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August 11, 2005


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Here's my history: unplanned c-section for the usual reasons -- I'll call that one basically unnecessary, or avoidable, though I doubt a vaginal birth would have happened before a real problem eventually developed with the situation as it was (mainly bc of my son's position.) Next, unplanned c-section after wholly non-interventive attempted homebirth with non-nurse midwife (and neat monitrice/doula who did most of the midwifey things) -- I'll call that necessary, though it could have been one of the presumably rare cases in which interventions earlier on might have been the only thing that allowed a safe vaginal birth!

I am so on your side, so frustrated with American birth culture, but I can hardly even bring myself to read the happy natural birth stuff anymore for personal emotional reasons (I confess I skimmed the post I'm replying to at such length, it's that raw); I know nearly for certain that next time I'm going to the hospital and I'm so glad there are one or two OBs left in the region who'll cooperate with a VBA2C (including the one who did my second c/s and was so very kind in spite of my unexpected arrival into his care.)

Labor at home was a very interesting experience -- got going only after my husband and the doula were napping, and went fairly quickly from exhilarated "wow, this is happening! wow, they're coming every three minutes on the dot!" to just plain excruciating. Then there was my decision to take a nap and labor some more later, heh. But before I took my break from laboring, we took my temp one more time since I had broken waters to be aware of and oops, a fever, so we were off to the hospital where they didn't even want to section me right away. When they did, it was so much more humane than the experience that had helped motivate my desire to have babies at home. This time, no one talked about soft p*rn on Cinemax while I was strapped to the table with my innards exposed... I could see my son while he was being weighed, cleaned, etc.... probably spent about 20 times (so, 3 minutes? more?) as long nuzzling him before he was taken away. Unfortunately, many details omitted here, my healthy son spent about four and a half days being observed as a precaution in the nursery because of the infection I'd developed, till I finally got in touch with a lactation consultant who finally had him brought to my room to stay so the milk would get flowing which it did immediately. He didn't have meconium and wasn't deep suctioned, and he took to nursing better right away, and we just bonded so much better in spite of the extensive non-routine early separation than my first son. I have wondered whether the natural labor helped any with my euphoric feelings right after the c/s *even though he wasn't there with me* -- yes there were probably narcotics, but there were probably with #1 as well -- and the easier bonding during the limited time we had together.

My second overall and first spontaneous, unmedicated labor was so painful I repeatedly had something resembling flashbacks when a sensation (afterpains, gas, sitting on the toilet) reminded me of the contractions, but I would absolutely do it again as naturally as possible; I just don't see the safety and stress factors coming together for homebirth unless I manage a VB in the hospital for #3. I've drifted from my local post-c/s support group, which is very homebirth oriented, as I was starting to do even before c/s #2, for so many reasons. Of the many who've recently tried for HBAC among my local group, I'm the lone uninspiring stat so far as I know, although one home VBA2C transferred to the hospital and managed a VB with a supportive doctor.

I loved what Kimberly Hahn had to say about her birth history in Life-Giving Love. I don't want to have c-sections for all the babies God blesses us with, but her take on the whole subject was so comforting and so admirable.

Like I haven't said enough. You touched a chord.(I actually much more than "skimmed" your post, btw; I just was trying to be careful with my own self-pity triggers.)

What you said about control -- I think my peace with attempting an even more now-or-never VBA2C in the hospital is greater than my peace with either the homebirth I chose last time (I thought it was the right decision, and I did all sorts of moral risk evaluation; I just wasn't a peaceful person about the whole uncertainty thing) or the hospital birth I thought about choosing. Because I know that I'm not in control -- and neither are they! Yes, I want and plan to do what I can to create a healthy pregnancy and birth and maximize those VBAC chances (I think about your "vegetable project" often when it comes to the weight loss I'm not yet doing to prepare, sigh.) But I don't know how much my previous "if I were in a hospital, people walking in and out of my room might make my cervix close up" mindset could have been a self-fulfilling prophecy if I had chosen hospital birth. Probably not describing it very well, but the point is that it's a "God is in control, I have to do my best with the options I have, and not lament that none are perfect" approach that has made me a much happier mother even in regard to future expectations after having my plans go awry and receiving a second scar that would deny me the chance to VBAC with many if not most doctors (and all local nurse-midwives.)

I agree that a 27% section rate is outrageous, and current childbirth practices must change. Besides home birth becoming recognized as a safe option, I'd really like to see more hospitals adopt low-intervention policies. I recently gave birth to my first child in a wonderful hospital that treated birth as a natural process that deserved support, and good medical intervention when absolutely needed. Rooming-in was the norm, and my son went to the nursery only once for his hearing and metabolic tests, with my husband in attendance. My husband also gave our son his first bath, with the nurse talking him through it. Throughout labor, my husband and I had free access to a stocked kitchen, I could get into a birth tub whenever I wished (or even have a water birth if I wanted), where the nurses helped DH with labor coaching, but were willing to leave us alone if I wished, etc. If anything had gone wrong, the medical equipment was in the cabinets above the bed. It was such an ideal birth that for our next child, we'll go back if we can, despite the fact that we've since moved halfway across the US.

I sense a lack of confidence in many women, regarding the ability of thier bodies to do the hard work of birth. It takes very little to convince them to hand over their births to the "medical establishment." I don't think the doctors who rely on c-sections are evil, just trying take as much unknown out of the process as possible, de-mystify birth, if you will. This is all a relfection of our culture - science is more reliable than nature, mystery has no place in modern medicine, and for God's sake, let's avoid a lawsuit. By and large our society is afraid of transcendence, mystery, and unknown outcomes. I find it awesome to correlate the mystery of birth with the fact that as a Byzantine Catholic, we use the word 'mystery' for "sacrament". It applies to so many parts of life.

I think it will take much concentrated effort to help women, starting when they are yound girls, to learn and hang on to confidence in their bodies, in their ability to endure the clean pain of birth. People in the birth industry need to be trustworthy, so a women in labor can trust the suggested interventions as truly necessary, not just expedient. This will happen only one birth at a time, but it can be done.

Part of the reason why there's a 27% C-section rate is because more women are asking for C-sections months before they even go into labor - they want a date they can put on the calendar. It's not so much that all these women are being pushed into C-sections at the slightest indication that things aren't going according to medical text-book standards - some of them are pushing the doctors into giving them C-sections.

And, of course, doctors are caught between a rock and a hard place in this litigious society of ours. It's not just insurance/profitability issues. One bitchy mom who doesn't have the Hallmark Card experience she envisioned, and a doctor can lose everything.

I think many doctors and hospitals are as frustrated as you are - but what can they do? Their hands are tied - by demanding and pushy women, by insurance companies/HMOs, and by the fear and threat of lawsuits.

Also, I think it's important to point out that there is a range of choices between the typical, clinical atmosphere of the kind of hospital births someone of, say, my mother's generation may have experienced, and the kind of homebirth you experienced. Some hospitals have lovely birthing wings attended by nurse-midwives, for example, and some home births are positively nutty and batty and barmy and probably dangerous.

I posted this last night in a hurry to get it out of my head before our school year starts, and this morning I am seeing the holes in it. RO, thanks for telling your story. I am sorry things didn't go as you hoped they would.

CC, point taken. I am reading this over again today and I sound more like Naomi Wolf (hospitals wresting away control &c) than I meant to.

I didn't see many holes in it, though there might've been some -- I think my sore spot is an acknowledgment of the truth contained as well as an acknowledgment that I'm presumptively not one of those "low-risk" women anymore. Many but not all people I know in the "birth community" would probably rebel strongly against that idea, and support me more if I planned to go try VBA2C in a cave than in a hospital, so now I'm kind of in this weird place as a would-be homebirther who is almost certain she should go to the hospital for a labor many hospital types would be very negative about.

I'm surprised. Usually I'm the first woman to jump into the comments section to say that I had a wonderful, empowering natural birth in a hospital. I'm glad that this time I'm not the only one who has had that experience! Between hypnobirthing and an OB who promised me as "non-medical" a birth as possible, I had an intervention-free birth that just happened to take place on the hospital's bed instead of my own.

I mention this not to knock homebirth, but just because I want women to know that they do have options, even if circumstances demand that they birth in a hospital. I think that the problems with medicalized birth go along with the general reticence of women to stand up to their doctors, to trust that they are smart enough to do their own research and understand it, to ask questions and expect real answers. Most people, I think, don't know their rights as a patient. We're just so cultured to think that the doctor is a superior being, that we shouldn't question the doctor's orders. Yet we always have the right to take charge of our own treatment, even to refuse treatment if we so choose. There are OBs out there who are happy to act as midwives, OBs who know that birth is usually a safe, natural act that requires observation more than intervention. It's just a matter of being bold enough to ask for the kind of birth you want, and being willing to walk away from a doctor who is too knife and needle-happy. (I recognize that this is terribly written, but it's just too hot for me to make sure that all of my pronouns agree. I hope my meaning gets across nonetheless.)

That was beautiful. I agree, 100%.

i wrote a long response, but I'm takin' it back to my own blog so as not to clutter your comments space unnecessarily with my rantings...

I agree with Jamie and the other posters about the need for birthing choices, and my original post wasn't intended to knock anyone who made (or is making) different choices from my own.

My point was that it's incumbent upon women to choose providers and birth locations that are a fit with their own birthing philosophies to ensure that they receive the best level of care. I'm sticking with my high intervention birth plan at my high intervention hospital, which is what I believe I require and what I believe my provider will do best. Had I wanted another bith plan, I would have chosen a different provider and a different birth location.

For me, my birth need not take place at home in order to be miraculous.

Thank you for this post. Like ro, this really strikes a chord for me. I'm still sorting out my feelings about the births of my three children. Before my first son was born, I considered a home birth. I felt very strongly that childbirth is a natural process(and still do), and I've always had the sense that, by God, this great big wide ass is here for a reason! Which is to say, I thought I would have no trouble.

I did opt to give birth in the hospital, but it was a very progressive, non-interventionist facility. So with my first child, I woke up with a crushing, overpowering contraction. I waited for it to pass so I could wake my husband (he was sleeping in another room), since I could barely breathe, let alone call out. And the clock showed five, ten, fifteen minutes, and it still didn't pass. Long story short, I finally managed to wake my husband, and the contraction didn't stop until they gave me a shot to stop it at the hospital a half hour away. I was only fingertip dilated and the baby's heart rate had got down to 50 during all this. They tried a couple of things, which didn't work, and then I had an emergency c-section.

I wanted a VBAC for my second child, which the doctor was happy to accommodate; she felt my first delivery was a freak event, possibly caused by an infection in the amniotic fluid(which it turns out I also had). Again, leaving out the details, pretty much the same thing happened.

This was all pretty crushing, because I had so wanted to have a natural delivery for both kids. I also had a few occasions where other women(strangers) would ask me about the births, and when I told them emergency c-section, I would get a knowing look and a little lecture about how uneccessary most c-sections are. Implication being that it was my fault, and I was a dupe of the medical establishment.

With our third child, we decided that we'd had enough trauma, and scheduled a c-section(the doctor wouldn't let me go into labor with my history anyway). Except I never made it to my c-section; my uterus ruptured while I was at home, at 34 weeks. This has a happy ending though-- the rupture was not along the old c-section scars (where the placenta was) but on the back, where I'd had laparoscopic surgery many many years ago for fibroids. So the baby was early, but fine.

So what's my point here? I always hesitate to put my story out there, because it sounds like I'm trying to scare people off home births or natural deliveries, and that just isn't the case. What happened to me just doesn't occur very often. But it does happen-- it happened to me, 100% of the time. I have a lot of grief about that, but I love to hear about women who actually are able to have a delivery that works the way it's supposed to. At the same time, without medical intervention, I wouldn't have any children, and I wouldn't be here either. Would I have had normal deliveries without the prior surgery? I don't know.

Sorry this post is so long, and such a mess. It's an emotional topic for me. But, again, thank you for your thoughtful post, and I'm so glad you had the positive experiences you did.

Btw, continuing with my previous "I just had to say this! Who cares how much space I'm taking up!" spirit of things -- my first c/s for the "usual reasons" means it followed an induction I consider unnecessary, epidural, artificial breaking of waters, etc., then I was "supposed to dilate 1 cm per hour" and the OB said she preferred to do c/s while everyone was "still healthy" rather than as a "rescue" (she said I could go on "like that" if I wanted to.) But my baby was in an asynclitic -- sort of tilted -- position when my womb was opened up, and I am very doubtful that that would have been righted just by my continuing to lie there hungry and thirsty and sleep-deprived once all the other interventions had been done. So I think there is no reason to think it likely a c/s would have been needed if it had not been so interventive from the start, but also unlikely that the "stuckness" would resolve somehow the way it was going.

Though in my second birth earlier intervention almost certainly would have given us *more* chance at a VB, just less likely to work than homebirth if my waters *hadn't* broken so early on.

I've apparently been to at least 6 cm both times. I never thought about transferring last time just for pain relief even though it was horrendously painful and I thought I could nap to make it go away for a while. So I think I can handle VBA2C and I thank God that VBA2C seems to be available to me with local OBs. My OB, who has many "credentials" to earn mainstream respect, is more informed than the usual about fetal positioning. He does vaginal breeches and twins (not sure about VBACs for those, maybe.) I'm so sure VBA2C is the way for me to go in the absence of other complications that if the locals begged off for some reason, I'd travel and rent a place if I could to be near a doctor I trusted in a setting I considered safe. But unfortunately, there is this "well, if you refuse to do a homebirth, why complain? hospitals aren't for natural processes" strain I hear in some birth-community quarters that leaves me thinking I'm just going to relax next pregnancy and not waste my time with that kind of "support" in person or on the Internet...

And Martha, I'm so sorry about your UR and so glad your baby is okay! Even though UR is so much more common among mothers with prior c/s, I've heard about the ruptures perhaps fairly often not happening along the c/s scar itself. I wonder whether there could be some kind of overall structural weakening from being incised in one place, particularly when there has already been other stress to the uterus like in your case.

That's one of my differences with some members of the natural/homebirth/VBAC groups: hey, my uterus has sustained wounds not everyone's has -- I can't just undo that by being "more natural" this time around.

Ban me, Jamie, or I might post more...

Please just don't ever take this post down. I have seven months to convince my husband that staying at home is NOT dangerous and that it's, in fact, better. Thank you for hopefully helping me get there.

Good for you for writing this. Whenever I start to think about childbirth and how it should be, I just tired, angry and overwhelmed. I have had three "natural" births at teaching hospitals (no epidural, no pain medication): one with just about every intervention possible (pitocin, waters broken, internal monitor, vacuum extraction) one that went quick and pretty smooth but I wasn't allowed to walk because I was leaking fluid, and one that went well considering that my emotionally unavailable midwife was also physically unavailable until about 15 minutes before the baby arrived (and about 15 minutes _after_ the baby was _ready_ to arrive) and no resident would touch me because I made my midwife bed and now I had to lie in it. See how incoherent I get? Anyway, good for you for getting your post out.

As a mom who has done it all (c-section, VBAC, homebirth,homebirth, homebirth transferred to hospital for emergency C due to cord prolapse, stillbirth and a scheduled C) I applaud your article Jamie! Well said!!

well said indeed. not too ranty, either.
I found that for years I had to explain(justify) my decision to have hospital births after having had 2 home births. I always told the casual listener that it was more about the people than the place, and that had the hospitals been staffed with nurses who actually listened or doctors who actually showed up before crowning (or midwives who acted midwifely) I probably would not have had homebirths. Not that the homebirths were bad, no, but there is something nice about being able to go away from the house and the housework to have a baby. At the hospital for my last two I was able to call the shots and keep away the curious, whereas at my first homebirth there were way too many spectators around. But I work in hospitals and they are 'home' to me in a way that is unusual for most pregnant moms.
But I do love home births, too. I love attending them because the families are so different than the whiny and scared moms that I see in my current practice. I don't blame them for being whiny and scared - that is what many of them have been taught to be by everyone from granma to the Baby Story on TV.
I do think, that if I were to be blessed with another baby (highly unlikely but not totally impossible - yet) I would NOT choose to give birth at the hospital where I work. I trust the other midwives and the OB docs there but the nursing staff on some shifts would make me bonkers, taking the baby to the nursery for every little thing. No thank you.
There are HUGE regional differences in how hospitals do things, and sometimes it isn't the docs who are fighting against the evidence based care. Many nurses prefer continuous fetal monitoring because it is all they have ever known and they are overworked and unable to spend enough time at the bedside.
The fear of lawsuits is a real disincetive to make any kinds of change that decreases the amount of data you gather or interventions you perform.
Maybe someday I'll post on what it feels like to give a deposition on a 'bad baby' case - especially when you know that no one could really have done anything differently.....

I didn't read all the comments, but I wanted to say, amen, and hell yeah! to your final paragraph. In fact, I think it bears repeating--

"I believe that for many women home birth can restore a welcome, appropriate feeling of autonomy. I believe, too, that a joyous birth experience lays an important foundation for new mothers. With home birth it's your living room, your fridge, your applesauce and your choice to eat it. It's your labor and you can climb in your own tub when it feels right to you. It's your pain: you own it, you ride it. It's your body, doing something astounding; it's your baby, whom you have yearned to meet. It's your birth -- your very own everyday miracle."

I think maybe I should say it every week, as a creed. ;-)

Thank you again for posting this!

I don't want to own ANY pain.

While I totally agree that American culture has unecessarily medicalized childbirth, my personal interest is in the disruption of antenatal mother-baby bonding.

I had a standard medical birth (induction/epidural) in the hospital, with which I had no problem. It was after the baby came when I started having issues with the hospital setting.

They took my son away from me after the birth and I didn't see him for hours. When they finally did bring him to me, they had already fed him from a bottle twice, and handed me a bottle of formula to "top him off" after I nursed him. They refused to let us room in together and put him on a three hour feeding schedule that left him too sleepy to wake up and eat when it was "time."

I was so lucky in the fact that I had educated myself on breastfeeding before ever coming to the hospital, and that my mother had breastfed five children. I knew enough to throw that bottle of formula in the trash, and to abandon their silly schedule. But how many new mothers know to do that? I think the lack of support for new breastfeeding mothers in this country is appalling, and it feeds back into the medicalized birth process.

I have since realized that if I want the kind of intense mother-baby bonding that I desire, I will have to abandon the medicalized birth situation, and go for either a home or birth center birth and hope for a healthy, term infant that won't need advanced medical care in a NICU.

I realize that some hospitals don't treat moms and babies in this manner, but in my area, one is hard pressed to find a hospital that truly values either natural birth or mother-baby bonding.

Re mother-baby bonding, second time around with my homebirth transfer turned c/s, some of the nursery people seemed to be the big problem. We nursed fine at first in spite of about *8* hours apart, but they wanted me to come on a 2 1/2 or 3-hour schedule, and didn't seem to want me hanging around or keeping the baby out of the box too much. The baby would get "tired" if I nursed him too long... Let me reiterate, this was a healthy, term infant being observed that the discharge report even said "never looked sick," let alone had symptoms of my infection. He never lost more than about 5 or 6 ounces off his 8 lb. 4 oz. birthweight. I understood him being in there at the very beginning, of course. It was also quite difficult to get any sleep and get to the nursery on their schedule with my painful c/s recovery -- one morning breakfast was unbelievably slow to arrive and I was slated to go there and try to nurse just feeling starved (this might have been during the formula phase mentioned below, I think I asked the nurse to feed him till I ate because I was so extremely weak and hungry and it was a bottle anyway :(.) I started to get engorged and couldn't pump almost anything (they wanted to top him up with my breastmilk for some reason -- maybe to "wean him off the IV fluids" or some such.) And of course they didn't seem to believe me that I had milk but the pump wasn't bringing it out -- they bought the idea that a pump is more powerful than a baby. Long story -- in the end I, who went through a lot to make sure my first cesarean-born son who had more trouble nursing at the very start, only had breastmilk and eventually was even bottle-free, let my baby have formula because I thought getting out to be with his parents was more important than being formula-free. The lactation consultant was "out" that day.

I got in touch with the LC the next day. Amazingly, like 10 minutes after she talked to me, she herself wheeled my baby right in... what a wonderful surprise, and that milk flowed -- pump more powerful than baby, my foot.

The nursery nurse who discharged us talked about how all these exclusively breastfed babies ended up coming back. Ha. When I made up a little Beach Boy song parody for us, "Nursing USA," (it's just a weird hobby) she got a mention: "Tell [nurse with 3-syllable name] I'm nursing, nursing USA!" Yes, triumph... but it still hurt a little to think about that unnecessary separation and interruption in our nursing relationship which led to some brief problems with serious engorgement once we were home. It obviously wasn't necessary for us to be staying separately and my son using formula if the LC could have my baby in my room within 10 minutes and the milk flowing so much that we were discharged with very little delay.

I never willingly used the nursery with son #1 -- after the basically unavoidable post-op stay of 2 or so long hours, we resisted all suggestions. So it was a function of the rest of what went wrong with the birth that he was there, but some staff were quite unhelpful. God bless the lactation consultant.

Living in Portugal means women do not have as many options available, which is sad. I'm very familiar w the German system and the choices women have there are mind-blowing. It seems that society in general tries its very best to ensure the mother can have exactly what she wants, even in a hospital, and there seems to be less misinformation and power struggles. This was so educational I don't even know how to thank you all, especially Jamie, who started the discussion. THANK YOU.

(Foropt, came via Leery Polyp)

Well said. Birth brings up such strong emotions. I have been thinking about your post all day. I've thought about my two c-sections (one breech, unexpectedly and one failure to progress mixed with my refusal to continue a spiral of medical interventions that seemed to me to lead straight into a c-section. I hadn't minded my first and I had easy recovery. Why prolong a terrible labor and then have a c-section? I quit while I felt ahead.) Such strong emotions that I feel the need to explain what doesn't really matter here :-) Each birth is amazing...we defend our birthing experiences or hate them because they can be described, dissected, regretted, rejoiced. They are an event. I wish we could use a post like this as a starting point with our health care professionals.

(Haven't read all of the comments, but am putting in my 2 cents...)

I can appreciate what you're saying with this post, Jamie. For most of my teenaged years I wanted to have home births, should the Lord bless me with a spouse and children. However, in nursing school I did my internship in Labor and Delivery (am currently a NICU nurse), and saw just how wrong the birthing process can go, even for low-risk pregnancies.

I 100% agree that birth is a natural process, that women usually don't need medical intervention, and that most OBs are way too intervention-happy (often for their own convenience). (Rules like no food or drink are just plain silly, and I intended to completely ignore them should I ever have children.) In spite of what many hospital births are like these days, with a little work to find the right midwife or OB and the right hospital, hospital births can be the same amazing experience that you describe when you wrote of Pete's birth.

Anyway, my point is that while, yes, homebirthing is usually safe and can be a wonderful experience, hospital births can also be wonderful and have the added benfit of being capable of handling any medical emergencies that arise. (Remember that even though birth is natural, many women used to die during this natural process...and some still do or come close to it...I've seen it.) So, given the medical crises that I've seen during the labor and delivery process, I want to be at a hospital...just in case.

Just to clarify my comment about some home births being nutty and probably dangerous:


Sorry, I don't know how to shorten links.

Suffice it to say, this is taking things a little too far.

Very, very well said.

I had my first baby at home 3 1/2 months ago. (when asked "Why homebirth?" I said, "What other options are there?") It was a very long, hard birth that did not go as I had planned. If I'd been in a hospital, they'd have cut me. However, it took me weeks to process it and learn to OWN MY BRITH. I was asked afterward if it would have been better just to have had a C-section. Absolutely not! I made it through and I did it in my own space. And the clincher: I was the first to touch my baby-- I pulled him up to my chest and held him and cried with him.

And afterwards, I realized that something in me had changed forever. I'm not the same person as I was the day before my son's birthday. When you say that we go through a door, you're exactly right.

Wow...you've given me a lot to chew on before the next one comes along...(God willing)
Thanks for this post.

lovely post.

I started out with a C section for "premature ruptured membranes, failed induction" I then had a mid forceps rotation delivery in the hospital, then a spontanous but not very happy hospital delivery...and after that six more kids born at home, some with lay (direct entry)midwives, some with just me and my husband there, and the last with a CNM.
For me reclaiming birth was a triumph of my life which otherwise has contained a lot of resigning myself and accepting rather than triumph. The youngest just turned 16 yesterday, and thinking about my births is still something which makes me happy. I have seen one quite uninterfered with hospital birth, my daughter's third, but mostly what I hear is that some of the unfortunate interventions of my day have been replaced by even more unfortunate interventions. When people make other choices I try not to say much, but my own experiences lead me to want to say "Right on" to Ina May.
I feel the norm should be home birth with midwives; the exception should be hospital with midwife support and OB consultation. I would say OB delivery for complications. if they would teach OB's to do what they used to do, difficult breech births etc, which they don't.
Most women can give birth and home is the best place to do it.
Susan Peterson

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