Tuesday, May 04, 2010

Yesterday's Appointment and my views on OB's

Yesterday I had a great and horrible appointment. I met with the obstetrician who would step in for the midwife if any complications arise or if I need a c-section. Just acknowledging the possibility that something would go wrong was tough, the idea of being cut open in order to get the baby out of me is even harder.

I'm a huge advocate against the high c-section rate in the U.S. I'm also against most routine interventions used in childbirth as most of them have been found to be completely unnecessary and usually more harmful than good. I just finished reading The Thinking Woman's Guide to a Better Birth by Henci Goer. The book is great, and extremely informative, but it made me extra-nervous about meeting with the OB. The book also makes me even more pissed about Illinois' laws about midwifery and home birth. Here are some of the main points from the book:
  • Cesarean sections increase maternal mortality rates dramatically.
  • Labor inductions create further difficulties in labor, increase fetal mortality, and often lead to cesareans. Even non-drug inductions (such as manually breaking the waters).
  • Pumping a woman full of IV fluids can lead to anemia in both mother and child because her body is unable to regulate the amount of liquids in the blood. It also restricts movement during labor.
  • Midwife attended home births have the lowest rates of maternal and fetal mortality and mothers tend to feel better about them afterwords. 
  • Obstetricians are trained to distrust the female body's ability to give birth. They're also a trained surgical field, why go to a surgeon for a common bodily function?
  • Women and babies perform better when the mother is allowed to eat and drink during labor. There is no danger of aspiration, and even if there was, it's better to choke on food than super-acidic stomach bile that can burn your lungs.
  • Continuous Electronic Fetal Monitoring leads to over-use of cesarean sections, increased maternal stress levels, and distraction from the mother. 
  • Failure to progress is most often a Failure to Wait.
  • Epidurals and narcotics lead to slowed labor, increase in cesarean, lower apgar scores in newborns, and a harder time nursing.
  • Episiotomies cause More perineal tearing, they don't prevent them.
  • There is absolutely no scientific reason that VBAC's should not be allowed. 
  • The entirety of the book makes allowances for issues during child birth that make these procedures necessary, but say that these interventions are being used far too often in routine deliveries
The good part of the appointment was some of the OB's answers to my questions. Being paranoid like I am, I came in with a huge list of questions to ask him about what would happen if he should step in at some point. His first answer was the best: I asked at what point he would step in to deliver the baby. His answer: "I don't step in until you want me to". His other answers were usually centered around educating me about whatever procedure he might want to do and getting my permission. Plus the midwife gets to remain through everything, even if the OB steps in.

The only answer that I really disagreed with was that he said that he would induce labor between 40 and 41 weeks. Keep in mind that 40 weeks is a completely arbitrary number and that first-time mothers average 8 days longer. This means that even if he induced at 41 weeks, he'd still be inducing one day before the AVERAGE length of pregnancy. If I do go over, and with all the debate about my due dates it's very possible, I will be refusing induction until at least 43 weeks unless there is some other reason to worry (i.e. slowed fetal heart-rate, etc).

The other observation I had about the appointment was just the general environment differences between the OB office and the midwife office. At the midwives there are toys and couches in the waiting room and the entire place is colorful and happy feeling, the OB's waiting room was cold with minimal decorations, very few magazines, and a TV with some horrible daytime programming in the background. The nurses and receptionist at the midwives are always really nice and ask us how things are going while the OB's couldn't seem to care less. Where the midwives and their nurses talk to us like we are actually intelligent people and tell us what my BP and the baby's heart rate is, while the people at the OB's office didn't even tell me if my blood pressure was normal or low and seemed to assume that I thought listening to the heartbeat on the doppler was just a novelty instead of an important diagnostic tool.

Otherwise, the appointment will hopefully end up being a complete waste of $150. I'm just sorry that the answer to the question about induction overshadowed what was otherwise a really positive visit. If it does come down to it, I'll be happy to have met the doctor that will cut me open should I need it >.<


  1. Oh dear. The really sad part about this is Google ads is actually pumping ads for OB's into your sidebar while this post is up!!

  2. Lori: LAME! I had no idea, I normally don't even look at what ads are up :-/ thanks for reading and commenting!

  3. you may want to talk to someone who's had a c-section instead of reading all that scary bs in baby books that are pro natural birth.

    things are written in books to get you to have a strong feeling about something.

    c-sections are not all that scary or bad

    i had one and i begged for one and i'm one not for medical anything. i think it was the best thing i did. it made it possible to for me to have a longer hospital stay and i never had stitches or staples either. i have actually no scar from it and i had one about 9 months ago

    i was never anemic either. i was back up and on my feet in 3 days and i was back to my normal routine the day i left the hospital. i know plenty of people who had c-sections and had very similar outcomes so it's not that scary in case something unsuspected happens

  4. Man, whenever I do get pregnant I am NOT looking forward to figuring out where to give birth in the Atlanta area...apparently there are no birth centers around here...my OBGYN (who I have loved...for the GYN part ;)) works at the biggest baby factory around here...and they have a 33%+ C-section rate...YIKES. I will surely have a lot of questions for her when the time comes. Do you know by chance, if I do decide on a midwife one day, do I still see my OBGYN through the pregnancy or do I just ditch her?

  5. Spirit and Seed: my experience has been that I've seen the midwife for everything pregnancy-related. I think it also depends on what kind of facilities and certification your midwife has. Still, I think it would be hard to see one doctor through the pregnancy and then deliver with another person. I'm glad that I've gotten the time to develop a relationship with my midwife (we're facebook friends, lame right?) since I'll be spending a lot of very vulnerable time with her. Good luck with everything!! that c-sec rate is CRAZY HIGH! be careful, but keep in mind that it all depends on the doctor or midwife.

  6. Nikki Cupcake: I'm sorry that it took me so long to respond. I'm glad that you had such positive experiences with your two c-sections, and that your friends apparently had good experiences too, but statistically that just isn't the case as often as it is with natural, or more natural births. Personal experience is great, but it does not substitute for the empirical research done on the subject.

    And honestly, I think that calling something 'bs' that is based on well-rounded research is childish. While I encourage discussion on my blog, especially from those who may not agree with my positions, I'd encourage a more adult approach.