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!

But ticktock, it's not a matter of preferring the North American model - I'm sure plenty of people are happy with the epidural package. My problem is that women don't really having any choices in the US. This is what they face:

#1 Home birth with midwife (experience/qualifications vary)
#2 Attempt vaginal delivery in hospital but accept time limits, pitocin augmentation, probable epidural and inactive labour and around 50/50 chance of having a caesarean.
#3 Schedule a caesarean

And good luck arguing with your insurance company and OB if you want anything which even slightly deviates from the standard package. Even refusing eyedrops (completely unnecessary if you have a clean STD test) can cause major problems. Couples in New York have had CPS called on them and the baby taken into temporary care for this.

As I see it in the UK, you /can/ schedule a caesarean if you make a good case (tokophobia probably counts). You can have a home birth with well trained medical professionals. You can have a hospital birth and pick and choose your interventions (or lack of them). You can opt for a physiological third stage. You can have skin to skin uninterfered with.

The US system generally removes choice and is dishonest. It also operates on an agenda that suits the insurance companies, lawyers and OBs rather than being woman or family centred.

That's my problem with it.

All that aside, only in America would the author of a satirical blog piece write
'This is satire' at the end of it!!! I'm still giggling 5 minutes later. Classic.

You might want to look up the word "bigoted" lily, since you don't seem to use it correctly.
While you're there, look up, oversensitive, opinion, and debate. Oh, and if you substituted Black for American, it wouldn't make any sense. A bit like yourself.

Well CSD I know alot of friends that have had births in hospital in North America with music, no pain relief, friends and family around, videoing the whole thing, etc.

Yes homebirths are not much of an option (although that choice exists here) but most North American women are fine with that. They would not want this as an option.

Women have many choices in North America but they are within the constraints of insurance because of safety and lawsuits. I don't believe it is dishonest. Although I am North American and I assume you are not.

I'm sure a few do, TickTock, but they either got very lucky with their OB and were luckily in the group of people who fell into that narrow category of 'just right/low risk' (not too fat/thin/old/young/slow in labouring/no previous C-Section/perfect baby position etc.)

Good for them. The majority don't have the same experience and the situation has got worse in recent years.

I've had OBs lie to me personally. I've witnessed hospital employed educators lie or dodge answering questions. The system is dishonest. It is not evidence-based and it's not woman-centred. Watch The Business of Being Born. Check out the bit about the peak times for C-Sections. 4pm and 10pm. Whose convenience is that for?

Well CSD, we will just agree to disagree. I am glad that the system that is in place in North America is in place. If North American's wanted it to be more like here, it would be, but it is not. Women-centred??? That comes purely from people that believe in those theories. I don't think that being pushed into things like homebirth, birth without drugs, etc and being admonished for other choices like drugs, ELCS, etc is women centred either. I believe that choice within the confines of safety for mother and child is the best. That is also the consensus on the whole in North America and thus why the system is the way it is.

I was in the high risk category long before I got near the hospital (already on medication for high blood pressure, family history of high blood pressure and pre-eclampsia; later IUGR and bleeding throughout pregnancy), but I am very happy that I gave birth in a hospital (UK teaching hospital with v good reputation) where it wasn't a black and white division between homebirth (=you can have things your way) and medicalised birth (=you are immobilised and helpless and everything is decided above your head). It really wasn't like that. Though I was induced and monitored, I was still very much part of the process and was allowed to make my own decisions on things like pain relief without being prompted one way or another.

Pace ticktock, noone was pushing me into coping without pain relief, but then noone was pushing me to have pain relief if I didn't want it either. The stuff was there, the choice was mine. Some of my friends did, some didn't.

And I have certainly never heard of anyone being pushed into having a home birth either.

The only place I saw any pressure was with the breastfeeding: they were a very pro-breastfeeding hospital and the mums who did not want to breastfeed were nagged quite a bit. Not a problem for me as I already had decided to breastfeed, but I could see that some other mums were a bit uncomfortable with this.

But a US-style hospital birth /isn't/ the safest option for mother and child. The US mortality rates suck. Pitocin and epidural certainly don't improve that. They increase complications and mortality yet are omnipresent.

Are you really arguing that birth shouldn't be woman-centred? That you shouldn't have a choice where and how you give birth?

The system is absolutely not designed for the safest outcome for mother and baby. It has evolved this way out of greed.

CSD...I agree. Higher population or not, the US should NOT have an increased rate of maternal mortality. It shouldn't!! And I don't really think that giving ELCS is empowering...C Sections can be DANGEROUS for the mother and the child...those of you who have had them can attest to the pain, the difficulty healing, etc...it's not an 'easy' way out. ELCS shouldn't be so readily available as a choice.

I didn't feel pressured into a home birth. I was presented with my options, discussed it with my husband and midwife, and determined that being at home was my best option. You MUST be joking that birth shouldn't be woman centered...come on!! I certainly wouldn't have chosen anything that could have put my baby at risk, but I should be able to make my own birth choices, without fear, without pressure, without the financial aspect hanging over the birth of my baby.

I think everything is in the balance. It is not just about the woman's interests, it is not just about the baby's interests, the interests of the woman can be divided- there are medical needs and psychological needs, and if psychological needs are not met that can lead to further medical needs or vice versa.

Of course, there are times when a consultant should try to persuade a mother in the best interests of her and the baby: if there is a complication and her preferences is likely to put them both at risk.

But even in such a critical situation, there are still ways to work with the mother, and I think my experiences did exemplify that. I was high risk, my babies were also high risk, that was the situation we had to work with, but the outcome was not actually bad even from the pov of my emotional needs.

And for a normal labour, there is an awful lot of leeway, which can be employed to meet all the mother's needs.

I liked it.

I felt much more comfortable that a fully qualified and experienced doctor would be caring for me.

ticktock a midwife IS highly qualified and experienced (in the UK at least). They are fully qualified in managing labour/childbirth. In the UK you get a choice - I was NEVER pushed into having a home birth (in fact gave birth in hospital) I was not pushed to go without pain relief (had pethidine shot) BUT I felt in control, I felt i knew what was happening at every stage. I had a fantastic birth experience because I chose the kind of labour I wanted, and wasn't pushed into a particular type of delivery. No the UK system isn't perfect but at least a labouring mum is treated like a PERSON.

Can we stop with the 'north america' as Canada is NOT the US, the system is different, there is no insurance etc.

Referring to the 'system' in North America makes as much sense as referring to an African system ... It is a continent with all the diversity that entails

Hmmm, there's a very thin line between satire & venomous sarcasm - I think this non-practicing Ob-Gyn crosses it. I see nothing witty or clever about her writing at all. It makes me very sad that there are such people with such a bitter narrow view 'caring' for women at a time when they are vulnerable & open to influence. I pity the poor women who had her as their main medical professional during pregnancy/labour & am very relieved to hear that she's no longer in practice.

To be brutally honest (and although I disagree with big chunks of what she says/thinks) I think her satirical piece is brilliant. It could be something real, written on the BF boards on MN or attachment parenting boards anywhere.

thanks chibi: and Mexico is also a part of North America as are 7 other countries south of Mexico.

Read this and thought that the clue was in the bit where it said "This is a satire"?! Also, reading right to the bottom, she thinks that different approaches to parenting are a good thing and work best for different families, and that no one should be made to feel bad for choosing a route that is not purely AP/BF/SAHM which seems to be the consensus... I think she is just trying to highlight that there are other ways of doing things than the above approach - and am surprised that on MN people don't like that!

The consensus on MN, from what I have read, is a lot around not judging when you don't know circumstances, and certainly not making someone feel bad because they had an emergency caesarian etc rather than a "natural" birth. While it is definitely pro-breastfeeding, again, if someone is FF that should not be a stick to beat them with, especially if you have struggled and it hasn't worked. Given that maternity leave in the US is 12 weeks, I imagine it is a hell of a lot harder for people to continue BFing if they have to go back to work as most women do. Returning to work is also something that is generally supported on MN, if that's what people want/need to do...

I think there are some extreme AP type parents out there who do take a very judgemental approach to how others parent (and particularly mother) and my sense is that this is stronger in the US than in the UK - her post is a send-up of all those people who make you feel bad for doing what you think is best for your child and family in your own particular circumstances.

"there's a very thin line between satire & venomous sarcasm"

I think that line is whether or not you find it funny. And I do.

lol at myself leaving out a chunk of N america in a post complaining about incorrectly describing n america

I'm with CheerfulYank and tethersend.

It's aiming a satirical swipe at judgipants mothers - that's all.

Very funny, I thought.