Who Gets To Decide

For previously disclosed reasons, I've learned a lot about how babies are born in the last few months. It's pretty fascinating, though I'm pretty nervous about witnessing the process myself come January. But there's a lot of controversy these days about labor and delivery.

There's a lot of concern around about how c-sections in the US are becoming more common and how that might be affecting babies and mothers. The effects on the mother are pretty easy to see. It's a surgery with cutting and stitching and removing large objects from the abdominal cavity, and all the risk that entails. There are a few people around talking about how this could be bad for the baby because they don't get the natural squeezing and the effects that has on the physical development of the skull bones and the physiological development of the brain.

The main argument you run into when researching birth methods seems to be that doctors are intervening in childbirth a lot more than they really should and that giving birth in a sterile, cold hospital isn't good for the state of mind of mother or baby.

There's both statistical and antecdotal evidence of this conclusion. It's a cold hard fact that c-sections are on the rise. It's less clear what that actually means, but there's a fair amount of support for the idea that doctors are intervening too often. Even if a c-section doesn't affect the baby, it's still a procedure worth minimizing just because of the effects on the mother. Most of the people advancing the idea that doctors need to be more hands-off are mothers. And they're mothers of multiple children. It's purely my observation, but most of the people I've heard with this point of view are mothers that had a bad hospital birth with their first baby so go to birthing centers or stay at home the next time.

Rachel did an interview with the REBIRTH blogger, who is a labor and delivery nurse. Here are some telling quotes (emphasis mine):

What are your favorite and least favorite things about your work in labor and delivery?

My favorite things… I don’t know if I could narrow it down. I
love the moment a baby emerges. I’m in awe every single time. It’s just

My least favorite thing is seeing how many women have little to
no options in their care. Actually, that pisses me off.

If you could change one thing about modern obstetrics and hospital
delivery, what would it be?

Obviously, that most women would be cared for by midwives. And there
would be no such thing as “active management” of labor.

There are so many things in obstetrics that are not scientifically proven
to be effective, and research shows in some cases such things (interventions) can lead to worse outcomes.

The fact that these women are asking these questions makes me think that
they didn’t agree with what was recommended or done, but didn’t feel equipped to
say no or ask for alternatives.

I just snipped what I needed, but I recommend you read the entire interview.

To be fair to the doctors, it's understandable to want to be overly careful. After all, it is the lives of children we're talking about here. Not to mention their own professional liability and assets in a litigation happy society. But I've heard so many stories about doctors and nurses pressuring mothers and just riding roughshod over their wishes. It's an easy position to take when you're not the one giving birth.

From a dad's point of view, the whole process is about risk and fear. Risk to the baby and risk to the mom. Risk of a doctor doing something unnecessary but with serious consequences, versus risk of a doctor not being there when he's needed. It's also a matter of trust. Do you trust the skill and judgment of your doctor or midwife to not advise something unless it's really necessary? There are a lot of people out there that think most doctors make decisions about what is medically necessary based on personal liability or solely on the baby's health.

So, to drag this from the abstract to the personal, we had a choice to make when The Mrs. turned up pregnant. Who do we want to deliver the baby and look after her until it was born? She was torn between a homebirth, a midwife, and the ob/gyn she's been a patient of for several years. We ended up compromising by using a midwife clinic affiliated with Vanderbilt. So all her natal care would be by a midwife, and the delivery would be by a midwife. But the birth would be at Vanderbilt Medical Center, and there'd be a doctor and a Natal Intensive Care Unit close if we needed it.

We did visit the doctor, since she had history with The Mrs. And it helped us make our decision. The doctor was brusque and hurried and didn't really encourage questions. Understandable since she has a busy practice, but not really what we needed as first time parents.

So you kind of get an idea of the quandary expecting parents are in. As the father to be, there's an extra little mental adjustment because ultimately it's rightfully her decision to make. I've no doubt that I will be consulted, but in the end it is'nt my decision. And that's hard to get used to.

Thanks to Women's Health News and REBIRTH for helping me get better informed.



I was driving in to work the other day, and I heard a Bob Clement commercial during my daily dose of the Bob and Tom Show. I know these have been around for awhile, but this was the first time I heard and paid attention to one since before the first election.

Bob pointed out some very important things to me during his 60 second sound bite.

#1. Since last year all property tax increases have to be approved in a general election. And that ordinance was approved by the voters.

#2. He, Bob Clement, personally guaranteed he wouldn't raise taxes.

#3. His opponent, Karl Dean, would not promise not to raise taxes. He said he would try not to, but wouldn't promise.

Now by show of hands, who can explain to me how #1 makes #2 and #3 irrelevant pandering? If the voters have to approve a tax increase, then what sort of point is Bob making here? If you parse that logically and consider the limitations he would be under, it seems to me that Bob is saying he would defy the will of a majority of voters in Davidson County by refusing to implement a property tax increase they voted on? Because that's the only way he's going to have any choice in the decision. If you're feeling generous I suppose you could interpret that to mean that as a citizen of Davidson County he won't vote for a tax increase during an election. Seems to me Bob is going for the inattentive people who won't think of that, and the knee-jerk no tax crowd. That kind of obvious pandering really bugs me.

Even leaving aside the property tax ordinance, I lose a lot of respect for any politician that promises not to raise taxes. Four years is a long time and there's no telling what sort of disasters or federal mandates might come along that the city will need funding for. So he's either going to break his promise or he's going to not be able to deal with the situation.

So in my eyes, Bob has a history of saying stupid things and attacking his opponent for doing a good job as director of the Metro legal department. That means either no one in the campaign realizes how stupid this all sounds, or they think voters are too stupid to think it through. If the Scene is to be believed, the second would be the true motivation.

I'm not sure Dean would do a good job (though he does have a bridge on his campaign signs) but he has managed to avoid insinuating Davidson County voters are stupid. That's my take on it anyway. Maybe I just read the Scene and City Paper too much.