As a both a birth attendant and a mother who chose for herself 4 unmedicated
vaginal deliveries, I have a lot of interest in the use of interventions in
childbirth.  I also just finished reading "The Impact of Birthing Practices
on Breastfeeding," and was interested to read the research on the effects of
bhildbirth interventions on breastfeeding.  (And also a little disappointed
that there is not more high quality research available.)
Before I entered private practice and was required to practice a more
interventionalist style in a teaching hospital, I thought if I just
explained the risks of interventions to moms, they would naturally choose to
have as little intervention as possible.  I also used to think women who
were educated about the risks of artificial feeding, would naturally choose
to breastfeed.  Turns out neither were necessarily true.  Birthing culture
in the US is focused around a medical model where women expect to need a lot
of medical help to have a baby.  Infant rearing culture is focused around
the "things" one needs to have a baby.  Simply providing knowledge cannot
often change these culturally held beliefs.
I can talk until I'm blue in the face to some women about the risks of
childbirth interventions, and they will continue to insist on epidurals and
inductions.  They arrive to the labor suite with absolutely no coping skills
whatsoever, and often refuse all non-drug pain relief measures (walking,
position changes, shower, massage, etc.)  For me, trying to practice in a
non-interventional manner is pretty difficult when so many of my patients
not only don't value normal childbirth, but insist that labor be
"pain-free."  These are the same women often who I can talk until I'm blue
in the face about the risks of ABM and they will continue on instead with
some variation of "formula-fed babies are just fine" thinking.
It is easy to blame HCPs for medicalizing childbirth, and in truth many may
be to blame for promoting medicalized birth.  But I find in my own practice
that many women insist on clinging to a model of relationship where the HCP
bears all the responsibility.  Add to that the litigation situation here,
and it's no shock that doctors have become interventionalist.  While I most
enjoy working with moms who have done their own research, and who want my
support for as normal a birth as possible, these women are in the distinct
minority here at least.
We tend to often harp on the role HCPs play in pushing interventions, but
HCPs are not the only ones to blame.  A cultural shift is needed!
Jennifer Tieman
Family Physician
Mom to 4, including nursling Caroline Rose born 5/31/03

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