Friday, May 11, 2007

An Ass-Backward View of the World

I had a long conversation with a friend last night. She is in her final month of pregnancy, with her first baby, who is in breech position, with her doc talking cesarean. If attempts to turn the baby are unsuccessful, she will consider a homebirth in order to avoid the surgery. I urged her to let her doctor know her thinking. Woman are often unwilling to have a frank discussion with their caregiver about their wants and desires. I reminded my friend that she selected this person (or group) and that she is paying them to be trusted partners in this process. Don't start doing things behind their backs but tell them exactly what you plan to do and why and listen to their feedback (but take it with a grain of salt- they don't have the final say- you do). I think this approach is important because it preserves the integrity of the relationship. Doctors and midwives are not mind readers. They need to know and understand what type of care clients desire, or what they don't want and why. Otherwise they'll just continue to think women are happy with the care they are getting. I also urged my friend to look at all her options. Its not just cesarean or homebirth. There are options between those two extremes. Homebirth should be the result of a move toward something you want, rather than a move away from something you don't want. I don't envy my friend's choices. The fact is, the med schools no longer teach docs how to deliver vaginal breeches. Why should they? Cesareans are the new cure for every maternal ill, and so easy (for everyone but mother and baby that it). Its absolutely unprecedented, the number of young healthy women getting cesareans. We have an entire generation of women who won't know what vaginal birth is like. This is a tragedy on a massive scale. Young women have been robbed of their births. What's so special about this generation that they can't give birth? Nothing. Its not the women that have changed- its the system. Active management of labor, manages labor right into the ground. Bogus research and outdated beliefs have set unrealistic expectations of birth. New technology has hindered and not helped the process. Litigation fears rule the birth place. Nature is not seen as kind and benevolent but cruel and deadly- a force to be thwarted at every turn. So who's really ass-backward here?


Mid-life Midwife said...

I love this piece!
You're so spot-on with your commentary.
I'm co-editor of The Birth Project, based in Michigan. You can check our website at ,
where you can request a free issue.
Perhaps you'd be interested in submitting this piece? :) It would be great in our 'zine~ which is all about options and empowering each other instead of taking "sides" in the name of birth.
We're new and poor, so we can't pay more than a free issue. But, we're getting fairly spread out across the county and subscriptions have been slowly rolling in since we published issue one in January.
Deadlines for issue 3 is June 15.
I've been reading your blog since you were maybe 36 weeks with your son, a fan of your work. :)

Laborpayne said...

Thanks midlife,
Perhaps I can submit an expanded essay for your publication. I don't mind writing just for the street cred. I like seeing the pubs I write for first though. I'll check it out online.

Pamm said...

Woah..I was a Lay Midwife from 1980-1986. I am starting to read blogs about homebirth and am shocked to hear you saying the SAME things we said twenty years ago. This is just tragic.

At the time, things were just starting to open to VBACS, docs seemed to be interested in alternatives, considering more things like vaginal breeches and such. I kinda got out of the scene for over a fifteen years, then had a grandson three years ago so am on the edges of the birthing community again. I cannot believe it!

Thanks for your work and commitment!

kris said...

that's very interesting. although i had 3 c-sections (all b4 i was on my quest to becoming a doula) when i got to my last birth i had a real heart to heart with my doc, and she listened. but i went into it feeling very much like it was me against her. and not for any reason of anything that she did, i guess it was an overall bad thought process. thankfully she was great;)

Anonymous said...

commented here months ago...jawndoejah

Sorry, I commented with this on an old post of yours...

I am pregnant with my 9th pregnancy, hopefully 6th birth. I opted for quad screen, and found out I have a 1 in 53 chance of baby having trisomy 18. My research has turned up many other possibilities with such a screen result, normal being the majority. I've had sonograms, and was ready to submit to amnio but since I won't terminate and baby looks good, the peri (over by OPRMC) said he didn't want to do amnio. We didn't, and now I'm stuck in this limbo land. I feel dumb for fearing with good level 2 sonograms, but then again want to have a birth plan. I don't want to risk miscarriage, and yet want to avoid extra intervention now that I am officially "high risk (besides being AMA and Grand Multipara...yes!). I do not know birth but hospital birth, and find that I can generally get no IV and eat and drink because I just do what I want. I fear too much intervention, or worse yet if baby has T-18, no "heroic" care because they don't give baby any chance despite the rare few that do make it longer. Ugh, this is hard.

Good luck with your article by the way...
Dawn Meisenheimer Lewis
recent midwest voices panelist kcstar

Laborpayne said...

shocking isn't it-from a historical perspective. I feel your pain, I've been involved since the eighties and I too thought things would get better. Instead I've had a front row seat to a steady decline in the world of birth.

I wish you and your baby all the best.