Because it's time to post this study on here....

nosoup4u · February 2013

A few links to help those who feel any and all inductions, c-sections, epidurals and pretty much all other interventions are because lazy pregnant ladies didn't spend the right amount of time "researching".

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3210636/

"Taking the woman?s study and provider?s studies together, it raises the question of how informed decision making can take place when so many women approaching their first birth are ill-informed and so many providers think they know, but what they believe is not evidence-based. That, together with the obvious power imbalance, places many women in a vulnerable position?they are not equipped to advocate for themselves."

Well looky here, a paper that talks about the fact that women and their providers are both unprepared to talk about best practices/evidence-based labor and birth choices! It's almost like...maybe women aren't solely to blame!

https://birthingbeautifulideas.com/?p=5327

Great blog post that covers the usual crap - we need to start realizing it's the system that is messed up, and there is only so much individual women have control over.

And ladies, let's just remember if we have any interventions during birth, they must be only for the "right" reasons, otherwise the Natural Board Bumpies will be criticizing any and all choices that were made.

joecubed · February 2013

Like.

ILoveRunning · February 2013

Thanks for the links. I particularly liked the birthingbeautifulideas post.

tokenhoser · February 2013

Pffftt... women have the right to choose a care provider that doesn't practice evidence based medicine and make choices based on incomplete information. Doctors have the right to ignore actual information, statistics, and ACOG recommendations based on their gut feelings and experience.

That's what I've learned on this board recently.

Nechie122 · February 2013

The two most interesting and potentially frightening observations I took away from the first article were that: 1, younger obstetricians are becoming more comfortable with/cavalier about the risks of surgical birth and 2, women who are the most "educated" about birth are most likely to select a midwife.

So now we're moving toward a two tier system where women with knowledge and resources will give birth one way and those without will give birth another way.

To the extent we'll see changes, they'll need to be at the institutional level. So let's take the subject of early elective inductions, by way of example. When my sister's OB wanted to schedule her for an induction at 38 weeks for suspected macrosomia, her hospital in NYC said he couldn't because they had a hard rule about no elective deliveries before 39 weeks. Any exceptions would need committee approval. To me, that's a good sign, but I recognize that women might bristle about policies put in place "for their own good" that ultimately restrict choice.

And I also recognize that a lot of us NBers are uncomfortable with leaving things up to "institutional policy," which in general has not been NB friendly ... like effectively creating VBAC bans at many hospitals.

What we need is something other than the two tier system we have now where you have to actively opt out of having a standard medicalized birth, often leaving the system entirely, rather than being able to have more "best of both worlds" options. I also think that if women had more good choices, they'd be more likely to explore their options but as the second article points out, we generally do things one way in this country and it can be very hard to get off that conveyor belt and choose other avenues.

wifeofadam · February 2013

Nechie122:
The two most interesting and potentially frightening observations I took away from the first article were that: 1, younger obstetricians are becoming more comfortable with/cavalier about the risks of surgical birth and 2, women who are the most "educated" about birth are most likely to select a midwife. So now we're moving toward a two tier system where women with knowledge and resources will give birth one way and those without will give birth another way. To the extent we'll see changes, they'll need to be at the institutional level. So let's take the subject of early elective inductions, by way of example. When my sister's OB wanted to schedule her for an induction at 38 weeks for suspected macrosomia, her hospital in NYC said he couldn't because they had a hard rule about no elective deliveries before 39 weeks. Any exceptions would need committee approval. To me, that's a good sign, but I recognize that women might bristle about policies put in place "for their own good" that ultimately restrict choice. And I also recognize that a lot of us NBers are uncomfortable with leaving things up to "institutional policy," which in general has not been NB friendly ... like effectively creating VBAC bans at many hospitals. What we need is something other than the two tier system we have now where you have to actively opt out of having a standard medicalized birth, often leaving the system entirely, rather than being able to have more "best of both worlds" options. I also think that if women had more good choices, they'd be more likely to explore their options but as the second article points out, we generally do things one way in this country and it can be very hard to get off that conveyor belt and choose other avenues.

This.

I live in an area without choices. We have no midwives in the hospitals, 95% epidural rate, and very non-natural birth-friendly OBs to choose from. We have one birthing tub in the hospital and as far as I know there are only two OBs in the area that will allow you to labor in them. Delivering in them is very rare. We have only one childbirth class offered in the area, which doesn't cover natural birth - only explains your options in the hospital and goes over normal protocol like when you can get your epi, what pitocin is, etc.

I was lucky enough to know someone who was a doula who taught me a lot after I had a bad experience giving birth to #1. She empowered me to start looking into alternatives. Without her, I'm not sure that I would have looked into different options for myself.

I now have midwives who are located an hour and a half away from me. I am blessed to have the resources to not only be able to travel to them for my prenatals, but also to pay for them out of pocket. Insurance doesn't cover their services.

So, I don't blame women who make a different choice. There are many who can't afford to hire midwives like I can or that aren't able to travel to get to them. They are stuck with the sucky system we have in place. And even the most educated woman (like a friend of mine who recently gave birth), has to fight the OBs that scare them into doing all sorts of things that they don't want to do.

I agree that it's mostly the system to blame. Sure, there are mothers out there that are uneducated too, but when you live somewhere like I do, you can't really blame them for that.

[Deleted User] · February 2013

This almost makes me want to "do my part" by having my next baby in a more conventional hospital and inviting every med student I can find into the room to watch.

principessa81 · February 2013

+adamwife+:
Nechie122:
The two most interesting and potentially frightening observations I took away from the first article were that: 1, younger obstetricians are becoming more comfortable with/cavalier about the risks of surgical birth and 2, women who are the most "educated" about birth are most likely to select a midwife. So now we're moving toward a two tier system where women with knowledge and resources will give birth one way and those without will give birth another way. To the extent we'll see changes, they'll need to be at the institutional level. So let's take the subject of early elective inductions, by way of example. When my sister's OB wanted to schedule her for an induction at 38 weeks for suspected macrosomia, her hospital in NYC said he couldn't because they had a hard rule about no elective deliveries before 39 weeks. Any exceptions would need committee approval. To me, that's a good sign, but I recognize that women might bristle about policies put in place "for their own good" that ultimately restrict choice. And I also recognize that a lot of us NBers are uncomfortable with leaving things up to "institutional policy," which in general has not been NB friendly ... like effectively creating VBAC bans at many hospitals. What we need is something other than the two tier system we have now where you have to actively opt out of having a standard medicalized birth, often leaving the system entirely, rather than being able to have more "best of both worlds" options. I also think that if women had more good choices, they'd be more likely to explore their options but as the second article points out, we generally do things one way in this country and it can be very hard to get off that conveyor belt and choose other avenues.
This.
I live in an area without choices. We have no midwives in the hospitals, 95% epidural rate, and very non-natural birth-friendly OBs to choose from. We have one birthing tub in the hospital and as far as I know there are only two OBs in the area that will allow you to labor in them. Delivering in them is very rare. We have only one childbirth class offered in the area, which doesn't cover natural birth - only explains your options in the hospital and goes over normal protocol like when you can get your epi, what pitocin is, etc.
I was lucky enough to know someone who was a doula who taught me a lot after I had a bad experience giving birth to #1. She empowered me to start looking into alternatives. Without her, I'm not sure that I would have looked into different options for myself.
I now have midwives who are located an hour and a half away from me. I am blessed to have the resources to not only be able to travel to them for my prenatals, but also to pay for them out of pocket. Insurance doesn't cover their services.
So, I don't blame women who make a different choice. There are many who can't afford to hire midwives like I can or that aren't able to travel to get to them. They are stuck with the sucky system we have in place. And even the most educated woman (like a friend of mine who recently gave birth), has to fight the OBs that scare them into doing all sorts of things that they don't want to do.
I agree that it's mostly the system to blame. Sure, there are mothers out there that are uneducated too, but when you live somewhere like I do, you can't really blame them for that.

Same here (don't look at my profile-I live in northern Louisiana, not Mass anymore!). There are no midwives at all in this part of the state, and I'm actually traveling to Texas to give birth with midwives at a freestanding birth center. The hospitals in my area have obscenely high c-section and induction rates, and the OB I was seeing at the beginning of my pregnancy told me that it was just fine if I wanted a natural birth, but soon afterwards kept mentioning that he wouldn't let me go past 41 weeks, if I wanted to be induced at 38w because I was "sick" of being pregnant that was fine, etc. I got out of there as fast as I could, and like adamwife, I was fortunate enough to find a group of midwives within driving distance that gave me a reasonable rate (insurance won't pay for me, either). It's ridiculous.

AmyRI · February 2013

overture:
This almost makes me want to "do my part" by having my next baby in a more conventional hospital and inviting every med student I can find into the room to watch.

I actually had a med student at my first birth. A lot of the reason I allowed it is that I knew seeing a NB in the hospital is rare. She even cut DS's cord as DH didn't want to. It was obvious that she knew nothing of NB given the dumbfounded look on her face when I said it wasn't as bad as I expected as I climbed out of bed to shower a half hour later.

pepomntpat · February 2013

tokenhoser:
Pffftt... women have the right to choose a care provider that doesn't practice evidence based medicine and make choices based on incomplete information. Doctors have the right to ignore actual information, statistics, and ACOG recommendations based on their gut feelings and experience.
That's what I've learned on this board recently.

Well, how does a woman know her provider is practicing evidence based medicine? Do you assume that all women know what questions to ask or even that they have the right to do so? How do you question someone who knows more than you when they say your baby will die if you don't listen? It's all easy when things go easily and you don't have to fight a good provider who you can trust. It gets harder when your baby is distressed and your provider says it will get even more scary if we don't act right now. It gets harder when your provider tells you all the right things and then at go time becomes someone you've never met.

I get it. I'm a reader and a researcher. I go to my appointments with a list of questions. Not everyone is. What women have a right to is the ability to trust their doctors. The doctors go to med school and they should be taught to practice evidence based medicine.

Pffft...yourself.

AmyRI · February 2013

pepomntpat:
tokenhoser:
Pffftt... women have the right to choose a care provider that doesn't practice evidence based medicine and make choices based on incomplete information. Doctors have the right to ignore actual information, statistics, and ACOG recommendations based on their gut feelings and experience.
That's what I've learned on this board recently.
Well, how does a woman know her provider is practicing evidence based medicine? Do you assume that all women know what questions to ask or even that they have the right to do so? How do you question someone who knows more than you when they say your baby will die if you don't listen? It's all easy when things go easily and you don't have to fight a good provider who you can trust. It gets harder when your baby is distressed and your provider says it will get even more scary if we don't act right now. It gets harder when your provider tells you all the right things and then at go time becomes someone you've never met.
I get it. I'm a reader and a researcher. I go to my appointments with a list of questions. Not everyone is. What women have a right to is the ability to trust their doctors. The doctors go to med school and they should be taught to practice evidence based medicine.
Pffft...yourself.

Doctors should practice evidence based medicine. So should midwives. Buy my midwife, who was great, does not practice all evidence-based medicine - she also relies on gut feeling. And swears by things like shoe size dictating ease of labor.

But patients need to be responsible, too. I'm not talking about the in-the-moment, baby in distress kind of call. I agree that those circumstances are best handled by the ones that have formal medical training. But you can't just say that it's the provider's fault if the patient pushes for elective induction, or elective c-section. Women need to educate themselves about birth in general or things will never change.

Do you also think it's not the mother's responsibility to know how to care for their child? Parents shouldn't have any involvement with pediatricians, teachers, etc forever - they are the professionals and you should just trust them? It's not that simple. It sure would be nice if that's the way it worked, but not all OBs, MWs, pedi's, or teachers are the same. It is a parent's responsibility to educate themselves to choose a provider wisely.

And every patient has the right to ask questions of their care provider. It's up to them whether or not they do. Our system is broken, but it is not so broken that you are forced to blindly follow only 1 provider.

ETA: And I don't think you're interpreting what Token said the way she intended it.

nosoup4u · February 2013

AmyRI:

But patients need to be responsible, too. I'm not talking about the in-the-moment, baby in distress kind of call. I agree that those circumstances are best handled by the ones that have formal medical training. But you can't just say that it's the provider's fault if the patient pushes for elective induction, or elective c-section. Women need to educate themselves about birth in general or things will never change.
Do you also think it's not the mother's responsibility to know how to care for their child? Parents shouldn't have any involvement with pediatricians, teachers, etc forever - they are the professionals and you should just trust them? It's not that simple. It sure would be nice if that's the way it worked, but not all OBs, MWs, pedi's, or teachers are the same. It is a parent's responsibility to educate themselves to choose a provider wisely.
And every patient has the right to ask questions of their care provider. It's up to them whether or not they do. Our system is broken, but it is not so broken that you are forced to blindly follow only 1 provider.

You don't think that a provider has the responsibility to tell women the risks of induction or c/s, or flat-out refuse to do it if it isn't necessary?

Not all women (or parents) are coming from the position of being able to research all their providers. In the US, a good amount of people don't have the option of switching providers, even if they want to.

Every person does have the right to ask questions, no doubt. But OBs (and MWs) are in a position of power, too. If someone tells you doing x, y or z will either help or harm your baby, why wouldn't you listen to them? Not all women have the resources to research the death out of their birth options, which I think a lot of people on the board don't realize. And then you are always going to have some women who just aren't interested, so unless birth ed classes are somehow mandated (and not only mandated, but evidence-based), it's not clear how you reach out to them.

tokenhoser · February 2013

AmyRI:
And I don't think you're interpreting what Token said the way she intended it.

Not really, but I'm not having much luck getting my feelings across here lately.

I blame the game, not the player. Doctors aren't putting women in situations where they have the proper options, and they don't properly explain risks before procedures like induction. I'd say that gets glossed over more often than it's properly laid out. Like: an induction raises your risk of c-section by X%. If you have a c-section with your first birth, this is what it means for your future births. It's all "Let's have a baby tomorrow! Yay!" I don't blame a woman for falling for it, but I do blame a doctor for being so cavalier, and for how frequently they do it before 41 weeks for no particular reason.

My doctor was good last time, but she wasn't really put to the test either. I went into labour at an "appropriate" time. I showed up at the hospital ready to push. I managed to push out my malpositioned baby in a hospital-allowed amount of time. Maybe she's good, maybe I got lucky. Time will tell.

ILoveRunning · February 2013

I think for the most part, that we are all on the same page. There needs to be more effort made by the medical community to 1) practice evidence-based medicine, 2) explain procedures and the related risks to their patients, 3) acknowledge that every patient has different needs and concerns and 4) taking into account everything listed above, actively involve the patient in the decision making process.

I do not think that a woman should have to go and independently do "research" in a healthy, low-risk pregnancy without any complications. The information should be given to her by the care provider so that she can make an informed decision. If things become complicated, I hope that the woman, with the support of her care provider, can look for additional resources to help her with any difficult decisions.

nosoup4u · February 2013

tokenhoser:
My doctor was good last time, but she wasn't really put to the test either. I went into labour at an "appropriate" time. I showed up at the hospital ready to push. I managed to push out my malpositioned baby in a hospital-allowed amount of time. Maybe she's good, maybe I got lucky. Time will tell.

Yup! There's such a narrow range of "normal" labor, that ending up with crazy interventions really is luck of the draw. Depressing thought of the day!

pepomntpat · February 2013

AmyRI:
pepomntpat:
tokenhoser:
Pffftt... women have the right to choose a care provider that doesn't practice evidence based medicine and make choices based on incomplete information. Doctors have the right to ignore actual information, statistics, and ACOG recommendations based on their gut feelings and experience.
That's what I've learned on this board recently.
Well, how does a woman know her provider is practicing evidence based medicine? Do you assume that all women know what questions to ask or even that they have the right to do so? How do you question someone who knows more than you when they say your baby will die if you don't listen? It's all easy when things go easily and you don't have to fight a good provider who you can trust. It gets harder when your baby is distressed and your provider says it will get even more scary if we don't act right now. It gets harder when your provider tells you all the right things and then at go time becomes someone you've never met.
I get it. I'm a reader and a researcher. I go to my appointments with a list of questions. Not everyone is. What women have a right to is the ability to trust their doctors. The doctors go to med school and they should be taught to practice evidence based medicine.
Pffft...yourself.
Doctors should practice evidence based medicine. So should midwives. Buy my midwife, who was great, does not practice all evidence-based medicine - she also relies on gut feeling. And swears by things like shoe size dictating ease of labor.
But patients need to be responsible, too. I'm not talking about the in-the-moment, baby in distress kind of call. I agree that those circumstances are best handled by the ones that have formal medical training. But you can't just say that it's the provider's fault if the patient pushes for elective induction, or elective c-section. Women need to educate themselves about birth in general or things will never change.
Do you also think it's not the mother's responsibility to know how to care for their child? Parents shouldn't have any involvement with pediatricians, teachers, etc forever - they are the professionals and you should just trust them? It's not that simple. It sure would be nice if that's the way it worked, but not all OBs, MWs, pedi's, or teachers are the same. It is a parent's responsibility to educate themselves to choose a provider wisely.
And every patient has the right to ask questions of their care provider. It's up to them whether or not they do. Our system is broken, but it is not so broken that you are forced to blindly follow only 1 provider.
ETA: And I don't think you're interpreting what Token said the way she intended it.

I am not sure if I interpreted right or not. I just get the feeling she thinks that all women should be educated enough to know whether the doctor is right or not. And that's a really, really, really big expectation.

THere is a difference in being able to care for your child-feed, clothe, entertain-and feeling like you are in a position to question decisions for a person who is more educated than you are. So many mothers out there can't even READ! And you think they should know to question a doctor about the risks of an induction on a paper that they are asked to sign? I don't think literacy should be a prerequisite for an evidence based birth.

And like I said, not every woman KNOWS she has a right to ask questions. The way I was poo pooed at my first OB after my D&E when I was in pain and he told me to eat bran flakes...it was seriously awful. I felt awful emotionally and physically and he didn't give a rat's ass. If it had been a serious problem (which it wasn't) would you have blamed me for not being in a good position to care for myself (getting out of bed at that point was a serious chore) or my doctor for not even examining me?

I think a lot of the women on this board are very well educated and with that assume that all women have the same resources, abilities and support system. And it isn't that simple.

tokenhoser · February 2013

I don't really think you're reading what I've written.

I volunteer with refugee women. I'm familiar with my privilege, thanks.

nosoup4u · February 2013

I think the Bump really needs to have a sarcasm font. I am typing that nonsarcastically.

tokenhoser · February 2013

nosoup4u:
I think the Bump really needs to have a sarcasm font. I am typing that nonsarcastically.

Sarcastica would make the internet a much better place.

sooner1981 · February 2013

bump burp.

sooner1981 · February 2013

AmyRI:
overture:
This almost makes me want to "do my part" by having my next baby in a more conventional hospital and inviting every med student I can find into the room to watch.
I actually had a med student at my first birth. A lot of the reason I allowed it is that I knew seeing a NB in the hospital is rare. She even cut DS's cord as DH didn't want to. It was obvious that she knew nothing of NB given the dumbfounded look on her face when I said it wasn't as bad as I expected as I climbed out of bed to shower a half hour later.

This is weird to me, as my husband is a medical resident in a very poor southern state, and in their teaching hospital, pain-med free birth isn't "rare" at all. Every resident sees several on their Ob/Gyn rotation. He has talked to several of his friends about this at hospitals around the country, and they have all had the same experiences, some more, some less--but everyone had seen several natural births during their rotation.

I think the whole "no residents see pain med free births anymore" is one of those things that people say so much, it just becomes "accepted," regardless of its veracity...

tokenhoser · February 2013

sooner1981, if residents are seeing natural births, they're not really enjoying them then. Have you seen this? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3210636/

The majority of young OBs would plan a c-section for themself or their partner. That's not a good sign.

ILoveRunning · February 2013

tokenhoser:
sooner1981, if residents are seeing natural births, they're not really enjoying them then. Have you seen this? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3210636/
The majority of young OBs would plan a c-section for themself or their partner. That's not a good sign.

That is frightening.

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