Speaking of having to advocate for ourselves and our babies as patients...

[Anonymous]

Anonymous wrote:

Anonymous wrote:I am a woman of color who has to have a c-section due to a myomectomy last year and all I can say is all these stories in the news lately (and this thread) terrify and sadden me. I keep telling my husband he will have to stay vigilant in the hospital. I don’t know what else I can do really, and that feels tragic.

Take birthing classes and get a doula!! (Even for a C section, they can be great support.)

If you can afford it, yes, this. I’m also black and (fortunately) doula-ing up for my impending delivery.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I am a woman of color who has to have a c-section due to a myomectomy last year and all I can say is all these stories in the news lately (and this thread) terrify and sadden me. I keep telling my husband he will have to stay vigilant in the hospital. I don’t know what else I can do really, and that feels tragic.

Take birthing classes and get a doula!! (Even for a C section, they can be great support.)

Ask your OB what the hospital's protocols are for monitoring post-c-section. Ask what their emergency protocols are in case you hemorrhage. Ask your OB how many c-sections they do a month on average. I read a study that showed those who perform fewer than 3 or 4 a month have worse maternal outcomes. Also, make sure your hospital has an adequate blood bank (pretty sure our large hospitals in the DC area do, but double check for peace of mind).

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I am a woman of color who has to have a c-section due to a myomectomy last year and all I can say is all these stories in the news lately (and this thread) terrify and sadden me. I keep telling my husband he will have to stay vigilant in the hospital. I don’t know what else I can do really, and that feels tragic.

Take birthing classes and get a doula!! (Even for a C section, they can be great support.)

Ask your OB what the hospital's protocols are for monitoring post-c-section. Ask what their emergency protocols are in case you hemorrhage. Ask your OB how many c-sections they do a month on average. I read a study that showed those who perform fewer than 3 or 4 a month have worse maternal outcomes. Also, make sure your hospital has an adequate blood bank (pretty sure our large hospitals in the DC area do, but double check for peace of mind).

What am I supposed to do with this info, though? Switch hospitals? All the ones in this area probably have enough blood. Switch OBs? Fine if you’re having scheduled c-section but otherwise you can’t really control who delivers you. I understand you’re trying to help, but I’m just not sure what actions one can meaningfully take. I don’t really care about “peace of mind.” I’d like my body to survive!

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Agreed - many of the most tragic cases do not involve a lack of intervention as the root cause. It often is an issue of no one listening to and closely watching the mother, and an over-reliance on test results to show danger signs, when tests can be wrong, or totally ineffective if no one in authority looks at them. I think the midwife culture of large amounts of time spent with mothers (at appts, in labor and after) and a focus on listening to the mother and taking her subjective experience seriously, is something OBs could really learn from. Midwives can screw up like anyone else, but they at least are starting from the viewpoint that the mother’s experience matters and that a healthy baby is not the only goal.

I think Shalon Irving is a good example of this - she was known to be high risk and was pretty closely monitored through her pregnancy, but after giving birth even though she knew something was wrong and told doctors that repeatedly, they ignored her because her tests didn’t seem that abnormal. But had they listened to her and examined her more closely, they may have been able to save her life.

so basically ... she lacked inteventions!! failing to see here how "low intervention" is a solution.

The problem was not that she lacked access to the necessary treatment, the problem was that she was not given that treatment because doctors did not listen to her and instead relied on tests that gave an incomplete picture of her health. The United States has more intervention-heavy medicalized births than anywhere in the world, and yet a terrible maternal mortality rate. Story after story of women dying illustrates the issue is usually not a lack of access to interventions - these women are all giving birth in hospitals. Instead, doctors are failing to listen when the women describe their symptoms and are failing to do basic physical exams to assess maternal well being. The low-intervention midwife model does not involve not intervening for serious health problems - hospital based midwives monitor closely for pre-e, Hemorrhage, infection, all the biggies, and treat those issues aggressively. But they do place a greater focus on maternal wellbeing and on listening to a mother’s subjective experience (the whole natural birth crunchy thing is based on a belief that it is better for mothers). And I would submit that a a belief that women should be listened to, and that their pain should not be ignored, is what is really missing from American health care. The common thread in so many of these deaths is the mothers knew something was wrong and their concerns were ignored by health care providers, sometimes on the basis that the “tests” were not abnormal.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I am a woman of color who has to have a c-section due to a myomectomy last year and all I can say is all these stories in the news lately (and this thread) terrify and sadden me. I keep telling my husband he will have to stay vigilant in the hospital. I don’t know what else I can do really, and that feels tragic.

Take birthing classes and get a doula!! (Even for a C section, they can be great support.)

Ask your OB what the hospital's protocols are for monitoring post-c-section. Ask what their emergency protocols are in case you hemorrhage. Ask your OB how many c-sections they do a month on average. I read a study that showed those who perform fewer than 3 or 4 a month have worse maternal outcomes. Also, make sure your hospital has an adequate blood bank (pretty sure our large hospitals in the DC area do, but double check for peace of mind).

What am I supposed to do with this info, though? Switch hospitals? All the ones in this area probably have enough blood. Switch OBs? Fine if you’re having scheduled c-section but otherwise you can’t really control who delivers you. I understand you’re trying to help, but I’m just not sure what actions one can meaningfully take. I don’t really care about “peace of mind.” I’d like my body to survive!

Second on hiring a doula with a lot of c-section experience. They aren’t going to prevent something like a straight surgical error, but they are going to know what “normal” looks like in the recovery phase and can raise holy hell if they see excessive bleeding, or no one is checking your blood pressure, etc. And an experienced doula may know how to navigate hospital bureaucracy to get the attention of an attending or department head if she thinks you are not getting good care.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I am a woman of color who has to have a c-section due to a myomectomy last year and all I can say is all these stories in the news lately (and this thread) terrify and sadden me. I keep telling my husband he will have to stay vigilant in the hospital. I don’t know what else I can do really, and that feels tragic.

Take birthing classes and get a doula!! (Even for a C section, they can be great support.)

Ask your OB what the hospital's protocols are for monitoring post-c-section. Ask what their emergency protocols are in case you hemorrhage. Ask your OB how many c-sections they do a month on average. I read a study that showed those who perform fewer than 3 or 4 a month have worse maternal outcomes. Also, make sure your hospital has an adequate blood bank (pretty sure our large hospitals in the DC area do, but double check for peace of mind).

What am I supposed to do with this info, though? Switch hospitals? All the ones in this area probably have enough blood. Switch OBs? Fine if you’re having scheduled c-section but otherwise you can’t really control who delivers you. I understand you’re trying to help, but I’m just not sure what actions one can meaningfully take. I don’t really care about “peace of mind.” I’d like my body to survive!

First, it's still pretty rare to die from childbirth. The vast majority survive even if there is a complication. All of us are taking on some risk with any pregnancy. There aren't any guarantees, the best anyone can do is make informed decisions.

Yes, you can switch hospitals and you can find out what the experience levels are of the OBs in your practice - chances are most of them probably have a lot of experience. These are meaningful actions because it means you are in charge of your own medical decisions and you have some control and some say in this process.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Agreed - many of the most tragic cases do not involve a lack of intervention as the root cause. It often is an issue of no one listening to and closely watching the mother, and an over-reliance on test results to show danger signs, when tests can be wrong, or totally ineffective if no one in authority looks at them. I think the midwife culture of large amounts of time spent with mothers (at appts, in labor and after) and a focus on listening to the mother and taking her subjective experience seriously, is something OBs could really learn from. Midwives can screw up like anyone else, but they at least are starting from the viewpoint that the mother’s experience matters and that a healthy baby is not the only goal.

I think Shalon Irving is a good example of this - she was known to be high risk and was pretty closely monitored through her pregnancy, but after giving birth even though she knew something was wrong and told doctors that repeatedly, they ignored her because her tests didn’t seem that abnormal. But had they listened to her and examined her more closely, they may have been able to save her life.

so basically ... she lacked inteventions!! failing to see here how "low intervention" is a solution.

The problem was not that she lacked access to the necessary treatment, the problem was that she was not given that treatment because doctors did not listen to her and instead relied on tests that gave an incomplete picture of her health. The United States has more intervention-heavy medicalized births than anywhere in the world, and yet a terrible maternal mortality rate. Story after story of women dying illustrates the issue is usually not a lack of access to interventions - these women are all giving birth in hospitals. Instead, doctors are failing to listen when the women describe their symptoms and are failing to do basic physical exams to assess maternal well being. The low-intervention midwife model does not involve not intervening for serious health problems - hospital based midwives monitor closely for pre-e, Hemorrhage, infection, all the biggies, and treat those issues aggressively. But they do place a greater focus on maternal wellbeing and on listening to a mother’s subjective experience (the whole natural birth crunchy thing is based on a belief that it is better for mothers). And I would submit that a a belief that women should be listened to, and that their pain should not be ignored, is what is really missing from American health care. The common thread in so many of these deaths is the mothers knew something was wrong and their concerns were ignored by health care providers, sometimes on the basis that the “tests” were not abnormal.

No. We need more interventions, in the form of more intensive and specialist care for mothers with chronic/high risk conditions; as well as protocols (like in California) for detecting, being prepared for and responding to emergencies like PPH and pre-e. Without those things, all the chats in the world with your midwife aren't going to do anything

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Agreed - many of the most tragic cases do not involve a lack of intervention as the root cause. It often is an issue of no one listening to and closely watching the mother, and an over-reliance on test results to show danger signs, when tests can be wrong, or totally ineffective if no one in authority looks at them. I think the midwife culture of large amounts of time spent with mothers (at appts, in labor and after) and a focus on listening to the mother and taking her subjective experience seriously, is something OBs could really learn from. Midwives can screw up like anyone else, but they at least are starting from the viewpoint that the mother’s experience matters and that a healthy baby is not the only goal.

I think Shalon Irving is a good example of this - she was known to be high risk and was pretty closely monitored through her pregnancy, but after giving birth even though she knew something was wrong and told doctors that repeatedly, they ignored her because her tests didn’t seem that abnormal. But had they listened to her and examined her more closely, they may have been able to save her life.

so basically ... she lacked inteventions!! failing to see here how "low intervention" is a solution.

The problem was not that she lacked access to the necessary treatment, the problem was that she was not given that treatment because doctors did not listen to her and instead relied on tests that gave an incomplete picture of her health. The United States has more intervention-heavy medicalized births than anywhere in the world, and yet a terrible maternal mortality rate. Story after story of women dying illustrates the issue is usually not a lack of access to interventions - these women are all giving birth in hospitals. Instead, doctors are failing to listen when the women describe their symptoms and are failing to do basic physical exams to assess maternal well being. The low-intervention midwife model does not involve not intervening for serious health problems - hospital based midwives monitor closely for pre-e, Hemorrhage, infection, all the biggies, and treat those issues aggressively. But they do place a greater focus on maternal wellbeing and on listening to a mother’s subjective experience (the whole natural birth crunchy thing is based on a belief that it is better for mothers). And I would submit that a a belief that women should be listened to, and that their pain should not be ignored, is what is really missing from American health care. The common thread in so many of these deaths is the mothers knew something was wrong and their concerns were ignored by health care providers, sometimes on the basis that the “tests” were not abnormal.

No. We need more interventions, in the form of more intensive and specialist care for mothers with chronic/high risk conditions; as well as protocols (like in California) for detecting, being prepared for and responding to emergencies like PPH and pre-e. Without those things, all the chats in the world with your midwife aren't going to do anything

Why are those approaches mutually exclusive? We should have all of these things like they do in the UK where the maternal mortality rate is HALF of the U.S.'s.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Agreed - many of the most tragic cases do not involve a lack of intervention as the root cause. It often is an issue of no one listening to and closely watching the mother, and an over-reliance on test results to show danger signs, when tests can be wrong, or totally ineffective if no one in authority looks at them. I think the midwife culture of large amounts of time spent with mothers (at appts, in labor and after) and a focus on listening to the mother and taking her subjective experience seriously, is something OBs could really learn from. Midwives can screw up like anyone else, but they at least are starting from the viewpoint that the mother’s experience matters and that a healthy baby is not the only goal.

I think Shalon Irving is a good example of this - she was known to be high risk and was pretty closely monitored through her pregnancy, but after giving birth even though she knew something was wrong and told doctors that repeatedly, they ignored her because her tests didn’t seem that abnormal. But had they listened to her and examined her more closely, they may have been able to save her life.

so basically ... she lacked inteventions!! failing to see here how "low intervention" is a solution.

The problem was not that she lacked access to the necessary treatment, the problem was that she was not given that treatment because doctors did not listen to her and instead relied on tests that gave an incomplete picture of her health. The United States has more intervention-heavy medicalized births than anywhere in the world, and yet a terrible maternal mortality rate. Story after story of women dying illustrates the issue is usually not a lack of access to interventions - these women are all giving birth in hospitals. Instead, doctors are failing to listen when the women describe their symptoms and are failing to do basic physical exams to assess maternal well being. The low-intervention midwife model does not involve not intervening for serious health problems - hospital based midwives monitor closely for pre-e, Hemorrhage, infection, all the biggies, and treat those issues aggressively. But they do place a greater focus on maternal wellbeing and on listening to a mother’s subjective experience (the whole natural birth crunchy thing is based on a belief that it is better for mothers). And I would submit that a a belief that women should be listened to, and that their pain should not be ignored, is what is really missing from American health care. The common thread in so many of these deaths is the mothers knew something was wrong and their concerns were ignored by health care providers, sometimes on the basis that the “tests” were not abnormal.

No. We need more interventions, in the form of more intensive and specialist care for mothers with chronic/high risk conditions; as well as protocols (like in California) for detecting, being prepared for and responding to emergencies like PPH and pre-e. Without those things, all the chats in the world with your midwife aren't going to do anything

Why are those approaches mutually exclusive? We should have all of these things like they do in the UK where the maternal mortality rate is HALF of the U.S.'s.

they're mutually exclusive when people claim that the solution to maternal mortality is more birth centers (which is what started this tangent).

[Anonymous]

Anonymous wrote:I am a woman of color who has to have a c-section due to a myomectomy last year and all I can say is all these stories in the news lately (and this thread) terrify and sadden me. I keep telling my husband he will have to stay vigilant in the hospital. I don’t know what else I can do really, and that feels tragic.

I just want to say, I am so sorry for this. You are right - it is tragic and unfair and I wish things were different. I hope the light that is being shined on this issue of maternal health and specifically the massive racial disparities in maternal health will lead to positive change. In the meantime, I wish you the best.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Agreed - many of the most tragic cases do not involve a lack of intervention as the root cause. It often is an issue of no one listening to and closely watching the mother, and an over-reliance on test results to show danger signs, when tests can be wrong, or totally ineffective if no one in authority looks at them. I think the midwife culture of large amounts of time spent with mothers (at appts, in labor and after) and a focus on listening to the mother and taking her subjective experience seriously, is something OBs could really learn from. Midwives can screw up like anyone else, but they at least are starting from the viewpoint that the mother’s experience matters and that a healthy baby is not the only goal.

I think Shalon Irving is a good example of this - she was known to be high risk and was pretty closely monitored through her pregnancy, but after giving birth even though she knew something was wrong and told doctors that repeatedly, they ignored her because her tests didn’t seem that abnormal. But had they listened to her and examined her more closely, they may have been able to save her life.

so basically ... she lacked inteventions!! failing to see here how "low intervention" is a solution.

The problem was not that she lacked access to the necessary treatment, the problem was that she was not given that treatment because doctors did not listen to her and instead relied on tests that gave an incomplete picture of her health. The United States has more intervention-heavy medicalized births than anywhere in the world, and yet a terrible maternal mortality rate. Story after story of women dying illustrates the issue is usually not a lack of access to interventions - these women are all giving birth in hospitals. Instead, doctors are failing to listen when the women describe their symptoms and are failing to do basic physical exams to assess maternal well being. The low-intervention midwife model does not involve not intervening for serious health problems - hospital based midwives monitor closely for pre-e, Hemorrhage, infection, all the biggies, and treat those issues aggressively. But they do place a greater focus on maternal wellbeing and on listening to a mother’s subjective experience (the whole natural birth crunchy thing is based on a belief that it is better for mothers). And I would submit that a a belief that women should be listened to, and that their pain should not be ignored, is what is really missing from American health care. The common thread in so many of these deaths is the mothers knew something was wrong and their concerns were ignored by health care providers, sometimes on the basis that the “tests” were not abnormal.

No. We need more interventions, in the form of more intensive and specialist care for mothers with chronic/high risk conditions; as well as protocols (like in California) for detecting, being prepared for and responding to emergencies like PPH and pre-e. Without those things, all the chats in the world with your midwife aren't going to do anything

Why are those approaches mutually exclusive? We should have all of these things like they do in the UK where the maternal mortality rate is HALF of the U.S.'s.

they're mutually exclusive when people claim that the solution to maternal mortality is more birth centers (which is what started this tangent).

I believe the birth center pp actually said something like, "why can’t they do this in hospitals?" She didn’t say more birth centers would be a good idea.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Agreed - many of the most tragic cases do not involve a lack of intervention as the root cause. It often is an issue of no one listening to and closely watching the mother, and an over-reliance on test results to show danger signs, when tests can be wrong, or totally ineffective if no one in authority looks at them. I think the midwife culture of large amounts of time spent with mothers (at appts, in labor and after) and a focus on listening to the mother and taking her subjective experience seriously, is something OBs could really learn from. Midwives can screw up like anyone else, but they at least are starting from the viewpoint that the mother’s experience matters and that a healthy baby is not the only goal.

I think Shalon Irving is a good example of this - she was known to be high risk and was pretty closely monitored through her pregnancy, but after giving birth even though she knew something was wrong and told doctors that repeatedly, they ignored her because her tests didn’t seem that abnormal. But had they listened to her and examined her more closely, they may have been able to save her life.

so basically ... she lacked inteventions!! failing to see here how "low intervention" is a solution.

The problem was not that she lacked access to the necessary treatment, the problem was that she was not given that treatment because doctors did not listen to her and instead relied on tests that gave an incomplete picture of her health. The United States has more intervention-heavy medicalized births than anywhere in the world, and yet a terrible maternal mortality rate. Story after story of women dying illustrates the issue is usually not a lack of access to interventions - these women are all giving birth in hospitals. Instead, doctors are failing to listen when the women describe their symptoms and are failing to do basic physical exams to assess maternal well being. The low-intervention midwife model does not involve not intervening for serious health problems - hospital based midwives monitor closely for pre-e, Hemorrhage, infection, all the biggies, and treat those issues aggressively. But they do place a greater focus on maternal wellbeing and on listening to a mother’s subjective experience (the whole natural birth crunchy thing is based on a belief that it is better for mothers). And I would submit that a a belief that women should be listened to, and that their pain should not be ignored, is what is really missing from American health care. The common thread in so many of these deaths is the mothers knew something was wrong and their concerns were ignored by health care providers, sometimes on the basis that the “tests” were not abnormal.

No. We need more interventions, in the form of more intensive and specialist care for mothers with chronic/high risk conditions; as well as protocols (like in California) for detecting, being prepared for and responding to emergencies like PPH and pre-e. Without those things, all the chats in the world with your midwife aren't going to do anything

Why are those approaches mutually exclusive? We should have all of these things like they do in the UK where the maternal mortality rate is HALF of the U.S.'s.

they're mutually exclusive when people claim that the solution to maternal mortality is more birth centers (which is what started this tangent).

I believe the birth center pp actually said something like, "why can’t they do this in hospitals?" She didn’t say more birth centers would be a good idea.

I'm talking about relatively simple steps (i.e. more attentive care to pregnant/laboring people) aimed at prevention of severe problems. This article explains it well:

Healthier Births and Babies—With Midwives
https://www.wsj.com/articles/SB10001424127887324468104578248033569255420

Here is the same article without the paywall:
http://california.midwife.org/california/files/ccLibraryFiles/Filename/000000000208/HealthierBirthsandBabiesWithMidwivesWSJ.pdf

For your awareness, ACOG and several other relevant national orgs has recognized modern maternity care focuses almost entirely on the newborn and this needs to change in order to reduce maternal mortality and morbidity in this country (their words from their 2015 consensus paper: https://www.acog.org/Clinical-Guidance-and-Publications/Obstetric-Care-Consensus-Series/Levels-of-Maternal-Care)

[Anonymous]

Anyone catch Samantha Bee this week on the diminishing access to ANY maternity care in rural areas? Surely additional birth centers in these areas could improve things if we can't pay for actual hospitals..

https://www.rollingstone.com/tv/news/samantha-bee-takes-on-americas-maternal-healthcare-crisis-w515338

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Agreed - many of the most tragic cases do not involve a lack of intervention as the root cause. It often is an issue of no one listening to and closely watching the mother, and an over-reliance on test results to show danger signs, when tests can be wrong, or totally ineffective if no one in authority looks at them. I think the midwife culture of large amounts of time spent with mothers (at appts, in labor and after) and a focus on listening to the mother and taking her subjective experience seriously, is something OBs could really learn from. Midwives can screw up like anyone else, but they at least are starting from the viewpoint that the mother’s experience matters and that a healthy baby is not the only goal.

I think Shalon Irving is a good example of this - she was known to be high risk and was pretty closely monitored through her pregnancy, but after giving birth even though she knew something was wrong and told doctors that repeatedly, they ignored her because her tests didn’t seem that abnormal. But had they listened to her and examined her more closely, they may have been able to save her life.

so basically ... she lacked inteventions!! failing to see here how "low intervention" is a solution.

The problem was not that she lacked access to the necessary treatment, the problem was that she was not given that treatment because doctors did not listen to her and instead relied on tests that gave an incomplete picture of her health. The United States has more intervention-heavy medicalized births than anywhere in the world, and yet a terrible maternal mortality rate. Story after story of women dying illustrates the issue is usually not a lack of access to interventions - these women are all giving birth in hospitals. Instead, doctors are failing to listen when the women describe their symptoms and are failing to do basic physical exams to assess maternal well being. The low-intervention midwife model does not involve not intervening for serious health problems - hospital based midwives monitor closely for pre-e, Hemorrhage, infection, all the biggies, and treat those issues aggressively. But they do place a greater focus on maternal wellbeing and on listening to a mother’s subjective experience (the whole natural birth crunchy thing is based on a belief that it is better for mothers). And I would submit that a a belief that women should be listened to, and that their pain should not be ignored, is what is really missing from American health care. The common thread in so many of these deaths is the mothers knew something was wrong and their concerns were ignored by health care providers, sometimes on the basis that the “tests” were not abnormal.

No. We need more interventions, in the form of more intensive and specialist care for mothers with chronic/high risk conditions; as well as protocols (like in California) for detecting, being prepared for and responding to emergencies like PPH and pre-e. Without those things, all the chats in the world with your midwife aren't going to do anything

Why are those approaches mutually exclusive? We should have all of these things like they do in the UK where the maternal mortality rate is HALF of the U.S.'s.

they're mutually exclusive when people claim that the solution to maternal mortality is more birth centers (which is what started this tangent).

I believe the birth center pp actually said something like, "why can’t they do this in hospitals?" She didn’t say more birth centers would be a good idea.

Thank you. I am the birth center poster and you are exactly right that my desire is not to move all births to birth centers; it is to have EVERY SINGLE WOMAN get the care and attention she needs, to be monitored and fully supported throughout her pregnancy, labor & deliver, and post-partum weeks, just as I was. Regardless of where she gives birth, if she delivers vaginally or has a section, goes entirely without meds or says "give me that epidural!" the moment labor starts. High quality maternal care is something we should have. That we don't is not just an embarrassment, but women quite literally are paying the price with their lives. That's unacceptable.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Agreed - many of the most tragic cases do not involve a lack of intervention as the root cause. It often is an issue of no one listening to and closely watching the mother, and an over-reliance on test results to show danger signs, when tests can be wrong, or totally ineffective if no one in authority looks at them. I think the midwife culture of large amounts of time spent with mothers (at appts, in labor and after) and a focus on listening to the mother and taking her subjective experience seriously, is something OBs could really learn from. Midwives can screw up like anyone else, but they at least are starting from the viewpoint that the mother’s experience matters and that a healthy baby is not the only goal.

I think Shalon Irving is a good example of this - she was known to be high risk and was pretty closely monitored through her pregnancy, but after giving birth even though she knew something was wrong and told doctors that repeatedly, they ignored her because her tests didn’t seem that abnormal. But had they listened to her and examined her more closely, they may have been able to save her life.

so basically ... she lacked inteventions!! failing to see here how "low intervention" is a solution.

The problem was not that she lacked access to the necessary treatment, the problem was that she was not given that treatment because doctors did not listen to her and instead relied on tests that gave an incomplete picture of her health. The United States has more intervention-heavy medicalized births than anywhere in the world, and yet a terrible maternal mortality rate. Story after story of women dying illustrates the issue is usually not a lack of access to interventions - these women are all giving birth in hospitals. Instead, doctors are failing to listen when the women describe their symptoms and are failing to do basic physical exams to assess maternal well being. The low-intervention midwife model does not involve not intervening for serious health problems - hospital based midwives monitor closely for pre-e, Hemorrhage, infection, all the biggies, and treat those issues aggressively. But they do place a greater focus on maternal wellbeing and on listening to a mother’s subjective experience (the whole natural birth crunchy thing is based on a belief that it is better for mothers). And I would submit that a a belief that women should be listened to, and that their pain should not be ignored, is what is really missing from American health care. The common thread in so many of these deaths is the mothers knew something was wrong and their concerns were ignored by health care providers, sometimes on the basis that the “tests” were not abnormal.

No. We need more interventions, in the form of more intensive and specialist care for mothers with chronic/high risk conditions; as well as protocols (like in California) for detecting, being prepared for and responding to emergencies like PPH and pre-e. Without those things, all the chats in the world with your midwife aren't going to do anything

Why are those approaches mutually exclusive? We should have all of these things like they do in the UK where the maternal mortality rate is HALF of the U.S.'s.

they're mutually exclusive when people claim that the solution to maternal mortality is more birth centers (which is what started this tangent).

I believe the birth center pp actually said something like, "why can’t they do this in hospitals?" She didn’t say more birth centers would be a good idea.

Thank you. I am the birth center poster and you are exactly right that my desire is not to move all births to birth centers; it is to have EVERY SINGLE WOMAN get the care and attention she needs, to be monitored and fully supported throughout her pregnancy, labor & deliver, and post-partum weeks, just as I was. Regardless of where she gives birth, if she delivers vaginally or has a section, goes entirely without meds or says "give me that epidural!" the moment labor starts. High quality maternal care is something we should have. That we don't is not just an embarrassment, but women quite literally are paying the price with their lives. That's unacceptable.

I don't disagree with you at all. Obviously, I want better maternal care. What I disagree about is that people suggest that the problem is TOO MANY interventions causing maternal deaths; when it's manifestly the opposite. For example, there were two women whose treatment caused the city to close down the United Medical Center (only hospital in ward 7 and 8) maternity wards. Those women did not need fewer interventions or to be with health care providers with limited scopes of practice (ie midwives and birth centers). They needed MORE interventions. They very much lacked access to the proper interventions. A "natural birth" approach would not have helped them; and they both would have risked out of midwife care. If you can point to some research showing how midwives prevent maternal and infant deaths I am all ears, but I am not sure it exists. Instead, you read articles like this one in ProPublica, which detail how medical care is improved through standardization of practice and review of errors so that risks can be identified. Yes, "listening to women" is important, but women aren't doctors! We rely on medical professionals to interpret our symptoms correctly.

https://www.propublica.org/article/why-giving-birth-is-safer-in-britain-than-in-the-u-s

https://www.washingtonpost.com/local/dc-politics/a-pregnant-woman-went-to-the-er-short-of-breath-six-hours-later-she-was-dead/2017/12/24/08642e6e-e4d8-11e7-ab50-621fe0588340_story.html?utm_term=.fc70ebdedd85