Tuesday, July 06, 2010

Delivery room wrestling match

In an article in the Omaha World-Herald about using alternative positions for labor and birth--aptly titled Stand and Deliver--one physician literally wrested an ambulating woman onto the delivery bed. Dr. Maureen Fleming is director of general obstetrics and gynecology at the Creighton University School of Medicine. Here's the story:
As for obstetricians preferring a more convenient position, Fleming said they, like midwives, are accustomed to strange positions and situations. She recalled a woman in so much pain that she angrily started to walk out of the hospital room. Fleming had to wrestle her back. “I almost fell on the bed with her because I had to throw her on the bed.”
The midwives interviewed for this article tended to be more supportive of alternate birth positions, including kneeling, standing, and squatting.
Alternative positions are by no means sweeping maternity units. The majority of births are done with epidural injections, which numb the lower body and make it virtually impossible for the woman to stand or squat. Nevertheless, some midwives and other delivery experts suggest that expectant mothers are more frequently considering delivering from some position other than the back. “I recommend women get out of bed all the time,” said Heather Ramsey, a certified nurse midwife at the Med Center.

Ramsey and other proponents of alternative positions say the benefits can include decreased pain, better blood circulation for the mother and baby and easier downward descent for the baby. Pain medications, they say, can make the mother and baby drowsy, which may impede the infant's ability to immediately breast-feed.
The two physicians interviewed for the article, on the other hand, viewed analgesics and epidural anesthesia as overwhelmingly positive:
Fleming and Pankratz, a board member with the Nebraska Medical Association, said pain medication and epidurals are fine. “We don't believe there's anything unnatural about alleviating pain in labor,” Fleming said. “My philosophy,” Pankratz said, “is technology is present to make our lives better.”
The article began with a woman who gave birth in a hospital standing up, one knee propped up on the bed. Rosalina Romero tried several different positions, finally finding one that alleviated the intensity:
Finally, she stood with her fists on the bed. The horrible pain dissipated and became more of a burning sensation, far more tolerable. “It's just what felt natural,” she said. She lifted one leg and her husband, Brent Vignery, held the leg up. The baby's head began to come out. She put a knee on the bed and kept one foot on the ground. Their baby, Dexter, emerged. “Gravity helped a lot,” she said.
In contrast, Dr. Fleming expressed her doubts that gravity helps the birth process:
Fleming said she doubted gravity played a role in delivery, as some proponents of standing or squatting believe. The opening of the cervix, or cervical os, holds the baby in, she said. “Babies don't just fall out,” she said.
My commentary:
Delivery room wrestling match = assault and battery
Does gravity cease to exist if you don't "believe" in it?


  1. "babies don't just fall out" well duh. people don't just randomly fall on the floor either, but the force of gravity helps us stay pulled to the ground, in the same way the pull of gravity must help the baby through the birth canal and cervix better is an upright position.

    glad to see a post!

  2. YAY!!! Someone else who had the same thoughts as me when I read the article!! Of COURSE the baby doesn't just fall out...what a completely nonesense comment!

  3. “I almost fell on the bed with her because I had to throw her on the bed.”

    That is unacceptable behavior. Period. You put it well, its assault and battery. Its very upsetting to think about.

  4. TO: mfleming@creighton.edu

    DATE: Tue, Jul 6, 2010 at 2:06 PM

    SUBJECT: questions on the "Stand and Deliver" article in the Omaha World Herald

    Dr. Fleming --

    I had a few questions for you about your quote in the "Stand and Deliver" article in the Omaha World Herald that was published yesterday.

    You were quotes as saying :

    As for obstetricians preferring a more convenient position, Fleming said they, like midwives, are accustomed to strange positions and situations. She recalled a woman in so much pain that she angrily started to walk out of the hospital room.

    Fleming had to wrestle her back. “I almost fell on the bed with her because I had to throw her on the bed.”

    Dr. Fleming, I truly, truly hope you were misquoted! I work as a doula, and if I witnessed and MD wrestling and throwing a patient, I would consider that assault, not a care provider dealing with a strange situation. I know that you likely constricted by confidentiality issues, but if you are able, I would love an elaboration - and any suggestions you have for doulas as well.



  5. As a doula in Omaha, I was displeased (to put it lightly) with this article. I did like that they included Heather Ramsey's comments, as she is one of my favorite local midwives. She is very supportive of natural birth and will work with mothers to help them with the birth they desire.

    A question to doulas - what would you do if a mother you were supporting was wrestled back onto the bed?

  6. SLAM.

    That was the sound of my jaw hitting the floor!

    I hope that mom who was walking out of the room got back up after the doctor threw her down and left - hopefully after kicking him in the babymaker to prevent it from happening again! I'm APPALLED.

    Also, as far as "babies falling out?" Isn't that the POINT?!?

  7. This absolutely terrifies me.

    I'm living just over the river from Omaha in Iowa, and I've been planning on moving to Omaha for convenience. (School is there, work most likely will be soon.)

    This just gives me more reason to birth at home when the time comes.

  8. @Jill - HER. Kicked HER in the babymaker, if I'm reading the article correctly. This is a female doc being interviewed.

    Thank goodness Dr. Fleming is an OB/GYN and not a physicist.

  9. As a doula I was witness to a women being pushed back down to the bed by her doctor. She had been on her hands and knees--but in the air (perfect for docs access) and had a good rhythm going. The doc came in and insisted she roll over even though she had been promised she could deliver in any position. I was on one side and the doc on the other. We helped her roll over and as soon as she went to lay back her instinct was to pull up into a squat holding our shoulders for support. Baby was crowing! Doc said, "Oh no." and took used both his hands on her shoulders to push her back onto the bed where she now started howling having lost all rhythm and concentration. I whispered in her ear, "you don't have to stay in this position" and she assured me it was fine.

    My assessment of the situation was:

    1. Completely inappropriate behavior by the doctor.
    2. Her birth was actually more painful directly as a result of his actions.
    3. She thinks the pain she felt was birth pain, but actually it was intensified by her positioning.
    4. In her position as a laboring woman it was difficult for her to know the difference of the doctor needing to do something for safety or just being inappropriate. Most people assume their doctor will not act appropriately.

    Side note: It was the first birth I attended in a hospital setting. I had only witnessed midwifery attended homebirth up until that point and I was appalled.

  10. I'm just totally nonplussed at Dr. Fleming's last statement.

    Ok. YES. The cervix holds the baby in . . . UNTIL dilation has completed! THEN gravity can play a role. It's not the only thing working to move the baby out, but it CAN be a factor!

    Gravity isn't the star player in the first stage of labor, but it can help maintain pressure of the baby's head on the cervix (which, yes, is holding the baby in at that point) and encouraging dilation, as well as other good reasons to be upright, i.e. moving the pelvis and helping baby to achieve optimal positioning. But once the cervix is complete and no longer holding the baby in - how can Dr. Fleming's statement make any sense whatsoever?

    Your logic is not our earth logic.

  11. Wow. Who gets to decide what positions are 'alternative' and what are 'normal'? I hated the unproblematic use of 'alternative' in the article quotes-- and it instantly connotes 'crazy hippie', too, to the average reader, I imagine. And that epidurals are completely fine and w/o risk. And everything everyone else said.

    A friend of mine gave birth 2 or 3 weeks ago and was coerced into being on her back in stirrups when she kept asking to squat. At least no one threw her down, I guess. UGH.

  12. @milkstained: Oops, you are right, SHE. My bad. I have a habit of defaulting to the generic he/him. I guess I got so outraged over the story that I forgot to pay attention to the doctor's sex, ha!

  13. Hey--what happened to the "positives" discussion for people who took pain meds/epidurals and were glad about it? I recall that you started with the negatives and never did the opposing view.

  14. Oh, for heaven's sake. Try having a bowel movement flat on your back and let me know how it works out fo you, okay?

  15. I don't know what is more horrifying: the fact that this happened, or the fact that I'm not entirely surprised that it *has* happened and is certainly not an isolated incident.

    I wish Dr. Fleming could have been at the birth I was at on Saturday. The mom began pushing on her back--not because of force or coercion or suggestion but because she was *exhausted.* But during one of her last contractions, she reached up for the squat bar that had been set up for her, got into a squat, and *pushed.* All of the nurses' eyes got as big as saucers as they witnessed the baby's head (gently) emerge *immediately*--that is, as they saw what GRAVITY can do when a woman is pushing.

  16. Mind boggling!The scenerio presented of Dr. Fleming throwing an angry laboring woman onto a bed to prevent her from walking out of the hospital...also suggests that laboring women have no idea what is good for them and are "out of their head,lacking intelligence, etc. We are instinctive beings and should be able to trust our bodies to guide our babies into the world without worrying whether we will be forced into a position of physician's convenience or preference!

  17. Actually, I dilated so fast with my 4th that he pretty much did fall out. I was upright until my legs got too trembly and I quickly went into an instinctive side-lying position just in time for my babe to come flying out.

    Good thing nobody was trying to throw me around at the time! We need to let women listen to their bodies and labor/push in instinctive positions, which are different from one birth to the next, even for the same mother!

    Stories like the one in this post make me ill. :-( I feel so sorry for the mom who got tackled. There could have been serious physical harm to both her and the baby. No doubt she suffered a good deal of emotional harm.

  18. By Dr Fleming's quote we know that it was an angry laboring mother who was "angry at the pain".
    However, how do we really know without talking to the mother that she was angry at the pain. She could have very well been angry at Dr Fleming herself.

    Either way, I'd call this assault.

  19. My heart goes out to whomever that mother was that got wrestled to the bed. I can only imagine how that made her feel. During my first birth, I was told I had to move from pushing on hands and knees to sitting with my feet in the footrests. I repeatedly said no, I can't, louder and louder, until two nurses grabbed me by the arms and turned me around. Have you ever seen on Discovery Channel when Steve Irwin and his guys would all jump on a croc to get it into a container for transport, and the croc is angry and confused and fighting with all its might? That's kind of how I felt. Like a wild animal that was being forced into a trap. My baby was born with the next push, but I am fully convinced my 2nd degree tear had everything to do with the change of position.

    We can't go on treating women this way.

  20. LOL, yes, the earths pull on all objects on the planet just doesn't apply to babies. *snort/giggle* Oh come ON!? Where do they find these great thinkers?

  21. Oh and I wanted to add...I loved what Rachel said about the term "alternative". I mean, really, when you look at human history as a whole and consider that our current practice of obstetrics is less than a century old how can you call normal, natural childbirth "alternative"? If we were being honest with ourselves, we'd call current conventional wisdom "alternative" because ultimately, that's what it is: the alternative to normal, undisturbed birth.

  22. I was a resident physician under Maureen Fleming years ago and found her to be very harsh and cold at that time. I can't imagine her comments are anything other than her continued harsh miserable view of life. We all get that way at times and there are people on this board that are that way, but it really is sad that one can come to a point in their lives where they feel they have to impose their views upon another person. If a patient wants to walk and you dont wan them to then have them sign an Against Medical Advice form where you are covered and they take responsibility for their actions but they can still do what they want. It's a hospital not a prison.

  23. WOW! Gravity does not exist in Labor and Delivery Units...an alternate universe!

    Check out these other equally stupid quotes on gravity by birth professionals


  24. This article should be forwarded to the NE Hospitals association and Joint Commissions for immediate investigation.

    I understand doulas have a scope of practice, but beyond that, we also have a responsibility to speak up if we feel a crime has been committed, especially if a mom feels one did occur. We need to know how to help these families address what happened.

    Wait. Didn't Jennifer Block's book Pushed talk about doula's roles in these types of situation?

  25. Wow, I am speechless! But not surprised how sad is that?

  26. Why? Why do women keep going back to these OBs. WHY?! Aaaaaack!

    I like the quote about gravity. I wish it were so simple that things didn't exist if we didn't believe in them. I'd like to not believe in cancer, aids, kidnappings, rape, molestation, mental illnesses... I could go on.

    What a mean simpleton this gal appears to be.

  27. How does an OB get to spend so many years in training, yet not know that vertical positions are better for birth?! The pelvic outlet opens more when vertical, squatting, on hands and knees, etc, yet narrows when the lady is lying on her back. Now how does a layperson like myself know this and the OB doesn't?

    I've birthed 3 times with no drugs. The last 2 were at home and I was left alone. I sat once and squatted once. The babies came out on their own with no pushing in 3 contractions.

    With my first in a birth center, I was doing fine on the toilet. My water broke and I was starting to feel the bearing down sensation. The midwife and attendants wanted me to get on the bed and put me on my back. I wound up pushing like crazy until baby's heart rate got low, and I ended up with an episiotomy to hurry up and get him out. I am convinced if they would have left me alone, I would have birthed fine.

    I love to read and learn about birth and other things, and am passionate about uninterfered with natural birth. I have educated myself about birth, yet most OB's seem to know nothing about the natural birth process. They are only educated about interventions, so that's what they do.

    This woman's experience is a sad example of why I would consider it torture to birth in a hospital.

  28. I am also a Doula in Omaha, where Dr. Fleming practices. I found the comments in her article to be ridiculous! Throwing a laboring women onto a bed??? When would that EVER be a good plan of action? Unfortunately many doctors here get away with treating their patients in a less than professional manner whether it be "throwing them onto beds" or purposely misleading them. I was at a birth recently with an OB who told the parents if she didnt artificially rupture the moms water "The baby wouldnt have a way to get out" I couldnt believe that she actually said something so ridculous and obviously untrue. We have a lot of work to do in NE changing the birthing environment! This article did make me very happy that I did not choose Dr. Fleming to deliver my first baby! I considered her bc she was covered by my insurance at the time!


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