An official statement was made today that says Baby Blue is taking over a whole floor, but is in an executive suite, with their own security detail and that she was not born via c-section, scheduled or otherwise.

As you’ve probably heard by now, Beyonce Knowles and her husband, Jay-Z, welcomed their daughter, Blue Ivy, this past weekend. You might expect this post to be about the reports that Beyonce chose a scheduled c-section, but honestly no, I have a different bone to pick with the whole situation.

The NY Post is talking to a dad who was prevented from visiting his premature twins because of security for Beyonce and her entourage.  Apparently there have been several such shut downs at the hospital during her stay, which reportedly encompasses a whole floor, minus the NICU, and costs an estimated $1.3 million for her stay.  This is also sad, that families in their times of need can’t get to babies.  What about moms who needed to nurse babies?  What about families who may have only had a few hours left with a baby who was very ill?  This is ridiculous.

The public health person is me started churning this over in my mind last night as I tried to sleep.  My first thoughts were to the waste of money.  Shouldn’t all patients have privacy?  Be it Beyonce and Jay-Z or me or you or anyone?  Okay, so that’s annoying, they get to pay extra and have windows darkened and people restricted from being in the halls.  The average person can’t afford it and probably doesn’t want it or care.  But then I started wondering – what about all the women in labor who were registered to have babies at Lenox Hill around now.  Do they get shunted to other hospitals?  In labor?  At what cost and to whom?  Maybe they just get shuffled to another area of the hospital, one less convenient for them and the medical staff, an area that maybe isn’t set up to specifically care for obstetrical patients.  What about the fancy modular birthing beds and birth balls that Lenox Hill brags about on their online tour? Did those move too?

To open a hospital, you need to get a certificate of need (CON).  That says there is a need for these services in this community.  Who is meeting the needs of this community while the whole floor is taken up for one family? While I used to think that Brad Pitt and Angelina Jolie were crazy to have their first baby, Shiloh, in Namibia with their LA physician by their side for her scheduled c-section, at least I know that once they were out of the OR, there wasn’t all this craziness in the clinic where she gave birth.  Even Michael Jackson, known for his extremes, simply took the baby and immediately left the hospital, paying for care in his own home.

_{Photo © Dreamstime}

Abby Epstein and Ricki Lake are looking to fund more Business of Being Born.  They are using a neat program called Kickstarter to help them raise their funds. But they only have 28 more days to do it… Can you spare a $1 or two?

_{Photo © Paulo Netto}

I think the problem lies in education. I feel like when a woman becomes pregnant and visits her OB GYN for the first time to confirm the pregnancy, it should be the OB’s responsibility to tell the woman about ALL of her options about giving birth; not just having about whether or not to have an epidural or a c-section. If women were to watch “Orgasmic Birth,” hospitals would lose a lot of money and this is probably the reason most OBs don’t want their patients to know about this side of birth. For the most part a skilled midwife and/or a doula and supporting friends and family is all that a woman really needs when giving birth. When a woman is brought into a hospital with all of the bright lights and commotion, it’s no wonder that labor becomes stalled. Stress and unfamiliar surroundings make it difficult for any real progression to take place. But, instead of sending the woman back home to labor, the doctor’s insist on jumpstarting the labor with Pitocin or other similar drugs. After the augmentation of labor comes a downward spiral of unnatural process that make it impossible for a woman to birth the way nature intended.

In my opinion, the fact that a woman’s body is not only able to successfully give birth (most of the time), but can provide the woman with such a rewarding cocktail of hormones after she has given birth is remarkable. This capacity in itself should be enough evidence to prove that outside interventions are not always needed and should be avoided if possible.

(The following is a short summary of a clip from the show, found here, starting at 5:15.)

Rebecca tries to explain the concept to her mother, noting that the birthing center is one of the biggest on the east coast and that “they emphasize natural childbirth in a relaxed atmosphere with no painkillers.”  As expected, a number of jokes follow about the pain of childbirth and a comment by Sophia likening the birth center to a Disneyworld theme park.  Dorothy encourages Blanche to keep an open mind and at least visit the birthing center.  In the next segment, the women all tour the birth center.  Blanche and Sophia make disparaging remarks about the lack of “equipment” and even Dorothy, ever skeptical, takes a negative view.  The women are interrupted by a yell, and then another.  An unseen woman in another room is giving birth.  The women seem alarmed- especially Rebecca, who asks, “Why is she screaming?”  Sophia answers, “Because she’s conscious!” and the group heads for the door.

In the next clip, Rebecca has changed her mind about the birthing center and decides to have her baby in the hospital.  She mentions she has a Lamaze coach and says there’s no reason she can’t have a natural birth in a hospital.  When she wakes up in the middle of the night wondering if she’s in labor, Dorothy has her get into bed to start timing contractions.  When Blanche and Rose wake up, the group heads to the hospital, where Rebecca is put flat on her back on a gurney and the obstetrician who arrives makes a number of snide remarks.

The  final clip has just about every cringeworthy stereotype about birth shown in popular culture.  Rebecca is in the delivery room, covered in all sorts of gowns and drapes, while everyone in the room is in scrubs.  Blanche at least gets to forego the mask over her face.  Rebecca is supported with her knees up around her ears, holding her breath while Blanche and the doctors loudly exhort her to push as they count to 10.  Between pushes, she’s nearly flat on her back on the delivery table.  (She’s probably only tilted up because otherwise the camera wouldn’t be able to capture her face in the shot.)  After Rebecca births the baby, the doctor immediately cuts the cord and hands her a perfectly clean, blanketed baby, and then the credits roll.

Granted, the original airdate of this show was in 1990.  But how much has truly changed in the intervening 20 years, in real life and in the mainstream media?  In many hospitals, women are still delivering in drapes, still in the lithotomy position, still being directed to push by doctors, nurses, birth partners, and whoever else happens to be in the room.  Certainly this is how birth continues to be portrayed on television and in the movies.  (see: Knocked Up)

I think the result is that we are stuck in a vicious cycle of expectations.  The general populace expects birth to be a horror show of screaming and sweating and laying flat on one’s back because that’s what is portrayed in the media.  The obstetric system expects that women (and men) will just accept their status quo.  And everybody expects movies and tv to depict birth the way it happened to them, further cementing the status quo and beginning the cycle again.

The birthing community has done a lot of work to break the cycle, especially in the arena of changing the status quo for births, both in and out of the hospital.  But if we continually portray birth in the popular culture as something that “happens to you” on the doctor’s or hospital’s terms, what lessons are we imparting to children, teens, and young adults who consume this type of media?  What stereotypes have those of us who advocate for choices in birth had to confront?  And most importantly, what can be done to turn the media tide?

We live in a time and place where in the media violence is recreated with painstaking authenticity, where we can watch any number of surgeries and medical procedures on television, where “reality tv” is a killer app.  And yet birth is treated alarmingly unrealistically.  In order to re-normalize birth in hospitals, perhaps it must first be re-normalized in pop culture.

Among the gems Dr. Mourik offers up:

“I think it is unrealistic for any 38-year-old having her first baby to think it’s going to be a normal delivery at home.”

“Half of women in labour the first time don’t realise how bloody painful it is.”

“Ninety-five per cent of women need pain relief during childbirth.” (Perhaps 95% of women in the hospital receive pain relief, but why did they “need” it?  Were they stuck lying in bed?  On Pitocin?  Need is situationally dependent.)

“Dr Mourik said that one in eight ‘low-risk’ births were actually potentially deadly.  ’One in eight of all low-risk women will have an acute, life and death emergency,’ he said.”

I didn’t see any of these assertions backed up by any research.  But I did a little Google search on Dr. Mourik, and found that he’s been arguing against home birth for years.  (See here, here, and here for just a couple of selections.)  It is difficult to give merit to any of his unsubstantiated “facts” given his anti-home birth stance.

When those who oppose home birth resort to scare tactics, unsubstantiated claims, and even outright lies, it makes it quite difficult to have a meaningful debate.  And when it comes from someone with an M.D. after his name, it may make women begin to question the motives of all OBs.  That doesn’t serve anyone well.  There are many of us in the pro-home birth camp who strive for knowledge and research, for careful weighing of the facts, for balance between potential risk and safety precautions.  Most of us advocating for home birth understand that it isn’t for everyone, but that the choice should exist for those who want to avail themselves of it.

• ACOG and ASA should revise their guidelines on the “immediately available” guidelines.
• The decision to do a VBAC or a repeat c-section should be made between a woman and her practitioner, after an informed discussion.

The problem with the last statement is that true informed consent and discussion is very rare in obstetrical care. The closest that we tend to come is the woman who is choosing a VBAC. She is likely to spend the last several months of her prenatal care being told of the risks of VBAC and the parameters in which it will happen. In contrast, had that same woman chosen to have an elective repeat cesarean, she would simply be handed an appointment card for her scheduled surgery and then sign a sheet of paper that would have to suffice as informed consent, all done a few minutes before her surgery. Neither of these is truly informed consent.

So how can women get informed consent, particularly when it comes to a hot topic like VBAC? My advice is:

• Do independent research.
• Seek out information from neutral sources.
• Talk to other mothers who have had a VBAC.
• Talk to other mothers who have had a repeat c-section (planned and not).
• Prepare for your birth by childbirth class, doula support and emotional support.
• Consider alternatives including midwifery led care.
• Make a decision only after a lengthy discussion with many people, including your practitioner.

Providers have to consider multiple issues when recommending one mode of birth over another: health of mother and baby, liability for complications, availability of self and staff during uncomplicated and complicated births, personal beliefs, medical malpractice insurance (if they choose to carry it), what other practitioners will think of their choices, etc.

Women have their own issues to consider when deciding her mode of birth: health of baby and mother, likelihood of the success of VBAC, physical and emotional pain after the birth, personal beliefs, etc.

The final point is that of informed refusal. ACOG has a policy of informed consent and refusal. This states that they believe that a woman who has all the information, is allowed to make a decision to choose not to receive the recommended procedure or therapy that is being suggested by her doctor.

At the panel yesterday, when asked specifically about the policy of informed refusal as it included forced repeat c-section, either by practice policy or individual recommendation, they basically said that this was unclear. Some advocates took this to mean that the consensus panel was suggesting that women did not have the right to choose a VBAC if that wasn’t the recommendation of her doctor or that if she did, it was acceptable to coerce her with threatened legal action. In other words, a woman is free to make any decision she would like, unless it conflicts with what her practitioner decides.

That leaves us in a sticky spot. What’s a birth activist to do?

Related:

• Maternal Decision Making, Ethics and the Law
• Refusal of Care Based on Religious Beliefs
• Women Need a Chance to Avoid Repeat Surgery

But what really ate at me was they way they portrayed a mother who was working towards a natural birth. Which made me think about the way that the public views the natural birth community, as well as women who simply want a natural birth for themselves.

They treated this woman in the episode like the butt of all the jokes in the episode until the emotionally charged climax of her birth viewed by perfect strangers that would have been a major HIPAA Violation.  The episode shows this woman with a multi-page birth plan, grinding on the door frame of the birth suite trying to squat to help her labor, joking about how she had been in labor for 3+ days, all of which as a mother who has labored naturally, I found offensive.  The character was essentially the comedy of the episode.

It made me think about the perception the American public is going to get from this message, as well as their views on women who do choose to give birth naturally. Do they think we are all just a bunch of hippies that bite on sticks until we drop a baby out in the middle of a meadow while singing show tunes?  Come on!

The problem is shows like this.
The problem is the myths about who has natural births.
The problem is typical stereotypes.

Where do we start?
How do we start to re-educate and properly educate the public so they don’t think all moms who want to have a natural birth aren’t ding bats like this character was?

I really hope that shows like this, and Grey’s Anatomy, and other medical drama’s take the time to fix the American stereotype of birthing naturally. Women from all walks of life do it!

Just on a side note, the character who was attending this woman’s birth “Dell” a “student midwife” came off as a Student OB/GYN if anything. He had no type of midwife qualities in him what so ever and I think that is another huge slap to the natural birth community. He at best was a “medwife” if that!

Over the past 24 hours I have seen some of this most disgusting comments via the internet on news articles, and just message boards. Whether Michelle was on her 3rd or 30th child, Pre-E can happen to anyone at any age and during any pregnancy. This family may live differently than the vast majority of Americans, but seriously, if you want to say something negative, say it when mother and baby are far out of the woods, not when a micro preemie is fighting to live.

Some people never cease to amaze me.

Michelle has been such an amazing asset to the VBAC community in having 12 VBAC’s herself.
I can only hope in future years she will continue to work with and praise ICAN like she has in the past.

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