D (9:06)

This is Dr. Chapa's obgyn no spin podcast.

C (9:36)

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E (10:06)

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D (10:36)

I'm simply saying that life.

D (10:39)

Finds a way that's pretty much the at the heart of this movement, which is, hey, it's nature. Life will get you through this. Your body's mechanics, the naturalness of this will work.

D (10:57)

I don't mean to make fun of it. I'm really not. And guys, I do believe there's something about grounding the practice, the exercise of meditation and mindfulness where you take off your shoes and you go walk through grass. As long as the grass isn't full of poop or snakes or something. And that grounding, that feeling of the earth, hey man, I'm all for that. And like I said, I'm very traditional medicine. But there is something to get your Butt outside, get some vitamin D. The sun is phenomenal, which is why we have seasonal affective disorder in parts of the world, part of our country that have a lot of cloud cover. Right. So there is something to that. No question. However, the idea that nature will entirely take care of you. Obviously you've never been out into the woods in West Texas because nature will kill you. So this is the idea. It's a right concept as everything else in a new fandom trend takes a little piece of good information that is actually correct but extrapolates it incorrectly. So free birth. Wow. Birth is actually a big thing right now on social media. Surprise, surprise. And it's gaining a lot of traction because of the distrust of medicine. And I get that y', all, I'm very profess medical, professional, society friendly. I get that. However, I also do get the room for discourse, the room for open discussion, the room to question things based on some of that's tradition, some of that may be, let's call it what it is, you know, corporate sponsorship of something where medicine, you know, soon becomes very similar or assimilates to a, you know, a pharmacy ad on tv. You're like, where's the line here? Let's just stick with the evidence. And then without getting the influences of other things. This is what frustrates not only physicians, but obviously patients. And this is where we are. So this, this rebuttal, this refusal of mainstream medicine is absolutely allowed in medicine because of patient autonomy. However, patient autonomy is a fine line and it's a fair balance, fine balance between that advocacy for the patient to be well informed and at the same time allowing a potential birth atrocity like is covered a heartbreaking story that is covered in the Guardian piece. I'm gonna put the link in our show notes. But of course as you would expect, the horrible case of a, of a birth shoulder dystocia which happens at home, you can pretty much imagine how that went. And it's horrifying. And not only because the labor and adverse issues are predictably unpredictable, but the grief and the self blame and regret that at time the mother and or the entire family have about choosing this when it otherwise potentially not that all things are preventable. And I'm not saying that, I'm saying they're much better manageable when they're in a clinical healthcare setting. Okay. Because this story does talk about almost this very cult like vibe here of these societies. And that is not my words. Okay, Please don't send me any ugly messages because Michael, I'm sure Deletes half of those stuff anyway. Some of them gets through. I don't know. I, I tell them just leave it alone, because I'm all for open discussion, but sometimes he's like, yeah, we're not, we're not sharing that, but whatever. And it goes through. It's a very long piece, very long piece. And it really goes through some heartbreaking causes. The short of it is, guys, is that an eclamptic seizure can kill somebody. Postpartum hemorrhage will kill a woman if we don't have uterotonic agents or the right skill to protect that and, or give her blood products. Shoulder dystocia may potentially severely neuronally injure a child and or cause fetal death. There's so much to potentially lose here, so much potential lose here, that our job isn't to be confrontational, is to give the patient exactly this education. If you are choosing a planned home birth, please, please know that that is part of your free will and ability to choose where you want to deliver. That's called patient autonomy. But there is a statement from the ACOG that predates Covid, but it was said again in 2020 in the middle of the COVID pandemic. And it's ACOG statement on birth settings. And of course, we'll post that link in our show notes. But as you would think, it says exactly what the previous guidance stated, which was ACOG's Committee Opinion 697, that the safest place is in a hospital setting. The next step down is at a certified birth center that has quick access or open communication to a hospital setting and that has medically trained peripartum personnel there. The least safe seems to be unattended home birth. Now, let me be very clear. This is unattended on purpose. There are some unattended home births where, you know, we have plenty of grand mole tips like G8S, G9S, and that's a risk factor, of course, not only for macrosomia and shoulder dystocia, because babies tend to get bigger as the pregnancies go, but also for a postpartum hemorrhage. But sometimes, you know, they just have a couple of contractions and boom, there's a kid. Now, thankfully, because they've been through it several times, they kind of know what to do. So that is the unplanned, undesired, unattended birth, because things happen so quickly. That's not what I'm talking about here. Even though that's risky in and of itself. I'm talking about the deliberate decision to when I break my bag of water, when I have regular onset of contractions, I'm going to stay home and do this joker in my bedroom. One, hope you have a lot of sheets and towels. Two, knock yourself out. It is part of patient autonomy. But we do have to be also that patient advocate to go. I really recommend you not do that and here's why. In an empathic and compassionate manner. So again, I'm not going to cover a bunch of articles here. I just wanted to give you those two references from, from the college. There is also a very nice piece from the New York Times and I'm not very New York Times friendly, but they do have a nice article that also covered this on the harms of unattended home birth based on, on this popularity, based on social media. So it is something that people are reading and that are out there so very quick. I, I and this also stems from two things. One, this Guardian article that came out, and somebody did message me actually when this came out the next day at the end of November, said, hey, can you just put something together? And I'm like, well, yeah, but there's not a lot to say except, you know, basically, buyer beware. I mean, if the patient wants to take the risks into her own hands, and that's fine. But there is a distinction between wild birth, which is absolutely no care at all, antepartum or intrapartum, which even extends, I guess, to postpartum, whereas free birth is. Some of those patients may elect to have at least some testing done to allow them to have an unattended birth, which in and of itself is very risky. But there's a lot of dangers here and a lot of this has to do with past ptsd, past patient dissatisfaction, a rejection of common medical practices and norms for a variety of issues.

D (18:16)

And when this has actually been published, it's really not for cost, guys, because there are a lot of patient financial packages and or state funds that can help patients for emergency coverage. This is typically those who have a distrust of the medical community, a distrust of medical professionals and or nursing professionals. This is deeper than just finances. So please don't message me and say some patients don't have the money to go to the hospital. I absolutely get that because those are all my patients, because there's ways to help them. The hospital will help them either through local funds, charitable gifts, state funds and or federal funds. So most of these are a deliberate rejection of medical care because of distrust or past negative experiences, not because of a financial issue. Okay, so the wild birth or home birth phenomenon, it really is kind of wild. And it really does go to show how a dissatisfaction with with a current system, in this case, you know, medical care and traditional prenatal care, can really actually kind of go south. So just because it's nature and just because it's natural doesn't always mean it's good for you. Just ask those bitten by a rattlesnake in one of our Texas woods.

D (19:40)

Look, man, a little bubbly bubbling brook, sounds of birds in the air. I love it. It's great. But nature is not always your friend. Podcast family. We've covered the free birth and the wild birth movement just as part of our own awareness of what's going on. So if patient asks you what do you think? Say, well, I'm all, I'm on your side. I want to be your advocate. However, that doesn't mean we always have to agree on you potentially picking a dangerous with devastating outcomes. Decision making that decision can be very traumatic. So let's talk about it. That's all I'm saying. Free birth and wild birth pocket family. Now that we've done all that, Michael, let's take it home.

D (20:54)

This has been Dr. Chapa Zobi Gyn no Spin podcast.

D (21:01)

Podcast family. Thank you for your support. Thank you for listening. And as always, we'll see you on another episode of the no Spin Podcast.