away from “harsh hospital lighting and strangers’ gloved hands”
November 7, 2018 11:51 AM   Subscribe

Freebirth offers women a tantalizing vision: Give birth at home, surrounded by loved ones, with the freedom to move and scream and do all the other natural things that hospitals keep women from doing while a babies are tearing through them. Listen to your body, freebirthers say, and everything will be alright. Medical professionals say that’s naive.

CW for online harassment and descriptions of a stillbirth

Previously on MF
posted by devrim (71 comments total) 10 users marked this as a favorite
 
This is kind of heartbreaking. I'm in no way qualified to say much about what women want to do with their own bodies, but as a premature baby I am profoundly glad that mom went to a hospital. If she hadn't, I would certainly not be here today. My instinct is to plead with these women to take advantage of the system available to them. :(
posted by Alensin at 12:04 PM on November 7 [7 favorites]


My instinct is to plead with these women to take advantage of the system available to them.

I mean, they did, and they had really bad experiences.

The problem isn't the choices women are making, its how birth is treated by medical professionals and the lack of alternative options.
posted by MisantropicPainforest at 12:08 PM on November 7 [29 favorites]


The problem isn't the choices women are making

Of course it is. Their choices are resulting in needless, preventable deaths. Their beliefs are demonstrably false.

This is the prenatal anti-vax movement: ignorant people (and/or con artists) preying on desperate or confused mothers. Anti-vax nonsense is also couched in terms of autonomy and choice and alternatives to the medical-industrial complex and all that.
posted by Sangermaine at 12:23 PM on November 7 [32 favorites]


We had both of our children with midwives, at a birth center, and it was a great experience - our first's birth culminated with my partner briefly having an irregular heartbeat and needing to go to the (nearby) hospital, though, to be checked out more thoroughly than they were able to. I am very glad it was there.

A few months after our second child was born, a friend lost hers during a home birth with a midwife. It is still unclear if being in a hospital or birth center would have made any difference, but they didn't have the time to find out. It was a truly agonizing experience for them.

Some hybrid of the birth center / home birth and medicalized model seems ideal, especially having been close to what can or could potentially go wrong when more serious interventions are not available. But the extremity and dismissiveness of the medical establishment breeds equally strident responses. Both seem indicative of the US childbirth model being totally broken.
posted by ryanshepard at 12:24 PM on November 7 [21 favorites]


My wife gave birth to our second child at BC Women's in Vancouver. We were in a large room with a tub, and a small second bed I slept on after the birth while mom and baby rested. We were attended on by a midwife. We had the OR and all the other normal hospital facilities on hand if we needed them (fortunately the birth went mostly smoothly). This felt like having the best of both worlds- a very human and natural process with the modern necessities should things go sideways.
posted by simra at 12:25 PM on November 7 [40 favorites]


I predict this thread will go off the rails really damn fast.

I did a fair bit of real, statistical research on outcomes before my kids were born, and arrived at the conclusion that the best option was to use a midwife at a hospital. My first daughter's healthy birth turned out to have truly required a hospital, and holy shit can you imagine making that choice wrong?
posted by mcstayinskool at 12:27 PM on November 7 [33 favorites]


they had really bad experiences.

I don't doubt that they did. This is one of the many systemic problems with modern medicine, particularly in America. Unless you are one of the lucky few to live in one of the few metropoles in our country that offer a top hospital system, you're basically rolling the dice with what kind of care you're going to get, as far as I understand it.

We had our kid a little over a year ago in the UCSF system, top 5 in the country. We had a wonderful, caring, concerned, and cooperative team help us welcome our son into the world. My wife asked for the lights to be lowered and quiet in the room, they made it happen instantly. I asked early on to be as involved in the delivery as possible, and the midwife coached me on how to guide him out once it was time. I caught him and held him in my hands as he took his first breath, and I got to put him on mom's chest. We had caring teachers educating us on the process and caring staff taking care of both wife and baby (and myself) on the end of the process.

If you had access to a resource like that, the pinnacle of modern medicine all around you - yes absolutely why would you not access that. The problem is so few have access to that, and don't want to gamble. I feel bad for the mothers of America at large.
posted by allkindsoftime at 12:27 PM on November 7 [12 favorites]


PTSD from medical trauma is a real thing and a shockingly common thing. Maybe if doctors don’t want women to avoid medical intervention, they could stop treating patients in a way that amounts to sexual assault.

There are many amazing healthcare providers in the world. Treating pregnant women like humans can absolutely be done.
posted by corey flood at 12:36 PM on November 7 [52 favorites]


I bet a birth clinic run by women doctors would be a nice alternative option. Have actual doctors and equipment and emergency rooms for the one in five births with life-threatening complications, but otherwise have comfortable, welcoming surroundings for the four in five births that are mainly extruding another human from one's body and calling it Noah or Mia.
posted by pracowity at 12:43 PM on November 7 [4 favorites]


I find the pullquote super interesting, because there is literally no reason that any woman in American can't have that now ... but also with a midwife present.

My own child was born in a freestanding birthcenter (independent, but the hospital was literally across the street), with only my husband and I plus two midwives in the building.

I understand the distrust. I understand the urge to demedicalize birth. But when things go wrong, man, they go wrong quick.
posted by anastasiav at 12:45 PM on November 7 [17 favorites]


I think the anti-vax comparisons are a little off base. There's no herd immunity for childbirth. I don't think anyone should be compelled to have a hospital birth. That said: my first kid would not be alive today if we hadn't been at a hospital for the birth. There were no particular risk factors in play; shit just goes wrong sometimes, and fast. If you're willing to stare down the odds and say that it's more important for you to have a beautiful experience than reduce the risk of losing your kid, that's your call.

Better birthing facilities attached to hospitals? Please. Childbirth at home? I won't stop you, but know the risks, because they are really, really scary.

(And what is with this "harsh hospital lighting" thing that keeps coming up? Is it code for something?)
posted by phooky at 12:51 PM on November 7 [10 favorites]


Child 1: hospital and doctor. Just in case there was a problem.
Child 2: No problem so midwife in hospital. Remembered to keep everyone together and the lights down low
Child 3: planned home delivery, and I ended up catching him

Handy tip: even if you deliver your own child, you still have to pay the midwife for everything else.
posted by mdoar at 12:51 PM on November 7 [6 favorites]


And what is with this "harsh hospital lighting" thing that keeps coming up? Is it code for something?

Trauma often makes the brain get stuck on particular sensory details, and physical pain can make one extra-sensitive to light; I would bet that for a lot of people who have traumatic medical experiences, the lighting really stands out in the memory. (A lot of people also end up giving birth on their backs, which in a traditional hospital set-up might mean they're stuck staring directly into the overhead lighting.)
posted by halation at 12:55 PM on November 7 [27 favorites]


I think we need to be very careful to distinguish home birth from freebirth. It is pretty clear that home birth *can* be safe (although personally I would not say that it is generally safely done in the US or in the UK) - we can look at studies from Canada which has a robust, educated, risk-adverse system of midwifery.

Freebirth, on the other hand, is risk-blind. It rejects all medical intervention, so there is no way for mothers to make an educated choice. Freebirth advocates present general statistics to show that births are safe, without considering the many, many factors involved. It's like telling someone with a tumor that, since most tumors are benign and don't require treatment, they shouldn't even have it biopsied in the first place.
posted by muddgirl at 12:58 PM on November 7 [59 favorites]


I learned about "free birth" (as opposed to just, say, "home birth") just a few weeks ago; see, e.g., the Wiki article for the distinction. Potentially NSFW image of childbirth, plus maybe NSFL content at the end (similar to the first linked article), with the description of the "Joyous Birth" case.

I can understand home birth with a midwife, I really can. Or, especially, at a birth center with a midwife. Neither is a choice I'm making for myself, and the former seems especially risky for me, but still within the realm of "You do you, as long as you know the risks."

But giving birth without any assistance is outside of my ability to understand. This isn't just "hospitals are bad", this is "midwives or anyone with professional knowledge is bad". That goes beyond, for me, "I'm knowingly taking a risk" to just plain recklessness.
posted by damayanti at 1:00 PM on November 7 [19 favorites]


I think we need to be very careful to distinguish home birth from freebirth

I totally agree. But, again, my point was that it possible, pretty much everywhere, to have the same "Give birth at home, surrounded by loved ones, with the freedom to move and scream" experience with a home birth (with a trained midwife) as with freebirth. Just, you know, with a midwife. You don't need to freebirth to have that experience.

Even medieval women mostly used midwives.
posted by anastasiav at 1:01 PM on November 7 [6 favorites]


Wow just about everyone in these articles is either misguided or an asshole! Except the author of the "Mom Wars" article.

I sort of wonder about this -- I guess this is a phenomenon? Because I fully support women's right to decide about their medical treatment, and to make even the stupidest of decisions about their own bodies. And those rights are definitely under social and legal attack in our society.

However, this societal focus on women choosing the most extreme options -- like "Let's film you giving birth in the woods for national TV!" -- is just bizarre. It's framed as empowering but YOU KNOW PEOPLE ARE JUDGING. So there's also this broadcasting of women's dumbass choices (yes! I judge that they are making dumbass choices), being paraded for our judgement.

And this, I feel, affects women in a way that, say, Jackass or Man Vs Wild does not affect men. Like men can do the stupidest, most unnecessary shit, and we will judge them on the internet or from our couch ("I would never try to fight that stingray!") but it does not reflect on them as a sex. But because women are still generally expected to be mothers, and so many women do give birth... I'm just not sure what to say. We're always focused on these edge cases ("Yeah but what if a pregnant teenager wants to abort at 39 weeks so she can fit in her prom dress") and the media and the internet just want to amplify all the possible edge cases.
posted by Hypatia at 1:01 PM on November 7 [13 favorites]


I don't think anyone should be compelled to have a hospital birth.

I never said anyone should. I feel like discussions of these topics always come down to these false dichotomies.

There are serious problems with the US medical establishment. Women experience real, valid pain. There are alternatives, some mentioned in this thread, to a hospital birth. Neither I nor anyone in this thread so far disputes any of that. What's being decried is the complete rejection of medical care advocated by this movement. It is wrong and dangerous to present this as just another, equally valid option, especially for reasons that are either simply incorrect or outright lies. It's really distressing how much of this "alternative" woo garbage has crept into the mainstream recently.
posted by Sangermaine at 1:10 PM on November 7 [9 favorites]


I've never given birth, nor been in the room while someone else has. But if even half of the first-hand accounts I've heard are true, man, there is a serious problem with abuse of laboring women in this country. It goes beyond anything I've seen with any other category of hospital patients.

And add that to the justified mistrust many women have of the medical establishment to begin with. I know women who have given up on getting medical treatment for anything, because they know they could go to the doctor with measles or a compound fracture and be told there's nothing wrong with them that losing twenty pounds wouldn't fix.

I mean, the fact that some women are feeling that going it alone is their best option has to tell you something about the other ones.
posted by The Underpants Monster at 1:12 PM on November 7 [19 favorites]


This is definitely one of those situations where the severe shortcomings of the U.S. medical establishment have played a culpable role in pushing people away from needed treatment. Every doctor who ever escalated an intervention against prior instruction, every creep of a doctor who did the "husband stitch," every monster of a doctor who ignored women's (especially women of color) reports of their own symptoms and thus contributed to a preventable fetal or maternal death--some of the blood here is on their hands.

Women do have the legal right to refuse medical treatment, even mid-birth. That doesn't mean they're immunized from moral judgment for doing so. Significant risking your baby's health and even life because you're filled with woo and enjoying the luxury of an Internet echo chamber is contemptible.

But, then, so is surveilling these women and reporting them to the cops.

A lot of people behaving terribly here.
posted by praemunire at 1:14 PM on November 7 [18 favorites]


Are these women are choosing "freebirth" over a midwife-assisted home birth, or is this freebirth instead of hospital birth? I could fathom that some women live in areas where there is no midwife, but it is just boggling my mind to think that one would opt not to have someone who's delivered many babies around when you're fixing to deliver the first one you've ever had.

I did RTFAs -- I mean, I guess it's just that they think birth is natural and they should just know instinctively how to do it? So is breastfeeding, and a ton of people need help with that.

Are midwives out of reach (either due to cost, or because it's difficult to get hospital privileges/insurance)? I live in a VERY crunchy place and midwives and doulas are everywhere, so I'm really not certain.
posted by fiercecupcake at 1:15 PM on November 7


Are these women are choosing "freebirth" over a midwife-assisted home birth, or is this freebirth instead of hospital birth?

The article says the movement pledges no outside intervention whatsoever:
Lisa was a member of the now-defunct Free Birth Society, an online community for women who insist on having their babies outside the hospital, with no medical intervention. Like other members, Lisa had pledged to have her baby without the help of a doctor, doula, or midwife.
posted by Sangermaine at 1:20 PM on November 7 [1 favorite]


That's not what I'm asking. I mean, is the choice of a midwife generally AVAILABLE to them, or are they realistically limited to freebirth vs. hospital?
posted by fiercecupcake at 1:21 PM on November 7 [2 favorites]


I don’t know about the women in that group and whether they would have had access to midwives if they wanted. But freebirthing as an approach is a thing even in my country, where if you want to give birth at home the NHS will send you a fully-qualified medical professional midwife, carrying rescuscitation equipment and pain relief, who will stay away from even touching you if you want her to. (Freebirth is albeit very rare here though.)

I can sort of understand the desire to give birth alone, on a deeply primal level. I can’t really understand why you’d take that approach as a rational decision ahead of time and then stick to it so determinedly that you don’t have a Plan B at all, even when you’ve been in labour for six days and have all sorts of red flag ‘medical intervention now’ signs happening. I wish she’d had someone she trusted online or in person who could have had that Plan B and who she would have listened to, in the long long time period they clearly had between things starting to go wrong and things being no longer fixable.
posted by Catseye at 1:41 PM on November 7 [7 favorites]


Ugh, that's just horrific. Even monkeys have been known to use midwives, and there's hardly a human society documented where birth isn't aided by women with expertise. I can understand alienation from the medical establishment, but rejecting all aid is alienation from humanity, IMHO.
posted by tavella at 1:44 PM on November 7 [7 favorites]


Here in the Netherlands we have a singular perspective on this. Quite recently, like in the 90s, birth at home was the standard. We had a well organized system where everybody would have a well trained midwife to aid them give birth at home. It's a system that was quite advanced for when it was started around the end of the 17th century.
But recently when the infant mortality in the NL turned out to be significantly higher than elsewhere we came to the conclusion that "not medicalising a natural process" is a fine sentiment but giving birth at a hospital is better.
posted by jouke at 1:45 PM on November 7 [24 favorites]


Sometimes I feel like people don't know what high levels of maternal deaths societies were willing to tolerate even a 100 years ago, especially when they look to the further past and get a bit sentimental about homebirths and wise women and midwives and such. Admittedly, knowledge of basic medicine is better, so you're not going to have the 30-40% of mothers dying that some cultures and periods did, but the odds are that freebirth as practiced by some of these people has a not unreasonable possibility really, really dangerous for women. If you want to chose this for yourself, fair enough, but don't lie about the risk factors and dangers of childbirth can have even for young and healthy women.
posted by lesbiassparrow at 2:15 PM on November 7 [18 favorites]


We have mostly hospital births here in our advanced medical paradise and our maternal mortality rates are going up. No one seems to care much.

Women widely report trauma, feelings of being assaulted, and high rates of PPD in the American system. Women who had "healthy" normal births that were, medically speaking, just fine. Except for the trauma that no one cares about, because if the baby's not dead, who gives a fuck?

I personally seldom tell the story of my son's birth and what happened to him and me because it makes people cry. And yet, though I am convinced I was a lot closer to being a mortality stat than anyone will admit, we survived, and we suffered no injury that you could sue for.

But I will always carry that trauma and I completely understand the desire to never let a doctor touch you again during birth. Had I had another child I would probably have risked a homebirth with midwife (illegal in the state I was in at the time, btw) on the principle that I had already come very close to my own death entirely due to medical negligence as well as being traumatized to hell and back.

Would that have made me a bad woman/bad mother? Maybe. I was a hurting woman for damn sure. I was frightened and angry and deeply wounded.

But of course, avoiding doctors entirely means high risks of a different kind. I get that. I'm not stupid, and neither are most women when it comes to decisions around birth, so I would greatly appreciate it if we could nip that gross little assumption in the bud. But my choices with another birth would have been take those risks or go back into a medical meat grinder again, and I can't really say what I would have done.
posted by emjaybee at 2:43 PM on November 7 [35 favorites]


Some encouraging news from California on maternal mortality. By studying where the medical system was failing women and implementing new protocols, they have reduced their rate to 4.5 per 100,000, better than most of the developed world and much better than the overall US rate in the 20's.
posted by Ralston McTodd at 2:56 PM on November 7 [9 favorites]


Reading this article gave me PTSD. I gave birth in the Netherlands at a time when the preference was strongly against medicalised childbirth. When my symptoms started to appear, my hospital assigned midwife was convinced there was nothing wrong with me besides first time pregnancy jitters and she could determine if I got tests or no. Since I wasn’t acute, she sent me home and didn’t run any tests. She explained to me how safe childbirth was and told me not to be afraid. 36 hours later I walked into emergency in the middle of the night and I will never forget her face when the panicked doctors packed me into an ambulance to rush me to a nearby hospital with a better neo natal ICU. Did not help. HELLP class 1/ severe preeclampsia. Result: dead child and nearly dead me. My case was the nightmare that all those intrusive tests are there to prevent. It is not clear if earlier tests would have saved my daughter— it went wrong so blindingly and decisively quickly. But I didn’t let it drop, and my case was one of the cases which led to the changes in protocol Jouke mentions above. There are all kinds of ways to make a childbirth experience which is both safe and pleasant without losing access to medical care. Most of the time, it’s fine regardless— but trust me when I say that if you need help quickly, you want to be able to get it.
posted by frumiousb at 3:14 PM on November 7 [95 favorites]


Sometimes I feel like people don't know what high levels of maternal deaths societies were willing to tolerate even a 100 years ago

I agree with this... but. While the history of childbirth before modern medicine is one of a lot of women and babies dying, the history of modern medicine dealing with childbirth is not brilliant either, honestly. Symphysiotomy in Ireland, twilight sleep in the US, puerperal fever in 19th-century hospitals (and that was very much caused by the medical practices of the time, specifically a lack of antiseptic procedures like handwashing + a system where doctors went from cadavers to live patients), this hasn’t been a steady uphill climb to progress for everybody.

I’m not suggesting we throw out modern obstetrics, not by any means, it has done great things and it has saved many lives. But it hasn’t always treated women particularly well and so there is a rich vein of history there for groups like this one to tap into. That’s before we even get to more recent experiences - that figure in the article that 60% of birth attendants and educators have seen a doctor perform some kind of procedure “explicitly against the wishes of the woman”, yeesh.
posted by Catseye at 3:37 PM on November 7 [15 favorites]


I have no dog in this fight, except inasmuch as I want people to be healthy and also have good experiences just on general principle. I see no reason why a home birth with a qualified midwife and a nearby hospital on standby just in case shouldn't be a normal and accepted option for women who want it. I've known women who've done this, including one who did end up going to the hospital when things weren't proceeding as quickly as they should. It all worked out fine in each case.

I can't blame anyone for not wanting to go to a hospital. Alternatives should be available wherever possible. I'm willing to accept that this means allowing people to make choices about their healthcare that aren't necessarily the safest possible one from a purely medical standpoint. Reasonable compromises should be found.
posted by Anticipation Of A New Lover's Arrival, The at 3:52 PM on November 7


...the pinnacle of modern medicine all around you

I live in the US and I beg to differ on this characterization of maternal medicine medicine, at least for here. America has the worst infant and maternal mortality rates in the developed world. And those outcomes are often worse for women of color.

And for birthing parents who don't identify as female, our system leaves a lot to be desired.

And while women do have the alleged right to refuse medical treatment, many are literally overpowered into "compliance."

I have very strong feelings about the options available to me for a hypothetical birth. Being overseas seems like the most comfortable for me, but how feasible is it to travel while 8 or 8.5 months pregnant?

Mary Douglas has done a lot of great anthropology on risk and culture, and risk and blame. The short version is that humans are shockingly bad at assessing risk. And when bad things happen, humans look for something or someone to blame. Other work in the field suggests that women are a pretty easy group to pin blame on (gosh, this feels familiar!)

I'm going to stop now except to say that Eli Lehrer (from the second article) characterizing the hospital experiences as "unsatisfying" is...quite the understatement.
posted by bilabial at 3:56 PM on November 7 [12 favorites]


> But if even half of the first-hand accounts I've heard are true, man, there is a serious problem with abuse of laboring women in this country. It goes beyond anything I've seen with any other category of hospital patients.

Ever been a psychiatric inpatient?

People tell me that watching birth videos and seeing screaming toddlers in the store is the best birth control, but I'll be damned if it isn't reading stories about how people were treated by hospital staff and reading how hospital staff talk about patients when they think they're among chums.
posted by threementholsandafuneral at 3:58 PM on November 7 [6 favorites]


And I also think it's pretty rich for anyone in a country like the US to chide women for making health care choices that might endanger themselves, while SO MANY pregnant people want but have no access to prenatal care, no real access to medical establishments of any kind in fact, which is demonstrably dangerous for many people. The number of people impacted by those realities far eclipses the number of people choosing "risky" birth practices.

This is one of those situations where I want to ask, "great you're concerned about keeping pregnant people, fetuses, and infants safe. What are you doing to help that happen for all people?"
But the answer is so often, "vocally judging someone else's choices, and perhaps working to make their preference illegal or impossible to obtain."
posted by bilabial at 4:00 PM on November 7 [14 favorites]


Uh huh. Because I live in a society with a crappy medical system, magically I can't criticize dumbasses who decide they are going to swear not to have anyone with a modicum of skill help with a birth because they are "warrior women"? Yeah, no.

A lot of people in this thread don't seem to have actually read the article. It's not about homebirth or non-medical birth per se, this is a subset of people who have decided that having even a doula, much less a midwife, around is a sign of horrible weakness. And of course, because it's 2018, there's an equally horrible crew of people dedicated to harassing them, but it doesn't make the "free birthers" any less dumb. Well within their rights, of course, but dumb.
posted by tavella at 5:44 PM on November 7 [21 favorites]


Medical professionals say that’s naive.

That's because it demonstrably is naive. Let's not 'shape of earth: views differ' about this.

Look, the US does have a shamefully high maternal mortality rate for a developed country. It also has a shamefully awful medical system for a developed country. Gee, I wonder if there is a link between those two things...

Sometimes I feel like we're developing a collective amnesia about the benefits of modernity.
posted by breakin' the law at 5:57 PM on November 7 [12 favorites]


And I also think it's pretty rich for anyone in a country like the US to chide women for making health care choices that might endanger themselves, while SO MANY pregnant people want but have no access to prenatal care, no real access to medical establishments of any kind in fact, which is demonstrably dangerous for many people.

"Some people are unable to access healthcare" is not a justification for "I can access healthcare and choose not to". I feel perfectly comfortable criticizing people who could have medical care during a difficult and hazardous experience but who choose not to.

My perspective is colored by having worked in perinatal research and knowing how quickly and badly things can go even with medical care available. Planning a natural birth is good if that's what works for you, but please please please do it in a way such that a medical team can intervene if necessary.
posted by Lexica at 6:00 PM on November 7 [8 favorites]


Are these women are choosing "freebirth" over a midwife-assisted home birth, or is this freebirth instead of hospital birth?

23 US states have no licenses for midwives who aren't nurses or doctors. Even in those that have certifications for midwives, those laws are new, and the medical industry pushes the message that you must have a doctor at a birth, especially for first-time mothers.

There's a combination of factors that can push women into unassisted homebirths:
  • Annoying propaganda from the medical industry, with its attitude of "look here, little lady, you can't just decide how to have a baby!",
  • A few horror stories about hospital treatment - or past memories of same,
  • Utter lack of information about danger signs in labor ("your doctor/the nurse team at the hospital will let you know if..."),
  • The growing doula industry (previously)
  • Factors like, "lives more than an hour from a hospital, so even being close to it means uncomfortable and unfamiliar surroundings, and lots of strangers nearby,"
... and I can completely understand how all that combines into a growing number of women deciding that they want no "interference" from anyone who plans on profiting from their new family member.

This is not like the anti-vax movement unless you think women should no longer have agency once they start to have contractions. They may be making poorly-informed choices based on hype and propaganda, but there isn't a "no hype, no lies; this is what's best for you and the baby" source of information.
posted by ErisLordFreedom at 6:00 PM on November 7 [6 favorites]


Hospitals are unpleasant places to be in the US. Birth is difficult and often dangerous for human beings in general. The USA is a place where groups vie for primacy of their differing versions of reality and the dialogue between camps is more often than not "Is so!" "Is not!" "Is so!" "Is not!" Doctors, besieged by over-informed (or resolutely deluded) patients and documentation requirements, become defensive and alienated from patient care, and dismissive of valid concerns.

And because birth is something that happens relatively infrequently and in only some cases to the large but societally marginalized subset of human beings equipped to do so, godawful things sometimes happen but most of those who experience it just subscribe to the social narrative surrounding it and move on.

That is to say, if you get pregnant, be prepared to hear some pretty horrific stories from those of your circle who have given birth. (Mine: 10 pound baby, tearing, retained placenta, blood loss, general anesthesia AFTER a "natural" birth)

But everybody will insist they know the Best Way and will want to pass on the name of their midwife/obstetrician/birthing center/etc.
posted by Peach at 6:01 PM on November 7 [2 favorites]


I lost a baby in hospital due to a series of errors and incompetence, and I was badly treated afterwards, and I suffered both the trauma of the loss and physical trauma. My daughter’s 89 hours of life were filled with seizures and pain though no sound or sight for her as her body and brain were horribly injured. By the way, up until close to the critical point, I was having a trouble-free, even cheery labour, with no extra instinct that bad things were coming.

A c-section where things started to go wrong would have been nice and lifesaving.

Having seen how fast things go wrong, my response has been to advocate and fight for better care, not go off and Freebirth. We can demand better care. The head of obstetrics resigned in the wake of my daughter’s injury. I found a better team and hospital and my next two births were respectful.

Frumiousb I’m very sorry for your loss.
posted by warriorqueen at 6:02 PM on November 7 [38 favorites]


The medicalization of birth and dismissal of mothers' needs is a huge issue, but I also wonder about the weird "machismo" (feminismo?) around birth that doesn't seem to exist around any other medical procedure. Whenever someone gives birth, beyond knowing that mother and infant are safe and well, people want to know the name, sex, and size of the baby, and then, if you're close enough to the mother (or just nosy enough), whether she gave birth vaginally and if so, whether she had an epidural. It's one of those things that "everyone knows": vaginal birth > C-section, and non-medicated vaginal birth trumps all. When you get your wisdom teeth removed no one really cares whether you went under general or local anaesthesia, and for the recovery you're encouraged to get your hands on as strong a drug as the doctor will prescribe. Freebirthing seems to be some horrible confluence of fear/distrust of modern medicine and a birth culture that praises women who can endure the most.
posted by Rora at 6:07 PM on November 7 [20 favorites]


There's some weird social pressure about "who can endure the most." However, for a lot of women, it's a case of, "what makes you feel most safe, comfortable, and in control, in a setting where you're in agony and terrified, and oh, by the way, you could die at any time?"

For some women, that's medications and the best devices that modern medicine can bring to the room. For others, that's a setting of their choice, with only the people of their choice at hand. And for those women, who've been raised their whole lives with "shut up and do what the doctor tells you" (because we all have), managing a birth on their own terms feels like a great victory.

It's also one of the few feats of physical endurance that women are allowed to brag about, and one of the few that cis men never get to say, "I would've done it better." So of course it gains a bit of social status and many women strive for it, even if that's not what makes them feel most comfortable and safe.
posted by ErisLordFreedom at 7:30 PM on November 7 [13 favorites]


Ever been a psychiatric inpatient?

No, that's not something I have experience with, and it's something I should have thought of. I'm glad you brought it up.
posted by The Underpants Monster at 7:55 PM on November 7


Because I live in a society with a crappy medical system, magically I can't criticize dumbasses who decide they are going to swear not to have anyone with a modicum of skill help with a birth because they are "warrior women"?

I haven't seen anyone here suggest that. You can criticize whomever you like.
posted by The Underpants Monster at 7:59 PM on November 7


OMG. The same disputes, the same fears....

I gave birth in 1968, when the only way for the father to be present was if he HANDCUFFED himself to his wife. (or joined Wavy Gravy or some other off-the-grid group). There were no midwives in urban areas. I asked a friend who was a labor and delivery nurse to be with me, since I would have no idea what "going wrong" looked like. In fact, something did: the cord was around my son's neck, and with no real midwife training she just pulled him out quickly. He was fine immediately, and I tore, and have never regretted it. My daughter was also born at home, with perhaps the last doctor-who-delivered-at-home in attendance.

But it's still "it's so dangerous, what if something happened, the baby is only okay because of what the doctor did" - and how often do we hear that from doctors. With the increase in C-sections, the increase in antibiotic-resistant diseases in hospitals, with the fact that the VAST majority of babies born in the world are not born in a medicalized environment and yet everything is fine.

The argument "What if..." will make you crazy if you cling to it as your child grows. There are so many things that can go wrong. Just as you have to let your child do dangerous things -- whatever you judge is dangerous -- you have to decide how important a natural birth (i.e. not directed by a doctor in a hospital) will be.

A side note: birth clinics sound great, but I wonder how expensive they are, how often insurance covers them. I suspect it's another thing that makes a huge difference in life if you're affluent enough.
posted by kestralwing at 8:02 PM on November 7 [2 favorites]


OK. I tried to compose something earlier, and it ran way to long, and rambled way too much, but I think this time I can keep focused.

BUT... Birthin' Babies brings out a lot of feelings/memories/etc.

OK, so, turns out that pregnant wife has some serious personal feelings against getting stuck in the spine, because she took a tumble wrong in gymnastics, and it's still a thing, mostly minor.

But the concern was there, and asking around, we found The Bradley Method. Natural/"Husband Coached". You can google it.

Anything alternative draws a wide crowd of people looking for alternatives. So, you see people with all sorts of motivation. We weren't there for any overarching moral feelings other than "Let's not stick me like a voodoo doll."

We "Took what we need, and leave the rest"

( Actually, the program wasn't too-woo. Some of the other couples, though. Yeah, it's a safe, nurturing place where you can share, and I'll listen attentively, you know because that's how civilization works.

I toured and seen a whole lot of Dead Shows, so if I think they're flaky or sharing too much... )

Anyway, focus.

The GOOD THINGS: 1) "Husband Coached can mean a lot of things. FOR ME, it meant that I had a framework of things I *could be doing*, and that made me feel almost useful.

Well, more than almost, see, the OTHER GREAT THING we took out of Bradley was a "Birth Plan". There's a lot of "I don't trust my OB, or the Hospital or...." but we had no preference.

THE PROCESS of writing it down though. It really focuses you. What you'll accept in the way of meds/treatment. What you WANT. What you don't want. Etc.

Now, I should have lead with this, but WE HAVE THE WORLD'S BEST FAMILY DOCTOR ( and I ain't giving her name, because it's hard enough to get an appointment unless you do the "I'll wait around" thing, and you could wait a long while until she can slip you in...

ANYWAY... Her insight against Home Birth was two-fold. 1) IF something goes wrong, Albany Med's delivery floor has 2 full-blown surgical suites on the floor, so if something DOES go wrong, you're there.

2) In the hospital, someone is paid to clean up the room when you are done. I have some great friends. I wouldn't ask them to help me ever move. I didn't want to ask someone to do this.

What we REALLY LEARNED after all this. ( 2 babies )

A) Other than a discussion tool, don't get overly formal with a birth plan. It's good to have guidelines, and it's GREAT to think about it before hand. But once you're in a delivery suite, the ONLY thing that matters is WHAT YOUR DOCTOR SAYS. If YOUR DOCTOR says you only need one nurse, then that's what you get. Soak in a tub? That's what you get...

Thus, this advice: IF YOU DO NOT LOVE YOUR OB, FIND ANOTHER ONE RIGHT NOW. If they're not open and acknowledging of your concerns, however founded, you need to get one who will listen, and offer appropriate advice.

B) Don't let your practical joker of a doctor "forget" to massage the blood out from between the clamps when putting on the second one, so that when she tells you to cut, you get a little placental blood shower. Hilarious.

Yeah, this is the short version of the post.
posted by mikelieman at 8:15 PM on November 7


a "no hype, no lies; this is what's best for you and the baby" source of information.

I don't quite get this? I mean, a few comments up you will see me making blistering comments about the state of obstetric care in this country, but if you ask me whether it's best for a pregnant woman and her fetus for her to deliver in a U.S. hospital, of course I'm going to tell you yes. Probably 90% of the people primarily raised in the U.S. would say that that is the optimum approach, even if some alternatives aren't insanely risky. This is completely baseline.

They may be making poorly-informed choices based on hype and propaganda

Unless you're one of the unfortunately large group of people who have had limited access to education and have led their lives in the kind of grinding struggle that leaves little time for anything but survival, or who have mental illness or trauma that seriously compromises their judgment, your inability to make a well-informed basic choice on such an important issue that you've had literal months to think about is your own fault and no excuse.

Women have the right to refuse treatment in labor, absolutely. But if you're a competent adult and your baby dies as a result, that death is your moral responsibility, and if there weren't compelling reasons for you to refuse treatment, all you are is someone whose folly and extreme negligence led to the death of her baby. Oftentimes the correct course of action in a medical emergency is a judgment call and two reasonable people could reasonably make different decisions; people are balancing real but not fully quantifiable risks against benefits which are the same (and in pregnancy, for two entities with possibly conflicting interests). That's not the case here. Freedom to decide without external coercion doesn't mean freedom from moral responsibility for the results.

the VAST majority of babies born in the world are not born in a medicalized environment and yet everything is fine.

Yes, and a very significant minority of babies aren't born in "medicalized environments" and either they or their mothers (or both) die or suffer significant injury that could have been avoided with treatment. "75% of babies were fine!" is a strange sort of statement to make when looking at that pile of dead and mangled bodies. It really is analogous to an anti-vaxxer argument in that it can only be made by people who have been sheltered from what the reality was like prior to the oh-so-terrible medicalization. Precise numbers are difficult to recover, but in early modern England probably something like 2-3% of mothers of babies who survived to baptism died. God only knows how many babies died. The present rate of maternal mortality in the U.S., which we rightly consider shameful, is about .02% for all deliveries: about two orders of magnitude less! Delivering with no medical assistance at all out in the wilderness is not so far off from teleporting yourself back to 1683.
posted by praemunire at 8:30 PM on November 7 [9 favorites]


The Underpants Monster: I haven't seen anyone here suggest that. You can criticize whomever you like.

The post directly above the post you were replying to said "And I also think it's pretty rich for anyone in a country like the US to chide women for making health care choices that might endanger themselves", so yes, someone has suggested just that.
posted by tavella at 8:31 PM on November 7 [2 favorites]


Kestralwing:A side note: birth clinics sound great, but I wonder how expensive they are, how often insurance covers them. I suspect it's another thing that makes a huge difference in life if you're affluent enough.

It’ll depend on your insurance, the birth clinic and the actual birth. Mine was significantly cheaper than the hospital would have been, by a couple thousand dollars if I recall correctly I think the estimate for the hospital was $10k for L&D plus another $1K? for the doctors prenatal visits and the birth center was $4K total? Friends of mine who went through a hospital without insurance and needing a c section said theirs was upwards of 30k.
-
I switched from an OGBYN to a midwife fairly late in my pregnancy. My midwife who spent almost all of my 45 minute appointments with me caught some stuff my obgyn who spent 5-10 minutes with me completely missed. She not only answered my questions but instructed me on things I didn’t know I needed to ask. Their practice did follow up check ups at my house post partum. The hospital tours I went on were terrifying. Doors that sent the entire maternity wing into lockdown if a baby went through without their corresponding braclet wearing parent, 3 separate transfer points to new rooms during the L&D, a complete crapshoot on who your attending doctor would be (you may not have even been able to meet them prior), Nurses who immediately whisk your new human away to clean them up and weigh them and test them. I really appreciated having given birth, I was helped over to my bed, my new baby was immediately handed to me and I got to watch his first moments in the outside world. After a while, the midwives came by, did the wieghing and measurements and tests and then coached me through breastfeeding for the first time.

All this is not to say I agree with the notion of going off into the woods (though I’m not sure I’m ready to judge harshly the motivations of those who do) but I guess it’s more in response to “why would anyone not choose a hospital?”
posted by HMSSM at 10:42 PM on November 7 [6 favorites]


Having seen how fast things go wrong, my response has been to advocate and fight for better care, not go off and Freebirth. We can demand better care. The head of obstetrics resigned in the wake of my daughter’s injury. I found a better team and hospital and my next two births were respectful.

Frumiousb I’m very sorry for your loss.


Thank you, and I'm very sorry for your loss as well. The club nobody wants to join.

And I agree with what you wrote.

I was not able to have another child (something about what happened left me unable to carry to term) but I am happy I was able to advocate for a system which prioritised access to medical care over a vaguely defined national wish to have "natural" childbirth. I got to know many other women who preventably lost their children during homebirths or as part of not having the standard tests which are generally available in other countries. I remember when the statistics Jouke were talking about came out (regarding higher neonatal and stillbirth rates in NL as a consequence of the homebirth-preferred approach) how vindicated many of us felt.

My story is not a popular one with many of my friends in the US who would prefer midwives to hospitals. I should stress that I am not anti midwife. I'm well aware that in most birth experiences, it is perfectly safe to give birth at home. There are many wonderful midwives (I'm friends with many) who are ethical and heroic and who mostly insist on a transfer to a doctor at the first hint of trouble.

However, I am strongly against privileging an idea of "natural" over the safety of women and children. There can be, for instance, tremendous pressure not to have C-sections because it isn't "natural". When I was back in NL, one of the friends with whom I did advocate work had lost her baby when she tried to do a breech birth at home with a midwife and her son suffocated. The midwife had convinced her she had been successful many times in similar cases. She told her: "if you go to the hospital, they'll make you have a C-Section and you'll miss out on this beautiful natural experience."

You know what's not natural? Burying your child due to a completely preventable childbirth accident. That's not natural.
posted by frumiousb at 2:00 AM on November 8 [26 favorites]


My story is not a popular one with many of my friends in the US who would prefer midwives to hospitals.

This also seems to be a result of the US system seeing midwives and doctors in two separate systems, both practically and in terms of their approach. So it's midwife='natural'=home or doctors='medical'=hospitals, with only a small degree of overlap in the form of midwives working in hospitals or alongside obstetricians in practices. (I don't know how this correlates to the Netherlands; my impression is that it is similar, with the majority of midwives in private practice, but also that midwifery has much more standardised training and qualification requirements and midwives are more integrated into the health system overall? I might be out of date on that though, I know it's changed a lot recently.)

In the UK in comparison we have a single doctors-and-midwives maternity system within the NHS, with only a few doctors and even fewer midwives in private practice. The bulk of antenatal and postnatal care is done by midwives, most babies are born in hospital with midwives doing most of the care during most labours. There is a very general distinction in which high-risk women get doctor-led care in pregnancy and birth and low-risk women get midwife-led care, but even then you're mostly in the same places at the same times seeing the same people. You can in theory choose doctor-led care even if you're low-risk but, ditto.

What this means in practice is sort of the best of both worlds and... sort of not. On the plus side you get fully integrated care: I had a mixture of doctors and midwives for my first baby, for my surgically-managed miscarriage (midwives ran the hospital clinic, midwife-sonographers did the scans, doctors did the surgery), for my first birth which was overseen by an obstetrician and attended by midwives and ended in an emergency caesarean with both doctors and midwives present. There was never a time when I felt doctors were pushing me one way and midwives the other, and not one when anybody was pushing me or anyone I know to stay out of hospital for birth at all, let alone for high-risk births like a breech presentation.

On the other hand: when there's only one system then you're stuck with that system even when it's not so great. Your choices for where to give birth are pretty limited and your choices for who'll be there when you do are close to zero. 'Midwife' doesn't mean one professional who'll attend your labour as well as your pregnancy, you might get a single midwife throughout pregnancy but for birth you'll get whoever's on shift at the hospital when you turn up. Midwives are probably in general a bit more inclined to a 'natural' approach and low interventions than doctors are, but not massively if that's what you're looking for. There is a strong momentum to push you along one specific recommended care pathway because That's Just What We Do, and you can encounter a lot of resistance when going against that whether what you want is more 'medical' than the recommended pathway or less than it. Most of the situations I know of where a labouring woman was subject to things done against her wishes during birth, it was a midwife doing it, not a doctor. Definitely not the kind of midwifery system that those US people who'd prefer midwives over hospitals have in mind.

Overall it's a pretty good system and I do like that it doesn't have doctors and midwives in opposition to each other. Still, I'm not sure it's the exact one I'd come up with if I was designing a system from scratch.
posted by Catseye at 3:48 AM on November 8 [2 favorites]


The free birthing movement can appear to be an analogue to an X-Game. Like that woman who gave birth in a stream in the Australian outback. I expect we'll see pregnant people hiking to evermore remote and/or dangerous locations to give birth before the trend dies down.
posted by Mitheral at 5:06 AM on November 8


My ob-gyn was perfectly competent despite some dumb decisions that happened during my labor. The air of scientific certainty many doctors adopt is a facade, because they make blunders like every other human being and the precepts of their field are (while not quite as uncertain, muddied, and belief-driven as my own field, classroom teaching) in surprising large part a social construct.

But when I met my ob-gyn's daughter years later in another setting, I felt avenged that my ob-gyn was apparently a month pregnant herself with her only child when she attended me, and had to go through the whole thing herself not long afterwards.
posted by Peach at 5:41 AM on November 8 [1 favorite]


The "free birth" idea is horrendous, leaving a woman in labor for so many days resulting in a dead baby should bring criminal charges. This should not happen anywhere. There are times when a C section is the only way to save lives. That it is over prescribed does not mean it is never the better choice. I can see home birth as an option, but with a trained midwife in attendance and quick access to a hospital should anything go wrong. Several of my friends did this years ago and were fine.

I had my youngest child 37 years ago in a hospital birthing room, where I could walk around as much as I wanted, there was natural light from windows (he was born around noon) and the bottom of the bed came away for the actual delivery. My husband was with me the whole time, I had no drugs, and everything went fine. If it had not, we were right there in the hospital. All the doctor did was catch the baby, cut the cord and see that the placenta came out as it should.

I had three previous hospital births, the first was a nightmare, but in the end all my kids and I were fine. I was young and very healthy for all the births. Women are waiting longer to have children now, and dangers increase with age. Childbirth was always dangerous to some extent, look at all the babies and women who died of childbirth complications over the years. Better to be safe than sorry or dead. Free birth sounds like a dangerous cult, not a rational choice. As others have pointed out, there were always midwives of some sort to attend a woman giving birth. Not that our hospital, medical system and prenatal care in the US is great, it is not, but the alternative is not giving birth alone.
posted by mermayd at 8:36 AM on November 8 [1 favorite]


The hospital tours I went on were terrifying. Doors that sent the entire maternity wing into lockdown if a baby went through without their corresponding braclet wearing parent

This is to prevent accidental or deliberate abduction of babies. How is that terrifying?
posted by Lexica at 9:27 AM on November 8 [6 favorites]


Are midwives not employed by the hospital and if not, why? As far as I can tell, they're just a medical professional specializing in birth. Or is it a thing where they take a course and get a certificate and can start peddling woo with some businesses accreditation?
posted by GoblinHoney at 9:40 AM on November 8


I agree with this... but. While the history of childbirth before modern medicine is one of a lot of women and babies dying, the history of modern medicine dealing with childbirth is not brilliant either, honestly. Symphysiotomy in Ireland, twilight sleep in the US, puerperal fever in 19th-century hospitals (and that was very much caused by the medical practices of the time, specifically a lack of antiseptic procedures like handwashing + a system where doctors went from cadavers to live patients), this hasn’t been a steady uphill climb to progress for everybody.

This is true, and I don't want to depict modern chlldbirth as something wonderful and magical. But...I've read about Cicero's daughter taking days to die and then the child dying in the 40s BCE and many other ancient accounts of the same right up to more modern material and it gets overwhelming. There are only so many inscriptions about dead children and mothers that one can read before you become incredibly grateful that we've gotten the maternal mortality rate so low even in the US, where it is relatively high for an industrialized nation. It is possible to romanticize what was really very possibly a fatal experience for mother or child in the past, and that's what I generally worry about. Women were terrified of childbirth, and it appears widows with money in Rome avoided remarriage like the plague so they wouldn't have to risk it.
posted by lesbiassparrow at 10:21 AM on November 8 [3 favorites]


Like anti-vaxxers, "I want to childbirth without medical intervention" types have not seen the history of people dying from vaccine-treatable illnesses/childbirth. But UNLIKE anti-vaxxers, these are women who have dealt with poor treatment from doctors for pretty much their entire lives, because doctors pretty much always treat women poorly. (There have been many articles, FPPs, etc about this.) So they see the risks of going with a doctor for childbirth -- and I know more than one person with PTSD from how they were treated in a hospital -- and say fuck that. And, as someone who also has had shitty treatment from doctors, I blame the entire medical system for this. If women prefer to DIE than to have to go to a hospital to give birth, maybe you've all fucked up.
posted by jeather at 11:01 AM on November 8 [5 favorites]


And, as someone who also has had shitty treatment from doctors, I blame the entire medical system for this. If women prefer to DIE than to have to go to a hospital to give birth, maybe you've all fucked up.

Yes, but. The "natural" childbirth industry/movement is not solely an empowerment movement that exists to be nice to women for a change. Don't mistake it for an uninterested party. And don't think that freebirth or non-sensible homebirth is necessarily less traumatic - I would say that people who make those choices, if things go wrong, are under an incredible amount of pressure not to betray the movement.
posted by warriorqueen at 12:10 PM on November 8 [4 favorites]


It would be great if hospitals were good places to be for anyone, wouldn't it? My husband ended up in the hospital last spring with pneumonia, and I bent all my efforts after he stabilized toward getting him the heck out of there before they made him really sick, because he was miserable, uncomfortable, and could not sleep even when not interrupted because the bed was so awful. He couldn't eat because the food was terrible. A kind nurse found us a wheelchair after we had waited for hours.

My mother, hospitalized briefly for a hernia repair, became demented and paranoid because of the disorientation, noise, and deprivation of all her supports, and still had to come back because they did it wrong and she was leaking feces.

But a trauma surgeon of my acquaintance, an otherwise very kind and funny lady, fulminated bitterly at great length in my hearing about how if they were nicer to patients, they'd never want to leave, and she subscribes to (and shares) horrible-patient stories.

And yet I'd rather give birth (or have acute pneumonia treated in the beginning) than in a hospital.
posted by Peach at 12:44 PM on November 8


I would imagine the venn diagram of "believes in the medical efficacy of essential oils" and "chooses freebirth" has a significant overlap.
posted by FakeFreyja at 1:22 PM on November 8 [1 favorite]


I don't think they're making the right choice, but I understand where this choice comes from. When birthing at home is traumatic, it's not because you have a doctor there ignoring your humanity, it's forces of nature, and sometimes that's easier to accept.

I'm not pro the movement, but I am sympathetic to the individual women in it, who are going there for entirely understandable reasons. There's a lot of "well they just don't know better", and I think that's unfair: they know perfectly well that women are ignored by doctors, that their preferences are discounted, that their pain is discounted, that their needs are at best a secondary concern.
posted by jeather at 2:10 PM on November 8 [4 favorites]


I'm not pro the movement, but I am sympathetic to the individual women in it, who are going there for entirely understandable reasons. There's a lot of "well they just don't know better", and I think that's unfair: they know perfectly well that women are ignored by doctors, that their preferences are discounted, that their pain is discounted, that their needs are at best a secondary concern.

There really is a lot of seriously fake information out there about the risks involved in hospital birth vs, home birth. So many of these freebirthers have a world view informed by woo and fake news. You are right that they know doctors don't treat them well (I will not argue that they do) but from what I have seen they are often terribly wrong about the risk they are taking and believe news sources which lack rigor and citation. Even in the "good" midwife community, you still see the crap circulated about the Brewer diet and preeclampsia (NOT true, and generally only serves to make women feel as though they brought pree on themselves by not eating as nature intended. And in some cases, it can actually make pree more dangerous. )

As a woman with a dead child, I would take my needs being discounted any day of the week over the mourning of a preventable death. It would be nice not to need to choose, there we agree.
posted by frumiousb at 3:54 PM on November 8 [4 favorites]


What are some of the ways a hospital birth can be made less oppressive/traumatic? I am always looking for ways my hospital can improve its L&D floor and would love suggestions.
posted by Easy problem of consciousness at 4:45 PM on November 8 [1 favorite]


It would be great if hospitals were good places to be for anyone, wouldn't it?

The neonatologist I worked for back in my perinatal research days used to say, with a knowing sense of irony, "The best way to stay healthy is to stay away from hospitals."

I think it's one of those "it's the worst possible option, except for everything else available" things.
posted by Lexica at 5:22 PM on November 8


What are some of the ways a hospital birth can be made less oppressive/traumatic?

Time devoted to informed consent - making it possible and then achieving it. Time devoted to dicussing birth plan (and taking it seriously). Continuity of care. Avoiding unnecessary examinations and interventions. No compulsory constant monitoring. Allowing food and drink (over here, many hospitals still starve women in labour). No scaremongering. Keeping rooms warm (one child of mine was born in high summer with air conditioning achieving 18 degrees Celsius in the room and staff saying they had no influence over the heating control, which is in another building). Keeping light and noise to a minimum whenever possible. Allowing lay birth attendants (not only one person, not only the father of the child, as is policy in a number of hospitals here). Respecting the golden hour, allowing newborns lasting physical contact with mother if she wishes it. Making rooming-in available. Not constraining visiting unless absolutely necessary. (I've seen hospitals that routinely suspend visiting on the grounds of "risk of epidemic" when the maternity ward is very busy.) Not enforcing a strict feeding schedule for women who do not wish to cohabit with their newborns for a day or two for whatever reason. Not sticking babies with apgar 9 in an incubator because "it is policy after a C-section".

I'm tired of arguing this now (did so for well over ten years), but after eight kids, two hospital vaginal births, two assisted home births, four C sections the first two of which were clearly attributable to suboptimal hospital routine and staff errors, reading a lot (and translating some) literature on the subject, I am firmly convinced that for the great majority of pregnancies, provided it is the mother's informed choice and provided the assistants are competent, assisted home birth is at least as safe as hospital birth as we know it today, or even hospital birth optimalised in an evidence-based fashion.

As for freebirthing - I acknowledge the extra risk, but I understand (some of) the motivations. And I think there is quite a lot a mother/family can do to increase the safety of that birth.

And I would prefer not to live in a world in which an exclusively risk-based ethics is compulsory.
posted by holist at 10:09 PM on November 8 [5 favorites]


my job is Mat Safety Transformation lead for the SE of the UK, first birth in a hospital, second home birth with midwife.

We are trying really hard to improve our figures through educating the workforce better but I think our systems are a happy balance. We are trying for Swedish stats but 98% of births in Sweden are in highly medicalised setting so I'm not sure we could either afford or accept this shift..

we offer community midwives on the NHS is many areas for home births, all the usual testing support is given generally in your own home. In some areas we don't have enough staff to offer this service and then new moms to be are profiled as either low or high risk. Low risk can access the community midwife, or attend a midwifery led unit. High risk are offered obstetric unit in a hospital with full ITU facilities. They are offered. Birth Rights we consider similar to human rights although that hasn't yet been fully accepted, it a kind of culture shift here in the UK.

I am worried for all involved with freebirthing and think we have alternatives that are safer. However, I have to accept a woman's right to choose no matter how concerned that makes me. We are in a very uncomfortable, politicized space right now wrt women's bodies and women's agency. Until we've worked more on this in a progressive, positive ,engaged way, I'll have to sit on my hands when a women chooses this option.

if anyone wants to follow the progress of the safety transformation work in the NHS you should follow the amazing @whoseshoes on twitter
posted by Wilder at 4:24 AM on November 9 [5 favorites]


What are some of the ways a hospital birth can be made less oppressive/traumatic?

In continuation of holist's excellent comments:

Help the person giving birth get comfortable. If she wants a particular condition or item or activity or person, and there is no notable risk attached to it, give it to her. Get rid of "hospital policy" as a reason to block temperature control, access to music, letting her walk around or eat or drink, having only one attendant, and so on. This means assessing the risks individually for each person, and re-assessing them if conditions change.

There are usually good medical reasons to not allow five of her best friends as attendants, no matter how comfortable that would make her; the room needs space for the doctor/nurse(s) and equipment. But there's no reason to limit it to one, even if it has to be one or two at a time- the friends could take turns visiting/helping. There are no reasons not to allow music, although I suspect this has gotten easier since I gave birth - most people can now carry many hours of music that don't require access to the hospital's electrical system.

After that: TELL HER what's going on, what the readings mean, what decisions are being made. At the very least, ASK if she wants to know. Some women probably don't; I would've been much more comfortable if the nurses talked with me rather than over me.
posted by ErisLordFreedom at 7:41 AM on November 9 [3 favorites]


What are some of the ways a hospital birth can be made less oppressive/traumatic?

#1 is excellent medical care. It doesn't matter what lighting you have if someone misses a bad reading, doesn't know how to interpret a strip, a decision is delayed, a woman pushes too long and injures herself, or a baby suffers brain damage. Front line staff need backup for when things get unusual.

#2 is managing workload so that the nursing team has time to speak with each woman about her particular needs, staff changeovers have time to communicate what's been happening, etc. For example I could not give a crap about lighting or jacuzzis, but I am a sexual abuse survivor as well as having lost a baby, and so having some time for me to outline what's helpful is going to both help - and take a few minutes. Not an hour.

#3 is definitely information...my 2nd & 3rd delivery team were excellent communicators. They were able to explain what they were seeing and discuss risk and outcomes very well.

And #4, respect for patients as individuals. I experienced the most dehumanizing treatment in the hospital that most "supported" "natural" birth, not just because of the bad outcome but because that hospital had taken a position that had nothing to do with me. They were working to keep c-section rates low, not concentrating on each person. They hid information from me. The staff said things to me like that I needed to be as strong as my ancestors, shaming me when I wanted to see the OB after 2.5 hours of pushing, because he might go to a c-section; meanwhile my daughter's birth was going off the rails.

This certainly includes things like letting women in labour make choices around birthing balls and positions and all that...not insisting on one particular way of doing everything, for sure. But it is way, way deeper than the playlist and the snacks.

The most respectful experience I had after the loss of my daughter was with a crusty old white guy OB with the bedside manner of a Marine. I came into the first appointment with a hard line in the sand: C-section at 38.5 weeks. He listened to me. He explored my history. He built rapport with me. And he said we would discuss it again at 30 weeks. At that appointment, he talked to me about risks and complications. He also discussed how, if I chose to move forward with his recommendation (vaginal delivery), he and I would develop not a birth plan but a road map for decision making along the way - what tolerance we would have for decels, for timing, etc. He discussed with me how their team operated and why I could choose to trust them. It was through that that I was able to have what in the end was a precipitous vaginal delivery with really almost no bumps at all.
posted by warriorqueen at 8:02 AM on November 9 [9 favorites]


Thanks for the suggestions, I'm going to spend some time thinking about how to make some of them happen at my hospital.
posted by Easy problem of consciousness at 12:37 PM on November 9 [3 favorites]


« Older Go into the hot bubbling oil, unaccompanied. Each...   |   SF Writer Greg Egan & Mystery Math Whiz... Newer »


You are not currently logged in. Log in or create a new account to post comments.