to think this American Obstetrician is a little extreme?

[dizietsma]

SkepticalOB

Anti homebirth, anti lactivisim, anti midwife...

Quite an insight into the highly medicalised model of birth in the US, wholly hostile to the concept of birth as a normal physiological process that need not be treated as a medical emergency.

Thank god I don't have to give birth in the US!

well, one woman's opinion is NOT a reflection of an entire nation, particularly one as large as the US.

And, she is NOT anti any of those things, just anti the people who are so pro those things that they judge others.

which is what you're doing.

You're not wrong, Dizietsma. The situation is becoming very polarised where I am. You either give birth at home or you accept the medical model, kit and caboodle.

There are a couple of birth centres, but insurance and fear of law suits drives them to only accept the lowest risk women possible - no VBACs.

Caesarean rates are rumoured to be approaching 70% in local hospitals but the hospital won't release recent figures.
The US medical model is terrifying and based upon the highly flawed Friedman's curve which describes a 'perfect' labour with one cm of dilation per hour. Almost all women have pitocin to keep their labour going on a curve. Generally they usually end up with an epidural too. I watched a hospital birth video which suggests birth without an epidural is 'unrealistic'.

Infant and maternal mortality rates in the US are consequentially appalling, considering how much money per head is spent on healthcare.

Sorry, did it all turn out to be ironic irony at the end? only I was feeling a bit stabby half way through and quit.

BTW, I know Barbara Herrera who she has slagged off in her previous posts. She's an incredible midwife and very experienced, knowledgeable and wise. More so than some quite blatantly ignorant OBs I've met here (as an example, none of the OBs in one 'esteemed' practice I talked to knew what gas and air were, and after explanation, one described it as obviously 'dangerous'.)

The midwives I know have studied birth all over the world and know all kinds of ways to deliver breech, twins etc. etc. OBs are one trick ponies.

Tuteur makes me sick.

Also, I talked to two paediatricians a couple of weeks ago on a breastfeeding course... they'd never heard of tongue tie and one had failed to recognise it in her own baby.

To qualify as a baby-friendly hospital, paeds are only required to study breastfeeding for THREE hours. Most hospitals are not baby-friendly so most paeds have barely even touched the subject.

The US medical system worries me. Doctors don't seem to study or learn outside of a very set list of practices.

gosh, carmen, i know nothing of the stats around here, but know far more women who breast feed than i did in the UK, and the ones who had cs really did need to - and i do know one who attempted VBAC, but ended up with emcs, so not unheard of.

as i said, the US is big, you're in California, aren't you? women round here talk about CA in hushed, scared voices. apparently, you don't do things down there the way we do up here!

Tinnitus - skip to the last 2 paragraphs.

Let's please note. Although this woman has excellent training, she is no longer a practising medic. This is just one woman's advice & it sounds as though she maybe has a chip on her shoulder.

Additionally (and sorry, I'm spamming now), California is considered one of the most 'progressive' states where birth is concerned.

At least midwifery isn't outright illegal here as it is elsewhere in the States.

One of the paeds was from Virginia. One was from Maryland.

Kickass, don't know where you are, but the US is terrifying for birth. Currently, in Oregon for example, they are trying to ban midwives from attending VBACs. As few hospitals support VBACs now, most women will be forced into repeat caesareans.

Most women who try for VBACs in hospital here are put under such strict conditions they inevitably end up with caesareans.

I don't think you'll find a hospital in the US that doesn't do an IV as standard and have lower than 50 percent epidural rates.

UK breastfeeding rates are poor too.

One of my friends gave birth in CA (over 20 years ago, so v out of date) but back then she said it was either hippies who wanted home births & no drugs, or techies who wanted the whole thing to be a miracle of modern science.

she just wanted a 'normal' birth.

people have midwives here & i like that they choose a midwife who is with them through pregnancy, birth & going home. i had a crap delivery, bordering on the dangerous (for me & dd) on the nhs, so feel quite envious of the birth stories i hear from my friends here.

gas & air is a bit of a UK thing, though, isn't it? don't think my sister had it in norway.

i don't love everything about US healthcare, but i don't think you can just malign the entire nation. do find the original article a bit odd & abrasive, though.

i'm in MI, and not keeping up with your typing either!

i would be worried about the costs of having a baby here though, they don't appear to do 'packages' like you can get for private healthcare in the UK. Lots of insurance doesn't cover it either, so people save up to have a baby, and mat leave is vv short. having said that, people seem to have more babies than in the UK, (loads of families round here with 4 - 5 kids) so i guess they find a way somehow!

Kickass, I'm no big fan of the NHS - my first two babies were born in Guernsey. So I don't blame you on that and I'm sorry you had a bad time of it.

But I am appalled by what I've learned about US obstetrics (and have trained in childbirth and breastfeeding through three nationwide organisations). I've also sat through a series of hospital childbirth classes in supposedly one of the best hospitals and seen outright lies and suppression of information.

The obstetricians I saw when I was pregnant told me a whole lot of non-evidence based rubbish. When I questioned it, they told me to fly back to England! I'd have happily had a hospital birth if I could have been assured it would have been 'normal' and my choice to have an unmedicated birth would be supported. They outright refused.

Gas and air is a UK thing, yep. But imo, a decent obstetrician would take a glance at the BMJ (and the CMAJ) occasionally and at least be aware of it.

Yeah... a man in one of the childbirth classes asked how much time off he should take after wife has the baby. The educator told him /three days/.

FFS, the baby blues will just be kicking in

I'm in MN (Minnesota, not mumsnet) and thought this was hilarious! It's a satire, people!

FWIW, I know plenty of American women who nursed til their kids were toddlers, and plenty of women who gave birth at home. I did neither, and somehow still manage to be a decent mother.

The writer is not judging these choices, she'd judging the women who make them and then judge other women for making other choices.

That was a complicated sentence.

actually , i have to admit, i had a fairly stereotyped view about US childbirth & have been happily surprised since arriving here.

also, i like that parents know the gender of the child. i was so depressed during my pregnancy that i think knowing the sex, being able to give a name, and prepare some clothes etc would have been really good & helped me to feel ready for motherhood more. i see my friends getting excited, & talking about their baby as a real person, when x is here etc, just seems to bring them that step closer to the actual baby arriving, than being left with the big unknown.

ladies, i'm soo tired right now, think i need to go to bed (v early, i know), so g'night. glad to hear some input from carmen, who knows a whole lot more than i do about these things.

I don't think Amy Tuteur is satirical. I've seen people hurt by her comments after she pops up on their blogs etc.

Yes, the birth movement in the US is rather evangelical. It has to be - it's facing extinction at the hands of people like Tuteur

I gave birth in the USA, in MN, had a fabulous wonderful experience with an enlightened OBGYN who was willing to listen to any of my requests.
I nursed until my children were at least 18 months old and was supported wholeheartedly.
Would this topic have been acceptable if you substituted the word "American" for "Black" - I still fail to understand why it is so acceptable to be bigoted towards Americans.

Gas & Air isnt' just a UK thing... we have it here in Australia too

Here in Australia a lot of people "go private" for childbirth and, from my limited experience of it, it seems to be far more medicalised than if you go through the "free" sector.

A friend of mine went private and when she turned up at the hospital in labour the staff were a bit surprised as in that particular private hospital you don't get many "spontaneous" labours... you either get induced or have a c-section, and that's to either fit around the OBGYN's schedule or the mother's "lifestyle" (ie induction is often done before 40weeks whereas in the free hospital they won't induce until you're at least 10 days over).

Good grief, I didn't read anything here that was anti-Americans, just one or two of things that have gone on in America. I thought kickass was quite vigorous in her defence of the US and critical of her own experience in the UK. I didn't for a minute think that she was being critical of everyone and everything there.

FWIW I had two good experiences giving birth with the NHS - the second one fantastic in fact - and as I am trying to get pregnant here in Oregon, I would be interested to find out more about the system here Carmen.

Sorry, but Dr. Amy Tuteur sounds rather loony to me. I have given birth twice in the US and the one time that I almost died (along with ds1) was when I had a midwife. I had a wonderful lactation consultant the second time around and may have done better the first time if three midwives hadn't misjudged a breech baby's position leaving me with severe PN PTSD.

Oh, and take a look at Mothering.com - pretty radical board that I absolutely couldn't take. A friend signed me up and I de-regged pronto.

This skeptical OB sounds like she has a lot of issues...

I gave birth in Washington State in the US. From the first I had a very "normal" birth plan, intending to give birth in a birthing center. As my pregnancy progressed it got more medically involved because of my health; I developed pregnancy-induced hypertension and toxemia. One week before my due date, my blood pressure spiked ridiculously high and I was induced, and then because dd's heart rate crashed during each contraction I ended up with an emergency CS. The cord was around her neck twice when they got her out.

It didn't end the way I wanted, but all along the way my OB worked with me to have the lowest-intervention birth that was safely possible. If I hadn't had the problems that I did, I really believe that my OB would have respected my wishes for a normal birth. And she encouraged me to breastfeed as long as possible, which I did for three and a half years.

So either all Americans are not like the one in your link, or I won the OB lottery. I am inclined to think the former.

You know, I didn't see an OB at all during my pregnancy with dc2, not even in the labour ward. I had the same midwife all the way through and two amazing midwives in the birthing pool at the hospital (in York). I seriously had no complaints at all and wouldn't have wanted to see a doctor. Is the system geared up in the UK that it is mainly midwives who deliver babies and therefore have experience of same, and here in America it is mainly the OBs who deliver babies so the midwives have much less experience?

I am genuinely interested as I really hope to get pregnant soon (I'm in Oregon now) and am slightly apprehensive about the system, about which I know relatively little. Please don't anyone think I am biased against Americans or America as that is so not the case.

Midwives in the US generally practice out of hospital. There is a minority of hospitals that have midwife led birth centres (only one in San Diego).

In the last ten years, the situation has worsened here. The tide turned against VBACs after a couple of lawsuits and hospitals are becoming increasingly reluctant to perform them.

Midwives are also facing considerable legal pressure. Direct entry midwifery is illegal in 11 states. The types of birth which midwives can attend at home is under threat and mothers of multiples or with breech births will be lucky to find ANYONE who will allow them to attempt a vaginal delivery. Few OBs will do it. Some midwives are comfortable with them but their position is under threat. In Oregon there is significant pressure on midwives to stop supporting VBACs.

I'm not saying all women should have vaginal deliveries but they should have the choice.

In my experience, women face significant difficulty if they request no pitocin, no epidural, active delivery, physiological third stage etc. etc. In the hospital I've studied in (considered one of the best in LA/San Diego), women undergoing caesareans are restrained to the table and their babies are removed immediately afterwards. No skin to skin or immediate breastfeed.

Those of you who have found good OBs over here are very lucky. I know of /one/ in the whole county who supports natural birth and San Diego is considered progressive. Also, if you had your babies more than five years ago, things may well have changed.

I also wonder how far out of the 'norm' your requests and your labours were. Additionally many doctors 'play along' with requests for a natural birth and then once you arrive in labour, your doctor disappears and you are stuck on the labour+delivery conveyor belt along with everyone else and coaxed into 'just a whiff' of Pitocin.

Also, cervical sweeps are performed regularly without consent. OBs insist on a vaginal examination at around 38 weeks. Generally, they perform an unconsented sweep during this exam.

I'm sorry to the poster who objected to the 'America bashing' but this /is/ an American problem. The American obstetric model is deeply flawed. As I say, it's based on Friedman's curve. Friedman himself has said it was the worst thing he ever came up with.

I've skimmed most of the thread now, and I didn't find any bigotry toward the US at all, so don't worry. I do expect the health care system to get flamed, mainly because it needs help!

I am American, but had the good fortune to never give birth there. Because of private insurance, birth is a business. Of course people have wonderful experiences, but the hard truth is that maternal mortality is higher in the US than in any developed nation according to the WHO, and it is because birth is medicalised and interfered with. Additionally, there is NO follow up care...your first Post Natal appointment is 6 weeks after the baby is born. That was one of the things that impressed me about England; not only did I have the option to have my baby at home, but I had a midwife then HV come to my house for 6 weeks after she was born. I am convinced that had I been in America, my PND would never have been caught.

So, though I know there are plenty of enlightened obstetricians over there...I tend to agree with OP and think that kind of attitude is the majority. It's all about money in that system!

Misconceptions by Naomi Wolf is an interesting read - it's written by an American about the American health-care and birth model.

It is critical but not biassed - the author freely admits that she couldn't do homebirth and doesn't find those risks personally acceptable. But she does look at how the profit motive interacts with patient care.

Her view is that you can't get away from the fact that there is a financial incentive in the US not to achieve a low intervention birth.

She is also critical of the NHS btw, so is not holding up any one system as perfect.

I am North American and yes OB's take care of women during labour and birth. Yes, midwives are illegal in many places. Yes it is seen by many people that it is hippies and weirdo's that give birth at home. I have been living in the UK for some time now and although I respect women's choices whatever they may be I prefer the North American model. I also know alot of people that have moved from the UK to North America and have had children in both places and the majority prefer the experience that they had in North American hospitals. I did ALOT of research before having my child here in the UK, everything from freebirthing to ELCS. I did not like dealing with a midwife and thus I paid for a private consultant. I felt much more comfortable that a fully qualified and experienced doctor would be caring for me.

The majority of maternal deaths occur in developing countries this is in relation to lack of medical intervention as well as high populations. The USA has a higher rate than countries such as the UK but also has a much higher population. WHO report