Home Birth, Barbie Style

I’m so not sure what I think of this slide show of Barbie having a home birth, with Ken and a midwife and her older child at her side.  

OT1H, some of the photos are hilariously similar to real birth pics (classically, in Black and White for additional gravitas):

But OTOH, I hate the idea of the homebirth being glamorized in some Barbie-like way, (making it seem like yet another unrealistically perfectionist thing on the to do list, along with having the Barbie-looking hair, body and face), instead of what it is: one of many options an informed adult can make regarding the care of her body.  

And then, since I have an eleven year old, I immediately wonder what a Minecraft-Homebirth would look like (hopefully no creepers).  I may now go ask my son and his best friend to design that for me…

Atlantic Monthly Gets It Wrong on Home-birth/Hospital Birth Thing

I used to love Atlantic Monthly, but in the past several years I noticed that their articles about motherhood issues can be super douchebaggy.  

I remember a crappy piece many years ago by the often great Sandra Tsing-Loh, basically arguing that the ruin of society was caused by parents who try to understand their kids, an article that conflated basic empathy with “zero parental boundaries.”  It had all the nuance of a cow bell.

Later, Hannah Rosin’s "Case Against Breastfeeding" (April, 2009) was similarly monolithic, transforming the author’s personal ambivalence about the act of breastfeeding into a million-watt advertisement for the formula industry and a defense of Neanderthal husbands.  (My response to this piece was published as a guest blog on California NOW's website, and the full text can be found, now, here).

And now it’s a piece about home birth, in their current issue, by a dude OB, who has never, obviously, had to make a decision about where to give birth.  Nor has he ever been to a home birth.  His assessment is based on a time that he accepted a mid-labor transfer from a homebirth midwife.  

I had been planning to ignore the article, since I’ve already cancelled my subscription and told them what I think of their “Cases,” and the way it seems they publish flame-war-generating pieces whenever a dull moment threatens readership.  And I had been planning to ignore it, also, because, as I’ve blogged about before, I’m sick to death of discussions of birth politics that lack nuance and sound like propaganda.

But when I read it, I found it was less of a diatribe and mostly a stupid whinge.  Here’s the gist:

OK, there was this OB, and once he was in the hospital and a woman came in in the middle of her labor, with her midwife.  She had planned a home birth, but after many hours of pushing, the baby hadn’t arrived.  Her midwife had advised her to transfer to the hospital because the birth was now outside the range of normal for homebirth, which is just what home birth midwives ought to do in such a case, just as any kind of care provider ought to refer out when something is beyond their scope.    

So, mom-to-be goes to the hospital and encounters Doctor.  Doctor scowls at her (this is his description, not hers!).

He tells us that he would have recommended a c-section hours earlier.  Not because the baby was in danger —  there is no suggestion that the baby was in danger when they got to the hospital — but just because he would have “worried” (his word, again).

Mom wants to hear whether there are other options.  Doc tells us that there was no medical reason to do a c-section then, but:

It would have been easy to tell Laura that a cesarean was recommended given how long she had pushed, but I knew it was the last thing she wanted, so I explained that we could try some other interventions … 

She agrees to try his suggestion of augmenting the labor with Pitocin to strengthen the contractions. 

After they start the Pitocin, though, the baby’s heart rate decelerates.  Doctor again informs mom of her options.  They can do a c-section.  Or they can use some tools that we’ve developed for this situation, which give us a closer look at the baby and the labor.  They are:  the internal fetal monitor and the intrauterine pressure catheter, and they exist, ideally, to give us a closer look and, hopefully, avoid doing a c-section if there’s no medical need.  

She proceeds with them and, a few steps later, again with his counsel, decides to use the vacuum extractor to assist a vaginal delivery.  

The baby is born safely.  

At no time does the doctor say that he thought that the choices that he gave and that she chose were unsafe or inappropriately risky.  

Afterwards, the mom conveys that she is happy the baby is born, but unhappy that she had to make the transfer, and unhappy with this doctor’s temperament.  To his great surprise, she hopes to try for another home birth next time.

Why is this so astonishing to the doctor, and why does that prove, to him, the “Case” against homebirth?  To me, this story is actually a great example of

• a patient engaging in responsible adult decision-making, communicating with her caregiver, learning her options, and making appropriate, safe personal choices.

• how a coordinated system with competent backup for homebirth could work. 

In fact, it seems that the biggest drawback in this case was that the doctor was scowling and the midwife — who actually knew this patient — had no privileges at the hospital and so she couldn’t provide the kind of assistance that helps give better care than you can get from a stranger.  

And why was this doctor scowling at the mom the entire time?  

• Because she tried for a homebirth originally, and couldn’t forecast this unlikely situation, which, though not dangerous to the baby (he acknowledges that there was no concern about the baby until after the mom received Pitocin) required a big change of plans?

• Because she wanted him to provide more options than just “we can do a c-section”?

• Because she expected personalized service, not a generic, “we do a c-section after 2 hours”?  

To me it seems that the mom was pretty much the ideal consumer.  Not because she wanted a homebirth, but because she sought explanations and information, and made good, competent, adult decisions about the care of her own body, with the counsel and guidance of the expert she was paying to help her.

**

At one point in the essay, the doctor complains that

Short of a cesarean, she had experienced about as invasive a delivery as modern obstetrics has to offer.

I don’t get this complaint.  The mom might feel disappointed, afterwards, that fate handed her this particularly difficult birth, which required medical intervention.  But even really Birthy people, if they are sane and reasonable, don’t reject the idea of medical intervention per se — they reject the idea of using it when it’s not necessary.  In this case, everyone seems to agree that it *was* necessary.

And if this mom preferred Pit and IFM and the vacuum to a c-section, who is this doctor to say that she ought to have preferred the c-section and spared him the extra hours by her side?  She is the customer.  She is the owner of her body.  She is the decider.  He is the servant.

Women seem to like to make decisions about the care of their bodies.  It is not “crunchy” to say that a competent adult woman can be trusted to choose, among safe options that have been explained to her, the course that will be best for her.  

**

Finally, the doctor whines that he hated this birth because he was forced to clean up “the midwife’s mess.”  

What mess?  

What if the patient had been his hospital birth patient from the start, and had had this exact same labor?  After a couple hours of pushing, he’d have suggested a c-section; she’d still have asked what the other safe options were.  

Would he have forced a c-section on her?  That’s not allowed — as long as we continue to say that laboring women are competent adults, you can’t actually force one to do a c-section, especially when you admit that there’s another safe option.  

They’d have landed in the same exact place.  

There they’d have been — with her preferring to continue to push and use a little Pit and ultimately IFM and the vacuum, and him wishing she’d just do a c-section and get it over with.  It’s clear he doesn’t get why the one is preferable to the other to her, but really?  Who cares why she sees it one way.  She’s the customer.

If she’d been his patient from the outset and had asked for more options instead of doing a medically unnecessary c-section, and they’d proceeded exactly the same, with the Pit and the IFM and the vacuum — would he have then said that he hated that birth because he’d have had to clean up his own mess?  

Or would he have said, perhaps quietly, to a colleague, that he hated the patient because she asked questions, knew her options, and used her doctor as a guide, not a god.  Would he confess that he longed for the days where women were conditioned to behave like docile little lambs, and not ask questions or realize they were competent to make decisions for themselves?  

Or lets say that he wore her down, because she was tired and suggestible.  Let’s say she caved to his pressure and said yes to him.  Let’s say he got to do his c-section and go home.  

And then she developed MRSA and was rehospitalized for days and days after her child’s birth?  

Or had trouble breastfeeding?  

Or was, “just”, deeply unhappy, felt that her integrity was bruised, or that she’d been bullied into beginning her course of motherhood with an unnecessary major abdominal surgery? 

Who would be cleaning up his mess, then?

Getting Away From An "Either - Or" Mentality About Childbirth

Recently there have been a bunch of good essays (links below) discussing how the birth location, and type of attendant, affect outcomes.  These pieces all take the time for some non-propaganda, nuanced thought and reflection about what would improve things for a diverse American population of mothers.  It’s a welcome change from some of the less rigorous thought we often see on this topic.  Instead of having a pitched battle about whether ALL HOMEBIRTH IS VERY DANGEROUS AND IRRESPONSIBLE AND RISKY!  and whether ALL HOSPITAL BIRTH IS TOTALLY OVERMEDICALIZED AND DANGEROUS AND HATEFUL AND NOT EVIDENCE BASED, these essays look at the improvements we need, overall, to our maternity care system.

Here’s a brief summary (but honestly, these are issues that aren’t well suited to brief summary):

• we need a standardized care practice for doctors, nurses, and midwives who attend hospital births.  The practice should minimize separation of mother and baby after birth to true medical need, appropriately support normal infant feeding,  prioritize comfort, dignity and infection-avoiding after-care for mother and baby, eliminate practices associated with post-partum depression and PTSD, and train all hospital personnel in all of these areas.  And this should be available to all women in every hospital across the land.  

     Is that really too much to ask for in 2012 in the United States of America?

• we need a nationally standardized training practice for midwifery that encompasses homebirth and hospital care, so that “midwife” means one thing, everywhere.  Without that, it is impossible to accurately say how “midwifery” care compares to OB care, or how home-birth compares to hospital birth.

These changes would create a more functional system in which each woman could get care appropriate to her particular needs, not the needs of women in general.  This is called reproductive choice, and it should be available to everyone, not just educated, white-glove-insured people in major cities.

A functional system would also get us away from the kind of strident hysteria that too often accompanies discussion about birth, which, when you care about these issues, become truly a pain in the ass to read.  (don’t get me wrong — emotional discussion of one’s birth when you’ve just had a baby is totally appropriate.  Ideally, though, that personal topic is handled separately from a policy discussion of how care can be improved for everyone.)

Here’s what you can do, meanwhile:

• If you’re pregnant and planning a hospital birth:  take the time to talk to your care provider about her training and experience, including her experience of this hospital’s post-natal care, which she may or may not be familiar with.  If you’re in New York state, you can look up your hospital’s stats including breastfeeding rates.  Take a childbirth class that covers infant care and breastfeeding.  In my childbirth classes, we do role-playing to help students get comfortable with how to talk to personnel in the hospital in a way that gets the information they need and reduce unnecessary stuff happening.

• During and after your birth, remember that you are the customer.  If you’re not getting good customer service, ask for better.  If that doesn’t happen, write a letter to your care provider’s office and/or the hospital, later, and let them know you weren’t happy.  Policies change when people do this.

• If you’re pregnant and planning a home birth:  take the time to talk to your care provider about her training and experience in, and out of hospital, and learn about the laws relating to midwifery in your state.

• Write to your legislators and propose standardized care practices for hospital births and midwifery training.  Send a copy of the letter to all your facebook friends and ask them to do it, too.

Here are the links to the essays:  The original piece in Slate by Emily Willingham, an article about it on Babble by Ceridwen Morris, Emily Willingham’s blog followup, and a Comment by Midwife Amy Romano.

This stuff matters.

How did it go for you?  If you gave birth in the hospital, how did you feel about the post-natal policies and the care you received?  If you gave birth at home, were you in a state where you had access to a CNM?  And what was her home-birth training?  You can email me comments or use the Disqus feature below.

Guess How Many Times A Day Someone Barges Into A Hospital Room On A New Mom?

Here’s one for the “I Can’t Believe We Needed A Study To Tell Us This” file: an article I read this morning from lactationmatters.org, entitled “Do Interruptions Interfere with Early Breastfeeding?”

I don’t mean that the article was stupid (at all!), and in fact, there’s something validating that someone actually recorded how frikkin’ often new moms and their babies are interrupted while they’re still in the hospital.  Want to know how many times? 

53.  Fifty Three interruptions in a twelve hour period.

This topic came up last week at the new MOMs group — I’d asked a group of new moms who’d just met to talk about what was most surprising since their babies’ births, and although that conversation can go lots of different ways, this group mostly talked about how the births had gone, and the first couple days in the hospital.  Several moms talked with annoyance about how frequently people barged into the hospital room, (“it felt like someone was constantly coming in to do something”) and how difficult it was to get any peace, privacy, or even just a little time to think straight.  

Well, they’re right:  The study found that over the course of a twelve hour period, mothers in the hospital were interrupted an average of 53 times.  There were more than twice as many interruptions as periods of alone time.  That means that a new mom had to deal with someone coming in to do something to her pretty constantly; and the study also found that the interruptions themselves lasted longer than the stretches of alone time.  In fact, half of the “uninterrupted” stretches were less than ten minutes long.

Guess what?  Moms didn’t love that.  

In my New MOMs group, many of the same moms were also complaining that they didn’t have enough help with getting the hang of nursing, or that they were “left alone” to figure it out by themselves.

These things aren’t at odds, at all:  New mothers are not supposed to be left all alone, isolated, without help or company or support.  They are supposed to have easy access to supportive, knowledgeable people who can help them, and who can attend to their needs as they learn to get the hang of dealing with the baby.  They are not supposed to be isolated and when they are, they languish.  And all too often, they not only don’t complain, they feel guilty and weak for not being able to figure everything out themselves.

Isolation is bad for mothers.

But isolation is not the same thing as privacy, and all interruptions are not equal.  One mom I spoke to described how frequently people came in to take her blood pressure and temperature, or to check on the baby, or to have her fill out forms.  Did anyone come in to just sit with her and keep her company?  No.  No one in the hospital is paid to provide company. Did anyone come in saying, “Good morning, what can I do for you that might help you feel more comfortable today?”  Of course not.  The hospital does not provide a concierge.  Did anyone give her a list of resources that might help or educate her if she wanted that?  No, the hospital is not a school that provides education for its customers.

Did anyone assess her breastfeeding before the baby was discharged and provide her with detailed, evidence-based guidelines about how to proceed?  No.  Apparently the hospital is also not concerned with infant growth and nutrition.  You and your boobs are expected to figure it out for themselves.

What did they do?

Well, lots of people commented that she should be breastfeeding.  People talk and talk and talk about how “best” breastfeeding is.  People gave varied opinions about how frequently she ought to nurse and how long the baby ought to stay on the breast.  Most of them disagreed with each other.  

And they got all the data they wanted, about her temperature and blood pressure and wound-healing, and her paperwork was all complete.  They did that on their own schedule, in the way that was most streamlined for the hospital, not for the woman who’d just done a day of labor followed by major abdominal surgery and whose nipples were cracked and bleeding and whose baby had lost a lot of weight.

This. Is. Not. Good. Customer. Service. 

Newborn babies need lots of skin to skin time with their mothers, but new mothers (understandably) often feel modest about showing skin to strangers.  Having the door of your room burst open while your shirt is off can throw even the most unflappable new mom, especially when it happens multiple times per hour.

New babies also need frequent feedings, but new moms getting the hang of nursing often don’t appreciate someone barging into the room just when they’re squeezing the breast and looking at the color of their colostrum.  New moms are human beings; they need privacy.  When they don’t get it, they cover up.

The study found that moms perceived that interruptions interfered with breastfeeding.  This does not mean that doctors and nurses came in and literally said “You need to stop feeding now” or that the moms were told to ignore their babies’ cues to feed if someone else was in the room.  What it does mean is that as a practical matter, the moms felt that being on the other side of a revolving door was getting in the way of learning to nurse.

Why aren’t we making it easier on new moms?  How about some hospital protocols that group necessary clinical interruptions together in a way that makes it a priority to get new moms longer stretches of privacy?  

And how about making sure that, if someone’s going to enter a new mom’s room, that person:

(a) ask the mom “were you about to feed the baby?” and offer to come back later if it’s easier for the mom, so that no mom leaves the hospital feeling like someone was barging in on her every five minutes, and

(b) be prepared, qualified, trained and equipped to ask about nursing, assess the breastfeeding dyad, and provide appropriate, supportive help OR ELSE SUMMON SOMEONE WHO IS, so that no mom is discharged from the hospital without a breastfeeding assessment by an IBCLC.

People like to feel like they know what they’re doing — that’s because we’re human.  And when you’ve just had a baby, you often feel the opposite.  No one wants strangers barging in on them constantly when they’re feeling like a big messy work in progress — that can make you feel like giving up on whatever you were working on.  Instead, what new moms need is enough privacy to get the hang of things, and enough help to be guided in the right direction.  

Here’s what you can do:  

If you’re pregnant and planning a hospital birth:  Make a sign for your door that says, “Please, Only Urgent Interruptions; I Am Feeding The Baby.” Hang it at will.  Feel free to ask anyone who comes in whether they can come back in half an hour.  Have contact information for an IBCLC who can help you out as you begin breastfeeding.

If you’ve just had a baby:  The hospital will contact you with a generic call or letter to ask how your experience was.  I know you have a baby and you’re tired.  But take the time to answer their questionnaire and answer honestly.  If you got lousy customer service and know what would have helped, tell them.  You don’t have to figure out how they should conduct all their business, let them sort out the logistics.  But you ought to let them know you have a complaint with the way they do it now.

If you are a friend of a new mom, and can see that she had a lousy hospital experience because of this: write to the hospital and complain.  

Things don’t change when no one complains.

Childbirth is Natural

     Back in the 1970s, a lot of oat-filled snacks appeared in my lunch box, labelled: “all natural,” “naturally sweet” etc.  At the time, we all thought we were sort of virtuous and extra healthy for eating these. 

     The thing is, “natural” didn’t, apparently, mean anything on food labels; it was just a phrase marketers realized people like.  Granola bars had as much sugar as cookies, though we all thought of cookies as “dessert.”  When I learned that the phrase meant nothing, I felt a little cheated.  After all, the granola bars claimed to be from Nature’s Valley!  

     But then I thought — isn’t any valley just a natural formation between hills or mountains?  Are there unnatural valleys?

     The funny thing is, it’s the same thing with childbirth.  When I’m teaching, invariably a student will use the phrase “natural childbirth,” either to say, “I want a natural childbirth” or “I’m not interested in natural childbirth.”  

     We all know what it means.  And yet, it’s just as empty as the granola bar packaging, and I dislike it just as much, and I suggest we stop using it altogether.

     Because isn’t all childbirth natural?  

     What could be more natural than reproducing?  For adult women who like men, reproduction is so natural that you have to work to avoid it.  Whether you’re partnered or not, your body prepares for pregnancy a dozen times a year.  If you get pregnant, the natural culmination is birth.  Somehow, whether it’s a vaginal birth or a c-section, spontaneous labor or induction, pain medication or no, the natural conclusion of the labor is that the baby comes out.  

     I said “we all know what it means,” but that’s not exactly true either.  Sometimes people use “natural” childbirth to mean “no c-section,” and it’s just a way of avoiding the word “vaginal.”  

     Here’s the thing about that:  I do know that regular people who aren’t childbirth educators aren’t, usually, comfortable with the word “vagina.”  And I remember, when I was a lawyer, one time when the guy in the office next to me (who had overly-long greasy hair and a chronic post-nasal drip, so I’d hear him hawking phlegm, daily, as he berated first-year associates with the door open) told me about his wife’s birth and managed to say “vaginal” eight times, gratuitously in the span of two minutes.  

     The image of him schnuffling beside his wife and her vagina — eight times — was really gross, and I felt, distinctly, that the point of this, for him, was that he got to say “vagina” eight times to the cute, young associate next door, which pretty much sums up why I didn’t like the practice of law, butanyway.

     Still, in truth, if he’d said “natural” it wouldn’t have been much better.  My objection was to him and his slavering TMI, not to the word “vaginal.” 

     So, I get it on the “vaginal” birth thing, but, hey folks, get over it.  Say it quickly, or just say, “I gave birth,” and lets have that mean vaginal birth without having to talk about your Nether Regions.  It might help us remember that c-section is supposed to be a last resort.

 **

     Some people use “natural” to mean “no pain medication,” but that’s tricky, too.  The idea is that a woman who relies on her own internal coping tools is closer to “nature” than someone who gets an infusion of chemicals injected into the epidural space.  But both women — all women in labor — naturally respond to pain by looking for *some* way to cope with it.  A woman who doesn’t use medication isn’t more stoic, she is just using different, non-chemical tools to get through the labor.  It is natural to look for pain relief.

     And the meds argument is tricky:  If you have Pitocin but no epidural, is it natural?  

     Suppose you have no medication at all, but you have IV fluids because you were dehydrated at the beginning of labor?  Natural? 

     Suppose you go into labor on your own labor at home in the tub and using massage and stuff, and, after 4 days of labor, are still a few centimeters dilated and request a c-section because you’re too exhausted to carry on?  Unnatural?  To me, the natural response to exhaustion is to look for something to help you deal.

     And, on the other hand:  suppose you planned to have an “all natural” birth but your placenta is completely previa and there’s no option besides surgical birth.  Do you lose your all-natural status?  Points for having wanted it?

** 

     I hate the way “natural” can sound like a badge of honor: “She went all natural!”  If “natural” is good, it seems like all the women whose labors don’t fit into the “natural” box are less entitled to bask in the accomplishment of having made it through a pregnancy and, somehow, gotten a baby out.   And that’s unfair.

     And I hate the way “natural” is, sometimes, a dis.  “I don’t feel the need to do it all-natural,” some folks say, as though “natural” means “martyr.”  It’s not being a martyr to rely on non-medical tools for pain.  It’s not selfish.  It’s not a birth fetish.  It’s not crunchy/granola.  People have different ways to deal with pain, period.  

     In the end, though, it’s all meaningless – “natural” doesn’t mean any more in the birth world than it does in food labelling.  All valleys are natural, but that doesn’t mean you’re in the mood for a granola bar today, right?  Childbirth is natural too.  

      Here’s what’s unnatural:

•  Being pregnant and not having any curiosity about what is going to happen at the end. 

• A healthcare system that treats women like they can’t comprehend labor unless they are doctors, or probably aren’t smart enough to make good choices for themselves. 

• Maternity care that is routinely managed in a way that leaves many women thinking their bodies don’t work properly. 

Instead of talking about “natural childbirth,” lets do this:

      When you’re pregnant, become educated about the physiology of labor, about medical tools available to address problem situations, and about all manner of ways to deal with pain.  You do not need an advanced degree; a high-quality prenatal class will suffice.  As you approach the birth, make sure you have access to at least one gentle, loving support person besides your caregiver, to be with you in labor and help you navigate your birth.  

      Afterwards, if you don’t feel like talking about the birth, don’t.  But if you do, I suggest that you say “I gave birth,” to mean a vaginal birth, or “I had a c-section,” if you did.  If you used pain medication and would like to talk about it, say, “I had an epidural,” (or fentanyl, or whatever), and if you didn’t use medication and would like to talk about it, you can say, “I didn’t use pain medication,” or “I had an unmedicated birth.”  If you’d like to add other info, you can do so specifically.  

      Does this sound wordy?  It is.  Childbirth is intimate and private and a big deal.  Your experience of bringing a child into the world and becoming a mother is more than can be captured in any two-word phrase.  You don’t need to tell anyone your personal business.  But if you want to, it’s OK to tell the story.  

“In the birthing world, it was big news: After a 15-year decline, home births in the U.S. rose 20 percent between 2004-2008. Though the actual numbers remain tiny — out of about 4 million births, 28,357 happened at home in 2008 — the reversal of the long downward trend is notable. So are the demographics: much of the increase was driven by highly educated white women. A full 1 percent of them decided to forgo the hospital and give birth at home, according to the new report published Friday in the journal Birth: Issues in Perinatal Care.”

—

I’m not sure I’d call it a trend, yet:  even with the increase, fewer than 1% of American women give birth at home. But what’s interesting about the data is that he biggest increase in home-birthing women is among white, highly educated women.  Home-birth is no longer just a “crunchy” option; increasingly, women who don’t even wear Birkenstocks are doing it.

Some folks have suggested that this proves more American women want “natural birth.”  If you’ve taken my childbirth class, you know I don’t like the word “natural” (in food labeling and in childbirth, it’s somehow both too-charged and unspecific).  Becoming a parent is quintessentially natural, though not everyone does it.  It’s natural, irrespective of how you cope with pain. 

To me, though, what’s even more natural is the desire for control and dignity when you face a challenge.   For some women, pain medication gives the sense of control they need, to cope with labor.  For other women, control means a familiar setting, not dealing with strangers, and avoiding hospitals’ institutional protocols that are designed for litigation-avoidance and not always for safety.   Part of the trend towards home-birth may be that more educated women, considering their options, choose a setting that gives them the sense of command they need in order to cope.  Hospitals wishing to draw women back might do well to consider what changes might let women feel more control.

For all women, control involves respect and dignity.  And one area where home-birth is unbeatable is customer satisfaction.  Women who give birth at home tend to describe a relationship of trust and respect with their caregivers.  I don’t mean in a soft-focus-let’s-all-gather-round-the-bonfire-and-talk-about-our-vaginas way.  What I mean is that their midwives treat them as competent adults and consumers, and remind them that birth is not only about the dilating cervix and the fetal heart tones.  It’s certainly more convenient to ignore the woman attached to the cervix – she might have questions!  She might want to tell you everything about her mother and her sex life!  She might need you to talk her down after she’s read all manner of horror stories on the internet!  She might want every single thing to be explained, or she might be so visibly scared that she says she is afraid of any information at all, to her detriment! – all of these things are complicated to deal with.  But it doesn’t compromise safety to take the time to meet her where she is and treat her as a human being so that she can feel respected and dignified.

Not everyone needs an intimate relationship with her doctor or midwife, but no one – not the Granola Birkenstock Mom, and not the Type A Wall Street Mom – can feel dignified if she is shamed, rushed or disrespected.  I meet several hundred pregnant women and new moms per year and the overwhelming majority are college educated women who give birth with an OB in a major hospital.  I hear many, many complaints about being rushed, chastised or even bullied, from moms who simply had questions.   It is upsetting to hear and it’s demoralizing how many of my clients don’t object because they despair that there is “no other option,” or that objecting would just make it worse.   Women planning a home-birth with a competent, professional midwife do not report being rushed, chastised or bullied – to the contrary, they typically report that they are treated like competent adults and human beings, and that being treated properly increases their self-confidence.  In this day and age, shouldn’t that be something we can all expect, anywhere?  

My hope is that the trend of highly educated women choosing home birth is a sign that women are voting with their feet.  And I hope that hospitals and OBs take note:  customer satisfaction is part of maternity care.  

(Full text of quote here).