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?