An Unnatural Birth Advocate

December 14, 2005 | 161 comments
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There are plenty of natural birth advocates out there–I know because I keep having to plaster a vapid smile on my face when they spout half-truths and didactical opinions at social gatherings. I’ve yet to meet an avowed unnatural birth advocate, so I’ve decided to take up that mantle for myself. So, if you are pregnant, or might be some day, here are some thoughts on why you might not want to have a natural childbirth.

The natural birth advocates will tell you that everything from epidurals to c-sections have risks that you should avoid. They are half right. Epidurals and c-sections have risks. But not having an epidural and/or having a natural birth have risks, too. They just have different risks. You should make your decisions not with the delusion that you will be able to minimize all risks, but that you can minimize the risks that you most want to avoid. For example, you are more likely to end up with an infection if you have a c-section. You may want to avoid that risk at all costs. More power to you, sister. But a c-section (especially if your baby is large) will lower your risks of future urinary and fecal incontinence considerably. You will also avoid a considerable amount of labor and postpartum pain. You will also be able to schedule your delivery. To some women, these things aren’t important. To others, they are. I think there is a vestige of paternalism in the idea that anyone (whether doctor, mother-in-law, or natural birth advocate) can weigh these risks for another woman and inform her which option is “safer.” (It is hard, for example, to imagine a male cancer patient not being given a choice between chemotherapy, radiation, and surgery when each would have different risks and benefits in his case.) I am also very concerned about the downplaying of women’s pain as inconsequential. Again, you don’t see men rallying around the banner of the Natural Dentistry Movement.

Similarly, home birth minimizes some risks (your risk of being in a hospital, your risk of losing control of the situation, your risk of other medical interventions, your risk of sleeping in a strange bed and not eating what you want to eat) and increases others (your risk of delay for additional treatment if something does go wrong). Again, weighing these risks is a very personal issue and I fully support any woman who chooses a home birth based on her own assessment of the risks.

I do, however, have some problems with how that risk assessment is happening. First, many women have a negative perception of c-sections because their experience with them is something like this: they were laboring along just fine, thank you, when all of a sudden a bump on the monitor meant that all hell broke loose and they were hustled in for an emergency c-section. Scary–all that rushing around and changing of plans right in the middle of things. Not to mention that they got to recover from labor and a c-section, which statistics suggest is the hardest recovery of all. So a woman who has had an emergency c-section may not be the most objective source of information.

I also have a problem with the assumption that a c-section is something foisted on an uninformed or deceived woman by a lazy or malpractice-paranoid doctor. Undoubtably this does happen. But many women choose c-sections based on an informed assessment of the risks (see above).

You may be curious about my personal background: I had a poor experience with natural childbirth followed by two very successful elective c-sections. If I am blessed with another child, I would without hesitation choose another c-section. It isn’t the right choice for every woman, but it is for some. I hope that at some point, prenatal care will involve women being provided the data concerning the risks of various birthing options so that they can make their own choices and that their health care providers will then support them in their choice of home birth, natural childbirth, medicated childbirth, or c-section. We need better data for this to happen. (For example, very few studies bracket purely elective c-sections, so the data makes it look as if c-sections are actually much riskier than they are because they do not account for the underlying situation that led to the c-section. There is also a terminology problem even in the medical literature: sometimes ‘elective c-section’ is used for people like me who walk into an OB/GYN and say, “I want a c-section despite having no medical need for one” and other times it is used to mean the opposite of ‘emergency c-section,’ meaning that the doctor decided before labor began to perform it [for any or no medical reason].) But this article is a start. This is also interesting, as is this.

A final note: I welcome comments from natural birth advocates, including links to data. Please present us with as much information as you can find on risks and benefits. Just refrain from weighing those risks and benefits for anyone but yourself.

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161 Responses to An Unnatural Birth Advocate

  1. Cates on December 14, 2005 at 1:58 am

    Looks like your information on the risks of incontinence is out of date: see this, a study showing that vaginal birth does not appear to be associated with incontinence later in life, after all.

    And if you don’t plan to breastfeed or have a family history of food allergies, you may want to avoid elective sections for the sake of the baby: here’s a summary of a study suggesting that c-sections increase the risk of food allergies in childhood.

  2. Tim J. on December 14, 2005 at 2:11 am

    My wife has had to have two C-sections, the first was a semi-emergency, the second elective. She is also electing to have one done this coming May with our third child in lieu of VBAC.

    Some of her random, paraphrased thoughts:

    “I don’t pee when I sneeze.”
    “An episeotomy is what?!”
    “Nothing like choosing our kids’ birthdays.”
    “My babies have normal-shaped heads when born.”
    “I get an extra two-weeks maternity leave.”
    “Mmmmmmmm, Percoset.”

    My wife does have a very low tolerance for pain, so avoiding natural child-birth was somewhat an easy decision for her, however she doesn’t like the longer recovery time. Having C-Sections does also limit the number of kids one can have. This, sadly, may have to be our last.

  3. fMhLisa on December 14, 2005 at 2:15 am

    I had three very successful and powerful experiences with natural childbirth. It was awesome for me.

    But having said that. I’m right there with you Julie.

    Those were my births, and my body, and my choices, and I don’t think it’s right to pressure or misinform anyone into making the same choices I made.

    I went into the hospital (I did consider home-birth, but it freaked out everyone in my family too much, and I’m not the freaking out the family type) with the idea that I would be all natural, but open to interventions if I felt I needed them. I never felt I needed them. But I think many variables could have affected that.

    I just think that there are too many variables to expect women to make the same choices, and it’s the height of arrogance for me to assume that what was great for me should work for everyone. Or even for myself under different circumstances.

    I remember during my first labor, how much it hurt, and how much concentration it took to stay focused and relax and breathe through the pain. My husband and dunna were right there with me, my life was in order, I am healthy and educated and generally happy, it was an easy-ish labor and a fast-ish labor and it was still the hardest thing.

    I remember worrying about very young women, women who were alone, or scared, or uninformed about their bodies, having to go through the same experience, and my heart just broke for them. It was scary and it hurt, and I was as fully prepared for it as a person could possibly be. And I had the most amazing support network.

    I remember my husband and dunna left for just a moment, to eat or go to the bathroom or something unforgivibly selfish like that, and I was alone for a really serious contraction, and I started to panic. It was unbearable.

    I decided then and there that all fourteen-year-old girls going through labor should be drugged up to their eyeballs. They had enough problems without all that pain and fear too.

    And after, when I talked to my mother (I’m the youngest of eight) and I told her what an amazing natural birth experience I had. And it was, it was amazing. I felt like the most powerful goddess, the most amazing astounding powerful brilliant madonna, I was totally stunned by myself, I knocked my own socks off. I was the coolest thing EVER!!! So when I was talking to my mom about loving natural childbirth, she just couldn’t comprehend it.

    Her own birth experiences were just scary and lonely and horrid. Alone in a beeping room hooked up to all kinds of instruments in pain and scared for hours and days until someone came and knocked her out and she woke up hours later with a baby. No wonder she wanted to be unconsious.

    And my best friend, who wanted natural childbirth, but who had a horrid, long, horrid, painful, long labor and finally need sleep and had and epidural, and she told me “You’re stronger than me, you did it without.” And can I just say that is the biggest load of bull crap. I push a baby out in three pushes, she pushes for three hours and she tells me I’m tougher. Seriously, that’s just wrong.

    So, that’s a very long way of saying, that natural childbirth really can be the coolest thing ever. For some people. For me.

    But for heaven sake, let people make their own well-informed decisions.

  4. ca-vee on December 14, 2005 at 4:42 am

    I really hate reading articles like this. There is such a culture of fear surrounding birth. We’ve scared ourselves into thinking we shouldn’t experience any pain at all. We scare ourselves into being scared which heightens our pain perception.

    We forget why Heavenly Father created sorrow in birth, so the joy is so much sweeter when we have our babies. Birth used to be more joyous in women and midwives gathered together to help. Women had help after birth. It was a celebration of life and community and womanhood.

    We have been entrusted with this great ability that no man will ever experience because no man would ever be able to handle it.

    I had two c-sections and I would give anything to of had natural births. They have damaged me for life and I will never have the big family I wanted. C/S reduces post partum pain? I could barely move for many weeks after both and I was still hurting a year after my second one. A year and a half later and I still have sensitivity in my 10 inch long incision area.

    Quote: “So a woman who has had an emergency c-section may not be the most objective source of information.”

    I was in labour for nearly a week when I had DS via emergency section and that recovery was easier than my second. With DD, my second, I hadn’t been in labour. I was scheduled because I was nearly 2 weeks overdue and the incision from the first was opening. That recovery was beyond anything I could of expected.

    DH often tells me he never wants to put me through giving birth again. It was traumatic for him too, especially not being able to be there for the births. It was horrible waking hours after having my babies and not caring when told I had given birth.

    Oh and yes, I pee myself about 5 times a day. I found out this is the case because most bladder problems occur during pregnancy, especially when you carry as low as I did.

    I know very few people who have had a positive c-section experience. I don’t talk about it much to anyone other than DH or to share my experiences online. I think if my family knew how traumatic an experience it were for me, they would stop saying how lucky I was (and I could stop giving them dirty looks when they say that, lol!!)

    Anyway that’s the most coherant I can be at 4am :)

  5. Seth Rogers on December 14, 2005 at 10:02 am

    My wife’s had epidurals for both pregnancies. Worked out great apparently.

    Oddly enough, the thing she was most afraid of was having the needle stuck in her back. Seems kinda odd to me after witnessing the mess the baby made of her coming out.

  6. Beijing on December 14, 2005 at 10:15 am

    I don’t think the natural birth movement “downplays women’s pain as inconsequential.” Rather, I think it attempts to glorify women’s pain; that is where the powerful goddess references come in. But that glorification makes sense because the origin of a new life gives a truly amazing purpose to the pain. We don’t see a Natural Dentistry Movement glorifying the pain of a root canal, because when that pain is over, you’re left with a healthier tooth. Big whoop. Not as cool as a human baby.

  7. Bryce I on December 14, 2005 at 10:40 am

    I’d never tell a woman how to have her baby. I will say that if you’re planning on getting an epidural or an elective c-section, you should be prepared for the possibility that you won’t get one. Epidurals don’t always take, or you may be too far along by the time the doctor shows up (we have several friends who have had these experiences). And my wife was born at home entirely unintentionally — labor was really fast. Her sister has had a baby at home in the same manner — there was no time to get to the hospital.

    So just because you’re planning on managing your delivery medically doesn’t mean you should completely ignore preparations for a natural childbirth.

  8. Karen 8 on December 14, 2005 at 10:43 am

    I have given birth 7 times and #8 should show up soon. I have experienced all different ways. Natural-in a birthing center (2), C-section(1), induced by pitocin no pain killers (1), Natural in a hospital (1), induced by gel w/ epidurals (2).

    It really is not an easy thing to decide what risks to take. It depends on you, the baby, your husband, the doctor/midwife etc. I was seeing a midwife who delivered in hospital when I ended up with the c-section. I had decided to have #5 at home, then ended up not feeling good about it, chose to have a hospital birth and was glad because my little one ended up in the NICU for eight days due to heart problems. (she later had open heart surgery)
    If you had asked me before my first or second baby, I was natural all the way. Birthing center was as close to a hospital as I would get. I soon realized that a healthy baby is the most important thing (I’ve had two go to the NICU). It does not matter how I give birth.

    Julie, you have some great points about c-sections. I would much rather have a planned c-section than labor and c-section.
    Looking at #8, I’m juggling what to do, having been told that this baby is already very big and will only get bigger (typical for me and my babies), and I don’t want to be induced. C-section is looking really good to me right now.

    Sorry to go on and on, I guess I just wanted to say that things change and it is not good to be set in stone. Side note, the medical side of birth is not all bad. I am rh- and all my babies rh+, if it wasn’t for modern medicine, I probably would have lost all but my first.
    And in my personal opinion, natural birth is not all ” they” talk it up to be.

  9. Allison on December 14, 2005 at 10:53 am

    I agree it’s a good idea to be prepared for the chance that things may not go as planned. I think this is true whether you plan a home birth or a c-section or anything else. Things sometimes happen contrary to planning. But Julie, I really like your way of approaching the topic. There are so many variables and so many different experiences that it’s really unproductive for someone to make blanket statements about what other women should do.

    Before I had kids, I was pretty determined to “go natural” because I’d read up on it and my mother had better experiences without anesthesia than with (although she never had an epidural). But she never went past her due date, and I think the largest of her babies was in the seven pound range. Somehow, with each of my three pregnancies, I never did go into labor on my own (with reliable dates, I should add), and had three very large babies. I don’t think you can compare the two situations, and although with the first two I still attempted to so without an epidural, by the time I had my third I welcomed it as a blessing. And for me, it was.

  10. b bell on December 14, 2005 at 11:16 am

    I have 4 kids.

    One kid natural. (too fast for anything else)
    One kid with a epidural.
    one set of preemie twins via c section.

    To me a male. They all worked out pretty good. If we have another my wife would like to avoid a C section cause of the longer recovery times.

    I think we should chill and let individuals decide how to birth. To me it seems to depend on the situation. I ahve negative feelings about home births because both of the people I know who did so had serious problems and were rushed to the hospital. In fact one of the babies died as a direct result of the decision to homebirth. In fact there was a prosecution. I know that stats though are pretty good on Home Births but be careful.

  11. Julie M. Smith on December 14, 2005 at 11:19 am

    Cates, you may have mised two points:

    (1) It isn’t about one set of statistics; it is about an ever-changing body of data.

    (2) “you may want to avoid elective sections for the sake of the baby” is precisely the kind of statement that assumes the right to make a decision for another person by guilting and misinforming (since purely elective c-section has, in the very latest studies, been shown to have the lowest infant mortality rate of all options). There are also other risks to the baby avoiding by c-section (while, of course, some other risks are increased). So statements like “for the sake of your baby” are not appropriate.

    ca-vee, once again, you don’t have the right to determine whether another person should experience pain or choose to avoid it. You description of natural (historical) childbirth is a little incomplete in that you forgot to mention the extremely high (compared to today) levels of death to both mother and child. (But note, for those who don’t know this, that homebirth, hospital birth, and c-sections all have extremely, extremely low levels of death for either party, so no one should play the ‘But you could _die_” card for another person’s choice.

    “We have been entrusted with this great ability that no man will ever experience because no man would ever be able to handle it.”

    I’m as raging of a feminist as you’ll find in the bloggernacle, but this is so offensive.

    I am sorry for your poor experience with c-section, but note that I have also done it both ways and can honestly state that the c/s were pain-free (because I was properely medicated) and the natural involved excruciating pain before, during, and 6 weekls after. So please don’t assume that what happened to you would happen to every other woman. I haven’t.

    And you may not know of positive c-s experiences because you made it clear 4 words into your post that you are not the kind of person who would be respectful of them.

    Bryce I–Very good point.

    Karen 8 and fmhLisa, thank you both for sharing your very diverse experiences and in such a nonjudgemental way.

  12. Paul Mortensen on December 14, 2005 at 11:25 am

    Call me callous but to me child-birth should be centered around what is best for the child. Most of the discussion so far has centered around what’s “best” for the mother in terms of “the experience” which I find truly sad and self-centered. My wife has been a labor and delivery nurse for more than a decade and has written a number of birthing protocols used in hospitals around the country. For the birth of each of our three children she made all the decisions and those decisions were always centered around what conditions would be most likely to produce a healthy baby and mother– without any of the selfish touchy-feely considerations. I’ll try and convince her to post something here (though I doubt I’ll be successful as she’s not into this “blogging thang” and she’s busy taking care of a colicky six week old baby).

  13. Julie M. Smith on December 14, 2005 at 11:27 am

    One other thing, cates, your studies involve (1) less than 200 women in the first case and (2) all c-sections–not just elective ones–in the second. So I want our readers to give them some weight, but they certainly aren’t the final word on those issues.

  14. Paul Mortensen on December 14, 2005 at 11:28 am

    Sorry, but I began posting at #7. Now my first two sentences seem entirely irrelevant.

  15. Julie M. Smith on December 14, 2005 at 11:29 am

    Paul, to look on the bright side, the fact that _all_ birthing options have low absolute risks gives us the luxury to consider how our options affect the experience of birthing. That said, I would certainly weigh (for myself) the health consequences to mother and baby over the experience itself, but don’t feel that I have the right to impose that on someone else.

  16. JA Benson on December 14, 2005 at 11:33 am

    My experience has me in the unnatural birth advocate camp. I have nearly twenty years of experience in mothering. The medical community has come along way in that time.

    With my first child I knew that I wanted an epidural, but the doctor made me wait until I was at a certain point in labor to have the epidural put in. I was alone in a room for two or three hours trying to breathe properly and suffering. The hospital had a record number of births that night and the nurses were all busy. My husband was stuck in traffic.

    Finally they gave me the epidural the relief was immediate. The epidural was a blessing given what came next. The baby then came fast. So fast that he was stuck in the birth canal and could not breathe. I was rushed into surgery to have an emergency c-section to save his life. The baby was stuck too far down the birth canal; so I apparently got the biggest weirdest episiotomy ever as every ob-gyn that has seen this scar has called others in to look at it. If I had not been already numb my child would have died in childbirth. He was nine pounds. After his birth I hemorrhaged and went into shock. Thankfully I was in a hospital where they could save both our lives.

    My second childbirth experience went a little better. Still having to wait until I was at a certain point; the epidural was put in and this baby again came fast. I was only partially numb and essentially delivered that baby natural. This baby was only eight and a half pounds.

    My third baby was easy. A nine pound baby again. The epidural worked. I remember thanking God that I was born in a time that I could receive wonderful care.

    My fourth (last) was again a nightmare. I asked for and got an epidural. The anesthesiologist set it for the lowest setting after I told him to give me a lot of juice as there was a chance given #1 and #2 this baby could come fast. He didn’t listen to me and left. Hard labor started immediately. The nurse paged him several times. He didn’t return until it was all over. In twenty minutes I delivered naturally a 12 pound baby. My OB said later that it was the scariest experience where everything turned out okay. I cannot describe the intense suffering I went through for twenty minutes.

    I am so thankful for epidurals for my first and third childbirth experiences. I am thankful that we don’t deliver children at home. In the past women and babies often died. I have several ancestors who died in childbirth or lost babies.

    Finally those of you who feel that your family is limited because of limits on how many children you can birth; please consider adoption. There are children all over the world who need a family to love.

  17. Mark B. on December 14, 2005 at 11:40 am

    Ditto re: Bryce’s comments. Our first child was born 20 minutes after we arrived at the hospital–having been sent home (from Utah Valley RMC) three hours earlier because the nurse thought we could be another 24 hours. Our second child was born 10 minutes we arrived at the hospital–Roosevelt Hospital on W. 57th Street in Manhattan. If the cabby hadn’t believed my threat that we’d have the baby in his car, and driven half a block up Ninth Avenue the wrong way (lucky for us, it was 3:30 a.m., the baby would have been born probably somewhere on 10th Avenue.

    Just as in war, sometimes the best planning goes out the window as soon as the first shot is fired.

  18. Karen 8 on December 14, 2005 at 12:33 pm

    Epidural comment-
    First epidural, the guy didn’t get there on time and I had the baby without the pain meds but with the pitocin yuck!
    Second epidural, great pain relief, but made me woozy, and I threw up and itched.
    Third epidural, baby turned sunnyside up, pain was bad, epidural did not help even when topped off.

    Things don’t always go as planned.

    My c-section recovery wasn’t that bad. I went home in two days and was on my own with three little ones 10 days later and I healed pretty well. Not too much pain.

    JA Benson- I am a little worried about a 12 pound baby! I’m glad everything turned out ok for you.

  19. Sue on December 14, 2005 at 12:39 pm

    Thanks for this post Julie. Just chiming in to say that my c-sections (all three – which were planned, but not elective, as I had no choice) were pretty pain free, and my recovery was a snap. Up and around within 2 days, skiing within two weeks. Not typical, definitely. But you can’t generalize and say that c-sections are always bad.

    Everyone should stop using their OWN experience, or the experience of their wives/mothers/children what have you – to make judgements about what other women choose. They are usually acting in the best interest of their infants. They are also usually acting based on their own study and input from their doctor as well. To assume that you know better, because your experience and home study has led you to a different conclusion, is arrogance at it’s best.

  20. The Wiz on December 14, 2005 at 12:42 pm

    I love this post. And I love all the comments, but mainly it’s because I have this (possibly unnatural) love of hearing birth stories. I love how they’re all different, and all universal at the same time.

    That being said, I’m with Julie. My pain tolerance is low, and I don’t feel like I’m a “goddess” or anything before the epidural kicks in. My labors have been really fast, once the water breaks. Fortunately we knew this after my first, and so scheduled inductions with my next two. With my third, I was dilated to a 4+, a resident broke my water, and shortly thereafter my OB came in. The nurse attending me assured her there was no need to check me, I was at a 4 twenty minutes ago. I am glad my Dr. knew me, because she just kind of smiled at the nurse, and said “I’ll just check her anyway.” So she did, and yes, indeed, the baby was crowning. He was born 20 minutes later. The doctor laughed and told me I had broken my own record, going from a 4 to a baby in 40 minutes flat.

    The nurse was in shock. Here my labor had been totally normal, and then BAM, he’s crowning. She just looked at me and said “Honey, if your water ever breaks in the world outside of a hospital, you are giving birth in a cab.” I just said “I know.”

    So thank heaven for inductions and hospitals, in my case. And God bless epidurals.

    But I will admit my ignorance here – I never even knew it was possible to have an ‘elective C-section’. I thought you could do a C-sec if the mother had already had one, or if there was a medically necessary reason.

    And, as a final thought, I will quote my anesthesiologist from my first baby. “You can breathe through an appendectomy, too, but why would you?”

  21. Andermom on December 14, 2005 at 12:45 pm

    I had my first baby (seen ad nauseum on my blog) in an hour and a half. My water broke at home with no prior signs of labor, then we leisurely went to the hospital (exptecting labor to last several more hours) only to have the baby less than half an hour after we got there. My Dr. barely made it, the anesthesiologist didn’t make it so there was no chance to give me any sort of pain medication. The baby came so fast that despite having an episiotomy I tore in three separate places down to the muscle in one place.
    Despite all of that, in four days I felt fine. I didn’t even need tylenol for my stitches/tearing anymore. I am incredibly lucky. I think next time (if I even have a choice) I won’t want drugs for just one reason: catheters. Childbirth was scary, but not as scary as a catheter.

  22. Sue on December 14, 2005 at 12:47 pm

    When I say “you” I don’t mean anyone in particular, just a generic “you.”

  23. The Wiz on December 14, 2005 at 12:50 pm

    Oh, I forgot to add (so much for my ‘final thought’) that I also agree with Julie, among others, that one woman’s birth experience has nothing to do with another woman’s decision to have a home birth/natural/induction, whatever. And I too get a vapid smile on my face when people start advocating one way as “the only way.” I just laugh inwardly and think to myself “Have you ever heard more than one birth story? They’re ALL DIFFERENT! Why is yours more valid than hers?” I used to say these things out loud, but it only makes them more vehement in proclaiming their point of view, and usually I want to end the conversation as soon as possible.

  24. b bell on December 14, 2005 at 12:55 pm

    I just want to clarify my comments on Home Births. I do know a couple that had a baby die as a direct result of a homebirth. They chose to homebirth even though they knew the baby was breech. The midwife was prosecuted and there was a hung jury. The couple later had a good home birth.

    That being said I am not opposed to Home Births you just need to be sure that there are no complications going in. Got complications? No Home Birth. No complications I say go for it if you want.

    Again I repeat that most birthing methods end up just kinda happening. Only one of our children was born by a method of our choice (epidural) even then the epidural was admin to late for it to really take effect. Things can just happen when a baby is about to be deilvered that can change the birth method.

    To much judging on birth method in my opinion.

  25. Karen 8 on December 14, 2005 at 12:57 pm

    Having had so many very different birth experiences, I could argue for all different points of view, which could be fun, but I try to restrain myself.
    I agree with you wiz- all birth stories are different and valid.

  26. Susan M on December 14, 2005 at 1:48 pm

    I went to midwives for my first, but he was breach and I ended up having a c-section done by the doctor they were associated with. Recovery was horrible because I was not properly medicated–they gave me a perscription, I just never filled it. (I hate taking medication.)

    My next I wanted to do naturally if I could, but was willing to ask for some medication if I needed it. She came too fast for me to have anything, though, and was born without any pain meds at all. I saw a doctor for that one because my insurance at the time didn’t cover midwives. Oh, and she came so fast my doctor wasn’t even there–she’d told me it would be hours yet and left to her office. Some other doctor delivered her–still don’t know who it was to this day. (Basically just caught her, I pushed 4 times and there she was.)

    My third delivery was weird–I had a constant pain throughout the labor so it was really hard for me to tell when contractions were starting/building. The doctor ended up using a vaccum-thing (whatever they use now rather than forceps), and that hurt. I took some demerol, which was a bad decision–it didn’t do anything for the pain, just made me loopy, and I’m the type who turns inward and likes to concentrate when in a lot of pain, not be seeing stars. I’d wanted to see midwives for this one but they wouldn’t take me because I was diabetic, which made it a high-risk pregnancy. I was glad for that after because Elijah stopped breathing and turned blue as soon as my husband cut the cord. (He was fine.)

    If I were to do it again (which I won’t, I’ve had my tubes tied), I definitely would not opt for a c-section. Surgery sucks. I’d probably try an epidural, but only after trying to do it without anything first.

  27. Boris Max on December 14, 2005 at 2:18 pm

    Julie–

    You begin your very well argued post with a throwaway comment about being accosted at parties by natural birth advocates. That comment raised a question that hasn’t been addressed so far: can unnatural and natural birth advocates share their birth stories without feeling misunderstood? It seems that a positive birth experience–natural or unnatural–would sound like propaganda to someone who was committed to the other side. Of course, you don’t know my wife, but she’s a natural birth advocate–I had to spend an hour during her third labor convincing her that taking pitosin (sp?) wasn’t a personal failure–who often feels harrased when unnatural birth advocates tell her how wonderful medical management is. Is the problem here really that intensly personal decisions shouldn’t be discussed at parties?

  28. Stephen on December 14, 2005 at 2:31 pm

    “For example, you are more likely to end up with an infection if you have a c-section.”

    This is false. You ought not, in your own words, “spout half-truths” – or in this case untruths.

    “I think there is a vestige of paternalism in the idea that anyone (whether doctor, mother-in-law, or natural birth advocate) can weigh these risks for another woman and inform her which option is ‘safer’ (It is hard, for example, to imagine a male cancer patient not being given a choice between chemotherapy, radiation, and surgery when each would have different risks and benefits in his case.) I am also very concerned about the downplaying of women’s pain as inconsequential. Again, you don’t see men rallying around the banner of the Natural Dentistry Movement.”

    Typical man-hating feminist spew, unsurprising given that it’s coming from someone who calls herself a “raging feminist” (great adjective choice there, by the way, Sister Rage). Interesting to examine the stupidity that rage apparently induces:

    Too bad all those female cancer patients aren’t given the same choices as their male counterparts — or did the “male cancer patient” example actually have *anything at all* to do with the sex of the patient? No, I thought not. Just garden-variety feminist babbling.

    Do you see women “rallying around the banner” of the natural childbirth movement? Certainly. Do you see women “rallying around the banner of the Natural Dentistry Movement”? Uh, no, because there is no such movement. So since neither men nor women rally around this nonexistent movement, therefore that shows us…what? Well, nothing. The example is far beyond specious; it’s meaningless.

    “But you’re missing the point!” cries the feminist. “There is no pressure on men to experience dentistry without drugs, so why should there be pressure on women to experience childbrith without drugs?” This is natural, of course; the feminist sees EVERYTHING as a contest between the sexes. Thus, to the feminist mind, it makes perfect sense to talk about not seeing men rallying around the banner of natural dentistry, irrespective of the fact that their example is both absurd and nonsexual in nature. See, in the feminist brain, men are the root of all evil. Comparing “natural childbirth”, a mindset adopted by and for women, to “natural dentistry”, a nonexistent whipping boy, is second nature to a feminist; and since men don’t talk about the latter, they are bad or wrong or evil for talking about the former. As long as you consider the “natural childbirth movement” to be a bad thing, as Sister Feminist Rage clearly does..

    “Just refrain from weighing those risks and benefits for anyone but yourself.”

    What?! How DARE you tell us what we ought or ought not weigh! Who are you to tell us what we should do?

    Blah, blah. More feminist doublespeak.

  29. Julie M. Smith on December 14, 2005 at 2:36 pm

    The Wiz–

    Whether a doctor will perform an elective c-section is the decision of the doctor. However, until the past few years, there was virtually no discussion of it in medical journals, etc–it was just done quietly. But with the recent round of research showing that many of the risks of elective c/s are on par with the risks for a natural birth, there has been some consideration in academic journals of whether all women should be presented with the choice. My experience was that I was prepared to shop around as much as necessary for an OB willing to do one, but luckily the first one I met believed in patient choice.

    Boris, I have rarely in real life been able to share my birth experiences without others trying to persuade me that it was “wrong.” (Because of the horrid natural birth and wonderful c-sections.) I don’t usually offer it up, but occassionally the “Oh, I’d hate a c-section–that’s major surgery!” comment is something I can’t pass up. I am pleased that the majority of commenters here are respectfully sharing without judging. I do agree with you that intensely personal decisions shouldn’t be discusses at parties, and that’s why the vapid smile–I don’t get into it with these people at parties most of the time. (Instead I suffer silently and then come home and blog about it late at night.)

    I am curious, sociologically, about why women feel the need to share their birth stories (the frequency with which it takes over the conversation is pretty amazing). Are they still processing it? Trying to convince themselves that they did the right thing? Amazed that others were so different? Grasping at the only thing they have to share? I don’t know.

  30. Sue on December 14, 2005 at 2:39 pm

    Woah, Stephen, relax.

  31. Julie M. Smith on December 14, 2005 at 2:40 pm

    Stephen, I’m not entirely sure your post is serious, but just in case it is, please link to your data that c-sections have no higher risk of infections than natural births. (And I could have just as easily used a female cancer patient or dental patient–the point is that only when the pain is something that only women experience does it not end up on the table as a factor to consider.

  32. Julie M. Smith on December 14, 2005 at 3:01 pm

    Andermom–

    Your comment about catheters cracks me up because usually after being pregnant forever and having to, you know, constantly, I consider it a treat (I know, TMI!)! Just proves my point about everyone weighing risks differently, I suppose.

  33. Stephen on December 14, 2005 at 3:15 pm

    “But a c-section (especially if your baby is large) will lower your risks of future urinary and fecal incontinence considerably.”

    This is the part I intended to quote, Julie. My mistake in deleting the sentence I meant to quote and quoting the sentence I meant to delete.

    “And I could have just as easily used a female cancer patient or dental patient”

    Yet you didn’t. You specified “male”.

    “–the point is that only when the pain is something that only women experience does it not end up on the table as a factor to consider.”

    Exactly. Typical man-hating feminist drivel.

  34. Julie M. Smith on December 14, 2005 at 3:20 pm

    Stephen, if you can link us to some data for your position, I’m sure our readers would appreciate having more evidence to weigh. But I’ve read studies indicating that when the baby is expected to be over 9-9, a c/s is recommended because the risk of future fecal incontinence goes through the roof. It is a good thing I didn’t know about any of this before I had my 10-3 baby or I would have flipped out. I am grateful beyond belief that I had no permanent damage from that experience. As a smallish person (5 foot, 1/2 inch) with a huge baby, the odds were not in my favor.

    Further, your final point is typical woman-hating misogynistic drivel. (When you argue your point with an actual argument instead of ad feminam attacks, I’ll do the same.)

  35. Stephen on December 14, 2005 at 3:26 pm

    “Stephen, if you can link us to some data for your position, I’m sure our readers would appreciate having more evidence to weigh.”

    You wrote the article, Julie. You provide the link to prove your point. “I read it somewhere” isn’t exactly sterling journalism.

    “Further, your final point is typical woman-hating misogynistic drivel.”

    Naturally. I point out feminist hatred, so that’s clearly anti-woman.

    My argument is perfectly clear: Your statement is absurd on its face. Ever heard of “menstrual cramps”? Too bad there is no medication for that, and absolutely no effort to alleviate that sort of female-only pain.

    Oh, wait. I guess there is. So I guess your statement that “when the pain is something that only women experience does it not end up on the table as a factor to consider” is proven false.

    “When you argue your point with an actual argument instead of ad feminam attacks, I’ll do the same.”

    No, you won’t. You already failed to do so when I pointed out that your sex-specific examples of a “male cancer patient” and of men not “rallying around the banner of the Natural Dentistry Movement” had nothing at all to do with sex, but that they were artificially sex-specific. Your non-response was, essentially, “I could have said women, but the point is that men don’t care about women’s pain” — which we have already demonstrated to be false.

  36. Julie M. Smith on December 14, 2005 at 3:32 pm

    Stephen, the link to the data is in the original post.

    Your cramps example doesn’t work because the situation is very different from birth: if you take Midol, the goal is simple pain reduction and there isn’t a whole host of other risks and benefits (effect on baby, effect on mother’s future health, etc.) that play into the decision. But when we assess birth options (where there are *many* factors to consider), the desire to minimize pain rarely is given much weight in that calculus. One (among several) reasons for that is that we don’t much care about women’s pain.

    Is there a reason, Stephen, that you are so invested in this issue?

  37. Stephen on December 14, 2005 at 3:49 pm

    “Stephen, the link to the data is in the original post.”

    What, you mean this?

    “[Cesarean section] may reduce the risk of urinary incontinence, which is a common postpartum problem…fecal incontinence, affecting about 4% of women giving birth, is usually a serious problem, and the risk may be reduced by cesarean section.”

    Your statement, “a c-section…will lower your risks of future urinary and fecal incontinence considerably”, is not supported by this paper.

    “Your cramps example doesn’t work because the situation is very different from birth”

    Of course not. It can’t be right if it proves you wrong. Yet what was it you wrote? “I am also very concerned about the downplaying of women’s pain as inconsequential”, and then later, “only when the pain is something that only women experience does it not end up on the table as a factor to consider”.

    Sorry, Julie, but you were proven wrong. Saying “That doesn’t count!” won’t change the fact.

    “But when we assess birth options…the desire to minimize pain rarely is given much weight in that calculus…we don’t much care about women’s pain.”

    Who is this all-encompassing “we” of whom you speak? I’m really curious how you became authorized to speak for me and everyone else. Perhaps this is another false accusation, as when you dishonestly accused me of attacking “ad feminam”.

    “Is there a reason, Stephen, that you are so invested in this issue?”

    Well, let’s see. I have a father, and he is a male. I have brothers, both of whom are male. I have sons, all of whom are male. I, myself, am (you guessed it) male. I have religious leaders whom I greatly respect who are male. A great many friends, other relatives, and admired acquaintances are — that’s right! — male.

    So, yes, you could say that I’m pretty invested in the well-being of men. And when a woman who represents herself as a sister in the gospel instead takes thinly-veiled and ill-considered potshots at men, I do indeed feel the need to speak up and point out her illogic, bad information, and/or hypocrisy, as the case may be.

  38. Karen 8 on December 14, 2005 at 3:56 pm

    Stephen seems to be a little up in arms about such a small part of this post, which really does not seem to me to be feminist anti man. He really must have some other issues.
    And I also have a dad, brother, sons, religious leaders, other relatives and husband who are all male. I’m quite fond of men.

  39. Julie M. Smith on December 14, 2005 at 3:59 pm

    Stephen, since the entire point of this post is to leave the assessment of data to the woman actually faced with the decision, I’m not going to engage you on whether the research says what I think it says. Every pregnant woman should read it and make the decision for herself.

    As for the pain issue, I think you’ve mischaracterized my position from the very beginning. I don’t think there is a male conspiracy to encourage women to suffer; I think there is a cultural norm (which includes women as much as men) that regards the suffering of women as not really important enough to be a factor. Some of this is sexism and some is just tradition based on the fact that the pain used to be unavoidable. It was never my intention to make this about those evil males who want women to suffer. If I haven’t responded to you more clearly up to this point, it is because you’ve substituted vitriol and name calling for making your position clear.

    My use of words like “we” is based on many, many, many conversations with women (and, less often, men) on their birthing decisions. It isn’t meant (as I think this post makes clear) to describe every person, but rather a common pattern in our culture.

    For example, I was recently listening to a woman who is a Bradley method educator explain that during her last homebirth, her pain was so intense that she became convinced that she was actually, literally dying. You would think that this might possibly cause her to consider the fact that medical management of pain just might be a good idea for her, instead of teaching classes that discourage laboring women from using pain medication. Again, I support the right of each woman to do whatever she wants, including choose to experience pain that makes her think she’s dying. But I question a cultural thought pattern that in many, many cases leaves women’s pain off of the table as a factor to weigh in making birth choices.

  40. Stephen on December 14, 2005 at 4:17 pm

    “since the entire point of this post is to leave the assessment of data to the woman actually faced with the decision, I’m not going to engage you on whether the research says what I think it says.”

    Let’s see if I have this straight. When Julie makes a claim, she need not substantiate it. She can provide a link to a document that does not in fact say what she claimed, then merely wave the whole thing off by saying that it’s for each woman to decide on her own if Julie is right. But if Stephen says that Julie is wrong, then Stephen is supposed to produce convincing, documented evidence that Julie is wrong.

    Is that right?

    “As for the pain issue, I think you’ve mischaracterized my position from the very beginning.”

    On the contrary, I’ve merely read what you have written.

    “I don’t think there is a male conspiracy to encourage women to suffer”

    Let us investigate this a bit.

    “I think there is a cultural norm (which includes women as much as men) that regards the suffering of women as not really important enough to be a factor.”

    If it’s simply a “cultural norm” you’re after, and not, as you say, a “male conspiracy”, then please explain the following quotation from your original article (words are yours, EMPHASIS is mine):

    “I think there is a vestige of PATERNALISM in the idea that anyone (whether doctor, mother-in-law, or natural birth advocate) can weigh these risks for another woman.”

    “It is hard, for example, to imagine a MALE cancer patient not being given a choice between chemotherapy, radiation, and surgery…”

    “Again, you don’t see MEN rallying around the banner of the Natural Dentistry Movement.”

    The first example is evidence of classic feminist hatred of men. (In case you have forgotten, the kingdom of God is based on the “patriarchal” order.) I anxiously await your explanation of how talking about “paternalism” has nothing whatsoever to do with “male conspiracy”. The second example would work exactly as well if you simply dropped the word “male” altogether. That is, it would work just as well IF the “maleness” of the conjectured cancer patient were irrelevant. The fact that you included the adjective pretty much proves that you did, in fact, considerit important and relevant. Same with your use of the word “men” instead of, say, “people” in the third example.

    “It was never my intention to make this about those evil males who want women to suffer.”

    Then I eagerly await your explanation for the above examples, which tend to sound exactly like that.

    “If I haven’t responded to you more clearly up to this point, it is because you’ve substituted vitriol and name calling for making your position clear.”

    Naturally. Your failings are clearly my fault, moreso because I am a man.

    “I question a cultural thought pattern that in many, many cases leaves women’s pain off of the table as a factor to weigh in making birth choices.”

    I question the existence of such a “cultural thought pattern”.

  41. The Wiz on December 14, 2005 at 4:30 pm

    It cracks me up when men talk about childbirth. Truly. And why Stephen chooses to attack feminists on a post about childbirth, I’m not sure I’ll ever understand. I guess some people just like a reaction. (Which I just gave him, so I just fed right into it. )

    Thanks for the info on the elective C-section, Julie.

  42. Sue on December 14, 2005 at 4:34 pm

    Don’t feed the trolls…

  43. Carrie W on December 14, 2005 at 4:36 pm

    I’m pregnant with Baby #3. First baby was long labor, but the epidural worked, hooray. Second baby was induced, epidural didn’t work, so I gave birth to a 9-7 baby naturally.

    Does anyone have experience with some pain relief that the nurse can administer so that I don’t have to wait for the anesthesiologist? My hospital is big and crowded and the C-Section ladies take precedence with the anesthesia.

    My post-delivery roommates (yes, roommates, see big and crowded above) have both been C-Section. The nurses are always in there, fiddling around with IVs and asking the “Have you passed gas?” question and I truly feel lucky not to have to go through the joy of some woman asking me about passing gas.

  44. Adam Greenwood on December 14, 2005 at 4:39 pm

    For the record, my wife chose to have a natural child birth. Contra Julie in S.’s suggestion, she was not railroaded into it by a patriarchal culture or a blizzard of misinformation or whatnot. Having been exposed (by my wife) to the women who advocate natural child birth, I find it farcical that anyone could think this is what’s behind the natural childbirth movement. Maybe Texas really is a different country.

  45. Greg Call on December 14, 2005 at 4:46 pm

    Julie: I have a simple, nonjudgmental question that I didn’t see discussed: Does having multiple c-sections limit the potential number of children a woman can bear?

  46. Adam Greenwood on December 14, 2005 at 4:49 pm

    “I find it farcical that anyone could think this is what’s behind the natural childbirth movement.”

    “this”=patriarchal indifference to women’s pain and women’s perspectives

  47. Julie M. Smith on December 14, 2005 at 4:49 pm

    Once again, Stephen, you haven’t linked to any data. I have. I’ve asked that for this discussion, people provide data and leave the evaluation of it to each individual. Hence, I won’t engage you further on this.

    Stephen, you continue to misread my position on the pain issue. You don’t seem terribly interested in understanding my position, so I don’t see any point in continuing this conversation. I won’t engage you further on this, either.

    Adam, I’ve read from your wife some of the special considerations that went into your wife’s decision for natural childbirth, and I respect them 100%. She’s the last person who I think was affected by misinformation. I’ll suggest that your third-hand exposure to natural childbirth advocates may leave a little to be desired, while recognizing that not every advocate of anything is advocating exactly the same thing with the same arguments. I can assure you that in Austin and Northern California and in homeschooling circles (which, I’ll admit, all three are out of the mainstream of American culture), I encounter(ed) many, many natural birth advocates in line with what I have suggested above. I’m glad that your wife’s experience has been different, but that isn’t the case for many other women.

  48. Adam Greenwood on December 14, 2005 at 4:52 pm

    I have yet to meet a male natural-birth advocate. But I have met them. Why you think my experience is ‘third-hand’ is beyond me.

  49. Julie M. Smith on December 14, 2005 at 4:54 pm

    Greg, the data here is not as complete as anyone would like for it to be, but what I have seen is that even those physicians who are comfortable with elective c-sections wouldn’t recommend them to women planning on more than, say, 4-5 c-sections. But since electives are so rare and families that large are so rare, the issue rarely comes up. Which, of course, isn’t to say that a woman drops dead on the 6th surgery, just that various risks go up. Thanks for mentioning it though, because it is certainly is a factor to consider.

    And Adam, I don’t think indifference to women’s pain is “behind” the natural childbirth movement, just that when natural childbirth advocates assess risks, they generally don’t consider the risk of intense pain in their calculus. If that is a woman’s personal decision, I’m all over that, but I’m not OK with inflicting that reasoning on other women if their assessment is different.

  50. Julie M. Smith on December 14, 2005 at 4:55 pm

    Adam, I thought it was third hand because you wrote “Having been exposed (by my wife) to the women who advocate natural child birth.” I read this to mean that you personally hadn’t been exposed to the advocates, but rather that your wife had related her experiences to you. If I read you wrong, you can clarify for me.

  51. Adam Greenwood on December 14, 2005 at 4:58 pm

    Well, I’m with you there. Most of the advocates I met were a little enthusiastic for my taste (I was kind of dubious about the whole thing until it actually happened).

    But I don’t think that doing away with pain requires c-sections. Drugs work pretty well. I’m sure that there’s some minority of women, yourself among them, for whom elective c-sections are a good idea, but for most?

  52. Adam Greenwood on December 14, 2005 at 5:00 pm

    My wife introduced me to them. Anyway, even if your reading were correct, I would still have at least second-hand exposure, wouldn’t I?

  53. lyle on December 14, 2005 at 5:11 pm

    My thanks for the comments; esp. as my wife is currently evaluating choices for an impending birth and I’m sure she will enjoy the discussion.

    Note: Does it matter when a C section is chosen for non-medical necessity reasons?
    Factoid:I was told that the hospital we are going to has an 85% epidural rate; largely due to the high level of C sections.

  54. Julie M. Smith on December 14, 2005 at 5:12 pm

    Adam, I never suggested that c/s (or epidurals, or home birth, or anything) should be done by any % of women. Each woman should make her own choice; let the percentages fall where they may. As various technologies advance, I would expect the percentages to change, as well. (A c/s was _not_ nearly as safe 30 years ago as it is now, for example.) (As a side note, a study of female OBs in Britain found that 1/3 would choose an elective c/s for themselves.)

  55. Julie M. Smith on December 14, 2005 at 5:13 pm

    lyle, I don’t understand your question: Does it matter to what?

  56. Greg Call on December 14, 2005 at 5:19 pm

    Thanks Julie. I would think that at least some LDS women would be interested in this risk factor when considering an elective c-section.

  57. Stephen on December 14, 2005 at 5:29 pm

    “Once again, Stephen, you haven’t linked to any data. I have.”

    Your data do not support your assertions. My arguments are not data-related, so I feel no need to provide data. I am questioning the basis of your line of reasoning, such as it is.

    “I’ve asked that for this discussion, people provide data and leave the evaluation of it to each individual.”

    This is, of course, bogus. Your article and the comments that follow are not merely a recitation of data, nor do they make any attempt so to be. They are *analyses* and *interpretations* of data. I am saying that your analysis and interpretation is bad, and the way you present it is skewed.

    “you continue to misread my position on the pain issue. You don’t seem terribly interested in understanding my position, so I don’t see any point in continuing this conversation.”

    You don’t seem terribly interested in owning your words. Why is that? I’m all for not anal-retentively holding someone to an absolutist interpretation of their words, making a man (or woman) an offender for a word, so to speak. But when your essay drips with thinly-veiled feminist venom against men, as I have pointed out at least twice and as you continue to ignore, I say that’s fair game for comment.

    Wiz, I’m happy you’re so entertained by men talking about childbirth. Here’s a real hoot: Some men even talk about PREGNANCY! Ha, ha! Who’da thunk? There ya go, a little midday laugher for you.

  58. Adam Greenwood on December 14, 2005 at 5:30 pm

    “Each woman should make her own choice; let the percentages fall where they may.”

    That’s you, Julie in A.–only judgmental of people who judge. But that’s not me. If everyone elected to do a c-section, I would think it a pity.

  59. Julie M. Smith on December 14, 2005 at 5:43 pm

    Stephen–I was serious when I said I was finished. I won’t be engaging you.

    Adam, if _everyone_ elected to do a c-section, I would think it a pity, too, because there are real risks and if 100% of women reached the same conclusion, I would think that they were doing something besides weighing evidence and doing what was best for them personally. So you caught me–I guess the percentages do matter at a certain point. But in reality, I don’t think that is a possibility on the table, and I don’t want to say that 1 or 5 or 20 or 80% of elective c-sections is what _should_ happen. That’s what I meant by letting the percentages fall where they may.

  60. Jesse on December 14, 2005 at 6:06 pm

    This article Localio, Russell et al., Relationship Between Malpractice Claims in Cesarean Delivery, JAMA Vol. 269, January 20, 1993, p. 366, makes some pretty clear conclusions about the link between fear of malpractice suits and a higher rate of cesarean section.

    Anyone considering any major surgery should get at least two opinions and you should certainly be aware that finances do indeed drive medical decision making. There is a rather extensive body of research demonstrating a difference in physician practice patterns on a geographic basis, without clinical justification. And interestingly, those living in areas where they tend to have the highest volume of more intensive services are not experiencing any better health outcomes. Dartmouth has sponsored a lot of that research. I forget the name of the guy who’s done it.

    The upshot is, if someone is offering to cut you open, you should A) ask whether they’re going to get paid more money for it (for less time, at that), and B) find out, if you can, the rate at which they tend to cut people open, versus the national rate, or what is a recommended rate by that physician’s specialty. And you should know that the hospitals definitely get paid more for a cesarean, so they have an economic interest in seeing that rate go up too.

    Virginia has a pretty good site for OB/GYNs and their individual cesarean rate. It’s http://www.vhi.org/phys_ob.asp

  61. Stephen on December 14, 2005 at 6:48 pm

    “Stephen–I was serious when I said I was finished. I won’t be engaging you.”

    Pity. I thought you would be intellectually honest enough, at least, to respond to critiques of your flawed analysis. But if you want to plug your ears and sing loud, that’s okay, too.

  62. Chad Too on December 14, 2005 at 6:59 pm

    Adam, re #58:

    Could you elaborate on why it would be a pity? As an adoptive father, I have no experience directly with choosing how to bring a baby into the world, but ultimately bringing a healthy baby into the world is the goal. What difference is there that makes it deserving of pity?

  63. Minerva on December 14, 2005 at 7:52 pm

    I know I should be ignoring Stephen, but I just can’t let the following go:

    He quoted Julie: “I think there is a vestige of PATERNALISM in the idea that anyone (whether doctor, mother-in-law, or natural birth advocate) can weigh these risks for another woman.�

    And replied: “The first example is evidence of classic feminist hatred of men. (In case you have forgotten, the kingdom of God is based on the “patriarchalâ€? order.) I anxiously await your explanation of how talking about “paternalismâ€? has nothing whatsoever to do with “male conspiracyâ€?.

    You should notice, Stephen, that when Julie listed those who possibly perpetuate paternal ideas, she included people who either can be or are of necessity are women (mothers-in-law are always women; natural birth advocates are likely to be; doctors often are). And yet you said that this example is evidence of a “classic feminist hatred of men.” I fail to see how. Paternalism is NOT a male ‘conspiracy.’ Most things that feminists are trying to change are not ‘conspiracies,’ if you take conspiracy to be an intentional plot. What feminists usually address are attitudes and practices that may be unhealthy for women that have gone uncontemplated because many of those in power in the realms of politics, education, religion, healthcare, etc., are usually men. This is not saying that these men thought “oh, let’s all get together and agree to ignore women’s needs”; it is suggesting that because women’s voices have not always been heard in power and decision-making, women’s needs have not been given enough consideration. This is paternalism: a bias toward the male and an insufficient consideration of the female, and it can be carried on by either sex because it is often invisible if not contemplated.

    And moreover, Julie is a woman who is married to a man and I highly doubt she hates him. You seem to have an idea that all feminism is anti-man. It isn’t! Many feminists really are just most concerned with revealing attitudes that have been passed along without thought by both sexes that are potentially damaging to women. I do not think there is anything threatening in this type of truth-seeking, and I hope you can learn to not be threatened by it.

  64. B on December 14, 2005 at 7:56 pm

    If pain mitigation is important to a woman, surely she will ask the natural childbirth advocate, “how does pain mitigation figure into the process?” Are pregnant women not thinking to ask that question, or are the natural childbirth advocates responding in a deceptive manner? If neither, then I don’t see a problem with natural childbirth advocates giving pain mitigation a low priority in their approach to childbirth. I don’t see how they’re “inflicting that reasoning” on anyone. They advocate their reasoning to those interested in hearing it, and those others are free to accept or reject that reasoning and do their own reasoning while they’re at it.

    I agree with Boris Max that the real problem is probably that intensely personal decisions shouldn’t be discussed at parties. It’s hard to politely tell a fellow party guest that you’re not interested in hearing their reasoning on an intensely personal matter.

  65. Julie M. Smith on December 14, 2005 at 7:58 pm

    Stephen, I don’t feed trolls.

  66. Julie M. Smith on December 14, 2005 at 8:02 pm

    B, to the extent that the scenario that you outline in your first paragraph is accurate (and it is in many cases), I fully agree with it. To the extent that some natural birth advocates pressure women to avoid medical pain management techniques (whether epidurals or cs) by acting as if pain doesn’t matter, they are inflicting their risk/benefit assessment on others. This does happen; in fact, it has happened to me on several occassions, despite the fact that I avoid entering discussions about it with natural birth proponents.

  67. Minerva on December 14, 2005 at 8:09 pm

    I think it would be sad if people stopped discussing child birth at parties. I love hearing about people’s experiences. I grew up in Salt Lake and practically everyone I know gets epiderals and so I think my experience at parties has been different from yours, Julie. Generally the younger generation talks about how much they love epiderals and how it doesn’t make them feel like less of a woman because they get them (there is usually not someone there implying this; the women just kind of re-present those arguments they must have heard somewhere else), and the older generation talks about how horrible it was in the days before such great advances in pain meds.

  68. queuno on December 14, 2005 at 8:25 pm

    Being a male, I don’t get to have any opinion as to the method of delivery. We’re having #3 next Tuesday (scheduled C-section). The first was an emergency C-section. The second was scheduled. The problem is that my wife doesn’t go into labor — even when induced (and with the first one, after 2 weeks, you’ve got to take them sometime).

    My wife loves the C-section. With #2, she was up and walking around the next day. She’s a quick healer.

  69. Beijing (formerly known as B) on December 14, 2005 at 9:33 pm

    Sorry, my computer is not remembering that I’m “Beijing” now.

    Julie, I apologize for still not understanding how “inflicting their risk/benefit assessment” is possible when the other party is a competent (and in your case, dare I say feisty) adult. Did they hypnotize or brainwash you into unthinkingly refusing all drugs under all circumstances? Did they physically get between you and the doctor when you tried to ask for drugs? If not, then I just don’t understand how they have been anything worse than impolite to someone eminently capable of making her own decision.

  70. Julie M. Smith on December 14, 2005 at 9:59 pm

    Beijing, I think a good example of inflicting risk assessment can be found in the very first comment on this thread, with its plea that c/s be avoided “for the sake of the baby.” Now, a competent adult should be expected to do her own research and determine what is in the best interest of her baby, but it doesn’t change the fact that that comment is designed to convey that someone choosing a c/s isn’t doing the best thing for her baby.

  71. Julie M. Smith on December 14, 2005 at 10:07 pm

    A few more thoughts:

    (1) You know, Beijing, it may just be that what I am calling “inflicting” you are calling being “impolite.” So it may just be a semantical difference.

    (2) I’m thinking back to my first birth and what I was told in prenatal care and in birthing classes (and the books I read, etc.) and when I compare that information to what I have learned since, it does seem that the benefits of c/s were neglected (c/s was presented as this scary thing that you needed to be prepared for Just In Case) and the risks of natural birth were downplayed. I’m not sure if this is a representative experience. So, no hypnosis or brainwashing, but I do think I was given a skewed presentation of the risks involved.

  72. Beijing (formerly known as B) on December 14, 2005 at 10:13 pm

    I think stating/implying that someone is not making the best choice for her baby is impolite. In fact, downright rude. But I do not think it takes away the ability of the listener to make her own risk assessment. I think “inflicting risk assessment” implies that one person is forcing their assessment on someone else, removing that person’s ability to choose for herself. But the natural childbirth advocates are not really forcing women to do what the advocates think is best; they’re just being rude (some of them).

  73. Julie M. Smith on December 14, 2005 at 10:16 pm

    OK, #72 confirmed my suspicion that we had a semantical problem and not a real one. Maybe I could have said “attempting to inflict,” because no woman should accept the inflicting, but the attempt is still rude.

  74. Beijing (formerly known as B) on December 14, 2005 at 10:16 pm

    (1) You’re right, it’s a semantical difference. A difference in what the words mean.

    (2) Doesn’t one expect a “skewed presentation” from an “advocate”? Next you’ll tell me that the missionaries failed to warn you about all the risks of church membership. :)

  75. Julie M. Smith on December 14, 2005 at 10:18 pm

    Re #74 (2)–that’s why I am taking up the role of Unnatural Birth Advocate–because no one else is doing it.

    (And if the sisters who taught me had so much as hinted that I’d spend a good chunk of my life searching for fifteen-cent CTR rings at the behest of sobbing 4 year olds, I would have been out of there like a flash.)

  76. Seth Rogers on December 14, 2005 at 10:32 pm

    You know, it isn’t always just the woman’s choice how to do the pregnancy.

    The doctors seem to have a lot of say too.

    For one thing, I’m pretty sure that once you’ve had a C section, the hospital will insist on performing all subsequent pregnancies via C section.

    Actually, you might say there’s kind of a C section craze among OB-GYNs. Malpractice liability is so high these days for baby deliveries that the delivering doctor will typically be pretty quick to switch to C section mode at even the slightest hint of complications. A lot of unnecessary C sections are performed in the US simply out of desire to avoid possible malpractice liability.

  77. meems on December 14, 2005 at 10:33 pm

    All hail the mighty epidural. My pain was so intense (pitocin and back labor – or “sunny side up”) that I begged to be put out of my misery. With the second baby, he came so fast that I didn’t have an epidural,but a localized shot, that helped me relax enough just to get the baby out. With all that pain, I was so tense that I couldn’t dilate any more. Vive le pain meds!

  78. LisaB on December 14, 2005 at 11:16 pm

    I was wondering when you would bring this up here, Julie. If anyone is interested, Julie and I discussed this at some length on Exponent II’s listserve earlier this year (spring?) after I’d introduced myself as a childbirth educator on the list. She’s read and critiqued a chapter that I’ve written about natural pregnancy and childbirth for an LDS natural parenting book that will likely come out next spring.

    I will act as Julie’s straw-woman here. :-) My husband (Jesse above) and I gave birth at home with a Certified Nurse Midwife (CNM) and non-nurse birth assistant/doula in attendance. I am a fairly rabid natural childbirth proponent who hopes that if given the data on the safety of birth and the risks of interventions, most women and men will be more cautious/less cavalier about medical interventions in birth. I hope this even moreso for LDS women and men given our beliefs about the sanctity of the body, the commandment to multiply, the desire to not tamper with the fountains of life, the view of parenthood as surrogate/spiritual fostercare anyway, the importance of choice and accountability… but agree that each couple should educate themselves and take responsibility for making the ultimate decisions about their pregnancies and births–not their midwife or doctor (even if their healthcare provider is also a church member in a leadership position), not their OB nurse, not their extended family members, friends, childbirth educators, those horrible baby story fear-inducing high drama birth TV shows, the perinatologist… Here Julie and I agreed in our previous discussion. But (as with Julie and Stephen here) we disagree in how we interpret the data and weigh the risks.

    The one distinction I would point out for this discussion is that when Julie says there are also risks inherent in natural birth, just “different risks”–that we are comparing divinely designed and naturally occuring risks (pain, stretching, tearing) versus risks created or assumed by people (the risks inherent in the hospital environment like infection and the effect of impersonal care on the physiology of labor, the disruption to the hormones of birth, the effect of supine positioning on labor and birth, the risks of drugs in labor to mother and baby, effects on bonding and breastfeeding success, the risks of induction including prematurity, cord prolapse, placental problems, uterine rupture, failed induction…) That is the difference. It is one thing to assume these risks when there are already risks in play (life/health of mother or baby). It is another to do so electively/ for convenience/to avoid temporary pain/ or even for the convenience of the medical provider (more common that I would like to believe). Yes, I am making a judgment call here.

    To those who have asked, yes, C-sections not only increase risks for future pregancies by increasing complications like placental problems and chances of uterine rupture, but also reduce fertility. This is not a concern for a medical professional who thinks 2 children more than enough, but will be a concern for many Latter-day Saints. Cesarean surgery also multiplies the risk of maternal mortality without improving outcomes for infants (across the board. There are legitimate indicators for cesarean surgery and it can be life and limb-saving. Thank God for it. But these days, because of soaring surgical birth rates, maternal mortality is again on the rise in the United States).

    When I teach birth classes, I am very open with my clients about the pain likely being the worst physical pain they will likely ever experience and try to describe it for them in some detail. I am clear the drugs are the most effective method of childbirth pain relief. The goal of childbirth education/ preparation is not pain relief. If your childbirth educator tries to sell you this fairytale, find a new one. The rates of induction and epidurals are high not because of C-sections, but because pregnancy is difficult and stressful and a burden, and birth hurts like hell. But C-section rates are what they are in part because of induction and epidural rates.

    Yup, pregnancy and birth are inconvenient and painful. Life-changingly so. “By divine design.” I think that’s why women tell and retell their birth stories. They are rites of passage much like missions are. I don’t see you as a sole advocate, Julie. Contrariwise, you are more than in the mainstream. 98+% of US women give birth with drugs & surgery. C-section rates in my area are around 1 in 3. 1 in 3. That’s astounding. I actually think natural childbirth is an endangered species. We are losing our very comprehension of birth, and with it, some key scriptural and ritual symbols for redemption. (I know, I sound like Prudence.) :-)

    Queuno–you don’t HAVE to get them out some time. They will be born some time. Without induction, 5% of babies go 3 weeks post-date. This is within normal range. We are just impatient. 40 weeks is an estimate anyway. The average for uninduced first-time mother is 8 days post-date. The average for uninduced birth thereafter is 3 days post-date. A study that looked at using due weeks instead of dates demonstrated that having a broader range in mind only reduces interventions. So inductions are not really benefiting babies. In fact many induced babies are premature since late sonogram estimates are relatively inaccurate anyway (1 lb either direction).

    Okay, I’m ready–aim, FIRE!

  79. Julie M. Smith on December 14, 2005 at 11:43 pm

    LisaB–I’m so glad you commented; I was hoping that you would. My very lengthy discussion with you on the listserv was very useful in refining my thoughts on risk, and I’m glad to see you state your position here. I’ll note the following places where I disagree with you, although I am genuinely pleased with what you wrote and would encourage any pregnant woman to closely consider your position.

    (1) You priviledge natural risks over medically-created risks. This is fine–for you. But there’s no theological reason for anyone else to do this. For example, Pres. Kimball chose the medical risks related to his throat surgery over whatever the natural risks would have been for not having the surgery. Same with all of the leaders who have had Elder Nelson’s hands in their hearts.

    (2) I think that you inaccurately state the risks of c/sections, but I also think that there is no point in us debating it here. What I recall from our extended debate on the listserv is that your evidence either (1) was quite old, and therefore reflecting the fact that c/s really did used to be riskier and/or (2) didn’t separate purely elective c/s from c/s done for some underlying condition. You should provide links to your data and our readers can compare your studies with mine and make their own evaluations.

    That’s it. I don’t have any other quibbles with you today :).

  80. queuno on December 15, 2005 at 12:43 am

    Lisa –

    Agreed that they eventually come on our their own. But, in our case, C-section is the best medical option. There is a family history of complications with (non-)labor (and not just my wife).

    I don’t want to get into a war of whether C-section was essential or not. With the first, the doctors made every good-faith attempt to do it naturally, until it became medically expedient to do a C-section (baby went into distress, with her heart almost stopping, while my wife wasn’t even beginning to dilate after nearly a half-day after attempting to induce). With the second, we compared family medical histories and percentages and cause-and-effects and recovery times, etc., and opted for a C-section. With the third, there’s no talking my wife out of this one.

    Maybe I trust too much in the arm of the physician flesh, but I think the Lord wants us to put our faith in the hands of those who are prepared. So when they recommend C-section, I tend to concur and then leave the decision to my wife.

  81. Erica on December 15, 2005 at 12:45 am

    I think I’ve finally found a reason to actively support elective c-sections- I prefer those birth stories. While I know that many women love birth stories, I’m not one of those. It makes Enrichment meeting difficult when I accidently sit with a 20- or 30-something group of mothers. I’ll have to find the elective c-section women and sit with them. Their stories are far more pleasant to listen to- no pain, no anguish, just the joy of a new baby.

    FWIW, I’ve only had natural births (and will again, if possible), but I honestly couldn’t care less how other women give birth. However, I’d go with a D&C if I have another miscarriage. Miscarriages hurt a lot and you get nothing for it. I never felt the least bit empowered after any of my “natural” miscarriages. I know the risks of a D&C and at this point, they’re worth it.

  82. Russell Arben Fox on December 15, 2005 at 1:10 am

    LisaB, thanks very much for your contribution to the thread–it was clear from the beginning that Julie was shadow-boxing with a particular position, and it’s good to be able to see that position clearly.

    If you’re willing to stick around and answer an impertinently ideological question, let me ask: to what extent does the apparent grounding for your “fairly rabid” advocacy of natural childbirth–namely, as it appears to me in your post, a conviction that there is a holiness to be found in the natural processes of the body, a holiness that is undermined by our modern concern for convenience and our technologically enabled distaste for the actual limits and designs which God has built into us as humans–lead you to other critiques besides that of contemporary childbearing practices? Do you, for example, have questions and doubts about the role which hospitals, doctors, and expensive funeral parlors have come to play in the way we die? How about the food we eat, or the jobs we perform: do you feel, as do a great many others, that we’ve distanced ourselves too much from the earth, from work that requires the sweat of our own brows, from simpler rhythms of life? In short, I guess I’m asking: have the concerns which led you to advocate natural childbirth also made you counter-cultural? Or do you focus on natural childbirth because you think this is a unique problem in our society, and you haven’t felt it to be a part of any kind of larger cultural concern?

  83. Julie M. Smith on December 15, 2005 at 1:16 am

    “it was clear from the beginning that Julie was shadow-boxing with a particular position, and it’s good to be able to see that position clearly”

    Just to clarify, the impetus for this post was someone I met at a party recently and not LisaB. From what I can gather, there are some important distinctions between their positions.

  84. Larrea on December 15, 2005 at 1:23 am

    Julie, thank you for writing this post. This thread is quite pertinent to me, as my husband and I have recently found out that we are expecting our first child, and I am admittedly a bit nervous about the whole thing. I am a bit older than the average first-time mother, old enough that the irrational exuberance of youth with its assumption of immortality has worn off a bit, and the reality of my own mortality and frailty has started to sink in. I am entering my pregnancy with no expectations of how my pregnancy should go or what it should be. I believe I understand the desire for a natural child-birth. There may be truth to LisaB’s statement “pregnancy and birth are inconvenient and painful. Life-changingly so. ‘By divine design’… We are losing our very comprehension of birth, and with it, some key scriptural and ritual symbols for redemption.â€?
    On the other hand, by divine design, shouldn’t my husband earn our living by the toiling in the fields, fighting thistles and providing food for his family by the sweat of his brow? Instead, he works in an air-conditioned thistle-free office, at a job he likes, and I have yet to see him arrive home soaked in sweat. I do think that our modern society has insulated us from nature, and in many ways we are spiritually poorer for it. But as much as I love nature, as much as I marvel at nature, as much as I am inspired by nature, I’ve been around nature long enough to know it is a harsh fickle beast. My family history is littered with the early deaths of ancestors who fell at nature’s mercy, not because they were heroic, but because they had no choice. Therefore, instead of depending on subsistence farming, I garden only because I personally find some deep satisfaction in doing so. I do not look down on my husband because he is not experiencing the sweetness of laboring in the fields. For if the crop fails, and crops will fail, our family will still be fed. I am happy for my husband that he can provide for his family doing something he enjoys, rather than something he despises. He grew up on a farm, so he knows the work involved, and decided early on that he was meant to do something else in his life. Likewise, although I harbor some romanticism for a natural birth, I will not be disappointed if the birth is completely medically assisted. I also do not believe I need to experience every labor pain to be a good mother, nor more than I believe my husband should be toiling in the fields to be a good father. Yes, spiritual insight can be gained by both of these activities, but the costs may be great, and we are lucky enough that we have choices in the matter. I only hope the child is healthy, and I am healthy enough to take good care of her.
    Larrea

  85. Gary on December 15, 2005 at 5:14 am

    Twenty-five years ago, there was a flap in the Ensign over home birth. It began with a question and answer article titled “Staying Healthy: Welfare Services Suggests How” (Jan. 1981, 10) which contains this tidbit:

    Q. There seems to be a movement toward giving birth at home, rather than in hospitals. What are the advantages and disadvantages?

    A. There is little available medical data on the safety of home deliveries. One of the most recent studies suggests that the infant mortality rate is at least twice that of hospital-born babies…. (See Burnet, et. al, “Home Delivery and Neonatal Mortality in North Carolina, 1974–76,” unpublished.)

    Three months later, in the “Comment” section of the Ensign (Apr. 1981, 79), the following letter appeared:

    On home deliveries

    One of your readers has called my attention to the note on home deliveries (January 1981 issue, p. 14). That note cites an article by Burnett et al. on experience with home deliveries in North Carolina during 1974–76. I was involved as co-author of that study.

    The note places an interpretation on our findings which I think is not appropriate. Our study showed that home deliveries which were 1) carefully screened for low risk, 2) were attended by trained people, and 3) had supervision and consultation readily available were associated with less neonatal mortality than hospital deliveries. The data show that home deliveries which might be hazardous are those which are unintentional, unplanned, and unattended by trained personnel.

    Many comparisons of the relative safety of hospital and home deliveries have been made. Home deliveries appear more dangerous only if data on the unattended and unintentional home deliveries are included.

    An appropriate interpretation of our study would be that childbearing among healthy, well-cared-for women is a happy and reasonably safe experience, but it is not free of risks. Some risks are associated with well-planned home deliveries; different risks are associated with deliveries in hospitals. Women might best become well informed about both kinds of risks and then elect which they desire to assume.

    C. Arden Miller, M.D.
    Professor and Chairman
    Department of Maternal and Child Health
    University of North Carolina at Chapel Hill

    At the time the January Ensign article was being prepared, the Burnett article had not yet been published. However, by January 1981, the Burnett article was in print—in the Journal of the American Medical Association. (See Claude A. Burnett III, M.D., M.P.H., et al, “Home Delivery and Neonatal Mortality in North Carolina,” JAMA, Dec. 19, 1980, vol. 244, no. 24, pp. 2741-2743.)

    According to the Burnett study, babies born in the hospitals of North Carolina died at the rate of 12 per 1,000. After excluding infants weighing 2,000 grams or less at birth, the figure dropped to 7 per 1,000.

    Home deliveries, without regard to their planning statues, were associated with an infant mortality rate of 30 per 1,000 live births. On the surface, this would seem to suggest that the infant mortality rate for home deliveries was at least twice that of hospital born babies. When subdivided by their planning status, however, a different picture emerged.

    The infant mortality rate was 4 per 1,000 for planned home deliveries attended by lay midwives; 30 per 1,000 for planned but unattended home deliveries, and 120 per 1,000 for unplanned home deliveries.

    These figures show how quickly the home birth risk rate rises when the unplanned and unattended out-of-hospital births are not first excluded. It is also worth noting that the study involved lay (not nurse) midwives.

    Regarding those infant deaths that occurred following planned home deliveries attended by lay midwives, the authors of the North Carolina study observed that all “were associated with congenital anomalies and may not have been preventable.”

    As Dr. Miller said in his letter to the Ensign, “Some risks are associated with well-planned home deliveries; different risks are associated with deliveries in hospitals. Women might best become well informed about both kinds of risks and then elect which they desire to assume.”

    My wife and I have nine children, all living. The first five were born in a small town hospital. The last four were planned home deliveries attended by lay midwives. Thanks, Julie, for this post!

  86. LisaB on December 15, 2005 at 10:02 am

    In order:

    Julie: Funny that you bring up President Kimball. He believed medicine and surgery should be last resorts. I’ll see if I can round up a good quote for you from the article I cited in my chapter. I myself use analgesics quite extensively–at least once a month anyway, and I have had elective surgery. 8 hour surgery. Semi-cosmetic (oral) but not without medical cause, too. Just to point out that I am not someone opposed to the use of medicine and surgery even in less than clear life-or-death situations.

    Yes, you didn’t like that some of the studies were older. That doesn’t mean their results should be dismissed out of hand. I agree that Cesarean surgery (as with all surgery) has gotten safer due to improvements in tools, techniques, sanitation, improvements in minimizing and counteracting the risks of anesthesia use in pregnancy, and even the experience of providers doing it. Natural childbirth has also gotten safer due to better available nutrition, more knowledge about risks of drug use in pregnancy, better sanitation, more readily available medical attention in the event of emergencies, and even the experience of providers attending out of hospital births. But surgery still carries a greater risk of death than even medicalized vaginal birth–even if the risk is comparatively low (as you brought up last time). And fairly recent studies have confirmed the safety and good outcomes of home birth and vaginal birth after cesarean surgery rather than the reverse. I don’t think these facts are even in question or really what we’re discussing here anyway. But nonetheless I’ll try to get back to post some links later when I have some time to do so.

    What we are really talking about here is the question of whether or not elective cesarean surgery is ethical. I think there may be legitimate medical reasons for your cesareans, Julie, but we’ll set that aside for now ’cause it’s just really not the blogworld’s business. Until very recently, when a few obstetricians have begun to argue to their peers in favor of the ethics of offering and performing elective cesarean surgery by (IMO) exaggerating the risks of (medicalized) vaginal birth, cesarean surgery has fairly universally been considered unethical based on the obligation of doctors to first do no harm. With other elective surgeries (such as cosmetic to use the extreme for the sake of argument) no other person is involved besides the individual requesting the surgery. Usually I hate mother against baby arguments in childbirth since usually what is best for mother is also usually what is best for the baby. But with elective cesarean I believe that is what is ethically at stake.

    So can we get to nuts and bolts here Julie and lay out the actually risks that we’re talking about and that have contributed to the reticence of the obstetric world to offer cesareans on demand in spite of their willingness–even eagerness in our current litigious climate–to perform cesareans on any medical pretext instead of pretending the risks are pretty much equal?

  87. LisaB on December 15, 2005 at 10:28 am

    Queuno–I agree that it is important to seek qualified providers we feel comfortable with and appreciate their expertise as they advise us. From your description, it seems clear that the first cesarean was necessary. Inductions often cause fetal distress and make surgery necessary because neither mother or baby’s bodies are ready for birth. This is one of the risks of induction– it’s called cesarean due to failed induction. Sometimes the risks of not inducing (like when a woman has pre-eclampsia) are greater than the risks of induction (including surgery when it fails). Usually couples are not even informed of the risks when they are given the choice (or simply told what the doctor recommends). Here I think Julie and I agree that fully informed consent is the ideal. This is almost impossible in an emergency setting, and is very difficult once labor has commenced. At any rate, I am not here to judge anyone’s individual decisions or experiences–the factors are just too complex. And I seldom think blame is productive anyway. I believe parents by and large make the best decisions they can for their families in whatever circumstances they are in and with whatever information they have at the time.

    As I’ve stated above, we’re not even talking about medically necessary cesareans here. We’re discussing Julie’s thesis that any woman ought to have the right to chose to have her baby surgically removed rather than born even in there are no medical reasons why surgery ought to be performed.

  88. LisaB on December 15, 2005 at 10:30 am

    Russell–I’m not so rabid as I charicature for the sake of keeping this light. Birth discussions are usually very emotion-laden and can get ugly. I respect Julie too much to let this happen here.

    To answer your questions, yes to all except the last.

  89. LisaB on December 15, 2005 at 10:46 am

    Larrea–Congratulations! I’m excited for you. Yeah, it does seem “fair” for us to have easier life labors (not just birth itself–but the life-long work of mothering–diapering, laundry, food preparation, etc.) since our husbands do, too. And I think sweat is undervalued these days in general. Are your children at physical risk as a result of your husband working in an air-conditioned office? Hmm… maybe so but that wasn’t my point. Not directly so anyway. So it’s kind of a different set up. Don’t know why, just is. Feed yourself/your baby well, rest well, exercise moderately, avoid medications (even OTC), junk food, caffeine, and other harmful substances if you can, and enjoy your pregnancy. These factors have far more to do with avoiding complications and ensuring a healthy baby than anything else.

  90. Kat on December 15, 2005 at 11:57 am

    Can someone please tell me how to insert a link into a comment? I am anxiously waiting to post, but the OP asked for links to data, and I want to provide them. Thanks!

  91. Not Ophelia on December 15, 2005 at 12:22 pm

    you don’t HAVE to get them out some time. They will be born some time.

    Well, I supose. The question is at what cost.

  92. Kat on December 15, 2005 at 1:14 pm

    I believe that LisaB’s comment (“You don’t HAVE to get them out some time. They will be born some time.”) was referring to the practice of artificial induction of labor, not to the medical complication of prolonged obstructed labor. They are two separate issues.

  93. JA Benson on December 15, 2005 at 1:31 pm

    On the lighter side. My fourteen year old son looked over my shoulder as I read some of the comments last night. After a moment he commented, “Sucks to be you Mom. I’m glad I am a man.�

  94. claire on December 15, 2005 at 1:54 pm

    Julie, wow. Very interesting. You, and some others, may remember us discussing this on another post earlier this year.

    I think we are all very deeply affected by our own personal experiences when interpreting the data. If your first birth had been an empowering experience, rather than one that went completely against what you had planned, I think you’d feel differently, as would I. As it stands, with three drug-free labor and birth experiences, it is hard for me to think of any data that would convince me that, statistically, elective surgery is a good option for someone who has never given birth to consider.

    The factor that hasn’t been considered here is that choices are made during the labor that affect the outcome. Many people have, in what feels like a judgement on my decision to birth at home, mentioned that “they (or their baby or both) would have died if they had a home birth.” This is assuming that their labor/birth would have progressed the same way at home as it did in the hospital or if they had had a different caregiver. What you do or don’t do during your labor affects how it progresses; if a woman doesn’t have support, information, and help from her caregivers to help her labor progress, she is more likely to _need_ medical intervention that she might not have _needed_ otherwise. There are many possible outcomes for any given labor; what women need to do is prepare themselves, consider options, and choose a caregiver that is going to be there to help their labor progress optimally. This is why we chose a Certified Professional Midwife to assist in our most recent birth 8 weeks ago.

    I was just yesterday discussing childbirth with a neighbor, who was left alone to lay in a hospital bed for hours not knowing what to do, ended up with an epidural of course and felt completely out of control and unhappy with her birth. On this point, I think Julie and I agree… prepare and inform yourself.

    There is ‘pain mitigation’ available other than drugs… education/information being the first. And please don’t tease those of us who believe relaxation (‘breathing’) is a form of pain relief. Childbirth hurts, like LisaB says, but hurting when you feel like things are in control and that things are okay is a lot different than hurting when you are left alone, scared, have no idea what to expect, and are made to feel like things could go wrong at any minute when you are hooked up to a fetal monitor.

    Babies clearly benefit -statistically- from being born vaginally in terms of breathing, breastfeeding success (success at eating in general, as need less vigorous suctioning if any at all), apgar scores, etc. Julie, as I recall this does not jive with your personal experience. But I’d be interested to see any studies that show that babies benefit from surgical birth.

    And LisaB, you are my hero… can I preorder your book?
    :-)

    Okay, enough of my blabbing and on with the studies:

    The British Medical Journal, in their June 18, 2005 issue, published “Outcomes of planned home births with Certified Professional Midwives: large prospective study in North America.”

    “Planned home birth for low risk women in North America using certified professional midwives was associated with lower rates of medical intervention but similar intrapartum and neonatal mortality to that of low risk hospital births in the United States. The study participants experienced substantially lower rates of epidurals, episiotomies, forceps deliveries, vacuum extractions, and caesarean sections than women with low risk pregnancies who gave birth in hospitals.”

    The evidence is overwhelming and consistent: the midwifery model of care is the most effective maternity care, resulting in fewer interventions, better outcomes statistically and individually, and at a fraction of the cost of the obstetrical model of care. Yet most women in North America either do not know this or do not have access to midwifery care. As a result, birthing women in North America are deprived of safe, high quality, cost-effective, and satisfying birthing options. See mana.org/foundation/links.htm for links.

  95. The Wiz on December 15, 2005 at 2:07 pm

    ‘Many people have, in what feels like a judgement on my decision to birth at home, mentioned that “they (or their baby or both) would have died if they had a home birth.â€? This is assuming that their labor/birth would have progressed the same way at home as it did in the hospital or if they had had a different caregiver.’

    OK, I have a question about this one. Full disclosure: All my babies were born vaginally via elective induction, so I had pitocin and and epidural with all three.

    My third baby swallowed some amniotic fluid on his way out and was whisked away from me moments after birth to have his lungs suctioned, more than they could do in the delivery room (he needed some stronger equipment). I asked them what would have happened to him had they not done that, and they told me he likely would have died, after developing a serious lung infection.

    Is this (suctioning of lungs) something that can be done at a home birth? Would a midwife have been able to accomplish it? I’m just wondering if he would have been OK had I chosen to have him at home, all other things being equal.

    I know ‘all other things being equal’ is not something easily assumed, but my first two would have been fine at home (zero complications, other than the pitocin) and the last one’s labor was great except for the lungs at the end. I didn’t even know anything was wrong, he looked perfect to me, he was just grunting instead of crying.

    I am a fan of inductions, totally colored by my experience. I agree with you that each person’s experience colots their opinion dramatically.

  96. Kat on December 15, 2005 at 2:12 pm

    Thanks, JA Benson, for trying to lighten things up. However, I don’t find your son’s comment funny at all, rather, I find it indescribably sad. With all due respect to your son, if I had a son that age, I hope that he would say to me: “Wow, Mom. Women really experience a lot in order to bring a child into this world. It must be an amazing thing to carry a new life inside you for nine months, and then to have the incredible and sometimes difficult experience of giving birth. I am so grateful that women are strong enough and capable enough to face that challenge. I think it’s great to be man, but it must be great to be a woman, too.”

  97. Not Ophelia on December 15, 2005 at 3:21 pm

    My third baby swallowed some amniotic fluid on his way out and was whisked away from me moments after birth to have his lungs suctioned, more than they could do in the delivery room (he needed some stronger equipment). I asked them what would have happened to him had they not done that, and they told me he likely would have died, after developing a serious lung infection.

    Is this (suctioning of lungs) something that can be done at a home birth? Would a midwife have been able to accomplish it? I’m just wondering if he would have been OK had I chosen to have him at home, all other things being equal.

    I don’t know the answer to your specific question, but I can tell you what I’ve observed genereally. I know lots of people who’ve had home births [comes from being a homeschooler, I guess.] Most were fine. Two were not. A friend of mine started hemorrhaging badly and was taken by ambulance to the hospital. She got there in time. All was well.

    OTOH, the wife of an aquaintance had a home birth. The baby got somehow stuck in the birth canal. By the time they got them to the hospital it wasn’t possible to do a caesarian. They tried everything to get the baby born — even broke his collar bone/shoulder — but to no avail. He died and they were devistated [wouldn’ve been there first]

    So? If you go for homebirth, make sure you have a low risk pregnacy, make sure your midwife is willing to call an ambulance if needed and try and live near a hospital, just in case.

    NO

  98. Not Ophelia on December 15, 2005 at 3:22 pm

    Sorry, that should have read: “would have been their first [i.e. child]”

    NO

  99. Chad Too on December 15, 2005 at 3:33 pm

    Kat, I get where you’re coming from, but that would be an awfully mature 14-year-old boy to come up with a line like that. He’s just barely discovering that girls don’t *really* have cooties. Can we cut him a little slack?

  100. Artemis on December 15, 2005 at 3:33 pm

    Wow.

    I have never had a baby, but I plan to in the relatively near future and have been studying up on my options because I don’t want to get caught uninformed. I realized this fully when I had appendicitis–I didn’t really know anything about what it was or what it could do to me, and I had to make quick decisions in the midst of severe pain and various drugs, based solely on what the doctors were telling me, and some of them I didn’t like (they were dismissive of my concerns). I tried to have my dad research “other options”, but with appendicitis, there’s really no time. Turns out surgery is (was) definitely the best option, and I’m grateful they did it lathoscopically (sp?) so there’s not much of scarring, nor was there a long recovery. But the experience convinced me that I want to know about things that will affect me, as much as possible so I can be prepared, informed, and able to have some control over what happens to me. And since pregnancy, labor & birth are a relatively known future event for me, I study. I’m hardly an expert, though.

    That said, I am rather pre-disposed to natural birth, I’ll say it up front. Lots of reasons, lots of what LisaB said (Lisa, can I pre-order your book too?). And what I read from both sides continues to lean me that direction. One thing I wanted to share–one of the books I’ve been reading makes an interesting analogy, comparing the modern medical tradition to a boy with a hammer. What does a boy with a hammer do? He finds lots of things to hammer, though not always the appropriate things. (This example was close to home for me–one of my brothers, raised in a home being remodeled his entire life thus far, wanted to help and hammered the glass sliding door to the backyard… sigh….). I think it’s fair to say that hospitals and traditional medicine do this. However, sometimes the hammer IS the appropriate tool and the (searching for a corresponding analogy here) leather lathe? raspberry-leaf compress? is not.

    So my plan is to go the natural route via a birthing center that partners with the University Hospital (well-respected), using a CNM as my primary care provider, possibly a doula, write up a birth plan with my preferences itemized and what alternative routes I want should things not go as planned, and hope for the best. If there are complications, we’ll medically intervene as necessary–the key word being necessary. So much of what is done routinely is almost always unnecessary–episiotimies, for example. Sure, there are cases when they’re absolutely essential, but usually they’re not. (I’m thinking of including a threat of certain litigation if this happens to me, unless it can be proved to be absolutely medically necessary ;) .)

    I guess this is a long way of saying that I agree with the idea that fully-informed choice is the most important thing. I think the mother’s and baby’s needs are equally important, though I agree with LisaB that what’s best for one is usally best for the other. (Sidenote: I disagree with those who say that the mother’s needs should be secondary to the child’s and that if she chooses her own welfare over the child’s that it’s unrighteous and/or ‘selfish’ (the negative connotation of the word). Take the church’s position on abortion, for example.)

    Which leads to my threadjack: the new contraceptive pill that makes it so you never have to bleed. What’s your pleasure? It’s really got the same arguments flying as the birth debates–some (including feminists) advocating it because it’s a choice that makes women’s lives easier and is (according to them) biologically unnecessary to bleed; and some (including feminists) who see it as a huge disrupter to women’s health individually and generally, as well as another attempt by traditional medicine and pharmaceutical companies to make money off of women and engaging them in a huge lab experiment.

    I should probably make that my own post, eh?

  101. Julie M. Smith on December 15, 2005 at 3:39 pm

    Larrea–

    Wow. I have no doubt that your wisdom will see you through this and every other decision you face.

    LisaB–re your data. I still think that you are misrepresenting it and then misinterpreting it, and I still don’t want to go through it again with you. Please provide links and leave it to our readers to read and interpret for themselves.

    You are welcome to question the ethics of elective c-section, and I thank you for stating your position. But note that the ethical question, as you frame it, relies on whether it increases risks to mother and/or baby. So, we are back to the question of safety, which I’ve dealt with as much as I plan on in the paragraph above.

    And, yes, the bandwagon that you and I are both on is that there needs to be way, way more information and therefore informed consent for all aspects of birthing choices.

    LisaB wrote, “We’re discussing Julie’s thesis that any woman ought to have the right to chose to have her baby surgically removed rather than born even in there are no medical reasons why surgery ought to be performed.”

    I hope that as you comment further on this thread, you will avoid using this kind of language: all three of my children were *born*, even though two of them were c/sections.

    I’d like to tweak the advice LisaB offered to Larrea: you should check a respectable website (I think the NIH has one) that will tell you which OTC meds have been studied and shown to be safe for pregnant women. There’s no need to avoid _all_ of them. Although, unfortunately (but for obvious reasons), there isn’t as much testing of meds on preg. women, so many of them need to be regarded as unsafe since they haven’t been tested.

    claire, I’ve already linked to data showing that there are some benefits to babies from surgical births. I’d like to make clear that while my first birth experience motivated me to do some research (which I wouldn’t have done if things had been peachy), I never, ever, ever would have asked for a c/s if I thought that I was increasing the risks to my baby. However, because the research shows that a non-emergency c/s is no more dangerous for the baby (net effect–some dangers such as accidental incision, obviously, increase while other dangers, such as cord prolapse, obviously, decrease), I went ahead with that decision. So I think your characterization of my experience is incorrect in that regard.

    claire, the evidence is you provide (and thank you for actually doing that–I’m a little bummed that very few people on this thread have actually done that) is great and shows something with which I fully agree: that for low-risk situations, homebirth is a reasonable option. However, I object to the conclusions the study and you make because different women are concerned about different risk factors and homebirth, as compared to c/s or epidural, clearly increases the risk that your pain will not be medicated. If this is not a concern for you, birth away, but if it is a concern for someone else, then the conclusions about it being the “best” model are clearly not appropriate for that woman. Again, let’s present data but leave the weighing of risk factors to the woman herself. It disappoints me to no end that you or anyone else would assume the right to tell another woman what should or should not matter to her.

    Artemis, make that its own post! We’re already over 100 comments here and I don’t think we are done yet, but I would like to read what you and others have to say about that topic, which I understand is somewhat complicated by the fact that “naturally” a woman pregnant or lactating and not hitting menarche until much later than we do would have way fewer cycles than the average woman today, creating the perverse situation that the ‘no bleed pill’ (what is the name for that?) is a better facsimile of what is ‘natural’ than what happens to most women now. But I really don’t know anything about it, and am curious about what others have to say.

  102. Jesse on December 15, 2005 at 3:44 pm

    Julie:

    Your first point in post #79 is not a valid comparison. You are comparing a cancerous condition with pregnancy. The first as an anomolous, disease situation, for which our bodies are not designed to respond or to handle on their own. Pregnancy and birth are conditions for which the female body is entirely suited. A mother’s body was made by God to be able to bear and birth a child. Not so with cancer. That President Kimball would elect medical intervention when he developed cancer is not the same sort of action as a woman selecting medical intervention as a way of delivering her baby. I don’t think, therefore, that the argument you lay out in point 1 is very strong.

    In terms of studies:

    1: See Lancet 2003; 362: 1779-84
    This study found that stillbirths increased among women who had had a previous cesarean. The rate among those who had not had a cesarean was 1.4 per 100,000 births. The rate among those who had a previous cesarean was 2.4 per 100,000 births.

    2: Obsterics and Gynecology 2001 Apr; 97(4 Suppl 1):S69
    This study examined complete and partial uterine ruptures among a population of 114,933 birthing women, approximately 10% of whom had had previous cesareans. Among that group the researchers found 16 complete and 23 partial ruptures. Of those thirty-nine, thirty-seven had had previous cesarean. Means that subsequent births after cesarean can be more risky, however, it is very important to note that 75% of those ruptures were associated with the use of induction drugs. So, a woman who has had a cesarean can substantially reduce her risk of uterine rupture, if she allows her labor to proceed naturally, without the intervention of induction drugs.

    3: Not a study, per se, but a review of evidence by the RAND corporation, published by Consumer Reports, concludes that cesareans are often done without reasonable medical justification: http://www.consumerreports.org/mg/free-highlights/manage-your-health/needless_surgeries.htm

    4: Neonates born by elective cesarean section are at greater risk of poor outcomes than those born vaginally, and are also at greater risk than those born to women who intended to deliver vaginally but were converted to operative vaginal or cesarean delivery, according to a large retrospective cohort analysis.

    Early neonatal outcomes were better among 3,134 patients who intended to deliver vaginally than among 117 patients who underwent elective cesarean delivery before the onset of labor, Dr. Nicholas S. Fogelson reported in a poster presentation at the annual meeting of the Society for Maternal-Fetal Medicine.

    Of the 3,134 patients who presented in labor and intended to deliver vaginally, 2,524 did so without operative intervention, 285 underwent intrapartum cesarean delivery, and 325 underwent operative vaginal delivery. About 5% of neonates from the intended vaginal delivery group were admitted to an advanced care nursery, compared with 14% of those from the elective cesarean group (relative risk 3.58), said Dr. Fogelson of the Medical University of South Carolina, Charleston.

    5: A letter to the editor of the New England Journal of Medicine notes that there are several studies demonstrating that the squeezing a baby goes through during vaginal delivery is beneficial for their pulmonary function and that babies who are delivered without that benefit are at higher risks for pulmonary problems: http://content.nejm.org/cgi/content/full/348/23/2364#R2

    6: Babies who are delivered by cesarean are at risk for being delivered prematurely because methods for determining their gestational age are not always accurate. This premature birth can result in negative health outcomes for the child. Parilla BV, Dooley SL, Jansen RD, and Socol ML. Iatrogenic respiratory distress syndrome following elective repeat cesarean delivery. Obstet Gynecol 1993; 81(3):392-5. and Hook, B et al. Neonatal morbidity after elective repeat cesarean section and trial of labor. Pediatrics 1997; 100(3):348-53. 9 Kramer MS, Demissie K, Yang

    7: Babies delivered via cesarean are cut by the surgeon’s scalple between 2 and 6 percent of the time, and possibly more. Smith JF, Hernandez C, Wax JR. Fetal laceration injury at cesarean delivery. Obstet Gynecol 1997; 90(3): 344-6.

    There’s a lot more information about risks to mothers, but I need to get some other stuff done now and won’t post more. Worth reading for those considering their birthing options and wanting to be informed.

  103. Julie M. Smith on December 15, 2005 at 3:52 pm

    Jesse–If you choose not to view pregnancy and birth according to a medical model, that is your choice. I think a medical model is an appropriate paradigm, in that medical interventions are helpful (for the risks that I am concerned about avoiding) to the mother and the baby. Hence, I think my comparison is valid, and I also think that you are free to reject it if you want to reject the medical model. Every woman should determine whether she finds the medical model a good fit for her.

    Thank you for the data. As I’ve stated repeatedly, I won’t be engaging specific data points on this post. But I will assure you that I have seen it all before (literally–I recognize every one of your data points [note: I originally wrote ‘citation’ here instead of ‘data point’, but that wasn’t what I meant to convey so I edited it]) and have weighed it against the other data I have linked to above and have concluded that an elective c/s is the safest choice for the risks that I am most interested in avoiding. I will also note on your (6) that you bring up a good point: any woman considering an elective c/s should keep careful track of her menstrual cycles before getting pregnant so that she has a good data point for determining gestational age.

  104. Tatiana on December 15, 2005 at 3:52 pm

    For what it’s worth, my first cousin is severely mentally impaired because her mother’s OB believed it was good for women to feel the pain and have the baby naturally, and that c-sections were for wimps. My cousin was oxygen-deprived in the birth canal causing severe brain damage. As a result, she has been unable to live anything approaching a normal life. I agree that people’s personal and family histories have a huge effect on their beliefs about the best methods. Even if that situation could not arise today, my aunt’s experience still makes me very wary of the idea of natural childbirth. I’m all for whatever produces the best outcome, and I’m far from convinced that natural childbirth does that.

  105. Kat on December 15, 2005 at 4:14 pm

    Chad Too, re #99: Of course I will cut any teenage boy some slack, and I realize that my statement wouldn’t likely come out of any fourteen-year-old boy’s mouth. What I was getting at, of course, is the underlying beliefs that each comment reflects – the former, that that labor and birth are always a difficult, horrible, awful experience for a woman, and the latter, that labor and birth can possibly be a difficult, yet amazing and empowering experience for a woman. How about hoping for a comment like, “Wow, Mom! Women rock!”

  106. Julie M. Smith on December 15, 2005 at 4:18 pm

    Note to all: I am trying so hard to stick with my position of not engaging in data debates and encouraging pregnant women to investigate the matter themselves, but it is very, very difficult for me to do this when deceptive data is presented in the comments. So I’d like to remind readers that any study that looks at all c/s births and finds that they are more dangerous than vaginal births on some measure is not useful because it ignores the underlying cause for the 98% [or whatever–I don’t know the exact number but it is in that neighborhood] of c/s that are NOT purely elective. In other words, whatever was the reason for the c/s may be the reason for the bad outcome, instead of the c/s itself causing the bad outcome. Further, as I mentioned before, even in the medical literature sometimes “elective c/s” means “planned beforehand for some reason; not an emergency decision made during labor” and therefore this data has the same problems that I just described. So please do not take any of the studies described here as gospel truth without investigating them for yourself.

  107. Larrea on December 15, 2005 at 4:21 pm

    LisaB,
    Actually, my husband’s work probably does pose a risk to my children. Type II diabetes runs on both sides of my family. My husband will not labor in the field with our children at his side as he teaches them how to farm by the sweat of their brow, instead our children will sit for hours at school as they prepare for careers that may be as sedentary as their father’s. This sedentary life puts them at an increased risk for type II diabetes, which very likely may be the cause of their demise. I am not sure how the set-up is so different, maybe I will understand when I actually have a child. I do believe my husband is an integral part of raising our child, and his decisions will affect our child, as do mine. I do not deny that there are risks with medical interventions or in other aspects of our modern life-style. I am grateful the natural birth movement has forced hospitals to provide a more women-friendly environment during the birthing process. The stories I’ve heard of women who gave birth in the 1960’s in hospitals are horrid and quite traumatic. I do believe that our separation from nature causes us to swing from one end of the pendulum (nature must be completely controlled) to the other end (where we idealize and romanticize nature). I think the truth is, sometimes nature can’t or shouldn’t be controlled, but as mankind, we have thrived only because we constantly strive at controlling nature. I think we are lucky to have the luxury to argue over the slight but different risks of c-section versus a vaginal delivery for a normal uncomplicated pregnancy. Because of modern society, I can feed myself and my baby a healthy and varied diet, I can choose to rest when needed, and to exercise only moderately. Because of modern society, I could choose not to marry as a teenager. Because of modern society, I know with a pretty good likelihood if my pregnancy will be high-risk. All of these factors increase the likelihood of having safe natural childbirth. Of course modern society also brings in new risks that would not be there if we went all natural. But I have too many female ancestors who died young, too many ancestors who were raised motherless, too many ancestors who wept over dead children, where I would feel uncomfortable glorifying in their natural outcomes. Nature has not been too kind to my family, even though they survived long enough to eventually produce me. Because of modern medicine and society, we should realize that the slight risks we are arguing about are just that, slight. Even if we go “natural”, it really is not all that natural. These modern risks are slight enough, that both sides should not feel too self-righteous about their birth choices. We are indeed a lucky group of women.

  108. Kingsley on December 15, 2005 at 4:29 pm

    Women rock.

  109. Heather Oman on December 15, 2005 at 4:30 pm

    This conversation really happened:

    Mother-to-be:”I’m having a my baby in a birthing center, because giving birth is natural.”

    Friend who happened to be an MD:” So is death. In this day and age, we’ve forgotten that childbirth was the leading cause of death of women for centuries.”

    Just my two cents.

    FYI-

    Massachusetts General Hospital completely did away with episiotimies (sp) when I gave birth almost 4 years ago, and since then, I have read several articles about how hospitals are doing that, finding that it’s not all that helpful. Sorry, Julie, I don’t have a specific reference, but I do know that conventional wisdom, if you will, is shifting. That gives me hope that medicene, as invasive as it is, does, by and large, have the patient’s best interest at heart.

  110. Kat on December 15, 2005 at 4:32 pm

    (Sorry – I still don’t know how to insert links, but I can’t wait to post any longer!)

    In the OP, the risks of natural (meaning vaginal) birth mentioned are the increased risk of urinary and fecal incontinence later in life. The Maternity Center Association summarizes and categorizes the current research evidence about this issue here:

    http://www.maternitywise.org/mw/topics/pelvic-floor/evidence.html

    They conclude that the increased incontinence risk is due not to vaginal birth itself, but rather, to the following interventions in the birth process: assisted vaginal birth (with vacuum or forceps), continuous electronic fetal monitoring, epidural analgesia, fundal pressure (pushing on the top of the uterus), caregiver-directed pushing, and pushing in the back-lying position.

    They also address the question “Will cesarean by choice (elective c-section) prevent pelvic floor dysfunction?� here:

    http://www.maternitywise.org/mw/topics/pelvic-floor/options-cesarean.html

    The Maternity Center Association offers unsurpassed, evidence-based, online resources for helping women make informed decisions about their maternity care. Their booklet “What Every Pregnant Woman Needs to Know about Cesarean Section� summarizes all the current research evidence about this issue here:

    http://www.maternitywise.org/pdfs/cesareanbooklet.pdf

    I, too, believe that judgment has no place in discussions about birth, and that birthing women always make the best possible decisions for themselves and their babies. However, I often wonder what those decisions would look like in a culture where:

    – women grew up believing that fertility is a blessing rather than a curse,
    – women believed that the physicality of labor and birth was a blessing rather than a curse, that their bodies are perfectly designed to give birth, and that their babies’ bodies are perfectly designed to be born (while recognizing that design does not always guarantee function),
    – all pregnant women received comprehensive prenatal care,
    – all pregnant women had optimal prenatal nutrition, and exercised throughout their pregnancies,
    – all pregnant women had excellent, comprehensive childbirth education that reinforced their confidence in their ability to give birth,
    – all women understood that for the vast majority of women, labor and birth is a normal physiological process, rather than a pathological process (there is a very small percentage of women for whom it is a pathological process),
    – all women took advantage of birth counseling services, in order to resolve any underlying fears of birth, or to process and heal from any previous disappointing, disempowering, or traumatic birth experiences,
    – the popular media showed realistic and positive images of birth, rather than birth scenes intentionally designed to be dramatic,
    – all pregnant women worked with their maternity care providers to create an appropriate and comprehensive birth plan,
    – all members of the maternity care team were familiar with, respected, and implemented each woman’s birth plan to the maximum extent possible,
    – the vast majority of birthing women requested (and were given) the six care practices that promote normal birth: labor begins on its own, freedom of movement throughout labor, continuous labor support, no routine interventions, non-supine (e.g. upright or side-lying) positions for birth, and no separation of mother and baby after birth with unlimited opportunity for breastfeeding,

    http://www.lamaze.org/institute/carepractices/intro.asp

    – all maternity care providers demonstrated evidence-based practice,
    – all maternity care providers were able to practice without institutional constraints, peer pressure, financial constraints, or conflicts of interest,
    – all maternity care providers adopted the wellness model of maternity care (except for the very small percentage of pregnant and/or birthing women for whom the medical model of maternity care is more appropriate),
    – women trusted their maternity care providers to intervene in their labor and birth only with compelling medical indication, and after exhausting all conservative treatment options,
    – there were no iatrogenic labor and birth complications (complications caused by interventions of the care provider),
    – all hospitals, birth centers, and home-birth maternity care practices supported the principles and steps of the Mother-Friendly Childbirth Initiative,

    http://www.motherfriendly.org/MFCI/
    http://www.motherfriendly.org/MFCI/steps/

    – all women could labor in an environment where they felt safe and comfortable,
    – all laboring and birthing women were given continuous emotional support from a knowledgeable and experienced woman, as well as their spouse and other family members, if desired,
    – all laboring women understood the difference between normal pain during labor and abnormal pain during labor,
    – all laboring women had access to every non-pharmacological pain relief method available, including: warm-water immersion (in a comfortable tub deep enough that the water covers her belly), shower, intradermal water blocks, transcutaneous electrical nerve stimulation (TENS), pressure techniques for back pain, cold and hot packs, massage and touch, ability to move and change positions freely, pain-reducing labor equipment (such as birth balls), acupressure, self-comforting measures, hypnosis, and environmental comforts; and if desired, access to every pharmacological pain relief method available,
    – all birthing women who needed medical intervention had access to it and were given it in a compassionate, empowering manner, and
    – in addition to a large number of natural birth advocates, and a large number of people working to improve medical interventions for women who need them, there was a large number of “empowered birthâ€? advocates (those working to help all women create empowering, positive, satisfying birth experiences that maximize their and their babies’ physical and emotional health, and bring them a lifetime of joyful memories).

    In such a culture, I think that many women’s “best possible decisions� would look somewhat different than they currently do.

  111. Andermom on December 15, 2005 at 4:33 pm

    Artemis said “(Sidenote: I disagree with those who say that the mother’s needs should be secondary to the child’s and that if she chooses her own welfare over the child’s that it’s unrighteous and/or ’selfish’ (the negative connotation of the word). Take the church’s position on abortion, for example.)”

    My dad told me the yesterday that during the time he spent as a bishop all of the instruction he was given in regards to giving counsel about having children is that the mother’s health is *the number one priority* end of story. Regardless of any counsel to multiply and replenish, ethical implications of birth control or abortion or anything else you can think of. He also gave the impression that this counsel included mental health, and general well being in addition to physical safety.

  112. Julie M. Smith on December 15, 2005 at 4:44 pm

    Larrea, I hope you’ll keep commenting at T & S, and I’m not only saying that because I agree with what you say, but because you say it so articulately.

  113. Jesse on December 15, 2005 at 4:44 pm

    Heather (#109)

    There’s a really interesting book by a guy named Ignatz Semmelweis called the The Etiology, Concept, and Prophylaxis of Childbed Fever (translated from the German by a BYU professor – K. Codell Carter). He was a mid 1800’s Ob in Austria who made the shocking discovery that medical students should not give vaginal exams to laboring women directly after having participated in dissections of cadavers and that, in fact, they ought to wash their hands first.

    So, possibly all those women who the MD said were dying all the time back before the docs came riding to the rescue (in his eyes), were doing so because of medical intervention. :-))

    The really distressing thing is that Semmelweis ranted and raved and provided absolutely rock solid statistical proof to demonstrate that the necrotic tissue from the cadavers, transfered to the mothers, was actually killing the mom’s off, and during his lifetime he was unable to convince his colleauges of this situation, even when his insistence that medical students wash their hands resulted in immediate changes in maternal outcomes.

  114. Larrea on December 15, 2005 at 4:58 pm

    One more thing, on the comment that our bodies were designed for natural birth. Yes, they were, but the design is the result of a trade-off. For successful reproduction to occur, the baby should be as big and healthy as possible, with a big head, while the mother should be as healthy as possible in order to take care of the child. Unfortunately these are competing forces. If we are lucky, we will hit that balance just right by creating as big babies as possible without killing ourselves or the baby in the birth process. Most women hit this trade-off, and most of us are the result of this biological tightrope walk. Unfortunately, the tight trade-off means some of us are inevitably off the mark. Personally, if it was up to me, I think I’d rather be a marsupial than a placental, at least when it comes to mode of reproduction :)

  115. Julie M. Smith on December 15, 2005 at 5:30 pm

    Not to mention that in that case, Larrea, you’d have a great place for your cell phone, check book, etc. when you were finished childbearing.

  116. Julie M. Smith on December 15, 2005 at 6:32 pm

    All–

    I’d like to call attention to Kat’s comment in #110 because due to a quirk in our system here, it showed up after comments #111-115 and therefore you may have missed it.

    (There are, of course, the usual misrepresentations and misinterpretations of the data in her comment.)

  117. Rosalynde Welch on December 15, 2005 at 6:51 pm

    I’m not an activist by nature, I’m married to a physician, and I’ve given birth twice in hospitals with late epidural anaesthesia—which is all to say that I do not reflexively reject the medical model (and inasmuch as I do prefer to minimize interventions, I do so for entirely different reasons than, say, LisaB does). But there’s something that puzzles me about this discussion, Julie, in the same way that your discussion of homeschooling (a similar sort of apologia) left me a bit puzzled.

    It seems to me that there’s a distinct epistemological mismatch between the sort of conclusion you draw and the sort of evidence from which you’ve drawn it. You’re emphatic in your argument that a woman’s approach to childbirth is radically subjective and ought to be, finally and above all, a matter of strenuously personal choice that one should not expect to be replicated in other conditions: blanket statements are the ultimate offense to you here, it seems. But the grounds you’ve provided and solicited—science-based data organized into clinical studies—can, by their very nature, do nothing BUT offer blanket statements and generalizations. Scientific data is intended to be replicated—indeed, must be replicable—and objective; it has nothing to offer discussions of radically subjective choice that, in the end, is more about taste and preference than about data. In fact, the one thing scientific data cannot do is allow a particular woman to “weigh the risks and benefits” of her own situation: statistical data can do very little to predict individual outcomes, but rather speaks to trends across groups and populations, and thus work as the building blocks for general protocols—not as the basis for an axiom of “personal choice.”

    I think your retreat to the position of “personal choice” puts you in a rhetorically and politically weak position: anytime someone starts pleading for choice, you can be pretty sure that he or she has permanently invested in the position of the embattled crusader. And this is ironic, in your case, because medically un-indicated c-sections are clearly on a precipitous rise: it’s entirely possible to imagine a time in the near future when they will constitute an equal or larger proportion of births. You don’t need to call for “personal choice”—you, I think, have the cultural momentum to make the argument that the surgical option ought to be the primary protocol. If you respond that, no, surgical births aren’t for everybody, just for those who want them, then you’ve taken your argument out of the realm of science, and you need to assemble a new body of evidence.

  118. Kat on December 15, 2005 at 7:05 pm

    Re #116: I apologize if you feel I misrepresented and misinterpreted data in comment #110. I was trying to do as you requested, which was to provide links to data that women can use to help them make informed decisions about maternity care. I do not feel that I represented or interpreted any data, either positively or negatively. I did repeat a conclusion that the MCA found, but it was not my conclusion. I did make one apparent judgment, calling the MCA’s resources “unsurpassed.” What I meant by this is not that they are unsurpassed in the conclusions they draw, but that I feel MCA’s website is the best resource I have found for helping women make informed decisions. The rest of the comment is my personal thoughts.

  119. Julie M. Smith on December 15, 2005 at 7:10 pm

    RW, the way out of your dilemma is, to me at least, very obvious: there are some aspects of birth that are scientific and quantifiable: whether, for example, home birth does or does not lead to higher infant mortality, or whether c/s does or does not cause a woman problems with future pregnancies. There are other aspects of birth, such as whether a woman would prefer to birth in the comfort of her home or in a place where she gets to relax in front of a flat-screen TV (with cable!!), order people to bring her food on little trays, and tell her older kids that it was nice for them to visit but it is time from them to go home now. That’s the personal choice part. So, that’s why I advocate that a woman get a feel for the evidence-based implications of her choice, and then weigh the other factors. Plus, the science part itself also requires some weighing based on personal choice: Which is worse: A 2-6% risk of an infection (c/s) or the potential for 30 hours of severe pain (natural)? That is simply not a question that your doctor or mother-in-law or the busybody on the playground can answer for you.

    An analogy: I’m not big on a woman making a personal choice on car seat use. The risks and benefits of use and nonuse are simple and straightforward, and any woman who decides not to buckle up her baby is making the WRONG decision. (See? I can be judgemental!) But when it comes to birthing, we have at least a dozen different weights and measures that may or may not matter to a certain individual and we have less-perfect data than we want on the safety of various interventions and non-interventions.

    As far as “primary protocol,” I don’t think we’ve yet mentioned here the study showing that about 30% of British female OBs would choose an elective c/s for themselves. My assumption is that if the analysis of the relevant data by a group that is far more competent to weigh it than anyone who has posted so far (including me, of course) shows that kind of division in choice, then there is both a scientific component to the decision (studies showing various risks and benefits) and a personal, subjective component to the decision.

  120. Julie M. Smith on December 15, 2005 at 7:14 pm

    Kat, I appreciate your conscientiousness. Perhaps without even realizing it, both you and the site you link use language that is loaded to make your biases very clear.

  121. Artemis on December 15, 2005 at 7:23 pm

    Perhaps the same could be said for you, Julie. ;)

  122. claire on December 15, 2005 at 7:40 pm

    I posted earlier a response to the Wiz’s question about resuscitating her newborn, but it hasn’t shown up.

    However, Julie, you HAVE mentioned (at least once in the comments on this post) the study about the British Female OBs (#119). I wholeheartedly disagree with your presumption that they are “a group that is far more competent to weigh it than anyone who has posted so far.” As I mentioned the first time I heard you bring this up, this is a flawed argument. Most births in the UK are attended by midwives (and up until this generation, most were at home) so OBs in the UK see mainly complicated and therefore more dangerous births- most of them surgical. It is what they do. They save lives everyday, and see all the possible complications there could be. They are trained to see birth as a procedure fraught with danger and complications. I’m surprised the percentage is only 30.

  123. Julie M. Smith on December 15, 2005 at 8:11 pm

    claire, I cannot accept that British female OBs are so ignorant that they don’t realize they are interacting with an unrepresentative portion of births.

    I think the study is important because it shoots down the argument that MDs overdo c/s for money (possibly true in some cases, but I don’t think the British OBs would make a choice just to line their collegue’s pocketbook) or litigation fears (again, possibly true in some cases but I don’t think they would put themselves at higher risk in order to protect their own OB from a lawsuit–brought by themselves) or just convenience of the doctor.

  124. Julie M. Smith on December 15, 2005 at 8:11 pm

    Artemis, let me know where I’ve used biased language and I’ll clean it up.

  125. Elisabeth on December 15, 2005 at 10:21 pm

    Hello – I’ve kept up with the comments here, but I apologize if I’ve overlooked if this question has been addressed eariler. My question is: will insurance companies pay for elective c-sections (i.e., c-sections for no medical reason)? Can you just walk into a doctor’s office and say “I’d like to have a c-section, please”, and the insurance company will pay for it, no questions asked? I thought c-sections were more expensive than natural births, so if a woman has no reason to have a c-section, would the insurance company still pay for the c-section?

  126. Julie M. Smith on December 15, 2005 at 11:14 pm

    Elisabeth,

    That question has not been addressed. I am not familiar with anyone’s experience besides my own. I had explained to my OB the physical and psychological trauma resulting from my first birth, and she may have used that as the rationale for the c/s, or she may have used the fact that the baby was expected to be huge, or she may not have provided a rationale. I have no idea. I just know that they paid for them.

  127. Mark B. on December 15, 2005 at 11:15 pm

    Complete unresponsive to your question, Elisabeth, but your hypothetical request reminds me of a trick played on green missionaries in Germany 40 years or so ago.

    You stop in front of cheesemonger’s shop (don’t ask me the German for that–high school was too long ago) and ask the greenie to step in and ask for “ein Stuck Kaiserschnitt.”

    It’s especially effective when a 20-ish woman is behind the counter. She won’t understand why he’s just asked her for a “Caesar cut”, a Caesarian section.

  128. Artemis on December 15, 2005 at 11:47 pm

    We’re all biased. To have an opinion is to be biased, at least a little bit. When it’s a problem is when you can’t respect other views that don’t agree with yours or play nicely in the sandbox. I don’t think what Kat posted was uncalled for, nor do think what you, Julie, have posted has been uncalled for either. I think most commenters on this thread, trolls excepted, have maintained respect, despite disagreements. But each post you make shows clearly your own biases, especially those where you respond to others’ biases.

    My post #121 was just meant to be a gentle, happy rib.

  129. claire on December 15, 2005 at 11:49 pm

    Julie, I don’t think British OBs are ignorant, my position is that they are, like you and me, greatly influenced by their experience. Since they have even more experience with this issue than you and I, as you mentioned when you classified them as “far more competent” I propose they are even more influenced.

    Julie, you call yourself an Unnatural Birth Advocate, but then fall back to the safe “everyone should do research and decide what risks are most important to you” argument. I understand you feel you are put in a highly defensive position by people you meet at parties (I can somewhat relate from my position at the fairly extreme far end of the spectrum) but I ask, are you an unnatural birth advocate, or not?

  130. Julie M. Smith on December 16, 2005 at 12:20 am

    OK, Artemis, thanks for clarifying.

    claire, I don’t think that they are influenced by their experience to the extent that they become ignorant of the risks and benefits of what they do to the point where they would compromise their own (and their own baby’s) health.

    But if you insist that their experience biases them, you will need to recognize that it cuts (haha) both ways. It would be useful to remember that they don’t spend all of their time cutting up pregnant women: they also (unlike midwives) see women who are post-childbearing and can assess the effects of their birthing experiences on their future health. So, to the extent that they may be biased by their day job, they are also carrying the bias of being very familiar with the consequences of birthing experiences on women 10, 20, and 50 years down the road–including, of course, those women who birthed with midwives.

  131. Julie M. Smith on December 16, 2005 at 12:25 am

    oops, sorry, forgot the rest of the question:

    I called myself an unnatural birth advocate because (1) I thought it was a catchier title than Why I Think that Women Should Make Birthing Choices Based on Data and Their Own Risk Assessment Instead of Listening to the Nature Nazis and because (2) I perceive that the natural side has advocates, but the medicalized side does not have clear advocates (you would think that this would be doctors, but they tend to follow the lead of their patients–which I think is a good thing) which means that there is no voice on this side of the line, so I am sympathetic to a reasonable position that is going unrepresented. But I hope I have made it clear in the original post and ensuing comments that I don’t advocate medicalized births in the same way that people like LisaB advocate homebirths–I don’t think that there is a best model overall, but only a best decision for each woman. For some women, that best decision will be a home birth.

  132. LisaB on December 16, 2005 at 1:45 am

    Nature Nazis. That’s real nice Julie.

    Advocates aren’t needed for medicalized birth because it is the cultural norm in the US and other industrialized nations.

  133. Not Ophelia on December 16, 2005 at 1:53 am

    Nature Nazis. Very good.

    I am going to totally side with Julie on this one. And I’m going to do it as one who’s birthing experience lies on the very opposite side of the bell curve.

    I had my children au natural. Not because I am more brave or more virtuous or more natural or more foolish or more in tune with my inner fem than most but for the simple reason that it all happens so fast that I have no time to get an epidural. Does my experience color my opinion? Certainly, but not in the way you might think. While I wouldn’t ever consider an elective C-section [or homebirth] for myself, I do understand that others’ opinions have very little to do with another’s reality. [For me birth was not a big deal experience. My longest labor was 4 hours and I didn’t think it was all that painful. It’s a lot of hard exhausting WORK, but not painful. This experience seems to be unimaginable to most people I know] So, I can understand the frustration that comes from dealing with the well meaning and [especially] evangelical ‘experts’ in the childbirth world. Nothing they said to me had anything to do with my experience and my reality. I can only imagine how much worse it must be for someone who has terrible birth experience to feel like she needs to somehow live up to the expectations of these people.

    So while the thought of an elective C-section makes me wince and cringe and want to flee into the night, I totally understand the underlying issue — my body isn’t your body and doesn’t act like your body. So back of, Jack. And kindly take your guilt trip elsewhere.

    As for the discussion of a simpler life: i.e. Do you, for example, have questions and doubts about the role which hospitals, doctors, and expensive funeral parlors have come to play in the way we die? How about the food we eat, or the jobs we perform: do you feel, as do a great many others, that we’ve distanced ourselves too much from the earth, from work that requires the sweat of our own brows, from simpler rhythms of life?

    Y’all should really, really read Ishmael.

    And [for those who have read it] while I agree with much to most of Daniel Quinn’s analyses of the shortfalls of our culture I really don’t agree with his solutions. i.e. I’m not willing to abandon “mother culture” and put myself back “in the hands of the gods” [i.e. nature] Anything technological from the invention of agriculture on has taken us further and further from the simpler rhythms of life. And the simpler rhythms of death, I might add. I think modern life has been mostly good for women and I’m very grateful to have been born where I can take full advantage of it.

    NO

  134. Not Ophelia on December 16, 2005 at 2:04 am

    Advocates aren’t needed for medicalized birth because it is the cultural norm in the US and other industrialized nations.

    Perhaps we need a better term? Advocate suggests a kind of presure that I at least find offensive.

    And ditto for the epidural nazis, the C-secions nazis, the Lamaze nazis, the breastfeeding nazis, the let-your-baby-cry-itself-to-sleep nazis. Information is great, guilt trips or authoritarian dictates are not.

    NO

  135. Gary on December 16, 2005 at 10:50 am

    Kat (#90 and #110), how to create links.

  136. Seth Rogers on December 16, 2005 at 11:37 am

    Does anyone else find it interesting that our current fashion culture is selecting women with hips too small for safe childbearing as the ideal?

    Whatever would Mr. Darwin say?

  137. claire on December 16, 2005 at 12:06 pm

    Since my earlier reply to The Wiz (# 95) never showed up, I will attempt to recreate it. Basically, I can’t speak to what kind of resuscitation her son would have received at home, just as we can’t speak to what kind of resuscitation he would have received from a different set of doctors and nurses, or in a different hospital. I do know the kind of attendant we chose for our home birth is trained in infant resuscitation and does carry quite a bit of equipment and even certain drugs with her when she attends births.

    Certainly, babies die because they are born at home. But just as certainly, babies die because they are born in hospitals. Here is where I can agree with Julie- there are risks all ways.

  138. claire on December 16, 2005 at 12:19 pm

    Julie, please think twice before using the word Nazi to describe someone who has strong feelings about natural birth again- I find it highly offensive.

  139. Kat on December 16, 2005 at 12:23 pm

    Thanks, Gary! Now my future comments can look cool like everyone else’s! (But not this one – I’ve got to post now and go get my daughter on the bus.)

    Since I am an “empowered birth� advocate, and want to be perceived as such, I want my comments to be free of vaginal birth bias. So I went back to comment #110 looking for it, and yes, Julie, you are right, there was some. Please forgive me. Here are the revisions of the statements that did not apply equally to women planning vaginal birth and women planning cesarean birth:

    “- the vast majority of birthing women requested (and were given) the six care practices. . .� should read
    “- the vast majority of women planning vaginal birth requested (and were given) the six care practices. . .�

    “- women trusted their maternity care providers to intervene in their labor and birth only. . .� should read
    “- women planning vaginal birth trusted their maternity care providers to intervene in their labor and birth only. . .�

    “- all women could labor in an environment. . .� should read
    “- all women could labor and/or give birth in an environment. . .�

    “-all laboring and birthing women were given continuous emotional support. . .� should read
    “- all laboring and/or birthing women were given continuous emotional support. . .�

    “- all birthing women who needed medical intervention. . .� should read
    “- all laboring and/or birthing women who needed and/or wanted medical intervention. . .�

    “In such a culture, I think that many women’s ‘best possible decisions’ would look somewhat different. . .� should read
    “In such a culture, I think there is a possibility that some women’s ‘best possible decisions’ might look somewhat different. . .�

    All the other statements, as originally written, apply equally to women planning cesarean birth and women planning vaginal birth.

    I also went back to the links I provided, looking for vaginal birth bias. In the Lamaze link, yes, there is obvious vaginal birth bias. Please forgive me for including it. However, Lamaze does not just promote vaginal birth – it promotes empowered vaginal birth. Thus, I feel that for women planning vaginal birth, it is an excellent resource. Also, the care practices of “continuous labor support� (which should read “continuous labor and/or birth support) and “no separation of mother and baby after birth with unlimited opportunity for breastfeeding� apply equally to women planning vaginal birth and women planning cesarean birth.

    In the Mother-Friendly Childbirth Initiative links, there was a very small amount of vaginal birth bias. In the “Principles� section of the first linked page, the statement “Birth is a normal, natural, and healthy process� should include a qualifier such as “usually.� On the second linked page, step #4: “Provides the birthing woman with the freedom to walk. . .� should read “Provides the woman planning vaginal birth with the freedom to walk. . .�

    All of the other statements on both pages apply equally to women planning vaginal birth and women planning cesarean birth. All of their statements allow for the appropriate application of technology, the appropriate use of the medical model of maternity care, the right of each woman to give birth as she wishes, the appropriate use of medical interventions, and the use of primary cesarean birth and repeat cesarean birth. I feel that for women planning cesarean birth and women planning vaginal birth, it is an excellent resource.

    In the Maternity Center Association links and website, there may be a very small amount of vaginal birth bias. However, I am having a difficult time finding it. What I find is a vast amount of research data that has been rigorously reviewed, analyzed, classified, and distilled for the use of childbearing women and maternity care providers. If anyone would like to see the undistilled research data, here are the methods and sources the MCA used in their systematic review of cesarean birth (then you can look up the sources):

    http://www.maternitywise.org/pdfs/methods_sources.pdf

    Here are the evidence tables that classify each of the hundreds of studies included in the systematic review:

    http://www.maternitywise.org/pdfs/tablesA-C.pdf
    http://www.maternitywise.org/pdfs/tablesD-F.pdf

    In tables A-D, all of evidence comparing planned cesarean birth with unplanned cesarean birth is clearly identified with thick black lines. As Julie pointed out previously, for all measured negative outcomes, the incidence of the negative outcome is lower for planned cesarean birth and higher for unplanned cesarean birth.

    All of the Maternity Center Association’s materials are designed to help women make informed decisions about maternity care, and to help providers give evidence-based maternity care. These two goals benefit all childbearing women, and I feel the MCA is an excellent resource for women planning vaginal birth and women planning cesarean birth.

    I hope that these changes help clarify my position as an empowered birth advocate. Thanks for an interesting discussion!

  140. Austin F. on December 16, 2005 at 2:07 pm

    My wife had the best of both worlds: an epidural and a midwife. The midwife was phenomenal. She made the experience so much better for my sweetheart, and the epidural was pretty darn sweet for her too!

  141. Julie M. Smith on December 16, 2005 at 2:38 pm

    “Nature Nazis. That’s real nice Julie.”

    Precisely why I didn’t use it in my title ;). Ditto to claire.

    Kat, I’m having a hard time scraping myself off of the floor. You’re amazing. Good work. Still, though, as I read through their c/s info, I found some other biases you didn’t note in your comment. For example, when they would list a negative outcome for a natural birth they were quick to qualify it (i.e., one thing I read said that although incontinence was higher, the study didn’t measure whether it was permanent or temporary, or whether it was a big deal [hard for me to imagine how incontinence wouldn’t be . . .]) but when they would list a negative outcome for c/s, they wouldn’t qualify it, even in cases where the evidence suggests that it should be (assuming that they are relying on the evidence that I think they are, which I couldn’t determine, because they didn’t footnote it). In any case, it is better than most of what I have seen, but it is not unbiased.

  142. Julie M. Smith on December 16, 2005 at 2:51 pm

    Kat, I finally got that PDF to load. Remember that ‘planned’ and ‘elective’ are not the same thing.

  143. Amber M on December 16, 2005 at 3:11 pm

    I made it! To the end of the comments I mean. Great discussion.

    I don’t think of myself as an advocate for anything but perhaps I am (if you count my blog entry). I just remember noticing, when I was starting to think about having a baby, that the medical crowd (be it induction, drugs, c-sec, epis, etc.) seemed to have a victim mentality. Woe are they, who go through suffering, pain, trauma, to bring forth babies. My whole family didn’t believe I could pass a baby vaginally. Except my husband, who is the world’s most laid back guy and would have supported anything. Good man.

    Well, I’m not one to accept the “inevitable”, and it did not escape my notice that low-risk women, like myself, who opted for a completely natural birth, seemed to feel very positive and empowered by their births. This made it easy to choose camps. I realized early on, that for a healthy woman such as myself, if I avoided the first intervention (like EFM and supine position) I would likely avoid the subsequent ones. I also realized that fear had an incredible influence on outcome, and so I worked at overcoming my fear of birth. Understanding the impact of fear is important… if a woman is afraid of giving birth naturally she may actually have a better outcome from c-sec or drugs. The choice was easy for me because my fear was of hospitals and those who would control my birth versus support me.

    By the way Larrea (#114) nature does not opt for the biggest possible baby and biggest head. From all my reading, even small mothers with big fathers more often have average babies that rapidly grow AFTER birth. As for more average mothers and fathers, babies do not normally grow too big in the womb for the mother to pass. Especially if the mother’s diet is healthy and she is a healthy weight.

    We (as in the medical community of our society) think we know everything. And why everything occurs. It is so much easier for me to put my faith in the Divine Designer than in a bunch of egotistical yay-hoo Docs. Oops maybe that’s not productive language. :)

    I feel strongly that, personally, if I had given birth in a medical way, I would be sporting a 10-inch scar on my abdomen. Not to mention the emotional scarring. Instead, after each of my three births I wanted to take on the world. I did feel like an “aahhhhhhhhhh!” goddess.

  144. Greg Call on December 16, 2005 at 3:38 pm

    Julie:

    Another quick question: on average, are elective c-sections more or less expensive (for an insurance company, typically) than vaginal births? With the state of our health care system, this ought to be a major concern. One reason the healthcare system has become so insanely expensive is that too often medical care consumers don’t do a cost/benefits analysis at all (since they are not footing the bill directly), which drives up costs for everyone.

  145. Julie M. Smith on December 16, 2005 at 5:04 pm

    I believe that c/s costs more; however, I disagree strongly that it ought to be a major concern. If you were about to undergo a medical procedure and the surgeon informed you that they wouldn’t be using the best approach for your condition because it was more expensive than the alternative, I think you’d see where I’m coming from.

  146. Rosalynde Welch on December 16, 2005 at 5:34 pm

    RE: #119: If I understand your argument, you’re suggesting that if the risks and benefits of the various clinical options reach a state of equipoise, then the decision should become a matter of personal choice from a menu of options according to preference and taste: that is, childbirth becomes an exercise in consumerism. This makes you not so much an advocate of elective c-sections as a salesperson. (Although, as Greg suggests above, this sort of “choice” language takes the form of consumerism but, because of the vagaries of our health insurance system, lacks the rigor of a free market; there’s a real chance, it seems to me, that as the rate of elective c-sections rise, the cost of maternity coverage for all women will increase.)

    It’s not clear to me why you insist that only the individual woman can determine whether the clinical options have indeed reached a state of equipoise—being a matter of statistics and probabilities, it should be an objective calculus—but I’ll leave that aside. The thrust of your argument, it seems to me, is what happens once it has been determined that there is no clear clinical answer—and what happens, if I’m getting you, is that women go on a shopping trip, and decide between a flat-screen television with cable and home-cooked meals. On one level, this is a completely natural extension of the cultural logic under which technology, the discourse of choice, and the proliferation of consumerism have grown up together in American society. You’re certainly not the first to apply this logic to medicine, or to childbirth, or, indeed, to almost any aspect of modern human experience.

    But on another level, it makes your argument a lot less interesting and, in a very real sense, a lot less important (not that the issue becomes less important, but that your treatment of it does). The retreat to a philosophically thin language of “choice” has always been the come-on of feminist thought—life for women becomes one big shopping trip, with career or kids or family or sex all hanging conveniently on the rack for our perusal—and our willingness to succumb to that temptation has really hindered the seriousness of feminism thought and, I think, the efficacy of feminism in the world. Part of me objects to “choice discourse” simply because it seems to me hackneyed and lightweight, but another part of me worries that it may have real deleterious effects on the most vulnerable: looking back on the last half-century, it seems to me that whenever the discourse of choice has annexed another aspect of human experience—whether it be sex (anybody catch Donald Trump’s “spaghetti and steak” riff on sexuality in “The Apprentice” a few weeks ago?) or family or the grocery store—privileged groups clearly benefit in the short term, and the most vulnerable groups, following the “regime effect” of class emulation, clearly suffer—and greatly—in the long term, often in ways that are unforeseeable. Informed choice requires access to information, the skills to handle it, and above all the resources to obtain the commodity, and when the system switches over to a model of “choice,” those without the above almost invariably suffer.

    (Note: this is a rambling meditation on the implications of your argument; I’m certainly not accusing you of even unconsciously wishing ill to the underprivileged and vulnerable.)

  147. Greg Call on December 16, 2005 at 5:43 pm

    Julie: Of course doctors and patients should choose the “best” approach for a particular condition. But I think we can and should think about costs when it comes to elective medical measures. The desire to have any and all of our ailments (or natural conditions) treated with the most fancy, expensive medical technology available, even where a less expensive alternative will produce the same result in all but the tiniest fraction of cases, is one of the things that is absolutely killing our healthcare system. (For example, patients will seek a prescription to Nexium at $120 a pop (with the insurer covering $100 of that), rather than buying nonprescription Prilosec for $20 at the drugstore, even though there is no indication that Nexium is more effective than Prilosec.) Now if you conclude that the benefits outweight the costs, that’s fine, but ignoring the costs hurts everyone.

  148. Andermom on December 16, 2005 at 5:57 pm

    Re: 144
    I’ll agree that cost shouldn’t be a major concern, but it is a major concern. For those that don’t have health insurance having a baby is very expensive. My labor & delivery costs came to about $7000. That is a 48 stay in the hospital (mandatory where I am from), about 4 percosets, and a bottle of tylenol. I didn’t have any anesthetics, or medical interventions (other than the episiotomy, but that isn’t itemized on the bill), and my baby was extremely healthy. My labor & delivery was dirt cheap. If having a elective c-section would put you in serious debt then you would want something cheaper and would consider cost to be a major concern, especially if you already had other significant debts.

  149. Nate Oman on December 16, 2005 at 6:07 pm

    RW writes: “it seems to me that whenever the discourse of choice has annexed another aspect of human experience—whether it be sex (anybody catch Donald Trump’s “spaghetti and steakâ€? riff on sexuality in “The Apprenticeâ€? a few weeks ago?) or family or the grocery store—privileged groups clearly benefit in the short term, and the most vulnerable groups, following the “regime effectâ€? of class emulation, clearly suffer—and greatly—in the long term, often in ways that are unforeseeable.”

    WOW! There is a massive emperical generalization. On what basis do you make this claim? I am with you about the importance of information and means, but I am doubtful that ANYONE has the evidence necessary to support the claim that you are making. Nor, it seems to me, have you made the case (or even gestured toward a set of arguments making it) on the basis of a priori theory, even if that was the case. Furthermore, the notion of choice and consent is hardly as thin or vacuous as you make it out to be. Even the consumer market is hardly the sort of morally vacuous place that you make it out to be. Aside from the utilitarian arguments in its favor, the notion of market and consumer sovereighty serve important political and social goals. They provide a successful mechanism for peaceful cooperation between those with violently differing ideological or religious commitments (no small social virtue that). Furthermore, to the extent that one is interested in the hermeneutics of suspicion because of the fear that the little guy is going to get squished, choice is powerful precisely because in social debates the little guy is almost certain to loose the thicker battles for which you hanker. Hence, you are likely to be much, much better off as a little guy pursuing your thicker goals within the context of an over-arching but thin language of choice and consent. Finally, there is nothing about the notion of choice or consent that requires that one be indifferent as to ends chosen, only to the notion that the presence or absence of choice is logically prior to the question of ends in our moral calculus. It seems to me that this logical ordering of choice is precisely what is entailed by the various stories that we have about the council in heaven and the importance of free agency.

  150. Julie M. Smith on December 16, 2005 at 6:22 pm

    RW–

    You are really misreading me; equipoise is very much the wrong word. It isn’t that it all sorta evens out in the end; it is that very real risks and benefits differ. If it were six of one but half dozen of the other, I’d suggest that a woman flip a coin instead of bothering with all of this evidence. In that case, concern about cost (and impact on the underpriviledged, etc.) would make very good sense. But it isn’t like that at all. Again, no one but the woman whose body is in question should decide if an X% increase in risk Y is worth the tradeoff of a Q% decrease in risk Z. (We’ve got about a dozen variables here, so it is even a lot more complicated than that.)

    Greg, I think the assumption all along has been that the benefits would clearly outweigh the costs (for certain women) or we wouldn’t be having this discussion. Maybe it would be easier to put another intervention up for consideration since elective c/s seems so radical to some people: What about epidurals? Clearly, more expensive to have one than not to have one. Should we insist that women don’t get them in order to keep costs down? (Note: I don’t have a solution to the cost problems related to health care. I posted about that before. But I’ll be darned if the first place we begin rationing health care is with childbirth while the insurers are still covering Viagra for old farts.)

  151. Paul on December 16, 2005 at 8:03 pm

    Leave the old farts and their jollies out of this! Actually, Julie, I commend you on a reasoned analysis throughout this post.

  152. Julie M. Smith on December 16, 2005 at 9:31 pm

    Thanks, Paul. :)

  153. Rosalynde Welch on December 17, 2005 at 11:50 am

    Nate, you know I live to scandalize you on Friday afternoons with my massive empirical generalizations, clothed in nary an apriori theory—all the more shocking for being appended as a throwaway tag to the 146th comment on somebody else’s thread!

    For what it’s worth, I think you’re overreading my critique of the language of consumer choice. Frankly, I’d far prefer to see childbirth ensconced in a market than in a metaphysics: markets, as you point out, are at least rational and efficient. I don’t dispute the point that a genuine market mechanism can promote cooperation and distribute power, and all the rest; nor do I dispute (indeed I explicitly acknowledged in my first comment) that the language of choice and preference originating in consumer choice, thin as it is, serves a useful political purpose for the embattled. But at this point, at least, modes of childbirth do not, in fact, array themselves as shelved products or traded futures—we just talk about them as if they do: as Julie acknowledges, consumers of childbirth services are largely unaware of even the *relative* costs of the items for sale (nor, of course, are c-sections actually for sale yet). My massive empirical generalization was directed at the application of a particular subset of consumer discourse—the value-free language of preference and taste as a form of subjective self-expression (the Amazon.com wishlist version of selfhood, if you will)—to areas of human experience that are not (yet) facilitated by genuine markets: sexuality, family life, spirituality and the like.

    Finally, it may be true that “there is nothing about the notion of choice or consent that requires that one be indifferent as to ends chosen.” But the presumption that structures at least the comments on this thread (I confess that if my last try was a no-go, I can’t wrap my head around what Julie herself is arguing) seems precisely to disclaim this: the “it’s my body, my preference, my choice, nobody else can judge me or even suggest that I should think about another option” line of thinking that has prevailed here assumes a thoroughly relativized—or at least radically individualized—array of ends. The point, made again and again, is that there is no right or wrong choice, so long as individual preference is served. This version of consumer preference, though it may share with the idea of moral choice a logically prior notion of agency, seems to me to share very little else.

  154. LisaB on December 17, 2005 at 12:45 pm

    I realized I didn’t answer the question a couple readers posed about book preorders. We’re not so far along as that yet, but I’ll keep everyone posted on FMH. Meanwhile, there is a good book out already by an LDS nurse and doula called “Pregnancy, Birth, and Your Growing LDS Family” by Kathleen Tooley Johnson. I’ve found it on Amazon (used) and also on an LDS homebirth website (google the title or author). She is cautionary about interventions, but emphasizes personal choice and seeking inspiration in individual cases. I especially like many of the pregnancy and birth scriptures she includes throughout the book.

  155. Julie M. Smith on December 17, 2005 at 12:58 pm

    RW writes, “I confess that if my last try was a no-go, I can’t wrap my head around what Julie herself is arguing”

    and then writes,

    “The point, made again and again, is that there is no right or wrong choice, so long as individual preference is served. ”

    Ah-ha. I think this is why you don’t yet get my point. There _IS_ a right and wrong choice–but that choice isn’t going to be the same for any two women. For example, if you are 38 weeks pregnant, your midwife estimates that your baby is over nine pounds at this point, pain avoidance is a high priority for you, you don’t want to be induced, and other considerations aren’t as important, then having an unmedicated birth is the WRONG choice for you. Similarly, if you have an ideological commitment to natural family living, are expecting a smallish baby, have a high pain threshhold, and have had a previous successful unmedicated birth, than an elective c/s is the WRONG choice for you.

    The part about not judging others comes from two things:

    (1) we almost never know enough details about the circumstances of another’s situation to be able to tell her in casual conversation on the playground, “Oh, in that case you should definitely _________.”

    (2) I reject the notion supported by (most of the) natural birth advocates that there is one best way for all women.

    Did that help, RW?

    LisaB, I’m a little chagrined (mostly at myself) that we’ve made it 154 comments and only now are explicitly introducing the idea of seeking inspiration for these decisions. Thanks for bringing that up.

  156. Julie M. Smith on December 17, 2005 at 1:13 pm

    Let me add to my (1) in #155 that we also tend in those kind of situations to imply what another should or should not consider important, as in downplaying their commitment to natural family living or shrugging off their desire to avoid pain.

  157. Christian Y. Cardall on December 17, 2005 at 3:10 pm

    Rosalynde: areas of human experience that are not (yet) facilitated by genuine markets: sexuality, family life, spirituality and the like.

    These may in fact involve markets, or at least market-like mechanisms, to a very appreciable extent. In the case of sexuality and family life, whether it’s prostitutes in search of a quick customer or a chaste virgin looking for lifelong support of her motherhood, the women are ‘advertising’ and the men are definitely paying. As for spirituality, the advertisement, sales, and PR techniques employed by churches are even more literally similar to those deployed for normal worldly products—and once again, the payments are definitely literal.

    You may object that the facets of life you mention here are more emotional and instinctive, but I think you have overstated the rationality and information basis behind much of consumer choice.

    BTW, your emphasis in an earlier comment on replication as essential to science provoked a post that would have been even more of a threadjack than this comment.

  158. Nate Oman on December 19, 2005 at 7:36 am

    RW: I don’t understand how anyone who has attended an LDS singles ward for any appreciable period of time can claim that sexuality is not facilitated by market-like mechanisms. If you want a real trip on this subject (ie love, sex, and markets) check out:

    Richard Posner, Sex and Reason

  159. Jennifer M. on February 1, 2006 at 12:54 pm

    I’ve noticed a trend for people to call a birth “natural” only when no medication is used at all. And unfortunately, as a whole that’s how society sees it today. BUT i disagree…why is a perfectly heathly birthing with the help of medication for pain management not called Natural. A birth with the the help of an epidural can still be delivered vaginally, labor that needs a “jumpstart” with pitocin can still be vaginally delivered. A Csection, elected or not still gives you a baby in the end!
    Laboring for hours upon hours, in horrible pain seems to be the only way in society’s eyes to “earn” your “Natural birthing Goddess girlscout patch” or something.
    GIVE ME A BREAK!
    Being pregnant for 9 months, going through the changes your body makes, the ups, the downs, and then….child birth…whether non-medicated, medicated, or elected cs. Your still left with the same end result. A beautiful baby!

    I had Group B strep with my first child, and so my doctor AND I decided to iduce my labor. That way i could get the anti-biotics in my system that would help protect him before delivery, and my delivery would be closely monitored from start to finish. I had no desire to be cut open, so i choose to deliver vaginally, rather than have an elected CS. I did have an epidural, only after I decided i was ready for one. Unfortunately my epidural was not effective and so I ended up delivering without the help of pain relief. All in all it was okay.

    I am 9 months pregnant with my second child now, and unforturnately I have been diagnosed with gestational diabetes. I have talked to my doctor about every option open to me. Obviously with concerns about a baby that is very large due to the diabetes, I was given the option of an elected CS. I have decided I would prefer a vaginal delivery again. Not because I’m scared of risks to myself or my child. I am well informed about the risks, but because i dont like pain medication, it makes me feel unnormal, and out of control.(I had a bad experience with pain meds after a minor surgery, but thats another story!) My doctor will be inducing me, my choice, and we will go from there. Whether i decide on some sort of pain management or not;having a baby, no matter HOW they come into this world is natural enough.

  160. Becky R. on March 7, 2006 at 3:35 pm

    We keep talking about doing your research and being well informed and I to think that is important. I am very thankful that I have the know how and the ability to utilize reliable resources on the web and know how to sort through biases.
    However I do feel that there is one are of the decision making process that keeps being overlooked in this decision making debate. That is the decision of your care provider. Every woman who is pregnant needs to find a care provider who they trust. Studies (I don’t have time to link to them) have repetedly shown that a womans feeling of being in control of her birth experience has a large impact on her perception of the experience of that birth – vaginal, medicated, unmedicated, or c-section.
    I know that while my first birth experience was not the one I had planned. However, having a doctor I trusted and had faith in still made it a positive and wonderful experience.
    A care provider that you trust should be able to help you sort through you choices and assist you in making the best decision for your individual case. If an emergency should arise having a care giver that you trust will ensure that you feel your and the childs best interests are still being considered and provide for a better overall birth experience.
    So while individual research is important, I belive a far more important consideration is that of a care provider that can help you make the best decision for yourself. Women need to choose a provider they trust and respect and who they feel respects them as a patient.

  161. Becky R. on March 7, 2006 at 3:37 pm

    Just one quick link to support my previous entry.
    http://www.ingentaconnect.com/content/bsc/bir/2003/00000030/00000004/art00003