The First Prenatal Vist: What to Expect

Because has been branded to mean ‘doctor attended hospital birth’, the first question people may as when a woman announces she’s pregnant is ‘has she seen a doctor yet?’

Therefore, here I would like to explore the many assumptions implicit in that question.

First of all, the obvious: the question is not ‘has she found a midwife yet?’ or ‘is she seeing a midwife or doctor yet?’ It is simply, ‘doctor’.

When should a woman go to the doctor? What should she expect? How much of what she may encounter is actually beneficial? Why or why not?

The expectation is that as soon as the rabbit dies, a woman needs make an appointment with a doctor to ‘begin prenatal care’. This is a bit of a misnomer. ‘Prenatal care’ is actually something only a mother can do. She’s the only one who can make decisions about what she eats, what stress she is exposed to, how much she exercises and whether or not she stops smoking. In other words, how she CARES for herself PRENATALLY. All a doctor can do is monitor, test and give advice; perhaps even educate. Still, the mother is the only one who can choose to accept or reject the advice. So, technically, going to the doctor immediately is the initiation of prenatal monitoring and testing, not prenatal care. This is a redefinition of the verbiage, intentionally.

Who wants to be monitored and tested? Of course I want to be cared for! This actually puts doctors in a bad place. I believe it is one of the reasons obstetricians are the most sued profession. They have set it up so that in the minds of the birthing families that they (the doctors) are responsible for outcome, because it is their medical care that determines outcome. It isn't true of course, but they need to foster that belief to maintain the monopoly on birth. The double edge sword is that then some women believe they are not responsible for their decisions. We see this in the language: "And then my doctor decided I needed...", "My doctor made me...", "then they gave me...".

The manipulation of language modifies the meaning, thus in the minds of many, implies something it is not. This is a technique used in rhetorical persuasion, as are logical fallacies, which are contained in the question ‘has she seen a doctor yet’.

The slippery slope: this asserts that if we got to the doctor, we will get the very best care, our baby will be healthy hence we must go to the doctor as soon as possible.

I've already discussed previously the abysmal outcomes in the U.S. which disprove these assumptions.

The hasty generalization: this would be the assumption that ‘everyone knows to be healthy you have to see a doctor as soon as possible’.

Again, this is not supported by outcomes.

Post hoc ergo propter hoc: this fallacy assumes causation, i.e. that one thing is because of another thing because it happened after the first thing. For example, birth is safer now than it was 100 years ago because we see doctors in pregnancy.

Birth is safer now than 100 years ago, but due to many factors unrelated to obstetrical care. Again, previously discussed here.

Ad populum: This is an emotional tactic that equates one thing with another. The example here might be that if you are a good mother, you go to the doctor immediately.

However, just because the entire concept isn’t what it might appear at first glance doesn’t mean it’s worthless. In pregnancy, women do need to be educated (although that happens more through the woman’s own efforts than through prenatal visits), may need sound advice, and should be monitored to a certain extent.

The first prenatal visit establishes ‘baselines’. It is important to know what your normal blood pressure is, what your normal heart and breath rates are and what your normal temperature is. It is important to check your blood sugar level through a finger prick or urine dipstick (which also tells if you may have a urinary tract infection) to determine if you could have diabetic tendencies (which is different from ‘gestational diabetes’ which we’ll get to in a minute). It is important also to find out if any sexually transmitted diseases are present, and to have your health and family history recorded, as well as the that of the father of the baby. It must be determined if you might be a victim of abuse or if you need public assistance to get nutritious food.

All of that can be done by a midwife, a nurse, or essentially anyone, even a group of other pregnant women.

Doctors are required for genetic screening, ultrasounds and glucose challenge testing, which round out the first prenatal visit. (Well, technically, a CNM can and does do this things too, but likely will explain the procedures and honor a woman's decision to decline a routine test or procedure that is not relevant to her individual situation.) What do those three tests tell you and how might it change your care? In other words, what good are they? What’s more, if anyone can do the rest of the stuff and doctors are only necessary for these, why is the first question people as is ‘has she seen a doctor yet?’

Genetic screening:

Ultimately, what this comes down to is, how comfortable is the mother with the possible loss of a healthy child due to the tests, and is she comfortable with aborting a fetus that has chromosomal abnormalities? She also must consider that healthy babies have been aborted because tests said they were abnormal, but they weren’t. Then there is the stress that testing adds to the pregnancy, which is addressed in The Tentative Pregnancy: How Amniocentesis Changes the Experience of Motherhood (Katz-Rothman).

Ultrasound:

What does early ultrasound tell you? It tells you that you are pregnant, which you already knew. It can tell you about ‘how much’ pregnant you are, which you also probably already knew. If not, does it matter if you know that you are due at the end of April or the beginning of June? Nope. You are still 'due' in sometime in the spring. It doesn't matter how many times your 'due date' changes with each ultrasound; your conception date doesn't change. You are the same amount pregnant whether a proclamation of an estimated GUESS DATE is made or not. Only about 5% of women actually give birth on their 'due date'. The rest will give birth within the 2-plus weeks or so on either side of it. Gestation can also be determined by cervical changes and size of the uterus, measured by fundal height (where the top of the uterus is). Fundal height also allows assessment of fetal growth as the pregnancy progresses.

It can detect certain abnormalities in the placenta or fetus. Then again, it can 'detect' abnormalities that aren't there too. Let's see, I've known women who were told the baby had Down Syndrome, which it didn't; women who were told they had placenta previa, which they didn't; women who were told they had too much fluid, which they didn't; women who were told they had to little fluid, which they didn't; women who were told their babies were too big, only to discover after surgery, they were normal or small; woman who weren't told they had twins, when they DID. You get the picture. (Pun intended.)

Is there anything that you need to know at this stage of the game that justifies the use routine use of a technology that has been implicated in a number of problems for babies, including more than 3000 annual miscarriages of healthy babies per year?

The cruel irony here is that many women get early ultrasounds to verify they are pregnant (which they already know) or to assess viability of a fetus because they have endured infertility.

The FDA has even urged caution.

And while some would argue that the warning is against ‘keepsake images’ I would argue that routinely used, without a true and clear medical indication, it’s the SAME TECHNOLOGY used for the SAME PURPOSE. The only different is the location of the machine and technician. I admit, it is a very cool tool. I’ve seen some amazing pictures, and it IS useful in some selected medical situations, but I am talking about the risks of non-medically indicated routine ultrasound.

Please remember, x-rays were used on pregnant women to determine fetal position for years before it was determined it was unsafe. Ultrasound hasn’t yet been proven to be safe despite wide usage, and there is a lot of evidence that it might be causing problems. If there were a probability that there was something wrong with my baby that could be fixed I would weigh the benefit and possible risks and might decide to take the risk. If the problem could not be fixed, or there was no problem, why on earth would I take the risk of CREATING problems for my child?

Gestational Diabetes:

“…no benefit has yet been established for glucose testing during pregnancy…” (A Guide to Effective Care in Pregnancy and Childbirth, pg. 77)

This test is wrong up to 70% of the time.

Think about that. 70 out of 100 times, it will be worthless. If a test is wrong far more often than it’s right, and the results lead to care that is does not improve outcomes, and the very test itself makes women (thus their babies) sick, WHY WOULD YOU DO IT?

What all of these do is add stress, and a previous post spoke to the detrimental effects of stress in pregnancy.

So, if the assistance that midwives provide (or women provide for each other) is proven to improve outcomes, but the few tests that require doctors provide little to no benefit to healthy women (with much risk), I ask again, why is it that the first question women get asked is, “did you see your doctor yet?”

That would be a logical question to ask a sick or injured person, not an expectant mom. Pregnancy and birth are normal, physiological functions! Just as with any normal, physiological function, they are not without risk, but we don't assume impending danger in every normal function.

I slept well last night. Tonight, or tomorrow night, or the night after, I could succumb to insomnia, or a circadian rhythm disorder, or a deadly sleep apnea. No one asks me if I saw a doctor because I slept well last night, but they certainly should ask if I'll be seeing a medical sleep specialist if a problem develops.

I digested my food without incident yesterday. There is every reason to think I will today, and tomorrow. But at any moment I could choke and die. I could develop diarrhea or I could become constipated. I might become nauseated or contract some food borne disease that could kill me in a matter of days. I didn't call the doctor today just in case one of these situations befall me, but I would if and when I did get sick, and I'd expect every test that might determine what the problem was.

My heart beat probably 90,000 times today. I didn't call a cardiologist. I even did things that caused my heart to beat faster than usual and raised my blood pressure. A cardiologist doesn't monitor me during sex or when I ride my bike, though people die of heart attacks doing those things every day.

I walked today. I didn't break my leg, so I didn't call an osteopath.

I breathed easily today. I didn't have an asthma attack, nothing accidentally obstructed my airway, and I didn't fall into coughing spasms. I might, but I didn't. So I didn't call a pulmonary or respiratory specialist. I would if I needed to, but I didn't.

The human body creates a human being from two single cells without a single thought or an ounce of effort on the part of the mother; just as easily as she breathes, walks, digests and sleeps. The human body knows how to birth that being without incident, and how to create food that is specific to that particular infant's needs.

Mothers need to know how to take care of themselves. They need to understand that THEY take care of THEMSELVES and that this pregnancy is not something happening 'out there' that is all about what someone else does or doesn't do, or about machines and tests that may or may not apply to them, or that may or may not be safe or effective. It's about what they are doing that has a direct effect on what's going on inside.

Nonsense and more nonsense

Now comes the time when I point out that accountability should go both ways.
There are some who have read my book or articles who assume that I hate doctors, hospitals and nurses (despite the fact that I repeatedly say directly that I do not) and that I hold all home-birth midwives up for sainthood (which could not be further from the truth).
What I do abhor is a lack of accountability, common sense, and integrity. In fact, part of the reason I decided not to continue my pursuit of midwifery (besides the fact that I discovered HypnoBirthing and experienced a paradigm shift that brought me to the conclusion that while midwives and home-birth should be an available option for everyone, not everyone had to have a home-birth to have a great birth) was that I had several unpleasant encounters with nasty women who just happened to be midwives. I have no illusions; people are people. The fault I find in obstetrics is not with individuals, but with a broken system.
In any case, someone told me of a situation where a couple was having a home-birth, but after a long labor with little progress, they transported and ultimately, a cesarean was the result. When it was all over, the midwife bad mouthed the doctor and second guessed his every decision.
This is my stand on this: the midwife was unable to assist this couple. She transferred care. What happened after that point was none of her damn business, and it certainly was unprofessional and unfair of her to say anything to the parents regarding the care they then received.
There certainly have been births I've wished could have been different. For years, I didn't have a problem speaking my mind about it either. Then a couple of things happened. One: someone second guessed my work and made assumptions about it, and judgments about me. None of it was accurate, because they weren't there and they didn't have all of the information. I vowed I would not do the same thing to anyone else. Two: when I realized that the best maternity care systems in the world require midwives and doctors working amicably together, I realized that meant there needed to be mutual respect. Now, granted, one reason that some midwives are so negative toward some doctors is that they have had bad experiences. Another is that they fail to make a distinction between the system and the people within the system. Again, that is because they are often dealing with the very individuals who keep the system broken. If you talk to a midwife who has physician back-up, you will find they have a very close relationship based on a great deal of mutual respect.
So, just to clarify, in situations where a true medical indication supports intervention, I am very grateful for highly educated and skilled physicians. I don't feel they have any place caring for healthy women and babies, but we need them for the exemplary care they can provide through the utilization of appropriate technology. For instance, every breech does not require surgery, but some do. Skilled midwives should be able to care for those that can be born vaginally, and they should be able to have surgical back-up for those that require surgical intervention.
That being said, I now have to kvetch about a fund-raising letter I got this week.
It starts out with the story of a newborn that contracts a potentially fatal infection within hours of his birth. This is to evoke emotion. It is intentional. Marketers want consumers to use a "Affective decision making" strategy. From Consumer Behavior, 4th ed., "Emotional processing can sometimes overwhelm rational thought, leading consumers to select an option that is inconsistent with their rational preferences-a decision they may regret later." (Hoyer, MacInnis, 2007) As I mentioned previously, marketing for the 'brand of birth' is entirely predicated on fear that is created and nurtured for the purpose of sustaining the "hospital=safe birth" illusion that maintains the 'brand'.
The letter goes on to say that the mother was tested for this disease, but she had tested 'false positive'. The doctor and the hospital then saved the baby.
Because the reader has been emotionally engaged, and further, believes that birth is dangerous and hospitals are the only place it can be safe, they won't question that the the baby got sick in the first place because the test was inaccurate. The mother had all the tests and interventions. Her baby got sick and almost died. To me, that illustrates that the system is not infallible, as is implied in the next line: 'because we believe our community deserves the very best...'. I would like to point out, had this been a home-birth, the midwives would be faulted with 'missing' something, even if they transported the baby and the the outcome was the same. Either way, the doctors are portrayed as heroes. Make note: I'm not suggesting they aren't. They helped a sick baby. However, the baby got sick in spite of the highly technological prenatal care they provided, so I'm suggesting there is inconsistency here, as well as an intentionally misleading and emotional appeal to disregard logic.
After the emotional appeal, the letter goes on to ask for donations for two new machines. The first is an electronic fetal monitoring system that provides 'continuous observation of mothers and babies form the central nursing station'. First problem: continuous routine fetal monitoring has consistently proven to do NOTHING in healthy populations except increase cesarean rates. It does not improve outcomes.
However, I happen to know that this particular hospital has astronomical induction/augmentation rates, and the use of pitocin introduces so much danger into a labor, it can render an otherwise 'normal' birth high risk. In fact, in some cases, hospital protocol mandates that once pitocin is administered, a mother and baby must be continuously monitored and a nurse must be in the room at all times. The solution to a high mortality rate possibly linked to unsafe routine practice is NOT to buy more equipment that removes personalized care yet further (In fact, the new device will allow doctors to monitor their patients from their offices so they don't even have to bother to come in and actually see the laboring mother face-to-face!) but to STOP the harmful practices that cause problems in the first place!
The other machine this hospital wants to purchase is one that protects against infant abduction. When I taught hospital classes, the facility I worked at insisted that I point out that they had a state-of-the art security system that set off all sorts of alarms and whistles if someone tried to walk off with a baby. The parents would 'ooh and ahh' when I did. It always baffled me. If there is such a danger of your baby being abducted from this place (or being switched), why on earth would you even go there? This, to me, would be a grand reason so have my baby at home.
My daughter never left my side. I received her from my own body into my own hands, brought her to my own breast, and then we safely slept in my own bed where she was conceived. While I'm sure she would like to think she is someone else's daughter sometimes, there is absolutely no doubt she is mine. I never feared at any point that someone would take her or that someone would give my baby to some other mother. This machine a selling point...why?
Again, because fear is used, it doesn't occur to most people that the thing they fear wouldn't exist if it wasn't manufactured by the very people who will fix the problem, and who sell their services by playing on the fear of the problem. Talk about job security!
In obstetrics, 'safe' means they can fix what they break. Pitocin and cytotec can't be used at home because they are so dangerous that the risks could not be managed outside of a hospital. Postpartum hemorrhage, ruptured uterus, fetal distress and fetal bradycardia (slow heart rate) are some of these risks. These are exceedingly rare in a natural birth. In some places inductions that introduce risk that wouldn't otherwise exist are at 60 or 70%. (The WHO says rates should be no more than 10%.)
Episiotmy is cutting of the flesh between the vagina and anus (or into the side of the leg). It also is an intervention that should be very rare. Women are built like accordions, unfolding to accommodate the passage of a baby without undue damage to muscles. Episiotomy damages healthy muscle that supplies blood to the pelvic hammock, including the clitoris. To cut this without reason can impact the sex life of a woman for the rest of her life. However, I have lost count of the number of women who have said they got cut because 'a cut heals easier than a tear'. But if the care provider is skilled, there shouldn't be a tear, not to mention the fact that a cut does NOT heal better. It is easer to stitch because it's a straight line. That doesn't negate the fact that it is a straight cut into flesh that didn't need to happen.
Epidurals require an anesthesiologist and a team of medical experts immediately available because they introduce a number of complications from such a fast drop in blood pressure that surgery must be performed immediately, to several effects on baby that require emergency assistance. Again, these didn't exist before the epidural, but because a doctor can fix the problem they created, they tell mothers it's 'safe'.
Is it just me? If I have a choice between 'put my baby in danger as long as you can bring her back from the brink of death' or 'don't ever put my baby in danger', I'm going for the latter every time. If I have a choice between 'cut me as long as you can fix me' or 'leave my genitalia completely intact and functioning normally', I'm going with intact!
If someone breaks your kneecaps, then promises to protect you from broken knee caps in the future, ensuring that no one else can protect you from broken kneecaps, what's that called again?

Going Green

Twenty years ago, my husband and myself were considered a bit 'fanatical' for dragging our garbage to a recycle center and using cloth diapers. Today, I read an article linked off the the MSN main page on 'How to Green Your Sex Life'!
Of course my mind went directly to the cost of birthing and babies, both financially and as it impacts the environment.
I read somewhere (And try as I might to provide a link or resource for you to follow, I couldn't find it. If someone has it, please share.) that the cost of a birth at Patch Adams' Gesundheit! Hospital was $28. This sounded about right at the time, because I think that's what I paid for my 'birth kit' from Cascade Birthing Supply for my homebirth. Today the kit costs $30.
Now, granted, that kit contains a lot of 'disposable' items, as does a hospital birth, but it doesn't have to. Let's break it down:
At home during a birth, a woman wears her own clothes (or none). There is no special bulk laundering with harsh disinfectants. The mother is immune to the germs in her own home, and those of the people in her home with whom she shares close contact. Thus, her baby is also immune. There is no need for harsh chemicals to be anywhere near her or her baby, because it is unlikely either would be exposed to anything that would make them sick, unlike the hospital nursery where infection is always a concern.
The birth bed is made up with fresh linens, then a waterproof layer is pinned into place. We used a shower curtain, but some people use a picnic tablecloth; the kind that has a fuzzy side and a waterproof side. Next, the bed is made up again with more clean sheets.
Sometime disposable chux pads are still used, sometimes towels, but as anything becomes soiled, it is cleared away by the midwives or her assistants and goes into the washing machine.
The midwives don't typically use disposable instruments: they are scrubbed between each use with an antimicrobial solution and either sterilized in an autoclave or the oven.
Nothing sterile is opened until it is used, and in many cases it will never need to be used. Gauze for instance, might only be used if there is a tear or an episiotomy, which is very unlikely at a midwife attended birth, in home or in hospital. My favorite all time midwives (CNMs-Certified Nurse Midwives) are hospital-based and are amazing at keeping a mother's bottom intact! They offer truly mother-friendly services all the way around!
In any case, if there is no tearing, there's no stitching. If there's no stitching, no IV, no meds, etc., there's nothing to dispose of. The bonus is that mother and baby get a birth that's not only inexpensive, safe, and gentle, but possibly ecstatic as in the You Tube video posted below.
The cord can be tied with new shoelaces and cut with boiled scissors, or the placenta can be left to fall off, which is called a lotus birth. Personally it grosses me out and seems like added work, but some people find value in it.
I'm always amused when I see check lists that require parents to spend a small (or large) fortune! My birth/baby cost very little for the first several years. My birth was inexpensive and eco-friendly. I never used bottles, formula or pacifiers. I used cloth diapers that I then used as rags for YEARS. I used a baby food grinder and bought all of 2 or 3 jars of Earth's Best organic baby food in a pinch. I barely used the crib I was given, and used the strollers for carrying stuff because the sling worked so much better for transporting baby. The highchair, however, I found indispensable when she started eating solids somewhere between 6 and 10 months. For me, it was the only way to contain her long enough to offer her food.
However, the following list is actually pretty good.
I did make a couple of comments in [brackets and an alternate text color].

What newborns need, the simple list:
Warmth (mother's arms), Food (mother's breast), and love (mother). In short, Nature designed this relationship so that all babies need is to to be held close to mom's heart just like they were on the inside.

What newborns need, the more complicated list:

Diapers (though those Using Elimination communication might argue that)
Clothing of some sort (also debatable, depending on climate; but oh! aren't baby clothes CUTE!
A couple of hats (although protection for the soft spot from heat and cold could be a blanket)
Mittens, if the baby is a scratcher
Outerwear if it's cold
Receiving blankets and/or larger, warmer depending on climate

[OK so far; babies need to be kept protected and warm.
Although one list I saw included how to fit your newborn for SHOES!
Babies don't walk, people, they don't need shoes until their feet need to be protected, and even then, they learn to walk better barefoot so the muscles can develop properly. In any case, one great resource for natural baby products is Baby Bunz.]

If you are nursing, you need no special equipment, just a few good nursing bras and some breasts pads, but some people try to include so much stuff and make it so complicated!
If birthing interventions haven't sabotaged breastfeeding attempts, it shouldn't be difficult.
Any pillow is a 'nursing pillow'! Breasts are portable, can't be lost, are always sterile and the milk is always warm. That said, you may find the following handy:

Breast pump and bottles (some would say hand expression works just fine once you get the hang of it, and that cup feeding is better as it doesn't confuse the baby)

If you are formula feeding:
Bottles
Nipples
Bottle brush
Bottle sterilization system
Formula (constant and immediate supply)

[All of this is hard on the environment, not to mention the production of artificial baby milk
and the impact that millions of frequently sick babies has on the environment and economy.]

Baby's Butt:

Diapers and covers, if you aren't doing Elimination Communication
If using cloth, get a few dozen in assorted sizes. You'll use them forever!
Weleda Diaper Cream
Homemade cleanser and cloths (Mix a squirt of natural liquid soap, a little olive oil or calendula oil, and a little water. Keep in a squirt bottle with some thick, soft paper towel or flannel wipes.)
Diaper pail
Diaper Duck

If using paper and plastic diapers:
[There is NO SUCH THING as a 'disposable' diaper. They last in landfills for up to 500 years. Tons of biological waste goes into landfills because people don't empty the contents into the toilet before tossing in the trash as they are supposed to do. That waste can contain the polio virus that sheds from babies getting live polio vaccines which can leach into water supplies as landfills were not built to deal with such issues. Other illnesses can be spread by flies.]

Babies grow fast! Buy a small amount of newborn, and check out Mothering advertisers for some that don't have chemicals.

Baby baths:
Babies don't get that dirty. They don't sweat and they don't play in the mud (yet). Keep their bums and creases clean and you really don't need to deal with wet, slippery babies for awhile. There are, however, a lot of neat new 'mother's helpers' you could splurge on. Just keep in mind their skin is sensitive, so stick to natural ingredients and avoid alcohol that will dry out their skin.

Bedtime:

You could keep it simple and sleep with your baby! (Yes, it is safe if you use common sense! Read Dr. Sears take on it here.)
A Co-sleeper makes it easier if you have a small bed.

If your baby sleeps all alone, you'll need:

Monitor
Crib
Crib sheets
Safe crib bumpers
Waterproof crib covers
Extra blankets to keep baby warm in place of you!

Extras like pacifiers, bouncy seats, baby swings, etc. are just more unnecessary 'stuff'. One acquaintance called these types of things 'super duper baby neglecting devices'. She meant that these kinds of things are often used to replace interaction with mom. Now, I agreed with her assessment before I had my baby (at which point I discovered some of the things I thought I'd never use, I actually found useful on occasion), and I still do to a certain extent. For instance, car seats are a must have for car safety.
However, they are so abused that its leading to 'flat head syndrome', which before the cause was recognized was leading to surgery! Where is the common sense in carrying around several extra pounds of plastic at an odd angle? Babies are meant to be picked up, carried, talked to, enjoyed, nursed.
Why stick them in a baby bucket for hours a day? There is a time and a place for distracting babies, but many people don't use such things appropriately.

A good baby sling (not a backpack as baby's bones are still soft and growing so splaying the legs is not good) is a wise investment though.

A care seat is a necessity (it's the law for the car!)
A bulb syringe can be useful, along with saline drops, if you baby is stuffy
Diaper bag
Baby Thermometer
Ear scope

After the birth, some mothers even use reusable sanitary products or go organic.
Really, living gently on the earth can begin with birth (or before)!

MRSA and random thoughts

I keep meaning to get back here to post more on the psychology of decision-making, however, I've been running non-stop.
This week is my daughter's 16th birthday. I was hoping she'd have some visitors to help make her feel important on this important day, however, its not looking likely. She was born on the opening day of deer hunting season, and while my take on the situation is pretty much the same as hers (she only turns 16 once and a person can kill a deer just as easily the 2nd day of hunting season as opening day, not to mention that the chances of actually bagging one on that specific day are probably slim anyway) I can see why she's feeling lonely and unimportant. We've explained that to expect people, even people who love you very much, to travel so far (we recently moved very far from where she grew up and where most of our family lives) is unrealistic, which she understands. What bums her out is that she'd rather people not say they are going to visit and then don't, because then she gets hopeful.
In any case, we have spent considerable time the last few days trying to set up something that will make her feel special, albeit on a shoestring budget. Fortunately, she has no expectation of getting a car or something outrageous for her sweet 16.
So, there's that, and then there is the regular school work, job hunting so I can pay for school, and continuing education requirements for membership renewal for the National Guild of Hypnotists.
That has been quite interesting, actually. I'm learning more about using hypnosis for IBS, pain and pre- and post-op assistance. I've already been working with and researching pain in association with Lyme Disease and cancer with promising results. (I take clients with a medical referral through Fox Valley Wellness Center and do non-referral hypnosis at the Fond du Lac Center for Spirituality and Healing.)
In addition, we are having a very exciting house guest this week; my husband's 'brother from another mother' as he calls him. He is a walking medical miracle! A few years ago, he was in a car accident and broken seemingly beyond repair. The fact that he lived is amazing (the person in the other car who caused the accident didn't), but he was so badly injured they had to put him in a medically induced coma to work on him over several surgeries. All of his blood was replaced several times over. THIS is where modern medicine shines, despite the fact that doctors are the third leading cause of death in the U.S. behind heart disease and cancer. In a case like my BIL, without the skill of those physicians, available drugs, prayers and healing energy work, I have no doubt he would not be with us now. We need all that modern technology has to offer for the sick and injured. When it comes to a situation like this, where one can weigh the risks and benefits and doing something means everything, doctors rule. The balancing factor is that we need to utilize the skill where it belongs, and keep out of where it does more harm than good; i.e. healthy birth or in the case of my chosen headline: MRSA.
MRSA is a huge concern these days. The problem is it's not new. 15 years ago, I went to one of the many doctors I've loved and respected over the years. I said, "I have strep throat. I need an antibiotic." He asked how I knew. I said, "I get it every year, and that's what other doctors have always done." He refused to give me an antibiotic. He explained to me that antibiotic resistance was a growing problem (15 years ago, remember) and that just because other doctors had given me antibiotics without determining if my sore throat was bacterial (in which case an antibiotic might be appropriate) or viral (in which case it would be not just pointless, but harmful as it would kill many of the beneficial bacteria my body needed) didn't make it the right course of action. He said most sore throats were viral, and that it would go away in 2 or 3 days, and if it didn't, I should come back and he would take a culture to determine which antibiotic would work. He explained to me that antibiotics were powerful drugs, and throwing antibiotics at a problem without knowing which would be successful was dangerous.
I left fuming, because of course, I'd been going through this for years and I was sure he was wrong. Antibiotics had worked for me every time, and I didn't buy his explanation that it likely wasn't the antibiotics that 'worked'; it was likely that the disease ran it's course.
Funny, but he was right. My sore throat was gone in a couple of days. He did his job. He didn't allow me to practice medicine by demanding a worthless and possibly dangerous course of treatment. Essentially, every time a doctor says they 'had' to give a patient an antibiotic for a childhood ear infection or cold, despite the fact that the CDC and the AAP have recommended against it for years, that is what they are doing. They are letting patients determine care. The CDC and AAP suggest a wait and see attitude, treating for pain only (if present) and reducing risk factors.
I used these recommendations as my daughter was growing up, although I found them in Healing Childhood Ear Infections. She had ONE earache in her entire 16 years thus far. She's had antibiotics TWICE; neither time for an ear infection. Sadly, she's just as much at risk for MRSA as anyone else, despite my caution.
So anyway, now there seems to be evidence that besides breastfeeding, avoiding dairy, sugar, hydrogenated oils and cigarette smoke, just chewing gum with Xylitol can reduce the incidence of ear infections!
It makes me sad when I talk to parents who miss a ton of work, and copious amounts of sleep because of sick babies. So many of the problems parents encounter can be avoided! It all goes back to the birth and early parenting choices.
A side note: please consider the inconsistency of prescribing unnecessary antibiotics because the 'patient made me', or doing unnecessary 'patient choice' cesareans because the patient wanted it, but taking a woman to court to force her to have a cesarean that she doesn't want. Or, using coercion to get compliance on any number of obstetrical options that the mother doesn't want.
I know, I know. I always end up in the same place. But the inconsistencies and lack of common sense drive me batty.
Look, the good doctors want you to keep tabs on your own health. Dr. Roison (who along with Dr. Oz, Dr. Ornish, Dr. Chopra, Dr. Weil, Dr. Northrup and several personal physicians past and present is one of my favorites) explains,

"The medical care we deliver is so complex, we cannot get it right without you," says the Cleveland Clinic's Michael Roizen, who co-wrote You: The Smart Patient: An Insider's Handbook for Getting the Best Treatment with surgeon Mehmet Oz and The Joint Commission. "One way that you can help us is by checking everything we do."

So, that's all I'm doing; encouraging people to be partners in their own care. Suggesting that people do some research before they make important health care decisions that could have far-reaching implications. Saying that physicians are only human, with the same problems we all have. To think otherwise can create unsafe circumstances.
(Speaking of my favorite doctors, If anyone knows Dr. Oz or Dr. Roizen, I'd love to collaborate on 'YOU: The Pregnant Patient'. I've even done most of the research already!)

Alternative Fuel

Sometimes it seems I just have to be the one who asks the stupid questions; or so it would seem.
In discussing alternative fuel for cars tonight I just had to open my mouth and wonder out loud what the long-term ramifications might be of both of the options we were discussing.
One was hydrogen fueled cars, which would output water. The other was water fueled cars that would output oxygen. So here is how my head works:
I'm thinking, 'Ok, the car runs on water and puts out oxygen. But humans need water and it's already in short supply, so there's one concern. Even if a car gets 1,000 to a gallon of water, with millions of people driving millions of miles, we are using a lot of water that we need to survive more than we need to drive. Unless it's salt water, which we don't need to drink, but do we need it for something else? Is the salinity of the aquatic environment balanced ever so delicately that we could cause problems with something like this?' So, I made the mistake of asking the question 'what might the ramifications be?' out loud, minus the thought process. The consensus seemed to be that because we breath oxygen, there couldn't be too much of a good thing. However, I know that we don't breathe 100% oxygen and that too much oxygen can be dangerous. Babies (mostly preemies) were blinded because they were given 100% oxygen in hospitals after birth. Well, that and the silver nitrate parents were assured was safe; until it burned their babies eyes and made them blind. Just more stuff in the child-bearning year that people assumed was safe because doctors did it, although nothing was actually scientifically tested or supported by evidence. Such as DES, x-rays in pregnancy and thalidomide in the past, or cytotec (or inductions in general) and ultrasound today.
Anyway, at the time I couldn't remember how much oxygen we actually breath (21%) or was too much though, so I didn't pursue it. However, since I'm not a scientist, I was curious to know, does oxygen build up in our little bio-spheric bubble, or does it dissipate? Is there a o2 saturation point at which our plants will no longer thrive? Does more o2 in the atmosphere change the way rays from the sun are filtered? You know, stupid stuff like that.
With the hydrogen car that creates water, the first thought is 'great'! We need more water. At first it could solve a great many problems. However, the planet seems to have a very delicate balance with a great many things. Perhaps there is a point at which the planet becomes too wet? What happens to the way light filters, or a myriad of other possible issues, if there is too much water in the atmosphere? Isn't that part of the problem with greenhouse gases heating the planet? Too much of our water ends up in our atmosphere through evaporation from the heat, instead of on the ground where we need it?
Now, I'm not against either of these technologies of cars that run on benign substances. I was recycling when we still had to take our stuff to a recycling center. I used cloth diapers and breastfed, not just for the health of my child, but for the health of the planet. I had a low-flow shower head in 1988 and friends and family complained about what a nut I was for conserving water. So, all I'm saying is 'what if'. It's the way I think. We keep tinkering with the balance and sometimes the ramifications aren't thought through very well. Water and hydrogen are certainly better than petroleum products, but are they harmless in the massive quantities that would be generated if they were a fuel source? That was all I wanted to know. It seems it's stupid to wonder about such things though.
So, I'll get back to wondering stupid things about birth again.

Attempting Understanding

My personal understanding of a ‘schema’ and a ‘script’ are as follows:

A ‘schema’ is a set of beliefs or facts we have about any given thing we’ve encountered throughout our lives. It’s a sort of a psychological short cut that helps us to not have to relearn everything about something before we make a decision about it. In advertising, it helps us to categorize something being presented; think of it as a ‘one of these things is not like the other’ sorting process in the brain.

For instance, my schema for books includes: they are valuable, they are entertaining and informative, it is fun to read them, they are essential in education. Obviously I like books. Someone else’s schema might be: books are a waste of my time, they are hard work and no fun and they are heavy when you have to lug them home from school.

I’ve learned certain things about books that make them important to me. I have certain associations with books. Therefore I make certain assumptions about books and make decisions based on that knowledge base. Someone who has a hard time reading or who simply dislikes reading has different associations.

A ‘script’ is a set of actions based on a schema. Using the above example, say I’m given a book. I’m likely going to put it in a book case until I read it, take very good care of it while I am reading it, read it cover to cover and put it back in a book case if I plan to read it again. If I don’t think I will read it again, or if I think someone else would like it, I’ll donate it or pass it on to a friend I think would like it. If someone lends me a book, I’m very careful to keep track of it, take extra special care of it, and return it as quickly as possible.

Someone who has the latter schema may toss it in the back seat of their car, ride around with it for months, not caring if it get’s stepped on or dirty or banged up. They may or may not open it, but if they do, they may skip to the end to see if it’s worth their time or to see if there are any pictures, and if not, they’ll (gasp-it pains me to even write this) possibly throw it away. If someone has loaned it to them, they may or may not return it in a timely manner (if at all), and it may or may not be in the condition it was in when they got it.

These are the ways we act according to what we know, what we think we know, or what we have concluded through the lens of our experience. Often these ideas are so ingrained we may not even think about them, but they motivate us none-the-less. In marketing this is on reason why we buy a certain product over another.

Ok, now to apply this to the brand of BIRTH.

The prevailing schema for birth is it’s dangerous, it’s painful and it’s a medical event that requires doctors and hospitals. It is the most dangerous time in the life of mothers and babies. Birth is safer because it happens in the hospital, and that’s why we give birth there. Something could go wrong at any minute, everything doctors do is for the safety of mom and baby and there must be science backing every intervention, because they are doctors after all.

Based on this set of associations, the script of birth goes like this (starting in pregnancy where most birthing decisions actually begin): the pee stick turns blue, we call our OB, we have an ultrasound, we have a bunch of tests done at each visit, many of those tests necessitate further tests, we take a childbirth class at the hospital, we go to the hospital when we go into labor (or we go to be induced), we get an epidural or narcotic for pain, we have pitocin to speed up labor, we spend most of the labor flat on the back hooked up to monitors, we push like made while someone counts in our face, we have an episiotomy at the very least, with a vacuum extractor likely, or we have a cesarean section.

Now, every decision in the script makes perfect sense considering the schema. Any other decisions would seem downright crazy and irresponsible. The problem is that the schema has been manufactured for the purposes of marketing BIRTH. It isn’t real. Well, that isn’t fair; it’s real enough to the people who believe it, and therefore it becomes a self-fulfilling prophecy. It just isn’t based on facts. It’s based on beliefs that are then reinforced by the decisions that manifest the expected reality. And part of it is actually factual; for a lot of women and babies throughout history and currently the childbearing year is indeed the most dangerous time of their lives, but not because BIRTH is dangerous.

A multitude of factors make it a dangerous time, but none of them are specific to the state of pregnancy or the physical act of natural birth.

The leading cause of death in pregnancy in the US is murder.

Young women who are pregnant before their bodies are mature are more likely to die in pregnancy and during birth, but it’s because they are too young. Malnourished women, women living in poverty who cannot afford to eat or who are constantly pregnant without access to birth control are at increased risk. (Decent nutrition can prevent about 85% of pregnancy and birth complications, i.e. hemorrhage, pre-eclampsia/toxemia, etc. Brewer.) Women who live with poor sanitation, little education and no access to medical care that can prevent or treat illness and injury are at risk.

All of these are socio-economic (and cultural) issues relating to the very condition of being a WOMAN, and because women are the only ones who get pregnant and have babies, by extension, pregnancy and birth. That does NOT mean the childbearing year is dangerous. It means it’s dangerous to be a poor woman just about anywhere in the world at any time in history, including during pregnancy and birth. In places where women are fed, supported and educated in the childbearing year, birth is not considered a dangerous medical event, but is seen in more of a sociological context with physiological components.

If the schema is all wrong, then the script must by necessity be also. Starting out with erroneous beliefs means that all decisions based on those beliefs must also be flawed. Is there any way to test this? Absolutely!

There are several books that have compiled all the scientific evidence and broken it down into understandable language for the average person. Obstetric Myths vs. Research Realities takes each intervention in the BIRTH script from pregnancy through birth, finds the evidence in the scientific journals, includes the abstracts from those studies, and then translates the findings into real language. Anything by Goer is heavily researched. A Guide to Effective Care in Pregnancy and Childbirth, uses the most comprehensive database for maternity care, the Cochrane Database of Systematic Reviews, to evaluate the effectiveness and risk of each intervention and then gives a recommendation on implementing those findings. Finally, Marsden Wagner’s book Born in the USA, uses available data on pregnancy and birth from around the world, compares US outcomes and provides solutions for our abysmal statistics, Faith Gibson’s website, and the new Business of Being Born (links to trailer) also have ideas for improving outcomes. I won’t even try to reinvent the wheel here. Anyone who attempts to be an informed consumer and seeks for information outside the 'birth machine' as Dr. Wagner calls it, will see they are heavily cited by objective sources and suggest that the script of BIRTH (the brand) is all wrong for women who want a safe, gentle and dignified birth. I could literally cite dozens and dozens of studies that refute this routine care, but they already have, so I won’t waste my time. I will however list one study per step of the script that refutes that particular step for the first few steps.

Keep in mind that we need doctors and hospitals for the sick and injured. When we are sick or injured, we make sacrifices; we weigh the risks and the benefits. It’s the healthy mothers and babies who are making sacrifices for NOTHING and taking risks without any benefit that need to rethink their schemata.

So, let’s dissect a bit of the script and see how the facts match the schema:

Frequent visits for low risk women-not supported

Villar J, Ba'aqeel H, Piaggio G, et al, for the WHO Antenatal Care Trial Research Group(2001). WHO Antenatal Care Randomised [sic] Trial for the Evaluation of a New Model of Routine Antenatal Care Lancet. Lancet.

Surgical specialists as caregivers for healthy women-not supported

Janssen, P., Ryan, E., Etches, D., Klein, M., Reime, B., (2007). Outcomes of Planned Hospital Birth Attended by Midwives Compared with Physicians in British Columbia. Birth 34 (2), 140–147

Routine internal exams in pregnancy-not supported

Wildner, K., (2002). Terbutaline or not Terbutaline…that is the question. Midwifery Today, Autumn. (Yes, I used my own previous article; I've done all the research I care to do for tonight and didn't see the point in doing research I've already done...)

Frequent, routine ultrasound-not supported

Beech, B., (1999). Ultrasound: Weighing the propaganda against the facts. Midwifery Today. Autumn.

No one has to believe me. No one has to believe the science that's already been done and compiled into books for your convenience. I had a great birth and have no regrets. I live by the motto: "Examine all you've been told; reject what insults your soul" (Walt Whitman) and no one should do anything based on anyone else's opinion or collected facts. No one can know the specifics of your situation. I just wish more women could experience the wonder and ecstasy of birth instead of the accepting needless suffering.

So, if you don't believe birth can be this way based on facts, would you believe it if you saw it? Painless birth; orgasmic birth; what would it take to change your schema?

Birth As We Know It

If you think how you birth doesn’t matter, think again:

What Babies Want

I wish that Born in the U.S.A. had a clip on You Tube, but they don't. However, there are plenty of organizations that don't have a vested interest who want women to have options for birthing.

Here's one that doctors who want to create change can join: Physicain’s for Midwifery

Access to information is easier than ever before. We don't have to be victims of our faulty beliefs. Our mother didn't have a choice; we do.

Life Lessons

So, I’m back in school. When asked why I’m working on a communications degree, I say that I want to learn to do what I already do, only better. I love teaching about pregnancy, traveling to lecture on birth, and writing about anything related to the childbearing year. All of that is true. Also true is that in the event I get burned out, I want skills that also translate into situations outside of the ‘birth world’ and the education to get me that ‘real world’ job. In fact, that real world job would come in real handy as I’m paying for school, so if there’s anyone in the FDL area who could benefit from my unique skill set, give me a call. My resume and press kit are available online. If my skills are removed from the context of birth, it’s clear that I possess excellent communication and organizational skills that would translate well to just about any business.

But I digress. The more classes I take in my communications program, the more excited I get about how all of this applies to what I will call the ‘product of BIRTH’. Because the more I learn, the more I understand that the reason the general population has the ideas about birth that they have is because BIRTH has been marketed to them that way for so long (and so well, I might add) that they can’t conceive of birth being any way other than the way they see it. BIRTH has been branded.

As Kleenex(R) or Band-Aid(R) or Lamaze(R) will tell you, once the generic product is linked with a certain brand, it can be a good thing, or it can be a bad thing. It’s a good thing in that if I ask for a tissue, I’ll probably ask for a Kleenex(R). Unfortunately, I may not actually mean I want their brand; I may just want any old paper rag that will catch snot.

The way I see it, when people speak about BIRTH in the US, they speak about hospital birth; the brand. They don’t speak about birth as it actually is; they speak about it as they have come to think of it through the branding process. The problem is that isn’t the way birth is supposed to be. It isn’t the way birth is for an awful lot of people here in the US (those HypnoBirthing® for instance) or around the world (in the Netherlands, for instance). It isn’t even the safest in the US, (Green, J., 2006) which is how it is marketed. Therefore, as I’m going through this class it is encouraging to me that if the beliefs and attitudes are what they are because of the way BIRTH has been marketed, those beliefs and attitudes may be changed through the same techniques.

So, actually, I’m going to use this forum to de-construct the BIRTH PR machine to try to see if we can’t figure out a way to RE-brand BIRTH. I will apply the concepts from the class as I encounter them. I’m seven chapters into the book, and only into class two of the semester, so I have some catch up work to do. The professor is a phenomenal teacher, so while the book, the work and the presentations all complement each other, they don’t duplicate each other. That’s means at least double usable material in the book which is considerable to begin with.

What I do want to begin with here though, is something that’s been keeping me up at night. I’m hoping that by writing it out, I can scratch that itch that’s bugging me, because right now, I can’t identify it other than to recognize that the incidence I'm about to recount just shows me what a monumental task this re-branding could be.

In class we were talking about how ‘affectively based attitudes are influenced’; meaning we were talking about emotional appeals in advertising. It struck me that the approach hospitals use in their advertising regarding birth is fear-based. I mean, I knew it before because the whole system is fear-based, but it struck me somehow different this time. The advertising is cloaked in positivism; i.e. we have state-of-the-art equipment that will save your baby when the catastrophic happens. None-the-less, the message is that something horrible could happen at any moment and if you don’t birth with us, you or your baby could die. This reinforces the beliefs our culture holds about birth, so the message is accepted and the advertising works. My contribution to the conversation was that this is very frustrating. How can we change the beliefs and attitudes regarding birth if they are accepted as self-evident truths, despite the fact that evidence does not support the beliefs?

To illustrate, I pointed out that the mortality rate for 15 to 35 year old women (childbearing age) is approximately 20 per 100, 000 for car accidents; 6 per 100, 000 for natural birth and 31 per 100,000 for surgical births. A woman of childbearing age is more likely to die in a car accident than to die in childbirth, yet we don’t have standard issue IVs in vehicles. Several classmates commented to the effect that ‘you have to consider your sources though’. I agree 100%. Those numbers came from an insurance company. Granted, they were compiled and quoted in a piece by a Faith Gibson, a midwife, but she used to be an OB nurse. I hardly think she has a reason to sway the attitudes of the general public, but let’s say she did. The numbers for birth are backed up by the CDC, the World Fact Book and the World Heath Organization. Not to mention, as my friendly infertility specialist explained to me, insurance companies were not created to help sick people get help or pay for help; they were invented by doctors for doctors to ensure they got paid.

In any event, the fact that the numbers came from an insurance company was seen as biased because insurance companies have a reason for bias; they pay for births. So, the logic was that it would make sense for them to cite other causes of death as more likely. Huh? Well, because if birth was seen as safer, more people might go to midwives, and midwives cost at least 1/3 less than doctors. I pointed out that midwives often don’t get reimbursed by insurance companies, which then several people were like, “Ah ha! See it costs them even LESS if people see midwives.” Except that if insurance won’t pay, people don’t go. People choose the higher cost provider, even if there is a better option, because they don’t have to pay for it. So, insurance companies are paying out a huge amount of money they don’t have to spend. That isn’t even including the health care dollars spent as a result of the higher morbidity (injury and illness) rates for both mothers and babies that doctors have when it comes to current birthing practices. I shut up at that point, because at that moment, I realized this was a perfect microcosm of what is ‘out there’ and I was overwhelmed. Here I was being told I needed to consider the source of my information, which is independently verifiable in a number of ways. Yet, the prevailing ideas were being defended with zero verification.

Thus, I think it’s fair to take a look at objectivity.

I advocate for natural birth and midwifery. What is my motivation? I’m not a midwife, although I have studied midwifery. This came out of my own birth experience. Even if I were a midwife, advocating for natural birth and midwifery does not give me an ulterior motive, because a midwife can only safely take so many clients per month. Increasing the number of people seeking midwives only creates a problem initially, because there aren’t enough midwives currently to take on a mass shift in consciousness. If fewer drugs are used in birth, I don’t make any money. I can't think of one benefit I would get if more women gave birth with midwives.

I personally don’t really care where people give birth; what I care about is that they honestly know what the risks and benefits are before they make their choices. My sister is currently pregnant and is seeing a wonderful OB. She will likely have a wonderful birth with this OB who has statistics completely in line with the ones suggested by the WHO. My step-mother is likewise a wonderful OB nurse and it’s possible she’d end up at the birth. If everyone practiced the way this OB and Dr. Lorne Campbell and a few others do, I wouldn’t be so passionate about what I do. In any event, I don’t have any vested interest even in where my sister gives birth or with whom. All I care about is that she makes her own best decisions with honest and accurate information.

In countries with the best outcomes many women give birth at home with midwives, but not all. Since probably 85% to 90% could safely do so, that means some people are choosing to birth in the hospital. I believe a certain amount of people would no matter what. In these instances, you can be sure it’s the wealthy that are choosing to birth in hospital without medical indication, because these countries have universal heath care. If the rich and famous prefer to deal with the pain of surgery with all the risks involved, it’s not my business. The government will only pay for hospital birth if there is genuine medical indication; otherwise the parents pay out of pocket. I think that’s a stellar idea. If we instituted that sort of a plan, infant and maternal mortality rates would plummet, as was the case when midwives managed the vast majority of births at Madera County Hospital in California in the 1970s: the neonatal death rate was reduced to less than half what it had been with obstetricians. Is it any wonder the California Medical Association opposed the experiment? What is very scary (and telling) is that once their objection terminated the program and OBs took back management of births, the death rate tripled. (Robbins, 1996. pp. 24)

What about the other voices advocating some truth in advertising when it comes to the BIRTH product? Henci Goer, researcher using the doctors very own medical research has no reason to distort reality. Dr. Marsden Wagner, former director of Women’s and Children’s Health at the World Health Organization (along with many other doctors like Dr. Christiane Northrup, the physicians who compiled A Guide to Effective Care in Pregnancy and Birth, Dr. Lewis Mehl-Madronna, Dr. Lorne Campbell, and so many more I can’t list them all) have no reason to support midwifery if it weren’t safe, or criticize current birth practice if it were safe. Citizens for Midwifery, the International Cesarean Network (ICAN), Childbirth Connection and the Alliance for the Improvement of Maternity Services (AIMS) have no reason to provide biased information, but even if they did, everything they make available can be tested for veracity. In fact, if midwifery became the standard of care, many of these organizations would cease to exists, and yet they are out there trying to inform the public anyway.

Let’s look at where the majority of our BIRTH press comes from now, however. Who drives the BIRTH PR machine? What would happen if they were forced to adhere to truth in advertising regulations? Is there a conflict of interest in any of what is current policy?

Because I teach independent childbirth classes (HypnoBirthing), let’s look at that set up first.

Part of the script of BIRTH is that one goes to a hospital childbirth class taught by OB nurses who are obviously employed by the institution in which they teach. Now, it doesn’t take a nurse to teach natural childbirth. A nurse is a highly skilled individual who knows everything from how to administer meds to babies to the intubation of geriatric patients. The knowledge base for childbirth education is very narrow. All you need to know is as much as possible about pregnancy and childbirth. Let me be more specific; you need to know about NATURAL BIRTH to teach natural birth classes. Most nurses have never seen a truly natural birth simply by virtue of where they witness birth and the fact that there is so much routine interference in hospital birth. At the very least they see the environmental effects on birth, as we are mammals that are affected by our environment. What they know is birth as it was taught to them and as it has been experienced by them. In both instances, the paradigm from which the learning takes place only knows birth as a dangerous medical event. That is a lens that creates bias. I’ve talked to a lot of nurses. This isn’t conjecture, its truth. Incidentally, I've witnessed both home and hospital birth. I've seen wonderful hospital births and horrible home births; it's just usually the other way around. I’ve also taught in two hospitals as well as independently, and I can say that what is taught in a hospital is what the doctors and hospitals want you to know, not necessarily what you need to know. You won’t be taught that you can question hospital policy, for instance, in most hospital classes. You aren’t paying that instructor to teach you how to have a natural birth or that you have options like midwives. That would be silly. The hospital doesn’t make money if you don’t use their services. You aren't actually paying the instructor. You are paying the the hospital to tell you when and how to use their services to the best advantage of the doctors and the hospital. That is why the classes are subsidized by Pampers and Abbot Laboratories. It is a marketing opportunity for BIRTH. It has to be, because if you don’t believe that BIRTH is dangerous and that you need to be in that hospital with those doctors, you might not birth there, and if you don’t birth there, you might not bring your family there for other things throughout your life. Because, you see, your BIRTH is yet another marketing opportunity.

No matter what happens at your birth, it is emotionally charged. Anything psychologically connected in your brain with this experience is going to be seen as positive, even if it was traumatic in a number of ways. Why? Because you’ve been conditioned to think that birth just IS traumatic. Therefore, those elements are simply part of the experience. (They don’t have to be, and perhaps shouldn’t be, it’s just more of the marketing, but that’s a topic for another time.) However, biologically, there are elements that are supposed to create a linkage to your love for your baby to the experience; the linking of your feelings about the institution is incidental. Hospitals know this. Again, this isn’t my own personal bias; this is straight from the nurse-manager’s mouth on a number of occasions at a number of hospitals. 25% of all hospital revenue is generated by birth alone.(CfM, 2004) Cesarean section is the number one surgery in the US, earning $14 billion per year for hospitals. (Gavin, M., 2007)

This revenue carries the other departments. If that revenue is gone, hospitals are in a world of hurt. So are doctors. Even if the unnecessary routine procedures are eliminated, making birth safer, revenue goes down. In a conversation with CNMs (certified nurse midwives) in MI one time, they confided they were making progress that they were proud of, until the hospital discovered what they were doing. When they took their stats to the year-end meeting to show that their epidural rate was down, their medication rate was down, their c-section rate was down, they were told to stop that! How can the hospital make money if they don’t provide the services that generate income?

So, the public at large is accepting the BIRTH information coming from doctors and hospitals as gospel, when that information is highly biased and NOT SUPPORTED BY SCIENCE. Not only are they not telling the truth, they have lobbied to ensure that you can’t GET the truth if you go looking for it. They don’t have to tell you how their mortality rates compare, or their cesarean rates, or their intervention rates. They clearly do have an ulterior motive, which then makes clear why they want to eliminate any competition. For while midwives do not want to eliminate the practice of obstetrics, only to limit the surgical specialty of obstetrics to medically indicated and appropriate applications, OBs DO want to eliminate the practice of midwifery. If more people go to midwives and have ecstatic experiences for less money, it wouldn’t be long before OBs had only sick and injured women to care for, and that costs money, it doesn’t make money.

Obstetrics is a multi-billion dollar industry, and yet we don’t question the bias of the information that they feed us? Dr. Wagner says, “…if the United States had an infant mortality rate as good as Cuba’s, we could save an additional 2, 212 American babies a year.” (Wager, 2006. pp. 212) So, thousands of preventable baby deaths, and at least 500 preventable maternal deaths occur per year in the US. (Wagner, 2006). 100 people died per year from chicken pox and compulsory vaccination was the result. Why don’t we have compulsory midwifery?

Ultimately, this little rant and research expedition came about because I was exceedingly frustrated by the irony of being told I needed to consider the objectivity of my sources. And because I got off on a tangent there, I didn’t get into schemas, scripts and other marketing madness. I will though. For now I need to go meditate release the overwhelming sadness that I feel every time I get even a glimpse of the enormity of the issue.

CfM, (2004). Effects of Hospital Economics on Maternity Care. Retrieved November 2, 2007 from Effects of Hospital Economics on Maternity Care

Gavin, M., (2007). What we learn from The business of being born. Executive producer, Ricki Lake.

Green, J., (2006). U.S. has second worst newborn death rate in modern world, report says. CNN. Retrieved November 2, 2007 from http://www.cnn.com/2006/HEALTH/parenting/05/08/mothers.index/index.html

Robbins, J., (1996). Reclaiming our Health: Exploding the medical myth and embracing the source of true healing. HJ Kramer.

Wagner, M., (2006). Born in the USA: How a broken maternity system must be fixed to put mothers and infants first. University of California Press.