How do you deal with anti-OB people?

rn/writer, RN · Jan 8, 2006

Having read this entire thread (and similar ones in the past) I don't see the terms "nature nazi," "breastfeeding nazi," and "medical nazi," as referring to advocates in general. Simply having a particular philosophy and being a strong proponent of such doesn't make someone a nazi. What does push them over the line is best summed up by using the phonetic equivalent-- not-see.

A nazi on either end of any spectrum no longer sees the person in front of her. She has become so immersed in whatever cause she espouses that the individual no longer matters or, indeed, even registers on her radar. She doesn't tailor the ideal to fit the patient. Just the opposite. The patient has to bend to fit the ideal, sometimes to their great detriment.

Not-sees are examples of the kind of people mentioned in I Corinthians 13. They preach whatever gospel they embrace, but they "have not love." Any "love" they show belongs to their particular philosophy, or rather, their interpretation of that philosophy, and the patient be damned if they need or want to color outside the lines.

Any ideal can give rise to extremism. It goes with the territory of believing strongly.

What is the antidote? The opposite of "not-seeism." Look at your patient. And look at the present situation through her eyes. If you can't meet her where she is, why should she trust you to lead her anywhere else? Establish a connection. Ask (in a non-confrontational manner) what led her to present decision and genuinely listen to her answer. If you feel that she has been given false or incomplete information, try to supply what's missing (without denigrating the previous source and making her defensive). A small minority won't listen to anything you say. They've become nazis in their own little world. But many will listen to a voice of reason, especially if you have shown them respect up to that point.

Respect for the patient and the willingness to seek balance within a group of wants and needs distinguish advocacy from naziism. No philosphy matters a molecule if you have to coerce, humiliate, or annihilate your patient in the process. This goes for either side of whatever debate is on the table. Patients should never end up being pawns on a political chessboard.

CEG · Jan 8, 2006

Point 1 --> I didn't coin "nature nazis" as it came from my OB/GYN and I used it for lack of a better phrase. I respect any birth plan that a woman makes -- be it at home or in a hospital. My problem is with those women who want to scare other women into delivering they way that THEY want them to. Telling them that their kid will be harmed if they use pain meds, that they will be paralyzed with monster headaches if they get an epidural, that if they have any medical interventions then the birth is "abnormal", etc. That kind of thing is what's bothering me.
While I understand that these may be extremists who are trying to scare people into going natural- the things you have listed here can happen. So do reactions from vaccines which you mentioned earlier. They are pretty rare and probably not as dramatic as the "nn" make them out to be but they do happen. I bet there are very few women whose doctors a point of making them aware of these risks. I received an intrathecal during my births which my CNM made a point of telling me the side effects of. I don't even remember signing the consent, let alone what it said:)

mitchsmom · Jan 8, 2006

They come in thinking that the nurses/docs/CNMs want to strap them to the bed, hook them up to a monitor, drug them, remove the baby surgically and wisk it away to the nursery so they can sneek it some formula to sabotage breastfeeding.

This is actually not far off for my town. Some of the docs are overworked and in a hurry and I know one (who I used to go to) who out and out makes no bones about it, he'll tell you he does it. No one is trying to sabotage bf ovbiously but a lot of the nurses have learned improper information about bf that they pass on &/or do a lot of taking the baby for mom to have sleep and just keep it for hours and give baby a bottle instead of taking it back to nurse. Huge amount of inductions (there's the bed, monitoring, and drugs right there) and c/s. I do like most of our docs personally and they are not out to get anyone, but they are simply not going to refuse a chance at a convenient delivery if they think they can get it. I wouldn't call most of them incompetent, but they are overly interventionist in general.

That said, there are always some bad apples no matter where or what you are talking about. As someone else said, birth and parenting just seem to get people going easily :)

I agree with the person who said that we just have to give people information and let them decide. Personally, I find that the more natural-oriented types of people are usually really interested in information, particularly evidence-based information. If you can show them the evidence they make take it to heart.

Also, about giving advice... I don't really think we should be presenting advice at all. I think we should give objective information (hopefully evidence-based), not advice. We give unbiased information and lay out the options for the patient to use to make their own decisions. (I know that whoever said that may have meant information, but I just wanted to clarify because I think it's important).

Now I'll practice what I preach and give some information for anyone interested: :)

Referring back to one of the posts re: La Leche League. The poster mentioned hearing some incorrect things from a local LLL. La Leche League as an organization actually has few tenants and they are pretty broad statements. Here they are:

Mothering through breastfeeding is the most natural and effective way of understanding and satisfying the needs of the baby.

Mother and baby need to be together early and often to establish a satisfying relationship and an adequate milk supply.

In the early years the baby has an intense need to be with his mother which is as basic as his need for food.

Breast milk is the superior infant food.

For the healthy, full-term baby, breast milk is the only food necessary until the baby shows signs of needing solids, about the middle of the first year after birth.

Ideally the breastfeeding relationship will continue until the baby outgrows the need.

Alert and active participation by the mother in childbirth is a help in getting breastfeeding off to a good start.

Breastfeeding is enhanced and the nursing couple sustained by the loving support, help, and companionship of the baby's father. A father's unique relationship with his baby is an important element in the child's development from early infancy.

Good nutrition means eating a well-balanced and varied diet of foods in as close to their natural state as possible.

From infancy on, children need loving guidance which reflects acceptance of their capabilities and sensitivity to their feelings.

http://laleche.org/philosophy.html

That's IT! If someone claimed something else, they were wrong. Other than that, LLL only advocates giving evidence-based information such as the AAP recommendation for breastfeeding for example. There should not be any judgements and a mother should be supported in whatever her personal breastfeeding goals are, whether 2 days, 2 weeks, 2 months, or 2 years.

"La Leche League International is a Non- Governmental Organization (NGO) in consultative status with UNICEF, is an NGO in official relations with the World Health Organization (WHO), acts as a registered Private Voluntary Organization for the Agency for International Development (USAID), is an accredited member of the US Healthy Mothers/Healthy Babies Coalition, is a member of the Child Survival Collaborations and Resources Group (CORE), and is a founding member of the World Alliance for Breastfeeding Action (WABA)." They also offer conferences sponsored by the American Academy of Pediatrics (AAP) and American College of Obstectrics and Gynecology (ACOG). Perhaps this is more mainstream than some people imagine.

I have to run... hungry kids! :)

rn/writer, RN · Jan 8, 2006

La Leche League as an organization actually has few tenants and they are pretty broad statements. Here they are:
Mothering through breastfeeding is the most natural and effective way of understanding and satisfying the needs of the baby.
Mother and baby need to be together early and often to establish a satisfying relationship and an adequate milk supply.
In the early years the baby has an intense need to be with his mother which is as basic as his need for food.
Breast milk is the superior infant food.
For the healthy, full-term baby, breast milk is the only food necessary until the baby shows signs of needing solids, about the middle of the first year after birth.
Ideally the breastfeeding relationship will continue until the baby outgrows the need.
Alert and active participation by the mother in childbirth is a help in getting breastfeeding off to a good start.
Breastfeeding is enhanced and the nursing couple sustained by the loving support, help, and companionship of the baby's father. A father's unique relationship with his baby is an important element in the child's development from early infancy.
Good nutrition means eating a well-balanced and varied diet of foods in as close to their natural state as possible.
From infancy on, children need loving guidance which reflects acceptance of their capabilities and sensitivity to their feelings.
http://laleche.org/philosophy.html
That's IT! If someone claimed something else, they were wrong. Other than that, LLL only advocates giving evidence-based information such as the AAP recommendation for breastfeeding for example. There should not be any judgements and a mother should be supported in whatever her personal breastfeeding goals are, whether 2 days, 2 weeks, 2 months, or 2 years.

There is nothing wrong with these tenets. What tainted LLL for me and has for many others is the use of this list as a subtle--but hurtful--club for bludgeoning those who don't fall immediately in line with their goals. I was young and well-intentioned but exhausted and discouraged and in a great amount of pain as well. The LLL people I dealt with made me feel as if I was nothing more than a vessel to feed my child. No one connected with me on a personal level except to ladle on guilt and expectations. No one even seemed to recognize that I existed apart from my breasts. They were the only parts of me that mattered.

Now, many years later, I wouldn't let anyone speak to me the way those women did, no matter how soft-spoken and polite they appeared to be. I would call them out on the "between the lines" messages that implied that I didn't matter except as a food source.

Back then, I went home and cried while I fed my baby. It hurt terribly. Today, I probably would be given a shield. That wasn't acceptable in those days. I nursed my daughter for two months and then fell apart from pain, lack of sleep, and overall depression. Finally, I did the unthinkable and switched her to formula and within about ten days, I crawled out of my cave of despair and felt human again. My cracked and blistered nipples healed. I got some rest. And I decided that I would not buy into the idea that my daughter had to be irreparably damaged because I had made another choice.

This lovely daughter grew up to have four kids of her own, all of whom she successfully breastfed without the trauma that I went through with her. I've been one of her biggest cheerleaders and have been very thankful that she didn't have to experience the physical or the emotional pain I endured with her.

supermo · Jan 8, 2006

This thread enthralled me.

I must say that I believe that calling it a "natural" birth only if it's without intervention, is wrong. When each of my sons came out of my body, it looked pretty dang natural to me. I can't tell you what the birth of my daughter was like, I was under gen anes when they performed the c/s. That I consider unnatural. I consider myself someone who gave birth naturally twice, 2 vbacs. Granted, I was eipuraled to the gills, but I did witness them emerging, quite naturally, from my person. When I go to the dentist, I request novacaine before anything is done. When I go into LD I request epidural before anything is done. I praise modern medicine personally.

Food for thought--

In 1900- In the US 6 to 9 of every 1000 women died in childbirth, and 1 in 5 children died during the first 5 years of life.

In 1977-The maternal mortality rate declined almost 99% from 1900.

Anyone want to guess why? MODERN MEDICINE!! No, I don't believe everyone should have to go to a hospital to have their children. I do believe that the people that are so anti-medicine should wake up and acknowledge that doctors and hospitals save thousands of mothers and babies everyday. Just be nice. Let people do what they want. Don't distort the facts one way or another. Present the information, trust the person's intelligence to make the right decision. If they don't choose the method you prefer, GET OVER IT.

Anything-"nazi" is going to be offensive. I say that anyone who feels the need to belittle your experience or choices should be called a nuisance. I think that women that want to experience the birth of their child in their home or want to do it all without medicinal assistance, are braver than me.

What really riles up each side is the condescension. I believe that I know what is best for me. I also believe that my opinion is saved for the person who asks for it. This holds true for politics, religion, abortion, gay-rights, etc.

I breastfed my children. Not as long as some people think I should have, but I did try. Once again, a personal decision.

Just my scattered thoughts......

lowly little mo bello:D

mstigerlily · Jan 8, 2006

When I go to the dentist, I request novacaine before anything is done. When I go into LD I request epidural before anything is done. I praise modern medicine personally.

I agree with most of your post but this quote above made me a little sad. It's not the first time I've heard it. I've gotten into discussions with people who have said this before and I just don't understand it. Getting a root canal or a lump in your breast removed - or another medical "procedure" is in no way comparable to giving birth to your CHILD. Yeah, they both hurt but that is where it ends. I think if you need an epidural to enjoy the experience of childbirth than that's fine but I think childbirth is an experience different from any other, one of the few times that pain can be pleasurable and something to be experienced instead of banished like a nagging toothache.

ayndim · Jan 8, 2006

What it comes down to is each woman should be able to make decisions about her child without being made to feel like a bad mother. And while I think that CNMs are competent and beneficial, the fact remains that they are NOT doctors-they didn't attain the same level of education as an MD, and I for one want the best care that I can have. Yes, your pregnancy may be low risk for the majority of the time but things can change very quickly. Also, I use the term "nature nazi" to refer to those women who see it as their right to tell another woman what kind of birth to have...Ultimately, if it's not your birth then I feel that you should butt out,and not try to make yourself feel superior because you didn't want an epidural, for example. My friend breastfed her children and all of them had terrible allergy and ear infection problems-my cousin( who bottlefed her two kids) almost never has to take them to the doctor except for immunizations. Every child is different and while I think breastfeeding is a great thing, I would never make a mother feel badly because she decides it's not working out. I think a large part of the problem is that as women, we tend to be very competitive and catty with each other, and that's where the superiority complexes come into play. There was a reason that centuries ago, women died in childbirth in droves. Mainly, because of infection, difficult labor etc. Also, some religious groups claimed that a woman should not have pain relief during labor, because it was against the bible's teaching. So really, medicine did a lot of positive things regarding childbirth. I do think they went a little too far but it is my personal opinion that to discard a medical approach completely is dangerous. I have no problems with midwives as long as they work in conjuction with a doctor, and I believe a doula's role is to provide support, NOT medical advice. P.S I can hear it right now, someone is going to say that I am telling women that it's wrong to take the natural approach-this is not true, I am stating that I think interventions are needed sometimes and I want them available for me...What someone else decides to do is THEIR decision.

Actually MW births usually carry less risk for mother and child in a low-risk pg and birth, and when MD backup is available for high-risk situations that could develop. I did a paper on it when I took statistics. Wish I still had the paper because it had all of my references but here are some that I found, for anyone who is interested. One of the references promoting MW care was from the WHO. If I manage to find it, I will post it later. Each person needs to make their own choices. In Europe, the MW's typically attend in hospital (although women do have a right to a homebirth in many instances. In fact, a Norwegian princess recently had her 2nd child at home with a MW.) A good MW will not berate the pt for chosing pain meds or other choices but give the mother the risks and benefits and let the mother chose. Whatever provider a woman choses, I believe she must feel comfortable and confident with the provider and the care given.

"In the Western European countries that have lower infant and maternal mortality, lower cesarean birth rates and lower health care costs than the U.S., midwives are the primary care providers for over 70% of births; about 5% of US babies are delivered by midwives. For years the World Health Organization has recommended that most births should occur outside the hospital, attended by midwives, without routine technological interventions. In the US, only about 1% of births take place outside the hospital."

Taken from

http://www.maternityservices.com/is_homebirth_with_a_midwife_safe1.htm

I love MW but for me personally I had mine in a hospital. I had problems with pg that would have prevented a homebirth but honestly with the last I wanted to be alone with the baby while my husband had the older 2 at home. I needed my 2 days away!!!!

"Percentage of nations in western Europe whose infant mortality rates are superior to ours - 100% (11)

Percentage of births attended by midwives in western Europe - 75% (12)

Percentage of births attended by midwives in U.S. - 4% (12)

Average cost of midwife-attended birth in the U.S. - $1,200 (13)

Average cost of physician-attended birth in the U.S. - $4,200 (14)

Healthcare savings obtainable annually by utilizing midwifery care for 75% of pregnancies in the U.S. - $8.5 billion a year (15)"

Taken from (under Beginning with birth, 2nd highlighted item.)

http://www.foodrevolution.org/roh_facts_print.htm

There are various references on infant and maternal mortality.

http://www.aneki.com/lowest_mortality.html

http://www.hhs.gov/news/press/2002pres/infant.html

http://www.safemotherhood.org/facts_and_figures/health_around_the_world.htm Notice that there is a lower risk of maternal death in MW traditional countries (i.e., UK than in the US)

fergus51 · Jan 8, 2006

I'm EXTREMELY pro-midwife, but I have to wonder about those statistics citing lower mortality in western european nations as being only because of midwives. We also have a lot of women in the US who get no prenatal care, have problems with nutrition, drugs, etc. which impacts morbidity and mortality rates as well.

Mimi2RN, ASN, RN · Jan 8, 2006

lol!
me too. i think she was burnt out honestly and knew i was determined so didn;t do much for me. i was a nurse and so she thought i was ok on my own, im assuming. i needed her badly though. i couldnt think straight.
nursery wouldnt let me breastfeed because he was 5 lbs 6 oz... he was healthy though. little jaundiced but never needed any oxygen excepting the first night. he was a mag baby. the whole experience was horrifying. i felt so alone and scared.

No reason you couldn't breast feed a baby that size. Your other comments-the baby was on O2, and was a mag baby, may have been the reason you couldn't breast feed at first. Depending on the way a baby is given oxygen, and his condition at the time (nasal cannula and screaming or oxyhood and lethargic) you could possibly have breast fed. The mag sulfate presents a different picture. We do mag levels on all babies whose mom had been on mag, even a bolus 4 hours before delivery. If that mag level is >3.0mg/dl, the kid does not get fed until it comes down. Mostly, those babies just want to sleep. The bolus 4 hrs before? mag level in baby 4.7! That was a couple of weeks ago, mom came in with PIH high BP, systolic over 160, diastolic over 100. Baby was a 36 weeker. It did go out to mom a day and a half later.

mitchsmom · Jan 9, 2006

rn/writer,

Sorry to hear you had that experience. Like I said, there are good and bad everywhere. ((hugs))

AngelaSPN · Jan 9, 2006

My first reaction was to set the record straight to some of these women on one mommy board, but I have not only lost my moderator status, but been basically named a "troll" for not backing down from that stance that it is no one's business how a woman opts to deliver her child (we should respect any birth plan that a mom-to-be has made and not degrade her for opting for an epidural or trusting that her OB knows best).

i think i know what message board you are referring to. there was a post about a mother who had had a previous c-section and had since then become an MD hater and would not deliver in a hospital under any circumstances. i guess at some point during her pregnancy an MD told her that she would need another c-section d/t shoulder distocia. so she hired an illegal midwife to deliver her baby at home with no doctors. she was over 40 weeks pregnant when her water broke and the illegal midwife tried to deliver the baby at home. guess what happened.. she couldn't get the baby out. after trying and trying they finally decide to call 911. i don't know if this part is accurate or not but i think when the ambulance got there they tried to deliver the baby and the whole time the woman was yelling at them telling them to do an episiotomy to get the baby out. i think they finally get the baby out and the baby had already died. the baby was 9 lbs. till this day the woman does not feel she did anything wrong and actually has the nerve to say she had a successful VBAC even though her child died. she blames the paramedics for not performing the episiotomy and according to her not doing anything once the baby came out. the illegal midwife was being investigated but the mother would not tell them her name or how she got involved with this person. this woman plans to get pregnant and not do anything different. it is crazy how people at this particular message board rally around her and tell how wonderful she did and how she did nothing wrong. and if anybody says anything different you are called a troll and banned from the site.

fergus51 · Jan 9, 2006

"Successful"? When the baby died?! That is crazyIMO.