This blog is intended to provide a discussion forum on topics surrounding pregnancy, labor, birth, breastfeeding and family health. The purpose is to review research studies, articles and highlight the buzz in health news. But please remember, I am not your health care provider and do not intend to give medical advice.:)

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Monday, May 24, 2010

I Thought We Were Supposed to be Encouraging People to Think for Themselves? Please Don't Place Me in 'Medical' or 'Natural' Birth Boxes

This is a lengthy one, as the title suggests:)

I have been pondering a particular issue that I see becoming more and more widespread. In the realm of natural birth (a realm with which I largely identify) I have noticed a common and disappointing attitude. It is this: not respecting families’ choices surrounding pregnancy, labor, birth, postpartum, newborn cares, infant feeding and family health. My admonishment is to those in the natural health world right now and particularly those in health provider and birth support/teaching roles, but anyone who takes an interest in the subject might gain something from this.

          We pride ourselves on being free-thinkers, not towing the party line, being non-conformists, being wise consumers who take responsibility for our health and family rearing choices. Yet, quite often, I think many in the natural birth world are actually guilty of the exact opposite. They encourage free-thinking and non-conformism, if they agree with certain viewpoints, but not others. Natural birthers (as I affectionately call us) get on the case of some in the medical community for being intimidating, bullies, or patriarcial and then some of them turn around and do the same thing, just on the opposite side of the argument. Many people, including myself identify with the natural birth world, but not simply because it’s different or countercultural and they want to “stick it to the man.” No, they identify with it because it reflects what they believe about pregnancy and birth: both are healthy, natural. History and current research continually confirm this fact: pregnancy, labor and birth are in and of themselves states of health, not states of disease. However, truly discerning people pick and choose exactly what they agree with even within the natural birth framework of thinking. The true free-thinkers pick and choose because some viewpoints are evidence-based and some are not. Many people get involved in the natural birth world because they are passionate about the subject and want to get the word out so to speak. Passion is wonderful, after all who wants to hear from a boring person who doesn’t care a lot about the subject? The dark side of passion, however, can show itself as coercion, manipulation and veiled (or not) criticism. Simply because a person identifies with some parts of the natural birth philosophies, does not dictate that he or she will or should fit into the “natural” box. Additionally, simply because some people are part of what some call Western Medicine, does not mean that they know nothing of natural remedies or nutrition or pregnancy or birth as nature intended. We all have our own backgrounds, our own philosophies and personalities; things that are important to us and things that are less important. Things that work for us and things that do not. We all have our own reasons for choosing one course over another. Let me give some specific examples. Below are a few examples of choices we have in health and family rearing:

Type of childbirth class to attend, if any – Lamaze, Bradley, CAPPA, Hypnobirthing, hospital sponsored classes, none, etc.

Type of Provider for prenatal and birth? Lay midwife, Direct entry midwife, certified nurse-midwife, OBGyn, Family Practice physician, none.

Type of provider for family wellness? MD, DO, nurse practitioner, chiropractor, doctorate of naturopathy, a combination, none.

To circumcision sons or not to circumcise sons?

Cloth or disposable diapers or both?

To use or decline or use selective prenatal testing (e.g. GBS status, GD, Quadscreen, ultrasound, etc)

To immunize or not to immunize or utilize selective immunizations?

To buy/eat organic or not or to purchase selective organic products?

Food or nutritional or supplemental substances: avoiding altogether, using in moderation, using selectively, not purposely avoiding (e.g. caffeine, alcohol, pharmacological medications, dietary supplements, vitamins and mineral supplements, herbs, tinctures, fast food, etc)

Controversial substances: avoiding altogether, using in moderation, using selectively, not purposely avoiding (MSG, TSP, BPA, gluten, s
uper absorbant polymers/sodium polyacrylate, artificial sweeteners, cleaning products etc).

To accept or decline or use selective medical interventions (e.g. pain meds, etc).

To accept or decline or use selective newborn routines: Vitamin k, eye prophylaxis, PKU or other labs, etc.

To breastfeed, pump/bottle feed or bottle/formula feed.

To use pacifiers or not.

To baby-wear or not to baby wear or to sometimes baby-wear.

Sleep-Wake Habits: infant sleep training, attachment parenting, scheduling, co-sleeping, combination.

Baby food -- making own baby food versus buy packaged baby food, use combination

Family “planning”—hormonal contraceptives, barrier, NFP, faith in a higher power.

          The list goes on. I am a firm believer that there are some things that are more safe and more healthy than others. No kidding! That is usually why we choose what we choose. I do not believe in wishy-washy relativism. I do not believe all life choices are relative to individual situations and that there is no best way to do things. Actually, I do believe there is a best way to do things. But, my only business is my own business. I can have an opinion, a strong opinion, but when it comes to sharing it with others, it needs to be tempered with encouraging them to research and decide for themselves and respecting them for actually making their own decision. Most choices in pregnancy and birth health are not moral issues, meaning they are not morally right or wrong, good or evil. They may be safe or unsafe, wise or foolish, productive or inhibitory, healthy or unhealthy. But these are not actually moral issues. Think about that. We are not speaking of morality here. We are addressing choices.

           One family may have found reliable information that leads them to decide to not immunize and another family may have found reliable information that leads them to decide to immunize. So what is that? Is one family right and one wrong? Let’s say yet another family decides they want to utilize some immunizations but not all of them. “What, but that doesn’t fit into either box?” Is the mere idea unthinkable? Two people can read the same research and come to opposite conclusions. Does that mean one is easily swayed and another is an independent thinker or vise versa? Consider, some choices really would be unsafe or cause distress for some individuals while the opposite would be the safest, most satisfying choice for other individuals. Only each individual can decide for him or herself. When talking about choosing between two things that both carry inherent risks (to use an intervention or not use an intervention for a potential problem), no provider or professional or friend can decide for a parent or family what risk they are more willing to bear. People make their choices for many reasons. Yes, there are many individuals who make their choices because someone told them to, or they think that is the only way it can be done or because they have never heard of let alone researched an alternate option. This is a great opportunity to share alternate viewpoints and encourage them to research the issue. It might get them thinking and actually researching. We shouldn’t shy away from sharing our opinions (especially as birth professionals or health care providers) or sharing that the choice the client is considering may be unsafe based on what the research says. In fact we should freely share what the research says. But I take caution not to assume that because a person has made a choice that is opposite of my choice (or what I would choose in a similar case), that they have neglected to do any research or really make an informed decision. Maybe they have researched a vast array of opposing resources and spoken to many individuals who vary in philosophy. You never know unless you ask them. Perhaps they have researched the topic more than I have. Having taken in all viewpoints, they have concluded that they will choose a certain route. A route that just happens to conflict with my philosophy. Well, so what? My philosophy isn’t their philosophy, now is it? I don’t have the same background, information, body, child, concerns or influencing factors. And, I am not the one who lives with the responsibility of their choice—positive or negative. We would be wise to remember that research studies, even very well done research studies can differ on results and conclusions and even professional researchers can interpret the data differently.

          Let me give more examples of seemingly opposing positions I have encountered: I've known women who faithfully take their hormonal contraceptives but would never dream of taking Tylenol for pain or Benadryl for allergies (pregnant or not). I know women who don't believe in taking medications (pregnant or not), but don't bat an eye at an epidural during labor. There are others who state they do not believe in using “birth control” (i.e. controlling pregnancy), but do use natural family planning to control pregnancy timing. Others don't immunize but do circumcise (their boys). Some immunize but don't circumcise. Others are committed to organic foods, homeopathic remedies, natural supplements but seek prenatal care from an OBGyn and wouldn't consider a natural birth, let alone a home birth. Some are passionate about home birth, natural living and also in sleep/feeding schedules and wouldn't consider co-sleeping or attachment parenting. Some believe in natural birth but don't breastfeed beyond a few months or at all. Some believe in low-intervention, natural pregnancy and birth, but don't buy/use organics, homepathics or chiropractic care. Some schedule their elective cesarean, but only buy organic foods from the grocery store. Some believe in natural birth or home birth, but also immunize and circumcise. Some believe in midwifery care for a natural pregnancy and birth, but utilize traditional western medicine for disease treatment and general health. Some believe in natural living but not in cloth diapers. Some use cloth diapers and eat fast food 5 times per week. Some are committed to fitness and nutrition but wouldn't consider a natural birth.

        Some look at the list of examples and say, what? There are people who will decline vitamin K for their babies at birth, but circumcise their sons? How does that fit together? Would it just blow your mind if I said these things actually CAN fit together? I know they can because these are real examples. I think some natural birthers unfairly tend to assume that if a person is choosing a certain path, she “obviously hasn’t done her research. Or if she did, she got her information from really bad, biased sources.” I think this is probably true in many cases. As an extreme example, any source that says it is “safer” and “wiser” for the majority of women to have a routine episiotomy rather than “risk” tearing is not a factually-based source. There is a lot of easily accessed, inaccurate information available. There are some things that we can confidently say are not healthy choices for most anyone and research has confirmed these positions, as in the above example. But let’s not assume because we felt black and white about some issues that others also should feel black and white about them or even that the issues themselves are indeed black and white.

         The point is that we choose what suits us, not because it fits into a box of “natural” or “medical,” but because our decisions and the decision-making process are as unique and complex as we are. We bring many things to the decision table. Each of our backgrounds is unique and no one else shares exactly the same history or future as another. There are many factors to consider when making decisions and we all have different factors and prioritize them differently. We sometimes make decisions that at the time seem like the best decision to make given the present information and our level of confidence and understanding. Sometimes, we look back and realize that wasn't the only choice we had, but at the time, we did what we felt was best. Sometimes great amounts of fear and distress are associated with our decisions, and we make the best decision we are capable of making at that moment in time.

         When providing information and resources to people, birth professionals and health care providers have an obligation to be honest and not provide only those resources which support their own opinion. Neither should we provide information from inflammatory, strongly biased and combative resources. These serve to appeal chiefly to emotion and often ignore variations in sources of evidence. If we provide only one side of the argument and discourage and berate the other side, in the end we haven’t encouraged free-thinking at all. We have merely attempted to clone ourselves and our philosophy. We have sent the message whether intentionally or not that the only good, intelligent and loving choice is the one we have presented. If the opposite choice is being considered, some families feel they are judged by others as “cruel,” “ignorant,” “lazy,” or “simple-minded” But, wow, whose being patriarchal and manipulative now? Again, I am not advocating that providers or birth professionals withhold their opinion, but they need to be very clear that it is just that, an opinion, not necessarily directly quoted from reliable research. On the flip side, we do have an obligation to share with patients, clients, students and friends what the research says is safer and what is more risky, but in the end, they decide. Remember, respecting a person's choices is not the same thing as agreeing with their choices. We respect their right to choose options and the fact that they did make a choice, even if we do not agree with the actual choice.

        Here’s the fundamental point. Let’s not shove people in a “natural” or “medical” box. There are so many variations on these two themes. Practice what we preach about encouraging free-thinking and informed consent. Consider the possibility that your viewpoint may actually be inaccurate and may not be supported by the research. Gasp! If we have been enculturated in a certain way of thinking, we often don’t research issues ourselves to validate our beliefs. We don’t feel the need to; we repeat what we have heard for so long from people we admire and trust or want to admire and trust. We get lazy and don’t check it out for ourselves. Every one of us does it at one time or another! So, it is very possible that another individual who has an opposing view (or even someone less experienced than you) has actually done more research than you have or, more specifically, studied more reliable and objective sources than you have. Let’s remember where we live; in a country where we have the right to decide what we want for our pregnancy and birth and what we choose to decline. These rights are threatened by groups who say things like mothers who “refuse” antibiotics for GBS positive status during labor are putting their babies in direct harm, or groups who advocate that any parent who immunizes or circumcises their children is cruel, ignorant and “unmotherly.” (I am very into quotation marks today.) Neither group is truly respecting that it is the individual’s choice, not theirs. New parents are often in a vulnerable place; they want to be able to trust that those caring for and teaching them are giving them factual information. Our job is not to make choices for our students, patients and clients or even to tell them what choice they should make. Our job is to show them where to find accurate information on all viewpoints and help shore up them up to make their own choices. This is no small task. Let me pose a question to you: did you get into the natural birth movement to have a platform for your soapbox or to strengthen those who need a voice and help them take responsibility for their health? Only you can decide the answer to that question.:)

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