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.