Monday, 15 November 2010
Today, I tuned into KFAI 90.3 and listened to the oddly-named program Truth to Tell. Today they were having a discussion on the rising popularity and pro-vs-cons of home births. Included in the discussion was one of Jennifer’s midwives, Kim.
Near the beginning of the show, host Andy Driscoll said that listeners were welcome to call in with questions or comments, which is radio short-hand for “you can either listen quietly to our program or you can frustrate yourself trying to get through for the next 60 minutes.” I opted to not call in.
But someone else did call in: an obstetrician named Dr. Jennifer. She’s from Minneapolis. She was pretty much the lone dissenter of home births during the entire show. Driscoll explained that he invited nurses, midwives and doctors who perform hospital births to join in the discussion, but they all either turned him down or refused to answer his calls (hmm…red flag #1).
Anyway, Dr. Jennifer argued that hospital births were preferable by asking a question: she asked if home birth midwives were able to care for birthing mothers who experienced [insert random, unlikely problem here]. I can’t recall the medical jargon she used – so esoteric, in fact, that Driscoll had to ask for a definition – but one of the problems she mentioned had to do with tearing from vagina to anus.
Disregarding the scare and yuck factors, Dr. Jennifer asked a good question – essentially, she was saying that since there exists medical care for a particular problem, then it is prudent for birthing women to position themselves as close to that help as possible. Let’s use Dr. Jennifer’s argument and apply it to another bodily function: eating.
I think the smartest thing a person can do if they eat is to, first, eat at a restaurant. Home meals, after all, aren’t governed by the FDA, and don’t generate as much $$$ for the economy. Second, while at a restaurant, a diner should ensure that they have with them a certified dietitian, someone who knows the Heimlich maneuver, and a doctor who can monitor the condition of the diner throughout the meal.
But of course, people don’t do this. Why don’t they? Is it because it’s cost-prohibitive? Perhaps. But I assure you: even if I inherited $50 billion tomorrow, I would never hire people to attend my meals. Oh, don’t get me wrong, it is a great idea to have people attending my meals, but I would need some assurance that they’d mind their own business. In fact, if a restaurant forced me to sign a blanket consent form before eating there, giving them the right to shove probes down my esophagus, strap monitors on my stomach, and continually check my heart rate and breathing, I wouldn’t eat there.
I tried calling in to say something like this, but I couldn’t get through. I wanted to ask Dr. Jennifer if there existed a place where I could bring my laboring wife – kind of like a hotel – where she could be in peace to use the bed, the tub, and the toilet as she desired, without nurses and midwifes forcing themselves on her despite her screaming no, but that also had all the equipment and expertise ready to go just in case the baby has a Klingon forehead (or even if my wife just wants their reassurance). Essentially, I wanted to say: “Is there a place where my wife can be within spitting distance of the finest medical care on the planet, but still be guaranteed autonomy over her own body – you know, where no one will bother her until she says, ‘hey, I think I need someone here’?” Because I think a place like that would be a great place to give birth.
Unfortunately, no such place exists. You can give birth in a hospital, where you might luck out with a nurse/midwife/doctor who respects your wishes, or you might wind up at HCMC. Either way, the best your nurse/midwife/doctor can promise you is that they’ll try to respect your wishes. Because when push comes to shove (and push often does come to shove at hospitals), the medical staff are more worried about their jobs and lawsuits than about your birthing experience.
As Kim, the home birth midwife, pointed out during the show, hospital births bring increased risk of pathogen and, in their hurry to medicate and treat labor as a ‘condition,’ nurses/midwives/doctors often cause many of the problems they think they’re saving you from. Dr. Jennifer agreed with this, as she explained that her practice has decided that episiotomies shouldn’t be performed unnecessarily. I don’t think any procedure should be performed unnecessarily, but good job, Dr. Jennifer, and welcome to the 21st Century. It’s good to have you.
Another problem relates to Driscoll’s reading of a statement of the Union of Hospital Lovers and Doctors Who Love to Put Their Fingers in Women’s Vaginas Even When Women Scream No and then Can’t See How That’s Rape But Instead Claim It’s Standard Practice (or something like that, I didn’t catch their actual name as I was too busy hitting ‘redial’ for the 48th time). They stated that birthing women who insist on giving birth at home, crazily blocks away from high-tech care, are forgetting that it’s not about them – it’s about their babies (red flag #2).
As soon as I heard this, I struggled to find the right word for it, and I think I finally found it. The word is Bullshit.
First of all, I love my kids, but they simply had no say in their births. The decision as to how and where they were to be born fell solely with my wife. And any medical practitioner who thinks that women should be drugged, controlled, denied their rights, and treated like a receptacle from which the baby needs to be saved, are sorely mistaken. I think this is another area where we can thank (Warning: redundancy coming up) religious nut jobs for believing pro-life means fighting for the rights of fetuses, but not people who have actually been born.
Second, while it is true that there are high-risk pregnancy and births, not all of them are. Not by a long shot. Just as not all meals are high-risk meals. Our home birth midwives screened my wife for all sorts of stuff, and they gave us paperwork (which I’m too lazy to go retrieve) that listed all sorts of reasons why they would recommend she transfer care to a hospital. Some of those reasons had to do with certain diseases (she had none), others had to do with her age (she was fine), or with gaining oodles of weight with the pregnancy (she didn’t) or having a whole litter in there (she didn’t).
Third, why do doctors think you have to choose one over the other? Can’t both mother and child have a safe, peaceable birth? The staph at HCMC may have tried to ‘save’ Owen from his mother, but in religiously following their ‘standard of care,’ they harmed both. Our home birth midwives, by contrast, were able to respect both mother and child.
I’d write more but I’m trying to be caller #10 for some concert tickets right now.
Nice. I agree with you 100%. And you know what is funny? Many OBs won’t even attend to a “high risk” delivery. A woman that is in most need of their services are denied them. They’ll just tell her to have a c-section as if it is her only option. The woman will have to sign a consent form – which you are assured is just a formality, because the risks are very low. What they don’t say is that the risks are often times higher than if she were to attempt a vaginal birth.
I could go on but I won’t. Suffice to say that many Obs (and possibly hospital midwives) want births that are uncomplicated, even if they say that “you need to give birth in a hospital just in case it gets complicated”. Ugh. Stupid.
I think that all births should be home births if possible. Hospitals are for sick people.
Thanks Teresa, I agree with me 100%, too.
Yes, the doctor who called in said that she would like it if she could screen for her patients, too, and send the high-risk ones on to other people. I thought this was a stupid argument for her to make, because if she doesn’t like working with high-risk women, maybe she should consider attending home births.
“Hospitals are for sick people.”
…That’s a great line; I’ll have to remember that. I would be a tad more conciliatory towards hospitals, though, and add that, besides being a place to visit for corrective action, it’s also a place to go for preventative action. Isla, for example, who was born at home, has visited a hospital – and it wasn’t because she was sick, it was for preventative action (or, more correctly, for exploratory purposes).
So she went to a hospital? Not a clinic?
I like that you put that first “red flag” up. I agree, anytime you don’t get the opposing viewpoint, you are only getting half the story and should put yourself on guard for arguments completely unchecked against poor logic and faulty reasoning. Still, even people who agree on the whole of an argument can be useful in pointing out weaknesses.
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I’m a little confused about the food eating analogy you introduced. You stated that Dr. Jennifer’s argument was essentially, “…since there exists medical care for a particular problem, then it is prudent for birthing women to position themselves as close to that help as possible.”
You then write that you are going to apply this argument to eating. How exactly does FDA regulation and generating money for the economy fit? Did Dr. Jennifer also mention something about hospital regulations and you forgot to include it in your post? Did she make an economic argument?
I also don’t think your addition of a certified dietitian fits. I mean, unless she made the point that hospitals provide birth consultants of some sort that women who give birth at home do not have access. Did she?
But you do finally get to the point by saying that meals should be attended by someone who knows the Heimlich maneuver. This is a proper analogy to the point Dr. Jennifer made (if we also assume that the Heimlich maneuver is something a diner partner or the clever use of a chair couldn’t handle). Most births and most meals run smoothly, but complications can crop up and since there is a medical modality for such problems, someone trained to handle it should be present.
So why don’t we eat in the presence of a doctor? My answer would be — odds. Probability.
I looked up how many people die from choking on their food. The first data I found was for the year 1999 in the United States. If this was an uncharacteristically good/bad year for choking on food deaths, I am sorry.
640 died from choking on food in the US in 1999. The population was about 275 million. There were 365 days in that year and I suppose people probably eat an average of three times a day. So 640 deaths in about 300 billion attempts. Put into Infant Mortality numbers, that’s a rate of .000002 deaths per 1000 meals.
I don’t have good numbers with which to compare that (considering the constraints of the analogy), but you get the idea. If you were set to die once a month from eating, you might consider spending some of your 50 billion on a little help with that. You might even be willing to sign up for all that probing and monitoring.
Of course, the disparity between hospital and home births is nothing remotely near that large. The idea would be that if there were some way of doubling your safety from .000002 to .000001 deaths per 1000 meals, but required all the probing etc., you would probably go ahead and take your chances.
Really, Dr. Jennifer would have had to argue that the risks are greater, to a significant degree, for home births. This would have to account for the medical maladies she put forward as well as the risks from having a hospital birth that you don’t have in a home birth.
It is my understanding that the risks between the two are narrow enough that there is plenty of room for weighing out other, non-health related, factors without being considered crazy for preferring a hospital birth or for wanting a home birth.
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I don’t agree that “no such place exists” as you described in your question regarding where to take your pregnant wife. There is a birthing center in St. Louis Park that, I believe, would meet your requirements for “a great place to give birth.” I also know of a couple with similarly stated goals who, after considerable research, decided on St. Joseph’s. They were able to bring in their own midwife and were not interfered with in their hotel-like room with bed, tub, toilet, etc.
I also don’t agree that your hospital experience is down to luck. It’s education, research, planning, preparation… that’s what makes the difference. The size of our brain is one of the big reasons why human birth can be complicated. Apparently the intellectual advantage that comes with having a big brain is greater than the problems associated with getting it out into the world. So yeah, you’ve got to use it if you want to be successful.
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The point that “the medical staff are more worried about their jobs and lawsuits than about your birthing experience” is an “appeal to motive”. To me it is like saying, “Mothers wanting a home birth are more concerned with the latest fad than about their own health and safety.”
But let’s go with it. Just as I don’t think you can argue that this is their motivation, I also don’t think I can argue that it isn’t.
I don’t doubt that nurses/midwives/doctors have concerns higher than your birthing experience. Most people, “when push comes to shove,” do as well. Further, if jobs and lawsuits are on a nurse/midwife/doctor’s mind, it’s probably because of an associated health concern. I don’t think it’s reasonable to think that there is someone fretting over being sued for NOT depriving a woman of her rights. I don’t think there is any concern over getting fired for NOT ruining someone’s birth experience.
Then again, you are probably right that there exists a concern among nurses/midwives/doctors that does not exist with mothers and their home birthing experience. If something goes wrong and the mother or child dies, the mother probably doesn’t have to worry about losing their job or getting sued. What a burden it is for the nurse/midwife/doctor — they have to worry about the mother’s life, health, and safety as well as losing their jobs and facing potential lawsuits stemming from not taking the appropriate, albeit birth experience ruining, actions. No wonder they have your priorities out of whack.
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I agree with the rest of your points. I don’t understand the statement from the “Union of ….” that you mentioned. Does it really say “crazily”? And that line about “it’s not about them — it’s about their babies” — wtf? I would bet (and hope) that if I showed my wife’s ob that statement, he would be embarrassed.
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Also, on the point of Dr. Jennifer saying that “she would like it if she could screen for her patients, too, and send the high-risk ones on to other people.” I suspect this was stated as a counter point, not a stand alone comment, and should be evaluated in context. Her comment might make sense if someone were comparing the risks between hospital and home births. For example:
“Home births are as safe or safer than hospital births…”
“I find that hard to believe. 5 to 10 percent of births require…”
“We screen for high risk pregnancies…”
“Must be nice. I wish I could screen for…”
The statement may not mean that she actually desires to screen for high risk patients, but is instead using it to underscore a difference that needs to be taken in to account when comparing the two birthing locations.
And I believe that this screening is typically factored out when comparisons are made between the risks of hospital and home births. This can be done by looking only at hospital births for women that would have met the requirements of the home birth screening process.
It also doesn’t follow that she should consider attending home births. Screening doesn’t remove all risk or potential need for intervention. Further, it has been pointed out to me that transfers to hospitals from home births have a lot of room to improve. So even for expecting mothers passing the screening processes, it is reasonable for her to still have the opinion that hospital births are preferred.
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I fully support the right for a mother to have the option of a home birth. I fully support expanding the awareness of the option to have a home birth with emphasis on its benefits, both medical and otherwise.
Teresa-
Most preventative care can (and probably does) take place at clinics, but we went to a hospital (Children’s, to be exact). I think the test was not available at our neighborhood clinic.
David:
Wow, this might be the first time a single comment has ever been longer than the post (1,376 words vs. 1,204).
My “red flag” comment was directed towards hospitals’ unwillingness to participate in the discussion. I made a similar comment at the Critical Thinking Club presentation I gave back in September: the club’s president said “I asked a couple JWs to come here and speak from their viewpoint, but they declined.” “Ooh,” I said to the crowd, “that should count as a red flag right there.” Still, I like how you took my comment and diverted it to mean: ‘Don’t put too much stock in this radio program, as it only has one viewpoint.’ Nicely done.
I was torn between using a food-eating analogy and a car-driving analogy. I opted for eating as it, like giving birth, is a bodily function (kind of). With cars, I was going to say that we should have a mechanic, a cop, and a diver’s ed instructor in the car with us at all times. Now that I read your comment, I see that perhaps the car analogy would’ve been better since driving in a car is far more hazardous to one’s health than eating; i.e., you’re more likely to face complications in driving than with eating. My point in including a dietician was so that they could say something like, “Woe, looks like you’re about to eat something made in a factory that also processes peanuts! I better get out your epi-pen.” And I apologize if this is not what a dietician does, I couldn’t think of a better term. Also, a dietician would serve the role of preventative action, something that Dr. Jennifer was concerned might not be adequate in home birth plans. My mention of the FDA & economy was to draw in the fact that eating out, and employing all these people, are government regulated and are (in part) controlled by greed. This was mentioned in the radio program, but I can see how reading my post cold would make it seem out of place. I was also shooting for a bit of humor (give birth in a hospital to help the economy! Eat at a restaurant to help the economy!); but I evidently missed the target.
And, yes, if I had $50 billion and a 1 in 100 chance of dying every time I ate, I would be more inclined to take precautions (again, this is where the car analogy would’ve been superior – I do take precautions with driving; e.g. insurance, seat belts). However, I would still not submit myself to a program whereby I had to relinquish basic rights. As a billionaire, I probably wouldn’t have to worry, though. I could just hire someone to work for me, much as my wife did in hiring midwives that we were free to fire at any point (and we did fire our first midwife).
Yes, I am aware of places known as “birthing centers.” In fact, my first hearing of this term was in regards to my mother-in-law’s birth to her 4th child (not my wife). I thought it sounded like a great idea, and when Jennifer was pregnant with Owen, I said we should go there. But it didn’t exist anymore. If such a place – where you essentially just rent a room, but where advanced medical care is prepared to come in should you request – does exist here in the Twin Cities, then I stand corrected, and I am very happy to hear that! I wish someone from St. Joseph’s would’ve been on the radio program, as that would’ve provided a 3rd viewpoint (or maybe ‘option’ is a better word). Birth centers were mentioned on the show as a great alternative, but there was no mention (that I recall) was made that any exist within a reasonable distance. Actually, if my wife ever does have a high risk pregnancy, I will suggest to her that we explore that option.
My use of the word ‘luck’ wasn’t intended to indicate that laboring women should just randomly show up at a hospital and hope they luck out with a good experience, as research and planning do play a role. For example, my wife looked at several hospitals and, when she finally picked one, she made several visits to meet their various midwives, and we attended a 2-class they sponsored which allowed us to ask many questions, formulate a birth plan, and tour the facilities. When she arrived to give birth, however, she was told there was no birth tub available for her to use, there were no we-leave-you-alone style rooms to use, and none of the midwives she had visited were available. You could argue that such things could’ve been dealt with using further research (e.g., my wife could’ve raised her hand during the class and said: “How many times has a woman showed up and been told you’re out of tubs?”), but in reality it’s difficult to plan for every possible scenario. As it is, she found out later that, had she arrived a couple of hours sooner, she would’ve gotten the room and the tub. There’s obviously more that went wrong that day, but just as I might get into a fender-bender on the way home today even if I check MN-DOT’s site first (another car example!), it’s just one example of how knowledge and planning can’t take care of everything.
An appeal to motive isn’t necessarily a poor argument (unless it’s all I’ve got). I think, if you asked a doctor: Are you more concerned with keeping your job or with me having the ideal birth experience? …that the answer is probably their job. A similar concern is newly revised airport security: are the TSA employees more concerned with respecting the travelers’ rights or with keeping their employment? This isn’t necessarily a bad thing. I, for one, when I worked at Lenscrafters, was more concerned with making commission and keeping my job than with ‘helping people see better one hour at a time.’ If I wasn’t, I probably would’ve been fired pretty quickly for giving everyone a 50% discount. In the case of birthing women, doctors performed needless c-sections all the time; they know they’re more likely to be sued for not performing one than for performing one. In a sense, then, everyone has my priorities out of whack: my boss, my doctor, my mechanic, even my wife, are surely looking out for themselves more than they’re looking out for me. This isn’t an indictment on any of them, as I do the same thing regarding myself. This is why I think it’s best to have autonomy over my own self to the extent possible.
I actually deleted a paragraph from my post before making it public as I had questioned the doctor’s reason for calling in. But in that instance, I realized that it would have been a specious point, as my post was not calling out Dr. Jennifer for phoning in, but was addressing her comments.
Incidentally, too, I think the birth-ruining experience is not an appropriate c-section, but an inappropriate one. It is possible that my wife could have a c-section one day, she may be disappointed that the birth didn’t go as planned, but I don’t think she’d say her experience was ruined unless it procedure was unnecessary and/or forced upon her.
No, the “Union of…” did not use the word ‘crazily.’ As I have done on this blog in the past, sometimes I exaggerate or change things (especially when I don’t have total recall). I hope it’s recognized as humor. For instance, obviously the union’s name was not what I said it was, and ‘crazily’ was an exaggerated term that (I hope) no self-respecting professional would use (a blogger, one the other hand…). Perhaps they used the word ‘carelessly,’ I don’t recall.
Regarding her comment about screening, I have made that point in the past, too: People have often said to me that they think home births must have more complications than hospital births, and I point out that, no, home births are smoother, if for no other reason than because if any complications were suspected, the woman would likely have opted for a hospital (or birthing center). Of course, this is somewhat offset by the fact that there are unplanned home births, which are (by their nature) more prone to problems, and by the fact that many who opt for a home birth are from uninsured, low-income mothers (at least that’s what a nurse on the show said).
In this case in particular, Dr. Jennifer said, “it’d be nice if I could pick out all my patients who are low risk when I am taking care of them…” Thus implying (to me) that she’d rather not deal with high risk patients, rather than that she was concerned with how the risk factor statistics are obtained. And, to be clear, it seems fair to say that home birth midwives don’t want to deal with high risk women, either (that’s why they refer them to a hospital). But in the case of this doctor, I think, if she doesn’t want to deal with high-risk women, then she’s in the wrong line of work (or at least employed with the wrong practice), especially since she said that her practice doesn’t turn away any woman.
Also – I agree 100% with your final paragraph. As I indicated to Teresa (above), I don’t think home birth is for everyone, so just I would hate to see home births outlawed, I’d also hate to see hospital births outlawed, too. Beyond being high risk, just being more comfortable near advanced medical facilities, not having a good home environment, or giving it up for adoption are all good reasons to go to a hospital.
1,636 words.
David,
I have to take issue with a few of your points:
You said: “I don’t agree that “no such place exists” as you described in your question regarding where to take your pregnant wife. There is a birthing center in St. Louis Park that, I believe, would meet your requirements for “a great place to give birth.” I also know of a couple with similarly stated goals who, after considerable research, decided on St. Joseph’s. They were able to bring in their own midwife and were not interfered with in their hotel-like room with bed, tub, toilet, etc.”
This was in response to James’ stated requirements of:
“Essentially, I wanted to say: ‘Is there a place where my wife can be within spitting distance of the finest medical care on the planet, but still be guaranteed autonomy over her own body – you know, where no one will bother her until she says, “hey, I think I need someone here”?’ Because I think a place like that would be a great place to give birth.”
I think you have misinformation on both counts. First, a birthing center is not “within spitting distance of the finest medical care on the planet” unless it is inside of or right next to a hospital. Free standing birth centers, like the one you mentioned, are exactly the same as having a homebirth as far as safety goes. They have the same equipment that a homebirth would have, and therefore are no safer than having a homebirth, though many a husband has been fooled into thinking so.
Also your assertion that at St. Joe’s one can “bring in their own midwife and were not interfered with in their hotel-like room with bed, tub, toilet, etc.” is also false. You can not bring in your own midwife at St. Joe’s, you must use one of their hospital-based Certified Nurse Midwives that work through their hospital and are covered by their hospital’s malpractice insurance and subject to carrying their hospital’s policies and regulations. Midwives used to be able to use rooms in hospitals, in fact my sister was delivered at the U of M with an independent midwife, however that practice is now obsolete because the insurance that the midwife would have to carry would be far too high for her to be able to practice within a hospital. Also, I do not know how you qualify “were not interfered with” but I’ve learned this statement is highly subjective. Surely the people you speak of were subject to St. Joe’s hospital policies, and may have been interfered with less than at other area hospitals, but were most definitely “interfered with” during the process of their labor and birth.
You also state: “I also don’t agree that your hospital experience is down to luck. It’s education, research, planning, preparation… that’s what makes the difference. The size of our brain is one of the big reasons why human birth can be complicated. Apparently the intellectual advantage that comes with having a big brain is greater than the problems associated with getting it out into the world. So yeah, you’ve got to use it if you want to be successful.”
I think making a statement like this based on a tiny sample size and offering no proof of your assertion aside from calling the intelligence of the birthing woman into question, must be breaking at least one of the logical fallacies you hold so dear. At the risk of appealing to emotion, I will just say it is also highly offensive to all the women who were very educated and fell victim to finding themselves birthing in a hostile environment. On a personal level I find this statement to be very cold-hearted and cruel, as you know me and you know that I experienced a traumatic birth, yet you claim here that this essentially means I didn’t use my large brain to educate, research, plan and prepare enough. I know you didn’t know me then, but I can assure you I did all those things in abundance. I was even accused several times of planning too much and being too prepared, especially after things went badly. I chose a hospital that promised the same things as St. Joe’s, complete with Nurse Midwives, hotel like rooms and birth tubs. These features are what is called an in-hospital birth center, and a few area hospitals have them. I even threw in a doula for good measure. In the work I do with Solace for Mothers: Healing After Traumatic Childbirth, I have heard hundreds of birth stories from women who were not lucky when it came to the hospital or provider they chose. Most of them were highly educated about childbirth, about the hospital and the provider, but still were mistreated and traumatized. Women who are educated are going against the grain in a hospital setting. This leaves them more vulnerable to being mistreated, not less. Let’s look at the research: Excerpt from an article I’m writing, “The 2008 Listening to Mothers Survey: New Mothers Speak Out Report http://www.childbirthconnection.org/article.asp?ck=10413 states that 18% of women experienced symptoms of post-traumatic stress after childbirth. The American study by Soet, et al. (2003, Prevalence and Predictors of Women’s Experience of Psychological Trauma During Childbirth, Volume 30, Issue 1, pages 36–46) says that 34% of women experienced an obstetrical event in childbirth that was traumatic. The current birthrate in the United States is around 4 million births each year. If we assume that the research holds true, and “18 to 33%” of birthing women will experience trauma following “normal” childbirth, approximately 720,000 to 1.3 million women are experiencing birth trauma each year.” The majority of women who report trauma cite difficulties with hospital staff and feeling a loss of control. They report being pressured, manipulated, coerced or forced procedures that they did not want, did not need, or were not offered informed consent to. Now that’s a whole lot of women who aren’t using their brains isn’t it? As many as 1 in 3 women are traumatized! How many are simply disappointed? The ones who have good experiences in hospitals and feel happy and satisfied with their births are truly lucky. And I’m not saying the things you mentioned are not important and don’t contribute to having a good birth experience, they just don’t protect women from being mistreated which is what James was talking about.
You said, “Also, on the point of Dr. Jennifer saying that “she would like it if she could screen for her patients, too, and send the high-risk ones on to other people.” I suspect this was stated as a counter point, not a stand alone comment, and should be evaluated in context. Her comment might make sense if someone were comparing the risks between hospital and home births.”
I can explain the context, and you can listen to the show yourself to verify this. Dr. Jennifer was asking what homebirth midwives do when things go south. Kim, the midwife, stated that their patients are screened and they only see low risk clients, but that in the event of an emergency they carry drugs and equipment to use while they transfer them. Dr. Jennifer replied, “well, you know it would be nice if I could pick out all my patients that are low risk when I’m taking care of them but the realty is, my experience has been, people that have had postpartum hemorrhages usually have been people that you would not expect to have that happen to, and so to go into that situation with the idea that you’ve been able to screen out those people that are gonna have low risk is, I think, being a little starry eyed”. I took this comment to mean, not that she only wished to see low risk women, but that she resented that homebirth midwives could simply wash their hands of high risk patients. It seemed to me as though she didn’t think this was fair, as if homebirth midwives and OB’s are in some kind of competition in who sees the most high risk clients, and the midwife gets to dispose of those patients before the contest begins. This is absurd of course, as midwifery should be fully integrated into our healthcare system, and like in Europe, Ob’s are for high risk patients. It isn’t a competition, OB’s are a specialty. Women should have the option of seeing a homebirth midwife and being treated by an OB if something happens beyond the scope of that midwife. That is woman centered health care.
James,
“Brevity is the soul of wit.” Which is why I write so much… because I’m an idiot.
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Yeah, I got your “red flag” meaning. It’s just kind of lame to suggest that declining an invite has any bearing on the argument. So I flipped it around. I mean, what kind of things were concluded about you and your family when you declined to meet with your former religion’s judicial panel?
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You are right, I was taking your “luck” comment wrong. You wrote, “You can give birth in a hospital, where you might luck out with a nurse/midwife/doctor who respects your wishes, or you might wind up at HCMC.”
Since you can pick your nurse/midwife/doctor and since you can interview them and ask them all the questions in the world before hand, I don’t see how luck would play into whether the nurse/midwife/doctor respects your wishes. I see now the “luck” comment was more about getting the right room.
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Yes, appeal to motive isn’t always a poor argument, which is why I didn’t call it poor. Instead I likened it to another claim that is equally likely and also supportable with evidence. I also didn’t deny the motive, making the point that worrying about their jobs and potential lawsuits will add pressure on them to make patient health a top concern.
If a doctor is more likely to be sued for not performing a C-Section than for performing a C-Section, doesn’t it mean that there is a greater chance of a bad outcome from not performing the C-Section? I know that sounded rhetorical, but it wasn’t meant to be.
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I’m glad they didn’t use the word “crazily”, but my reason for asking was that it wouldn’t surprise me. Jennifer sent me some statement once by one of those groups and it shocked me. I don’t remember what it said, but I remember being in complete disbelief. Of course, it’s been only recently (since talking to you guys about it) that I learned that there is an opposition to home birth.
Jennifer,
I’m glad you joined the conversation. I was hoping you could correct me on some of this.
When I heard about the birthing center, I was told it was next to the hospital. You are right, it is not within spitting distance — more like throwing distance. Further, it is across a busy road from the hospital and would certainly require a laboring mother to get in and out of a vehicle. There’s actually a row of houses that is closer to the hospital! So that’s out.
As far as St Joseph’s goes, I only talked to one couple, but I thought I was pretty thorough and specific with my questions. The dad is a very precise person. I’m also assuming honesty. One of the nurses put a monitor on the mother. The dad asked what she was doing. The nurse briefly explained (I don’t remember the details, but the father recalled her explanation — they needed to see a certain rate for a certain duration or something like that). The dad said, “We don’t want that — that’s got to go.” The nurse took it off. That was the only time they were interfered with. But you are right, I don’t know exactly how they take the word “interfered”. Perhaps you can suggest some follow up questions so I can get a better sense of their experience.
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My comments regarding James “luck” assertions were solely in answer to his statement. He may have meant something else, but his words were, “You can give birth in a hospital, where you might luck out with a nurse/midwife/doctor who respects your wishes, or you might wind up at HCMC.”
Let’s just change to another subject for a second. Let’s say James was pontificating about the best way to establish his superiority with words. His rival suggests Scrabble, but he says that Boggle is the real test. Both sides have good arguments going. Boggle is so limited in word length, it favors quantity over quality — James’ rival hates it. Scrabble, on the other hand has its own faults.
James comment then becomes, “You can play Scrabble, where you might luck out by drawing letters like M-U-Z-J-I-K-S which gives you winning points, or you might end up with A-A-A-I-O-U-T.”
Even if I agree with James, such a statement reduces Scrabble to a dice roll. If I wanted to counter it, I might posit that a greater knowledge of words is “what makes the difference.” I wouldn’t mean that the person with the best vocabulary would always win. I wouldn’t be arguing that the letters you draw do not play any role. I would not be saying that a person who knew every playable Scrabble word would win even if they only drew one point letters the whole game.
I would be arguing that there is an element besides luck and, in my opinion, that element is greater than the luck element. Despite being greater, it can and does get trumped by the luck of the draw from time to time. But if you are going to go play a game of Scrabble, you will do better to know more words.
And I know you agree with this in regards to educating yourself about child birth. James too. You’ve both said as much in your replies.
James said, “… research and planning do play a role.” And you said, “I’m not saying the things you mentioned are not important and don’t contribute to having a good birth experience.”
So we agree on that.
What I do not agree with is the idea that preparation can’t influence whether you are mistreated. We also may disagree with the degree to which luck and preparation play, I favoring preparation, you favoring luck. You might be right (this is your area, after all), but I think mine is a fair argument to make.
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I hope that helps you understand my comments regarding James “luck” statement. I would like to address some of the other things you said in that paragraph though.
First your “tiny sample set” comment. That would be great to bring up if I were citing a study or making a scientific claim. I wasn’t. I was speaking purely from the point of (let’s call it) logical plausibility. Let me ask you something, what was your “sample” when you agreed that preparation (etc.) does play a role?
I’ll give you four options to choose from — feel free to add your own fifth.
A. You agree that preparation (etc.) plays a role in having a good birth experience and have evidence to support it. In this case, please use that evidence to support my statement. I knew I was right.
B. You agree that preparation (etc.) plays a role in having a good birth experience and have no evidence to support it. In that case, you see what I mean by basic logical plausibility? I bet we’re right.
C. You disagree that preparation (etc.) plays a role in having a good birth experience and have evidence to support it. In this case, please let me know what you’ve found. I’ll make sure to recommend “just show up to a hospital on game day” to all my pregnant friends (if they ask how they can have the best outcome).
D. You disagree that preparation (etc.) plays a role in having a good birth experience and have no evidence to support it. In that case, you see what I mean by basic logical plausibility. I guess we’ll have to employ Science to settle it. Drat.
Further, I mentioned no specific case or cases to go with my claim that preparation (etc.) plays a dominating role. I just don’t like to support my arguments with anecdotes. You, on the other hand are calling up your own experience (sample size: n=1) to refudiate ( <— word of the year, by the way) my claim.
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As for your comments regarding the cold-hearted and cruel nature of my comment, I assure you, your history had no bearing on my comment. If I were to say that wearing the proper safety gear is key to a safe work environment, I suppose I might risk offending the guy who got hurt despite the fact that he came prepared. I don't think it would change my position though.
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As to all of your data, none of it speaks to the correlation between education/preparedness and outcome. I was very hopeful when you cited something called, "Prevalence and Predictors of Women’s Experience of Psychological Trauma During Childbirth." But if that study shows that level of preparedness is a predictor, you failed to highlight it.
You did show that a lot of women report trauma etc., but you also say that educated women are going against the grain in a hospital setting. Is this a minority of women? For all I know (for all you presented), it could be that all these 18-33% of women are in the following-the-grain, uneducated group.
You ask, "Now that’s a whole lot of women who aren’t using their brains isn’t it?" Are you putting this forward as an argument that would refute what I stated? Because there's nothing that says that all 720,000 didn't just show up and say, "I'm pregnant, what do I do?"
This is your area of expertise so I'll let you answer this. What percent of the population does the research? What percent of birthing mothers educate themselves adequately? What percent just shows up, taking whatever direction their doctors give them? I'm sure you are involved or know people involved in educating women about birthing. I'm betting that they have some statistic (accurate or not) that agrees that the majority of women aren't particularly prepared and educated.
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Now I admit, my comment was poorly written. I had some specific things on my mind when I wrote it, but did not include those things. So, yeah, I can see why you could take my comment in a way other than I intended it. That's on me and I apologize. Let me take a minute to explain myself.
First, and we already went over this, I was addressing a statement that emphasized luck as the key to whether you have a good birth experience at a hospital. It's not the only factor and, in my mind, it isn't the dominating factor. Nothing about that says that there is no element of luck involved. It simply emphasizes the role of preparation and education over the role of luck.
This would be the same way I would respond if someone were to say that the only reason James does well at Scrabble is because he gets the best tiles.
Second, there is a point to be made for how human ability to figure things out evolved in concert with a brain size that made birth especially challenging.
I've read books that make the point that other animals don't require all the intervention that humans seem to think they require when giving birth. It put forth the idea that you should be able to just go out in the woods by yourself and figure it out. (Actually, I think that one said you had to go out in the woods with your husband… I don't remember.) This is what I had on my mind. And they make a lot of these books. So you could read dozens of them and really think you are educated. And when things go poorly, you can say, "Well it must have been luck because I was prepared as hell and still had a bad time of it."
And Third, I almost always have the naturalistic fallacy on my mind. This is part of my last point, I guess, but I see that people can think that evolution worked out all the kinks over the millions of years. It's the idea that our species wouldn't be here if laboring took all kinds of extra intervention. But it's just not the case. The process of evolution isn't survival of the fittest, it's reproduction of the good enough. But "good enough" isn't good enough for us sentimental humans. We don't want success for most of our births or even the vast majority of our births. We want 100%.
If my wife or one of my children died during childbirth I would have been devastated. I wouldn't have said, "Well, I guess I'm still around to pass on my genetic material so all is well." I wouldn't have said, "Well my wife died, but the child survived so that's what counts."
But that's precisely what nature gives you.
So I had that on my mind, not educated, prepared women who were traumatized.
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And lastly, please, please, please, in this conversation and every other conversation we ever have — when you read my comments, try to see if there is a way to take them that doesn't color me a a big jerk. If that's the only way they can be taken, please ask me, "Are you being a jerk here?" and wait for my answer before taking offense. I almost never mean to offend anyone and when I find out I did, I almost always feel bad about it. When I read your comments and I see a particularly long paragraph coming up, I, right away, start fretting that I've pissed you off. And then I read it and then I go back and reread what I wrote and I think, "Oh crap, I'm an idiot."
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How's that for word count?
David,
Okay, I can kind of see where you are coming from, but I have a few thoughts of course.
You said, “Since you can pick your nurse/midwife/doctor and since you can interview them and ask them all the questions in the world before hand, I don’t see how luck would play into whether the nurse/midwife/doctor respects your wishes. I see now the “luck” comment was more about getting the right room.”
I don’t feel that James “luck” comment was about getting the right room only. There are a lot of things that have to come together to have a satisfying birth experience. This can get confusing to discuss as there are so many elements. The woman’s labor has to progress normally, the parents have to be knowledgeable about which interventions to accept or refuse, the hospital has to have policies that are conducive to normal birth, the provider and hospital staff have to be kind and supportive, etc. I think though that James was specifically talking here about the environment of the laboring woman. How mother/baby friendly are the hospital policies? How caring and supportive are the staff? How respectful of the woman’s right to informed consent and refusal is the provider? And as to the way that luck plays into how well the nurse/midwife/doctor respects your wishes is that you may not know how they will treat you until you are in labor, which is too late to make a change and switch providers. You can try to ask them any question you want to before the event to get an idea of how they practice, but they can lie to you or they may not tell you the whole truth. They might give you best case scenario answers only, they might only show up to your birth during the last 5 minutes after you’ve been given every intervention under the sun. You can not interview nurses and they will be your main provider for most of your labor. You won’t get a specific nurse, just the nurse who happens to be on call. Same for midwives, they practice in groups and you won’t get a specific one for your birth. At HCMC they have about 14 midwives on staff, so you would need to interview all 14 to make sure they all jive with your expectations. And as I said they can lie anyway. Childbirth is big business for hospitals. They want your business and they will tell you what you want to hear to get you to give birth there.
You said, “If a doctor is more likely to be sued for not performing a C-Section than for performing a C-Section, doesn’t it mean that there is a greater chance of a bad outcome from not performing the C-Section?”
No. This is about perception of the patient, not the realty of the situation. A C-Section is seen as trying everything, but in reality it is often a more risky course. C-Sections are more dangerous for mothers and for babies than vaginal birth. 1 out of every 3 women now has a C-Section and maternal mortality is going up likely due to this. It is major surgery. The more C-Sections a woman has the more her risks increase for subsequent births and for fertility problems. Doctors just know they are less likely to get sued if a baby has a problem and they performed a C-Section, than if a baby has a problem and they didn’t. It doesn’t mean that babies are more likely to have problems without a C-Sections. The risks to that baby also need to be weighed with the risks to the mother for that birth and for subsequent births and for those children, especially if she plans to have many children (because repeat C-Sections were the general rule until very recently and with each one the risks increase).
As for the birth center, it is not affiliated with the hospital it is next to, so I’m not sure how quick a transfer would go. I didn’t realize it was that close to the hospital though, I thought you meant the birth center itself provided that criteria.
As for St. Joe’s, I highly doubt that there was no interference at all in the birth process. I can’t imagine that the nurses and midwives just stood back and watched from across the room as the couple’s child was born with no handling of the woman or baby (which is how James and I define ‘no interference’). That would be unheard of in a hospital setting. It’s not even that common in a homebirth, but is possible given the right circumstances and being able to find a midwife who is comfortable doing this.
You said, “What I do not agree with is the idea that preparation can’t influence whether you are mistreated.”
Preparation can influence it, but that is not what you stated and what I took issue with. You stated that, “It’s education, research, planning, preparation… that’s what makes the difference. … So yeah, you’ve got to use it if you want to be successful.” Had you merely said that it influences the outcome I would not have taken issue with the statement, but you said that it “makes the difference” and it makes you “successful”. This implies that if you do these things you will be successful in being respected and if you do not do them you will fail and be disrespected. When we are talking about it influencing the outcome I completely agree, when you decide to give birth I think you should take a childbirth class, learn about pain coping techniques, learn about interventions, learn about birth locations and types of providers. Research the facility and the provider on The Birth Survey. Ask that provider several questions during prenatal visits. Create a birth plan and go over it with the provider. Tour the facility and ask the nurses questions. Show up for labor with a tray of cookies for the nurses. Etc. Etc. Etc. This will give optimal odds of getting lucky and being treated well the day you give birth. However, women can do all this and still be mistreated. Preparing ourselves only prepares ourselves, but we do not know how the provider will treat us during labor until we are in labor. Many women do all this preparation and are still mistreated during labor and birth by the staff or by the provider. That is where luck comes in. I believe you can increase your odds by making certain choices about where and with whom you give birth, but you can never prepare away the possibility of being mistreated in the moment, that just isn’t possible to know and it is more likely to happen in a hospital setting because more people are treating you and there are hospital policies they have to adhere to.
You said, “Further, I mentioned no specific case or cases to go with my claim that preparation (etc.) plays a dominating role. I just don’t like to support my arguments with anecdotes. You, on the other hand are calling up your own experience (sample size: n=1) to refudiate ( <— word of the year, by the way) my claim."
You didn't claim that preparation plays a dominating role, you claimed that you would be successful if you prepared. That is a big claim to make with no proof, and when the writer of the blog post you are commenting to had a wife who prepared and was not successful you should have assumed that you would have to offer a lot of proof for why you believe this to be true. I called up my own experience, true, but also the hundreds of other women that I work with through Solace. I have also read through thousands of free text comments on The Birth Survey, so I think that would be a few more than 1.
You said, "As for your comments regarding the cold-hearted and cruel nature of my comment, I assure you, your history had no bearing on my comment. If I were to say that wearing the proper safety gear is key to a safe work environment, I suppose I might risk offending the guy who got hurt despite the fact that he came prepared. I don't think it would change my position though."
Two points:
1st: when you are responding to someone who's wife was traumatized by her birth experience you might not want to accuse women who are mistreated during their births of not using their brains.
2nd: This is a false analogy. We were talking about being mistreated in the hospital not about being safe. Also, certain types of education can increase the chances of a woman being mistreated. For example, if a woman learns that delivering in an upright position is a better position for delivering a baby in, she may increase her chances of being mistreated in a hospital if she decides to push in an upright position and the care provider and nurses are not accustomed to this. They may start shouting at her to lay down, they may even physically force her into a different position (this has happened – I know of several cases). It is extremely rare for hospitals to allow upright positions. So did her education and preparedness help her not to be mistreated? Or what if a woman learns that breaking the water is not something she wants done. Then, during the birth, her provider goes to break it and she tells them not to. They may become annoyed at her and use force to break it anyway. Did her education help her? What if she learns tearing is preferable to episiotomy, and when she sees the doctor go for the scissors she tells him no, but he cuts anyway. How did her education help her? Doesn't she just end up feeling more mistreated than if she hadn't of known any better?
You said, "As to all of your data, none of it speaks to the correlation between education/preparedness and outcome."
It wasn't my intention to correlate that with the cited research; there is no good research currently that shows why trauma during childbirth is occurring (as in risk factors), just that it is occurring. I cited that research because many people do not believe that women can be traumatized by childbirth at all, and others believe it is as low as 1 – 6% of women as that is the number diagnosed with postpartum PTSD. I cited that research to first show how many women each year are traumatized, and then I followed it up with an argument about why I felt many of these women were traumatized due to feeling mistreated by hospital providers. I thought I had also made the argument that more educated women are the ones we see being traumatized more often than less educated women at Solace for Mothers. My point isn't so much that education leads to higher rates of trauma (though I could make an argument for that) but just that education does not protect women from experiencing trauma. And, of course, you would have to accept that in many (at least 50%, if not more) cases of trauma are caused by mistreatment as opposed to true emergencies in order to accept my argument. I can't prove that with any legitimate research though, but I know it to be true based on my own experience and the hundreds of stories I've read.
You said, "Is this a minority of women? For all I know (for all you presented), it could be that all these 18-33% of women are in the following-the-grain, uneducated group."
Perhaps. There is no research I can site to prove my point here, but what I know about trauma, and the women I have seen who are traumatized, would back up my opinion. Birth trauma often happens when your experience doesn't match your expectations. If a woman plans to have an epidural, she can be traumatized if she is denied one. But, because hospitals want women to have epidurals to the point that women have to fight them off if they don't want them, then women are usually not denied them and therefore not traumatized for this reason. Fighting during labor is a big reason women are traumatized. Women who want everything the hospital is offering are not the ones fighting during labor. Anyway, you also fail to provide any evidence or proof of your assertion that education and preparedness will protect women from being mistreated, so I guess that just leaves us with two different opinions that can't be proved one way or the other. You can say, "so and so prepared and had a great experience therefore preparing will protect you from being mistreated" and I can say, "well, so and so prepared and was mistreated therefore preparation contributes to being mistreated". We both have the burden of proof for our statements, and we are both failing to provide sufficient proof to convince the other. However, since I can offer up people who prepared and were mistreated, I can then prove that your statement is false, though I can't prove that my statement is true.
You said, "Are you putting this forward as an argument that would refute what I stated? Because there's nothing that says that all 720,000 didn't just show up and say, "I'm pregnant, what do I do?""
That's just not what most women do. Most women are prepared to some degree. Are you saying that trauma is caused by not being educated? Can you prove that?
You said, "What percent of the population does the research?"
Most women learn about childbirth and where and with whom to give birth in their own way. Most women also do not have access to good information on the subject – though they feel their information is good. Women trust their doctors, their mothers, their sisters, and their best friends to dispense information to them on this subject. A lot of women take childbirth classes through the hospital they will give birth at. A lot of women read the book "What to Expect When You're Expecting". When you say "the research" are you talking about some specific way of researching, or just generally gathering knowledge as you normally would about a subject?
You said, "What percent of birthing mothers educate themselves adequately?"
Almost every birthing mother thinks she is adequately educated, otherwise she would continue to educate herself. Also, how does one educate themself? Should I drop Owen off at the library and tell him to go educate himself? How would he know where to be begin? What to look up? And when to stop looking? I don't even think this question is quantifiable. I would not know how to asses such a thing.
You said, "What percent just shows up, taking whatever direction their doctors give them?"
I'm sure very few "just show up" without having gathered any information or formulated any ideas or plans on the issue beforehand. I think probably a very large percentage go along with their doctors advice. We have been socialized to place a lot of confidence and faith in our doctors.
You said, "I'm sure you are involved or know people involved in educating women about birthing. I'm betting that they have some statistic (accurate or not) that agrees that the majority of women aren't particularly prepared and educated."
I think most women are prepared and educated, but they are all prepared and educated about different things. Many women are educated about pain relief and prepared to get an epidural. Some women are educated about C-Sections and prepared to get one. Some women are educated about natural childbirth and prepared to have one. You have to qualify what 'prepared' and what 'educated' mean before I could answer this question. Like everything, there is a variety of information out there on childbirth and different women have different opinions on what they need to know and how they will prepare.
You said, "And lastly, please, please, please, in this conversation and every other conversation we ever have — when you read my comments, try to see if there is a way to take them that doesn't color me a a big jerk. If that's the only way they can be taken, please ask me, "Are you being a jerk here?" and wait for my answer before taking offense. I almost never mean to offend anyone and when I find out I did, I almost always feel bad about it. When I read your comments and I see a particularly long paragraph coming up, I, right away, start fretting that I've pissed you off. And then I read it and then I go back and reread what I wrote and I think, "Oh crap, I'm an idiot.""
Fair enough. It's just a very sensitive topic for me. I don't want people to assume that I did not educate myself or prepare myself for childbirth and was therefore mistreated, so I jump on this type of comment because it couldn't be further from the truth. Also, I don't feel any woman should be mistreated during childbirth whether she is prepared or not. All women deserve kind and respectful treatment regardless of how much work and time they put into it beforehand.
My use of the word “luck” was in reference to the nurse/dr/midwife you will get. Of course, you can interview and possibly find the ideal people to attend your birth, but there’s still an element of luck involved: Perhaps you’ll show up at the hospital/clinic/center and the nurse/dr/midwife you wanted had to leave due to a family emergency or maybe you arrived after they’d already worked for 10 hours, and your labor lasts another 30 hours…and they need to bow out to get some sleep.
Since, to me, “interfere” implies an unwelcome act, I would say that to “not interfere” would mean that the nurse/dr/midwife does nothing unwelcoming to mom or baby. If, for example, a woman says she wants the baby’s heart rate checked every 10 minutes, then I wouldn’t define such monitoring as interfering.
I realized in my last comment that David did not say appeal to motive was a poor argument, but since he brought it up, I figured I would clarify my reasons for pointing out their motives.
On the subject of declining an invite, it doesn’t (in itself) have any bearing on the decliner’s argument. But it does make people wonder: why don’t they want to participate? The reasons might be totally pure – perhaps they are too busy, for example – or perhaps they don’t feel the playing field will be level. On the former, it’s hard to believe everyone the radio show’s producers contacted were too busy. On the latter, it seemed pretty level to me – the host made a point of trying to argue what a hypothetical hospital nurse would say in such a situation, and when a hospital OB/GYN finally did call in (Dr. Jennifer), the host implored her to stay on the line, which she did for ~20 minutes.
In the case of my invitation to meet with the elders:
-They weren’t looking to engage in a discussion on the pros and cons of celebrating birthdays and being a JW. They were looking to tell me why (in a closed-door meeting) I sinned, to coax out remorse, and to pass out punishment as warranted. Should I ever be invited to engage in a moderated discussion regarding my withdrawal from the JWs, even if the North Monticello Congregation elders are all present, I will gladly attend.
-David asked: “what kind of things were concluded about you and your family when you declined to meet with your former religion’s judicial panel?” Of course, I can only guess, but I think I can make good guesses: They probably concluded I had something to hide, that I did not wish to be a JW anymore, that I was not remorseful about celebrating my son’s birthday, that I did not respect their authority, that I did not care what they said/did in my absence, and that I intended to continue going against their religion’s policies. They would have been entirely correct on every one of these points.
-I didn’t decline the meeting. I simply wanted to ensure the playing field was level.
James,
It seems that the unlucky scenarios you mentioned could also happen in a home birth. I suppose the home birth advantage (in this regard) is that, if you are at a hospital, the hospital people will insist you have someone attend to the birth while at home you can choose to have no one (or family etc.). Further, at home, if you do desire a pinch hitter, you are in full control of who you contact while at the hospital they might try to supply someone who you would not approve of. Is this what you are getting at? Or something else?
I’m glad we agree that their declining the invite has no bearing on the argument.
You are very generous in your supposing what the JW’s concluded.
Jennifer,
Good catch on the false analogy. Let me try again. I will ditch the work environment since I can’t get it to fit.
If I were to say that knowing more words and practicing the game were the key to winning a Scrabble tournament, I suppose I might risk offending the guy who, despite their preparation, lost to someone who cheated throughout the entire game. I don’t think it would change my position though.
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One last thing that I wanted to clarify… Although I agree that the pregnant woman has the final say on all decisions related to pregnancy, labor, and childbirth, it is my OPINION that education and preparation extends beyond the pregnant woman. It seems that every time you mischaracterize my position you also add “women” to the misquotes as if I wasn’t including men in my non-gender-specific comments.
For example, when I point out that the size of the human brain adds complications that might not have been selected out for because along with the increase in size comes the increase in understanding how to deal with the problems associated with the big brain and therefore we have evolved to a position in which using our big-brain intelligence is sometimes required to overcome this somewhat unique-to-humans situation, you turn it into, “…you might not want to accuse women who are mistreated during their births of not using their brains.”
Just a minor quibble, I know, but when dealing with a topic heavily associated with misogyny, I worry that it will be perceived that I’m just another guy trying to tell a woman what to do with her body.
David,
While I agree that it has no bearing on the argument (which is why I said it was a ‘red flag,’ and not a flat-out indictment), it does look bad. My resistance with the elders, indeed, any JWs non-compliance with meeting with the elders, is viewed as an admission of guilt. I hear all the time on the radio stuff like: “The FDA released this new statement regarding the health hazards of smoking. We contacted several cigarette manufacturers for their take on this new study, but they declined to respond.” …and it sure makes them look bad.
I recall back in ’08, John McCain said he wanted to cancel a debate with Obama, as he claimed, as Senators, they should be busy with working on the failing economy. But since Obama responded with: “Why can’t we do both?” then McCain knew he HAD to go, lest he look bad for not showing up.
So, when no one from any hospital agreed to take part in the discussion, I rolled my eyes and thought, “Yep, sounds about right…” They immediately looked bad to me, and probably lots of other listeners.
I’ve felt this away when “my side” has declined, too.
I think, part of the reason, can be what they (think they) have to lose. Just about any JW would likely decline a debate with me. Among other reasons, if they were to prove me wrong about something, I could just say, “Oh, wow, you’re right! My apologies.” But if I was to prove them wrong, it would topple their belief system (since their system asserts it is entirely correct). They, therefore, have much, much more to lose.
Same thing with hospitals. Since only 1% of women give birth at home, if the home birth advocates were to not make a good case, they’d probably be okay, since most women listening in probably have no intention of ever giving birth at home, anyways. On the other hand, the hospitals might worry that, should they not make their case sufficiently, at least some of the women listening in might think, “Huh, I guess I’m gonna give birth at home from now on.”
Also – I’m not clear on what you mean by my being “very generous” in supposing what the JW elders concluded. Are you saying I made too many guesses? Or that my guesses were way off base? Or that my guesses were too vague?
Regardless, I think it’s safe to say that my reaction to the elders’ attempts to meet with me were met with an increased negative view about me. Just as declining to engage in a discussion (not even a debate, just a discussion) about the growing popularity of home births was met with an increased negative view by me and, I suppose, others, too. Some people might have been listening and thought, “Hmm…no one from any hospital agreed to participate in this discussion? Well that certainly improves my opinion of them,” but I gotta think they were in the minority. In fact, Dr. Jennifer’s call was started with her dissatisfaction that none of her colleagues agreed to participate – she practically apologize on their behalf – something she wouldn’t likely have done (if she would’ve even called in at all) had she felt her colleagues image was being improved by their non-participation.
David,
You’ve failed to prove your point. You statement is still highly offensive. And when you are talking decisions that women make about their pregnancies and births, and the consequences that they suffer, then you are talking about women, not men, despite your lack of a gender qualification. Also, I don’t give a crap about Scrabble.
Jennifer,
For that specific instance, my point was that it was not solely down to luck. All parties agreed.
Anyone can take offense to anything at any time. Whether the statement is offensive is subjective. I think you didn’t understand my statement or took in a way I did not mean. When I tried to explain it better (clearly adding that there is an element of luck which can trump all the preparation in the world), you went back to the original wording. There’s not much more I can do.
I am not talking about the decisions that women make about pregnancies and births and the consequences they suffer, I am talking about poor arguments. We agree on everything else.
Let’s review.
First post:
I thought the “red flag” comment was used to hint that the hospital folk were hiding something simply because those contacted were reported to have declined to participate in the radio program. No one here knows why they declined so it’s not indicative of anything. The whole angle is faulty logic.
The food analogy begged the question in a way. Surely one of the biggest components in the pro-hospital stance is the odds of needing intervention. The food analogy was poor in that it is a very low odds situation. There were also regulatory and monetary points made with no analogous components in the hospital/home birth argument (at least not as presented).
I pointed out that I thought the statement that no hospital exists in the area with the requirements put forth by James was false. (I was later corrected)
I pointed out a statement that I took to mean going to a hospital is a dice roll. It was later clarified by James that he did think there were other components.
I pointed out a potentially spurious appeal to motive.
I questioned the interpretation given for one of Dr. Jennifer’s statements.
Next post:
I clarified that I did think the “red flag” comment was faulty logic (there was some confusion with how I presented my point in the earlier post).
I conceded taking the “luck comment” wrong.
I asked a question about C-Sections.
I conceded that the birth center does not meet James requirements as stated.
I explained how I gathered my information regarding St. Joseph’s
I clarified that my comment regarding James’ “luck” comment was only seeking to add that luck isn’t the only component.
I explained that tiny sample sizes don’t come into play when you are talking about basic logical plausibility and refuted the claim that I was calling up anecdotes
I attempted to assure you that my comments had nothing to do with your own birth trauma experience.
I then pointed out that the data you presented did not support the argument you put forth.
I conceded that a previous comment was poorly written and attempted (in vain) to explain what I had on my mind when I wrote it, pointing out a possible appeal to nature logical fallacy.
Finally, I asked that you give me the benefit of the doubt when judging whether I am being offensive. You agreed, but then rejected my expanded explanation that was meant to clarify a statement you took as offensive — going back to my originally worded comment instead of addressing the updated version.
Last post:
James put forth an argument that could have been made against either home births or hospital births, but levied it solely on hospital births. I pointed this out, but tried to find a hidden point that he may have been making.
I conceded that I made a mistake with my analogy and offered a better one.
I asked that you not twist my words to fit what you think I am saying instead of just reading the actual words.
As you can see, most of everything I said was in regards to proper arguments. And that’s all we really could argue considering I AGREE WITH YOU AND JAMES ON EVERY POINT except, possibly, the degree to which luck and preparation play a role in how births will go at hospitals.
Whether you like Scrabble or not, it is an analogy that I’m sure you can follow.
And finally, do you think it might be offensive to a person who carefully researched and prepared for the birth of their baby, ultimately deciding on a hospital birth, that they left their health and well-being and the health and well-being of their child up to a roll of the dice? That when they actually did bring a birth plan to the show, that when they took the 12-week birthing classes, that when they chose a doctor with a high probability of being the doctor they get on game day, that when they did inquire of every doctor in their clinic whether they supported their choices, that when they did the daily pain coping exercises, that all of it was just a big waste of time and effort because they irresponsibly decided on a hospital birth? That their fears of not being able to handle labor, birth, and the first days of being a parent ultimately set them up for failure because of the reckless choice to go to a hospital? Could you stretch your imagination to accept that maybe someone might take offense to this?
Maybe on some subconscious level I was. Maybe that’s what moved me to inquire further. But when I did, I approached it logically and rationally.
And boy howdy was I happy to see that you agree that there is some merit in education and preparation. Maybe the resident birth expert doesn’t think we’re irresponsible uninformed fools rolling dice with our lives.
James,
I agree that such a comment regarding the willingness for one party to participate can move us to draw up potentially false conclusions. My argument is that we shouldn’t let it.
As regards to “generous”, I meant kind. I have no idea what they would have said — we didn’t have any judicial proceedings etc. Perhaps they are levelheaded and fair.
What I do know is that one elder who doesn’t know me personally, who lives in another state, who I only met a few times put forth the idea that my wife and I had some inappropriate relations before we were married and the guilt slowly tore us away from Jehovah. It was baseless BS, but he assured a relative of mine that this was most likely what was really going on with our leaving the church. He’d seen it a lot.
They’ve said I didn’t pray, I never really “made the Truth my own, I just wanted to do “bad” things (in this case things I actually don’t want to do, unlike celebrate birthdays)…
I guess my question was rhetorical and I assumed you would agree that they would take your refusal to meet (if you had refused, I stand corrected) for an acknowledgment of things beyond what might actually be true. Maybe I just have a bad attitude toward JW’s.
Oh my goodness, David. This post was about Hospital birth vs. Home birth, not about winning an argument. Your tedious arguing about every little word and phrase are just way over done. I could not even read all of your posts. On the positive side, your rantings gave James and Jennifer the opportunity to give good reasons for their wanting a home birth and how the medical community in general, is traumatizing some women in labor.
Debbie,
You’re right, the post was about hospital vs. home births. I agree with James’ and Jennifer’s position 100% so my comments here were not to argue the other side. I have thanked Jennifer for her work with the birth survey and other birth advocacy activities. I have said that (in my opinion) the best place for her to give birth was at home.
I noticed that James’ arguments were not as strong as they could be (in my opinion). I very often point out this type of thing. That level pedantry is not for everyone, I know. Please don’t feel compelled to read everything I write. I can be very tedious.
My goal here, just like every other time I point out errors in arguments when I agree with the arguer, was to improve the arguments. I admit, I lost that battle.
David,
I am a direct person. I talk about the things I am passionate about. When I am talking directly about something I am passionate about, and you are talking about the way I am talking about that thing (without openly acknowledging this except perhaps in a cryptic way) then that leaves you able to be emotionally detached, and me open and vulnerable. Awhile back you and I had an email exchange about homebirth. At first it seemed that you were sincerely interested in the topic and wanted to know more about it. I shared more information with you. As the conversation went on though, at some point I realized that we were no longer talking about homebirth – we were just talking about the way I was talking about homebirth. Realizing that this was just an exercise in frustration and that you had no real interest in the topic, just in my proficiency at arguing the topic, I ended the conversation. I would never take it upon myself to try to strengthen someone else’s argument without being extremely open as to what I was doing so that they are not becoming emotionally invested in a fruitless conversation. It is one thing to correct fact – it is perfectly acceptable to correct a wrong statistic or some concrete verifiable tidbit – but when we are talking based on our own personal views of gathered anecdotal evidence, then there is no reason for you to try to strengthen my argument – just as there is no reason for me to try to strengthen yours. In the future, please remember that I have no interest in this type of discussion. The only reason I would ever want this type of scrutiny over the way I say things is if I ever write an article for a peer reviewed journal, other than that I can’t think of any reason I would want someone to scrutinize the way I say something instead of taking in the idea I am trying to get across.
I would like to address this paragraph though, as it is the first thing I have seen from you in this discussion that seems real and true of your own opinion, instead of just hiding behind logical arguments to “strengthen” mine:
“And finally, do you think it might be offensive to a person who carefully researched and prepared for the birth of their baby, ultimately deciding on a hospital birth, that they left their health and well-being and the health and well-being of their child up to a roll of the dice? That when they actually did bring a birth plan to the show, that when they took the 12-week birthing classes, that when they chose a doctor with a high probability of being the doctor they get on game day, that when they did inquire of every doctor in their clinic whether they supported their choices, that when they did the daily pain coping exercises, that all of it was just a big waste of time and effort because they irresponsibly decided on a hospital birth? That their fears of not being able to handle labor, birth, and the first days of being a parent ultimately set them up for failure because of the reckless choice to go to a hospital? Could you stretch your imagination to accept that maybe someone might take offense to this?”
Absolutely. If I had a good experience, after everything I did to plan for my first birth, I would certainly take offense at the suggestion that what I did had nothing to do with the outcome of my birth. Now that I have the experience of two births to draw from, I can also agree with you 100% that planning and education do contribute to having a good experience; it worked for me 50% of the time. I feel that when one plans and educates themselves and experiences a good outcome, they have every right to credit their planning. However, I don’t feel that one can say that if you plan and educate yourself you won’t have a bad experience. This is where luck comes in; plan and educate yourself and then roll the dice and see if it pays off. I’m sorry if that offends you, but I feel that is the reality of the situation. What I really object to is your saying, essentially, that planning and education are the biggest factor affecting not being mistreated – and I am talking specifically about the one issue of being mistreated, not the several other issues that education helps. I think you can agree that there are several factors that contribute to having a good birth experience. Knowledge of the bodily processes of childbirth, knowledge of the interventions offered and which ones might be chosen or refused (if the woman is given this freedom), knowledge of pain coping techniques and pain reducing drugs and epidural and which one might be chosen or refused and under what circumstances, knowledge of newborn attachment and ways to promote this around the time of childbirth, knowledge of the different types of providers (hospital based midwife, home or birth center based midwife, family practice doctor, and OB) and what these types of providers generally offer their patients/clients and how they tend to manage labor and birth in general, knowledge of the role of a doula and how she can support women in different birth settings, knowledge of the hospital, birth center, homebirth setting and how these settings influence labor, birth and newborn attachment in general, and then finally knowledge of a specific provider – how they typically deal with labor and birth and their rates of interventions such as episiotomy, epidural, and c-section, or hospital transfer in the case of home or birth center midwives, and knowledge of a specific hospital and the options they have available and how often women actually get to use these options – birthing rooms, birthing tubs, squatting bars, birth balls, skin to skin contact, rooming in, exclusive breastfeeding, etc.
Now, being mistreated in a hospital is hard to educate ourselves for because up until The Birth Survey there was no transparency in maternity care. If the only information I am getting on a provider or institution is from that provider or institution, my information is going to be skewed. For example, if we didn’t have the health department checking restaurants to tell us if they are using healthy practices and instead it was up to us consumers to find this out for ourselves, it might be very difficult to get any accurate information. This is why I thought of creating a birth survey and then eventually found an organization that was already working on it and joined with them to help, because I realized there was a hole in my education. I realized that the only information I had about HCMC was from HCMC and the only information I had about their midwives was from their midwives. I certainly explored the hospital and its options fully, and I talked extensively with every midwife I saw about the birth and what my expectations were, but this brings me to my second point about mistreatment and hospital birth; I had no idea that there was such a thing as being mistreated and outright assaulted in the hospital while giving birth. Thus I had no idea to even ask questions that addressed this subject. Being raised as a JW, I thought that medical workers had to get informed consent for any procedure before performing it and that I would have the right to refuse any procedure – whether it was an emergency or not – just as JW’s are told they have the right to refuse a blood transfusion even if they will die without it. I had no idea that once I signed the hospital’s blanket consent form that I would be signing my human rights away at the door, that the perceived well-being of the fetus I carried would trump me in any and all medical decisions from the very small and non-emergent to the biggest emergency there could be. That my providers would be making many decisions to avoid being sued by me, instead of to give me and my baby the best treatment possible. This leaves the medical staff able to alone interpret what I need at the time and whether or not I should be made to accept it. This means I can not sue them if they force procedures on me or my baby – that we did not need or want – because they are legally protected to do so. If you do not believe my assertion on this or think I am bringing it across in a bad way I encourage you to visit the website National Advocates for Pregnant Women found here: http://www.advocatesforpregnantwomen.org/ and read the book Policing Pregnancy http://www.amazon.com/Policing-Pregnancy-Ethics-Obstetric-Conflict/dp/075464412X it is available at Hamline’s legal library so James can check it out if you want to read it. Due to all of this I feel there is no way to educate ourselves against mistreatment, and in some cases certain types of education can increase our chances of being mistreated. I agree with you that planning and education are generally a way to have a better birth experience, except for in this one area, where it is unclear according to the research, and I could provide a lot of anecdotal evidence in the form of hundreds of women who educated themselves in the ways you described, were assaulted or mistreated during their birth experience, were traumatized due to this and can not get legal recompense for it – which would protect other women from getting the same treatment.
So, perhaps now you can stretch your imagination a bit and imagine that you did all of the things you mentioned, then showed up at the hospital and got nothing you were promised, were assaulted and mistreated during your birth, your baby was also mistreated during the hospital stay, you were not allowed to make any decisions for yourself or your baby. You were subsequently traumatized, your first 3 years of parenting plagued by mental illness, you had to pay to treat this yourself out of pocket with no help from the hospital or midwives who assaulted you, and you spend the better part of the first two years blaming yourself and wondering where you went wrong. Then when you share your story you get questions such as, “well, did you hire a doula because doulas can advocate for you?” “did you have a birth plan?” “did you take [insert popular childbirth class here]?” “did your husband stand up for you?” “didn’t you just say no, you have to advocate for yourself?” “didn’t you ask your midwives questions beforehand?” or the more smug “this is why women need to educate themselves!” “this is why I had a homebirth!” “this is why I took [insert popular chilbirth ed class here!” “I would have kicked my midwife/doctor/OB if they tried that!” “I would have sued/this is why women need to start suing for things like this!” etc. etc. etc.
So, sorry if I jumped all over your comment, but I’ve heard it all before and it doesn’t do my mental health any good. And the bigger issue to me is why do women need to educate themselves in order to avoid being assaulted? Are we saying that these (hundreds of thousands – or possibly over a million per year) women deserved what they got because they missed some aspect of educating themselves? Are we searching for where they went wrong so we can walk away happy that we did everything right and we deserved the good experience we got? Are we saying that a woman who walks in off the street and did no preparation deserves to be treated badly in order to punish her for her lack of preparation? Perhaps this is not the intention of your words, but this is what is internalized by women like me – women who were “educated” beyond what is typical and despite that (or because of that) were mistreated; manipulated, coerced or assaulted.
Please don’t respond if you only wish to discuss how I said this. I have no use for that kind of discussion. I have taken college courses where I am graded on my use of properly arguing my points and I have done very well in those courses and do not wish to be assessed by you.
Just to clarify-
I don’t really mind if someone questions (or asks for clarification) on something I post here. As Jennifer said, a blog is different than an article – or even a class essay – in that I’m just writing something, willy-nilly, and so I don’t always have time or care to do extensive research.
So, while my mention of a ‘red flag’ and my use of the word ‘luck’ were not the main points of the post, I certainly don’t mind being questioned on them. Just as it’s offensive to suggest that a bad birth experience could’ve been avoided with more education, it’s also offensive to suggest that a good birth experience is just a matter of luck. So, you know, my use of the word was thoughtless, and I will be more careful about using it in the future.