more lowdown on Australia's anti-midwifery, anti-woman, anti-liberty legislation

The lying bastards of the Australian Ministry of Health have released an amendment to the proposed legislation which will affect midwifery care in Australia.  In short, there will be no true midwifery care.

There will be people who will argue that a midwife under the auspices of an obstetrician is better than no midwife at all.  Maybe.  But we know for a fact - BC's recent study proves it - that outcomes are better for midwife-attended homebirths than for midwife-attended hospital births, so why deny women that choice?  We also know that midwives and doctors who refuse to play by regressive, interventionist, choice-limiting or -eliminating rules routinely have their privileges revoked.  So I call a big ol' bull$hit on anyone who claims that this is better than nothing.

"Better than nothing" is a stupid, idiotic argument.  It is NOT GOOD ENOUGH (and yes, I am yelling.  Hell, I'm screaming!).

My DH weighs in on this issue from a political perspective here.

meta-post: responses to The Today Show's "Perils of Midwifery"

As I wrote last night, Friday's Today Show segment is bad , bad journalism, not only because it shamelessly attacks people, but because it lacks the journalistic integrity of unbiased and balanced reporting and fails to bolster its argument with substantive research (clue: the plural of  "anecdote" is not "data").  NBC will receive hundreds, if not thousands of angry letters, including one from me.  But (to quote Levar Burton) don't just take my word on it:
 

Iridescent tile makes all the difference -  A very impassioned post relating the claptrap so many hospital administrators think we birthing mothers "need" to the name-calling in The Today Show segment.  (Also, having just discovered this woman's blog, I am already a huge fan. She's made of awesome.)

Grassroots Network: Today Show in bed with ACOG - Susan's post is quick and to the point (*cough* unlike my own *cough*) and includes helpful links like this one so that we can email our thoughts on the segment to the people at The Today Show.  I'm sure they'd love to hear from all of us.  Multiple times. :)

Reality Rounds Calls a "Code Bullshit" on The Today Show - a great post from another one of my new favourite blogs (I've got to hand it to The Today Show: thanks to their shoddy, smarmy segment, I have discovered some fabulous blogs!  So, thank you, I guess.)  The comments to this post are particularly awesome, including one from a woman who has spoken with Catherine, the mother featured in the segment.

Physicians Take Anti-Midwife Smear Campaign to the Airwaves: Home Birth Mothers, Celebrities, Insulted on National TV - a pdf of The Big Push for Midwives press release in response to The Today Show's segment.
And last but most definitely not least:
Code Mec! Code Mec! - Rixa of Stand and Deliver calls a Code Mec (because it's icky and leaves a stain) on The Today Show, and delivers an extensive and superb meta-post of her own wherein you will find commentary on the segment and links to other responses.

Found another response to the segment that you think I'd like to read: post a link in the comments!  Written one yourself (perhaps you, too, have a blog?): post a link in the comments!  I am perpetually expanding my blogroll.  There's always room for more, so get in on the fun.

ACOG has sunk to a new low

As if scare-mongering and fact-twisting weren't enough, they have now sunk to exploiting a heart-broken couple's pain.  This Today Show segment is rapidly making the rounds on the internet (I've had about four or five friends post it to their Facebook pages so far, and it's popped up in at least four blog feeds, as well) and for good reason.  The segment is so obviously intended to further the position of the ACOG, so obviously meant to attack the midwifery and homebirth movements, and so obviously lacking in any effort to provide unbiased or well-balanced journalism that it is almost laughable.  Almost.

Exploiting a family tragedy in a veiled effort to shore up their own image by undercutting the alternative is utterly ludicrous.  Sadly, though, it's extremely common in this sensationalist-style "journalism" (though to call it that insults all of my journalist friends who do actual, you know, research before airing their stories).  No, what I find even worse is the blatant and slanderous insult.  Andrew Goldman of New York Magazine, and author of the article "Extreme Birth" is briefly on screen and delivers this soundbite:

 One of the doctors I spoke to said that he thought that homebirth had become almost the equivalent of a spa treatment, that it was this sort of hedonistic concept of birthing.

 As if insulting every woman who has ever considered or had a homebirth wasn't bad enough: they felt the need to slander, shame and blame the woman whose story they were exploiting for the very basis of the segment!  Obviously, if only she hadn't been so selfish, so self-involved and self-important, if only she had really considered her baby, she would have happily bought into the load of lies and half-truths and evidence-less practices so often sold by members of the ACOG.  If only...  

What's even more spurious about this segment is the date of its airing.  The very day the ACOG released the results of their 2009 Survey on Professional Liability, in which the ACOG admits that current practices are known to harm women and babies.

"This latest survey shows that the medical liability situation for ob-gyns remains a chronic crisis and continues to deprive women of all ages—especially pregnant women—of experienced ob-gyns," said Albert L. Strunk, JD, MD, ACOG deputy executive vice president. "Women's health care suffers as ob-gyns further decrease obstetric services, reduce gynecologic procedures, and are forced to practice defensive medicine."

 Forced to practice defensive medicine.   Let's all just ruminate on that phrase and consider it's meaning.  Continuous Electronic Fetal Monitoring.  Mandatory IV's.  Mandatory antibiotics for GBS mothers.  Mandatory induction after rupture of waters.  A national caesarean rate of 31.8% in the USA.

It has been stated to me recently that ob-gyns do not begin their practices in an effort to victimize women.  I would tend to agree with this statement.  I would like to think that, at their core, or at least in their genesis, doctors have a desire to help or to heal.  But that does not excuse engaging in practices and procedures which hurt women and children!  It does not excuse ignoring study after study after study which shows that common procedures routinely harm the very women and babies they are supposedly to help!  And it certainly does not excuse denying women bodily autonomy or informed consent.  For this there is simply. no. excuse.

It has been suggested that the current expectations for birth are unrealistic, that parents expect "perfection" from their doctor and that when their experience falls short they choose to litigate to make up for it.  Perhaps that is so.  Perhaps a 91% claim rate against respondents to the 2009 liability survey is indicative of parents having ludicrous expectations.  But should the doctors not shoulder some of that blame as well?  Should we, instead, address and acknowledge the fact that if the doctors are the "experts" they should be imparting a little of that wisdom to their "patients" (I'm utilizing sarcastic quotation marks again: a pregnant woman isn't sick) and having frank and earnest conversations about the realities and limitations of practitioners and birthing environments?  Perhaps if doctors were honest with women, were honest with parents, and actually divulged some of the information they so often try to keep hidden, there would be a greater understanding on the part of those parents after the birth for any perceived shortcomings.  Marsden Wagner writes in his recent paper "Fish Can't See Water":

One reason for the epidemic of epidural in many countries is that women are not told the scientific facts about all of the risks to them and their babies when epidural block is used for normal labour pain. Indeed, at one meeting of obstetric anesthesiologists in the US, discussions were held on how to prevent any information on risks of epidural from reaching the public. The excuse used was the typical patronizing approach of some doctors: "We don't want to scare the ladies." It is absolutely essential that any women offered epidural must be told all the scientific facts about the risks before she gives informed consent to the procedure. 

 Instead of respecting women - and also men; we must not exclude male partners from the equation - and dealing with them honestly, there is an overwhelming air of paternalism which often just smacks of chauvenism and downright misogyny.  And what's so totally ridiculous about it is that it only serves to shoot these same, paternalist, controlling doctors in the foot when claims are launched against them by dissatisfied and even injured women and parents (I say parents because if it is the child who is injured, the infant will obviously not be launching the claim).  Holly Barhamand, a doula and childbirth educator, contributed a comment to a recent post on Reality Rounds about whether patients can ever have any say in their own healthcare.  Her comment sums up my point better than I ever could.  With her permission:

I’m sure it’s a prevalent attitude, but I think it’s dangerous. When a patient has the decision making taken away from them, they are no longer responsible for the outcome. So when the outcome is adverse (and it will be sometimes, inevitably), then the doctor is at fault. Even if it was always out of the doctor’s hands. And this is a setup for distrust and fear for both sides and probably litigation. If a patient has a true voice in his healthcare, the responsibility for the outcome falls on his shoulders as well. I think this would solve a lot of problems, even if it means more time and investment for both sides.

How does this all come back to the Today Show segment?  The ACOG - through the guise of Peter Alexander - is trying to tell us that self-determination and personal responsibility are bad things.  They are trying to convince us that we want no part of the decision making process.  And they are, unequivocably and entirely, WRONG.

BirthLove - a truly phenomenal online resource

I was linked to a website, BirthLove, through a Facebook friend. It is an absolutely amazing resource. I haven't yet read everything on there because there is, quite simply, WAY too much on this site to be read in one day while also playing with a toddler, feeding a toddler, dealing with meals... It is a very prolific site.  Amongst their contributors are Gloria Lemay - one of Canada's best known and respected birth attendants - and Marsden Wagner - former director of Women's and Children's Health with the WHO - as well as Gretchen Humphries - I've linked to her site in the 'Resources' sidebar - and Sarah Buckley - a mother and writer from New Zealand.

One article recently really jumped out at me from the site.  It's entitled  Rape of the Twentieth Century.   It is a shockingly honest and brutal portrayal of the sadly-common tragedy of unpleasant hospital births.  The author begins with a description of her five hospital births, each one a broken birth, a birth in which her choices and her body were treated with disregard and disrespect.  She describes how her body and her births were used as teaching tools, rather than treated with honour and sanctity, how unnecessary and unwarranted procedures were performed on her and her unborn children "in the name of science".  It is a harrowing tale.

She goes on to discuss the interventions used in medicalized births and many of their untold risks: the use of episiotomy motivates heavy suctioning to clear the infant's lungs, and poses the possibility of cutting the baby, forceps can disfigure women's genitals, caesarean section increases the likelihood of maternal death by a factor of sixteen.  And as the author writes:

In a cesarean section, a private, secret, and sensual event becomes a sterile crucifixion in a room full of slicing, staring strangers. And the ultimate rape is that we are told we need to be cut. The sanctity and power of birth becomes a meek "yes, doctor" and we become spectators to our own violation; we even thank the doctors as they scurry on their way out of the operating room.

Her description of medicalized birth is unforgiving and cuts deeply, but she writes as one who has had more experience with hospital births than is average.  Five hospital births.  Five births which left her alone and weeping.  Five births in which she felt her body a failure, defective and incapable.

She argues strongly in favour of homebirth and midwifery, not purely because it is so pleasant, it is so simple, but because hospital births truly do pose such a grave risk.  It is a risk not only of undesired intervention or surgery, not only of dissatisfaction, but one of deep and abiding sadness at what has been lost, and of avoidable death.

We are living in strange and savage times. This century will be remembered as one of war and genocide; and violent, coercive childbirth. Birth is weeping, and bleeding. We are made to believe we must give birth in sometimes hostile and mostly indifferent hospitals, where interference with a woman's natural birthing rhythms is the norm. Our vaginas can be stared at and cut by strangers, and abnormal emotional and physical behaviors- such as excessive fear, crying, and stress-induced stoppage of labor- have become normal and expected. Babies are routinely harmed; and the perpetrators are exalted as life savers, instead of reviled as child abusers. A birth without unnecessary intervention is now unusual, even though we all have the potential to birth beautifully- if only left alone.

The numbers support planned homebirthing

If this doesn't bolster the push for a wider acceptance of homebirthing, I'm not sure what will.

The results of a study conducted in BC were recently released (about a week ago; I'm a little late to the plate on this one).  The cases of three groups of women who were considered low-risk were compared: those who had planned hospital births with an obstetrician, those who had planned hospital births with midwives, and those who had planned homebirths with midwives.  The numbers don't lie: perinatal mortality results were the same for homebirths as for hospital births, and homebirths had "reduced rates of obstetric interventions and other adverse perinatal outcomes compared with planned hospital birth attended by a midwife or physician."  

What's particularly great about this study is that midwife-assisted hospital births were included in the study, thus eliminating the attendant from the equation.  It cannot be argued that a hospital birth with a midwife is "just as good" as a homebirth.  The fact is: they aren't.  Outcomes are, by and large, better for homebirths.  

Hopefully, the results of this study will help encourage professionals and legislators to support homebirth, and will provide women with some additional ammunition to assist them in convincing reticent spouses that homebirth is a safe and encouraging choice for birth.

The hollow echo of the cave (a post in which my Humanities degree exerts itself)

See human beings as though they were in an underground cave-like dwelling with its entrance, a long one, open to the light across the whole width of the cave.  They are in it from childhood with their legs and necks in bonds so that they are fixed, seeing only in front of them, unable because of the bond to turn their heads all the way around. Their light is from a fire burning far above and behind them...
...Do you suppose such men would have seen anything of themselves and one another other than the shadows cast by the fire on the side of the cave facing them?..
...Then most certainly...such men would hold that the truth is nothing other than the shadows of artificial things.  The Republic of Plato, 514-515c

I recently had a revelation, an epiphany of sorts.  For months, almost years now, I have attempted to explain natural parenting (natural birth including homebirth and midwifery care, breastfeeding, co-sleeping, babywearing, etc.) to more "establishment" parents, and never feeling like any communication was really successful.  It isn't just that we weren't agreeing - this wasn't some argument that was to be won or lost, but just discourse - it was that those who were firmly entrenched in the more established way of doing things seemed to truly not understand what I was saying at all.  It was like we were speaking totally different, unrelated languages.

The other day, it occurred to me: it's Plato's Myth of the Cave.  What I have seen of birth, of parenting, is so entirely different, so entirely foreign, it must be unbelievable.  "How can birth possibly be enjoyable?" I am asked.  How can I not resent my child for still nursing more than a dozen times a day?  How can we not find her continued presence in our bed not intrusive?

And if he once more had to compete with those perpetual prisoners in forming judgments about those shadows while his vision was still dim, before his eyes had recovered, and if the time needed for getting accustomed were not at all short, wouldn't he be the source of laughter, and wouldn't it be said of him that he went up and came back with his eyes corrupted, and that it's not even worth trying to go up?  And if they were somehow able to get their hands on and kill the man who attempts to release and lead up, wouldn't they kill him?  The Republic of Plato, 517a

Sadly, the response is not exclusively one of disbelief, but sometimes violent dislike and offense.  Rather than listening to one another, to hearing the truth behind each other's words, there is attack and defensiveness, on both sides of the debate as, unfortunately, the discourse and discussion has now become.

The truth behind the defense of unnecessarily medicalized birth is often fear.  Fear of the unknown, fear of loss of control.  Fear of our own bodies, our own humanity, even.  The truth behind the attack of the natural birther, the natural parent, may well also be fear: fear of constant criticism, fear of losing our resolve in the face of that criticism, fear of legal action as a result of our choices.

We must - we must - keep yelling into the cave, despite this fear.  Even if what we hear echoing back to us is distorted or unpleasant, we must: after all, there may be people in there looking to escape.

Something interesting is happening in birth: Part II

As I said, something interesting is happening in birth.  That interesting thing is that birth has now, seemingly suddenly, become interesting.

I spend a lot of time on the internet.  A shocking amount of time, actually.  One of the few benefits of having a child who still nurses, oh, at least 15 times a day, is that I certainly have an excuse to sit on my couch and do some surfing (though it does make typing difficult sometimes, hence the several days it's been since my last post).  I read a lot of blogs, and spend a great deal of my time on Facebook looking at birth-related groups and following links posted by other women (thank you, Emma!).  I think it's fair to say that about 75 percent of my time on the internet is in some way birth, pregnancy and parenting related.  Because so much of my time is spent on topic-specific sites, though, I wasn't sure that the trend I was perceiving was actually real, and not just the result of the lens through which I view the media.  That trend is toward a general interest in birth-related topics.

Birth blogs are many.  I just Googled "birth blog" and got 60.5 MILLION hits.  Yes, MILLION.  Well past the first 50 pages of hits, the links are still largely to blogs about birthing, birth stories, or pregnancy and birth blogs.  For women and couples who are pregnant, it's to be expected that the topic might cross their minds.  For those of us who have birthed, who have experienced what birth is like in North America and who didn't like it, it's equally understandable that we'd find such a subject engaging. Likewise, those who are employed in the distressingly-termed "birth industry" would be expected to be interested in the subject of birth (one would hope, at least).  But the topic has always seemed somewhat sidelined to these demographics who are directly affected by the state of birth.  There have been books about birth, classes about birth and cheesily-produced movies about birth, but they were very much separated from the other books (Chapters shelves the pregnancy and birth books in the children's section) the other classes and the other movies (I dare you to go to Blockbuster and ask where their birthing dvds are located.  Go on: it'll be funny!).

Recently, though, there's been a shift.  Major media, news media, have started highlighting stories on birth topics.  Just this week, Fox's Detroit station aired a news feature on Marie Mongan's HypnoBirthing method of birthing.  It's a surprisingly pro-natural-birth story; rather than finding obstetricians to discuss the validity of such a technique, they instead interviewed an instructor as well as two women who have benefited from self-hypnosis.  Last week, Artvoice, a publication out of Buffalo, featured Getting Off Our Backs, an article about the midwifery model of care, homebirth, and how women are changing how they see and experience birth, as a cover story.  Late last month, The Huffington Post featured an article posted by sociologist Louise Marie Roth about the status of women in labour in which she referenced specific instances of births 'gone bad' so-to-speak, where birth choices by women resulted in legal action and the suspension of parental rights.  This wasn't her first post on the state of birth in America.  The New York Times' Home and Garden section online featured a slideshow of images and anecdotes on homebirth back in November 2008.  It's beautiful, it's inspiring, and it's very positive.

At the recent staging of Karen Brody's Birth in Ottawa, I was delighted to see that not every audience member was a woman, and that not all the women were mother's or birth practitioners.  There were single women present who had never given birth, and young couples who were not yet even expecting their first child.  But they were there, and they were interested.  During the Red Tent before the Saturday evening performance, many of us told our birth stories.  I was one of the very last mothers to recount her story, and I was inexpressibly excited to see such interest on the faces of those who had yet no personal encounter with birth.

We could discard this trend.  Who cares?  we could say.  It's a fad. Interests come and go: what difference does it make?  The difference is that with interest comes information.  The more people inform themselves, the more likely they are to demand change, to demand respect, to demand their rights and the rights of their babies.  The more women and men, mothers and fathers, stand up against a system that would have them lay down and lay still, the more likely that change will come, and sooner, too.  No mother or father should ever need to weep while acknowledging that their rights and the dignity of the mother's and baby's body were violated, and not just by one doctor or one hospital, but by an entire system.

I think it's interesting.  I think it's exciting.  It gives me hope.  Just as the world in which I grew up was a far, far different one from that in which my mother grew up - I never had to stage a protest in order to be allowed to wear trousers to school, but she did - I have great hope that my daughter will not have to fight so hard to have positive birth experiences should she choose to have children.  I have hope that her choices, her rights, and the sanctity of her body will be automatically respected and upheld.  I have hope that any births she may have in her future will be positive ones, as empowering and uplifting as any can be.

It can only come with change.  That change has already started.  And that is very, very interesting, indeed.

The Trust Birth Initiative

I came across the Trust Birth Initiative in the links sidebar of the Fearless Birth blog. Their manifesto is really something to read. I like everything she says in describing the outlook and ideals of Trust Birth. Is it extreme? Yes. Do I agree, totally and completely? Yes, I do. There is another post to come about the paradox of childbirth in the 21st century, and it relates back to the statements on the Trust Birth site. In short, though, I am extremely enthusiastic about the initiative, and wish there were a meeting nearby (only one in Canada?! Come on people!).

Something interesting is happening in birth: Part I

Yesterday evening, I attended a performance of the play “Birth” by Karen Brody. The play was staged by Three Sisters, a company of professional actresses in Ottawa, and was staged in order to raise funds and awareness for the Coalition for Breech Birth. The Coalition was founded by consumers, women who had had their births stolen from them by a system which refuses to admit the reality of breech birth, a system which fails to instruct its physicians in catching breech babies, and allows those physicians to coerce mothers into unwanted, unconsented and unnecessary caesarian sections.

The play is beautiful. It tells the story of 10 women's births with their first (and in one case, second, third and fourth) children. There are stories of joy: a woman chanting a mantra as she births squating, supported by her husband and her doula, believing and trusting her body; a woman kneeling in a pool in her home, her three children beside her, cheering her through her labour. But there are many, many stories of sorrow. Women coerced into deviating from their birth plan, into denying the needs of their own body. Women treated with disregard and disrespect while pregnant and while labouring. Women assaulted while birthing: cut, without need or consent, while bringing her child into the world.

It's extremely difficult to watch, even when staged in a minimalist, Vagina Monologues-style format. An actress, mimicking birth, telling the true story of a true woman's birth, screaming, not only in pain but in terror, in sorrow, in rage, at the realization that, just as she reached between her legs to feel her daughter's head being born, her doctor, her practitioner, was slicing through her perineum. Watching it, it was not just unethical, and not just assault: it was rape.
 
This is happening. This happens far more often than we'd like – and than any physician would ever dare – to admit. This is one of the realities of birth in North America. Women experiencing the trauma of rape during their births.

What do we do? Me: I'm getting mad. I'm getting really, really mad. I'm getting vocal. I'm pissing people off. I'm happily making an obnoxious ass out of myself. But here's one of the problems: too often, when we start talking about birth choices, and making options truly available to women, those who've chosen non-traditional births (I'm using the word traditional in the, well, traditional sense, to mean the sort of births that women have been having since the dawn of Creation) and gone a more medical route, become defensive. Arguments start being made about the importance of medical intervention, the value of pain-managing medications, the reassuring availability of caesarian sections.

I struggle to express to people that my issue is not with their personal choices – after all, those choices should be theirs and theirs alone – but with the fact that for many, many women, their choices are not their own: they belong to a nurse, a doctor, a midwife. But not to the labouring parents.

I'm not fighting other mothers to make decisions the way I would make them: I am fighting a system that is telling mothers, all mothers, what decisions to make about their bodies, their babies, their births. I am not in the practice of fighting mothers. I am fighting the medical establishment. I am fighting social norms. But I am not fighting the mother in front of me.

For far, far too many people, birth continues to be viewed as a black and white issue. You're either all-natural, crunchy-granola, kum-ba-ya and western medicine is the work of Satan, or you're not. And so many of the people – men and women – seem to assume that we who are natural-birthers, who are birth activists or working with birthing women, see things that way, too.

I don't. Western medicine has saved countless women and children from certain death. This is a fact. Surgery has literally saved the lives of mothers and babies I've known. And thank God for it. Thank God that J, our prenatal instructor, and her son were saved when she suffered a placental abruption with her first birth. But thank God, as well, that she was able to go on to have two midwife-attended homebirths after that. I

t isn't so simple as saying “old is bad: new is good”. It's equally not so simple as saying the reverse. There is a place for life-saving medicine in birth. But let it be life-saving. Let's not let it be time-saving or pride-saving. Let's not let it be about the doctors. Let's let the reasons for intervening in a birth be good ones, important ones, lives-hanging-in-the-balance ones. Let's not let it be about dates or estimated weights or breech presentation. Let's let it be about need.

So I will continue to tell people about birth. I will continue to cull statistics and research results and store them away in my mind for those conversations with sceptics and the uninformed where there is the possibility of educating one. More. Person.

And maybe, someday we won't have to. Maybe, just maybe, someday...everyone will already know. Originally posted on knit me a new one