Doctor, Did You Wash Your Hands?

From the NY Times:
Despite national campaigns encouraging patients to take an active role in improving hospital safety, many patients aren’t comfortable asking doctors challenging questions about their care, a new report shows.

As much as we talk about changing the culture of birth in this country, and as much fault as we sometimes find with hospitals or obstetricians, nothing will change with our healthcare in general, or birth in particular, without consumers asking for that change.

Why do we treat doctors as authority figures? Why are we afraid of making them angry or disappointed in us? Why would we rather sacrifice our own or our children's health than risk offending? They do not naturally have that power or authority -- in fact, consumers hire their care providers. We have the right to receive the information we need, as well as the care. Would you tolerate it if your mechanic was snippy or evasive if you asked a question about a recommended repair on your car? Would you keep going back to that mechanic, and recommend him to your friends?

“Patients need to feel they can ask questions that may be perceived as challenging without causing offense to those involved in their health care treatment,'’ the study authors wrote.

Women, if you have ideas about how you want to give birth, you must communicate with your doctor. If you're afraid to ask questions or make your intentions known and stand by them, it's not realistic to think you'll get the birth you want. And if your doctor does seem offended when you ask a question, isn't that an excellent sign that s/he isn't the right care provider for you?

In addition to it being part of your own health, dealing with your care team is one of our first acts of parenting. Now is an excellent time to start advocating for your baby. Start with asking questions!


April is Cesarean Awareness month!

Promote Cesarean Awareness and tell a birthing family you love about ICAN and check out their fancy new website!

A friend of mine just had a baby, and the Cesarean rate of the women in her childbirth class was 57%. These were all first time moms who now have the choice between an elective Cesarean and all its attendant risks with their next births, or a VBAC which is increasingly becoming less of an option with many mainstream care providers. Mothers attempting a VBAC face the physical barriers and restrictions in place at many hospitals, as well as the emotional hurdles that come with attempting something widely regarded as "more dangerous" by the medical community and society at large. (for more information on the REAL risk comparison of VBAC vs. repeat Cesarean look here)

This problem is epidemic and it affects us all, whether we are birthing women or not. 57% of women in this class were told they couldn't birth their babies. This is startling, and wrong. It will not stop until we do something to stop it. ACOG is telling us the rising Cesarean rate is due to more overweight and older women getting pregnant and ignoring the other major issues like their own fear of litigation. It's up to us. We cannot know the possible effects that a large Cesarean rate could have on humanity at large. What we do know is that it has the potential to obliterate the confidence and feminine wisdom of an entire generation of women. Women deserve the opportunity to give birth vaginally without fear!

Pregnant women, what can you do to help reduce your risks of Cesarean? This is a short, quick and dirty list. I'll be posting more Cesarean prevention tips throughout April.
  • Consider an out of hospital birth if you are healthy and low-risk. Both birth center and homebirth midwives have dramatically lower Cesarean rates than their hospital counterparts.
  • Hire a doula. A doula can help you navigate the childbirth system and teach you how to ask the right questions to decide whether intervention is appropriate or not.
  • Read EMPOWERING birth stories. Don't watch "A Baby Story" or shows that focus on "baby emergencies". Try both of Ina May Gaskin's books for a start. Focus on what your body is capable of instead of what can go wrong.
  • Take a GOOD childbirth class. Consider an independent instructor. These classes often cost more but they are worth it because you're not going to be fed only what the hospital wants you to know. ALACE and Birthing From Within are organizations to consider.
  • Turn that breech and try to prevent the odds of back labor with a well-positioned baby. This offers no guarantees against back labor, babies move throughout labor, but it's healthy to try! Do yoga, and check out Spinning Babies for more tricks and techniques for turning both breeches and posterior babies.
  • Stay home until you are in ACTIVE LABOR! Simply getting to the hospital too soon skyrockets your chances of Cesarean. More on how to know "it's time" later...
  • Choose your care giver wisely. Ask good questions, and expect them to give you open, honest answers. If you feel like they are being evasive, press harder. Don't put your care giver on a pedestal: you are the ULTIMATE expert on your pregnancy and baby, and they work for you. Don't be afraid to look elsewhere for answers or second opinions. TRUST is essential for a good relationship with your care provider. Another note on care providers: if your OB is known as "THE best C-section doc in town"...there is probably a reason for that. And it is more than likely because s/he performs a lot of them. Find out why.



When I'm talking about choices in birth, I've found the subject consistently turns to risk. What are the risks of home birth? What are the risks of hospital birth? What is the safest possible way to have a baby?

The fact is that risk is an inherent part of life, and birth is no exception to that. There are situations in which being in a hospital is very desirable when you're giving birth. Isn't it wonderful that we have that option, and the benefits of all modern obstetrical technology, available to us when it's needed? On the other hand, the mainstream medical community doesn't seem eager to discuss the risks of giving birth in a hospital. It's painfully ironic to me that midwives are stereotyped as superstitious women who walk around the house burning herbs and chanting, when in fact many -- if not most -- of the procedures in your typical hospital maternity ward are based on fear, ritual, and lack of evidence.

We all have to choose the risks we're comfortable with. Personally, I'll take the risks of birthing at home, over the risks of birthing in a hospital. I feel I'm much more likely to experience the risks of unnecessary interventions in a hospital than I am to face a true emergency at home. I only wish for all women to have the option to make their own choices without bullying, superstition, or manipulation.

This lovely post from Rixa at The True Face of Birth provides a great summary of the risks of VBAC and elective repeat cesarean. What a breath of fresh air! We cannot keep disrespecting women and their babies by refusing to provide them with enough information to make the right decisions for them. If a woman has had a cesarean, her next delivery carries risks -- it's insane to pretend that repeat c-sections are risk-free.

Women are empowered when they can make their own choices, not be pushed into what ACOG would like them to do. If both choices carry risk, we need to make sure that women can choose the risks they're most comfortable with. Is that really so much to ask?

PS A more specific look at some of the risks of home vs hospital birth coming... someday. I promise!