Ob/Gyn Wants Women to Stop Feeling Guilty About the Birthing Process

Stephanie Cajigal; Amy Tuteur, MD

Disclosures

May 20, 2016

Editor's Note:
Obstetricians may be losing ground to a natural parenting movement that's making women feel guilty about the birthing process, an ob/gyn blogger says.

Amy Tuteur, MD, is the author of a new book, Push Back: Guilt in the Age of Natural Parenting, that argues that misleading claims about natural childbirth, breastfeeding, and attachment parenting are causing women to feel like they're just not measuring up. Dr Tuteur is a former obstetrician at Beth Israel Hospital and clinical instructor at Harvard Medical School who now blogs at The Skeptical OB. She recently shared her views with Medscape.

Check out the interview below, and then let us know in the comments section whether you agree with her statements.

Amy Tuteur, MD

Medscape: Could you talk about what inspired you to write this book at this time?

Dr Tuteur: I've been a blogger for 10 years. During that time, women started writing to me, saying that they think they're horrible mothers and they hate themselves and they think their baby deserves much better than them. What's the reason? Well, maybe they had a cesarean section, or maybe they're having trouble breastfeeding. I would try to provide reassurance that these things were not the important things about parenting.

The first reason I wrote the book was because I felt that there were a lot of people who needed that reassurance. There shouldn't be, but there are.

The second reason that I wrote the book was because I began to ask myself: What are we doing to young mothers? We need to have a society-wide conversation about what's going on here.

Medscape: How has this feedback changed the way you view childbirth?

Dr Tuteur: It hasn't changed the way I view childbirth, because before I became a blogger, I was a specialist and I had had four children. So I knew a lot about childbirth. It changed the way I understood the pressures that a lot of young mothers face. There was a lot of competition when my children were small, but it was nothing like it is now. The more I looked into it, the more I thought that it was being driven by a business model from certain forms of midwifery—particularly homebirth midwifery—and the breastfeeding industry.

In its own way, it is every bit as toxic as body-shaming from the fashion industry. The fashion industry decrees what you should look like, so you buy more make-up and clothes and whatever else. The birth industry sets up an ideal of birth that's nearly impossible to achieve and then sells you all sorts of products and services with the understanding that if you buy them, you'll achieve that and you'll be okay with yourself.

Medscape: How do you define the "birth industry"?

Dr Tuteur: Midwives, doulas, childbirth educators, and such organizations as Lamaze International and the Childbirth Connection. I know that when I first say it, a lot of people are like, "Oh, there's no industry"—perhaps because they think of an industry as something where you make a billion dollars. Individual purveyors of goods and services won't make a fortune, but their work is generally 100% of their income, so they're very motivated to commodify birth and sell products.It's not to say it's a cynical effort, or that they don't believe it. They absolutely, positively believe it, but it isn't true; it's all made up. It has nothing to do with what's good for children and everything to do with convincing women to buy their goods and services. For example, doulas promote the idea that obstetricians don't listen to or care about women's preferences, and therefore they ought to spend hundreds of dollars hiring a doula to "communicate" with the medical staff.

Medscape: You really take the natural childbirth movement that became popular in the 1970s to task in this book, basically saying it led women to believe that anything that's natural is safe. However, isn't it true that this movement also helped make the birthing process a more humane experience and helped foster better mother/baby bonding? For example, it's now commonplace for babies to sleep in the hospital room with their mothers and for mothers to be introduced to breastfeeding immediately after giving birth.

Dr Tuteur: The thing about initiating breastfeeding immediately always struck me as weird. I breastfed all my children, and I enjoyed it. But really, a baby has just been through—for some—a very difficult experience. Is that what a baby really wants to do? Eat? I've seen babies who want to see who's here or what's going on, and other babies who are completely wiped out. This whole idea that in order to mother properly, you have to do everything in a certain sequence and at a certain time, has nothing to do with what we know about babies' needs. The work of [John] Bowlby and others on infant attachment never even looked at feeding.[1]

That's one of the things that's so disturbing to me about all these rules. Babies rooming in? That's awesome if that's what you want. But what if you had a 40-hour labor and a C-section and you were up for 3 nights in a row and are exhausted, and you don't want the baby in your room because you want to get some rest? Is that really so unreasonable? Why should the baby be in your room if you're too tired to take care of it? If you talk to the activists, they'll say that it enhances breastfeeding. There's not a single piece of research that shows that it has any impact on breastfeeding at all. If it has no impact on breastfeeding and it's harmful to mothers, why are we doing it?[2]

Medscape: Breastfeeding rates have been going up, however. What would you attribute that to?

Dr Tuteur: There has been tremendous pressure to breastfeed, so a lot more women are starting. Exclusive breastfeeding rates are going up but are still relatively low. The thing is, if you look at breastfeeding rates from, say, 1900 to 2000, during that century the breastfeeding rate in the United States varied dramatically.[3] It went from about 90% at the beginning of the century and dropped like a rock until about 1973, when it was at its lowest, with 24% of women initiating breastfeeding; then by 2000, it was back up over 70%.[3] The infant mortality rate dropped slowly all through the 1900s, while breastfeeding rates dropped, and continued to drop a little more slowly while the breastfeeding rate rose.[4]

Medscape: Is there anything obstetricians can do to help their patients feel less guilty if they need an intervention during childbirth?

Dr Tuteur: I think obstetricians are already trying to do that. There's a lot of bewilderment among obstetricians about what is going on. When I was practicing, I would make rounds after delivering the baby—there was a healthy mother and a healthy baby—and I'd go in the room and the mother would be crying, and she'd say, "I'm a failure." I'd say, "Wait, what happened here?" and she'd say, "I had an epidural." I would say, "Yeah, so why wouldn't you have an epidural? [Childbirth] hurts worse than anything." We don't say that men are empowered by pain, so why do we tell women that they'll be empowered by it?

I think the big problem is that obstetricians have no idea of the level of craziness of the stuff patients are reading. Obstetricians could do a better job if they understood what they were up against. The problem is they don't have time to read this crazy literature the way I have time because I don't practice anymore.

The other thing is the kind of stuff that patients read is meant to foster distrust between obstetricians and patients. In these books—such as The Thinking Woman's Guide to a Better Birth by Henci Goer—women are told, "If you tell your obstetrician that you don't want X, Y, Z, he's going to complain, or she's going to complain because all they want to do is get to their golf game." When the patient tells the doctor, "I want this (thing that isn't really reasonable to want)" and the doctor tries to discuss it, she says, "See, this is just what they told me was going to happen."

Medscape: What's the message that you feel patients aren't getting?

Dr Tuteur: The good news is that modern obstetrics works so well that people actually think childbirth is safe. It's kind of like vaccines. People don't realize what vaccines do because they've never seen what it's like without them. But it's very hard to convince women of [this message] because they've been primed by all these books and websites and message boards to believe that childbirth was always safe, and that the people who screwed it up were the obstetricians.

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