Lisa Epsteen is a woman.
A caring mom.
She is not a risk factor.
And she is capable of deciding her own medical care.
The truth that came out with Lisa’s case goes well beyond her and the reasons why she fought back are her own but here is what is really happening in US Health Care and in Florida to an extreme degree.
Women call their doctor’s offices looking for care. They are told they cannot be seen until 13 weeks because it will mean they are out of the danger zone of miscarriage. This is not safe or effective care.
Women looking for a VBAC are told by the MAJORITY of midwives, birth centers, doctors, and hospitals in the United States that they have no right to choose vaginal birth and if they do, they cannot come into their care. Over 80% of care providers…not providing care. That is not safe, effective or evidence-based care. It’s also coercion. “Surgery or go away”.
Women are not treated nor provided care according to their own condition but according to protocols or personal preference of provider. They are not treated as equal decision makers even when there is no evidence of an actual medical condition or complication.
Women are told they “have to” be induced. “My doctor wouldn’t LET me go past 40 weeks” “My baby is too big” and numerous other non-medically indicated reasons are trumped up and trotted out as standard of practice in a medical system gone massively awry.
When homebirth midwives have a 3.5% cesarean rate, a high and effective vbac rate and the further up the educational chain of command into CNM, OB, etc you get, the more complications LOW-RISK women get and the more cesareans (as high as 78% at some hospitals) occur, we have to understand that we are doing something drastically wrong in the medical care system. And we are shocked that our women wind up with higher maternal mortality, more permanent damage and their babies carry the health consequences for life.
CPS/DCF has been called or threatened on other mothers in Florida and across the US for non-compliance with a doctor’s opinion for induction or cesarean and even for mothers choosing home birth simply by virtue of their DISAGREEMENT as two adults on how things should be handled.
Lisa’s OB didn’t do anything more than what OBs across the country are doing. The difference is, he did it in writing and wound up with a mother not willing to tolerate it who then had the resources and strength to fight back. Thank God there are women like her, willing to stand up and say “My baby is fine, I am fine, I have the right of autonomous decision making, you cannot force me”. Perhaps more women will stop going under the knife without medical indication or being coerced into inductions they don’t need for babies that aren’t even fully term.
Women are adults.
Women who are 9 months pregnant are anticipating holding a newborn.
They want what is best for that baby.
A care provider who is more worried about their liability than the woman standing in front of them, isn’t a care provider at all. They are violating the most basic tenets of humanity and medicine.
Lisa is the most extreme case but every day, in every hospital, there are women being treated this way.
They agree out of fear.
They agree out of fear for their babies.
They agree out of fear that someone will take their children.
They agree out of fear that their providers will dump them.
They agree because they don’t have access to ethical care providers.
It’s time that we supported the women and this stopped.
You hear about some books as iconic “should be reads” but if you want a quick view that will change your world view of birth, read the third chapter on Symbolism in birth.
From Chapter 3:
There is a line that states “It’s funny-it seems so normal to lie down in labor-just to be in the hospital seems to mean “lie down.” –
I think this speaks to everything about birth in a hospital. The expectation, the assumption of positions, of authority, of what is normal to expect.
This one line says so much.
It’s not that cesareans and inductions can’t save lives.
It’s that modern obstetrical practices are endangering them.
Our society loves education. The more the better. The epitome of education, the highest you can attain: doctors and lawyers. So we have a basic societal expectation that if you’ve trained long enough to be a doctor, especially a specialist like an obstetrician-gynecologist, there has to be something to that training.
The problem lies in what we are fundamentally assuming those doctors have been trained in. And while we’re at it, the same goes for certified nurse-midwives and to some degree, a lot of certified professional midwives as well. Medical school, nursing school and even midwifery school, teaches you either diagnostic or reactionary skills. The difference with medical school is that it does not teach you normal birth and as you go further and further down the scale of education, the more normal birth becomes the trained skill of watchfulness and lack of intervention unless obviously needed.
Obstetricians are not better placed to make decisions simply due to their education. Often, their education is outdated before they get out of training and worse, it could have been outdated when they went in. Current standards for breech birth, episiotomy, cord-cutting and vaginal birth after cesarean are not based on medical evidence in many cases and therefore, for the last twenty years, obstetricians have been trained incorrectly. Period. There is no getting around that.
There are things taught in medical school which affect the climate, environment and accuracy of information or treatment given to women. Malpractice becomes a fear ingrained in many new doctors while they are in medical school. We know they deserve to be wary and protect themselves, but they need to be taught that doing the right thing is still doing the right thing and we need to encourage atmospheres of honesty with clientele and a spirit of responsibility and understanding at all levels.
There is also the conundrum of midwifery education. What is enough? What is too little? What are the goals of this education?
Cesareans bring up a whole different set of issues in regards to education. We know that our society does too many of them but our providers are left out in the cold as to how to lower these numbers without risking lawsuits. Therefore, their education never enters the process. That a potentially life-saving intervention such as a cesarean surgery has become so day-to-day the scapegoat of care that is is rarely truly warranted, often indicated after failure of induction (another often unwarranted action), rarely necessary and rarely given a good, solid medical indication after surgery except that which will provide the best insurance coverage, all of these factors point out that education level is indicative only of a higher cesarean rate. Midwives have lower rates because they are not increasing interventions and they are pragmatic in explanation, PER THEIR TRAINING, that birth outside of the hospital or at home has specific risks. It’s a wonder that obstetricians are still touting themselves as the premier providers when 1/3 of their women, despite their extensive years of training, still wind up with a significant morbidity and further complication. Perhaps they should start being very forthright that birthing in a hospital has specific risks. And as for midwives, their training is not medical nor are they medical providers and as they increase the drugs they carry and the actions and interventions they do, their rates of morbidity also go up.
And finally, who are protocols and practices designed to protect? Mothers? Babies? Babies from their mothers? Providers from the women they serve? In almost all cases, the licensure laws in the United States are establish to run practices and are called practice acts. They are not for safety and/or protection of mothers or infants but instead they are for providers to be held to a community standard, which as you see above, isn’t actually a true educational, midwifery or medical evidence standard.
When we invite judges and/or administrative hearings in to judge midwives or doctors on their care practices, evidence and normal are often thrown by the wayside by this lack of true accountability of normal birth or evidentiary standard. In the case of administrative hearings, these providers on the panel are not unbiased. In the case of judge’s rulings or jury trials, there is often sympathy for the victim without a maintained balance in hearing the evidence of the case. Often, midwifery or medical practice acts allow for these administrative hearings to circumvent the “pity” of the jury without finding any way to actually adhere to the spirit of the law and its intentions rather than to punish classes of individuals who do things they have a personal bias against. These administrative hearings are force of law and they can ask anything on a wide variety of items, down to whether or not your underwear is clean, and consider that part of their decision. I know that sounds overboard, but sometimes, the questions they are are intrusive and non-related to the case. These administrative panels can also force providers to turn in other providers who might be doing suspect things without evidence that they are in fact doing so. As provider turns on provider, each hoping for a good outcome in their own case, we realize that these are not being used appropriately to determine what is the best practice for providers but instead as personality or policy witch hunts.
One of the points that Dr Glezerman brought up at the Heads Up! Breech Conference was that not only were physicians not trained to do vaginal breech, there’s some evidence that they aren’t getting the best training in how to do breech cesareans, either. He referenced the following study:
Eur J Obstet Gynecol Reprod Biol. 2005 Jul 1;121(1):24-6.
Levy R, Chernomoretz T, Appelman Z, Levin D, Or Y, Hagay ZJ.
The final conclusion of the study was that out of 3105 cesareans done was that the “push” method of extraction resulted in 50% of the women having more extension of uterine scar versus 15% in the “pull” method of removing baby. Fevers were also greatly reduced with the “pull” method.
This is something women need to consider when discussing cesareans that are recommended by their provider.
Thank you, Dr Glezerman, for bringing this up.
I’m at the Heads Up! Breech Conference and I will be posting conference updates, as I usually do, but with hopefully a bit more science and information since that’s what I’m here to learn, but today something came up that made me want to isolate it and write about it.
One of the speakers, Marek Glezerman, is a world-renowned Israeli obstetrician/researcher who wrote a commentary that shredded the Hannah Term Breech Trials.
It’s called informed decision-making.
I believe that every woman should have it.
I believe that providers and laws and legislators should respect it.
I believe in personal responsibility.
I believe in letting a woman decide if she should have an induction based on sound medical information, not provider bias.
I believe that women should be the final decision-makers on whether or not they need a cesarean, not a physician’s fear of malpractice or lawsuits.Do I understand those fears? Yes.
Ultimately, I still believe that a woman has the right to choose which risks of morbidity and mortality over her provider’s right to practice. ANY provider.
I support providers who support women.
I understand providers who live in fear but I do not support their practices because they result in unnecessary surgery for millions of women.
Providers who stand up for what is right rather than doing surgery out of fear.
I’m willing to support providers trying to come out from under their fear. I’m all for supporting women trying to overcome theirs. I want to have conversations that bring providers and women in on the same page.
But until that occurs, Just picture daily that someone takes you into surgery against your will and spends their time convincing you it’s for the “best” that you have this surgery and that you and your child will be harmed by it but that’s okay because it means that other women can have healthy births…and see whether or not you develop an “AGENDA”.
It’s been noted over the past few weeks as the Breech Conference rolls on towards us that many women aren’t aware of it. Or I should say, they aren’t aware of the importance of it. There are a lot of conferences in the “birth world” and maybe we’ve come to a point where we are saturated with good times and great company without realizing that there is a different kind of gathering, an educational meeting of the minds that reaches out to try and actively change the current paradigm of how things work.
If I posted a link today about how to do vaginal breech birth, how it was possible, how there were studies, I think that the majority of my friends would pass it on. Instead, I’m passing out information about how providers can learn to do this and I feel as if I’m speaking in a vast emptiness.
Would you give $5? A silent auction item? Would you donate $10? if you thought it would help to educate providers and produce change? It DID produce change in Canada so why are American women so stuck in what is going on with the status quo that they aren’t willing to rock the boat?
I’ve heard a few providers say that there is NO WAY they can do vaginal breech here, etc. and these are providers that are supposed to be supportive of normal birth. We need them to step out, we need them to come, we need them to be supported and educated and we need to hold them accountable.
WE do. The WOMEN do.
This is not a “I hope someone gets through to them” situation. This is a “DO WE REALLY WANT WHAT WE SAY WE WANT” situation. I’m tired of having to tell women that their providers are cutting them for no reason because too many other women before them haven’t stood up and said no.
Be a part of the change and action:
Go to the Breech Conference and learn the information you need and get the skills you should have.
Support the Conference if you can’t be there.
Donate or be a sponsor.
Invite a provider.
If you don’t want to be forced to
I was reading this evening, yet another study that shows the evidence of epidurals being bad for babies, how breastfeeding is better, how no drugs is better, how fewer complications happen, all the stuff that birth and breastfeeding advocates read on a regular basis that sends them into paroxyms of stress and ugly feelings about how ignorant modern women are.
And it slowly dawned on me.
It’s not modern obstetrics or hospitals that are stressing mainstream mothers out. It’s us. It’s the women who say “you can fight” “you can change” “you don’t have to have another cesarean” or even to the providers “You can practice evidence-based medicine and do breech and vbac and twins and give mothers choices. We are the ones rocking a very steady (business) boat. We create the waves and the stress in the water.
Don’t misunderstand me. There are women who realize that they are trapped in that boat and want to jump out. They break for shore and normal birth and some, in fact, a lot of the women