This is a long reply to a post on Wandering Scientist’s blog called Thoughts on Labor, in which she tells her birth story:
I was fascinated by your birth story. You know, I have read so many of them online, but reading yours while I am learning about qualitative research through my fellowship gave me an idea.
You know, I have read so many of them online, but reading yours while I am learning about qualitative research through my fellowship gave me an idea.
One of the reasons I am interested in these birthing issues is I want to examine the power relationships between health care practitioners and women. I am going to use a survey (quantitative) and some in depth interviews (qualitative) with obstetricians in my area. Maybe I could follow up with some qualitative and quantitative research with women regarding birth interventions. Listening to Women has already approached this, but I think it’s mostly quantitative. Maybe I could do some qualitative research on birth stories on the internet to examine women’s perspectives on their interactions (and those of their personal support system, such as your husband in your case) with health care practitioners during the birth process. You did some thoughtful processing of this in your post.
Should a woman need to be so educated on interventions and when they are appropriate that she or someone she brings or hires can run interference to protect her from her paid health care practitioners?
Your husband takes the frequent claim that cesarean is the malpractice preventing option and jumps to the conclusion that it is somehow a safer option and prevents catastrophic problems. However, research usually shows that outcomes are generally worse for the mother, the baby, and future pregnancies with cesarean delivery. There are so many aspects to this I can’t just cite one study. There will be an extensive bibliography on this in my final paper, and you can search my blog history or The Unnecesarean for references .
Or, just search the recent contents of the so called Gray Journal (follow the search link and enter this: “Am J Obstet Gynecol”[TA] AND “cesarean”[TIAB] ) and Green Journal (enter: “Obstet Gynecol” [TA] AND “cesarean”[TIAB]). These journals are the bully pulpits of mainstream professional American obstetrics.
Coming to the realization that physicians, nurses, midwives, and even patients with full informed consent and insurance and/or means may make decisions during birth that do not favor the health of the mother or the fetus / neonate is a difficult one for people realize and discuss. My theory is that the interventions chosen by health care practitioners favor the practitioner’s role and make it easier, and that certain risks to the birthing unit are acceptable if it favors the correct direction in the power relationship. Women respond to pregnancy, birth, and subsequent pregnancies and births in a wide variety of ways, and may choose anything from elective cesarean to unassisted homebirth, depending on a variety of factors. There is less of an expectation for women to follow evidence based practices, but I hope there is an expectation for health care practitioners to do so.
Malpractice is a commonly quoted boogeyman as a reason to intervene, but research also indicates that using evidence based algorithms for interventions can lower cesarean rates and malpractice rates simultaneously. Many studies show an association between high malpractice payouts and premiums and high cesarean rates, but the casuality is missing in that association. What if it is the other way around? Interventions chosen despite evidence against their usage in many situations may arguably cause more malpractice suits and higher premiums. Causality is hard to prove in complex situations like this, but it can easily be argued that this association may not only be influenced in one direction.