Documentary

[Antiviral22]

Anyone.seen.the.documentary."The.Business.of.Being.Born"?...by.Ricki.Lake

Thoughts?
Comments?
Critiques?

(sorry.about.the.periods.between.each.word,my.spacebar.is.broken)

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[Trillgirl]

Haven't seen it yet... need to line up my anti-N/V meds first.

However, I've already had a patient refer to the movie and ask questions and make rather insulting comments about ob.gyns and how we practice.

Needless to add... she is a prime and at 37 weeks. No birth plan. Was "quite upset" because she thought she signed a consent for episiotomy and pitocin with her initial prenatal consent forms. I reassured her that she did not and showed her, her own signed consent where there were no mentions of episiotomies, etc.

She also tells us now that since she saw the movie and has done "other" research she does not to give birth in a lithotomy position, because it is the "worst one". I told her that my partners and I were trained in programs that almost exclusively used a semi-Fowlers or lithotomy position, and I would not feel comfortable delivering her on all fours or squatting. Is it possible, sure. But I'm rather not take that risk. Anyhow, to make a long story a little shorter, she basically would prefer a midwife home birth and stated that rather bluntly. I tried to talk with her about things we can agree on and try to make the process as comfortable as possible for her and her SO.

From my little bit of reading, this movie takes research published in non-US journals, that are out of date and tries to do the usual extrapolation.

Ya know... I'm willing to work with a family to make them comfortable and give them a positive experience, but my ultimate goal is healthy mom, healthy baby. Period.

Just my two cents...

 

[ashbrant]

She also tells us now that since she saw the movie and has done "other" research she does not to give birth in a lithotomy position, because it is the "worst one". I told her that my partners and I were trained in programs that almost exclusively used a semi-Fowlers or lithotomy position, and I would not feel comfortable delivering her on all fours or squatting. Is it possible, sure. But I'm rather not take that risk.

Why would delivering in a squatting or all-fours position add risk? I'm not second-guessing yuour decision, just trying to understand the reasoning.

 

[chrisisinnocent]

Why would delivering in a squatting or all-fours position add risk? I'm not second-guessing yuour decision, just trying to understand the reasoning.

If your Dr is not used to delivering babies in that position and the nursing staff is not trained for it it's a risk because every method has its own set of potential problems and complications. You want your Dr to be aware of them and be able to react accordingly.

 

[Global Disrobal]

Although in the majority of the instances the delivery will be uncomplicated in the squat or "all-fours" position, the concern arises with the problematic deliveries.

We all train in an apprenticeship model and attain a degree of comfort with our practice. For most of us, we have run through a shoulder dystocia, operative delivery, normal delivery with perineal protection in our head numerous times. Almost always, the scenarios have been in McRobert's/lithotomy position, hence our comfort lies in that position.

The patient has every right to deliver in the manner they choose, however if they want us to do the delivery, then dialogue must take place as to the most optimal conditions for both parties. I echo the above poster in that I do not do deliveries in squat or all-fours. My reasoning is that, my standard practice of protecting the perineum is hard to perform in those positions. Further, if faced with a dystocia, I want the patient ready to be put in McRoberts, amenable to suprapubic pressure, and most importantly in a position where I can perform the delivery through the dystocia to the best of my ability (training).

Hope this helps answer your question.

 

[Trillgirl]

Thanks, guys...

The additional point I think is important is the conversation. The discussion between a patient and her physician shouldn't start in the LDR room, but many, many weeks earlier. I want my patients to be happy with their birth experiences, but my priority will always be: safe and healthy mom, safe and healthy baby.

 

[OphthoBean]

I'm not an OB but I am a physician and I recently saw the film on netflix. I expected it to be pretty scathing because I first heard about it from one of the midwives I interviewed who was very strongly anti-physician (didn't hire her anyhow). I thought it was reasonably balanced and that the main purpose was to cause the viewer to pause and consider that there are alternatives to the standard birthing process for some women which are both appropriate and safe. One of the births was a hospital birth, and needed to have an OB attending and the others were homebirths with a midwife in attendance. The commentary portions IMO were to provide food for thought and a starting point for further investigation should the viewer be so inclined to research.

I have the utmost respect for my OB colleagues because they provide necessary and lifesaving care in many cases. What I am critical of is the system which tries to fit every pregnancy (low or high risk) into the same mold just as a matter of policy. And as both a physician and patient I think it is appropriate to question if things are done a certain way because it is in the best interest of the patient or if it is just part of a routine or is what always has been done.

I had an OB during my last pregnancy, and was fortunate that she attended births at the Alternative Birthing Center which was part of the teaching hospital with a regular L&D unit, though it was in a separate wing of the hospital. I had laboring experience in both areas of the hospital and it was amazing to me the huge difference in how I was treated by staff despite being under the care of the same OB. In the ABC I wore my own clothes, labored in a homelike room with a regular bed, labored in the birthing tub, was encouraged to move about or reposition as needed for comfort, was provided yummy food and refreshing drinks, had minimal internal exams, no IV, and intermittent fetal monitoring via doppler even if in the tub. My same nurse even came by for a home visit after discharge to help me with breastfeeding.

In the L&D I felt like I had to fight or be on guard for everything. You MUST wear this gown. You MUST have an IV (and they put it in the worst place in my forearm so my baby was resting on it when I held him to nurse). You must wear these tocometer and EFM sensors at all times and you must remain in bed and not move too much lest you mess up the readings. And all they wanted me to "eat" was ice chips. When I asked for water the resident looked at me like I had 2 heads or something. Doesn't ice melt into water? I just prefer the room temp version, so I had to drink my illicit water off the books by having my husband keep refilling my cup for me as I wasn't allowed to have a lousy pitcher of the forbidden drink. It was all too ridiculous for words, but those were the policies applied to me without exception because obviously every single woman is identical and must fit into the proper L&D mold and just shut up and take it. And none of those measures improve the ultimate mother/baby outcome, they just make for a really unpleasant experience. It becomes unbearable to labor supine so then I ended up requesting pain meds after agonizing that by doing so I was increasing my risk for further intervention such as cesarean. Fortunately my awesome OB didn't have to do anything to me but be there for me when baby came.

Ideally every region would have a set up with an ABC attached to a hospital attended by OBs willing to let low risk women labor and birth in peace but since that is not the case women who don't want to be cattle prodded though their birth process have to choose homebirth. I am on staff at 5 local hospitals with L&D units, a few of which are very well respected and are the preferred locations for local women to birth. I could get a professional courtesy discount from the OBs I have interviewed and have all my hospital fees waived as staff courtesy, but I know I will have to fight every little policy and I just don't want to waste any emotional energy standing up for myself like that while I am in labor. Even if I had a note from the OB okaying intermittent monitoring, consumption of nutrients, and mobility, I know the unit nurses would be troubled by such uncommon orders and try to get me to comply and fit into their favored patient mold.

I am having a homebirth attended by a licensed midwife because it is safe for me and my pregnancy and because I don't have to ask for permission for every last thing. In my area it is the only acceptable alternative available. My goal is for me and my baby to be healty too, and since I include my emotional health in that equation, the birth experience does matter.

I don't think Trillgirl's patient should have been rude to her as it is uncalled for, but is sounds like the patient is kind of unsure of what she wants (no birth plan) and wants some reassurance that her doctor has her (the patient's) best interests at heart. I know it feels nicer to do things in a familiar and trusted manner, but I don't think that pushing position should be an issue if the patient is healthy, mobile, and not connected to a bunch of lines. It takes a few seconds max to flip over from all fours or lie back from a squat (some of those labor beds have squatting bars for moms to hold onto, you just let go and assume the position) and a few seconds are not going to result in a difference of outcome for mom or baby.

The most interesting thing I have found in my hunt for a birth attendant is that the OBs (out of my area) that are willing to offer a more natural birth experience (and pediatricians who offer a more natural approach to patient care) are very sought after in the natural living communities, so much so that many don't even accept insurance, their patients pay them cash and drive ridiculous distances to be part of their practices. Their practices thrive and the OBs don't appear to be practicing risky medicine as they have good outcomes. The patients feel listened too and well cared for. It is a practice pattern to consider.

 

[Spittz03]

OphthoBean, everyone is free to choose the setting they want to deliver in, position, and Ob, Midwife, home, etc. At the end of the day, the patient, the provider, and the institution has to be comfortable with the approach and potential for bad outcome. If you get a bad paraurethral tear or a 4th degree on all 4s ... ultimately it was your choice. If you get a shoulder dystocia, trust me those few seconds will seem like a lifetime and if you end up with the injury while moving or the baby doesn't do well ... maybe you will accept the responsibility for decision making and lifetime of guilt. All in all, good communication and advance planning is key.

P.S: Speaking of which I need a cataract surgery ... can we do it at my home in my chair while I have my morning muffin

 

[Heathcliff]

I had an OB during my last pregnancy, and was fortunate that she attended births at the Alternative Birthing Center which was part of the teaching hospital with a regular L&D unit, though it was in a separate wing of the hospital.

Would you mind sharing the name of this teaching hospital?
Although I am going into psychiatry, that teaching hospital sounds like a great place for training in obstetrics.

 

[OphthoBean]

Very funny Spittz. However I don't equate a low risk pregnancy and natural childbirth with a surgical procedure for a pathological condition done in a sterile operating environment. So no, no home cataract extraction, and no muffins in the operating suite. When I had my appy it was 100% reasonable to deny my access to muffins in the OR, knock me out and pose me in whatever manner the surgeon preferred. If you think normal pregnancy is some kind of dread disease or automatically assume it will be a surgical procedure, well we'll just have to agree to disagree. You are, however, welcome to eat a muffin during chalazion I&D so long as you don't move too much while I'm applying the scalpel.

Heathcliff
The hospital is Providence Hospital in Michigan. I don't know if the residents do any work in the ABC or if they are limited to the regular LDR area because I didn't have any residents peeking in on me when I was in the ABC. I just loved that ABC, it was so wonderful!

 

[bigapple34]

St. Lukes Roosevelt in manhattan offers the same services. They have a birth center where midwives deliver one floor down from the "regular" l&D. Incidentally, alot of the the documentary was filmed here. I watched the movie, and was pretty offended by the way they portrayed OB/GYN's as pushy mal-practice paranoid practioners who don't really care about their patients and just follow the "plan". While I do agree with some points made such as a normal, healthy pregnancy could most likely be handled perfectly by a midwife. I think the main attack was on the hospital system itself, thus promoting home birth. The filmmaker herself was pregnant at the time the movie was being filmed. She was followed by a midwife and was planning on a homebirth, I won't give away the end but I was very annoyed with what happend to her and wondered if her situation could be avoided if she had been followed by an OB from the begining. I am completely for a patients right to choose what kind of birth she wants, provided that ALL of the risks have been made explicitly clear. I do not think most of the women who were shown in the documentary and who delivered at home were told all of the complications that could happen during a so called "normal delivery". Without all the information informed consent cannot be made. A shoulder dystocia at home could be absolutely devestating. Incidentally for anyone who wants to become irriated and watch the documentary you can do it for free at:
http://bestdocumentaries.blogspot.com/2008/04/business-of-being-born.html

enjoy

 

[veo1]

Call me a troll but....

Wow. I just happened across this post while scrolling down to my forum on the main page. For those of you who haven't seen the film, a preview can be seen here: http://www.youtube.com/watch?v=4DgLf8hHMgo

What sleaze. It made me sick just watching the preview. I'm a resident in another field and have just become disenchanted by the way people just come out and bash the medical profession. They have no idea what it takes in terms of sacrifices and flat out hard work to get the M.D. and practice medicine. Since midwivery is the answer to all of the profession's problems, you guys (OB residents/attendings) should just quit and show everyone how important you really are. This isn't limited to OB and applies to most if not all fields of medicine. I always felt like we should strike since we're not important. If they believe what's portrayed in the media, then every alternative but the M.D. is the right choice in managing medical care. Sickening.

 

[OphthoBean]

The filmmaker herself was pregnant at the time the movie was being filmed. She was followed by a midwife and was planning on a homebirth, I won't give away the end but I was very annoyed with what happend to her and wondered if her situation could be avoided if she had been followed by an OB from the begining.

Um, did we watch the same movie? Ms. Epstein WAS followed by an OB/GYN, a Dr. Moritz. It was at her 20 week ultrasound that she mentioned having a homebirth to him. It is not clear if she continued parallel care with him or if she switched her prenatal care completely over to the midwife. In anycase after her c-section for a breech, preterm, IUGR baby, she asked her OB outright if her problems could have been detected earlier and why everything seemed fine for those first 30 weeks. Unless he was lying to her, and who knows, maybe he was, he told her that usually they are not aware of the problem and that these babies are usually found to be stillborn. Apparently THIS particular OB was not endowed with the special powers to avoid PTL, breech presentation, and IUGR, and I know this isn't my field of specialty, but I don't recall anyone having the power to influence these things.

Part of Ms. Epstein's problem was inaction on her part. She started having regular contractions and acted as if it was amusing to her and she couldn't believe it, knowing she was a good 4 weeks away from her EDC. This would have disqualified her from a homebirth, so instead of sitting around at home and eventually calling her midwife who straight up told her she needed to go to the hospital after finding her 3-4 cm dilated with a breech kiddo, she should have gone into her local L&D straightaway for evaluation of her PTL. Preterm and breech and high risk deliveries are outside of the scope of practice of midwives so I honestly don't know what she was thinking sitting around for so long. Maybe she was in denial.

And Veo1, are you paranoid much? No where in the film which you did not watch does anyone say midwivery (sic) is the answer to all the profession's problems. OBs are absolutely necessary and irreplaceable in caring for high risk patients or patients requiring intervention. The issue is that not all women, heck, not even most women, are high risk or require intervention and most midwives are going to be more supportive of a normal laboring woman than the average OB. My midwife only accepts 2 patients with due dates in any month, and the busiest practice in the area only accepts 6 per month. It is because they plan to be at the delivery themselves and spend a good deal of time with the laboring mom. There is no way in heck any OB is going to hang out with a laboring mom for several hours. It is just not the OB model of care. It is the midwife model of care, however, and so I don't think OBs have anything to fear from a practioner delivering 2-6 babes/month versus their 2 or more deliveries/day (not sure what the average is for OBs).

 

[OphthoBean]

I also wanted to comment on bigapple34's assertion that women planning homebirths are unaware of risks or lack informed consent. IME most women planning homebirths are very well informed, well read, and have done extensive research on both home and hospital births before making a decision. Most women who deliver at the hospital have done much more extensive research and contemplation of which stroller model to purchase or which wallpaper border goes best with the nursery wall color. They have no clue that each little intervention (heck even walking through the hospital doors) increases the risk for major abdominal surgery (c section) and are poorly informed of the risks of the procedure. If they really knew the risks they would never agree to c sections performed for such pressing medical indications as "well, your due date was 3 days ago so it is time for the baby to come" which was 100% honest to God the reason my BFFs sis "had to have" a c section.

 

[smq123]

Most women who deliver at the hospital have done much more extensive research and contemplation of which stroller model to purchase or which wallpaper border goes best with the nursery wall color.

This assertion is just as bad and as narrow-minded as the people who categorically dismiss homebirths and midwives, without even bothering to consider the reasons for wanting these things.

Some women go to the hospital because they're just not interested in homebirths. It doesn't make them shallow, or superficial, or even (*gasp*) bad mothers. It's a choice that they make - just like the choice that you made. Dismissing all of them as uneducated and superficial may do wonders for your sense of moral superiority, but is hardly fair to the women who DO deliver in hospitals.

What I am critical of is the system which tries to fit every pregnancy (low or high risk) into the same mold just as a matter of policy. And as both a physician and patient I think it is appropriate to question if things are done a certain way because it is in the best interest of the patient or if it is just part of a routine or is what always has been done.

To an extent, I agree - MOST pregnancies turn out well, without complications.

The problem that I have with proponents of home births is that it sometimes seems that they equate "low risk" with "NO risk." And that's just not true.

As an ophthalmologist, I'm sure that many of the procedures that you offer your patients are safe and "low risk." But there's no way that you'd ever call ANY procedure "no risk" - that's just not true, and not fair to your patient.

I think it's really a difference in mindset. Most pregnant women seem pretty sure that their pregnancy will turn out well - none of them really anticipate anything bad happening. And most of them will be correct.

But I think that a lot of OB/gyns are trained to think of the "worst case scenario" - and a lot of current practice seems dictated by that mindset. But until we can turn "low risk" pregnancies into "no risk" pregnancies, then the current practice model probably isn't going to change much.

(Have you read the anesthesia forums? Some of the OB emergencies that the anesthesiologists argue about are absolutely hair raising. )

 

[bigapple34]

Just a quick reply to opthobean...

Yes you and I watched the same movie. My concern regarding ms Epstein's care is that she was followed by several practioners during her pregnancy (this is documented on the internet in several interviews with her and the midwife who ended up following her). Her scan by Dr. Moritz at 20 weeks showed a fetus at the 50th percentile. In general this would not be a concern, however we will never know if she had subsequent scans after this 20 week scan, which would most certainly have aided in the diagnosis of IUGR (interuterine growth restriction). Is it a foolproof diagnosis, no. However, unless miss Epstein's infant had some strange and rare event that caused him to be suddenly growth restricted I do believe this could be picked up with quality prenatal care. Am i suggesting that the midwife who cared for her (who incidentally started seeing her at 28 weeks) provided substandard care? No of course not, however she provided care with in her scope of practice, which is a normal healthy pregnancy. Something miss Epstein unfortunately did not have. Again, I am just a lowly soon to be PGY 1, and I am most certain a midwife could handle a delivery better than i could right now. I am not against midwives, and think that they provide an excellent service to women. My biggest complaint about the movie is the way they portray OB/GYN's themselves. Midwives and OB/GYN's come from different prospectives, however we all went into the "business" because we are generally concerned about health care for women, and this documentary very unfairly suggests that we are not. Lastly, you are a highly educated individual who I am sure did alot of research on homebirth prior to deciding to go that route. However, I do not believe this applies to the general public. If home birth becomes the "fad" i think it might, than I believe wrongly or not that most women will not be as informed as they should about the risks invovled. Are there risks in hospital births, most certainly. The difference is the necessary interventions are readily available in a hospital setting, where they are not available in a home. I wish you a happy and healthy delivery.

 

[ashbrant]

I am completely for a patients right to choose what kind of birth she wants, provided that ALL of the risks have been made explicitly clear. I do not think most of the women who were shown in the documentary and who delivered at home were told all of the complications that could happen during a so called "normal delivery". Without all the information informed consent cannot be made.

Informed consent in the L&D unit of a hospital is a complete joke. I've heard a L&D nurse explicitly say that there are no side-effects or negative consequences to getting the epidural. Pros and cons of possible intereventions are rarely discussed before the birth, which means that parents are trying to weight the benefits and risks of procedures during an already stressful time. A lot of the routine procedures in L&D increase the chance that a mom will need more intervention, but we never tell them that.

Women who choose homebirth are generally highly educated (have college degrees) and have done quite a bit of research on birthing options. Research has also shown that homebirth attended by a trained attendant is just as safe as hopsital birth.

 

[nykka3]

Informed consent in the L&D unit of a hospital is a complete joke. I've heard a L&D nurse explicitly say that there are no side-effects or negative consequences to getting the epidural. Pros and cons of possible intereventions are rarely discussed before the birth, which means that parents are trying to weight the benefits and risks of procedures during an already stressful time. A lot of the routine procedures in L&D increase the chance that a mom will need more intervention, but we never tell them that.

I am not sure which hospital you are referring to, but your n=1 analysis is a joke.

 

[smq123]

Informed consent in the L&D unit of a hospital is a complete joke. I've heard a L&D nurse explicitly say that there are no side-effects or negative consequences to getting the epidural.

I like how you're basing your statement that "informed consent in the L&D unit of a hospital is a complete joke" based on what you heard ONE person say. In fact, based on what you heard one NURSE say.

A lot of nurses are really good at their job, but sometimes they're pretty crappy sources of information. I heard one nurse say that the reason why a patient's breast milk wasn't coming in was because the patient "probably had PCOS" and should start on glucagon right away. (Never mind the fact that if the patient actually DID have PCOS then she probably wouldn't have conceived a child in the first place, and that, furthermore, glucophage is used to treat PCOS, not glucagon.)

I also heard another nurse tell a family that a retinoblastoma was "some kind of tumor" but that it "wasn't very worrisome."

So I wouldn't base my entire opinion of the every single L&D in the country based on what ONE NURSE said.

Pros and cons of possible intereventions are rarely discussed before the birth, which means that parents are trying to weight the benefits and risks of procedures during an already stressful time.

This is . If you DON'T discuss the pros and cons of possible interventions, then you might as well GIVE your house and car away to the nearest malpractice lawyer. And seeing as how hypersensitive OB/gyns are to the possibility that they'll get sued, I can't imagine anyone being that careless and stupid.

Your assertions don't really hold up.

 

[Global Disrobal]

Interesting thread... I take my proverbial time off to study for the boards and miss such fun discussions

"n=1" CLASSIC!

 

[ashbrant]

In response to smq123...

I was giving one example of something I head in L&D simply because I was in a hurry, it’s definitely not the only example I can think of. In our current medical system L&D patients interact with nurses more than they interact with physicians. It doesn't matter who provides the information, the patent is still receiving substandard care. I know that n=1 doesn't give insight to how the system works, but these single examples of poor care are what cause women to choose another provider the next time around. Most home birth women I know had a hospital birth the first time, were very unhappy with their experiences (some of the extreme cases resulted in PTSD), decided to do some research on alternatives, and chose homebirth for their subsequent births.

In response to the issue of informed consent... Do OBs discuss all of the routine procedures and possible interventions that could occur during prenatals? Are they made aware of the fact that some interventions increase the chance that they will need additional intervention? My experience is that they don't. If you have a different experience, I would be interested in hearing about it. I am sure there are wonderful models of maternity care within the US, but I'm not aware of very many.

I will admit that I'm relatively new to the field of women's reproductive health, but what I have seen so far honestly makes me sad. I do believe that physicians care about their patients, but our system is flawed. Most OBs spend such little time with their patients and that compassion is rarely felt. As a women who has done extensive research on the pros and cons of home birth and hospital birth, I will be choosing home birth in the future as long as I’m low-risk.

 

[ashbrant]

Outcomes of planned home births with certified professional midwives: large prospective study in North America

Kenneth C Johnson, senior epidemiologist, Betty-Anne Daviss, project manager

BMJ 2005;330:1416 (18 June), doi:10.1136/bmj.330.7505.1416

 

[kelaskov]

I would like to know how some european countries like the Netherlands have a 30% homebirth rate and almost half the MMR compared to the US?

I there any correlation?
Any hard data out there?

http://www.who.int/whosis/mme_2005.pdf

 

[smq123]

In response to smq123...I was giving one example of something I head in L&D simply because I was in a hurry, it’s definitely not the only example I can think of.

Okay.

So what are some of the other examples that you've seen?

If you choose homebirth, that's fine. I don't agree with it, and a lot of OB/gyns have some negative things to say about it. That doesn't mean that it's the wrong choice FOR YOU. But it's not an OB/gyn's place (or job) to encourage homebirth for everyone. Nor is it an OB/gyn's place to criticize people who opt NOT to have a homebirth.

 

[ashbrant]

But it's not an OB/gyn's place (or job) to encourage homebirth for everyone. Nor is it an OB/gyn's place to criticize people who opt NOT to have a homebirth.

I completely agree. I believe women should give birth where they feel they will get the best care. For the majority of women in the US that will be in a hopsital and for some women that's at home or at a birth center with a midwife. I'm simply trying to point out some flaws in our current system that lead women to choose alternatives to the mainstream.

Here are some examples of poor informed consent. The ones in quotations are examples that friends have given me. I have listed a few that I've witnessed at the bottom. None of these situations were immediate emergencies, according to the moms. Whether or not these interventions were necessary is irrelevant to this discussion, the point is that these women were not given a say in what happens to their bodies.

“My best friend and BIL are both medical residents. In both the hospitals they work in, it is standard procedure to administer Pitocin to the mom as the baby's shoulder is being delivered to speed up delivery of the placenta. The mother is never asked whether she wants this, nor is it explained to her.”

“[I was] threatened with the possibility of my baby becoming a 'failure to thrive' baby if I didn't accept an induction, without being told what 'failure to thrive' actually meant. (I thought it meant the same thing as 'stillbirth', so naturally I agreed to be induced immediately.)”

“When they broke my water they didn't mention the risks of cord prolapse, fetal distress and infection. [When they] didn't mention the risks of the epidural, including the fever I got. When they cut an episiotomy while I was screaming "no." They also administered Pitocin over my objections during the third stage of labor.”

“AROM without being told risks, or even what he was really doing. He told me that he was going to check me, but nothing about the AROM. Placed internal fetal monitors after my telling them 'no'...Started pitocin without my consent or knowledge (didn't know I'd had it until I got my medical records 10 months after the fact!)”

“After my friend's otherwise natural hospital birth, I noticed the CNM was hooking her up to a bag of fluid. I asked her what it was, and she said it was Pitocin. I asked my friend if she wanted Pitocin to help her deliver the placenta, and she said, no, and the CNM told her, "You don't have any choice in this. You can't decline it."

A few examples that I have witnessed:

AROM without offering it as an option or discussing pros and cons, the physician just said "this is what we're doing."

Offering to sweep the membranes during a prenatal visit, and then doing the sweep, without a discussion of possible pros and cons

Stating that narcotics just make the baby "take a nap", with no discussion of more serious risks or side-effects.

No explanation of what internal monitors are. The mom thought that the monitor was taped to her baby’s head. She had no idea that it screws in to the baby’s scalp or that it increases the risk of infection.

 

[Whirr]

I've put quite a bit of energy and research into birthing options because I'm interested in women's health and have often considered going the Ob/Gyn route. I agree with the others here who have said that the important message of the documentary really is that women are not well-informed about their birthing choices, and that they should have rights when it comes to delivering their babies. I was born at home with a midwife. My mother describes it as a great, relaxing experience; she was much less stressed out than if she'd had to go to a hospital, her labor progressed at a decent pace, and there were no complications. Obviously, she was one of the lucky ones. She had a backup plan with her doctor, but if something had gone wrong, it could have been devastating.

I'm a strong supporter of home birth, but I'm an even stronger supporter of women (and men) being educated about their options and not just following the general concensus blindly. Most American women today feel more comfortable giving birth in a hospital; I understand this completely, and I think it's really important that they get to do what they feel is best. I think most doctors working in this field are excellently trained, especially in risky or emergency situations. And I don't think that blame can be assigned blindly to doctors, or to their patients, or to the media, or any other group in particular. It's up to the patient to ask important questions, and it's up to their physician to help guide them through the process.

I would also argue that people have an unrealistic understanding of what birth can be like. We are used to instant gratification in our daily lives, and drugs that solve all ills, but I suspect there is a lot we don't know about the effects of epidurals and Pitocin on both mother and baby. Do I think these drugs should never be used? Absolutely not. Am I an anti-C-section nut? Maybe for myself, but I don't presume to make that choice for others. I do think they are over-used, mostly because doctors are afraid of lawsuits, and that is a problem that is beyond the medical system to fix. "They can't sue you if you section 'em"--if that doesn't indicate a broken legal system where medicine is concerned, I don't know what does.

What I find particularly unfortunate in all of this is the conflict between all these groups who should theoretically all be working towards the same goal: a healthy, happy mother and baby and a good delivery. I understand the crux of the conflict is disagreement on what is the best situation for giving birth, but I think it's really important to realize that there is no "one size fits all" approach.