Don’t just do something — stand there!

We’re used to the saying, “Don’t just stand there — do something!” and many times it’s true. Many times, however, it’s not. We value action — as measured by clichés like “He who hesitates is lost.” But we also understand the value of assessing a situation, to determine the best course of action — “Look before you leap.”

The father of a former coworker is a good example of not rushing into doing the first thing that pops into your mind. One time, there was a small kitchen fire that somehow started and caught the window curtains on fire. He rushed in, saw the fire, and pulled the curtains down. With his bare hands. Severely burning his hands, and if I remember correctly, requiring hospitalization. Far better would it have been for him to pause half a second longer, and grab a broom or some other object to get the burning curtains away from the walls and into the sink. Other similar stories abound of people throwing water on a grease fire, and spreading the fire instead of stopping it. They just reacted to the immediate situation… and reacted wrongly.

A great medical example is that of a nurse, pharmacist, or anyone else handling medication to double-check to verify that the medication they are dispensing is the medication they are intending to dispense to that patient. Or do an ultrasound to make sure that the baby really is breech before doing a C-section for a supposed breech baby (who may have flipped sometime in the past few minutes or few days).

Sometimes, it is better to pause, take a breather, and really think before acting. Or not to act at all.

What is commonly trumpeted by obstetricians is that maternal, neonatal and infant mortality dropped during the 20th century, for which they claim sole credit; what is not commonly told is that in the first part of the century, maternal and infant mortality increased under the care of doctors and particularly with births in the hospital. There are numerous quotes which demonstrate this, and show that it was known by some of “the powers that be” at the time, but I’ll just include a few [emphases mine]:

~ “Why bother the relatively innocuous midwife, when the ignorant doctor causes many more absolutely unnecessary deaths”. [1911-B; Dr.Williams,MD,p.180]

~ “In NYC, the reported cases of death from puerperal sepsis occur more frequently in the practice of physicians than from the work of the midwives’”. [Dr. Ira Wile, 1911-G, p.246]

And from the same source, later quotes from a 1975 study on the topic:

~ “Whether because midwives provided more skilled care or because obstetricians were too eager to interfere in labor and birth, obstetric mortality rates often rose as … midwife practice declined.” [DeVitt, MD; 1975]

And then from this document, quoting a conclusion made about midwives, a report presented to the White House,

“…untrained midwives approach and trained midwives surpass the record of physicians in normal deliveries has been ascribed to several factors. Chief among these is the fact that the circumstances of modern practice induce many physicians to employ procedures which are calculated to hasten delivery, but which sometimes result in harm to mother and child.

On her part, the midwife is not permitted to and does not employ such procedures. She waits patiently and lets nature take its course.”

While the doctors’ motto was, “First, do no harm,” the reality was that oftentimes, they caused harm by acting, when less harm would have come to mother and/or child had they not acted. “Well,” you might say, “that was then! A lot of things have changed since then.” Yes, and no.  Sometimes waiting patiently is still the best course of action:

Sometimes acting and intervening and speeding things up is the best course of action; but how often is slowing down and waiting on nature to take its course much better! When you have technology and gadgets and other things at hand, it’s easy to use them even when unnecessary. “When all you have is a hammer, everything looks like a nail.” And the ever-excellent quote from Jurassic Park via Jeff Goldblum, “Yeah, but your scientists were so preoccupied with whether or not they could, they didn’t stop to think if they should.”

First make sure you’re right, then go ahead. — Davy Crockett

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Twin Home Birth Story

Click here to read Robin Elise Weiss’s story of the home-birth of her 5th and 6th children — identical twin girls. A lovely story!

Would’ve, Could’ve, Should’ve

It’s so easy to play “Monday morning quarterback.” Take any situation, and say, “Well, if that had been me…” or, “If I had been in that situation…” And you may be right. Some people are just wired differently — are able to come up with a witty comeback, or are able to think more clearly or more quickly, or able to react faster or better than others. But you may be wrong — most likely, you would have reacted in exactly the same way as the person you are (unknowingly) criticizing.

There have been several instances on the My OB said WHAT?! blog in which comments have taken that turn — doctors making rude or nasty comments, or even downright sexual harassment, and several women have said things along the lines of, “If my husband had heard that, they’d probably have arrested him for assault, for punching the doctor’s lights out!” or “I’d’ve kicked that doctor in the face!” (for saying x, y, or z when he’s between the woman’s legs while she’s pushing.” Although I don’t think I said anything along those lines, I know I thought it, or agreed with those who did say it out loud. And yet… would I have? Sure, it’s easy enough to say when I’m reading it on a computer screen, in the comfort of my home, and the full force of the hurtful, rude, or harassing words comes through loud and clear, with no other “background noise” to drown it out. But what if I were really in that situation? How would one go about kicking someone in the face, when she’s numb from an epidural? or with her legs up in stirrups? — not exactly an easy position to get out of quickly.

Some of the women who had submitted the comments originally replied to some of the comments, saying that the “could’ve, should’ve, would’ve” comments were actually hurtful. I know that none of the commenters (or those who did not comment, but thought the same things — like me) intended for the words to hurt. For myself, I would say that when someone said, “I’d’ve kicked that guy in the face!” that she was really meaning, “that guy deserved to be kicked in the face for what he said!” Most of us probably tend towards non-violence against our fellow man, so we probably would not really have physically acted out what our immediate, visceral reaction was. Or if we were in the room when a husband did punch a doctor in the face, we might be shocked and/or horrified (even if we would have been shocked and/or horrified at the comment or action that provoked the violence).

It’s so easy to say things. It’s much harder to carry through with them. It’s easy to say, “I would never have given in to the pressure to have an unnecessary [C-section, induction, augmentation, epidural],” but much harder to actually do — especially when you’re in that particular situation, facing that particular pressure. There is an element in which it is good to hear these kinds of stories, and play through them in your mind, so that if you’re ever faced with it, you may be better prepared for a certain reaction. “Practice makes perfect.” But far better to keep these things in mind while you’re screening your midwife or doctor, or during your prenatal visits, so you can completely avoid situations like these. That’s not fool-proof by any means, unfortunately. Sometimes you can do all the “right” things and still end up on the wrong end of the stick.

If you’ve been in situations like these, please, please, please go to The Birth Survey and report the health-care provider, so that others can be forewarned and forearmed. If you’re looking for a provider, go there to see what others have said about doctors or midwives who are options for you. And if someone you know is pregnant or of childbearing age, be sure to tell her about The Birth Survey so she can get a good match for a care provider. Otherwise you or someone you care about may end up saying, “I should’ve picked a different care provider, and I would have if I only could have known.”

Doctor or Midwife?

Take this quiz to find out which would be a better match for you, based on your preferences.

h/t to Midwife Connections for the link

Tangled in the Safety Net

One of the blogs most recently added to my blogroll is “Birth Sense,” previously, “The Midwife Next Door,” and I’m glad I’ve found it. In a recent post, she details a birth story, illustrating that the “safety net” of a hospital may not always function like it should.

In most hospitals today, you will see a central monitoring station with nurses clustered around it, eyes fixated on the monitor screen.  Rather than spending this time in one-to-one assessment of their patient, observing the whole picture of how things are going, they focus on one element of the labor–the fetal heart rate.  Where is the physician?  At the office, or elsewhere, while the nurse is expected to monitor and identify problems with the labor and notify the physician if problems arise.

This is one common misunderstanding regarding home vs. hospital birth.  Many women feel safer in the hospital because they have emergency services immediately available.  But if you have an emergency and your physician is not at your bedside, who is going to perform emergency surgery?  The nurse? The anesthesiologist?  No, you will have to wait until your physician is summoned and arrives at the hospital, assesses you, and makes the decision to perform a c-section…..

I paged the chief again.  I called my supervisor again.  No other doctors were  on the floor, or I would have begged one of them to help.  No one was answering my calls.  I finally called Brianna’s physician again and told her that I had notified the OB chief  and the nursing supervisor that she was refusing to come in.  Very angry now, she hung up on me.  A few minutes later she walked into Brianna’s labor room.  I still had not heard back from the OB chief, and the nursing supervisor was also trying to reach him….

Click here to read the rest of the story.

Denialism

I liked NavelGazing Midwife‘s post on this.

Denialism is spreading in our country. From the “birthers” who don’t believe Obama is an American citizen to the continued denial of the Holocaust, standing on the moon and that HIV doesn’t cause AIDS. Depending on where you stand, the other side looks foolish, if not downright stupid, to believe in such absurd ideas. Denialism isn’t just not believing something, but not believing in the face of scientific, hands-on, well-studied and multi-checked facts.

This begs the question, whose facts are to be believed?

Definitely food for thought.

Win a copy of Breastfeeding with Comfort and Joy!

Home Birth vs. Birth Center

Pinky RN is looking for home-birthers to answer questions about home birth vs. birth center births:

Would folks who want a homebirth because of the restrictive nature of the hospital, come to a freestanding birth center? Is there a demand for Birth Centers? Especially a Birth center across the street from the hospital that has a large staff and 24 hour Ob and anesthesia folks so they can handle anything you throw at them. And a Nicu would be good too. I was thinking, if we did start up a birth center across the street from the hospital I worked at, would it be used? If we build it, will they come?

So for any home birth folks out there, could you please leave me a comment on your thoughts. What would you need in a birth center to make it attractive to birth at?

Go to her blog and give her your opinion!