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

[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.

Did you call your insurance company and ask them "will you deny coverage if I decline induction"? Somehow I doubt that you did.

[Anonymous]

All the OBs I have encountered (and it's a fair few, multiple DCs born in 2 countries) generally do not follow an informed consent model of care. I have rarely felt as though I had a true say in my care and how to proceed, it's mostly OBs trying to coerce me into following hospital policy. Individuals in the medical profession have big egos and do not enjoy being challenged. I don't want to endanger my baby, but might have a higher risk tolerance than my OB. So I would be okay going to 42 weeks without being induced, but that was not what the OB wanted. I also wanted to decline GBS screening but again, not acceptable bc the OB wanted it. I could go on and on, but let's not pretend like women are in charge of their births here.

[Anonymous]

I took care and picked a great doctor, then trusted his advice.

Anyone who doesn't do this is foolish. Anyone who tries to "freebirth" and has their child die should be in jail for manslaughter -- and stupidity.

[Anonymous]

Anonymous wrote:All the OBs I have encountered (and it's a fair few, multiple DCs born in 2 countries) generally do not follow an informed consent model of care. I have rarely felt as though I had a true say in my care and how to proceed, it's mostly OBs trying to coerce me into following hospital policy. Individuals in the medical profession have big egos and do not enjoy being challenged. I don't want to endanger my baby, but might have a higher risk tolerance than my OB. So I would be okay going to 42 weeks without being induced, but that was not what the OB wanted. I also wanted to decline GBS screening but again, not acceptable bc the OB wanted it. I could go on and on, but let's not pretend like women are in charge of their births here.

The problem is that if you experience a bad outcome (heaven forbid) there’s a very good chance the doctor is getting sued for not adequately advising you of the risk no matter what your prebirth self thought about the safety of going to 42 weeks or skipping a test. That’s the world OBs are practicing in.

[Anonymous]

Anonymous wrote:

Anonymous wrote:All the OBs I have encountered (and it's a fair few, multiple DCs born in 2 countries) generally do not follow an informed consent model of care. I have rarely felt as though I had a true say in my care and how to proceed, it's mostly OBs trying to coerce me into following hospital policy. Individuals in the medical profession have big egos and do not enjoy being challenged. I don't want to endanger my baby, but might have a higher risk tolerance than my OB. So I would be okay going to 42 weeks without being induced, but that was not what the OB wanted. I also wanted to decline GBS screening but again, not acceptable bc the OB wanted it. I could go on and on, but let's not pretend like women are in charge of their births here.

The problem is that if you experience a bad outcome (heaven forbid) there’s a very good chance the doctor is getting sued for not adequately advising you of the risk no matter what your prebirth self thought about the safety of going to 42 weeks or skipping a test. That’s the world OBs are practicing in.

a) they have malpractice insurance, and b) that's not an excuse to inflate the risk and coerce that patient into doing something she's not comfortable with. Going to 42 weeks of pregnancy is not a death sentence. Declining an induction/waiting for labor to start is usually not a death sentence (if it were then they certainly wouldn't sit there and let you labor on pitocin for 2 days, waiting for the pre-e to worsen). Declining a c-section is, in some cases, a death sentence - that's when they should pull out the big guns of AMA.

[Anonymous]

Anonymous wrote:

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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???

Outcomes that are found only among low-income women probably don't apply across the board, or indicate some other variable is influencing the outcomes, which discredits the results of the study as being "generalizable" on a population level.

[Anonymous]

There was a fascinating article I read (and I forget where, my apologies), that said hardly any patients actually sue. It is not something most people have the resources to do. Not to say the threat isn't real to OBs, but its not a real option for most people.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:All the OBs I have encountered (and it's a fair few, multiple DCs born in 2 countries) generally do not follow an informed consent model of care. I have rarely felt as though I had a true say in my care and how to proceed, it's mostly OBs trying to coerce me into following hospital policy. Individuals in the medical profession have big egos and do not enjoy being challenged. I don't want to endanger my baby, but might have a higher risk tolerance than my OB. So I would be okay going to 42 weeks without being induced, but that was not what the OB wanted. I also wanted to decline GBS screening but again, not acceptable bc the OB wanted it. I could go on and on, but let's not pretend like women are in charge of their births here.

The problem is that if you experience a bad outcome (heaven forbid) there’s a very good chance the doctor is getting sued for not adequately advising you of the risk no matter what your prebirth self thought about the safety of going to 42 weeks or skipping a test. That’s the world OBs are practicing in.

a) they have malpractice insurance, and b) that's not an excuse to inflate the risk and coerce that patient into doing something she's not comfortable with. Going to 42 weeks of pregnancy is not a death sentence. Declining an induction/waiting for labor to start is usually not a death sentence (if it were then they certainly wouldn't sit there and let you labor on pitocin for 2 days, waiting for the pre-e to worsen). Declining a c-section is, in some cases, a death sentence - that's when they should pull out the big guns of AMA.

what a bizarre attitude. OB's should be correctly informing women about their actual risks. Not threating "AMA" whatever that means. Pointing out that going to 42 weeks increases stillbirth risks is not coercion. It's facts.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

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???

Outcomes that are found only among low-income women probably don't apply across the board, or indicate some other variable is influencing the outcomes, which discredits the results of the study as being "generalizable" on a population level.

Well, low-income women form a huge percentage of women AT RISK OF MATERNAL MORTALITY. So if you're dismissing them, then you are not really part of the discussion about maternal mortality. If all you want to talk about is how privileged white women give birth, that's a different discussion.

[Anonymous]

Anonymous wrote:

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?

Take a close look at what CA is doing. It's proving to be effective.

And what are they doing? Providing direct training and feedback to doctors and hospitals on standards of care both to reduce over-medicalization AND on appropriate monitoring and response to emergency events.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

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?

Take a close look at what CA is doing. It's proving to be effective.

And what are they doing? Providing direct training and feedback to doctors and hospitals on standards of care both to reduce over-medicalization AND on appropriate monitoring and response to emergency events.

NP, but my understanding of the CA outcomes is that the vast majority of the improvement in CA maternal mortality outcomes due to is implementing statewide standard and required procedures in reaction to postpartum hemorrhage incidents, not lowering interventions. And I say that as a midwifery patient who is hoping to avoid interventions.

[Anonymous]

Before OBs existed, and EVERY birth was overseen by midwives, the maternal death rate was 1 in 3. Now you want to suggest the solution to today’s maternal death rates, which while not perfect, are no where near 1 in 3, by going back to a no doctor/hospital/surgery/medicine model? It a makes no sense.

[Anonymous]

Anonymous wrote:Before OBs existed, and EVERY birth was overseen by midwives, the maternal death rate was 1 in 3. Now you want to suggest the solution to today’s maternal death rates, which while not perfect, are no where near 1 in 3, by going back to a no doctor/hospital/surgery/medicine model? It a makes no sense.

Literally no one has suggested a non-medical model. No one. People are advocating for using medical interventions judiciously, not foregoing medical care.

Now, time for a history lesson lest you continue demonizing midwives armed with nothing but ignornace.

1 in 3? Before antibiotics were invented it was more like 1 in 100-200. Interestingly, when obstetricians started attending births, maternal deaths increased because they hadn't discovered germ theory yet. Whereas midwives, who didn't have antibiotics either, were at least not touching cadavers immediately before touching women's bodies in childbirth.

https://ourworldindata.org/maternal-mortality

[Anonymous]

Anonymous wrote:

Anonymous wrote:Before OBs existed, and EVERY birth was overseen by midwives, the maternal death rate was 1 in 3. Now you want to suggest the solution to today’s maternal death rates, which while not perfect, are no where near 1 in 3, by going back to a no doctor/hospital/surgery/medicine model? It a makes no sense.

Literally no one has suggested a non-medical model. No one. People are advocating for using medical interventions judiciously, not foregoing medical care.

Now, time for a history lesson lest you continue demonizing midwives armed with nothing but ignornace.

1 in 3? Before antibiotics were invented it was more like 1 in 100-200. Interestingly, when obstetricians started attending births, maternal deaths increased because they hadn't discovered germ theory yet. Whereas midwives, who didn't have antibiotics either, were at least not touching cadavers immediately before touching women's bodies in childbirth.

https://ourworldindata.org/maternal-mortality

Um, the topic of this pose is freebirth. so yes, someone is suggesting a non-medical model.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Before OBs existed, and EVERY birth was overseen by midwives, the maternal death rate was 1 in 3. Now you want to suggest the solution to today’s maternal death rates, which while not perfect, are no where near 1 in 3, by going back to a no doctor/hospital/surgery/medicine model? It a makes no sense.

Literally no one has suggested a non-medical model. No one. People are advocating for using medical interventions judiciously, not foregoing medical care.

Now, time for a history lesson lest you continue demonizing midwives armed with nothing but ignornace.

1 in 3? Before antibiotics were invented it was more like 1 in 100-200. Interestingly, when obstetricians started attending births, maternal deaths increased because they hadn't discovered germ theory yet. Whereas midwives, who didn't have antibiotics either, were at least not touching cadavers immediately before touching women's bodies in childbirth.

https://ourworldindata.org/maternal-mortality

My midwife happily would have let me stroke out in the name of avoiding “interventions.” so that’s not a good answer.