Why birthing women take an advocate to the hospital

This oped piece was published in the Canadian Medical Post. Read my reply to the doctor at the end of the item. Gloria

February 18, 2003 Volume 39 Issue 07


OPED: The unpopular science of birth
We have to incorporate the connection ‘natural’ healers such as doulas
make with patients—without abandoning science

By Richard Gruneir

I’m beginning to think everyone but you and I are crazy, and I’m not so sure about you any longer.

I practise obstetrics. I know you are already questioning my sanity but I can assure you I remain moderately sane most of the time. But as Bob Dylan sang, “The times they are a’changin.’ ” What is going on around me is putting pressure on my tenuous hold on normalcy.

Everyone who has had a baby or knows someone who has had a baby, or even watched the scene in Gone With the Wind where the baby is birthed, thinks of herself as an expert on the subject of obstetrics.

I have attended about 7,000 pregnant women and have a good idea how the complicated collection of things that must come together in just the right way for there to be a good outcome actually come together. I still get a big kick out of seeing the “munchkins” show up. Truly a marvellous event.

What scares me is that the experts seem to be taking over. (See two
paragraphs above for who is an expert.) And they all purport to support something called the “natural way.”
I have seen the natural way and am pretty sure the women deep in the hinterlands of developing countries aren’t thrilled to have it so
Natural includes experiences that filled the obstetrics textbooks,
including dead babies, dead mothers and everything bad in between that can happen to both of them. These things are usually preventable if someone with skills and knowledge and understanding is there to help. Natural is what our grandmothers and great-grandmothers had here in Canada when only 30% of their babies reached their first birthday.
Off-hand, I was unable to think of anything natural around me that isn’t today considered pathologic. The great public health initiatives of the early 20th century intervened in the natural processes and life
expectancy skyrocketed. The two most important are likely water
purification and vaccination programs.
Just think about Walkerton, Ont., and what happened when the basic water purification system broke down. A substance everyone needs daily went from being safe to being deadly.
Some will argue water without contamination by civilization was clean to begin with, but that’s not true. Animals in the forest deposit parasites in the water that can find a human host not in the normal life cycle of the parasite (Beaver fever anyone? A great Canadian favourite).
Seen any smallpox, diphtheria, pertussis or polio lately? Ask your
mother what these epidemics were like when she was a kid.
So where did this worship of “natural” come from? What prompted women who otherwise seem intelligent and motivated to have good outcomes to trust helpers who are often uneducated, untrained and unlicensed with their health and the health of their babies? Where did all of these expensive helpers come from to give “natural treatments” to their “clients”?
When I say expensive, I really mean it. Apparently, doulas (a term from the Greek to describe a helper of women in labour) in the Toronto area are paid as much as $2,000 to help with the deliveries. The job requires being a coach, back rubber and supporter. The doctor who assumes all the responsibility for whatever happens gets only $340 in Ontario.
When I say uneducated I mean that the training course to become a doula is basically only a weekend, some reading and spending time with another doula during a delivery or two.
And unlicensed means no controlling body. Even your gardener is licensed to use pesticides. And bad or uninformed advice during labour and delivery can be as deadly as the incorrect use of poisons and pesticides.
The most incredible thing is that this “natural” approach trumps doctors and nurses. When did we become the enemy? When did it start to appear to our patients we didn’t have their best interests at heart? What did we do to lose our patients’ trust?
The only thing I can think of is that we are seeing an attempt to regain control. The white coats are much too scary and too much in a hurry to be viewed as empathetic and part of the process rather than just as controllers and disinterested observers.
We are going to have to slow down and reconnect with the mothers.
Maybe the real solution is just to act natural.
—Richard Gruneir is an ob/gyn in Leamington, Ont.

In response to:
OPED: The unpopular science of birth

Dear Medical Post

I read with interest the OPED piece by Dr. Richard Gruneir in which he
laments the rising trend of patient advocacy in obstetrics. (February
18, 2003 Volume 39 Issue 07) This obstetrician wonders why women in his community are spending up to $2000 per birth on a doula and asks the (probably rhetorical) questions:

“When did we become the enemy? When did it start to appear to our
patients we didn’t have their best interests at heart? What did we do to
lose our patients’ trust?”

These are truly valuable questions because, in examining them, some
solutions to the rising cesarean rate and malpractice insurance rates
might arise. Physicians have lost the trust of childbearing women
precisely because of the attitude that Dr. Grunier displays when he
makes the statement: “I have seen the natural way and am pretty sure the women deep in the hinterlands of developing countries aren’t thrilled to have it so natural.” By painting the desire to give birth normally as backward and
ignorant, he shows that he has no clue as to the sexual, spiritual and
social importance of the birth of a child in a woman’s life. This is
the same denigration of importance that many physician’s placed on
breastfeeding at one time.

Modern women cannot wait until some
“scientific” randomized controlled trial tells them that having their
abdomen sliced open is horrific. It took 50 years until we got the
“science” that told us what we had already known
instinctively—episiotomies are horrific. The science is coming that
will show beyond a doubt that epidurals hurt women and babies, breech babies are best born vaginally without medications, nitrous oxide is harmful to babies’ brains, learning disabilities are related to vacuum extractors, routine Vitamin K administered at birth does cause heart disease in later life, ultrasonic non-ionizing radiation does produce cellular changes in the fetus and the ova, etc, etc, etc. One day all the physicians practising today will do a mea culpa about the harm they have caused childbearing women and babies (or as Dr. Grunier prefers–munchkins). Meantime,
Canadian women cannot wait for the “science” of obstetrics to tell them what will hurt their children today. Dr. Grunier is correct in thinking that the rise of the doula is a sign of the mistrust women have toward those who used to have dominion over their births.

Gloria Lemay,
Vancouver, BC
2002 Recipient CHOICES Women’s Voice Award
1997 Nominee YWCA Woman of Distinction Award
Advisory Board Member International Cesarean Awareness Network
Contributing Editor Midwifery Today Magazine

10 thoughts on “Why birthing women take an advocate to the hospital

  1. OPED reply:

    You must be a little nervous now. RN’s are. They are seeing more and more births happening away from their hospitals & L&D so they don’t have anything to do with new born infants! It’s leaving your facilities in the droves!

    Most MD’s won’t see new borns either, as most women birthing at home are attended by their midwife for the first 3 weeks and then over to an ND who doesn’t recommend the usual innoculations – so no illness’ caused there either!

    The birthing woman today would much rather pay $2000 to someone she knows and trusts than to leave herself and her infant open to these kinds of assaults on her body and her mind during a life changing event for her -is testimony yet…times they are a changing!

    YES! Doc. I would recommend you read: Magic In Practice by Garner Thomson, it’s a British book utilizing NLP – and it’s time this highly skilled technology make its way into the world of medicine!

    Maybe it’s time to learn how to speak to your clients
    with respect, and with appreciation for how much work they have done to educate themselves on this experience.

    How to treat them, how to behave civily to another human that is in an intense experience, except to hack into her and cut out what seems to be causing her problem!

    The only way you will get this is when you start losing business! And you are! Women prefer to birth at home, labour in their own enviornment and have trusted friends and assistance than to be assualted with :

    Birth on the doctors time line
    Birth within the parameters of the doctors guidelines
    Follow doctors directions exclusively
    I will decide on your outcomes
    I will tell you…
    I will convince you with all the negative priming that can happen to you, and if you don’t believe me the way I want you to, then I’ll bring even more things to show you I mean business!

    And one last little point, using the past history of the millions of dead babies and women, well how ever then did we ever get to 5billion plus on the planet?

    Your arguments Sir are just as inadequate in meeting the needs of birthing women today as the environments you ask them to birth in!

    That’s another can of worms that makes no sense whatso ever to ask a perfectly healthy woman to submit herself to the infections, bacteria, virus’ and super bugs of a hospital when her own home is much more suitable – however lacks an OR.

    These few small points alone are enough to convince parents today to take a second look at birthing at home!

    Empowering the parents is another huge positive that gets overlooked! As a father to be, why leave him standing in the shadows as others take over his wife and his child and leave him feeling inadequate at best

    In the past in this country (Canada) where a couple were farming on the praries, a doctor would not get out to the farms until the spring. Who do you think birthed those infants? And how did those families get to the numbers they did? 10 & 12 strong!

    We need to look at just how much you are deleting and distorting the information Doctor, because that’s manipulation to get birhting women into a position that works for you! Not her.

    Pay attention, because you are going to lose more and more of the normal birthing in this country. 87% of births in the Netherlands are in homes with midwives and doula’s.

    That cuts down on :

    Hospital staffing, hospital costs, Nursery costs and Care, and cuts down on liabilities and hospital boards managing the birth problem in their hospitals.

    And your costs of $340 for a birth in a hospital today is just ridiculous, because if it’s a C-section that fee is somewhere in the area of $4800 – $5500.

    Isn’t it?

    hence our 33% C-Section rate….and growing.

    Pay attention, there’s Google now, and we can find out about every statistical report you throw at us to maneouver a woman into a C-Section!

    And then some!

    And you know what you know, so be aware we do too!

    Magic IN Practice – More doctors in the UK and Europe are taking this training, because medicine should do what it says it’s main objective is:


    Kathy Welter-Nichols,
    Cht., NLP Medical, HypnoBirthing, Doula
    Post Partum Care.

  2. I was 38 when I gave birth to a beautiful healthy baby girl at home here in Chicago. We searched and read a lot about homebirth advantages and we decided to give our baby a very nice start of life. We were lucky to live in Chicago, because we chose to have a birth at home with both midwife and a doctor through HomeFirst. Homefirst is a group of doctors. I took care of myself very well for my baby. We enrolled in a child birth class and had the nurse/midwife come over for the 4 classes. I was educated and informed better and got ready for my homebirth. I had a doula too, who was a big help to me. It was her that I held onto and hugged and walked around the house with during my long hours of labor. But most of all is I have my husband beside me whenever I wanted him to take place of the doula. We payed $400 for the doula which stayed from 8 am to 12 midnight. The doula came over first and then the nurse/midwife who monitors the baby and make sure that I am doing fine, and the doctor was there to make sure that everything was OK. I had my mother in-law, my 2 sister in-laws and I delivered my baby kneeling down holding on to my husband’s leg beside the bed. I didn’t want a bright light so our room was dim. I ate, I walked around the house. It was so special moment to us. I didn’t had any injection or medication. My baby was perfectly fine and we even decided not have any injections to our baby after birth. An hour after I gave birth I walked to the living room and sat in a rocking chair carrying my baby and breastfed her with all the support from my nurse, doctor, doula, specially my husband and the love of my in-laws. A joyful and wonderful moment that ever happened in our lives. The cost was $6000, which included the pre-natal visits. We recommend home birth to all our friends.

  3. Pingback: Why don’t women trust hospitals? | Best Health

  4. Dear Dr. Gruneir:

    Please provide source citations for your claims.

    P.S. You lost our trust when you decided “that’s the way I’ve always done it so that’s the way I’ll always do it” was a better choice than evidence-based practice.

  5. Dear Dr. Gruneir,

    Please read your posting again. If you don’t get why women don’t trust you, read it again and again and again and keep reading it until you ‘get it’. If you read it a hundred times and still don’t get it, you are hopelessly devoid of self-awareness and deserve to be left behind by those who do ‘get it’ – I’ll give you hints: attitude and propaganda. . . . . . I doubt that you are a stupid man so stop whining and dare to ask yourself the hard questions. It’s about so much more than the scary white coats.

    Good luck.

    Laurel Brant

  6. Someone should direct him to My OB Said What. Then he can see exactly how the medical profession lost the trust of birthing women. We all either have been or know someone who has been injured because they were foolish enough to trust doctors/medwives with their own and their babies lives and health.

    More women are becoming aware that doctors and courts feel free to strip pregnant and birthing women of their right to informed refusal. Why on earth would they trust that they would be lucky enough to avoid a careprovider who refuses to listen to “NO!!” when there are so few who do. Maybe if there were actual, legal consequences for doctors who violated pregnant and birthing women, women would have a bit more reason to trust them?

  7. Why am I sitting here clapping? I wished I had thought of the problem of overpopulation in the world – what a good reply. Of course women in Australia were and many still are hundreds of miles/kilometres from “civilised hospitals”. Many of our local hospitals have been closed as it is too dangerous for them to not have a doctor. However they are allowed to drive 150 miles along a winding narrow coast road at night in labour to the nearest “civilised” hospital .

    My grandmother in the early part of last century had 12 children. All she had was a bottle of brandy to “get her through”. For the last baby guess who drank it – her alcoholic husband so she got “through” without it. That woman lived till her late 80’s and I was told by locals when I nursed in the bush hospital that old Grandma S was seen taking her laundry in a horse and sulky to the river to do her laundry in the 1930’s.

    Midwives worked out in the bush during settlement days and mostly aboriginal women gave them lessons. Aboriginal women here are being forced to fly away from home to birth – and they wonder why families become dysfunctional. It is the woman who runs the home she is the hub of the wheel.

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