UnBreaking Birth

Would you pay more than full price for something that’s broken? If not, or if that seems like a silly question,
then how do you explain that as a country we’re paying for what might be the most
expensive and the worst-performing maternity care in the developed world? In order to answer this question I would like to share three things with
you: how we know that our birth care system is broken why it’s broken and how together we could un-break it. Now you may be
saying ‘wait a minute, isn’t our birth care system
the best in the world?’ It’s not. We have broken birth, and we can
either let the situation persist or we can turn things around. We can provide better care for the mothers and children our lives
and those still to come and it doesn’t require more money, more
technology, or more infrastructure. My name is Ryan.
I’m a parent, a bio-physicist, and a research professor
at Georgetown University. Years ago when, I first started studying
medical ethics a woman confided in me about her
experience giving birth in a well-known hospital. “It was like being helpless and being
raped.” she said. I was shocked — utterly stunned, and I’ve been thinking about it ever since. I had to ask myself what’s the point in having a society if we
don’t protect and empower people at their most
vulnerable moments? I’ve been studying maternity care for
over a decade now and I’d like to share with you some of
what I learned. For me at least early on I was
introduced to pregnancy and childbirth mostly in sensationalized
TV shows in a pretty mind-numbingly dry
introduction in seventh grade health class. Was anyone else’s experience kind of like
that? I hear some yesses, I think. I don’t think we talk about birth reasonably often enough. It’s as though
there’s some sort of cloud of taboo about it that makes us feel like it’s inappropriate
to talk about with people unless they’ve been through the
experience are about to go through the experience. But giving birth and how you’re born are
very important. How you’re born affects the rest of your
life and can affect the rest of your mother’s
life, too. Birth is an amazing event. It deserves respect. It deserves to be
thought about, talked about in depth, wondered at. There are real risks and there are a host a values at play beyond safety. And safety is important, it’s worth
paying money for but we are trying to buy safety from a system that’s broken birth. Look at
this: This graph depicts international
statistical data on maternal mortality rates. Each little bubble represents a country and
I’ve had room to put names on a few of them but not all of them. The vertical axis is the maternal
death rate per hundred thousand live births and the horizontal axis is the health
care spending per capita in international dollars. Would
you have guessed that back in 1995 the US would be this out liar on the far
right hand side of the graph spending the most per capita of any country in the world on health care and yet at the same time with mothers
dying more often than in at least 30 other countries? Now, watch as time goes forward maternal mortality seems to be
decreasing everywhere except in the United States where it has
increased consistently year after year from 1995 until 2010 the
last year in this GapMinder statistics set. So now we’re doing worse than 45 other
countries, and we’re not talking just about wealthy
countries. And as of 2011, our infant mortality rate is worse than 50 other countries. We also
suffer from terrible health disparities for example the infant mortality rate is
between one and a half and three times higher for people of
African-American and Indigenous heritage. And as you’ll see, death is not only our bad
outcome. So what are we doing wrong? Well I want
to tell you about my friend Donna. When I first met Donna, she was a bright young college student. She had long, dark hair and engaging brown eyes and she charmed me with her intelligence,
her passion for philosophy, and the fact that she fluently spoke five
languages. Donna went to law school, she met her husband there, she graduated
with a stellar record, practiced law, and became the head of legal at powerful commodities trading company.
In other words, she was a woman in a very strong
position. When Donna was 29 years old, she went to
a New York Hospital to give birth to her first child. This experience left her scarred, shaken and forever changed. Donna had gone to
the hospital that day because she was three days past her due
date and obstetrician had told her that if she didn’t deliver soon, her baby might die. No one had told Donna just how uncertain
due dates are. What you’re seeing here are the
spontaneous delivery dates of 865 women, all with clock-like 28 day menstrual cycles
for the year prior to delivering their babies, with the date from conception calculated two different ways once by ultrasound and once by last
menstrual period. What I ask you notice is just how wide these curves are and
how different the curves are. But they both represent
the same population of women. So what this leads me to conclude is that a healthy due date cannot all be ascribed to a single day, or even a week. It’s a very
wide window. Every pregnancy is different. Growing a
baby inside you is not at all like clockwork. But Donna
didn’t know this. She accepted the pitocin in induction
her O.B. be ordered. No one told her to ask about her bishop
score, which tells you the likelihood of successful induction.
No one told her that induction would be painful, and
could put her baby in extreme distress. So four hours later, her OB told Donna that her baby had developed a “non-reassuring heart rate” and that she needed to perform emergency
c-section or her child might die or be brain-damaged.
Once in the operating room Donna began to question whether a
caesarean was really necessary or an emergency, because no one seemed to be in a hurry. But when she looked her husband for help, he said “I know it’s your body, but I want a
normal baby even if that means you have a caesarean.”
So, step-by-step Donna had come to feel entirely alone and this is what moves me. Shouldn’t our
mothers feel supported, protected,… safe? Donna is one of the 15 million women
represented on this graph of Caesarean rate by year in the United States, which has risen to
almost one-third of all births. The World Health
Organization used to estimate the optimal rate of caesareans was somewhere between 10 and 15 percent some literature estimated to be lower. While at some point we may have a better
picture, it’s clear to me that the caesarean
rate in this country is far are too high. And a caesarean is major surgery as Donna found out. For her, intense pain lasted for weeks, and the birth experience left a rift
in her marriage. Soon, Donna went from feeling like a
victim to having righteous indignation, identifying
herself as a survivor of an unwanted and unneeded surgery that resulted from interventions she neither needed
nor was explain the consequences of And evidence supports her For example, in this survey of
750 first-time mothers delivering at term either epidural or induction alone
quadrupled the rate of c-sections, while both together multiplied it by a
factor of six. And you might expect that a Cesarean
subjects or exposes the mother to the usual sorts of surgical risks,
such as pain, long recovery time, hemorrhage,
infection reaction to the anesthetic, or organ injury. And you’d be right. Also, a previous caesarean is one of
the strongest predictors of maternal morbidity or significant
negative outcomes of a birth, with a vaginal birth after Cesarean being
slightly less risky for women than repeat Cesarean in most cases. But the hidden group injured by
Cesareans is actually the children who are
delivered by them/ A caesarean birth is associated with a
20 percent increase in asthma, an 80 percent increased risk of
juvenile obesity, and possibly respiratory and digestive
allergies, all for the child,… because the moment of birth is the crucial first opportunity to be inoculated by the healthy bacteria
that we all depend on. And, as you might guess, the bacteria you
get exposed to a hospital is not nearly as healthy as the bacteria you’re naturally exposed to as you pass
through your mother’s vagina. Now I’ve heard physicians argue that high caesarean rates are due to
problems with mothers for example that today’s mothers are
getting fatter, and that their babies are heavier. Now, leaving behind the way that that uh, position feels, to me, offensive, I want to look at
the data. So it turns out, compared with 1990, the rate of high birth weight babies has actually decreased by 10 percent probably in part due to our
excessive tendency to induce, and it’s never been shown in the medical
literature that heavier mothers are better off with
caesareans. So, now that we’ve seen some of the evidence
their birth system is broken I would like to share four real reasons
with you that do not involve blaming mothers why our birth care system’s broken. First, in Medscape’s 2011 report, they found that obstetricians, on average, see between 50 and 125 clients per week and prenatal visits
last year than 15 minutes. So let’s imagine ourselves an O.B. who
sees a hundred patients a week for 10 minutes apiece every week. Can you imagine trying to build a trusting relationship with that many people in an amount of time? And to come from the other point of view, can you imagine the frustration those women might feel trying to build a
trusting relationship with their physician in that amount of time? And I want to point out that this is a
very intimate event that we’re leading up to. And these are the opportunities for
crucial prenatal counseling to occur. So what comes to my mind is the sort of
disclaimer that you hear at the end of an infomercial. Do not drink or smoke while pregnant. Remember to eat well, exercise, and take your vitamins. Call your physician if any of the following occur: High blood pressure, low blood pressure, dizziness, depression, weight gain of more than 2 pounds in a week, shoulder pain, changes in vision, or if your baby delivers on its own. [Laughter] At the same time, interventions have become so routine in the hospital
that I would argue that attention in the
hospital setting has become focused on preparing for and
applying them rather than on attending to and noticing
what that mother and baby in particular need. Interventions began subtlyly as soon as you arrive at the hospital. This is a incomplete list interventions that are over-performs, or in some cases, like circumcision and infant gender assignment surgery are entirely against the patient’s
medical best interest. And interventions are not benign. Every intervention exposes the mom and
baby to increased risks and the chance of
additional complications. Right when she checks into a hospital,
a mom may be told not to eat or drink even know being hungry alone can slow
and complicate labor. I mean, this is an athletic activity
we’re headed up to. Can you imagine preparing for a
marathon and your coach telling you “please do not eat or drink” the day
before you run your marathon? She’ll probably then be given IV and her movement will be restricted
which also makes labor more painful and can increase the chance to
complications. She may be given a belt to wear, an
electronic fetal monitor and maybe encouraged or told to labor on
her back, which angles the birth canal uphill, reduces, circulation
to the uterus, and can increase the chance of
complications and pain also. Well over forty percent of moms in the US are currently induced. Many or most unnecessarily like my friend Donna, which increases pain the chance of uterine rupture, and
escalation to a c-section, oh and fetal distress, as we heard
earlier. And a falling but significant number of mothers are still receiving a episiotomy, an almost
universally unnecessary incision into the vagina,
that can increase the risk of severe vaginal tearing, incontinence and
sexual complications. Okay, and you seen her c-section data and
as did you know, by the way, that obstetrics is a surgical specialty?
So I would argue that by training with essentially set
obstetricians up to operate this way. I mean can you imagine if we told
architects only how to build with steel and concrete, what would our
homes look like? and maybe that would be fine if there were good, consistent evidence that this kind of
treatment improves birth. So the next question is, is there? This is the American Congress — they changed their name to
congress recently — this is the American Congress of Obstetricians and Gynecologists’ own internal review of the evidence basis of their
practice guidelines. They divided their guidelines into three
levels of quality evidence Level A are those guidelines based on good and consistent scientific evidence
and, accounted for one-quarter of obstetric guidelines. Level B were those guidelines
based on limited or inconsistent evidence and account for about forty percent of
obstetric guidelines. And level C, those guidelines based essentially on opinion accounted for 35 percent of obstetrics
guidelines. They then break is guidelines down by
topic. In particular, please focus on the far
right. Notice that, of motive of delivery guidelines, about five percent of them are based on
good and consistent scientific evidence, but those are the guidelines that say
whether or not you should receive a C-section, or a mechanical delivery, for example like
forceps. So, O.B.s are very good at performing interventions, but they don’t have available to them as much information about when those
interventions are needed. And some others interventions are
entirely counter to the evidence. For a
second example related to the baby I want to talk to you about cord clamping. Clamping of the cord before the placenta finishes pulsing makes breathing urgent for the child rather than giving a few moments start, it deprives the baby or some their own
blood, thus we have actually created an
epidemic of anemic newborns in hospitals and those two things
together can cause further emergencies and the scientific literature is
entirely unanimously against early clamping of the umbilical
cord. Okay, hopefully that sounds convincing. So at Georgetown University Hospital, I talked with a neonatologist
there when I asked her if she agreed with my
assessment of the literature about cord clamping, she said unambiguously “yes.” When I asked her what they do at the hospital she said “we
clap and cut the cord right away.” I said, “Um, why do you do that?” and she
said “because we want to separate the baby
from the Mom as quickly as possible” I said, “wait, why do you want to do that?! I mean, that’s traumatic for an infant?” and she said “because different people
are responsible for the mother and the baby in the hospital.” And what frustrates me about
this is that it is representative of my conversations
with people in the hospital setting about all kinds
of procedures; even when they know that practicing a certain way
would be better for their clients they have some reason to practice
differently. So that means that there are conflicts of
obligation within the hospital meaning that, at times when the hospital’s
best interest is over here and the patient’s best interest would mean you behave this way the hospital’s best interest wins. And I
don’t think hospitals are doing very well at communicating or
disclosing those conflicts of obligation to their clients. So, our birth care system is broken for at least four reasons. Number one,
there isn’t a sufficient amount of space and time to build an adequate relationship
between the mother and the caregivers. Number two, our interventions have become routine instead of based on the mom and babies’
best interests. Number three, those interventions are often opinion-based. And number four, there are conflicts of
obligation within the hospital that systematically cause behavior that’s out of alignment that
the client with the mom and babies needs. And all this happened I think for well intended reason. I think
obstetrics has been organized around handling
high-risk, emergency surgical births. And they may do this well, but treating
all births this way actually derails well birth, which is the vast majority of births. So I
think we need to keep the good of this system and pair it with another approach that doesn’t break well birth. “Oh my goodness,” you might be saying, “how could we possibly find or create highly trained,
experienced professionals who have evidence-based practices, who work within a context of a strong relationship with the mother,
compassion for newborns, and who don’t experience conflicts of obligation
with a large institution?” Well, if you were asking that, I’m glad, because there’s an answer… those practitioners already exist. They are independent midwives. Now, I don’t know if I lost anyone at the
word “midwife,” So I want to ask everyone to take a moment to reflect, what’s the image in your mind
of a midwife? And, perhaps more importantly, Where did that image come from? So in this next part of the talk, I want to introduce you to three midwives, I want to discuss some of the literature about safety of midwifery care, and I want to talk about how and why midwives are key to un-breaking birth in
the U.S. And I’d also like to tell you how Donna’s story ends. First, let me introduce you to three midwives. “Midwives are experts in normal. There are wide wide variations in normal. Doctors are experts in pathology. In modern medicine, we use an elephant gun to kill a mosquito.
The more you can work in a holistic way. and work with people day by day and teach them as you go.” “The basis or the foundation of
health disparities is racism that, you know, African Americans, Native
Americans have sort of this basic truth about how they live their
lives in the United States and so when you’re dealing with a community that
by definition or communities that by definition have increased stress due to all of these factors you can be providing prenatal care that
doesn’t address those things or attempt to address them. Midwives who are providing care to women of color are having better outcomes. First of all, midwives typically have longer
appointments. Longer might mean in some settings 20 or 30 minutes as opposed to 5 or
10. It may mean for a home birth or an out of hospital birth midwife more like
45 minutes to an hour In the course of an appointment that is that long, a woman is just going to get a feeling like this person actually cares what happens
to me. There is a level of concern that goes just beyond the bare physical necessities of providing
prenatal care, and goes towards her personhood.” “I cared for a a mother who had hearing loss that caused a speech
impediment that made it hard for her to understand because she was from rural
Virginia and had a strong southern accent in addition to hearing
loss and this was her second baby and we requested records and when the
records came written across the top in the front was ‘mental retardation’ That really, you could tell, drove a lot of
the decision-making that happen with her first baby related to induction in that
she wasn’t really given much explanation and things
happened in the course in her care where it wasn’t
even about consent. There just wasn’t a conversation. And that was why she sought out
midwifery care and home birth for her next baby.” So, as a human being, I find these narratives very compelling.
And I’m also a scientist which some people would argue is quite
different from being a human being [laughter], and so I’d also like to look at data
at the same time. Now, midwives can work in homes, in
midwife-led birthing centers and in hospitals depending on their
training paths, so this makes the midwifery scene a little confusing. I would like to focus
on home births while we look the next part, the safety research in part because I think people will have the
most concern or doubt about safety of midwifery-assisted birth
at home. So I found 21 studies published between 1995 in 2013. of home birth outcomes in industrialized
nations. Planned home birth at full gestational age attended by professional midwives always equaled or outperformed hospital
birth and that’s low-risk hospital birth that
we’re comparing and I would like to mention the somewhat famous meta-analysis by Wax et all, that was published in 2010 that found that the neonatal mortality
rate was higher in home births. That is their finding. However, they
included unattended births in their analysis. So I would argue that it’s unfair and perhaps not very useful to judge midwives by the outcomes of
births to which they were not invited. And, if you look at the paragraph Wax et al. gives to their
sensitivity analysis, you’ll see that, when they remove the unattended
births, they say that there’s no
statistically significant difference in neonatal mortality
between home births and low-risk hospital births. Which leaves the only difference is that
they found that were significant between the two groups particularly maternal morbidity in the
forms of severe laceration, hemorrhage, and infection all worse in the
hospital. So midwives have lower morbidity and
complication rates I think for many reasons one of them is
that they do not intervene unnecessarily very often. This is from one of those home birth studies that I mentioned. It is a comparison of intervention rates in different settings. The green bars are the rates that particular
intervention among 2,000 home births assisted by certified
professional midwives. The pink bars where data was available are the rates
that intervention for low-risk hospital births, and the
blue bars are the rates of that intervention for all
hospital births lumped together. By the way, the green bars include
interventions that occurred if that mother was escalated to a
hospital setting, it includes any interventions that occurred
in that setting too. And you’ll notice that hospitals only counted successful
inductions which means that my friend Donna’s
induction would not be one of the inductions noted in this
statistic. So as you can see, attendance by professional midwives led
to lower intervention rates across the board so how to midwives manage to do that? Independent midwives are trained in assisting well-birth, in
preventing complications and in administering life-saving
treatments. A Certified Professional Midwife, for example, must show competency at 780 skills attend, in various roles, over 50 births and successfully pass an eight-hour
hands-on examination all in order to qualify for the written exam. Midwives also spend more time with the mother, they intervene conservatively, and — I
think this is very important — instead of organizing the mother’s
body around themselves, the way that obstetricians are trained to
do, midwives organize themselves around the mother’s body. So, for example, you know if a
mom say is up here; she’s squatting, leaning
on a partner or friend as the baby’s head is showing, the
midwife might very well be down here you know, keeping an eye on the perineum, checking for cord prolapse, and so on…. And midwives know how to
screen and escalate their clients as needed to obstetrical care. So, about her second pregnancy, Donna says, “I spent the first few months
the pregnancy respectfully asking countless
obstetrical practices to permit me a ‘trial of labor,’ while
inside I was agonizing, ‘why is my labor on trial?'” After yet another OB practice scheduled
her for repeat Caesarean, Donna turned her husband and said, “This
baby is coming out of my vagina. I am NOT going to hospital we are having
this baby at home.” “Are you trying to kill our son?” he said. At their first meeting with their
midwife, Donna’s husband shifted in a way she never expected. He was going to trust her, and trust the situation. When the day came, Donna’s son was born at home, without an epidural, without an induction, and without a
repeat Caesarean section. She told me, “Through the haze of hormones, joy, and exhaustion I could hear
my husband talking to me, ‘You did, it, I’m proud of you’, he said.” Donna’s marriage experience healing. So, Let’s zoom back out and look at the astonishing situation that we have here: We are spending a lot of money training
very well-intended people to do unnecessary harm to mothers and
babies, all the while thinking it is normal and
for the good of everyone. And we have given this broken system a
near-monopoly. On the whole, obstetricians can be
fantastic at what they do, which is handling high-risk, surgical, and
emergency births. We need them. But thankfully, we don’t
need all births to be surgical. So we started with the question, “why
would we be paying so much for maternity care that’s so expensive and
yet performing so poorly at the same time?” I think the answer is because we don’t
really know how badly it’s doing and because we don’t know about or have
available to us other options. So that’s what I’d like to see change. Being aware of and making available these
other options especially independent midwives but also
including other birth assistants such as doulas is key I think to un-breaking birth in the U.S. independent midwives can work in homes
and in midwife-led birthing centers, which also perform quite well. In fact
the National Birth Center Study Two show that birthing centers also
outperformed or equaled low-risk hospital births and that
their Caesarean rate was one in sixteen compared with our national one in three. If even 10 percent of births last year had occurred in bringing center, we would
have saved over one billion dollars. But this could only happen if Medicaid
and every insurance company paid for midwifery services. We could even improve hospital birth by
giving midwives independent admitting privileges so they
were not constrained to practice against the evidence. And that would give
possibly the best of both worlds to women who want to give birth in a
hospital, or who have elevated risk factors. And did you know, by the way, in many of
the countries that are outperforming us midwives actually train obstetricians in
well-birth? Imagine the possibilities if well-birth was
that well respected here. It will change — it will take a change of that magnitude to unbreak birth in the U.S. So let’s ask for that. A system in which independent midwives
can practice legally in every state and in which medicaid and every insurance carrier cover their services is a system in
which all women, regardless so well can choose where and
with whom to have their babies. and this might help protect other choices that are often very
constrained in the hospital setting such as whether or not to eat, what position to labor in, what interventions
you have, and what happens to your baby after the
birth. So to do this, we need every state to enact legislation that protects the right of midwives to practice legally, and we need insurance
companies we need every insurance company, including Medicaid to cover their services. And that’s where you come in, because
sadly independent midwives cannot
legally practice in almost half of U.S. states. and it’s exceedingly rare for insurance
company to cover their work. Now you may be thinking, “that’s all good, but I’m not gonna have kids or I’ve already had
mine. Well, look around you. Think about your
friends, your daughters, your granddaughters, think
about the children will someday be friends with who haven’t
been born yet. There are a lot steps to unbreaking birth in the U.S. I would like to ask you to start with just two. First, talk with your friends and your legislators. Second, find
and join your local pro-midwifery organization.
Sign a petition for them, write a letter for them, ask them what
needs to be done. They’ll know what needs to happen in your state. it’s time I think and I hope for us all to take action. Only together can we unbreak birth. thank you very much [Applause]

23 Replies to “UnBreaking Birth”

  1. When evaluating presentations such as this one, good sources will not only provide citations on each slide but also have a reference slide at the end of their presentation.  Also reliable presentations tend to stick to the facts and not use persuasive techniques such as referring to emotions, opinions, and case reports.  As an example, here is my opinion based comment: as an individual leaning towards the methods he refers to, I think he weakens our case by presenting this information so poorly.

  2. Dear Ryan, this lecture is an eye opener. I'm from India (Mumbai), the story in India is no different & I have been trying to create awareness in Mumbai about the ideal maternity care model. Have you ever been able to find data on the birth scene in India? Its very difficult to get the exact statistics. There is no such thing as Natural Birth here. You will be amazed that there are just 2 midwives in Mumbai. India has no midwifery school. I have used your video as well to create awareness. Thank you for that.

  3. I love this, so objective on a topic that is so heavily debated and at times controversial. 
    I feel the biggest barriers to revolutionize the current robotic style of child birth is the legislation, finance and the bureaucratic red tape that stands in the way of women being able to birth naturally/ chose their own birth style. I’m currently developing research on the perception of interest for young mothers (16 – 23) birthing in public hospitals, which sounds very similar to a few stories in this lecture. Communication and joint decision making is very poor, and fewer and fewer young women are listened to or given a chance to birth naturally, despite the overwhelming evidence that younger women are more likely to have fewer complications during natural childbirth. These women are labelled ‘high risk’ because they’re low socioeconomic, homeless or just uneducated. Medical professionals are not taking into consideration that these women are physically fit and healthy, and more then capable of delivering naturally if just given the chance. Unfortunately this is where the red tape comes in, a lot of these these high risk mothers need to have a social worker present in case the baby is born disable, under developed or addicted to drugs, for legal reasons. 
    So, my question to you; how do we get around these legislative and bureaucratic barriers? to un-break birth?

  4. Ryan,
    I am a Labor and Delivery nurse and I LOVE your presentation and agree wholeheartedly. I have posted in the nurses' station at work your graph with the cesarean section rates with no induction/no epidural, epidural, induction and epidural/induction. Most MD's (OB/GYNs and anesthesiologists) who look at it don't believe the numbers at all. I have looked on Childbirth Connection for research to back up the numbers, but have not been able to track it down. If you could help me track it down, I would really appreciate it!
    [email protected]

  5. Dr McAllister, another fantastic video, on another issue of critical importance that's been too long ignored.  Well done!

  6. Dr. McAllister, thank you, thank you, thank you! I hope a generation of families takes heart to your findings. I am a Bradley childbirth educator and a Mom of two children born at home – I am looking forward to sharing this with my students! 🙂

  7. I watched this video with tears in my eyes. Dona's story is my story too. 40w2D I was convinced by a OB I had no relationship with, that the best thing for my baby was an Induction. after 2 failed inductions and almost 24 hours I was rushed into the theatre with no explanation, no understanding of what was about to happen to me. I had an Emergency C-section and I had a terrible reaction to the Epidural. this horrific birth experience is one of the major factors in my decision to be "one and done" I can't bare the thought of going through that again. Birth is broken… not only in America. I am a South African.

  8. I realize that this is a couple years old… But I would like to make a couple of observations of weaknesses in your argument Mr Ryan McAllister. 1. Why do MDs spend so little time with their clients? Not all of them are social retards who don't know how to connect with people. I contend that it is our broken insurance system that forces them to fit as many women as possible into their day, because only by having a high volume practice does the insurance system pay Drs what they need to maintain their practices and their quality of life.2. You did not mention CNMs when you talked about midwives. They are trained and credentialed and most are already practicing in the hospital system. Most of them are practicing as 'medwives' mimicking the practices of their OB colleagues – due to this broken system that you outlined so well. But some of us are practicing independently and providing home and birth center births. I am unable to find an OB willing to "supervise" me in the hospital. I started out in my private practice providing both home and hospital birth choices, but there is no financial incentive for an OB to take on the responsibility of my practice in the hospital – especially if it means that they may be responsible for what I do outside the hospital. Insurance companies need to be disbanded, Medicaid needs to pay midwives for the extra time they spend with their clients, and hospitals need to independently credential CNMs. I would add these points to your list of unbreaking birth. Thank you for taking the time to read my comment

  9. I will be showing this to our midwives at orientation at our birth centre in Rwanda. Thank you!

  10. Thank you for this powerful video, which I'm going to share with my friends and on my FB page. Your findings are totally consistent with my experience of giving birth in Germany, a country which seems to be at the forefront of the home birth / natural birth movement. I was blessed with a wonderful team and didn't have to pay a dime for it.

  11. Superb video. This makes me not want to give birth in a hospital. I am leaning more towards my home or birthing center.

  12. This presentation is such an eye opener. I am a Midwifery lecturer in South Africa. We have got brilliant guidelines for practice, and there is nothing that includes the woman as a person. I am encouraged to sensitize my peers, doctors and student midwives. Thank you

  13. Dear Mr. McAllister, your video has spoken volumes. I was referred to watch your video by a Midwife, who I sought out to avoid a RCS in an VBAC-restricted area. The nearest VBAC-friendly hospital is 2.5 hours away and I would have been completely transferred from local care at 32 weeks if I chose that route; imagine the cost and risks that ran through our minds and were voiced back to us by our current OBGYN. Unhappily, we chose RCS to remain local and to avoid the risky drive during labor. At the same time, we were informed of the risks that a third pregnancy would bring after a second cesarean, so, again, unhappily, we chose tubal along with the RCS. A little background with my first, weighing 175lbs, I was told that my baby was breech, we attempted a ECV, which did not turn out to be gentle at all, and was attempted twice with two epidurals, which was both unsuccessful. I had leakage but was sent home after a negative amniotic test and was in active labor a short week later. At that moment, I felt more like a guinea pig and my baby a science project and my concerns that had gone unheard led to me laboring and rushing to the hospital in fear of my baby’s life. Once there, clad in only a robe and terrified for the life of my child, I was listened to and cared for at a slow pace. While I distressed, they calmly asked me for identification and insurance cards. Once I had completed paperwork and verified my identity, I was taken to the back, where I was confined in a room as small as my apartment bathroom and a thin table where I rocked back and forth in an attempt to remain balanced. I was forcibly sat when I attempted to stand, ignored when I complained of the strange feeling down below, mishandled to the point that I had bruises on my arm from the horrible bedside manners my nurse displayed, ears ringing with her cussing out of frustration that I was not cooperating alike to a prone dummy while she drew blood (explained that I wouldn’t have to later) and struggled to insert the IV and had to seek help after piercing a vein that lead to me bleeding all over the sheets and her cussing in her blame at me, angry over something as simple as explaining to me what she was injecting me with, and then also insisted that I keep the doors shut in a stifling room with no fan or AC in order to be considerate of my undress and vocal displeasure to a man mopping down the hall. We hid in the cool bathroom until we were spoken to by the surgeon, who ordered the door to remain open, shocked at how we were being care for, how hot and uncomfortable the room was, and in agreement to another nurse taking over my care. Four hours after arriving, I was being wheeled in, epidural in full effect, and the strange feeling still down below… the surgeon announced that my baby had begun descent and would have to be pulled out of my birth canal to remove her through the surgical opening. The strange feeling, the reason why I couldn’t sit (and the nurse had mishandled me and forced me to), had been my baby’s leg dangling out, my sitting had me on top of it, while the rest of her remained stuck inside me as she sat on my hip, her other foot tucked underneath her on my hip bone, unable to finish the descent out and had been left in that awful position since my arrival, forced to wait rather than being rushed in and taken out. My daughter was born 6lbs and 9oz, beautiful, but had bruises along her arm and leg, as well as a strange lump on her spine and strawberries (hemangiomas) that had popped out along her right side at birth. I felt like a failure. I was then accused of drug abuse after my first visitors, demanded to give more blood (the reason behind my first sample made pointless), my baby’s diaper stuffed with cotton balls to be urinated on and taken to be tested, and at the “negative”, I answered with an “of course it was.” I refused the three shots; vitamin K, Hepatitis B, and Whooping Cough. I allowed an oral Vitamin K dose to relieve Jaundice, but still wondered if I was making any right choices. When my newborn baby needed to be burped, the pain from my c section and the low pain dosage I had requested in fear of giving it to my baby through breastmilk, hindered me from caring for her and when I requested help, a nurse held my baby up into a forced sit, head dangling in a way I feared for her neck, as she was patted on the back and her body flung forward into a crunch with every swing. Alone in a hospital with my baby, I worried that she would be taken from me, I held onto her like a lifeline; she was all I had during that dark time, a time that should have been special. I was helpless and afraid, and demanding to leave after 3 days. A single mom, I had to push myself to care for my baby alone while recovering, I tore my external cut and now harbor a thick scar in its place, and it took me much longer, close to a year, to use the restroom and to eat normally. I had weighed 175lb at birth and after, I went back down to my 140lb and still had complications. I relate to the feeling of being raped during my birthing experience. Then my second pregnancy, I am hitting walls to avoid the worst procedure of my life, which traumatized me, had been abusive to me, because one c section means that’s all you’ll be able to have. In order to have a VBAC, it has to be in an approved hospital (for some women, one that’s hours away), they give you a time limit to labor, they happily induce, and most are wheeled in to a cesarean anyway because of the intervention. Midwifes are changing that. If you attempt to go to another hospital, one that isn’t VBAC-friendly, you encounter a hostile and unsupportive environment, and if you’re at an early stage of labor, when dilation is less than 7cm, they force terbutaline, the drug to stop contractions, stop your labor, until you can be wheeled in due to the fear of uterine rupture and disagreement leads to the nurses scaring you with “your insurance won’t cover you for choosing AMA” and “a drive to a VBAC-friendly hospital is too risky and not worth it in my opinion”. The birthing system is broken. Mothers are being broken by the system. Thanks for reading.

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