“What outcomes are we looking at? In the developed world, everybody talks about death. What will happen? What if something terrible happens? Everybody’s worried about mothers and babies dying. But in actuality, mothers and babies—unless you’re in Mozambique where it’s a 1 out of 13 chance the mother will die—in the developed world that’s not really happening. Maybe we should be really looking at what type of care is producing optimality. Which babies and mothers are healthier. Not just at the moment of birth but long term.”

Saraswathi Vedam, speaking at Amherst College after being awarded an honorary doctorate. (You can read the entire talk at the Amherst College link above.)

Safety is not inherent in a place, but in the philosophy of the care provider.

Sherry Payne,BSN, RN 

If you’re going to the hospital for the birth of your choice, you’re going to  the wrong place… they don’t sell that there.
Carla Hartley (HT: Hathor the Cow Goddess)

“As doulas “reframe” the birth experience for their clients, they are also shielding the hospital and its care providers from criticism and complaint. [Birth doula] Hedley did her job so well that even though she felt her client was “abused,” her client will go right back to the same obstetrician and hospital for the next pregnancy. “The unanswered, fundamental question is whether [doulas] are making birth better for women, or just making women feel better about their births,” write sociologists Bari Meltzer Narman and Barbara Katz Rothman. They raise a fair critique of the doula as an enabler. By supplementing the handholding and informed consent conversations that nurses and doctors should be doing, and by buffering the level of intervention, they are perpetuating the very system that they are in the business of changing.” Jennifer Block, Pushed, pg 160

I found this quote — midway through a book that chronicles in meticulously researched detail the problems with modern American obstetric practice — extremely thought-provoking. Klaus and Kennell’s research certainly shows doulas make a difference in actual outcomes and rates of intervention, not just in mother’s feelings about their births. But when I took Penny Simpkin’s doula training course, way back in 1996, I certainly came away with the idea that, despite my inability as a doula to truly protect my client from bad obstetric practice or hospital protocols that might negatively impact her labor, I could profoundly influence the way she felt about her birth — feelings and memories that she would carry with her for the rest of her life, and that would color the beginning of her relationship with her newborn.

Penny Simpkin’s website boasts, “Nurturing Positive Birth Memories Since 1968.” I agree with Simpkin that this is important and meaningful work… but it is not enough. Even if every woman who was subjected to non-medically-indicated inductions and cesareans had a doula holding her hand and helping her come to terms with her birth experience it would not be enough.

And Joseph also went up from Galilee, out of the city of Nazareth, into Judaea, unto the city of David, which is called Bethlehem; (because he was of the house and lineage of David:) to be taxed with Mary his espoused wife, being great with child. And so it was, that, while they were there, the days were accomplished that she should be delivered.

And she brought forth her firstborn son, and wrapped him in swaddling clothes, and laid him in a manger; because there was no room for them in the inn.

And there were in the same country shepherds abiding in the field, keeping watch over their flock by night. And, lo, the angel of the Lord came upon them, and the glory of the Lord shone round about them: and they were sore afraid. And the angel said unto them, Fear not: for, behold, I bring you good tidings of great joy, which shall be to all people. For unto you is born this day in the city of David a Saviour, which is Christ the Lord. And this shall be a sign unto you; Ye shall find the babe wrapped in swaddling clothes, lying in a manger.

And suddenly there was with the angel a multitude of the heavenly host praising God, and saying, Glory to God in the highest, and on earth peace, good will toward men. Luke 2:3-14

“Unfortunately, the role of obstetrics has never been to help women give birth. There is a big difference between the medical discipline we call “obstetrics’ and something completely different, the art of midwifery. If we want to find safe alternatives to obstetrics, we must rediscover midwifery. To rediscover midwifery is the same as giving back childbirth to women. And imagine the future if surgical teams were at the service of the midwives and the women instead of controlling them.”

Michel Odent, MD

“Our slogan is ‘midwifery is the art of doing nothing well.’ It’s true — sometimes the best thing to do in childbirth is nothing. But you have to be very well trained to know when that’s the right thing to do.”

Elizabeth Steinfield, Certified Nurse-Midwife

“Doctors in America were not always the powerful and authoritative profession that they are today. A century ago they had much less influence, income, and prestige. “In all of our American colleges,” a professional journal commented bitterly in 1869, “medicine has ever been and is now, the most despised of all the professions which liberally-educated men are expected to enter.” Although a few eminent doctors made handsome fortunes, many before 1900 could hardly scrape together a respectable living. […]

Beginning in the 1760s, some educated doctors took the initial steps to reproduce in America the professional institutions that in England gave physicians a distinct and exclusive status. They succeeded in organizing medical schools, and in some fields of work, such as obstetrics, doctors gained ground against rival practitioners. But they failed in their larger efforts to establish themselves as an exclusive and privileged profession. The licensing authority doctors secured had little more than honorific value, and during the Jacksonian period in the 1830s and 1840s, their claims to privileged competence evoked a sharp backlash that crippled their ambitions for the next half century. State legislatures voted to do away with medical licensure entirely. No profession was being allowed, Oliver Wendell Holmes told the graduating class at Harvard in 1844, “to be the best judge of its own men and doctrines.” Lay practitioners, using native herbs and folk remedies, flourished in the countryside and towns, scorning the therapies and arcane learning of regular physicians and claiming the right to practice medicine as an inalienable liberty, comparable to religious freedom.”

Paul Starr, The Social Transformation of American Medicine

“The obstetrician may say to the pregnant woman, through attitude, words or continual reliance on technology, “You have to prove to me that you can give birth to a baby.” The midwife, on the other hand, with her attitude that birth is, in most instances, a reliable event, says to this same woman, “You have to prove to me that you cannot have a baby!”The midwife is (or should be) an expert in normal birth, while the obstetrician must be an expert in pathology. This is exactly the way it should be. For it is that expert to whom we must turn when we do encounter the abnormal. I believe that oftentimes, the midwife is more likely to recognize situations which demand attention than the caregiver who sees all pregnancy and labor as a potentially dangerous and lethal process.”

Valerie El Halta, CPM

Having a highly trained gynecological surgeon attend a normal birth is analogous to having a pediatric surgeon baby-sit a normal two-year old child.

Marsden Wagner, M.D., M.S.