(James Henderson, Hospital birth vs. Home birth: a debate on choices, 2010, http://www.babyzone.com/pregnancy/labor_birth/article/hospital-birth-home-birth-debate-pg8)
James Henderson is an advocate of midwifery. He tries to keep his opinions on the matter as objective as possible given that he is in disagreement with the opposing side. In this case the opposing side is obstetrician Dr. Jay Dileo. While Henderson does not discredit hospital birth he discredits the argument of Dileo against home births. Dr. DiLeo tries to persuade people to avoid home births by using scare tactics, something quite common amongst obstetricians. He discredits DiLeo's arguments by calling him out on not having accurate statistical evidence to support his claims as well as showing the flaws in the logic of his arguments. Henderson says it quite well in his article " On a purely intellectual level, this makes no sense whatsoever." What precedes this quote is Dr. DiLeo saying that home birth is not safe, (more anti-home birth propaganda), etc. He follows this up by saying people who chose home births are generally more educated and "knowledgeable" on the birthing process. Those statements obviously contradict each other. You would expect a more logical argument from someone who went through such extensive schooling. The lack of logical arguments is not Dr. DiLeo's fault because truthfully home birth is AT LEAST AS SAFE as a hospital birth and therefore saying it is not so is factually incorrect and arguments against is are opinion based with little statistical fact to back up the opinions.
(Marsden Wagner, Born in in The USA, 2006)
In this book Wagner argues for alternative birthing options. He starts by showing the corruption in the system that obstetricians and obstetricians soon to be go through to become professionals in their field. He points out the flaws in the system rather than making all obstetricians out to be bad. He also does not let obstetricians off the hook by pointing out how they look the other way and ignore wrong doings although they are aware of them. This book not only shows the flaws of hospitals births but brings to light the reality of alternative options (ie. birthing centers, home births, etc)
(WISCONSIN SECTION - AMERICAN COLLEGE OF OBSTETRICIANS AND GYNECOLOGISTS, Position Paper on Midwifery Licensure, 2005)
This is an article put out by ACOG on their stance on licensure for midwives. At one point in the article the talk about how much they should keep the public from making unsafe birthing choices, etc. This insinuates that home birth is unsafe even under a certified midwife. Their statistical backing for this is that in the last 4 decades infant mortality rates have decreased. I would hope so, if it was other wise regardless of the method there would be serious issues. The complete disregard models from other countries that are less expensive and much safer and effective. A very biased article but necessary in arguing and disproving the opposing side.
(Marsden Wagner, MD, MSPH, What Every Midwife Should Know About ACOG and VBAC: Critique of ACOG Practice Bulletin No. 5, July 1999, “Vaginal Birth After Previous Cesarean Section”)
Marsden Wagner discredits ACOG's recommendation to only have VBAC(vaginal birth after cesarean) in hospitals. Their recommendation has no statistical evidence and is purely opinion. This is not uncommon in ACOG recommendations. He also shows how many VBAC's performed in hospitals have led to uterine rupture due to induction drgus used such as oxytocin. He also shows how ACOG lied about the true statistics in saying no statistics showed oxytocin caused uterine rupture when in fact it did. Although this conclusion could not be drawn from the single data collection because it lacked statistical power. Therefore regardless the conclusion from the data would not be accurate enough to make a medical recommendation. This shows the true nature and incentives of ACOG's "recommendations. It is a good article to use when arguing anti-ACOG.
Thursday, March 31, 2011
Tuesday, March 22, 2011
hw 39
In the second hundred pages of "born in the USA" by Marsden Wagner he builds on his main topic from the first hundred pages but he also explores a different method of birth delivery. Organization-wise Wagner reffered back to obestetrics practice in explaining the benefits of a midwife facilitated birth throughout the section. Although there was big focus on midwifery this section was not as exclusive to one topic as the first section was in talking about obstetrics. In comparing obstetrics to midwifery Wagner makes the essential distincition between the placement of power in the two different types of birth. The obstetricians are in control of the birth when in the hospital, he has many stories to show obstetricians using their power for their convinience. However, with midewifery the focus is more on the mother, she is in control, she in empowered and the attention and care is both for her and her child. Wagner also strengthened his arguement by showing how obstetricians use their power to manipulate patients. They often make "medical recommendations" to keep on a convinient schedule, c-section rates makes this pretty obvious, and although the patient may legally refuse the doctors instill fear in them by telling them the baby could die and it would be solely their fault; although as we have seen many of these "medical interventions" are what cause complications to the child.
Wagner also introduced alternative birthing centers. This was one of the alternatives he believed to be healthier than hospital birth, and with the nightmarish stories from hospital births he seems to be correct. In a hospital women are under almost complete control of the doctor and a lot of the birth is often done at the doctors convinience. However, birthing centers offer, baths, birthing chairsn candles, etc. In short the woman is allowed to create an enviornment she feels comfortable in. She is given control, she is more relaxed, and subsequently her birth should be relatively easier, less painful, and natural. Birth is a natural process and for 90 to 95 percent of births no surgical intervention or induction is neccesary yet this is how we treat birth. The alternatives being presented are much better options. The incentives in OBGYN handled hospital births are not always doing what's best for the baby. Often the agenda of the hospital or even the individual obstetrician is above that. There is obvious corruption and malpractice that is jeopardizing the health of much too many children each year. This in itself is a huge problem. Furthermore, the fact that many of the fatal or disabilitating decisions made by obstetricians are so easily avoided with patience and compassion make this problem that much more unethical, immoral, and inhumane.
Wagner also introduced alternative birthing centers. This was one of the alternatives he believed to be healthier than hospital birth, and with the nightmarish stories from hospital births he seems to be correct. In a hospital women are under almost complete control of the doctor and a lot of the birth is often done at the doctors convinience. However, birthing centers offer, baths, birthing chairsn candles, etc. In short the woman is allowed to create an enviornment she feels comfortable in. She is given control, she is more relaxed, and subsequently her birth should be relatively easier, less painful, and natural. Birth is a natural process and for 90 to 95 percent of births no surgical intervention or induction is neccesary yet this is how we treat birth. The alternatives being presented are much better options. The incentives in OBGYN handled hospital births are not always doing what's best for the baby. Often the agenda of the hospital or even the individual obstetrician is above that. There is obvious corruption and malpractice that is jeopardizing the health of much too many children each year. This in itself is a huge problem. Furthermore, the fact that many of the fatal or disabilitating decisions made by obstetricians are so easily avoided with patience and compassion make this problem that much more unethical, immoral, and inhumane.
Sunday, March 20, 2011
HW 39
The book "Born in the USA" by Marsden Wagner deals with the heirarchy and elitism of the OBGYN sector of doctors in the US medical system. The profession of OBGYN is highly regarded in the medical field. The beginning of the book tries to give the reader insight into the pride and cult like society that comprieses the OBGYN profession. Wagner emphasizes greatly the loyalty of this specific medical field as well as the status that accompanies it. However, the essential question this book deals with is the reform and reconstruction of a medical profession which is set up for failure in dealing with normal births. Wagner tells stories of neglectful and unsympathetic OBGYN's who are not compassionate with patients, make unneccesary interventions and put their own schedules over the needs of the mother or the baby. However, he makes a very distinction between a cartoony view on the situation and a realistic view. Although he aknowledges the wrong that many people in this profession are guilty of he places the blame on the system more so than individual. Wagner shows how the impossible amount of work and the OBGYN specialties conflict with many of the patients they deal with who have normal births. OBGYN's are surgeons who are taught to make incisions and "cut first when in doubt". The conflict here is obvious, birth is a natural process and OBGYN's are surgeons. Birth is not a medical problem that needs to be fixed by doctors. A more effective healthy way is assisting with the birth rather than trying to control. This is where the pride and loyalty in the profession restrains change. It is hard for doctors to admit they are doing things incorrectly or make mistakes because they are viewed as the experts who are all knowing on the subject, when in reality the are humans and they are bound to mess up as well.
The biggest message I have extracted from the book was that the problems we face are very easily solvable however the system in place is very resistant and restictive against change. There is a strong sense of traditionalism even though sientific evidence opposes many of the practice deemed normal by OBGYN's. Wagner has expertly stated his opinions and used very concrete, relative, and influential evidence to back it up. He used a number of personal stories, stories from patients, and numerical data to back up all his opinons. Besides the point he is trying to prove being pretty obvious, he does a good job of explaining the complexity of the issue and why it hasn't been solved already. Once again it is the system, ideals, and tradition that are holding us back from progressing and bettering the way we deal with birth.
The biggest message I have extracted from the book was that the problems we face are very easily solvable however the system in place is very resistant and restictive against change. There is a strong sense of traditionalism even though sientific evidence opposes many of the practice deemed normal by OBGYN's. Wagner has expertly stated his opinions and used very concrete, relative, and influential evidence to back it up. He used a number of personal stories, stories from patients, and numerical data to back up all his opinons. Besides the point he is trying to prove being pretty obvious, he does a good job of explaining the complexity of the issue and why it hasn't been solved already. Once again it is the system, ideals, and tradition that are holding us back from progressing and bettering the way we deal with birth.
Tuesday, March 1, 2011
HW 36
Interview 1
From the first interview the interviewee had a relatively "easy" birth. One point that she reiterated was that she was so scared going into labor from all the terror stories she read and her friends told her. Although the birth was painful she had her husband to help her relax and that made a very significant difference. She found the birth process much easier to handle when she focused on relaxation. Although she had her birth in a hospital she refused the epidural. She made a point of the importance of her husbands help and the difference that made in her situation.
This story was very different from many of the terrible stories that one many times associates with birth. The fact that the birthing process was less painful then she expected reflects a lot on our society's persepective on birth. Howevern of course every woman's experience is different so although she found relaxing helped her significantly that is not the case for everybody. Birth is a difficult subject to study and categorize since experiences vary so drastically. However, one thing that can be studied in a more concrete way, or at least more accurate, is society perspective on birth. This story showed the transformation of birth as a natural process into something that is medical. The fear and the medicalization of birth could be a coincidence, but I believe they are not. As is many other things connected woth medicine. Much of the fear of birth is warranted as so much can go wrong during birth. However, in the end if birth is a medical process more drugs can be used, hence creating more profit. As we learned in the illness and dying unit those in charge of the health care and hospitals in this country are very insensitive to human issues and feelings. I don't see why birth would be treated any different in the eyes of those in power.
Interview 2
Interviewee 2 had a relatively "easy" birth as well. However, she did not make as much of a point of emphasizing the difference in her birth from stories she read/heard. Her birth was still very painful, in fact it was the most pain she ever felt. She talked about focusing on breathing and relaxing. She also gave birth in a hospital. However, the relaxation seemed less theraputic for her. She was able to make it through the birth by keeping in mind the outcome and the reward of the process. She was so excited to be a mother that this became her drive during the actual birth.
With this interview I got much less insight on societal views in relation to birth. However, there seems to be a common theme between this interviewee and the last one. They both had something to push them through, something to use a drive to make it through the birth. They also birth described their birth as fairly easy s o it seems this is a pretty good method. Or maybe they are just lucky
Interview 3
Interviewee three had a very different birth from the first two. She, like the last two interviewee's gave birth in a hospital. Similar too the last two she also wanted to have a birth without the epidural. She seemed to follow many of the same things that helped alleviate the pain of the last two women. Unfortunately this was not as helpful for her as she gave in and got the epidural. She seemed fine with getting the epidural and although the birth was very difficult she emphasized that it was not as scary as it was made to see.
This last interview was most interesting to me because although she had a very difficult birth, especially compared to the last two interviewee's she also emphasized that the stories she heard/read had her overly scared. Once again the societal views on birth have shown to have a big impact on the mother emotionally. It can not be helpful to have someone go into a painful experience believing the experience will be in some cases will not be as painful. The mindset someone has will greatly affect the way the feel and react, and ultimately have some impact on the way the birth goes.
From these interviews the biggest point I extracted was that a womans mindset going in to birth is very highly correlated with the severity of pain and stress she feels during birth. Furthermore, societies perspective on birth has not shown to beneficial for woman as in general in our society birth is viewed as a medical issue doctors have to "fix" rather than a natural process that should take it's course naturally.
From the first interview the interviewee had a relatively "easy" birth. One point that she reiterated was that she was so scared going into labor from all the terror stories she read and her friends told her. Although the birth was painful she had her husband to help her relax and that made a very significant difference. She found the birth process much easier to handle when she focused on relaxation. Although she had her birth in a hospital she refused the epidural. She made a point of the importance of her husbands help and the difference that made in her situation.
This story was very different from many of the terrible stories that one many times associates with birth. The fact that the birthing process was less painful then she expected reflects a lot on our society's persepective on birth. Howevern of course every woman's experience is different so although she found relaxing helped her significantly that is not the case for everybody. Birth is a difficult subject to study and categorize since experiences vary so drastically. However, one thing that can be studied in a more concrete way, or at least more accurate, is society perspective on birth. This story showed the transformation of birth as a natural process into something that is medical. The fear and the medicalization of birth could be a coincidence, but I believe they are not. As is many other things connected woth medicine. Much of the fear of birth is warranted as so much can go wrong during birth. However, in the end if birth is a medical process more drugs can be used, hence creating more profit. As we learned in the illness and dying unit those in charge of the health care and hospitals in this country are very insensitive to human issues and feelings. I don't see why birth would be treated any different in the eyes of those in power.
Interview 2
Interviewee 2 had a relatively "easy" birth as well. However, she did not make as much of a point of emphasizing the difference in her birth from stories she read/heard. Her birth was still very painful, in fact it was the most pain she ever felt. She talked about focusing on breathing and relaxing. She also gave birth in a hospital. However, the relaxation seemed less theraputic for her. She was able to make it through the birth by keeping in mind the outcome and the reward of the process. She was so excited to be a mother that this became her drive during the actual birth.
With this interview I got much less insight on societal views in relation to birth. However, there seems to be a common theme between this interviewee and the last one. They both had something to push them through, something to use a drive to make it through the birth. They also birth described their birth as fairly easy s o it seems this is a pretty good method. Or maybe they are just lucky
Interview 3
Interviewee three had a very different birth from the first two. She, like the last two interviewee's gave birth in a hospital. Similar too the last two she also wanted to have a birth without the epidural. She seemed to follow many of the same things that helped alleviate the pain of the last two women. Unfortunately this was not as helpful for her as she gave in and got the epidural. She seemed fine with getting the epidural and although the birth was very difficult she emphasized that it was not as scary as it was made to see.
This last interview was most interesting to me because although she had a very difficult birth, especially compared to the last two interviewee's she also emphasized that the stories she heard/read had her overly scared. Once again the societal views on birth have shown to have a big impact on the mother emotionally. It can not be helpful to have someone go into a painful experience believing the experience will be in some cases will not be as painful. The mindset someone has will greatly affect the way the feel and react, and ultimately have some impact on the way the birth goes.
From these interviews the biggest point I extracted was that a womans mindset going in to birth is very highly correlated with the severity of pain and stress she feels during birth. Furthermore, societies perspective on birth has not shown to beneficial for woman as in general in our society birth is viewed as a medical issue doctors have to "fix" rather than a natural process that should take it's course naturally.
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