmedicalized. Is freebirthing the answer? No.

+1

The distance between inducing at 39 weeks with a 12 hour limit before c-section and going to a remote cabin with no medical supervision to labor for 6 days while your kid dies inside of you because a wackadoo online community thinks having a midwife present would "disrespect your goddess" or some such BS is measured in miles, not inches.

[Anonymous]

Anonymous wrote:I think a lot of posters actually are arguing the same points. Yes, births in the US have become overmedicalized. Is freebirthing the answer? No.

Thank you for a sensible position.

[Anonymous]

Anonymous wrote:I think a lot of posters actually are arguing the same points. Yes, births in the US have become overmedicalized. Is freebirthing the answer? No.

What do you propose IS the answer, when US hospitals CONTINUE to have the highest maternal death rate in the Western world?

[Anonymous]

Water birthing in a hospital perhaps? No damn way is anyone putting a belt across me when I'm in labor. Wouldn't work in the birthing pool anyway. And how would i be able to move the way i need to to alleviate pain?

[Anonymous]

Your hospital can be a torture chamber because they can do what they want to you.

[Anonymous]

Anonymous wrote:Your hospital can be a torture chamber because they can do what they want to you.

Laboring for six days off the grid while my baby died inside me is my definition of torture, but you do you.

[Anonymous]

Anonymous wrote:Water birthing in a hospital perhaps? No damn way is anyone putting a belt across me when I'm in labor. Wouldn't work in the birthing pool anyway. And how would i be able to move the way i need to to alleviate pain?

My hospital (in DC area) didn't have remote monitoring. My options were pitocin or to go against medical advise and insurance wouldn't pay. So I took pitocin and monitoring. There went any change of me moving to alleviate pain or a birthing pool. I just laid on my back in pain because that's all I could do. I felt unsupported.

[Anonymous]

Anonymous wrote:FYI guys, it is a complete and utter myth that insurance won't cover going "AMA". They won't cover medically unnecessary care; but, for example, what are you even talking about that you "had" to show up for an induction at 40 weeks? What is there to not cover at that point? Are you claiming that they would not have covered your birth when you showed up in labor at 41 weeks? Bullshit, and you know it. Logic, guys.
Same goes for checking yourself out of a hospital "AMA" 24 hours after a c-section. I wouldn't do it, but your shortened hospital stay doesn't become medically unnecessary because you left early.

Uh, it's not a myth. Your insurance company can deny coverage for services related to birth if you go against medical advice. It's coercive and hopefully rare, but it does happen.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Water birthing in a hospital perhaps? No damn way is anyone putting a belt across me when I'm in labor. Wouldn't work in the birthing pool anyway. And how would i be able to move the way i need to to alleviate pain?

My hospital (in DC area) didn't have remote monitoring. My options were pitocin or to go against medical advise and insurance wouldn't pay. So I took pitocin and monitoring. There went any change of me moving to alleviate pain or a birthing pool. I just laid on my back in pain because that's all I could do. I felt unsupported.

How crappy! Were you at least able to get an epidural?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I am not a freebirther but I did have three homebirths with certified nurse-midwives and a hospital less than 10 minutes away.

I do think though that it's important to recognize as well the risks to women and babies both*from* the hospital. Some non-zero number of babies are born still due directly to medical interventions/malpractice. And a much larger than necessary number of women are harmed --many permanently -- or even killed by medical malpractice as well. One of the reasons that maternal mortality is so much higher in the US than in other developed countries is that women become secondary to babies in the labor and delivery process. Like so many of the PP upthread -- you cast aspersions and yes, hatred towards women who choose to freebirth (and/or homebirth) and accuse them of caring about their experiences more than their babies' lives, but there are very real risks to modern obstetric practices.

Women die *because* of medical practices -- and malpractice and not always for lack of them. In fact, half the maternal deaths are preventable! That's not about how dangerous childbirth is inherently -- it's how screwed up and flawed our obstetric system is.

Yes, a live mother and baby at the end of the process is absolutely the goal, but the mother should not have to sacrifice her own physical well-being because of the laser focus on delivering her baby rather than keeping her safe and comfortable throughout the process.

See this story just published today in the NY Times:

https://www.nytimes.com/2018/11/16/opinion/sunday/maternal-mortality-rates.html?action=click&module=Opinion&pgtype=Homepage

And of course this landmark series from ProPublica earlier this year:

https://www.propublica.org/series/lost-mothers

So instead of hating on freebirthers, maybe you could be a little more critical of our truly poor healthcare system and try to imagine why women would object to being part of that system. It's not a choice I would make -- but it's also not appropriate IMO to dismiss all concerns about the medical system as whacko.

Completely illogical. The women who died in those stories needed more medical care, not less.

If by “more care” you mean “the most basic care available” then yes, they needed more care.

Because what’s really happening in Westernized countries is obstetrics providers (OBs and midwives) becoming too dependent on technology ($$$$$) to tell them if something is wrong. Modern women dying of 16th century childbirth killers is making them wake up to the fact that we’ve reached the point of over-dependence on technology to the exclusion of basic medical care. More isn’t always better.

I read through all the Lost Mother stories and have been following these articles on maternal mortality. Most of the deaths and near deaths detailed there were from complications that are treatable, but the providers missed something they would have picked up on had they paid more attention to the new mom’s symptoms instead of dismissing everything but a beeping monitor or a positive lab result. The miraculous medical advance California started implementing to reduce deaths from severe postpartum hemorrhage? Crash carts to weigh bloody pads on a scale rather than the old method of care, which was to assume a woman was bleeding normally until she started going into shock. Oh, and reducing elective inductions and c-sections to reduce the risk of severe postpartum hemorrhage happening in the first place. Novel approach medical community!

And doctors are generally hugely dismissive of the risks associated with the technology they use, believing that if something is life-saving in some circumstances it must be harmless when applied to everyone, even healthy people. It’s not! Especially not when you are getting the stellar combination of ultra-technology + minimum basic care.

Can't you even see the contradictions? You first write, that OBs are "too dependent on technology" and then you acknolege the proven efforts to reduce mortality (crash carts and other techniques to ACCESS technology). There is some role for reducing c-sections, but again, that's STILL dependent on modern technology to monitor the labor. And I don't believe there is any evidence about inductions increasing maternal mortality -- the research I've seen indicates the reverse.

Women need MORE and BETTER medical care. Not less.

I wrote that inductions increase the risk of severe postpartum hemorrhage, which is more likely to kill you in the modern U.S. than the non-severe kind that sometimes happens after spontaneous labor for which the treatment is usually one or two shots of pitocin (both kinds of hemorrhage are extremely dangerous in under-resourced areas where hospitals don't typically have supplies of pitocin or blood banks).

Here are some articles that make a strong or significant association between induction and severe postpartum hemorrhage:

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0054858
https://www.sciencedirect.com/science/article/pii/S0002937810000220
https://www.sciencedirect.com/science/article/pii/S0002937810010264
https://europepmc.org/abstract/med/21366123
https://www.tandfonline.com/doi/abs/10.3109/00016349.2010.514324
https://obgyn.onlinelibrary.wiley.com/doi/abs/10.1111/j.1600-0412.2011.01298.x
https://link.springer.com/article/10.1007/s00404-015-3725-y

Also, extra high-tech monitoring during labor does not reduce the need for c-sections, in fact, continuous fetal monitoring has been shown in study after study to do nothing but increase intervention without improving outcomes at all. What California did to reduce c-sections was to train nurses to provide more one on one labor support to the mom, to urge doctors to exercise patience during labor (and gave them tools for how to know when it is appropriate to intervene, to minimize errors of judgment) and to use intermittent rather than continuous fetal monitoring for low-risk patients.

So yes, more attentive, personalized, low-tech care combined with judicious use of technology is what is needed as demonstrated by California reducing maternal mortality by half with these simple measures… and if you do that stuff at baseline then you won’t need as much of the high-tech care, and those resources can be focused on those who need them the most.

Once again, you completely miss the point. Women die because they don't get the high tech care they need, FFS! Women get induced due to conditions that will hurt them or hurt their babies. Just waiting it out does not actually improve infant or maternal health. https://www.washingtonpost.com/national/health-science/should-pregnant-women-be-induced-at-39-weeks/2016/06/27/e1bb9d16-27fe-11e6-b989-4e5479715b54_story.html?utm_term=.f08fbe2960d9

The problem is that high-risk women are being ignored and not getting the advanced medical care they need. Particularly women of color.

There’s actually a mountain of evidence that a lot of the things they induce for don’t improve outcomes.
http://www.childbirthconnection.org/giving-birth/labor-induction/research-evidence/research-and-evidence-q-a/common-reasons-given.html

At the end of the day, a 55% reduction in maternal mortality in the span of a few years by implementing a low-tech/low-intervention care model pretty much speaks for itself.

That article is worthless. The ARRIVE trial (a randomized trial) showed fairly conclusively that induction at 39 weeks improves outcomes. It's REALLY shameful how you try to scare women away from getting adequate medical care. And that's just for low-risk women. https://www.nejm.org/doi/full/10.1056/NEJMoa1800566

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Question for the home Birthers: what happens if a woman is discovered to need an emergency c-section while doing a home birth? Can an ambulance get the mom to the hospital in time?

Yes. The premise of home birth is there is a midwife monitoring you closely and recommends a transfer before something progresses to a full-blown complication.

well, that's the fantasy of homebirth. homebirth has a higher rate of death and disability precisely because it's difficult to identify and manage a complication in time. Obviously.

And yet other wealthy countries seem to manage getting good outcomes with home birth. In the U.S. you are correct that outcomes are worse, likely because of the lack of professionalization in midwifery, persistent bias in the medical community against the midwife profession, and total lack of integration of models of care within the healthcare system. There are ways around those things in some areas, and home birth is slowly becoming more accepted so hopefully that will bring about improvements in home birth outcomes.

Actually that's also a fantasy. For example, the Dutch homebirth rate is plummeting due to safety concerns (and desire for pain relief).

https://brightthemag.com/dutch-moms-are-choosing-hospitals-over-home-births-and-maybe-thats-a-good-thing-23d2d304c7ed

Hmm, this lady was angry at being transferred to the hospital - which her midwife did out of valid concern for the baby's safety. This is exactly how it's supposed to happen. If you're high risk of you develop a complication then it's not safe to give birth at home, period. I didn't see mention of the safety rate plummeting.

Anyway there's plenty of evidence of the safety of home birth in countries where it's more accepted and the system is equipped for it.

The Dutch homebirth rate is falling, and the Dutch infant mortality rate is improving.

https://www.washingtonpost.com/news/wonk/wp/2015/07/08/why-home-births-are-safer-for-rich-women/?utm_term=.fc9b82df0e46

Okay, that study found home birth neonatal mortality increased only for low-income women. It also only looked at where the women actually gave birth, rather than where they planned to. So if you choose a hospital birth and plan for that, and then you have an accidental home birth, that is generally a less safe scenario. All of the other home birth studies (including the one by de Jong et al that uses the same source data as the one in this article and concludes home birth is just as safe for low-risk pregnancies) recognize the confounding effect of using actual birth place and use only planned birth place.

So the outcomes of low income women don't matter to you???

[Anonymous]

Anonymous wrote:I think a lot of posters actually are arguing the same points. Yes, births in the US have become overmedicalized. Is freebirthing the answer? No.

NO, only the privileged women are saying births are "overmedicalized." Low income and African American women need more and better medicine.

http://www.nationalpartnership.org/research-library/maternal-health/black-womens-maternal-health-issue-brief.pdf

[Anonymous]

Anonymous wrote:

Anonymous wrote:FYI guys, it is a complete and utter myth that insurance won't cover going "AMA". They won't cover medically unnecessary care; but, for example, what are you even talking about that you "had" to show up for an induction at 40 weeks? What is there to not cover at that point? Are you claiming that they would not have covered your birth when you showed up in labor at 41 weeks? Bullshit, and you know it. Logic, guys.
Same goes for checking yourself out of a hospital "AMA" 24 hours after a c-section. I wouldn't do it, but your shortened hospital stay doesn't become medically unnecessary because you left early.

Uh, it's not a myth. Your insurance company can deny coverage for services related to birth if you go against medical advice. It's coercive and hopefully rare, but it does happen.

Can you point to one specific documented example where a woman was denied insurance coverage for declining induction and waiting to go into labor? Because what there's ACTUALLY evidence for is the reverse: insurance companies penalizing hospitals for ALLOWING induction -- the so called 39 week rule. The fact is, the women who have a hard time accessing the pregnancy care they want are the women who want planned c sections or inductions. NOT the women who are declining "interventions."