A father + husband's critique


I just finished the documentary -- As a husband, father, and soon-to-be father for a second time, I was very interested in it. I've been through the process twice and am convinced that the medical establishment maximizes visits, tests, and procedures to maximize their profits from paying patients, to offset their losses on non-paying or Medicaid patients. I have a certain anti-establishment bias, so I thought the documentary would be preaching to the choir.

That being said. I was disappointed in the documentary and found it incredibly biased and unconvincing. Some of my problems with it...

1. I found the statistics to be incredibly misleading. One of the reasons why the USA has such disproportionately high infant mortality rates is because of the prevalence of neonatal units. An extremely newborn baby in the USA who dies would be considered an infant death, while elsewhere it would be considered a miscarriage. The definition of a "live birth" varies considerably from country to country.

One of the primary reasons why mid-wives have such high success rates is simply because they take low risk patients. This results in an inherent sampling bias.

2. It completely ignored the role of fathers and husbands. Child birth is an emotional and painful time for a woman but she isn't there alone up against the medical experts. It's the job of the husband to be her advocate, motivator, and emotional support in the process. This is the same whether the mother goes to a midwife or a hospital.

3. It focused on the absolute worse case situation with obstetricians. In most situations, the goal is to have the same OBGYN who handled the prenatal care perform the child birth. It isn't an anonymous experience and you build up a relationship over the course of 10 months.

I think the documentary made many important points (as echoed by other posts in this message board) but it felt more like something from a trade show or lobbying group than an unbiased analysis of obstetrician vs. midwifery.

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You make very good points. This film definitely leaves out key things that you should know going into this.

My wife and I went through a home birth 4 months ago. The week she was due the midwife measured and predicted the baby at about 7 lbs. She went into labor one week over due date, and baby was born at 10 lbs 4 ounces. So she needed a episiotomy, which the midwife performed on our kitchen floor.... I compare this to a man having his penis cut off, then asking a nurse to come to his house to stitch it back on.

Anyways we were naive to all of this, we only cared that our baby was healthy. Now months later when we go to have sex my wife and I have no enjoyment anymore. She would likely need surgery to try and correct it if she chooses.

Now in the film when you hear them try and make these "NY city women" who choose to have C-sections sound evil; realize the real reason many women chose this. The midwife certainly won't tell you.

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OBs are notoriously off in their size predictions too, that has nothing to do with whether you have a midwife or not. It is simply difficult to predict with accuracy late in pregnancy how big a baby is. I had an OB with my first, and he was totally off in his prediction as well. It's totally normal.

Given the same weight predictions, the doctor would likely have followed the exact same procedures, and given your wife DID successfully birth a large baby, would you really have chosen a c-section over an episiotomy anyway? I doubt it, considering the risks from episiotomy are way lower than that from a c-section. One is major surgery and the other, while certainly crappy, is not.

It is awful that your wife unfortunately had complications from her episiotomy and I am sorry for you both, but assuming you would have had a happy shiny experience if she'd given birth in a hospital instead doesn't make it so. Is it possible? Of course. It's also possible it could have been a much worse experience too. From the details you gave, the midwife didn't do anything wrong.

Also, I've had an episiotomy, and I am confident in saying it is nothing like having your penis cut off :-).

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In regards to point , I believe that's why they compared the US to other developed countries and not to just anywhere, and made specific mention of places like the Netherlands. That's hardly a backwards country with no neonatal care, and a preterm infant death would not be considered a miscarriage. While the stats may be slightly skewed, they are not skewed that much. Just as a point of comparison, I live in Canada where definitions are pretty much the same but our rates are better; we also have lower rates of interventions. That being said, our rating has dropped from 6th to 24th for infant mortality in the last decade, and this drop coincides with a dramatic increase in - you guessed it - interventions and c-sections.

If you look at a lot of the countries above both the US and Canada, you'll see most can't be dismissed as a lack of neonatal units; many of the countries are considered to have some of the best and most advanced health care in the world.

One argument that CAN be made, however, is that these are also countries where everyone has access to health care; it is possible the US has worse infant mortality rates, not just because of interventions during labour, but because women aren't getting proper prenatal care before delivery and babies aren't getting adequate care afterwards in the period where death is still counted towards infant mortality.

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