Thursday, June 09, 2011

Is autonomy just for the natural birth crowd?

In response to the post about autonomy, beneficence, and non-maleficance, someone left this comment:
And, you know, if random women didn't declare their consent invalid after something *did* go wrong, docs just might be more willing to go along with your riskier ideas. One of the more annoying parts of your "trust birth" idiocy is that you want to refuse all the stuff that might let you know something is going wrong, show up at the hospital with you and the baby in distress, and then bitch blue murder about the evil docs who couldn't pull one more rabbit out of the hat and save your ass, your baby and your uterus.

Does it not cross your mind that docs don't like losing babies, and don't like being sued---because in order to be sued, there has to be a bad outcome? And a bad outcome is a dead or injured baby? Midwives have no insurance, little training and less accountability.
There are gross generalizations, false accusations, and other logical fallacies in this comment. Leaving those aside for a moment, this comment implies that only those of a certain ideological persuasion care about autonomy, and that the desire for autonomy is essentially selfish and misguided.

So what do you think? Is autonomy just for homebirthers (or those who use midwives or want a "natural" birth)? Do more "mainstream" women really not care about, or not benefit from, autonomy in their maternity care?


  1. While I'm not certain of this, I have read different things about how very rarely midwives are sued. Neither are doctors who have a relationship with patients involving trust. I would like to see numbers saying how many home birth transfers sue docs. I bet pretty few.

    Is autonomy only for the HB crowd? Certainly not! How many patients have ever been shocked when an appendix was taken out in addition to a colon polyp (happened to my MIL), or simply wish to know the name and risk/benefits of drugs being given.

    People sue doctors because they don't have a relationship with them.

    1. Agree, there was a study that showed some doctors NEVDER get sued while others are sued more often. Didn;t seem to correlate with skill, though. It correlated with bedside manner. Patients do not want to sue a doctor they like.

  2. LOL! One of the first things doctors learn in med school and are constantly reminded of is 'patient autonomy' so gasp! they've heard of it too!

  3. My personal opinion is that most women have been conditioned (by years of exposure to birth stories told by their mother's generation as well as their own friends, as well as birth shows on TV, and standard internet/book fare) to expect a certain amount of interventions as normal, expected, justified, and not to be questioned.

    I think that most "mainstream" women would really benefit from autonomy in their maternity care, but they have not been conditioned to expect it, and don't feel it as a loss when it doesn't happen. They just take it for granted that they will follow orders w/o question. Oh, but I think a great change would occur in our society, in our families, and in mothers, if they were as respected in the birthing room as they expect to be respected as a CEO in the board-room!!


  4. Meg, I would respectfully disagree with you! People sue Doctors because of bad outcome that are proven to be caused by the doctor's fault, since Doctors do carry malpractice the families of injured or dead babies have an outlet for closure and monetary compensation(in case of injured children it comes handy!). the reason why people dont sue Midwives is that none ( or very few) carry malpractice, it is plain and simple.

    1. It is nor plain and simple, actually. Many midwives do carry malpractice insurance, usually in states where they are required to be licensed, even home birth midwives. Now I would agree that midwives, esp home birth midwives, work with a lower-risk population, a self-selecting group of typically healthy educated women, and if a woman is or becomes high risk a midwife can refer them out, while doctors esp OB's are trained to deal with high risk and therefore see more of these pregnancies. That would be a reason why midwives do not get sued as much. But I still do not think this is the whole reason.

  5. I am what you would call a "mainstream" birther. I feel like I had plenty of autonomy. The doctors recommended procedures, but never left me feeling like I had no choice. I went with their recommendation every single time. I respect the fact that they know a lot more about birth than it would even be possible for me to learn from reading some birth books while pregnant. To me, autonomy meant I could decide whether to move around or not. I could decide if and when to seek medicinal pain relief (which I did). Most importantly, the birth was only ten hours of following medical recommendations, but afterwards, I was the one who was going to be taking home my beautiful baby and raising him for the next eighteen years. That's a lot of autonomy!

  6. First, I just have to say I'm impressed that someone so antagonistic would've chosen that post (not a very accessible one, imho) to make this comment on. Maybe it was just the most recent one at the time?

    This reminds me of some points in the Birth as an American Rite of Passage book, where the author was surprised by how satisfied many women were with their births even when they seemed to be so un-empowering, and I think the point was made that how well your experience matches your expectations is more important than how "objectively" good your experience is. Or, that autonomy (any sense of being in control, even if for a woman that means scheduling her own c-section) is a big predictor of satisfaction.

    I think autonomy is an incomplete way of looking at "natural" birth, because while a home birth can be free of technological intervention/hegemonic oversight, it involves a surrender/submission to the natural process instead, right?

    Autonomy doesn't mean you get to decide how your birth goes, when labor starts, how contractions progress, for e.g.

    Unless autonomy is strictly a legal term?

  7. I totally agree with you Jane! I think as long as a mom was able to make her choice freely who the heck are we to tell her..." you had a heplock...sorry that wasnt right"
    "you had this kind of birth , you should feel this way..."
    I also like the idea that a HBers have to submiss to certain things, different from Hospital Birthers of course. You ll will have to accept that there might be things you wont be able to prevent, or risks you will have to embrasse ...

  8. I think perhaps the women who would choose autonomy, or informed choice and the power to decide for themselves first choose that, and then end up gravitating to natural birth and home birth.

    I don't think it's the other way around, but rather a process of learning and making informed choices, or perhaps recognizing that it is not possible to have autonomy in the OB-hospital setting that sends women who want it to homebirthing and midwives.

    It was like that for me, anyway, once I realized I could have a choice, I went for the options where I preserved the choices and autonomy. When I didn't know options existed, I went along with the OB-hospital route and thought nothing of it -- just that that was the way things are done. No questions asked. Questioning is "dangerous" and leads people to believe they can question other things... and usually they do. And then you get all kinds of radical ideas like that we should have a say in what happens to us in labour and where we deliver. :P

  9. Here's the problem (and I've had 3 home births)

    I tend to see the appearance of autonomy without much *actual* autonomy to speak of. It's just that instead of handing over power, knowledge and decision making to the medical authorities women in the natural birth crowd participate in a submission of will to natural birth authorities and more loosely to "nature" itself, trusting that if you just don't anger nature with Evil Interventions that nature will smile on you and everything will be fine. I only see lip service to the idea of a woman having "autonomy," because how autonomous are you really when it's so clear that there is a "right" answer to any intervention raised outside of a clear cut emergency? I'll give an example:

    How many women in natural birth circles are aware that prophylactic anti-bleeding meds (whether pit or ergot) after birth is a World Health Organization recommendation? Remarkably few for a subset that gives so much credence to "evidence based medicine." Is the choice for physiological management of 3rd stage when no information about what Cochrane and the WHO state about active management of 3rd stage really "autonomous"?

    I've been an active reader and sometimes participant in online natural birth circles for at least the last 5 years, and I know that there are "right" answers (NOT THE EVIL HEPLOCK! NOT AN INDUCTION AT 41 WEEKS! SURE I TRUST MY BODY TO DELIVER THIS BABY WHOSE FUNDAL HEIGHT IS 46CM AT 32 WEEKS!!) and there are "wrong" answers. I don't dispute that women need greater autonomy in birth, but I dispute heartily that such autonomy truly exists in a meaningful capacity in many natural birth leaning environments.

  10. Simple enough: I can think for myself whether I chose to birth at home or at a hospital. We all take in information that is given to us. Just depends on your definition of risk, and what is more valuable to you - the experience or the baby.

  11. Amen to catcreekcreations. I gravitated toward the natural and midwife route initially because I feared for my autonomy in a hospital setting. Even before I had done any research about natural birth, I had heard stories of everything you can't do in the hospital (eat, get up, etc.). My husband is very non-confrontational and I worried that I wouldn't have anyone to stand up for me while I was in labor. It wasn't until a friend posted an article about natural birth (about half way through my pregnancy) that I even considered doing anything but the default OB, hospital, epidural, etc.

    Anyway, on the non-autonomous extreme, one woman I spoke with expressed her desire to completely check out of the decision-making process during labor. The whole experience daunted her so much that she felt the most secure in sitting back and letting the professionals handle the situation as they saw fit. While I could understand the fear part, the notion of not being a part of such crucial decisions regarding your body and your baby boggled me.

    I think there a lot of women who worry primarily about things going wrong, and they feel a sense of security knowing there is an MD in charge. I don't think they necessarily see that "security" as a trade-off for their autonomy. Maybe it just boils down to priorities. For some (like me), autonomy is at the top of the list. For others, autonomy is nice, but not as important as an epidural or the "security" of a hospital. And, unfortunately, there are many who are simply unaware of the viability of other birth options. Waterbirth and midwives certainly weren't even on my radar until I stumbled onto some literature well into my pregnancy.

  12. PS - when I say that autonomy is at the top of my list, that is with the understanding that the very first priority is my and my baby's wellbeing. (I think that goes without saying, but I know some people will infer that I care more about my independence than my baby's life, which is not only absurd but insulting.)

  13. I don't believe anyone is trying to be "absurd or insulting" it is just the reality of having a homebirth. There are very few places I would want to be when birthing my child if an emergency would arise.

  14. Atina, by stating such nonsense, you are only showing your ignorance when it comes to homebirth. Not only are you insulting and condescending, you are just plain wrong. Just because you think the hospital is a safety net, doesn't actually make it one.

  15. Because if an emergency arrose during birth being at home with a CPM is a wonderful place to be.....It isnt about focusing on potencial problems, but it isnt either about sticking your head in the sand, convincing yourself that problems only happen to the one who dont trust birth enough...or the ones who didnt educate themselves enough....Homebirth is amazing when everything goes well,now if you have a way to garanty before hand that a birth will go without a hitch you should share it!!!!

  16. Anonymous 12:25 am: Right because I'm so ignorant about birth in general and say breech birth. Here can you stomach this video of a footling breech getting stuck? What would you do if this happened at home? FFS.

    And nice job calling people out on being stupid, but hiding behind an anonymous tag. Brilliant.

  17. Short answer: no. Long answer: I transferred to a hospital after having planned a home birth. I did not leave my autonomy at the maternity ward door. I listened to what the doc said because I was there to seek his care, but I still had final say (with the consultation of my midwife, labor nurse and husband).

    When I first came in the door the doc said, "c-section". I asked questions about how the baby was doing, how I was doing and if the section was needed immediately. Answer, no. So I declined the c-section.

    I did this a couple more times throughout the day. My baby's heart rate was fine, I was fine and my labor was progressing, albeit slowly. Eventually, I felt I reached my limit for trying to push the baby out, and consented to the c-section.

    Still exercising my (our) autonomy, my husband requested and got to hold our daughter skin-to-skin shortly after she was born. I also breastfed at soon as possible, and refused formula.

    I actually found my experience in the hospital to be not that bad. I had expected the worst because I had heard stories of how poorly many women are treated in the hospital. My experience was good because I was given my autonomy to make informed decisions and give consent before any procedure was done to me or my baby.

  18. I guess you firstly need to define autonomy - for me this starts with the woman knowing what she alone wants for her childbirth experience. This decision would really need to be based on a prior understanding the vital importance of having the most natural childbirth for her and her child's future health.

    The fact is she would have to agree with the notion that a "natural childbirth", an " externally managed childbirth" and a technologically intervened childbirth" are not all equally weighted choices - it is like someone offering you a meal of organic fruits and vegetables, a meal replacement shake (drink) or deep fried GMO fast food verses them offering a choice of either organic apples, pears or potatoes. The former choices are vastly different but without up to date nutritional education you might feel like it did not make a big difference which one you "picked" because surely they would not be offered if they weren't as good as the other options, right?

    It is this belief or initial choice that I feel guides a woman's subsequent choices in maternity care; personal responsibility for the life of herself and child and begins a path against the mainstream 'grain'. So many people focus on the birth outcome and location in isolation but in reality a woman planning for a natural home birth is completely different to one that didn't but had a natural homebirth 'by default' of a fast labour or becoming educated and changing her "plans" at the end of her pregnancy. I think "autonomous" women understand that they (and their pregnancy) are a part of nature ( I mean we are all mammals after all!) and that nature has a balance with consequences - So if you try to control it or even override them, it is natural that nature will eventually "push" back.

  19. I think that the prevalence of ignorant, uninformed, and vicious people like the person who left this comment causes many more "mainstream" women to question their right to autonomy. Because these people know so little about the truth of medicalized and non-medicalized childbirth, they make women feel that only those who "don't are about their baby's safety" would ask for autonomy in the matter. It saddens me that people like this exist, and that some women are made to feel that they are bad mothers if they want some measure of control (and information!) over their experience. Shameful. Thank you, Rixa, for continuing to try to educate people like this!

  20. @Michelle, you said :"I think "autonomous" women understand that they (and their pregnancy) are a part of nature ( I mean we are all mammals after all!) and that nature has a balance with consequences - So if you try to control it or even override them, it is natural that nature will eventually "push" back."
    Does that means you would accept your child dying of a preventable death in the name of nature's balance?

  21. Anon 10:07, I think you can be very autonome and still give birth in a hospital, ! i would say that woman who have known risks, such as diabetese, or GBS+, or are over due( past 42 weeks and 1day) do take a risk by staying at home, now it is my opinion and I base it on scientific facts, we can argue all night about it in the end numbers dont lie. The problem with HB in general is that the numbers are very small, data isnt collected dilligently. So for anyone to say this is right way to do things VS any other way is only based on gut feelings and anecdotal experience.

  22. I find it hard to relate to this comment at all. I think whether you get involved in your care or not, you're somewhat culpable for the outcome(s). Just because you choose to trust a birth professional does not ensure a good outcome. Iatrogenic injuries and deaths should be pursued legally and institutionally. Ideally, accidental naturally occurring injuries and deaths would not need to be pursued legally. (I have mixed feelings about tort reform.)

    As I am now 37 weeks pregnant, I'm having to really work through some 'hang ups.' When push comes to baby, I know that I bear the bulk of the responsibility. This is where Faith comes in, for me.

    (I apologize if this seems vague. I just don't have a lot of time this am to be terribly articulate!)

  23. I have had four hospital births that were good. I didn't even have stitches (great OB!)! Autonomy? didn't even think of such an idea (though I was getting a little less satisfied with them whisking my baby away immediatly by the time of #4). You just do what the Dr says, right? Then we moved half way across the country. I had done enough research to know the chances of my getting another Dr who wouldn't automatically do an episiotomy or c-section was slim (mid 30s, 5th baby, all big...many dr's would even consider "letting" me "try" for a natural birth). After a great deal of research I found a midwife and had a homebirth. In fact I am now planning my fifth homebirth. As long as I stay low risk I will stay home.

    The reason to stay home if your priority is baby's health? You are LESS likely to even have an emergency at home. The interventions in the hospital CAUSE many of the emergencies we hear about. Breech at home? #7 surprised us by turning over at the last minute. Didn't know she was breech until it was too late to get to the hospital. Midwives are trained to deliver natural breeches, though, so it was no big deal. Even though she was 10 pounds, she didn't get stuck or hurt in any way. In the hospital there would have been mass panic and drs who weren’t trained in natural breeches which would have caused all sorts of problems. #8 had a shoulder dystocia, but it resolved with little fuss. Frankly, once you have a SD or a breech with all but the head out, the hospital has no more tools than the midwife. It's too late for a c-section.
    As for midwives being untrained, it is true that they don't spend 7years studying male anatomy, geriatrics, pediatrics, cancer, etc. OBs only spend a year or so focusing on pregnancy and most of that is studying surgery and problem pregnancies. Midwives spend a minimum of 2 years studying nothing but normal pregnancy and how to prevent problems. An OB often only catches one baby before setting up his practice. A midwife (CPM) must catch at least 20 babies before she can be certified.

    All this to say that most of us come to homebirth because we have done the research and recognize it as the safest way to have our babies. The hospital way of having babies causes problems way more often than the homebirth way.

    And autonomy? If a woman is given the true options and told the true risks of those options and is not pressured into making a choice one way or the other (“Your baby will DIE!”), she has autonomy even if she has a c-section. But what happens most of the time in a hospital is that the dr presents just the option he wants her to take or only tells her the bad things that happen with the options he doesn't want her to take. Because he talked to her, she thinks she had informed consent when in fact it was blatant manipulation. Dr's don't have to take the baby home after the birth and deal with the results. Mom does. Dr's have other things to worry about, too, besides mommy and baby (and, yes, midwives do to). That is why it is essential that the woman be the one making the decisions no matter where she births. She is the one who has to live with the consequences.

    You know, our courts have declared that a woman has the right to kill her baby inside the womb because she has the right to control her own body. We shouldn't have to give up that right when we decide to give birth to that baby. The place you are most likely to receive all the information and truly have control of the decisions is at home. It is possible in the hospital, but because of the factory-line atmosphere, it isn't nearly as likely.

    Being home doesn’t give any guarantees anymore than being in a hospital does. Having the right to make decisions about your own body doesn’t give any guarantees either. But home and autonomy do increase your odds of a good outcome.

  24. @ Anonymous/Florence - Preventable death is something that is hard to identify. All people will die at some point, mums all need to know that yes their babies WILL die, however it is when this death takes place and why that is most important (to me at least).

    Regardless of maternity "care" diagnostic tests the biggest predictors of a baby's health and chances of death are the mother and father's preconception health, possibly their genetic history and their lifestyle during conception and gestation. If my baby died despite me being informed, prepared, supported, being holistically healthy and having an unhindered birth I would have not choice but to accept that for some natural reason that child was not meant to survive.

    The way I see is if I can't accept the very small chance that death with be the outcome of my birth then I should avoid reproducing altogether because any human being (maternity health care provider) that can grantee the life of myself or my child is a liar. The same way I choose to eat food that I trust I can digest unaided, is similar to my thoughts that if I naturally conceived and gestated a child unaided then I can give birth to it that way too.

  25. The doctors have autonomy also; and some of them use it to practice in a way that reduces their risk of lawsuits, whether this is in the interests of the individual women or not.

    The interactions of autonomous persons need not always be antagonistic, as the presentation in the original post showed.

  26. @JM - I have looked a little at the research on 3rd stage, and I believe most of the research has been flawed because it did not use true expectant management. A recent study in Australia found a higher risk of PPH with active management than what they called "midwifery guardianship of the 3rd stage." However, I think you have a point about some women's decisions being dictated by "natural childbirth ideology" over evidence. I think (hope?) that the natural birth community is becoming more aware of things like common midwifery practices that are not supported by conclusive evidence(the Brewer Diet, evening primrose oil for cervical ripening, black/blue cohosh induction, etc) and the variations in midwifery skill in the U.S. that can make a big difference in whether the person you trust to help you decide whether it is going to be safe for you to give birth at home is really trustworthy.

    @Atina, my midwives don't do breeches at home because of the risks. I am in the camp that believes homebirth should only be for low risk birth, and a footling breech does not qualify, IMO. The research we have (including a very large study out of the Netherlands) shows no statistically significant difference in mortality and morbidity rates between planned homebirth for low risk women with a qualified attendant and hospital birth. If the hospital is really the only place to be when a complication arises, these statistics wouldn't be what hey are. Many complications that occur in hospitals are iatrogenic (for example, there is more space for the head to be delivered in a breech if the woman can be squatting or on her hands and knees--doesn't guarantee that the head will never get stuck, but decreases the risk) or occur in births that SHOULD be in the hospital because the mother is high risk. The same rates of complications don't occur at home for women who are good candidates for homebirth.

    @Florence, I agree with you that women with certain risks should not birth at home, and most midwives I know practice accordingly--they do not take diabetic patients, they transfer women past 42 weeks to a physician, they risk out women with symptoms of pre-e, etc. (And GBS antibiotics actually can be given at home by a midwife). I do think there is good data about homebirth, though most of it is from other countries where the homebirth system is very different.

    @BettySue, I liked your comments. Some of the comments were getting me depressed before I read yours :)

  27. @Brittany, unfortunatly you cannot compare europeans midwives , with extensive university education and hands on training,to our americans ones, unless you speak of CNMs specifically.

  28. Regarding April's above comment that: "I respect the fact that [doctors] know a lot more about birth than it would even be possible for me to learn from reading some birth books while pregnant."

    Fair enough, but most doctors know a lot about *a certain kind* of birth--an epidural, intervention, c-section kind of birth. They DO know more about that stuff, and if I need a c-section, I trust that most OBs would do an excellent job.

    I once spoke to an intern from my local university hospital who said that all she had ever seen was c-sections. She had no idea what non-cesarean birth looked like. Doctors need training in surgery and she was getting it, but non-surgical or low-intervention birth was something she was not being exposed to--despite the fact that she would someday be required to attend these kinds of births as well. I would think this kind of training must condition doctors toward surgical approaches.

    That particular intern actually contacted a couple homebirth midwives and went along to some births, so that she could she what vaginal and non-medicated births were like.

    This hospital also has an 80% epidural rate (90% for first time moms), so any non-surgical birth exposure the intern might have eventually acquired was almost certainly going to involve an epidural. This would also condition the doctor's style of practice, I think. When a non-epidural, non-surgical birth is encountered, what is that doctor going to do? How do you competently deal with something you've never seen? A few women will choose not to have an epidural--how will the doctor know what to expect during their births?

  29. I believe autonomy is about freedom of choice... informed choice. Luckly, women are slowly learning that they do have a right to make choices determining how their labor and delivery should go. HB just seems to facilitate choice more than the hospital setting. If you choose to HB, that's okay. If you make the informed decision to have an elective c-section, it's your choice to make (not a choice I would make that but that's not the point.) Autonomy is just one side of the birthing coin. Some people feel more comfortable handing over control to someone else.

    Hopefully, as people begin to trust birth and their bodies more -- and we get away from the misconceptions that are thrust upon us -- more women will stand up for their birthing rights.

  30. Where I live there are very limited choices when it comes to childbirth. There are no homebirth midwives. There is one hospital (not natural birth friendly at all). There are only a hanful of OB practices. The next closest of any of those things is about 200 miles away.

    I had a baby two months ago. At one point I went to the hospital in what many would call "false labor." The doctor was going to break my bag of waters because it was "a little bulgy" and I was at four centimeters. I told him no. (He didn't ask. He was just going to do it.) I stayed at the hospital overnight for observation. Contractions had died out by morning with no additional dilation. He ordered pitocin. I opted instead to go home.

    It was more than two weeks before I had the baby. He just wasn't ready to come out yet. If the desired interventions had been performed, most likely the labor would have been a lot longer and more difficult, there may have been complications, and the baby may not have been as healthy.

    The doctor acted like the situation was strange and unusual. Apparently breaking the waters from the start is so routine to him that he considers false labor unusual (he has been in practice 30 years).

    We have a friend who works in the OB department at the hospital. She said I was much talked about by the nurses for telling the doctor no. Apparently that is a very rare thing.

    I found out that most of the reasons doctors give for inducing are not even recommended by the ACOG. When pressed for a reason, my doctor didn't even pretend it was medical. He said right out that it was for his own convenience. I was made to feel inconsiderate for wanting let the baby come in his own time, rather than when the doctor wanted to do it. That was more important than the well-being of myself or baby.

    That is just one example of why I feel I not only have the right but the responsibility to educate myself as thoroughly as possible and make my own decisions rather than blindly trusting a doctor, just because he is an "expert". I have come to wonder how many childbirth complications are the result of routine practice by doctors stuck in their ways.

  31. I got interested in natural birth because of experiences in medicine (in general, not just maternity-centered) that opened my eyes to a need for autonomy and respect. Too many experts doing things *to* me, rather than *for* me, with my permission and understanding. And the kicker? They were often the "wrong" things: either because I didn't need them, didn't want them, or because they were risky, pointlessly painful, or clearly contraindicated. So I realized that I was allowing other people to be in charge of me, my health, my body, and even my goals. And that it had to stop.

    It was only after I realized that I was in charge of my health and would would fare better if I operated on that understanding that I became interested in natural birth, as an outgrowth of my interest in taking responsibility for my health and retaining personal autonomy.

  32. You do know that the reason that MD's induce after 41 weeks is because of statistical increase in fetal distress and demise, right? That you can't "see" fetal distress with intermittent ascultation? That beat to beat variability is damned near impossible to hear at 160 beats per minute?

    There is nothing good that comes of homebirth besides dead babies. DEM's of any stripe cannot be compared with European educated midwives, and the Netherlands have an atrocious perinatal mortality rate. Stop lying, for pity's sake, and own up to the fact that you don't promote intervention because you can't offer interventions and therefore can't make money off of them. Your own birth video, with that pitiful limp blue baby in the water, is proof that sometimes you get lucky. Don't bet the farm on luck, though---or your baby's life.

    1. you don't know much about fetal monitoring do you? loss of variability is a late sign, decelerations begin before

  33. Comments like "Mainstream Mommy" April's and several "anonymous" defenders of the medical establishment are depressing to read, not least because they are, indeed, mainstream.

    Let's see. Why, certainly, "average" birthing mothers get lots of autonomy and informed choice. They make choices based on What To Expect, Baby Story, Deliver Me, ACOG pamphlets, and what their (trained surgeon)care providers tell them is necessary for their safety. And what their friends say, of course. And their families.

    They get to decide what DOCTOR (or, if they are very daring indeed, nurse midwife) to see, what place of death/sickness/emergency/injury/healing to "deliver" in (er, hospital, I mean to say, hospital!), and make up birth plans to show that they are indeed making informed choices, although of course in case of emergency the plan must be scrapped.

    They will try for a vaginal "delivery," but if that doesn't happen, oh well, c-section is just another way to give birth.

    They may try to give birth "naturally" (in this context, that means "a vagina is involved, and no epidural" - nothing else about typical hospital birth can be framed as remotely natural). But they'll keep an open mind, just in case the pain is bad enough that they feel a need for an epidural.

    And whatever the doctor says, goes. They make the "choice" to have, what is it? "just ten hours of following medical advice" (unquestioningly, experts know best!) and at the end they get a precious little baby who they will make the choice to raise per the recommendations of medical experts, educational experts, relatives, friends, and pastors. It's the RIGHT CHOICE. All that matters is a healthy baby!

    Except there is no choice. There is never a choice when one makes choices based on misinformation, propaganda, conventional wisdom, and other forms of controlled input.

    We have the most advanced, safest medical establishment in the world! It's so much safer to give birth in America - not like it is in Finland, Sweden, the Netherlands, or Japan, where mothers and babies die in droves because of unsafe, noninterventionist, superstitious midwives, and uncontrollable nonmedical settings like homes and birthing centres - and American women are delivered from pain, too! Really, our way is the best and safest. Only a martyr goes without an epidural, only a smug extremist hippie brags about how she didn't need one and neither should most other women, only a crazy, selfish, foolhardy woman risks her life and the life of her unborn baby by birthing at home...

    Oh. Wait. We don't have very good maternal/foetal outcomes, compared to other countries, do we? And mothers and babies don't die in droves from homebirth, and mothers who have adequate support and things like freedom of movement, available food and drink, water therapy, no pressure, and who don't spend their labours lying on their sides and backs for continuous monitoring don't tend to find labour unbearable and beg for epidurals. Oops.

    So, which pill do you want to swallow, the red one or the blue one, mainstream mothers of America?

    I see. That's what I thought. SIGH

  34. Absolutely! - I think that every woman should have the right to make her own decisions, especially when it comes to her health. It disgusts me that women are treated little more than birth pods as soon as we get pregnant, and are told to "just get over" so many horrible things done to them. It does not matter where a woman gives birth, she has a right to being treated like a human being.

  35. Holy Moly, I'm mainstream, not by choice- I would have rather had home births, and I TOTALY CARE about my freedom of choice! I hate being told you HAVE to have an IV, you have to have EFM, You have to stay in bed, and we HAVE to pick and poke and nuke your baby! (they X-rayed my 1 hour old baby at the hospital against my wishes)
    I will darn sure make sure my daughters and daughter-in-laws of the future get the whole shebang of autonomy, I can garuntee that! Great post Rixa!

  36. Of course women who birth in hospitals are interested in autonomy.

  37. a completely ridiculous and false dichotomy, as if the doctors are god or something and always do whats right for the patient.


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