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Monday, July 2, 2012

Midwife vs Medical Establishment

As a rational person you have done your research and you know you want to give birth without drugs. You also know that women can give birth naturally with a doctor, it's just much less likely they will be successful at it. 30-50% of women who want to give birth naturally will fail if they choose a doctor for delivery compared to 5% of women who will fail with a midwife. If you are a rational woman, it's a very simple decision: the goal is to succeed at having an unmedicated birth and using a midwife maximizes your chances of success.

Due to the philosophical differences between how midwives and the medical establishment view pregnancy and labor, the choice to use a midwife will hugely impact, not just your birthing day, but your entire 40-week experience of being pregnant.

To summarize the philosophical differences:

  • Midwives encourage women to stay in tune with their bodies and think for themselves throughout the entire pregnancy. Doctors encourage women to do as they are told.
  • Midwives schedule 90 minutes for every prenatal appointment. Doctors schedule 15.
  • Midwives believe birth is a normal physiological process. Doctors believe birth is unpredictable, unreliable and often unsafe.
  • Midwives seeks to let the woman be in charge of her birth. Doctors seek to control the woman's birth.
  • Midwives believe giving birth without medication is an emotionally empowering and transformative experience leading the woman to feel that she can conquer the world. Midwives believe medical intervention is undesirable. Doctors believe medical interventions improve labor
A personal note on how these philosophical differences played out in my pregnancy:

When I found out I was pregnant, my OBGYN recommended I go on progesterone to ensure that I didn't miscarry. There was no medical reason for her to make that recommendation. She recommend it purely based on my age--29. I told her that I was a very healthy person who hadn't even had a cold since 2004 and she told me that was irrelevant. I was 29 and I should not trust my body to make enough progesterone to keep the baby.

Of course my emotional brain acquiesced to her controlling mentality but my rational brain knew better: if the tiny bunch of cells in my uterus wasn't genetically healthy and my body wanted to get rid of it--why would I want to prevent that?

After a quick Google search I learned that taking progesterone came (of course) with side effects: bloating, breast tenderness, diarrhea, dizziness, drowsiness, dry mouth, fluid retention, headache, heartburn, irritability, muscle pain, nausea, stomach pain, stomach cramping, tiredness, vomiting, bleeding or spotting, amenorrhea, edema, weigh changes, cervical erosion, cervical secretions, cholestatic jaundice, skin reactions including a rash or acne, mental depression, pyrexia, insomnia and somnolence.

I said "no" to the progesterone. My doctor, with the air of an all-knowing mystic, said she didn't approve but that I could take that risk if I wanted to.

Then she told me that I was not allowed to eat alcohol, caffeine, sushi, raw dairy or take hot baths. I had heard those things before so I asked what was on my mind:
"Don't pregnant Japanese women eat sushi?"
"Pastuerized dairy has only been popular for 80 years--doesn't that mean pregnant women have been consuming raw dairy for thousands of years?"
"How does a hot bath hurt my baby and not my internal organs? What about women who live in hot climates--are they hurting their babies every time they go outside?"

My doctor practically growled at me and repeated her recommendations with a dramatic flurry that included the phrase "hot baths will cook your baby". Then my fifteen minutes were up and the appointment was over.

It was time to check out the other route, the route only 5% of women choose. I went to a presentation called "meet the midwives" at The Birth Sanctuary, a birthing center in Los Angeles. The presentation was held in their "birthing suite", a large, elegantly-decorated apartment with a bathroom and full kitchen.

The midwives were sweet, emotional types and neither their personalities nor the way they tried to sell a midwife birth did anything for me. I hadn't chosen a natural birth for emotional reasons (though that video of the drugged newborn trying to nurse and failing does haunt me a little).

The business manager sold the idea of a midwife birth to me a little better. She was from New York; she thought fast, spoke fast and didn't sugar coat anything. She talked numbers; she said things like, "Only 5% of midwife assisted births require medical intervention, unlike 30-50% of OBGYN/hospital births." Unfortunately, she didn't deliver babies.

But whether or not the birthing center was a little too touchy-feely for my taste, I loved their philosophy on prenatal care: first prenatal appointments should be somewhere around twelve weeks--unless you are feeling anxious, then you could come in earlier. It was a different world from my OBGYN who had demanded to see me immediately, like it was an emergency, when I was only six weeks along. The midwives trusted me and my body to be pregnant for the entire first trimester without their input. Oh to be treated like I have a brain!

At my first prenatal at the birthing center (at twelve weeks), I asked the same questions I had asked my OBGYN. On raw dairy and sushi, I was told to use my common sense and not eat things that smelled or looked funky. Getting really bad food poisoning while pregnant could cause a miscarriage--but more food poisoning is caused from lettuce these days than raw dairy. If the milk and sushi I had been eating for the last thirty years hadn't given me food poisoning yet, there was no reason to assume it would give me food poisoning now. On hot baths, I was told to use my common sense and that if I felt dizzy or woozy, I should get out of the tub. If it felt good, however, it was probably helping me relax which would benefit me and my baby.

And what about an occasional glass of wine? The facts on the no-drinking rule are: a full-on alcoholic will only have a 4% chance of giving her baby fetal-alcohol syndrome if she eats healthily. An alcoholic who doesn't eat healthily will have an 80% chance of harming her fetus. It's not the alcohol that harms the baby but the nutritional deficiencies related to drinking too much that harm the baby. A healthy eater who has a glass or two of wine every day is unlikely to harm her baby. Women used to be encouraged (by doctors) to drink throughout pregnancy for relaxation and then get raging drunk for labor.

So why does the medical establishment give pregnant women so many rules? Because just like in elementary school, rules are made for the lowest common denominator. There are women who will eat some pretty funky stuff, stay in hot tubs until they pass out and not know that a handle of vodka every day is drinking too much. It's easier (and faster) to just give women a blanket list of "don'ts" than to explain to them what's going on and then trust them to use their common sense and self-control.

The one downside (or so I thought) to having a midwife instead of an OBGYN is that midwives don't usually offer ultrasounds. This made me sad as I longed to see my little fetus! Then I read Birth: The Surprising History of How We Are Born. Here is the paragraph that made me glad my midwives weren't into ultrasounds: "Frenchman Paul Langevin discovered that high intensity ultrasound could destroy schools of fish in the ocean, and when a person put a hand in a tank of water that had ultrasound waves running through it, they experienced pain, a discovery that led doctors to use the technology to destroy tissue, such as a brain tumor." That's high-intensity ultrasounds. On modern prenatal ultrasounds Susan McCutcheon says, "We do know that in the short term cells behave abnormally after just one diagnostic ultrasound exposure. The shape of cells so radiated changes temporarily and their movement becomes frenetic."

An ultrasound would make my little blueberry a frenetic glob of cells? I was happy to skip them. (I did get one, at 20-weeks, to find out the gender of my baby though, figuring since my little one was no longer a glob of cells it would be safer.)

I have to say that this was not a hard philosophical decision for me--did I think pregnancy was a natural process and I could trust my body and evolution to do it right or did I think pregnancy was a disaster waiting to happen? Did I want someone who would take my questions about baths and food seriously or someone who would bark rules at me? Did I want to maximize my chances of succeeding at natural birth?

I chose the midwife route.

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