I Want It Natural

(Full disclosure: both my father and brother are Ob/Gyns.  I, however, am not.)

I remember once, in a completely unrelated discussion, talking to Adam about the benefits of electric shaving vs. razor shaving.  One argument he made at the time was that if he could have a machine do the job for him, why do it himself?  (I am not going to address the merits of this argument, the point is as an intro).

Essentially, the argument is technologist.  Whatever science and technology can do to improve our lives, it should.  And we should take advantage.

One area where there always seems to be resistance is in childbirth.  I have had (surely less than my father and brother have had) many conversations with women who laud the wonders of “natural childbirth.”  The conversation usually goes something like this:  The woman will say something along the lines of “I want to experience it” or “women for millenia have done fine without _______ (fill the blank: drugs/hospitals/doctors)” or some such argument.  And I always respond with some variation of “would you turn down anesthesia for surgery?  why feel pain when you don’t have to?  There’s a name for that, it’s called masochism.”  Or “yes, women have always done OK, but never as well as they do today.”

See, this is what bugs me.  That’s a BS argument.  At the turn of the 20th century, a woman was 100 times more likely to die in childbirth than she is today.  ONE HUNDRED TIMES!!!  Not 100%.  100X.  10,000%  So, no, by today’s standards, women have not done fine for millenia.  They were dying at alarmingly higher rates.  Why?  Oh, maybe because doctors, hospitals and modern medicine have prevented those deaths?

And it’s not just women, it’s babies, too.  The perinatal mortality rate (defined as deaths from 28 weeks gestation to 6 days post partum) in 1950 was 32.7 deaths per 1,000 live births (that includes 14.9 late fetal mortality and 17.8 7 days neonatal mortality – see the chart below).  That number goes down to 6.9 in 2002.

Deaths per 1,000 live births
Year Under 7 days Late fetal
mortality rate
Total
1950 17.8 14.9 32.7
1960 16.7 12.1 28.8
1970 13.6 9.5 23.1
1980 7.1 6.2 13.3
1990 4.8 4.3 9.1
2002 3.7 3.2 6.9

(Source)

That’s a huge reduction.  Do you think, maybe, the quality of prenatal care and advances in childbirth have a little something to do with that?  The World Health Organization does:

Prolonged labour or prolonged rupture of membranes causes infections in mothers and babies.  However, babies are more susceptible than mothers and infections in infants are more difficult to detect. It is estimated that 26% of newborn infants who die do so as a result of infections that occur around birth.

The perinatal period covers the period leading up to birth and the first week of life; deaths occurring in this period are largely due to obstetric causes. More than 3.3 million stillbirths and over 3 million early neonatal deaths are estimated to take place every year. In the year 2000, over 6.3 million perinatal deaths occurred worldwide: almost all of them (98%) occurred in developing countries.

The perinatal mortality rate is five times higher in developing than in developed regions: 10 deaths per 1000 total births in developed regions; 50 per 1000 in developing regions and over 60 per 1000 in least developed countries. It is highest in Africa, with 62 deaths per 1000 births, and especially in middle and western Africa, which have rates as high as 75 and 76 per 1000. The perinatal mortality rate in Asia is 50 per 1000 total births, with a peak of 65 per 1000 in South-central Asia, the third highest rate among the subregions, lower only than those of Middle and Western Africa. Oceania’s rate of 42 per 1000 falls between the rates of Asia (62) and those of the Latin America and Caribbean region (21).   (Source)

Aside from the historical trends, the present difference between developed countries and developing countries is stark and indicative of the point.  Where obstetric medicine lags behind in modernity (and approximates that of the 19th and early 20th century) women and babies die at much higher rates.  So why do women insist on giving birth in a way that mimics those times and places?  It seems just so assinine to me.

Then today (which, btw, is what spurred this post) I saw this: The Business of Being Born (I didn’t actually see the movie, just the website and the trailer).  And it infuriated me.  People make villains out of doctors and nurses.  They cry and moan about not wanting any medication, “natural.”  OK, if you want to be an idiot and suffer through the pain without the epidural, whatever, that’s your call.  But there are some medications that are necessary.  For instance, without pitosin, I have no idea when my first child would have been born.  For that matter, my second either.  And that my wife’s water broke the morning the second one was born, but she wasn’t really contracting, there was a serious infection risk to both the mother and the baby if she didn’t deliver soon.  Giving her pitosin helped her contract and helped the baby come out.  Why is it better to do “natural” which means suffering through a long childbirth and taking the chance that the baby develops an infection?  That’s better?  It’s absolutely idiotic.

I’m not saying that modern medicine is perfect, and that you’re for sure going to suffer some terrible tragedy if you reject it.  But why increase your chances?  Why not take advantage of everything modern science has to offer to make the process easier and more likely to go smoothly?

 

 

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18 responses to “I Want It Natural

  1. I haven’t read past the first paragraph yet, but I remember that conversation. Great recollection!

  2. That movie trailer is infuriating. I hate liberals.

  3. I was writing a whole comment about how natural birth is understandable, and then I watched the trailer, which is nonsense. You are absolutely right that the trailer makes an irresponsible argument, that women are better off without medical care. It’s one thing to have a natural birth with the medicine as a backup, but something entirely different to reject medicine altogether.

    Just nonsense.

  4. I’ll elaborate, since I realize that my last comment isn’t exactly laden with reasoned discourse. The Know-Nothings who are complaining in this movie are the same people who have fought to ruin the health care industry today. The producers of this movie argue for longer hospital stays for new mothers, yet they also believe that the mother’s hospital stay should be free of charge. They want the ob-gyn to work harder and be available at their beck and call, yet at a 75% lower reimbursement rate. They expect loyalty and undivided attention from their doctor, yet they’ll have no hesitation to sue the hospital and doctor at the first sign of a hiccup. These intellectually-diminutive Hollywood liberals are absolute hypocrites who unfortunately have a loud microphone at their disposal. If the trailer is an indication, the movie is a one-sided hit-job that doesn’t even attempt to be even-handed. The scene with pitosin is particularly infuriating, because the insinuation is that doctors are pushing the medication so that they can “be home in time for dinner,” even in cases where there is no medical indication; yet the scene (at least from the trailer) provides no context and is obviously spliced and edited to suit the storyline and the producer’s worldview. Sickening. Infuriating. Liberal. (Sounds like the tag line for a negative campaign ad.)

    When are liberals going to learn some economics? If you want your hospital stay to be free, it’s going to have to be more efficient!

    My name is Adam, and I approved this message.

  5. My name is Meir, I am an OB/GYN, and I am Noyam’s father. I couldn’t have said it better myself, and I’m very proud of N’s post. Elloquent and bright and every word is true.

  6. I would like to begin by saying that name-calling is never productive. If you call someone an “idiot” for not wanting an epidural, it’s very disrespectful.

    You should really see the movie in its entirety before commenting on it. The movie does not promote rejection of medical interventions when necessary. If you watch it, you will observe a more balanced view than what you are talking about. There are risks of waiting for labor to start too long after srom and there are risks associated with Pitocin. There are those who really do reject medical intervention for childbirth, period. But those who made this movie are NOT in this category. Does the movie promote the idea that for a healthy, normal, low-risk pregnancy, homebirth with a midwife is an option? Yes. Does the movie insist that there is no place in any pregnancy and birth for an ob/gyn. Certainly not.

    As for Adam’s comments — You cannot criticize a movie that essentially promotes homebirth with a midwife on the basis that “liberals” expect too much from an ob/gyn while being sue-happy.

    Also for Adam — I would really like for him to think about what a more “efficient” hospital stay means and how it breaks down financially. A woman with an epidural and has a labor that is augmented with Pitocin may or may not have a labor that lasts longer. These procedures are not free. Speaking from personal experience, my first labor (ob/gyn, pitocin, arom, epidural, c-section, 3 day stay) was a lot more expensive than my second (midwife, no medication except for 3rd stage pitocin, 2 day stay). And I sure did pay for both!

  7. Karen:

    I would like to begin by saying that name-calling is never productive. If you call someone an “idiot” for not wanting an epidural, it’s very disrespectful.

    It might be disrespectful, but I believe that anyone, birthing mother or otherwise, who chooses to experience pain when there is a pain-free alternative is an idiot. I think I made my point on that quite productively, actually.

    You should really see the movie in its entirety before commenting on it…Does the movie insist that there is no place in any pregnancy and birth for an ob/gyn. Certainly not.

    I was commenting on the trailer, which I saw. If the trailer misrepresents the movie, then whomever produced the trailer has acted irresponsibly. I am actually interested in seeing the movie, though I am skeptical to the extent to which the trailer is so far off from the movie. This is not a documentary simply about the benefits of home birth. If it were, it would be named “The Beauty of Home Birth” or some such. But it isn’t. There is a clear and unambiguous villianization of the medical profession (doctors, nurses and hospitals) in the title “The Business of Being Born” and the many cuts and words spoken about how doctors want to do anything possible to speed along a delivery just because they want to go home, including unecessary pitocin and unwarranted c-sections. That is irresponsible of the movie-makers. There is a line in the trailer that “C-Sections are very doctor friendly.” Is there, in the movie, a balanced counter-point that they are also very patient-friendly, in that they save lives? Or is that line not in the movie, but only in the trailer? Either the trailer grossly misrepresents the movie and its agenda, or my reaction to the movie is not so far off.

    Finally, I think you’ve misunderstood Adam’s point. He is not comparing the economics of home birth to the economics of hospital birth (in fact, your comparison of such is a red-herring and adds nothing to the discourse). His point was that with regards to hospital birth many women complain from both sides of their mouth: they want longer and more comfortable hospital stays while at the same time wanting lower cost health insurance and lower cost obstetric treatment. They want to have more time to spend with their doctor and more personal treatment, but they want to spend less for it. This is ignorant of reality at best, hypocritical at worst. Coupled with the rush of malpractice suits for even the most unavoidable and natural of complications, when the result was inevitable and there was nothing the doctor could do, makes it even worse. When it comes to the woman, special time and respect is demanded of the doctor, but when it comes to the doctor, the same is not reciprocated.

    The fact is, if a woman wants a longer hospital stay, she can have it. She just needs to pay for it. The hospital acts on the instructions of the insurance company when deciding the length of the stay. Should the hospital, knowing it will only be paid for one night in the hospital, donate two more free nights to whomever wants it? That’s the ignorance of economics that Adam was talking about. I don’t do my job for free, nor do I expect you to. So why demand the same from doctors and hospitals?

    You’ve also misunderstood my point: I am not saying that women shouldn’t be free to do whatever they want when it comes to birthing practice (of course, within the confines of what can be considered reasonable without endagering the baby). I just take issue with the cries of “we can do this without them” and demonization of the obstetric profession, when in fact, the simple fact is, without doctors and hospitals, women and babies would die much more often. It is that simple. For me, when two lives hang in the balance, I want the most advanced and knowledgeable care available. If somehow a machine were invented that delivered babies painlessly and within 30 seconds, that caused no harm to the baby and no traume to the mother, and made childbirth and ambulatory procedure with no required hospital stay, I would advocate its use in all instances, and I would call whomever didn’t use it, for whatever reason, an idiot.

  8. Listen Karen, I haven’t seen the movie — just the trailer. The trailer tries to entice viewers to see the movie by appearing as though doctors and hospitals will be demonized. The arguments I was making were directed at the trailer. I will not see this movie because it looks like a low-rent Sicko-wannabe. From the trailer, I don’t believe the movie is going to be an interesting, balanced, or thought-provoking discussion about the potential benefits of midwives. I *would* see a movie that would make me think about positions other than those I hold; this trailer has no convinced me that “The Business of Being Born” is such a movie. The entire trailer (indeed, even the title itself) suggests scorn to the medical establishment. I see no need to sit through two hours of mindless propaganda.

  9. Well, I guess I’m an idiot by your reckoning and therefore worthy of disrepect, and as such you may as well not read what I’m about to write as it clearly must have no value.

    I valued each of my childbirth experiences and I wouldn’t have used your 30-second baby machine. I’m glad women have choices and I am not about to call someone who chooses something that I wouldn’t an idiot, as long as they make informed decisions. Your chart does not represent homebirth today versus hospital birth today. If a woman chooses a homebirth with a well-trained midwife and receives proper prenatal care throughout her pregnancy, the numbers change quite a bit from those in your post.

    I find it off-putting that those who favor natural birth and homebirth are branded as idiots and radicals, even though most freely express that neither is appropriate in every situation, while those who so brand them hold themselves up as reasonable for suggesting that in every case, one way is the best.

  10. My problem is not with those who want to have home childbirth. My problem is with demonizing doctors and hospitals, and also with those who marginalize the impact of modern medicine (such as ignoring noyam’s mortality rates by saying things like ‘women have been giving birth on their own since the beginning of time, and have done just fine.’)

  11. Karen, do you have a martyr complex? it clearly must have no value Did I say that I reject and ignore everything people have to say, even if I think they fall to the wrong side of smart? No. In fact, I’ve read your comment, and responded to it. So why the whining about respect?

    I wonder if this idea of savoring the childbirth experience is itself the product of propaganda and brainwashing. Hundreds of years ago, women didn’t want to savor anything, they wanted to survive it. Now, with the luxury of the modern world making survival an almost forgone conlusion, women can have the luxury of “experience.” But that itself is the product of the female empowerment movement.

    You see, the women’s equality movement has a HUGE problem when it comes to childbirth. It’s the one thing they can’t get around. Childbirth has to be done by a woman. You can’t get equality in this area, it’s biologically impossible. So what to do? Empowered women are stuck. Do they accept nature and biology? of course not. Nature and biology don’t empower women. So the empowerment focus shifts now to reject the “male dominated medical society ” (even though many, if not most, of the obstetric health professionals, including doctors and nurses, are women) and all of its norms and benefits, and instead pushes women to embrace the pain and “experience” the childbirth. This is ridiculous, but it’s the only way the woman can get the “upper-hand” in this battle with men. “You’ll never have the bond I have with our daughter, you didn’t feel her coming out of you.”

    Your reference to mortality rates, by the way, in home births is misleading. Here’s why:

    You yourself admitted that home birth is only appropriate “for a healthy, normal, low-risk pregnancy.” You yourself admit that there should be medical backup in the case of complications. So I ask you: if all cases of complications and high-risk pregnancies end up in the hospital, and only the lowest-risk, most normal pregnancies are home births, then OF COURSE there will be a higher mortality rate in hospitals. That’s like saying “don’t go into the ICU. The percentage of people who die in intensive care is much higher than in the rest of the hospital. Clearly, it’s not as safe.” If you see the huge flaw in that statement (which I hope you do), then you should see the flaw in statistics (malleable numbers) that show lower mortality in home births.

    it is the medical advances that back up home births, and give proper pre-natal care, and train midwives (to be the “highly trained midwives” you espouse) that make home births possible. Yet, the home birthing community wants to ignore that, and make hospital birthing a bad thing.

  12. What I suppose MY problem is with, then, Adam, is that Noyam seems to be on the margin — that a 30-second baby machine would be idiotic not to use in every circumstance — whereas the makers of this film are not, and it bothers me that they are being portrayed as such on the basis of a 1-minute trailer (that granted, they put out, but the purpose of advertising a film is not to give a synopsis).

    They do not disregard mortality rates and they see the value in modern medicine for the women and fetuses who can benefit from it. Since you have no intentions of seeing the film, I won’t bother with a spoiler alert. The director of this film, Abby Epstein, in fact was planning on a homebirth with a midwife but due to complications, had a Cesarean birth in the hospital. Neither she nor her midwife make blanket statements that homebirth with a midwife are marginalizing the impact of modern medicine.

    Perhaps they are providing a balanced point of view with which you don’t happen to agree, that modern medicine may also have risks when applied in the same manner to every laboring woman, and removes some of the opportunity to view birth as an event that creates a family, not just as a physiological event in a woman’s life.

  13. What I suppose MY problem is with, then, Adam, is that Noyam seems to be on the margin — that a 30-second baby machine would be idiotic not to use in every circumstance — whereas the makers of this film are not, and it bothers me that they are being portrayed as such on the basis of a 1-minute trailer (that granted, they put out, but the purpose of advertising a film is not to give a synopsis).

    They do not disregard mortality rates and they see the value in modern medicine for the women and fetuses who can benefit from it. Since you have no intentions of seeing the film, I won’t bother with a spoiler alert. The director of this film, Abby Epstein, in fact was planning on a homebirth with a midwife but due to complications, had a Cesarean birth in the hospital. Neither she nor her midwife make blanket statements that homebirth with a midwife are marginalizing the impact of modern medicine.

    Perhaps they are providing a balanced point of view with which you don’t happen to agree, that modern medicine may also have risks when applied in the same manner to every laboring woman, and removes some of the opportunity to view birth as an event that creates a family, not just as a physiological event in a woman’s life.

  14. Noyam seems to be on the margin — that a 30-second baby machine would be idiotic not to use in every circumstance

    Do you seriously think that wanting a complication-free, 30-second delivery is “on the margin”? You’re delusional. You are so far into your propaganda-driven, anti-medical-establishment ideals, that you think you’re mainstream, and that I and people like me are the margin.

    Notice, by the way, that the medical profession isn’t putting out documentaries about the dangers and potential problems of home births.

  15. Noyam, I’m not going to respond after this post as I have tried to be polite and respectful and you continue name-calling. I have never read your blog before, I don’t know you, I don’t know what you do for a living, I don’t know your past experiences — but if your last comment indicates your view on women and men, then we will disagree until our dying breaths. I can assure you that not every woman would tell the father of their children that he will never have the bond that she does. If this has happened to you, I am sorry that such a hurtful thing has been said.

    I’m not sure what sort of birthing community you’re speaking of because I am part of the birthing community and I do not believe that about hospitals. Are there some that do? Yes. But they are on the margins, and most birth professionals I know, homebirth midwives included, do not see hospitals as absolutely evil. I have seen births in homes, freestanding birth centers, and hospitals, those with many interventions and those that have had minimal interventions. I’ve seen excellent outcomes in every circumstance. I am not a radical and neither is the community in which I practice.

  16. Karen – I am in a meeting and can’t comment anymore either. My point is that the movie (according to the trailer) is meant to demonize and scorn the medical establishment, including doctors and hospitals. I have a problem, as I wrote in more detail above, with many of the positions espoused in the trailer. It’s a simple lack of reality-testing. This is not about whether there might be some nice benefits to homebirth.

  17. Karen, I’m not sure what name-calling you’re talking about, but I will say this:

    it is often the person who has the logical flaws in her argument laid bare for all to see, and as such has seen her argument crumble around her, that is the one that is left with nothing but crying about “name-calling” and appeals to personal, anecdotal experience, instead of empirical logic or evidence.

    I appreciate that you took the time to come here and comment, though I wish you would have acknowledged, at least, the points I made about the inherent logical and statistical flaw in the arguments you use to buttress your claims.

    Just to be clear, nobody, especially not my holy and saintly wife (which I say without the slightest hint of sarcasm), has said something like that to me. But that doesn’t mean it doesn’t exist. I am not so narrow-minded to think that because I haven’t experienced it myself, it doesn’t exist.

    I mean, you said this: I’m not sure what sort of birthing community you’re speaking of because I am part of the birthing community and I do not believe that about hospitals. Are there some that do? Yes. Well, if you know of those that are exactly like that, then you know exactly what I’m talking about. It’s your own narrow-minded view that thinks I’m only talking about you (or about you at all, for that matter).

    And finally, you said this: I don’t know your past experiences — but if your last comment indicates your view on women and men. You’re right, you don’t know me. And I really don’t feel like justifying myself to you.

  18. http://en.wikipedia.org/wiki/Appeal_to_emotion

    I think you’re talking about this… Methinks it’s actually very similar to old-school baseball writers who, when faced with overwhelming evidence suggesting that their analysis is antiquated and flat-out wrong, say “you internet nerds don’t know what I know – I’ve been interviewing ballplayers for 20 years so don’t tell about your stupid stats and numbers” — http://en.wikipedia.org/wiki/Appeal_to_authority

    (Yes, I just wanted to start talking about baseball – it’s been too long since you’ve posted on this critical subject matter… 1 month and 3 days ’till pitchers/catchers report)

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