Why posting when tired and grumpy isn't such a fine idea.

Once again, I find my hand slapped (though very kindly) by a gentle reader for being less than careful with my choice of words. Can you tell that this is an ongoing struggle for me! :)

I wanted to reply, and my comment to her got very long (also a recurrent theme!) and I thought I should probably apologize to anyone else who didn't get my meaning as it was intended.

I'm finding that we walk a fine line between raising very great concerns about the status quo, and not offending or upsetting anyone. This is especially true when inferences might be taken as a challenge to someones choices in birth, or mothering (perhaps the most sensitive of topics!)! I agree that my choice of words here was poor. I was irked by the first comment only in that I felt that it inferred that women who chose hospital deliveries (for whatever reason - and I'm among them!) can say goodbye to their choices and wishes. I suspected, as she posted, that this wasn't Marjorie's intent either but regardless that is simply not acceptable. I think there are too many women simply walking into hospitals to have their babies and are offering themselves up to their providers to do whatever. No matter how 'nice' your doc is, this is not informed consent, and it certainly isn't shared decision making which is supposed to be the hallmark of modern medical and obstetrical care.

Your care provider, physician or midwife alike, have a responsibility to properly involve women in their care. As much as I personally liked my two obstetrical providers, as much as I trusted their clinical judgment and their ability to intervene in a life-saving fashion if that became necessary, I was NEVER adequately informed about tests or procedures, my permission was never sought, it was assumed; and ultimately, though I was a healthy, low risk woman, I endured the cascade of intervention (each precipitated by the last) narrowly avoided a surgical outcome based entirely on my caregiver's expired patience and hospital routine which failed to serve me or my baby appropriately. This is just my one story, but we all know that this isn't an uncommon tale. This is why our c/s rates are unacceptably high. The disconnect between research evidence into best practices and current hospital obstetrical practice is glaring, and the c/s rate is symptomatic of that.

I *know* that there are many fine providers who work within the hospital system - I had a couple of them, and know a bunch more. But there is something going very wrong when women go into hospital healthy, low risk women, and become high risk, surgical outcomes while there. The c/s rate of most midwives is by comparison, shockingly low. Clearly midwives are doing something differently which is impacting this outcome of the birth process. This should be taken seriously, and steps taken by hospitals and more doc's to address these issues. When more than 30% of women birthing in hospitals in the US are ending up with abdominal incisions and the increased morbidity and mortality which accompanies it, not to mention the staggeringly high costs to our already failing healthcare system, I don't think any of us (midwives, physicians, women, families, taxpayers) can ignore this. It has to be addressed.

My point in all of this is that good care involves working with women. Placing her individual needs, wants, fears, hopes and wishes for each part of her pregnancy at the top of the lists of considerations in her care. This should also be the case through her birth and then supporting her properly through her postpartum - which I think we all suck at, frankly, to a greater or lesser degree. Dictating what woman can and can't chose for their pregnancies is unethical. Involving them in thorough shared decision making throughout their course of care should be everyone's goal, not only of homebirth midwives. VBAC is the tip of a very large iceberg.

So.
It wasn't my intent to infer that those women who chose (for whatever reason) to have their babies in hospital, or even to chose as you did (?) ERCD's for their babes after a first C/S 'couldn't give a crap' . Just that its patently *not ok* for midwives to be offered up as the care providers of choice if you happen to be a woman who wants to have more say in your maternity care. This is a right which all women have, no matter who their care provider is, or where they chose, or must give birth. There is a clear lack of woman-centered care in modern obstetrics is all, and research evidence suggests strongly that not everything that could be done to improve the health and well being of women and babies is being done. In fact, it doesn't seem to be really being addressed much at all.

Thanks for reading. I shall continue to try harder to be clearer with my words and intent.

As for tort reform, raised by 'perinatal educator anon'. That will have to wait for another post.