What do they tell women with endometriosis? Or ovarian cysts? I have no interest whatsoever in medical Ludditeism. (Luddism?) Wev.

Exactly–that’s wonderful and very humane advice. Your daughter-in-law is fortunate to have such a compassionate mother-in-law, hysperia. Thanks for stopping by and commenting.

Your comments about breastfeeding are also revealing. Many of my friends had run-ins with the “nursing nazis” as well as “anti-nursing nazis.” The breastfeeding clinic in my town was wonderful, but like all things under discussion in this thread, whenever people get too attached to one particular model or way of doing things, it interferes with offering women and new mothers all of the options they may need to do what’s best for their families. I too felt extremely guilty about my baby having a supplementary bottle at bedtime–as if there was Drano in the bottle, rather than FOOD. And now I feel like such a jerk for having felt so guilty then. It never ends!

Adding my bit: “natural childbirth” was the talk when I had my first child in 1981 and I was committed, as a potential mother and a feminist. I think I did everything I could to make it happen. My labour was long with nothing particularly wrong and, in the end, I simply could not bear the pain. I opted for an epidural after which I slept for four hours and then gave birth, perfectly naturally, I would say, to a healthy baby and I was overwhelmed and overjoyed to see him born. And very comfortable. I know there is an issue about the quality of care one receives from people like midwives and, of course, I can’t say what the outcome may have been had I had someone “better”. I can say that I experienced shame that I hadn’t managed to soldier on and give my child “the best start possible”. I found it difficult to admit to people that I had caved.
To add insult to injury, I was physically incapable of breast feeding. Once again, someone can and has argued that I just didn’t have the right care and support and so on.
At the time that I was feeding my child from a bottle, it seemed a crime. I tended to hide with him and once again, was ashamed.
I don’t think I’m a whiner and I admit that I had specific sensitivities that inclined me toward the shame response. Nevertheless, I still believe that prescriptions and proscriptions about the “best” childbirth and child care practises are ultimately harmful to women who don’t fit any mould. I do find that, nowadays, there seems to be some degree of greater openness regarding a woman’s “right to choose” what is best for her and her impending baby. I hope. My son and daughter-in-law informed me yesterday that I will be a grandmother in a few months. I was impressed that they will be visiting their doctor together in two weeks to make decisions about what kind of medical care they want, including the midwife option, and where my daughter-in-law will deliver. You can be sure that, if I offer any advice at all, it will be “Get all the information you can, try to make sure it’s accurate and then do what you feel best about. And don’t get too attached to the plan – child birth is an unpredictable process to some extent and you may have to make a decision on the fly.
Above all, have confidence in your intelligence and your desire to do what is best for yourself and your baby. Don’t let anybody push you around, and non carborundum illegitimati.”

I’m saying there are some very solid health reasons to avoid C-sections, if at all possible. The gray area is always in the stated reason for the C-section, because so much of it is intertwined with the medical establishment’s tendency to “medicalize” everything.

You might see this trend as a positive for female consumers, while I think it’s a triumph of medical and pharmaceutical marketing.

My point is, the choices should be made with all available information. The OB-GYN establishment is so heavily weighted on the side of intervention; the natural childbirth movement has nowhere near the clout. Just sayin’.

HJ: I didn’t put patient empowerment at the top of the list (you did), but it’s certainly a nice bonus.

As to cord compression: well, lay midwives consider water breaking before the second stage of labor to be a complication, and treat it as such with close monitoring. Usually there’s some other contributing factor, like a malpresentation (again, which shouldn’t be a surprise if the birth attendant is paying attention). If there’s too much amniotic fluid (again, should be picked up in prenatal care), there’s a high risk of a prolapsed cord being swept out in the sudden rush of waters. It’s a matter of hydraulics.

The cord is more likely to prolapse and compress in a hospital because doctors so often puncture the amniotic sac to speed labor – which makes C-sections more likely, and now they get to “save” the baby. My hero!

Look, all I’m saying is that a lot of the reasons doctors give for C-sections have more to do with the fact that they rely on machines instead of highly-experienced human beings to monitor care and labor.

Lay midwives always had one big advantage – we didn’t have a quota to cover the overhead, so we had time to pay closer attention.

Bing–yes, I have been reading your mind! (Although, it’s a little creepy in there sometimes.) I read the Gawande article when it first came out, although it was difficult to read about Rourke’s experiences because they were so much like mine. (Times two and a half!) The allopaths I worked with told me that gravity worked, which is why I spent 5 days walking around and jumping up and down, to no effect. From what I remember–you or Susie or KC might know better–gravity works if the child’s head is actually in contact with the cervix and helping to pound it open. If the child’s head isn’t in the right place, then you’re just a hugely pregnant woman jumping up and down and looking like an idiot. (And that was me.)

Regarding Bing’s comments — they seem rather chilling to me. Why should women surrender their rights as adult health care consumers simply because their pregnant? Should a court be able to demand a woman have a C-section even though it will probably kill her {this happened to a cancer patient recently}. See this recent article from Our Bodies, Our Blog about how women’s rights to choose how to be pregnant and the right to choose to terminate a pregnancy, are all connected:

http://ourbodiesourblog.org/blog/2008/06/making_the_connection_between_abortion_pregna.php

It’s strange. I just read the Gawande article for the first time about 3 weeks ago and was intending to write about it in my next screed. It’s like you have been reading my mind. Have you been reading my mind?

Dr. Teuter: You rule. I would add another point. American women enjoy, historically, very low rates of infant death. Women who take safe deliveries for granted are overlooking the vast amount of work that OBs did devise the interventions and procedures that made it safe. Confident that delivery is safe, they decide to forgo modern medicine and, I don’t know, go squat in the woods or whatever. (Does this sound at all like Robert Bly for girls, or is it just me?) The logic strikes me as similar to that of the “organic” foods movement. Fact: we need to extract as many edible calories from the ground as possible as long as the population is growing. We have plenty of food if we want it, so we can be terrifically inefficient if we like and buy organic. Exporting those practices and scaring people over GM (nobody has ever been killed by GM food), is a positive disaster for countries that depend on aid and refuse to accept donated GM crops. We can do complete logical loop-the-loops. I’m going to soak my head.

Susie: Patient empowerment is only worth so much. Whether or not a woman felt “empowered” does not contribute to positive outcomes for the baby. Once a woman has decided to see a pregnancy through, she really, in a non-bizarre world, should accept safest, most reliable health care. This includes monitoring. You have less than 10 minutes from the second that the cord gets pinched (should it happen) before you have brain-damaged babies. For life. Best I can reckon, it’s just not worth the fleeting sense of “empowerment” if you will changing the child’s diapers for the rest of your long life–talk about chaining yourself down! To put any distance between timely intervention and a distressed delivery (and NOBODY can predict which babies are going to go south), it’s just selfish and short-sighted. Re: walking around. Gravity has no discernible effect on the speed of labor, and women can get up and walk around if they like, as long as they are able. It’s like the ultimate placebo–you feel like you are doing something, but it doesn’t do anything.

Just thought I’d put my 2 cents in.

HJ

This discussion of pain as an absolute evil to be avoided at all costs sounds so strange to me. I mean, I know women who are outside training for marathons in all kinds of weather extremes, suffering shin splints, heat stroke, etc. for a sport!!! But some relatively short-term pain in order to have a healthier delivery (for mother AND child) is a huge imposition? Geeze.

I never lied to the women in my childbirth classes. I took them the pain was like having a REALLY BAD stomach flu, but it would be over soon enough.

A C-section is major surgery. You’re talking about a much higher risk of infection (in fact, there’s a increasing number of cases of necrotizing fasciitis after C-sections).

I’m also surprised no one’s brought up one major factor in C-sections: fetal monitors. Given a normal pelvic opening, labor progresses more quickly if a woman can adjust her position, get up and walk around. Having to lie in bed with a fetal monitor strapped around your belly not only slows labor, it makes fetal distress more likely. (Seems to me this “passive” position makes women into mere child-bearing vessels.)

It’s interesting that no one seems to think the sense of psychological empowerment that comes from delivering a baby as an active participant is worth much. I disagree; I had my first child in the hospital, and my second at home. A much better experience in every way! I got up and cooked breakfast for a household full of guests a few hours after I delivered; I felt fine. I mean, I’m not some kind of freak with an abnormally high pain threshold – I reach for the Advil as quickly as anyone.

Finally, my perspective on this is only peripherally related to feminism. I used to be a journalist and a medical writer – I approach ANY healthcare procedure or treatment from a skeptical perspective. I’m a big advocate for patient empowerment.

P.S. Oh yes, doctors DO perform C-sections to get to a golf game. I accompanied several laboring clients to the hospital we used for backup, in a wealthy suburb of Philadelphia. I’ve seen it happen.