Apparently her patients are happy and the births she works on have good health outcomes. Nonetheless, the hospital pressured her to more than double her rate of c-sections. LAmom has the story.
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“the main concern reiterated several times was an overall practice attitude rather than any individual case.”?
Of course. They can’t deal with it on an individual basis, because that would require forcing ten percent of her patients to get C-sections. She should’ve sent these people her case list (identifying info deleted) and asked them to tell her which of them should have gotten C-sections. Thing is, they HAVE to deal with it on an individual basis in order to be fair, because that’s how she does things. SHE doesn’t take patients in 20 at a time and say, “Now I’m going to look at all your medical information, and the four with the most risk will have C-sections.” She deals with them qualitatively, not quantitatively, and so should the hospital. Her patients happen to have a lower rate of C-sections because fewer of them need C-sections, and she does not share other doctors’ deplorable habit of doing C-sections because it’s more convenient for THEM.
This has all the logic of a police department being sued for sex discrimination because all the rape cases under investigation are cases of women being raped. Or a complaint that Pepsi-Co does not serve enough Coca-Cola drinkers. Or a teacher giving an F to a student with a score of 90% because it was the lowest score in the class. Or someone saying that politically conservative women don’t account for enough of abortions.
This woman is a specialist. People come to her because they DON’T want C-sections. It is pure, malevolent stupidity to try to make all groups of life conform to average percentages. A group of honors students does not fit a standard bell curve. A group of women who really want to give birth naturally, and want it enough to seek out a specialist, do not fit the standard community who want a live baby and don’t care as much how it gets there.
C-sections are more profitable for all concerned.
This makes me wonder what the critics’ motivation is here.
Did y’all read the entire story?
Amp,
What the hospital is telling the MD is to not keep her C/S rate artificially low (based on personal philosophy) in a high risk population. It’s not so much that the hospital cares about/objects to the MD’s philosophy; their main concern is exposure to lawsuits.
I’m not about to jump on a bandwagon to support this md either without knowing some facts, which I probably will never know unless I study obstetrics. I’m skittish of natural birth at almost all costs- a silly philosophy when we consider that so many women used to die in childbirth, and still do. To say an old phrase differently than it’s usually said- women have been dying in childbirth for centuries. We’re lucky that we don’t risk our lives with every pregnancy anymore and I think that natural childbirth extremists forget that sometimes. I can think of about a dozen women who would probably be dead now if it weren’t for doctors who intervened “unaturally”.
No-one is arguing that intervention where it is medically necessary should be prevented. Intervention, when not necessary, for profit, out of ignorance or so we don’t miss the golf club dinner is less easy to justify.
Dr Sandland would be very welcome in the UK where all and sundry are trying to get our rate of C-sections DOWN!
Major surgery, with its attendant risks, and premature delivery of an infant less than fully developed are not things any sane person would advise just because “we have the technology”.
I’m rather skepticle of c-section needs in the US as well. At this point c-section is used almost as a ‘get ‘er done’ option, and many women aren’t aware that if they accept it the first go around, chances are they will be forced from there on out. In my case I was given the ‘choice’ for this pregnancy to either accept c-section (prior to any physical examination even), or potentially not be covered if I try for v-bac. It’s big business, after all. Given the multi-thousand dollar difference between a c-section delivery and a natural one, I think doctors are a bit too eager to go down that road, and wanting to pawn it off on potential lawsuits.
Ema- What’s your basis for calling this doctor’s patients a ‘high risk population’? Surely if that were the issue, she would have been warned about particular ‘high-risk’ patients for whom vaginal delivery was inappropriate. Given that the instruction was to raise her c-sec percentage generally, rather than with reference to ‘high-risk’ patients, I really don’t believe that this is an issue.
Mythago- What, in your reading, is in the whole story that would change anyone’s reading of the situation? I’ve read the whole thing and I can’t figure it out.
As one who has delivered around 6,000 babies, I’d like to make a few point.
1. We get paid around $1,800 for 9 months of care and a vaginal delivery… $2,100 if it is a c-section. (not enough to fuel the profit motive theory)
2. If a doc gets sued, the hospital ALWAYS gets sued with them because they have deeper pockets and have the duty the insure that docs aren’t doing weird things.
3. There is a direct cause/effect between malpractice lawsuits and
c-section rates. If you ever have a bad baby…. they lawyers always claim “things would have only been different if only the doctor had preformed a c-section sooner”.
4. VBAC’s will becomes a historical footnote due to malpractice.
5. Six countries now allow for elective c-section as part of their national health insurance benefits.
well……. that’s enough for now
Doktor,
Thanks for chiming in, it’s interesting to hear from someone with a different perspective. I can’t say, however, that I agree with the practice of forced vbac without even so much as a medical examination. Statistics that I’ve read give a 70% success rate of normal vaginal birth, post c-section, with the rest, barring extremely rare problems being normal c-section deliveries. I don’t think that the risk of malpractice, if the statistics I’ve read are a good rule of thumb, is enough to warrant cutting a person open versus at the very least attempting a vaginal birth.
I -definitely- can see, and agree with a need for more caution to be exercised with vbac; hospital delivery, shorter labor allowance and planned c-section if upon thorough examination the need for c-section can be pre-established as a medical condition, beyond that of ‘she’s had one before’.
It’s a very frustrating thing as a grown woman to have what in essence is economics determine whether I will have to go under anesthesia and cut open, versus have a chance at what most likely would be a normal, healthy vaginal delivery.
Greed might not be motivating doctors, but the article pretty much says it is motivating hospitals:
Other times, especially when the unit was overrun with laboring moms, she said, there was pressure from department heads to speed up labor or consider a c-section.
“Quite a lot of c-sections are being done for so-called failure to progress,”? Dr. Sandland said. “If you haven’t progressed in a couple of hours, a c-section’s waiting. There’s certainly a pressure to keep patients moving on through.”?
And why do you want them to keep “moving on through”? Because you need to keep the fancy OB ward, which you have been enticing pregnant women to use (in competition with other hospitals, birthing centers and midwives in the area), by advertising that they can have the “birthing experience they choose”, full.
That letter they sent to Dr. Sandland is a joke. She is delivering babies with a birth weight “above average.” (!) Undoubtedly the reason the birth weights are “above average” has to do with the fact that Sandland rarely induces labor and allows babies to be warn when they are ready, as opposed to scheduling them around her golf games and vacations and weekends, for that matter. Ditto as to the gestational ages being “above average.” The reason birthweights and gestational ages average as they do is that doctor almost routinely induce pregnant women, artificially lowering the “average” birth weight and gestational age.
Sorry, Elena, but I can’t agree that there are all of these women who would be dead without doctors helping them deliver. Women say this about their labors and deliveries quite often because of the traumas which result from having been (usually unnecessarily) induced and from having their labors and deliveries mismanaged in all sorts of ways. Then once the doctors and staff people have created the emergency, women are frightened into having c-sections, told they are in danger, their babies are in danger. Well, yeah, this may be true, but it is danger the hospital staff itself has put them in! I could tell countless numbers of stories of botched labors and deliveries which put the lives of women and their babies at risk or which killed them.
Women didn’t die by the droves in times past because they needed the help of doctors and the medical establishment. They died because they were in poor health to begin with, because they birthed in unsanitary conditions, because they developed infections. In this day and age, women are more likely to *encounter* unsanitary conditions and to develop infections when they birth in hospitals than in their own homes! Actually, they have been more likely to die of infections for this reason in the past as well. Thousands of women died from childbed fever, for example, in the 1800s and before because doctors didn’t know they had to wash their hands between deliveries, or, say, after they touched someone who was really sick or dead and before they strolled in to deliver a baby.
I know of nobody who is “pressured” to have natural births by anybody, but I know of many, many, many women who have been pressured to birth in hospitals, pressured to allow their labors to be induced, pressured to have episiotomies, pressured to have anesthetic, pressured to allow all sorts of procedures to be done to themselves and their babies. The women who birthed with Dr. Sandland undoubtedly chose her, more often than not, because they wanted both the experience of a midwife-attended birth (as Sandland says, she wanted to be a midwife with an “MD” after her name, go HER) and the safety of a hospital setting. Now they will have neither thanks to a male-dominated patriarchal birthing establishment which cares first and foremost about covering its ass and making sure its own policies are honored.
Women who want a woman-centered birthing experience ought to do what I and thousands and millions of other women have done for millennia with great success: they ought to birth at home with midwives. I hope Sandland continues to practice as a midwife, sets up her own birthing center, continues to make the health and well-being of her pregnant patients and their babies her highest priority, and I hope she writes about her experience, that it gets a lot of publicity, and that increased pressure is brought to bear on hospitals and doctors for their anti-woman practices and procedures.
Heart
http://www.gentlespirit.com/margins
One more thing. Mythago was probably making reference to mothers requesting c-sections. Number one, it’s unlikely mothers interested in Dr. Sandland attending their birth would be all about c-sections. Number two, we need to go a little bit deeper, yanno. The reason a lot of pregnant mothers request c-sections is, they are really scared of the pain of labor and delivery. And why are they scared? Because they hear so many women tell about their horrendous labor and delivery experiences, most of which were made horrendous by doctors. And most of which began with the really *bad* decision to induce labor in a woman. Induction is a HUGE problem. First of all, induced labors are really, really painful labors, far more painful than labors which come on in their own good time. Second of all, induced labors often go on and on and on and on interminably, because how much medicine to be given to any individual woman is always a crap shoot, so the doctors give not so much and the labor goes on and on, and the woman gets exhausted, and then either she is begging for a c-section because of weariness and pain or she is bumping up against hospital rules about duration of labor. OR the doctors administer TOO much medicine in the course of induction and the woman is IMMEDIATELy vaulted into extreme pain and dangerously powerful, uncontrollable uterine contractions (with the risk that the uterus can even be ruptured). So then she might be given medications to *slow down* her labor (!) because it is dangerous and risky, so now after all that pain she’s back to a lot of pain but not unbearable pain, and this time it goes on and on, so HELL yeah, bring on the c-section. Not to mention in all of this inducing effort the doctors and nurses are creating all sorts of high drama via endless monitoring of both the baby and the mom and she is on the edge of the labor bed in fear wondering, is the heartbeat okay, is the baby okay, why did they say that, what does that mean.
So yeah. That’s traumatic. That is a horrible, painful birth experience and mothers can believe they “almost died,” or they “would have died.” And they come out of the hospital needing to talk about it and women here that stuff and they think, “Fuck this, I’m having a c-section!” And who can blame them!
When the reality is, you know what? Birth can, does and most often will occur peacefully and beautifully and pleasurably as a continuation of the process which began right where the birth takes place: in a woman’s own bed, in her own room, in her own home. With her partner right there holding her. And a midwife who really is most interested in supporting her. Pregnancy is not a disease any more than menstruating every month is a disease. Birth is not a medical crisis; it is the culmination of the work a woman’s body has been doing in creating a child. Really, the treatment of pregnant and laboring woman in the United States is a horror story, despite how hard feminists have worked to change things.
Heart
The notion that 40 weeks is the duration of a normal pregnancy is backed up by no more studies than the notion that a person’s normal temperature is 98.6 F or 37 C — which is to say, exactly one study. I am currently pg (7 months minus a few days) and I participate in pg chat boards and am shocked at the number of babies who are “taken” between 36 and 39 weeks — in order to avoid what risk I can’t even begin to imagine. So the “average” age at which birth is taking place is probably even earlier than 40 weeks — no wonder Dr. Sandman’s babies are bigger!
I was “threatened” with induction with my second child (that’s about what it amounted to) if I went more than 2 days late and my OB prophylactically called a perinatologist to back him up so I couldn’t disagree (and spoke to my husband the entire time I was there in order to get him to pressure me as well). I went into labor normally anyway, and they still “enhanced” with the same drug used to induce, and everything said about induction is absolutely true. It makes the experience miserable, even the l&d nurse told me that. So of course you need an epidural. Which means you can’t move around or push as effectively. So of course you are likely to push for longer and end up needing forceps. It’s so predicable that I can’t blame women for staying at home and waiting until they are practically crowning to come to the hospital.
And oh yeah, I did a VBAC. It even included pitocin. And here I am to talk about it. VBACs are unsafe if a hospital isn’t committed to making them safe. That about sums it up, along with everything else: how can the hospital cut its costs and still delude women into thinking that they are looking out for their best interests. Usually, it’s by offering them “nicely appointed luxurious” birthing suites. However, that’s just a smokescreen. The real answer is, they aren’t. Not by a long shot. The c-section rate went up way before the so-called “malpractice crisis.” That too is a bogus explanation.
Heart & Barbara: YIKES!! What terrifying information, but so good that you’re passing it on as it’s vital for women to know these things.
Thanks.
How fast things change! My best friend nearly died 8 years ago because the hospital was pressuring the doctors to “go natural”, and now a doctor who has a high natural birth ratio is being pressured to do more C-sections.
I think modern medicine has done a lot to make childbirth overall safer for women and babies, but there is still risk involved. (I’m sure the OBs out there will concur.) The insurance companies are the villains here, and the doctors don’t have much of a leg to stand on because they need to be insured to keep practicing medicine. Which is why there is such a shortage of OB/GYNs in some areas, and why there is starting to be a shortage of pediatricians, too.
Lee, your friend might nearly have died from a VBAC but the overall incidence of complications from VBACs is less than from cesareans. The complication rate for VBAC is higher than it needs to be because of the other types of interventions that are being done — in particular, induction via pitocin and cervical ripening. There is simply no philosophy of “leaving well enough alone” in the world of mainstream obstetrics. Here is a summary of the evidence:
“The majority of studies report that in the rare event of a uterine rupture, if the labor was carefully monitored, the birth attendant was trained to attend VBAC births, and if the medical response was rapid, mothers and babies do well. The focus should be on improving the quality of care for women who want a VBAC, not on discouraging them because of negative outcomes publicized in high profile medical malpractice law suits.
“The Society of Obstetricians and Gynaecologists state that “maternal uterine rupture with haemorrhage and fetal compromise, or even death, occurs with an incidence of 0.1percent [1/1000].” In other words 1 per 1,000 uterine ruptures, not 1 per 1000 trials of labor.
“In a recent Swiss study of 17,613 planned hospital VBACs, the uterine rupture rate was .40% (4/1000). There were no maternal deaths, and 5 babies died as a direct result of a uterine rupture.
“The same study compared outcomes for women who planned an elective repeat cesarean and women who planned a VBAC. The rate of uterine rupture was 0.40%for planned VBACs and 0.32% for planned elective repeat operations. However, all other maternal and newborn complications (hysterectomy, complications from blood clots, infections, and neonatal transfer to ICU) were higher for women who had an elective repeat cesarean.
“Dr. Bruce L. Flamm, an eminent researcher on VBACs cautioned that if US physicians were to discourage women from planning VBACs and to adopt a policy of elective repeat cesareans, it “would mean performing an additional 100,000 cesareans every year. It is unlikely this huge number of operations could be performed without many serious complications and perhaps even some maternal deaths.”
The link, a little dated, is here: http://www.abcbirth.com/hVBAC.html
I would heartily *disagree* that modern medicine has made birth safer for women and their babies. What has made birth safer for women and their babies is women steadfastly resisting the intrusions and interventions of modern medicine, demanding the right to birth in their own way, and holding modern medicine’s feet to the fire with respect to the way it has violated pregnant and birthing women in an ongoing way for centuries. What has made birth safer for women and their babies is women educating ourselves about pregnancy and birth and about our own overall health. The risks doctors insure themselves against are far and away risks which are the creation of male-centered medicine.
Heart
Modern medicine has made SOME births safer. Those for which c-section is clearly needed — where the head cannot fit through the pelvis, for instance. Some (but not all) breech births are much more difficult and dangerous without c-section. But there are hospital practices that are unsafe and not conducive to a faster, less complicated birth experience:
1. No eating and drinking allowed (makes you dehydrated and exhausted and unable to participate as effectively).
2. Giving IVs (especially in advance of an epidural, where they force it in, or because you’re not allowed to eat and drink!) (can raise blood pressure and dilute electrolytes and various other complications)
3. Requiring a so-called lithotomy position for delivery, for convenience of the doctor (This, as well as other “anti-gravity” measures (like requiring a woman to lie in bed) prolongs labor by working against gravity and makes it impossible to push effectively and leads to an increased incidence of forceps birth)
4. Episiotomy (greatly increases the number of postnatal sexual and urinary complications due to scarring and related issues)
5. Induction (doesn’t work well if less than 2cm dilated, which leads to protracted, ineffective and extremely painful labor)
Barbara, my friend did not have a VBAC. This was with her first pregnancy and her first child. The baby’s position was not optimal (it was breech), plus the head looked a little large to pass through the pelvis when they did a detailed sonogram, so the doctor wanted to do a C-section. However, when the doctor did whatever it was she had to do to get the operating room prepped for a non-emergency C-section, the word came back that a C-section was not medically necessary and the doctor should proceed with a vaginal delivery. After about 3 more hours of labor, the doctor tried again, but was told that my friend needed to have been in labor for 36 hours before they would consider allowing a non-emergency C-section. During this entire time, unbeknownst to the doctor, my friend had developed a small tear in the placenta, which was quietly bleeding away. It was not until my friend’s vitals started ringing alarm bells that they were able to rush her in to surgery.
I agree that hospitals are not automatically superior places to give birth, but already being in the hospital when things start to go wrong is usually way better than not being there.
Cheryl:
I don’t buy it that you have never known anyone to be pressured into natural birth. Just about all women in this country who try to educate themselves a little about giving birth are pressured into doing it without any relief for the pain and many are made to feel like failures if they do take something for pain or end up having c-sections. My friend just had a baby and was extremely dissapointed at not having a “positive birth experience” because she had an emergency c-section. I told her she was a hero, and she was. There was all this dogma at her “birthing center” that tainted her son’s birth.
You’ll all excuse me for actually diferring to the expertise of obstetricians. I know enough about pregnancy and labor of my dogs to know that it is indeed a dangerous and vulnerable time, and there’s no way in heck anyone will ever convince me that having a baby at home is the safest way or pleasurable (like labor pains are “discomfort”?). I understand that midwives are in the habit of sending high risk pregnancies to the hospital, confirmed by the article that appeared in salon a few weeks ago. The pregnant woman ended up in the hospital because she couldn’t deal with the jumpy midwife who had to abdicate quickly to all signs of possible problems because she wasn’t prepared to deal with them herself. The same article implied that midwives success rate has to t
Argh, I think I need to avoid this thread. These are issues I try to put in the back of my head because I currently am ‘that woman’. The one being forced into c-section regardless of my body. The most offensive day for me in my pregnancy thus far was getting the phonecall, prior to any physical examination (just the urine test confirming my pregnancy) by one of the office managers saying I needed to agree to c-section before they would even start my prenatal care.
*sigh* so…….stressful…… :(
Kim, it doesn’t matter what you agreed to. You can revoke your agreement once you start labor. There’s not a damn thing they can do to you legally and they sure as hell can’t abandon you.
Elena, I was extremely disappointed that I had a c-section with my first daughter and it wasn’t because I was brainwashed by natural childbirth advocates. It’s natural to be disappointed even if you know, rationally, that a c-section was necessary (as I did, and I immediately agreed to it). I subsequently had a vaginal delivery (f’ed up as it was see above post) and there is nothing like it. Your friend’s feelings are valid and they shouldn’t be pooh poohed or blamed on overzealous childbirth coaches. One of the reasons these people may seem to be so strident is because they know what they are up against in the way of nurses and doctors who start trying to strong arm you into accepting all kinds of intervention as soon as you walk in the door. You have to be pretty tough and committed to resist.
Barbara;
They aren’t letting me get to labor. We have to pre-schedule a c-section date, so I don’t accidentally go into labor.
Kim, I think it’s a no-win for you, unless you manage to switch doctors. But since it’s likely the insurance company that’s forcing the whole C-section decision, changing doctors might not fix things, either.
A close friend with 4 kids kept trying to have her children by vaginal delivery, and every single time she ended up having a C-section. Her first child was breech and she was in the military at the time, so hello, C-section! She felt very frustrated that with each subsequent kid, the doctors would all tell her, “Oh yes, VBAC, no problem!” and then whisk her off to the operating room when she showed up in labor. So at least your doctor is being up front with you!
Kim, I assume from what you say that you’ve had a previous C-section? Is there any chance of finding a doctor who’ll support a vaginal birth for you? I have a friend who pretty much lost her chance to have a VBAC because the hospital she was delivering at didn’t have an anaesthesiologist available 24/7.
Believe me, doctors can be jerky even about non-VBAC births if they disagree with your choices. My (back-up) obstetrician dropped me during my last pregnancy because I was planning a homebirth and wouldn’t have the dating ultrasound (there was literally one day that I could have gotten pregnant. Can’t date much better than that).
Kim, I would try to switch doctors. Let me put this as gently as possible. A doctor who bases treatment on predetermined ideas that advance his benefit rather than yours isn’t really “treating” YOU, and whatever personal connection you have formed isn’t really that significant. He is engaging in paint by numbers medicine and if there is an alternative I would try to find it. It may not be possible. But you can always reassure yourself that you tried.
And no, to whoever said it above, health insurance companies are not pushing this, not by a longshot.
If a woman wants a C-section and knows both the risks and benefits, to her and/or to the baby, she deserves to be able to have one.
And has anyone else noticed the all-natural obsession? No preservatices in drinks, even though you really can’t taste the difference? Pianos made entirely out of high quality wood despite the fact that wood shifts according to the season, thereore making the pianos difficult to tune? Alternatice medicine that has not been proven because of the belief that because it is natural, it can’t hurt you? (Don’t get me wrong. I strongly support alternative adn traditional medicine alike. Anything that WORKS.) In other words, everything that is natural is better than anything “unnatural.”
But let’s not forget that everything at the very core is natural. Everything is made up of all the basic NATURAL elements.
Even more to the point, arsenic is natural, too. But it sure as hell aint any good for you.
Just thought I’d throw that in.
I agree, and probably so does everyone else here.
What this thread is about, however, is the completely opposite case; hospitals in effect trying to force unneeded c-sections on women who don’t want one. As I’m sure you agree, women should have their choice respected in either direction. Right?
Barbara, I was the one who mentioned the insurance companies. It’s not just certain close-minded doctors who discourage VBACs, it’s also the the health insurance companies and, more importantly, the malpractice insurance companies. If either the health insurance company or the doctor’s malpractice insurance company says that they will not cover VBACs, the doctor who is willing to assist a patient who wants a VBAC has to choose between being covered in case of a lawsuit or not. The ob/gyn practice I use asks patients choosing VBACs to sign a liability waiver statement; this may not be an option in some states.
Lucio, there are many times has a seemingly harmless intervention turned out in fact to be harmful. Most doctors won’t approve of things like dying one’s hair, taking various types of medication (including that which is clearly needed) during pregnancy, yet they endorse all of their own interventions without too much thought.
So the desire for “natural” childbirth is an acknowledgement of several important principles: First, doctors don’t really know to what extent all of these drugs affect babies. It’s probably not that much, but all interventions carry risks, and if you don’t need it you shouldn’t accept the risk associated with it.
Second, it’s a shift in –yes, let’s just say it — the power between the birthing woman and the doctor, an acknowledgement that nature designed MOST women to be capable of experiencing childbirth without all kinds of surgically and medically based interventions. I don’t give a rat’s ass if that makes OBs feel useless during most births, or even worse, if it means that they can’t have the kinds of fun that doctors have when they use needles, knives and other medical gizmos.
Lee, provide just one example of a health or malpractice insurer that is insisting that a physician not provide a VBAC. I am not saying you are wrong but I work with these insurers day in and day out and I don’t know of any.
P.S. The real catalyst for the “no VBAC” movement was the updated ACOG guidelines that require hospitals to have 24/7 anesthesia coverage in order for VBACs to be considered safe. Most of the horror stories occur in facilities that aren’t able to get an anesthetist in to help quickly enough. I happen to think that this is probably a sign that there are lots of other types of care that are provided at a substandard level of care (God forbid that you would have a traumatic injury requiring urgent surgery at such a facility) but it’s a bigger problem for pregnant women because they are more numerous. Most of these hospitals are either rural or smaller community facilities, although the attitude appears to be spreading.
Barbara, I can’t list specific companies because I never needed VBAC myself, I just know what my ob/gyn practice does and the reason for it they gave me. It could be that the ACOG guidelines are the real reason and they just thought it was simpler to say it was the insurance companies.
I am disgusted by the anti-doctor bias on this thread. If I were to believe everything written here, I’d believe doctors and nurses were out to hurt me and my baby all because that way they get more money, or else get to go golfing sooner. Or something else- how do these anti-obstetric people explain their belief that medical professionals have bad intentions? The irony is that the natural birth movement or whatever it calls itself is just as full of bullies and prejudice as they accuse the medical profession of being. Now it’s not enough to give birth in extreme pain without relief, you have to do it without a doctor, no backup and at home. Otherwise, you’ve bought into the medical profession’s pack of lies. Motherhood as martyrdom, indeed.
I am all for educating oneself about childbirth, and for taking a little control, but advocating for patients to distrust their doctors is disastrous. It is also unethical, in my opinion.
Elena, I do trust my doctors and I sincerely believe that they (there are two) believe that they are doing their best. However, there are too many studies that show that there are many routine obstetric and obstetric related practices that are not only not evidence-based, but that are actually contradicted by evidence based studies. To list a few: routine episiotomy (a form of genital mutilation that becomes apparent if you’ve had one); no eating and drinking during labor on the off chance you might need general anesthesia; and the notion that c-sections are “safe enough” which is equated with being as safe as vaginal birth. Other risks are downplayed (like the risks and consequences of epidural and induction). You can be as disgusted as you want to be but there is no reason why women should not be aware that many standard obstetric practices are questionable. If that’s viewed as anti-doctor bias then so be it.
Thank you, Elena. It also is insulting to women who had c-sections as a medical necessity, and Cheryl, if you are going to make claims about modern medicine being “anti-woman” or not working to prolong and enrichen the lives of many, many people, please provide some statistical backup to show how quality (modern medicine) health-care has increased pre-natal or post-natal death, or made women’s lives worse.
Of course I agree that no woman should be forced to have section against her will, but the attitude “you must have a baby via natural means instead of c-section, or else you aren’t as mother as the mothers who go through vaginal birth” is bigoted. Besides, the “natural” argument kind of sucks. Humans are part of nature by virtue of being biological organisms, so please drop the “but’s that not natural!” arguments. Human nature is to be inventive and think up new solutions.
Vaginal birth, btw, is safer on the average, but in some cases c-section is simply better and safer. And yes, women do die on complications arising during child-birth, if it is a safe, wonderful experience for many it doen’t mean that it is the best, or even viable option for some women.
It does seem, though, that american hospitals are unnecessarily pushing for more c-sections, for unmedical reasons. This is far from good medicine or scientific, rational approach. What needs to be done is evaluate women on invidual basis taking into account the differences between inviduals.
Ampersand,
No woman should be forced to have a C-section.
Bean,
And show me just how drink preservatives are so unhealthy that do drink them is a wish to die. Show me that by attacking someone who had done nothing to harm you that you are so much more in the right than I am.
I rest my case. Thank you for proving my point.
Tuomas, basically I agree with you, but if you look at what happened to medical care from the 1950s forward until women began demanding better treatment, I think it is possible to make an argument that medical care was, if not anti-female, suffused with with the arrogant belief that medically imposed procedures were in almost all cases superior to natural processes. Women were actively discouraged from breastfeeding (my mother and my mother-in-law, who gave birth in two very different places in the country, are both adamant that this was in fact the case). Women were in some cases actually strapped to delivery tables and forced to lie down. Husbands and any other personal helper were banished from the delivery room. Babies were not permitted to room with their mothers.
And finally, they were and in some places are still routinely subject to episiotomies on the theory that a “natural” tear would always be worse than a surgical cut. Can you imagine an entire profession ignoring study after study showing that a surgical incision with a high risk of sexual and urinary dysfunction was almost always unnecessary if the recipients of the incision were male? What does that say about the value placed on female sexuality?
So, yes, the situation has improved considerably since the early 1970s, when women basically rebelled. But all too often, the changes have been cosmetic only — the nicely appointed birthing suite — while there is still a core belief that medical intervention is best in spite of evidence to the contrary.
P.S. I had a c-section because my baby needed for me to have one done. I would have smacked anyone who tried to make me feel guilty. But that doesn’t mean doctors don’t have a responsibility to ensure that interventions are necessary, even if no woman should be made to feel guilty for accepting an intervention that was portrayed as necessary, falsely or not.
Frankly, I won’t listen to anyone talk to me about the evils of the mecical profession. I have a chronic illness, and by that time two years ago, which changed my life, I had kept it a secret for almost two years. By that time, my condition was one of the most severe that my doctor had ever seen. They promoted a “less invasive” meothd of treating me, but also, they gave me the option of surgery, which was likely to be “more efective,” i.e. faster, and continue with medication after that. That was all they said. No one told me, “Have surgery or you will never be treated.” Nor did they throw the “natural-ness” of the former option in my face. I loved my doctor and regret never having had the chance just to thank him.
I chose the surgery. Iwas thirteen at the time-yes, I will be sixteen in Sept.-moving on with a busy life, in constant pain, and was simply not going to put up with that crap anymore. Besides, I had already tried numerous “less invasive strategies,” and they didn’t work as well as I wanted them to. I have NO PROBLEM with anyone who chose to go that course, but it just wasn’t right for me. But I know someone who thought it was-and she was my mother. She was so angry that I had not gone with the “better” option that she refused to speak to me the day of my sugery and for some time the next day. I had “shamed” her. Now, I have to take the birth control pill to avoid having periods because they make me sick. Plus, I just find them inconvenient, and I don’t want to get pregnant, thank you very much, but that is not the point. So please do not bash me for thinking my menses is a disease, because in my case, it is.
Personally, I can’t wait to have a hysterectomy, and some other changes, because I am transgender. Am I less supportive of the rights on women because I don’t entirely want to be one?
Once again, don’t get me wrong. Every woman has the right to decide how, when, and where she delivers, to have medical staff that support her, to be informed and given a balanced view, and so forth. We all have that right in whatever health care we get. I commend those who support that. What infuriates me is those comments by people who pass judgment on those who, for whatever reason, chose not to take the “natural” route with out knowing about their situation, and shooting their mouths off about the people who refuse to promote only those interventions that fir within their “natural” doctrine.
As for the actual story, like Elena, I refuse to comment abotu this M.D. or her situation, because I simply do not have all the facts, and lately, I have become so distrustful of most of my news-some of which are actually propaganda-sources that being informed has become that much harder.
Interesting to come back to this today. I don’t think anyone is pressing for no c-sections at all, but come on, are you folks saying you don’t believe me when I talk about the phone call I received? Are you saying that is responsible medicine that is respectful of women? It’s a reality for me three months from now, and it’s frightening and overwhelming in the sense that my medical choices are so out of my hands.
Because I don’t want to have more stress, I’ve chosen the path of least resistance, but I did attempt to put up a struggle in the beginning to basically no avail. They said they would send me off with a recommendation of VBAC performers, which are few and far between in Portland. It also would likely affect my insurance because prior to ANY PHYSICAL CONSULTATION AT ALL THEY WERE STATING I NEEDED SURGERY. Their diagnosis was based on the fact that I had a c-section with my first daughter.
So anyways, excuse my lack of complete confidence that the Doctors only have MY CHILD AND MY BEST INTERESTS at heart. This is why I need to avoid this thread.
You’re transgender, and you still see no reason to be a little, I dunno, wary of the medical profession? None whatsoever? No problem with people like John Money, say? No problem with the earlier versions of the HBSOC, or with the current one? Never encountered a therapist, counsellor, doctor, or surgeon who sees a transgender patient as a collection of stereotypes and nothing else? Never been billed, but not treated? Never been excluded from demographic healthcare? Never been treated to negligence, ignorance, or heuristic bullshit from a healthcare-provider? Never had trouble getting a gynecological exam or STD test? Never had a doctor insist–just to take a common example–that every ftm absolutely must have a hysterectomy at the earliest possible opportunity?
Wow. Lucky you.
Piny, I’m fifteen, not even out yet, and nowhere near the gay community. (That is rural America for you.) Not to mention that the scenario I was discussing doesn’t so much as creep into that issue. So, actually, yes, I have no problems. And did I ever once say that there is nothing wrong with some aspects and definitely a few more people within the medical profession? Read the next to last paragraph. No, I did not say anything of the sort, and I would appreciate it if you did not treat me in such a condscending manner that you think I am just stupid and unaware of the issues with my own community and self and that I am simply laissez-faire when in comes to action.
Kim,
If you want a VBAC, then have one. Do you feel in danger by not having a C-section? Is VBAC really what you want? Do you have the means and support to change doctors or maybe put up just a little more of a fight? You should! Most of the medical profession, I think, is a real blessing. I have never once-yet-encountered an asshole doctor, except for this one whoel clinic that refused anyone under the age of 18 to be alone in frigging doctor’s office to talk to the nurse. I lied to the nurse that day, because my mom was in the room and I did not trust her.
But that is not what this is about. I just don’t think it would be wise for ANYONE to push away possible allies-in traditional or alternative medicine. If it works, or feels good, do it.
Lucio,
Piny is your community. He speaks from experience, not patronization. As for ‘just have it’, it’s not as easy as all that. It’s expensive (additional costs due to additional caution), and my insurance is Oregon Health Plan because I’m a student. You’re viewing this from a limited perspective of not dealing with beauracracy, as well as disregarding the fact that stress and a huge all out battle and worries over money is the last thing that a pregnant woman wants to have facing them down 3 months prior to delivery.
And while I appreciate your contribution to the thread, and I know you’re going to hate hearing it, your 15 years ‘never once yet encountered’ analogy is lacking in practical experience both overall, and economically. People aren’t pushing away allies, but instead questioning motives, and this is an absolutely legitimate thing, and I can tell you that from first hand knowledge and experience in this particular topic.
Barbara;
You suggested I consider trying to push harder for VBAC as well – I had considered it – went through a few months of agonizing the decision and then realised that due to me being high risk for c-section anyways my health and the babies health would be far better off with me accepting the situation and not letting this stress play a huge factor through the pregnancy which could cause problems of its own. I weighed my options and came up with this decision for a few reasons: 1) my mother and grandmother both had c-sections at a time when they were less common 2) I’ve had a c-section before 3) I have an anterior placenta with this baby which at times can end up blocking the birth canal.
I can say that it’s definitely colored my view of the birthing process and business though.
Why you had a c-section previously says alot about whether you’ll need one again, and if it’s likely you’ll end up having a c-section anyway, then you are almost certainly making the right decision. There’s never any way to know for sure and you shouldn’t beat yourself up about it or carry added stress that you definitely don’t need.
Piny,
I am sorry about that last comment. I should not have said anything without really knowing.
And Kim,
No, I do not hate hearing that I have limited life experience in some areas. I know that I do, and I just have to say I am damn lucky that I live in a state as great as New Hampshire. Plus, the last thing I wanted to do was attack anyone who did have a sucky doctor. But I do think that there are some, as Elena said, “natural childbirth extremists” here on this blog that I really wonder about.
Ot maybe I just misunderstood some of the people’s posts here. If so, sorry for that, too.
This thread is full of women who have said, “I was forced into a surgical procedure I did not want which may not have been necessary,” and some women who have said, “I was forced into a surgical procedure I did not want which was almost certainly not necessary,” and many, many other woman who have said, “I have encountered a great deal of pressure to undergo this surgical procedure I don’t want regardless of its necessity.” And then, of course, there’s the story of the doctor who was fired for having lower c-section rates, with no attention paid to the health of the mothers in her care.
So, yes, coming onto this thread and acting as though the people commenting about fear, mistrust, and episiotomy studies have some spurious blame-the-evil-doctors hair up their butts is indicative of some pretty serious bias and lack of awareness.
These women are not a bunch of orthorexic hippies with a fear of sterile needles. Technology is not the problem, nor is it what anti-unnecessary-c-section people are afraid of. Nor is this an issue of a few bad apples, individual doctors who insist on c-sections for a few patients who don’t need them. It’s an industry-wide problem, involving institutional pressure on most if not all women, that has resulted in a higher likelihood of c-sections for all women. “The medical profession,” in other words, does not refer to physicians as opposed to osteopaths, or to obstetricians as opposed to midwives. It refers to the professional conflict of interest between treating individual patients well and upholding a generalized, profit-driven standard that cheats them.
You will encounter this conflict as you transition and as you live your life as someone with a new medical condition–your available treatment options are affected by it, the information that informs your choices is affected by it, and the doctors who treat you will be no less vulnerable to it. Of course this doesn’t mean that milk thistle is a substitute for regular blood tests, any more than this termination means that the AMA is a worthless entity. But this is not the same thing as refusing to drink pasteurized juice out of a vague phobia of “preservatives.”
But this is not the same thing as refusing to drink pasteurized juice out of a vague phobia of “preservatives.”?
I know that. I was talking abouta general trend toward a dislike of anything considered unnatural.
>>Piny,
I am sorry about that last comment. I should not have said anything without really knowing.>>
Oh, look, an escalatory cross-post!
Don’t feel bad. There’s really no way you would know. And I get royally pissed off, too, with people who insist that surgery=mutilation, testosterone=dangerous drugs, or my lesbian therapist=John Money. Plus, I’m trying to break the habit of outing myself to people just to win arguments.
And I don’t want to sound patronizing even _as_ a transperson–I’ve encountered that myself, too, particularly around medical issues.
It’s just–this isn’t like how John Travolta’s kid got botulism because Travolta refused to allow anti-bacterial soap to touch the household produce. Unnecessary VBAC’s are something that most women deal with at least as a threat, along with a host of other reproductive horrors. It’s true that there are some crackpots who think that we’d all be better off treating clinical depression with dandelion tea, and that no one should ever give birth in a hospital, but they’re a small minority.
Make that “delivery-room horrors.” I don’t want to sound like I think pregnancy is a disease.
Tuomos, Elena (and others): a couple of books for your libraries, if you really are interested in answers to the questions you’ve posed and responses to the challenges you’ve issued:
MalePractice: How Doctors Manipulate Women, by Robert Mendelsohn, M.D.
Also, Confessions of a Medical Heretic and How to Raise Healthy Children in Spite of Your Pediatrician by the same author, who was incidentally the chair of the American College of Pediatricians before his death.
The Hidden Malpractice: How American Medicine Treats Women as Patients and Professionals by Gena Corea.
Witches, Midwives and Nurses: A History of Women Healers
by Barbara Ehrenreich & Deirdre English
How the alliance of the Christian church and patirarchal medicine deliberately and systematically suppressed female healers and the harm to women as a people
Gyn/Ecology: The Metaethics of Radical Feminism by Mary Daly, Chapter 7, “American Gynecology: Gynocide by the Holy Ghosts of Medicine and Therapy”
And if you read those and want more, I can provide you with titles.
Heart
Wow, Piny, I was very wrong about you. Thank you very much for clearing that up, and I think I’m really going to enjoy blogging with you.
Anyway…this is a bit off-topic, but I saw the website, LAmom, and I’m glad that at least she is a liberal pro-life person. I am pro-choice, obviously, but I am more than happy to work with anyone who generally considers themselves liberal. I think it is partly because I trust them not to have paid them to completely spin the story, like the Bush Administration does!
Heart,
Thanks, I’ll check my local library for those (or, I’ll put a note to do that in the autumn when the wonderful summer has ended). I try to keep an open mind. A random thought occured to me (and I’m surprised I might have such “Marxist Feminist” thoughts, or judge yourself, here comes): I am a big proponent of consevative medicine (not on conservative-liberal axis, but conservative-invasive axis), like using surgery only as last resort, avoiding strong medications etc. preferring instead to empasize rest, healthy life habits and less dangerous medication.And could it be, that in America where medicine indeed is male- and market-dominated, and thus is probably dominated by ideas of aggressivity, penetration, invasiveness, competition and dominance,unlike scandinavian countries for example, where medicine is more equal field of men and women and society-driven, and less invasive, more passive and caring procedures are preferred? (Disclaimer: I absolutely refuse to believe that men are necessarily more aggressive, and women more nurturing, but such is the way people are raised in many [almost all] cultures, thus “masculinity” is paired aggressiveness and dominance, and “feminity” with passivity).
Some other thoughts on the issue (some have been mentioned by others): I see several motives why doctors would prefer more technology-oriented or “unnatural” procedures.
1) Some patients believe that the more expensive and complicated a procedure is, the better, thus creating market-demand for more involved procedures (this would include, “look our hospital makes many c-sections, we’re not like some cheapskate hospitals that don’t”) Of course, this is FAR from truth, as more complicated procedures usually risk more complications (for example, many patients would like to have total anesthesia for even small operations, but knowing that the risk of compilications a responsible doctor would advice against it.)
2) More money involved. This is obvious.
3) Gaining experience on these operations. Again, very irresponsible to use some patients as practise dummies when not medically warranted.
4) Using average percentages, to justify doing operations just to keep up with supposed quotas. This is faulty logic.
Some years ago, on my health economics class I encountered a hypothesis: Privatized healthcare (where the patient pays) has a natural incentive to over-treat patients, while public health care (where the government or similar organization pays) has a natural incentive to under-treat. On public health care, I must point out that the nurses/doctors aren’t actually the ones who manage the finances, so I’m not sure if this theory works so well on that system.
But the issue I had with your comments is, in a nutshell; methinks you paint modern medicine with too big brush. Scandinavian countries are world leaders on many health issues, especially women’s and children’s health. And we do use and trust modern medicine a lot (this is one contributing factor), however, it is more tailored to meet the needs of patients and society. Also, more equality on many issues is also a positive contributing factor. (Disclaimer, I’m not saying this as “our system is perfect”, of course there are many problems that Scandinavian countries face in terms of equality and healthcare.)
Of course my long post was a bit off-topic, maybe. But the point is: Unnecessary surgery is an antithesis of doctor’s ethics and a doctor who does that is not only unethical, but in fact incompetent. Necessary surgery is not.
(and typo fix: empathisize, not empasize)
Amp, I thought the thread was about a hospital not wanting an OB who had a low rate of C-sections. That is a different question than “forcing women to have C-sections.”
I started off my first pregnancy wanting to ‘go natural,’ being highly suspicious of the medical profession, and learning about the natural-birthing movement. And anyone who claims that childbirth is only painful, scary and dangerous because doctors made it so is welcome to kiss my *entire* ass.
I got very tired of bad science and scare tactics and distortions. I was injuring my eyeballs rolling them at people who said “You have an OB…instead of a *midwife?!?!” And don’t even get me started on the outdated insistence on what “hospital practices” are always like. There was the midwife who called me a sheep because I preferred to give birth at the local hospital’s comfortable, nurturing birthing center instead of my cramped high-rise apartment (you know, “at home”).
>>Amp, I thought the thread was about a hospital not wanting an OB who had a low rate of C-sections. That is a different question than “forcing women to have C-sections.”?>>
Didn’t we just have several discussions about how allowing pharmacists to refuse to prescribe birth control results in fewer options for women? And how there’s no reason to believe that there will always be BC-prescribing pharmacists available nearby or at all?
They aren’t being operated on at gunpoint, sure, but this certainly makes it more difficult for them to find doctors who prefer alternative means.
piny, that’s yet a third discussion, and one which I agree is an effect of this doctor resigning. It’s not the same as the hospital “forcing women to have C-sections.”
tuomas, the public/private split seems backwards to me. If you know the public fund will pay for whatever treatment you bill, that’s an incentive to overtreat; whereas if your private insurance company kicks back to the doctor if they limit the number of procedures ordered, that’s an invitation to undertreat. In other words, it depends on the incentive structure.
> Amp, I thought the thread was about a hospital not wanting an OB who had a low rate of C-sections. That is a different question than “forcing women to have C-sections.”?
It isn’t a _very_ different question, surely? Ultimately, for most women, the decision as to whether she will have a c-section is in her doctor’s hands. If the doctor says that it’s medically necessary, most of us don’t have the training or knowledge to disagree. You let the doctor do what she says is necessary, and thank providence that you live in the 21st century with modern medical care. If it wasn’t really imperative in your case, you’d never know.
So if you would strongly prefer not to have a c-section (just as a purely personal, one-person choice, not trying to oppress anyone else), your only way to act on that preference is to select a practicioner who assures you that she will treat a c-section as something to be resorted to only when absolutely necessary, and will try other options first. If such practitioners aren’t allowed to practice, then there is no way to act on that preference.
I’m sure the natural childbirthing community can be hideously annoying — most communities can — but their annoyingness isn’t the issue in this case. No one here is trying to keep anyone from getting a c-section who wants one, or from working with an interventionist practicioner who wants to. We are (or I am) regretting that the hospital has shut down a low intervention option for those women that wanted it, and has done so with no obvious medical justification.
There is a difference between deliberately attempting to force women to undergo surgery, and a decision in the interests of avoiding malpractice which has the side effect of limiting women’s choices at that hospital. Neither is good. But they are not identical.
I’m sure the natural childbirthing community can be hideously annoying … most communities can … but their annoyingness isn’t the issue in this case.
It seems rather lopsided to say that discussion of the evils of medical birthing practices are relevant, but similar discussion of ‘natural alternatives’ is not–especially when part of the debate is whether the physician’s low C-section rate is good medical practice.
Mythago:
Yes, the “rule of thumb” is quite invalid because it depends on too many things. But public health care system wants to undertreat, assuming it is a homogenous organization, as there is no clear profit for the system.
Absolutely, this was my objection to the rule (sort of).
Never thought it that way. But you are right.
mythago, there is almost no way to avoid institutional medical imperatives unless you are willing to forego all organized medical treatment. Midwives must be backed up by physicians and all physicians must have access to hospitals. I participated in a disciplinary hearing in which a physician was nearly kicked off her medical staff for not requiring the midwives she backed to require more of their patients to be referred for c-sections. So this post really struck a chord with me.
I had a c-section, no one will convince me that all natural all the time is an appropriate attitude, but I do not accept that the possible risk of a malpractice suit is a valid justification for ignoring the results of studies on the actual risks in specific patient populations of undergoing — or foregoing — a given treatment. And when the specific treatment being pushed happens to coincide with the convenience and economic interests of the OB, the anesthesiologist, and the hospital, well yes, call me suspicious.
>It seems rather lopsided to say that discussion of the evils of medical birthing practices are relevant, but similar discussion of ‘natural alternatives’ is not”“especially when part of the debate is whether the physician’s low C-section rate is good medical practice.
Well, personal annoyingness hasn’t got a _lot_ to do with figuring out what is good medical practice (What would the argument look like? Dr. Sandland should have been censured because whiny hippies who talk about the magicalness of birth irritate me?)
What I see as the central questions are: Is Dr. Sandland’s c-section rate compatible with good medical practice? If it is, how can the hospital be regarded as being justified in instructing her to change her mode of practice to one that produced no better results medically, and was contrary to what her patients wanted?
To the first question: we’re all working off a newspaper story that’s clearly sympathetic to her — maybe she was committing malpractice right and left, and North Carolina is littered with the injured children that resulted. If that’s true, certainly what the hospital did is justified. If the article is reliable, though, her results were as good as any other doctor’s. There’s nothing intrinsically improbable about that — while I haven’t looked at the stats in awhile, entire countries have had c-section rates close to 10%, with outcomes as good or better than those in the US.
To the second question: If that’s the case — her methods aren’t unprecedented, and have reliably produced good results, they’re just unconventional by North Carolina standards — then I can’t see another way to look at what the hospital did than to consider it an unacceptable infringement on her autonomy and that of her patients. The malpractice suit fear, in light of a decade of past good results and happy patients, seems entirely misplaced.
What I see as the central questions are: Is Dr. Sandland’s c-section rate compatible with good medical practice?
Exactly. The issue about ‘natural childbirth’ isn’t whether it’s merely irritating, but whether it’s good medical practice. I don’t see how a medical approach rooted in the idea that any pain, fear or danger from childbirth is largely due to doctors is good medical practice.
I don’t agree that the hospital is ‘misplaced’ in its concern about malpractice; you could argue that they should look at factors other than the numbers. We don’t know from the article. I’d bet money that I know exactly what the hospital’s legal department was imagining: having a hospital administrator on the witness stand, facing the question “So you *knew* this doctor was extremely reluctant to perform C-sections because she thought of herself as a midwife with OB credentials?” Or “So isn’t it true that you let this unorthodox medical practice continue because many patients thought it was ‘healthier’ and that brought in money for your hospital?”
As you say, I don’t think we have enough information to be sure what was really going on here. Maybe the hospital had concerns about her practice other than the 10% rate. Maybe she is a great doctor who was the victim of paranoia about malpractice. Can’t tell from the article.
>I don’t see how a medical approach rooted in the idea that any pain, fear or danger from childbirth is largely due to doctors is good medical practice.
Attributing this attitude to Dr. Sandland, or to anyone else, because they’re concerned about the rate of unnecessary c-sections is unwarranted, don’t you think? I, for example, think that the rate of c-sections in this country is unnecessarily high, but I certainly wouldn’t say that labor pain can be blamed exclusively on doctors, nor that modern medicine doesn’t save many lives in child birth. You’ve erected a straw man here.
With respect to malpractice: taking the article at face value, the hospital couldn’t find any particular cases to second-guess her on as cases where she should have done a C-sec and didn’t. It doesn’t sound as though her methods were particularly unorthodox on a case-by-case basis. I can see why an administrator would think just what you describe, but in the absence of any evidence suggesting that Dr. Sandland was any more likely to commit malpractice or to be sued than any other doctor, their decision looks illegitimately cautious to me — they don’t appear to be at any genuinely greater risk of a big judgment from her than from any other doctor. It’s the hospital’s money, they can make decisions with it, but I can, and do, disapprove.
>Maybe the hospital had concerns about her practice other than the 10% rate.
Anything’s possible.
>Maybe she is a great doctor who was the victim of paranoia about malpractice.
But this looks more likely.
Mythago;
Two things, first, the whole good medical practice really needs to be tempered with remembering it’s invasive surgery we’re talking about here. I’m far less worried about the whole ‘natural’ element, and more affronted and boggled at the idea of giving carte blanche permission to doctors and hospitals to say ‘you get a c-section’, without so much as a physical because of a prior surgery. It also takes away a patients rights of informed consent with regards to reliable insurance.
Second, this concept matters very little to someone that isn’t thinking about litigation, but instead just a healthy child-birthing experience, that is suddenly faced with bodily autonomy being something people discuss around you, and not with you.
>>I’d bet money that I know exactly what the hospital’s legal department was imagining: having a hospital administrator on the witness stand, facing the question “So you *knew* this doctor was extremely reluctant to perform C-sections because she thought of herself as a midwife with OB credentials?”? Or “So isn’t it true that you let this unorthodox medical practice continue because many patients thought it was ‘healthier’ and that brought in money for your hospital?”?>>
Considering the publicity and the potential for complications from c-sections, their decision could cause the exact same problem in reverse for any other obstetrician at the hospital. “Bring your c-section rate into line with our averages, or lose your surgical privileges,” is pretty good evidence for someone trying to prove she was given an unnecessary c-section, don’t you think?
You’ve erected a straw man here.
Uh, no. If you scroll up, at least one poster has criticized the hospital’s decision on that very basis.
But this looks more likely.
How so? Because we don’t like the hospital’s decision? As you’ve already said: we don’t have much information, other than Dr. Sandland’s resignation and the article’s discussion of how doctors lean towards C-sections, sometimes out of fear of litigation and sometimes because their patients want them. I’m not willing to tag one as ‘possible’ and the other ‘more likely’ based on one sympathetic news article that has little information from the people involved.
but in the absence of any evidence suggesting that Dr. Sandland was any more likely to commit malpractice or to be sued than any other doctor, their decision looks illegitimately cautious to me
I’ll repeat myself: the issue is not that Dr. Sandland is more dangerous than another doctor, although perhaps the hospital administration thought she was. The issue is that if there were a lawsuit, the hospital administrators would have to explain why they knew about yet did nothing to intervene in her disinclination to do C-sections, and why they permitted a maverick physician to make choices not in tune with standard medical practice.
Perhaps their concern was overblown–but I doubt that, as some posters have suggested, it was motivated by greed or a sinister desire to meddle in the natural process of childbirth.
Kim, did I miss the part where women were not even given a prior physical for non-emergency C-sections in that article?
“Bring your c-section rate into line with our averages, or lose your surgical privileges,”? is pretty good evidence for someone trying to prove she was given an unnecessary c-section, don’t you think?
Do you think that doctors are often sued for performing an unnecessary C-section? Unless the child is damaged, it’s going to be very hard to show that the doctor should have let the birth proceed vaginally and everything would have turned out better.
Look, I’m not rah-rah about C-sections or the hospital’s decision; but knowing about how doctors think about medical malpractice, their decision doesn’t look sinister. It’s possible it was a stupid decision. (It’s possible something else is going on.) We don’t, IMO, have enough information to throw stones either way.
Ahh, I was referring to my situation, Mythago. Which is part of how the whole forced c-section issue came up. I had commented on this being (as I understand it) pretty common in Portland, and definitely the case with me. The conversation seemed to be trending a bit to ‘well doctor’s wouldn’t do it if it wasn’t a necessity’, which unfortunately just isn’t the case, from my personal experience.
Mythago: I don’t see how a medical approach rooted in the idea that any pain, fear or danger from childbirth is largely due to doctors is good medical practice
Lizardbreath: You’ve erected a straw man here.
Mythago: Uh, no. If you scroll up, at least one poster has criticized the hospital’s decision on that very basis.
If you’re referring to me, I haven’t done that at all. I have said that the risks doctors insure themselves against are risks they have created by their own practice and policies. I’ve also said that doctors and hospitals are not the ones who have made childbirth safer for women, in general, *women* have made childbirth safer for women.
And you (and others) have certainly created and argued against straw men consistently here, from the first time someone came in shouting about all those women who bully other women to have natural births. From the time someone started arguing with all the invisible people here who are touting all-natural-all-the-time-is-the-highest-good — which nobody here has said or inferred or hinted at even once.
Which is why I’m not bothering to engage besides suggesting a few of a huge list of books which could be read on the subject. I am not interested in arguing points I’ve never made or refuting positions nobody is taking, just because somebody wants to vent their spleen because once somebody they know got her feelings hurt when the suggestion was made that natural birth might be a good thing. Which made her the forever-phantom-bully invoked in these arguments.
I have also never said there was no pain in childbirth or that doctors created all of the pain in childbirth. I’ve barely talked about that issue at all.
I am just wanting to clarify what I *did* say in the event someone thinks she is arguing against what I said, or responding to it, or something. What I see here is you, Mythago, and others, arguing against positions nobody has taking, tilting at windmills. That is pretty much what always goes down in this kind of discussion, so useless.
Heart
>knowing about how doctors think about medical malpractice, their decision doesn’t look sinister. It’s possible it was a stupid decision.
Does it have to be sinister for it to be a very bad, lousy, messed-up decision that should be publicly commented on with disapproval in the hopes that similar decisions are made differently in the future? I doubt the hospital has a fiendish plan to come after innocent healthy women with scalpels — you’re probably right that they think they’re covering their ass from malpractice liability. They appear, however, to be doing so stupidly, and in a way that insures that at least some women who don’t want c-sections, and who don’t actually need c-sections, will nonetheless get them. I strongly disapprove.
And on the strawman point — the only person whose medical practices we’re talking about here are Dr. Sandland’s. In the absence of any indication that _she_ believes that doctors are the devil and childbirth would be a mystical pain-free experience if laboring women would just click their heels together and think about dolphins, saying that such beliefs are bad medical practice is a strawman.
>>I am not interested in arguing points I’ve never made or refuting positions nobody is taking, just because somebody wants to vent their spleen because once somebody they know got her feelings hurt when the suggestion was made that natural birth might be a good thing. Which made her the forever-phantom-bully invoked in these arguments.>>
Actually, Mythago’s experience was firsthand, and the things said to her were much more unpleasant and most definitely grounds for taking offense.
So you might want to read what other people have really said about what they’ve really been through before you start squealing about strawmen.
Well, sure, if were were talking about how natural childbirth advocates should be politer. In the context of whether the doctor in the story practices medicine responsibly and with good outcomes, attributing the beliefs of the most extreme natural childbirth advocates to her (particularly given that she sections 1/10th of her patients) is a strawman.
> If you know the public fund will pay for whatever treatment you bill, that’s an incentive to overtreat
Mythago, that’s assuming that the decision on treatment are taken entirely and exclusively by the patient. You can’t just go up and ask your doctor or state hospital to provide you with anything you want. It has to be justified because it’s about spending taxpayers’ money, it’s about using limited public resources, not clogging up the system, etc. In the absence of widespread corruption and fraud, any moderately efficient public healthcare system such as the one Tuomas was talking about will tend to avoid unnecessary procedures much more than a private hospital where it’s only your own money that counts.
In terms of elective c-section, that’s a different story of course, no matter if the system is public or private, any woman must have the right to choose that option even when it’s not considered strictly ‘necessary’ for her health or the baby’s. I definitely agree c-sections shouldn’t be pressured or forced, but like you said there can be too much of a tendency to idealise ‘natural’ childbirth.
(Also, assuming the decision is well-informed, there is another reason for elective c-section aside from the legitimate desire to avoid pain and risks: the desire to avoid stretching and tearing and other disruptions to a woman’s sex life after birth. I hope that no one thinks it’s a taboo or a frivolous reason.)
Cheryl, I didn’t read mythago’s comment as a straw man, I also got the impression you were indeed attributing the painful aspects of childbirth to hospital delivery – you said most women who choose c-sections are traumatised by horror stories like those you described in hospitals, and those are the “horrible, painful experiences”, then you said the reality is that “birth can, does and most often will occur peacefully and beautifully and pleasurably as a continuation of the process which began right where the birth takes place: in a woman’s own bed, in her own room, in her own home. With her partner right there holding her. And a midwife who really is most interested in supporting her.”
That does sound like an idealised view where pain is not even factored in. I have never seen that scenario (without any drugs?) except in films.
In the past, especially if you were poor, giving birth at home was the only option, not some ideal. Now there are more options, and I don’t think it’s realistic to treat it as a matter of horrible hospital delivery vs. beautiful home birth.
I don’t believe in one-size-fits-all solutions and I think it’s definitely a good thing for women to be more confident about pregnancy and childbirth and to avoid excessive medicalisation of it, but it won’t be a pleasant, peaceful and beautiful experience just because we want it to be. Especially if you’re supposed to do without any medication for the sake of doing it the ‘natural’ way.
Mythago, that’s assuming that the decision on treatment are taken entirely and exclusively by the patient.
I wasn’t making that assumption. That’s why I noted that there are competing forces; it’s not as simple as private = good care and public = bad (or vice versa).
Which is why I’m not bothering to engage besides suggesting a few of a huge list of books which could be read on the subject.
You did engage, actually. It’s rather dishonest of you to disavow your own words, post a counterattack and then claim you’re “not engaging”. “The reason a lot of pregnant mothers request c-sections is, they are really scared of the pain of labor and delivery. And why are they scared? Because they hear so many women tell about their horrendous labor and delivery experiences, most of which were made horrendous by doctors. ” That’s you, not a strawman. (I particularly liked the attack on doctors for not washing their hands back in the 19th century. Midwives didn’t know about germ theory, either. It was a male doctor, btw, who introduced the practice.)
Does it have to be sinister for it to be a very bad, lousy, messed-up decision that should be publicly commented on with disapproval in the hopes that similar decisions are made differently in the future?
Nope. But it would be nice to have a little more information before decidint that the doctor is clearly a shining beacon of good medical practice and the hospital administrators are merely stupid.
Hmm. I’m pretty comfortable with saying that if, as represented by the article, the doctor does not have an elevated rate of maternal or neonatal mortality or morbidity over the decade she has been practicing at this hospital with this c-secton rate, then the hospital administrators are making a bad decision, and holding in abeyance the possibility that she’s leaving a trail of mutilated children behind her until anything at all that suggests that might be the case comes out.
There’s no evidence whatsover suggesting that there’s anything wrong with the doctor’s practices, other than that her c-section rate would be more conventional in some other countries that have childbirth statistics as good or better than ours than it is here..
There’s no evidence whatsover suggesting that there’s anything wrong with the doctor’s practices
There’s very little evidence at all. We know what she has said, and we know that the hospital felt her C-section rate was too low. There was also concern, apparently, over birth weights and over shoulder dystocia from vaginal breech births. (I know fancy terms like “shoulder dystocia” because I read about them in my trial lawyer magazines. People sue over these things.)
So yes, there’s a whole underlying debate over C-sections and whether women are over-surguried and why this doctor’s rate was low–was she sensibly avoiding unnecessary surgery? was she avoiding *necessary* surgery and has been lucky so far? is she just in that gray area where you might or mighn’t do a C-section in some cases and if it turned out OK then you don’t know if it would have been different?
That’s where the information is lacking.
>shoulder dystocia
Heavens, that is a big word. It’s also a word that’s entirely absent from the linked newspaper article. The hospital threatened to watch her number of *collarbone fractures*, a common event in vaginal deliveries, that almost always requires no treatment, and that people don’t sue over. If there’s another article suggesting that the hospital had some basis for concerns over her shoulder dystocia rate, I’d appreciate a link. Likewise with the birth weights — higher average birthweight, cited in the hospital’s letter, shouldn’t be cause for concern. Higher rates of macrosomic babies would be, but there’s no indication that Dr. Sandland had such a higher rate.
>was she avoiding *necessary* surgery and has been lucky so far?
For a decade?
I can’t believe someone’s midwife called her a sheep for not wanting to have a baby at home. Was it Mythago? Yikes.
A lot of doctors would never attempt a vaginal birth for any baby in a breech position, even though some breech positions are more dangerous than others. This was the fact that stood out for me in the article as a likely concern of the hospital, and dystocia is nothing to underplay.
In closed network systems that keep close tabs on such things, the optimal rate of c-section is thought to be between 10 and 15% of births, depending on the patient population. Many Latina immigrants, for instance, cannot do a VBAC because Latin American doctors don’t do low transverse (horizontal) c-sections, so I imagine that the c-section rate for them would be higher.
I am sensitive to concerns of malpractice, but the kind of knee-jerk reaction we are seeing is a form of litigation psychosis. On the chance that 1/10,000 patients (at most) might sue in a given scenario, ALL WOMEN are being subjected to an incredibly personal form of coercion regarding a major life event. This truly is to let lawyers practice medicine — and it isn’t true that doctors won’t get sued if they do a c-section, there will always be some way to claim that the doctor screwed up — didn’t monitor enough beforehand and take the baby earlier, etc. The real problem is that parents with injured and sick infants have no safety net to fall back on to obtain expensive care, UNLESS they can prove that the doctor or hospital is at fault. This isn’t fair to doctors, but it sure as hell is a lot less fair to patients, and forcing all patients to pay for it in the form of irrational and coerced medical care makes it even less fair.
The hospital threatened to watch her number of *collarbone fractures*, a common event in vaginal deliveries, that almost always requires no treatment, and that people don’t sue over.
Then why is the hospital watching them? As a pretext? Probably more because they are concerned about OTHER problems (e.g., shoulder dystocia) that may lead to lawsuits.
For a decade?
You deeply misunderestimate doctors’ paranoia about malpractice.
We have the doctors’ own comments, two letters from the hospital, and a bunch of comments from outside experts. I’m perfectly willing to believe the hospital fucked up. I’m not willing to believe that the article is a neutral summary of all the pertinent facts.
Elena, it wasn’t *my* midwife, but yeah. To be more accurate, she made bleating noises.
At this point we’re just going around in circles. Sure, if there are unreported facts that indicate Dr.Sandland is a danger to her patients, the hospital did the right thing. If the facts are as reported, they were stupidly paranoid, and took a valuable treatment option away from patients in their area. Until I see any facts suggesting the first is true, I’m going to assume the second. (And I simply don’t know what to say about the argument that the hospital’s threat to monitor collarbone fractures indicates that they were concerned about shoulder dystocia.)
piny, quoting me, Cheryl/Heart: I am not interested in arguing points I’ve never made or refuting positions nobody is taking, just because somebody wants to vent their spleen because once somebody they know got her feelings hurt when the suggestion was made that natural birth might be a good thing. Which made her the forever-phantom-bully invoked in these arguments.
piny Actually, Mythago’s experience was firsthand, and the things said to her were much more unpleasant and most definitely grounds for taking offense.
So you might want to read what other people have really said about what they’ve really been through before you start squealing about strawmen.
Let’s take a look at what Mythago said about her own experience:
Mythago: got very tired of bad science and scare tactics and distortions. I was injuring my eyeballs rolling them at people who said “You have an OB…instead of a *midwife?!?!”? And don’t even get me started on the outdated insistence on what “hospital practices”? are always like. There was the midwife who called me a sheep because I preferred to give birth at the local hospital’s comfortable, nurturing birthing center instead of my cramped high-rise apartment (you know, “at home”?).
I am not seeing the “unpleasantness” and “cause for offense” in asking a woman why she’s chosen an OB instead of a midwife. That is a question which might well be asked sincerely and honestly, including by women who are pregnant or thinking about getting pregnant and hence, are making that decision themselves. The talk about the “bad science” and “distortions” and “outdated insistence about what ‘hospital practices’ are” don’t seem to me to be statemenst about unpleasantness or offensiveness; those are judgments Mythago made about whatever she heard or read based on her own opinions and views. As to the midwife who called Mythago a sheep, Mythago, don’t lie: Did some midwife say straight up to you, “Mythago, you are a sheep because you won’t birth at home!” Or did she just refer to the way pregnant and birthing women are herded sheep-like in the direction of obstetricians, hospitals, medications, interventions and so on, something you took personally and which you are now reporting as her attacking you by calling you a sheep. Come on.
I don’t know who first started ranting on about all of these bullies who advocate for natural birth, but it’s about then that I began to lose interest. The real bullies, you know, are women who have birthed naturally, have birthed at home, midwives; the real bullies aren’t the hospitals and doctors and entire medical establishment that regulates, or attempts to regulate, the pregnancy, labor, delivery and postpartum process from beginning to end with real consequences to the women and babies it is regulating. The real bullies are those women who birth naturally and their midwives and doulas who believe in it and speak up about their own experiences. How dare they. The very idea that they should suggest there are alternatives to patriarchal medicine. I like what someone said about that, maybe Kim, that advocates for natural birth HAVE to speak up; they DO, to be heard above the din of hospitals and drug companies and formula companies and all of the various mouthpieces for patriarchal medicine who are interested in controlling the process of pregnancy and labor and delivery, not only out of a profit motive, not only because heteropatriarchy likes to control women, but also for more nefarious reasons. The policing of women’s reproductive capacities includes refusing abortions, includes controls on birth control, includes the “harvesting” and selling of women’s eggs and bodies in surrogacy. So it is in women’s best interests that at least SOME of us continue to assert that these are OUR bodies, we will get pregnant, or not, we will discuss that with y’all or not, we will seek your advice or not, we will ignore it, or not, we will birth wherever we damn well please, and if we want anything from you, we’ll tell you about it. And when we hear young pregnant women lining up and cutting checks to hospitals, obstetricians and drug companies, we want to make sure they’ve considered the alternatives. That’s not being a bully, that’s being a feminist, but if somebody wants to call that bullying, be my guest, let the “bullying” continue, because it is no such thing.
noodles: Cheryl, I didn’t read mythago’s comment as a straw man, I also got the impression you were indeed attributing the painful aspects of childbirth to hospital delivery – you said most women who choose c-sections are traumatised by horror stories like those you described in hospitals, and those are the “horrible, painful experiences”?, then you said the reality is that “birth can, does and most often will occur peacefully and beautifully and pleasurably as a continuation of the process which began right where the birth takes place: in a woman’s own bed, in her own room, in her own home. With her partner right there holding her. And a midwife who really is most interested in supporting her.”?
That does sound like an idealised view where pain is not even factored in.
How so? I didn’t say one word about pain– I think the pain of labor and delivery and postpartum is a complicated discussion, would require many posts to discuss, but birth being pleasurable, beautiful and peaceful says nothing at all about it being painless. And that is also not an idealization– that’s the way it really *is*, the majority of time, for those of us who birth at home.
And I stand by everything I said there. Women *have* and *do* hear horror stories about birth, all of the time, most of the time from women who have birthed in hospitals with OBs. Those horror stories are the result of specific medical practices, of interventions and hospital policies and regulations which have *caused* the practices, and yes, indeed, the *pain*. Which says nothing about the natural and predictable pain that accompanies childbirth. I am talking there about the pain that hospitals and doctors and their policies cause or inflict in the course of attending laboring and birthing women (even when the women don’t realize, as they usually don’t, that the interventions and practices and policies are what caused the pain to be so unbearable.)
Noodles: I have never seen that scenario (without any drugs?) except in films.
How many births have you attended? How many times have you given birth? How many home births, as opposed to hospital births, have you attended?
Noodles: In the past, especially if you were poor, giving birth at home was the only option, not some ideal. Now there are more options, and I don’t think it’s realistic to treat it as a matter of horrible hospital delivery vs. beautiful home birth.
And that is not how I have treated it at all. I have talked about home birth as a beautiful option to hospital birth (which most here are defending), because it is.
Noodles: I don’t believe in one-size-fits-all solutions and I think it’s definitely a good thing for women to be more confident about pregnancy and childbirth and to avoid excessive medicalisation of it, but it won’t be a pleasant, peaceful and beautiful experience just because we want it to be. Especially if you’re supposed to do without any medication for the sake of doing it the ‘natural’ way.
And this is exactly what I mean by straw man arguments. Maybe somebody else argued the above and I didn’t see it, I haven’t read really, really carefully, but I don’t see anyone here advocating for one-size-fits-all solutions or for doing something the “natural” way for it’s own sake. Nobody has said any such thing here. As to the idea that home birth won’t be pleasant, peaceful and beautiful just because we want it to be– that just strikes me as a very odd thing to say. For one thing, I think that is a foregone conclusion. Most of us know that we don’t always get what we want. But why is it *so* important to communicate that we might not get the birth experience we want at home? Isn’t it at least *as* true, and of course I believe *more* true, that we will not get the birth experience we want in hospitals just because we want it. And one reason for that is, it’s not going to be up to us. As women have said in this thread, and as I have experienced personally (I have given birth 11 times, all babies are still alive, the first seven were birthed in hospitals, the last four were at home), I could write *books*, much less threads, much less posts, about ALL of the things that were done to me and to my babies against my will in hospitals and to the hundreds of similar stories I have heard from other women who have birthed in hospitals, or witnessed myself, even when doctors and hospitals agreed they’d do it my (or their) way, signed off on birthing plans and you name it. A lot of the time you don’t find out what was done to you without your consent until AFTER the fact, and lots of times you never really find out at all. You just are wheeled away from the hospital reeling over your horrible birth experience not even understanding that it was horrible because of what was DONE to you. And you don’t realize this fully until you HAVE a child outside the hospital and see the tremendous difference between *that* experience and hospital birth.
Mythago quoting me, Heart which is why I’m not bothering to engage besides suggesting a few of a huge list of books which could be read on the subject.
Mythago: You did engage, actually. It’s rather dishonest of you to disavow your own words, post a counterattack and then claim you’re “not engaging”?.
Oh, come on, Mythago. What I *meant* was I haven’t been engaging in the ongoing back and forth, in other words, I haven’t involved myself much in this thread, although I would have if there wasn’t so much arguing with what nobody has ever said.
Mythago: (I particularly liked the attack on doctors for not washing their hands back in the 19th century. Midwives didn’t know about germ theory, either. It was a male doctor, btw, who introduced the practice.)
True, midwives didn’t know about germ theory, but it was FAR less an issue, because they delivered women one at a time in their own HOMES. Not in filthy hospitals where and when nobody knew about germ theory! When a woman was in labor, the midwife went to her and stayed there with her in her hom until the baby was born. She wasn’t attending to multiple laboring women in an unsanitary ward full of them while popping in and out to, say, treat someone’s tuberculosis or gangrene or other infection or to take a look at a corpse or to bandage someone’s gaping, bleeding wound or whatever. All she did was attend births. There weren’t cars, she didn’t zip from home to home, she cared for each woman, in that woman’s home, for as long as it took, which *tremendously* reduced the risk of infection to moms AND babies. A woman’s own surroundings are what her body is accustomed to, familiar with. There is much less risk in such surroundings. Even now, with understanding of germs and sanitation, hospitals are hotbeds of infection and for this reason many patients, not only birthing women, are STILL sent home quickly whenever possible. The longer they are in the hospital, the greater the risk of exposure to infection. At home, again, there is MUCH less risk.
And for what it’s worth, it is still the same with midwives. They come to your home when you ask them to and they stay with you until the baby is born, even if it’s 24 hours or more.
As to a male doctor coming up with germ theory, *of course* it was a male doctor, hello. Women weren’t even ALLOWED to go to medical school or to BECOME doctors until the early part of the 20th century in the United States and Europe. Women who are kept out of colleges and universities because they are women aren’t going to be making too many scientific discoveries (although if they do, and some did, a man will have received the credit). But tell you what, had women been allowed to practice medicine, go to medical school, they would sure as hell, I bet you a million bucks, have applied themselves to what was happening to birthing women in hospitals.
Mythago: There’s very little evidence at all. We know what she has said, and we know that the hospital felt her C-section rate was too low. There was also concern, apparently, over birth weights and over shoulder dystocia from vaginal breech births. (I know fancy terms like “shoulder dystocia”? because I read about them in my trial lawyer magazines. People sue over these things.)
And if we are going to accuse one another of “dishonesty,” which I think is not a good thing to do, but since you did it, here is where I will hear your accusation and raise you better one as follows. The “concern” over the birth weights was that they were too high. That is a CRAZY thing to be “concerned” about, unless she was routinely delivering 11- or 12-pound babies which I *doubt*. Low birth weights are a huge concern and associated with high infant mortality. But *higher* birth weights are a GOOD thing, which is what makes that hospital’s letter so incredible. The goal with pregnant women is always to ensure that they birth when their babies are big enough. Which *happens*, as has already been said, when doctors wait until babies are ready to be born instead of inducing labor to keep their schedules tidy.
As to “soldier dystocia,” I don’t recall reading what was said in that letter, but I do know that (1) it is a VERY rare situation; (2) midwives are trained to deliver babies with shoulder dystocia whereas MD’s usually are NOT. I have two friends who have birthed soldier dystocia babies at home with midwives — one weighing nearly 12 pounds — and there was no problem. Doctors are taught “shoulder dystocia = c-section.” Midwives are taught, “Shoulder dystocia = get mother onto her hands and knees with one leg up and …. , OR, put one hand on the baby’s back and one on the baby’s chest in kind of a praying position, thumbs outside the mom, and gently rotate the baby,” OR a bunch of other maneuvers which midwives use successfully. It’s the same thing with breach births: doctors are taught that breach = c-section. Midwives are taught breach = external version, rotating the breach baby into the head-down position, something I experienced with my ninth, successfully, late in pregnancy, and she was born head down just fine at home. (And one thing we haven’t even touched on is all the things doctors do c-sections for just because they aren’t taught less invasive ways to address the problem, again, something midwives ARE taught.)
And as to choosing a hospital over a high rise apartment, my 10th was born in the back seat of our car. It was sweet, very pleasurable (though not painless, none of my births has been), beautiful, and in no way would I have preferred to have birthed him in the hospital, even though he was born in an 80s model Pontiac, hardly plush surroundings. My 11th was born when I was still living in a very humble double-wide on acreage out in the country, and when I say humble, I mean humble. But it, too, was a beautiful, pleasurable experience in SO many ways.
Heart
And tell you what, up until the time midwifery was outlawed and pregnancy and birth were medicalized, women were *not* dying, in droves, of childbed fever. That was a direct result of the medicalization of pregnancy and birth.
Heart
>>As to the midwife who called Mythago a sheep, Mythago, don’t lie: Did some midwife say straight up to you, “Mythago, you are a sheep because you won’t birth at home!”? Or did she just refer to the way pregnant and birthing women are herded sheep-like in the direction of obstetricians, hospitals, medications, interventions and so on, something you took personally and which you are now reporting as her attacking you by calling you a sheep. Come on.>>
I know it’s a long thread, Heart, but do try to keep up:
Mythago, #83:>>Elena, it wasn’t *my* midwife, but yeah. To be more accurate, she made bleating noises. >>
And you’re certainly making up for your lack of engagement in the back and forth now, aren’t you? I’ll be back to read the rest of The Poisonwood Bible later.
Depends, I suppose, what you consider to merit the word “droves”. I’m glad you and your friends have had good childbirth experiences (or quite a lot of them, in your case), but complications sometimes do occur. And who the hell cares whether Louis Pasteur was a man or a woman (not me, and was Marie Curie a “token”, btw, seems insulting to imply that she was)? What matters is the theory saves lives.
But I may be wasting my energy here. Clearly you have vested much in your conspiracy theory of modern medicine=killing women, and doctors=greedy bastards who want to kill women out of sheer fun, and science=anti-female religion or something. Any and all evidence of contrary will probably be considered as biased because of male dominance on field of science (which fields? Women are doing great in science…)
Disclaimer: I am not dissing your choices in life, or midwifery, but this ridiculous bias does annoy the hell out of me.
Yeah, piny, I made up for my not engaging, because there is *way* too much misinformation in this thread about a subject of great importance to women and to those who are allies to women.
As to “keeping up,” Mythago and I cross posted. She posted 10 minutes before I did, while I was still penning the Poisonwood Bible. But what she says just ratchets my level of suspicion up a notch. Now we have someone telling Mythago that her midwife made “bleating noises.” I find that hard to believe, but if it did happen, I am betting it happened in some generic way, in the course of a general conversation, and Mythago’s friend took it personally, and here Mythago is suggesting that a midwife straight up told her friend she was a sheep complete with bleating noises. You will excuse my unwillingness to suspend disbelief I’m sure.
And that leaves to offend Mythago only women asking her why she was using an OB instead of a midwife, as opposed to having had to suffer all of this seriousness and offense at the hands of women who advocate for natural or home birth. Right?
And I think it’s pretty lame, given all that I have taken the time to post here, to respond with insults because you can’t come up with anything substantive, or more, or better, or anything at all. This is a topic of serious concern to all women, and to all feminists. I hate seeing so much misinformation and so little real understanding of the situation as it exists on profeminists boards.
Heart
What? No, your totally unsubstantiated refusal to take Mythago at her word is _not_ a good reason to dispatch all her complaints with, “Whatever. Moving on.” Calling her a liar doesn’t make her one. I don’t have to excuse your calling her a liar, and I will not.
Furthermore, Mythago did not say that natural birth advocates asked her why she wasn’t using a midwife instead of an OB–they asked her in an extremely rude way and then proceeded to rudely disparage her choices. That’s like the difference between asking, in a nonjudgmental way, why a woman does not breastfeed and behaving as though she might as well be giving her child toilet water cut with Drano. It’s like the difference between talking about all-natural foods and throwing a shit-fit when you see a woman giving her toddler Juicy Juice. Any sane reading of her descriptions–one not based on a self-serving need to cut them apart because you can’t deal with an experience that doesn’t jibe with yours–would yield that interpretation: she was insulted.
You know what else is a serious concern to women, and to their reproductive choices? Cliquish, judgmental bullshit like yours.
>>And if we are going to accuse one another of “dishonesty,”? which I think is not a good thing to do, but since you did it, here is where I will hear your accusation and raise you better one as follows.>>
Also? This is chutzpah defined.
Tuomos, I did want to say, in partial response to your earlier post, that I have been talking here about medicine in the the United States, not in Norway or Sweden or Finland, countries which have the lowest rates of both infant and maternal mortality in the world. As does Canada. All of the above are, like, in the top 10 nations. The United States, for all of its wealth and resources, is way down, not in the top 10, not even in the top 20, if I’m not mistaken. Which is serious. Which is something for Americans to think deeply about. I am betting a lot of what I have said here does not hold true in Norway, Sweden, Finland, even Canada.
Tuomos quoting me, Heart: And tell you what, up until the time midwifery was outlawed and pregnancy and birth were medicalized, women were *not* dying, in droves, of childbed fever. That was a direct result of the medicalization of pregnancy and birth.
Tuomos Depends, I suppose, what you consider to merit the word “droves”?.
Puerperal, or childbed fever was the greatest killer of women in the 1700s and 1800s. One in 4-5 birthing women died of it. Mary Wollstonecraft died of it.
From an article which I will link to:
“…in ancient and medieval times, mortality from puerperal sepsis was apparently relatively low, as women generally gave birth at home.
“The 17th century saw the establishment of “lying-in”? hospitals in many European cities. While these institutions were, in some ways, an advance … in particular, by relieving obstructed labour with forceps or intrauterine manipulation … the crowding of patients, frequent vaginal examinations and the use of contaminated instruments, dressings and
bedlinen spread infection in an era when there was no knowledge of antisepsis.
“The first recorded epidemic of puerperal fever occurred at the Hôtel Dieu in Paris in 1646. Subsequently, maternity hospitals all over Europe and North America reported intermittent outbreaks, and even between epidemics the death rate from sepsis reached one woman in four or five of those giving birth.5
” …in Vienna, Dr Ignaz Semmelweis, a native of Hungary, was beginning a life-long obsession with finding the cause of, and preventing, puerperal fever.
In 1844, Semmelweis was appointed assistant lecturer in the First Obstetric Division of the Vienna Lying-In Hospital, the division in which medical students received their training. He was appalled by the division’s high mortality rate from puerperal fever … 16% of all women giving birth in the years 1841″“1843. In contrast, in the Second Division, where midwives or midwifery students did the deliveries, the mortality rate from the fever was much lower, at about 2%. Semmelweis also noted that puerperal sepsis was rare in women who gave birth before arriving at the hospital.6,11
“…Semmelweis began experimenting with various cleansing agents and, from May 1847, ordered that all doctors and students working in the First Division wash their hands in chlorinated lime solution before starting ward work, and later before each vaginal examination. The results were extraordinary … the mortality rate from puerperal fever in the division fell from 18% in May 1847 to less than 3% in June”“November of the same year.11”
http://www.mja.com.au/public/issues/177_11_021202/dec10354_fm.pdf
I’m glad you and your friends have had good childbirth experiences (or quite a lot of them, in your case), but complications sometimes do occur.
It isn’t just me and my friends, it’s millions of women throughout the ages, throughout the world who have birthed at home, with midwives.
And who the hell cares whether Louis Pasteur was a man or a woman (not me, and was Marie Curie a “token”?, btw, seems insulting to imply that she was)? What matters is the theory saves lives.
Well, evidently Mythago cared which is why she posted that Semmelweis was a man, evidently as evidence that some male scientists and doctors have done good things for women (something I have never disputed and wouldn’t dispute.) But I can’t get too excited that a male doctor discovered a solution to thousands of deaths which male medicine caused in the first place. You know?
And these are feminist boards. It *matters* that male doctors’ practices killed women. It *matters* that women couldn’t BE doctors and address these women’s issues. It mattesr that women couldn’t BE scientists. And it isn’t going to do to say that a man discovered germ theory without ALSO reminding those reading that only a man *could* have because women were kept out of those disciplines.
Clearly you have vested much in your conspiracy theory of modern medicine=killing women, and doctors=greedy bastards who want to kill women out of sheer fun, and science=anti-female religion or something. Any and all evidence of contrary will probably be considered as biased because of male dominance on field of science (which fields? Women are doing great in science…)
Disclaimer: I am not dissing your choices in life, or midwifery, but this ridiculous bias does annoy the hell out of me.
It’s about history, Tuomas. It’s about what patriarchal medicine and science have in fact done to women through the ages. I am quite sure they never sat down and conspired to kill women and hurt women– as is almost always true of the way women are hurt under male supremacy, the damage was caused because women were marginalized, were kept out of the equation, because the perspectives were male perspectives, and were perspectives which celebrated male dominance over women. Meaning women were hurt and killed in droves and nobody meant it to happen. It happened because women were a subjugated underclass and were not valued in certain ways or were not valued at all. And that’s not about any “conspiracy” theory– that’s about history which is readily available for anyone to brush up on, which is why I posted that list of books.
Heart
Cheryl;
I don’t think there is anything wrong in asking a woman about her choices, but I do think the tone taken by the mid-wife Mythago described was extremely inappropriate. I’d have been hard pressed in not telling the mid-wife to go diddle herself. It was a patronizing, disrespectful and unprofessional.
I think we all can agree that respecting a womans bodily processes and her choices are at the core of this issue, and that treating the woman as ‘a patient’ instead of an individual should be important to both doctors and midwives.
Come on Tuomas, that’s not at all what Cheryl said or implied. While she has staunch beliefs in birth and midwifery, you’re taking what she said and twisting it around in a really spiteful way.
The issue of maternal mortality is very complicated. Here is an article regarding the downward trend of maternal mortality from the 1930s forward, if you are truly interested.
http://www.ajcn.org/cgi/reprint/72/1/241S
“The beginning of the sudden improvement in
maternal mortality was in 1937 (Figure 1). In the first few years,
it was almost entirely due to the introduction of sulfonamides
and later penicillin, and this applied to other countries as well. If
the decline is plotted on a logarithmic scale, you get a straight
line. Richard Doll (personal communication, 1993) remarked
that this showed that the decline was not due to one factor but to
many. The factors that may have been responsible were, first,
sulfonamide and penicillin for infection; second, ergometrine
use to reduce postpartum hemorrhage; third, universal blood
transfusion; and fourth, much better cooperation and better medical
education and so on.”
The article talks in some detail about disastrous medical innovations, and how physician assisted births were associated with a higher maternal death rate from about 1870 through the 1920s (as exemplified by the fact that during that time period, upper class women were at greater risk of death than the working class, a complete inversion of the traditional state of affairs, the difference being attributable to access to physicians).
It was other developments — really, antibiotics and the ability to manage postnatal bleeding, along with the standardization of healthy practices through better education, that caused the steep decline in the maternal death rate from around 1935 onward. (It was pretty steady between 1890 and 1935.)
It’s also useful to keep in mind that a large component of OB-Gyn training and practice is surgery. I dated a surgeon for a long time. Surgeons love doing surgery (probably overall a good thing) but the downside for women giving birth is the impulse to find a surgical solution for just about any complexity. Some Ob/Gyns are starting to do versions now, so the cause is not hopeless, but depending on where you live you are swimming upstream in trying to change the focus of ob-gyns. And overall, they simply discount the importance to many women of giving birth vaginally.
Tuomas, it’s not a conspiracy theory. The experience of women on this score is remarkably consistent. I don’t talk excessively about patriarchal medicine, it usually doesn’t help, but medicine has often in the past and is even now often very — let’s say dismissive, if not exploitive — of women. The mother of a friend of mine woke up after giving birth and was told by her physician that he had tied her tubes because five children was enough for anyone. This was in 1965. That’s an extreme example, but it reflects an attitude that is chilling and not that uncommon (even if a practice as extreme as that was uncommon). Fear of litigation is just the latest justification, it’s just plain hard for doctors to cede control. Everything about their training demands that they assume control.
My biggest fear is, as Cheryl says, that I can talk until I am blue in the face but my OBs won’t listen to what I want once I walk into THEIR territory, even though they are very agreeable to doing a VBAC for now (I already did one — I am a tough nut to crack on the subject).
Cheryl, Thank you for your response, here is mine:
Yes, I do realize we are indeed talking about health-care in America, and I too am baffled by the (by statistics at least, not to bash american doctors, there are societal factors…) low quality of American health-care. However, your accusations were aimed at modern health care as bad and anti-woman, and anti-child instead of midwifery which is supposedly superior. And the thing is… Scandinavian countries are big on modern health care. There is much distrust here against alternative medicines, and much trust toward doctors. And/but we are in the top 10. Consistently. So I think it is relevant to the question: Is the treatment that doctors give bad for you? (As there are some differences in american medicine and scandinavian ones, mostly minor ones about proper treatment in specific cases, the field of science is essentially same and many study books, anatomic pictorials etc. are from America. Germany is also big on study books…)
History of medicine is indeed filled with shameful stuff. I would not be the one to dispute, that perhaps in 1700 or 1800, or early 1900 the field was, what we would define as quackery and horrid treatments today. It is a very dynamic field of science and is constantly evolving, mostly towards being better. And I do agree with you that medicine may indeed have considered women as not important, and has had bizarre anti-woman, and racial biases. But for the love God, times have changed!
I mostly disagree with your solutions on the issue. I think you are too quick to dismiss modern medicine. What I would like to see, as an outside observer of course (but one whose probably primary concern among social issues is indeed health care), not polarization, or gender separation on the health care in America to pro- and antiwoman, or scientific and “natural”, but instead reclaiming the field of medicine from law-suit based medicine, or unwarrantedly surgical and demanding better health care from the powers that are. I see absolutely no reason to dismiss the field of medicine simply because it has indeed been very much influenced by patriarchal values in the past, and probably still is to a lesser extent. (Btw, did you see the comment I jokingly referred as “Marxist/Feminist”). But I do think that some of your concerns about american hospitals/doctors are valid. but you are seeing it, IMHO, too much in black and white terms.
Piny: Post please, paste from my words, where I called *anyone*, including Mythago, a liar. You won’t be able to. Because it didn’t happen. Meaning if anyone is “lieing”, it’s you. Mythago accused me of dishonesty and I responded to *that* accusation.
Piny: Furthermore, Mythago did not say that natural birth advocates asked her why she wasn’t using a midwife instead of an OB”“they asked her in an extremely rude way and then proceeded to rudely disparage her choices.
Here again are Mythago’s words:
Mythago: got very tired of bad science and scare tactics and distortions. I was injuring my eyeballs rolling them at people who said “You have an OB…instead of a *midwife?!?!”? And don’t even get me started on the outdated insistence on what “hospital practices”? are always like. There was the midwife who called me a sheep because I preferred to give birth at the local hospital’s comfortable, nurturing birthing center instead of my cramped high-rise apartment (you know, “at home”?).
Where is the “very rude way” part? And where did those people “rudely disparage” her choices? I think Mythago’s eyeball rolling was, arguably, as rude?
And I see here that it *was* Mythago who was called a sheep, complete with bleating noises, just not by her own midwife. I do have to take Mythago at her word — I was being facetious and smart-alecky when I said “don’t lie,” — but for the record, in all of my years around midwives and doulas, I have not seen anything like this, and that’s a lot of years, 33. Mythago also appears to be someone who can take good care of herself, I’m pretty sure she stands up for herself quite well, and in view of all the eye-rolling, possibly the midwife got pissed off and said some things she should not have.
And I could also post quite the lengthy list of horrendously offensive statements made by OBs and gynecologists to their patients, you know? Not to mention statements like, “If you don’t [do what they say] your baby will DIE.” When it isn’t remotely true. I could even talk about the ones who molest or rape their patients, for that matter, like this idiot out here where I live has just been found to have done, and lots of them, too, omething midwives just don’t do and never have, you know? I realize that patriarchal medicine is a sacred cow. Dr. Mendelsohn who wrote the books I posted up there referred to medical books as sacred texts, doctors as priests in vestments, hospitals as sacred in that that IS how highly they are regarded. While there *are* good doctors and there *is* good medicine, patriarchal medicine *has* in fact hurt women, and particularly birthing women. And sacred cow or no, that is something it is important for people to know about and change.
piny: That’s like the difference between asking, in a nonjudgmental way, why a woman does not breastfeed and behaving as though she might as well be giving her child toilet water cut with Drano. It’s like the difference between talking about all-natural foods and throwing a shit-fit when you see a woman giving her toddler Juicy Juice. Any sane reading of her descriptions”“one not based on a self-serving need to cut them apart because you can’t deal with an experience that doesn’t jibe with yours”“would yield that interpretation: she was insulted.
Yes, she was insulted. As, I’m sure, were women on the other end of the eye-rolling and all of the insulting language around natural birth and home birth and midwifery. I think some insults rise to the level of more than insults, though, I think some rise to the level of the oppression and subjugation of birthing and laboring women and their babies, and those are the insults I’ve described in my posts, and *none* of them are to be found in that paragraph there which you just wrote. It’s as though to be a judgmental woman (because male doctors, men, period are not judgmental, they are discerning, they are thinking critically and so on), is the worst possible offense. Never mind *real* offenses, the ones that injure, hurt or kill women or their children or deprive them of the birth experiences they want and have paid for; let’s focus on all those judgmental women talking about natural birth and home birth and midwives! Um, no. If it takes women being loud and strident and judgmental and even “cliqueish” and chutzpah’d as can be, such that it gets people talking and arguing and finally beginning, even against their will, to understand history and all that has happened to women in our history, at the hands of men, then I think that’s what it takes. So we’re judgmental sometimes. So someone gets offended or insulted. So what. Women are getting hurt every single minute of every day by doctors, my medicine, in real ways, nd that’s what is at issue in this thread.
Heart
Barbara, cross-posted with you and I agree your concerns are valid on:
This seems to me a classic case of paternalistic, authoritarian and outright arrogant doctor. Study of medicine (in scandinavia at least) values a more cooperative approach, mainly because it seems to be more effective. Again, it seems to me that this is an issue in your (more) anti-woman culture affecting the field of medicine towards being biased, and thus NOT in the best interests of the patient which is the definition of good medicine. I am sorry if I’m getting off-topic with this, or nit-picky, but I cannot idly stand by watch a field of study that is about helping people getting painted in a negative light by these blanket statements.
Kim (Basement Variety!):
Um, seeing this and my relevant comment I have to agree, it was snarky, straw-mannish and probably didn’t come across too well.
Cheryl: I apologize for that post, I’ll try to be more respectful in the future.
Cheryl – How so? I didn’t say one word about pain”“ I think the pain of labor and delivery and postpartum is a complicated discussion, would require many posts to discuss, but birth being pleasurable, beautiful and peaceful says nothing at all about it being painless.
It is a matter of points of view. I cannot picture anything described as pleasurable, beautiful and peaceful, and picture extreme physical pain and discomfort in it.
It’s precisely the fact you described home birth without making any references to pain, after having talked hospital births as stories of pain and horror, that gave me the impression it is a very idealised view.
And that is also not an idealization”“ that’s the way it really *is*, the majority of time, for those of us who birth at home.
All right, then, again, I guess it’s different points of view, different experiences and preferences, and different notions of pleasure and pain.
I am glad it was such a beautiful experience for you and all the women you know that had home births. I just have my doubts it would be so for most women.
Now like Tuomas I’m not American so we’re speaking from different backgrounds here. I don’t have this experience of hospital care as a nasty, horrible thing with frantic rhythms and disregard for patients esp. pregnant women. Quite the contrary. (NB: I’m not saying I believe the US has horrible hospital care! I don’t think so, but I don’t have direct experience of it, I am just referring to the examples of ‘horror stories’ you mentioned, which of course can happen anywhere). Also, home birth was the done thing in my grandma’s times, in rural Spain. Out of necessity, not out of choice, or as a luxury (now women who *choose* to have home births – rather than have it happen unexpectedly, which is still more frequent – are wealthy people who can afford personal midwives and private assistance and so on. And of course, at a stone’s throw from the nearest city hospital so in case anything goes wrong they have that option too. Quite different from my grandma’s times again). Midwives were great, indeed, still, there are things that midwives alone couldn’t do. My grandma gave birth to seven children at home, two of which died for lack of care that today *is* the *basic* standard in any hospital. One was a premature twin – only the other one survived. They had hot water bottles to keep them warm, as home-made incubators… that is one reason I do tend to view medical progress as a good thing. Not horror stories of frantic hospitals and over-medicalisation and unnecessary procedures and awful episiotomies, of course I do agree those shouldn’t happen. But basic, decent medical assistance, I do view as a Very Good Thing.
So my view is biased that way. The fact those two babies died was entirely “natural” and “predictable” by the standards of care of her times and environment. Even without that kind of misfortune which used to be far more common than today, of course, yes, the pain itself is predictable and natural. I just think it’s a good thing that today we have the means to at least reduce all kinds of predictable and natural pain. I don’t see why ‘natural’ has to mean “good” when it comes to pain. To me, it doesn’t.
And this is exactly what I mean by straw man arguments. Maybe somebody else argued the above and I didn’t see it, I haven’t read really, really carefully, but I don’t see anyone here advocating for one-size-fits-all solutions or for doing something the “natural”? way for it’s own sake. Nobody has said any such thing here.
Nobody was putting up that straw man either. I was not attributing that “one-size-fits-all” view specifically to you or anybody else here, I only wanted to make it clear that I personally am not here to make any statements about what is *the* best option. I don’t think there is one, I think it depends entirely on a woman’s choice and her individual situation, health, finances, etc. I am only responding to what I personally see as a rather extreme black-and-white view of things that has home birth at one end as the ideal thing and hospital care on the other as the cause of all wrongs and even of pain itself. I am not telling anyone what to do, I am perfectly happy for everyone to make that kind of choice individually, of course. I simply have objections to the notion of “natural” as the best thing, and to the consequences of demonising other options. I also strongly disagree with the notion that medicine has not dramatically improved things for women giving birth and for their babies, because that is not my reality, in the world I grew up in.
I mean, honestly. “If you don’t stop breastfeeding, your baby will, or even might DIE.” That is “judgmental.” And especially when it is spoken by someone with the authority to report a woman to child protection services, as recently has happened to women who refused c-sections.
I was told I had to stop breastfeeding because my child had jaundice. I knew this was bullshit. My babies always had newborn jaundice, they recovered nicely, and lots of breastfeeding HELPED their recovery. And of course 10 years later or so, we get the revelation: “Breastfeeding does NOT aggravate newborn jaundice.” Well, I knew *that*. Which is why I ignored my doctor when he told me my baby would “die” if I didn’t put her under the bili lights.
But that’s the kind of “judgmentalism” which concerns me– judgmentalism with teeth and issuing from the mouths of those with money, and power, and prestige in American society, people who can do real harm to women.
“Judgmentalism” in the form of women judging the likes of the above? I don’t think it’s judgmentalism at all. I think it’s a public service.
And yeah, Kim, the midwife should not have behaved like an asshat, I do actually agree.
Tuomas, one reason there is faith in medicine in your country might be that your country IS so progressive overall and its policies and laws so much more egalitarian and even favorable to women. That isn’t so in the U.S. and especially under Bush’s reign of terror, where women are losing their rights over their bodies steadily and daily, very scary.
Fwiw, I’m not so much about most alternative medicine, either? I don’t really understand midwifery or home or natural birth to be about alternative medicine. I am glad hospitals and doctors are around for broken limbs and big, bleeding gashes, and some diseases, and yes, for the times when a birthing woman really does need help. I am not opposed, iow, to doctors and hospitals. I just think that far and away, they are not woman-friendly or woman-centered, particularly, again, in the U.S.
Heart
>>Piny: Post please, paste from my words, where I called *anyone*, including Mythago, a liar. You won’t be able to. Because it didn’t happen. Meaning if anyone is “lieing”?, it’s you. Mythago accused me of dishonesty and I responded to *that* accusation.>>
Oh, here we fucking go again. Do you have a macro for this? You should consider it.
This is what you said:
>>But what she says just ratchets my level of suspicion up a notch. Now we have someone telling Mythago that her midwife made “bleating noises.”? I find that hard to believe, but if it did happen, I am betting it happened in some generic way, in the course of a general conversation, and Mythago’s friend took it personally, and here Mythago is suggesting that a midwife straight up told her friend she was a sheep complete with bleating noises. You will excuse my unwillingness to suspend disbelief I’m sure.>>
Now, it’s absolutely true that nowhere in this post did you call her a liar _using those exact words_, but objecting to what I said on those grounds is pretty fucking disingenuous.
Oh, look, I just didn’t call you a liar!
So let’s look at the section I quote above. You say that you’re suspicious of what she’s saying. Then you say, “I find [what she just said happened] hard to believe, but if it did happen, [it must have happened in a completely different context than the one she’s implying].” Then you reiterate that you don’t believe what she’s saying. It’s sensible to assume that Mythago can read the words she’s typing, and there’s no reason to believe that she doesn’t know what impression she’s creating, so it’s purposeful on her part. You’re accusing her of lying, telling untruths, misrepresenting facts, misleading all of us, and so on. Call it whatever you like, but it is, too, calling her a liar.
Also, just so we’re clear, it’s not a second-hand report. This is what she says happened–not her midwife, but a midwife speaking directly to her:
>>There was the midwife who called me a sheep because I preferred to give birth at the local hospital’s comfortable, nurturing birthing center instead of my cramped high-rise apartment (you know, “at home”?).>>