Tuesday, April 5, 2011

Wax study might be onto something

Ugh, I can't help myself. Despite the heap of schoolwork before me - grown even larger by four days of conference attendance - I can't help but keep dwelling on some of what I heard over the weekend. What really rocked the boat for me and was outside of what I would have expected to hear at a midwifery conference (I mean - Huge maternal and infant mortality: big, bad problem, Midwifery model of care: good, appropriate solution - that's pretty predictable and formulaic, right?) was what Michel Odent said about the recent research about neonatal mortality and other indicators of birth outcomes that has made home and hospital vaginal birth appear more dangerous for mothers and babies. It wasn't "Those studies are shoddy." It was, "They're right, I would have expected as much, and here's how we're doing harm even in home births."

Since Science & Sensibility posted about the Wax study again yesterday, I had to comment:
I got to hear Michel Odent speaking about this study last week and was really fascinated to hear his take. Rather than criticizing the study methodology, he said that its results as well as a couple of others of the last 6 months (Netherlands and China) indicate that birth is becoming more difficult in all settings. He suggests that we have a gross misunderstanding of the needs of a laboring woman across the board, even in natural childbirth circles. I’ll be writing more about this in the coming weeks because it is possible that we are largely turning a blind eye to a lot of widely accepted and in fact celebrated and endorsed practices even in the most natural and low-intervention approaches that may not actually be physiologically sound.
That being said, I’d be delighted to see this study retracted or taken down as inflammatory or unsound – but if there IS a kernel of truth in it, I think we’re wise to look directly and honestly at the implications.
I made a few corrections over the actual comment I left where I made a bunch of mistakes - my fingers are thundering through this today so I can get to "real" work. If you see any typos or mistakes, please give me a heads up.

I had no idea, until this weekend, that midwives are widely ignoring a number of the less convenient and conventional (midwifery-wise) criticisms Odent makes about very common and very accepted interventions (or as we like to think of them, practices.) That dude is way more fringe than most midwives, makes some very specific and potentially revolutionary observations, and we're not listening.

To give you a teaser... Is it possible, despite all our advocacy for allowing women to have food and water freely in hospitals, that they don't actually need food and water in labor, and that we are actually making their labors more difficult, prolonged, and unnatural by insisting that they do? 

More to come, more to come.


  1. Intriguing. I will look forward to hearing more of your thoughts! From what I know of Odent and 'le cocktail d'hormones,' I am guessing his push here is for extremely hands-off, woman-led birth? I wonder what percent of women desire that, though. Mainstream birth narratives seem to suggest that many women have a lot of fear about birth and in fact expect and seek high-intervention managed births. A systems approach that advocates for widespread hands-off birthing seems to deny women the managed births that many want. Which, to some degree, is equivalent to managing birth for women who don't want that. (I'm thinking of a few data points here - "About seven mothers in ten (71%) reported feeling confident as they approached labor. A slight majority also felt fearful (53%), and one in four felt unprepared (24%)." from Listening to Mothers II and also that study about how even someone sitting in the hospital room silently improved birth outcomes, etc.)

    I want to make a turn to 'choice' as an organizing construct for birth practices, but two realities get in the way, one systems-related (the fact that medicine wants and will create a standard of care) and one individual (the fact that many or most women fear birth and want it simply 'handled').

    I go back and forth on physiology as an organizing principle because of the problem of pain. I believe that some forms of pain relief are physiologically non-optimal, but that we have no right to deny them to women and maybe even are making a mistake in advocating for less pharmacological pain relief in childbirth - this from a feminist, rights-based perspective.

    This comment is a mishmash of jumbled thoughts and I hope you will forgive and overlook that. -also, based on a huge assumption about what it is Odent had to say! Maybe I should have just said I'm very curious to hear more and left it at that. :D

  2. Hmm...well, I think if a woman is asking for food and drink, though, it'd be a good idea to let her have them. It's not so much about forcing food in her (though I think it's a good idea she not be dehydrated) as letting her have the choice. As it is with everything, really.

  3. I know, Valerie.. it totally seems that way, I'm right there with ya. But women are coached and encouraged to drink food and water by many providers, husbands and doulas are sometimes instructed to offer it continuously and asserting one's right to them in unlimited quantities is often stressed as an important part of the birth plan which creates the impression that they are necessary and helpful. We have a very strong culture around having food and drink in labor (at least within the natural childbirth movement) even though hospitals generally don't allow it. So yes - I'm all for letting women have what they ask for - but I also think we have to see the issue in the broader context. If we're operating on a fundamentally erroneous assumption (that it is necessary or even beneficial to have food and water during labor routinely) then laboring women are operating under that assumption as well. (Just as when our broader cultural assumption is that women can't give birth without drugs and/or surgery and women then request those things we may want to look at the soup of influences and beliefs that created that request rather than just seeing it in terms of honoring individual women's power of choice by giving them the drugs and surgery. On the individual level, yes. But on a level of changing the larger culture of care providers, let's look further out.) I note that Michel Odent is a lonely stander on this question - the overwhelming majority doesn't take his position - but the argument he made was compelling enough that I really took pause and wondered if we are really off base in this area. I'm sorry, I don't mean to be cryptic about the details - I just want to give it some semblence of justice and haven't found the time.

    I also adored your comment, JMT, and even drafted a long comment in response but somehow it degenerated into a long and winding road including me telling parts of my latest birth story (the first time I've found any words for it at all, which is progress I guess) but was too overwhelming for a comment. So thanks so much for reading, thinking and commenting - I really appreciated your thoughtful points - and I will do my best to deliver on the "more to come" in the near future.