Ina May Gaskin has blood on her hands

Why are reporters so credulous? Why don’t they ask hard question? Why do they fall for smoke and mirrors?

That’s what I’d like to ask the long list of journalists who take Ina May Gaskin at her word and never investigate. Samantha Shapiro is the latest reporter to allow herself to be hoodwinked by Ina May Gaskin in the article Mommy Wars: The Prequel: Ina May Gaskin and the Battle for at-Home Births.

Let’s get something straight: Ina May Gaskin has blood on her hands, and not merely the blood of her own child sacrificed on the altar of homebirth. Gaskin presides over a large multi-faceted business empire comprised of trade, propaganda and lobbying organizations, all with one purpose in mind: allowing uneducated women like herself to provide substandard medical care to pregnant women while ignoring the growing pile of tiny bodies.

In discussing homebirth, there is one question that MUST be asked and answered. How many babies die at the hands of homebirth midwives? As far as I can tell, Shapiro didn’t ask, wasn’t answered, and didn’t bother to investigate on her own.

It’s not like the data isn’t available:

The latest CDC figures (publicly available on the CDC Wonder website) show that planned homebirth with a non-nurse midwife has a mortality rate 600% HIGHER than low risk hospital birth.

Nearly all the existing scientific studies, as well as state, national and international statistics, show that planned homebirth increases the risk of perinatal mortality 3-7+ times higher than low risk hospital birth.

Colorado has had a rate of homebirth death that exceeds that of the state as a whole (including premature babies and women with pre-existing medical conditions) AND has risen in every year since they licensed homebirth midwives in 2006. California has a homebirth death rate that is double that of low risk hospital birth. In Missouri, the risk of intrapartum death at homebirth is nearly 20 times higher than hospital birth. Oregon has received complaints on 19 deaths, nearly 4 times the rate expected in the years the data was collected. And North Carolina is vying to be the homebirth death capital of the US: they had 5 publicly reported homebirth deaths last year for a rate 12X higher than low risk hospital birth.

Studies from the UK show that homebirth increases the risk of poor perinatal outcomes. The data from Australia shows that homebirth increases the risk of perinatal death. The data from the Netherlands shows that low risk birth with a Dutch midwife has a HIGHER death rate than high risk birth with a Dutch obstetrician. There are one or two studies from Canada that demonstrate that homebirth rates can be safe when transfers during labor exceed 40%, a truly massive transfer rate.

The Midwives Alliance of North America (MANA), the organization of American homebirth midwives started by Gaskin, has collected death rates of 24,000 planned homebirths attended by their members. During the years they were collecting that data, MANA told their membership it would be used to promote the safety of homebirth. Once they analyzed the data, they reversed themselves. MANA refuses to release the number of those 24,000 babies who died at the hands of homebirth midwives. It doesn’t take a rocket scientist to figure out that MANA’s own data reveals appallingly high rates of perinatal death.

Shapiro ignores this mass of data. Indeed she never even bothers to look for any data. Instead her piece contains passages that could have been lifted directly from Gaskin’s promotional literature.

To her credit, she acknowledges that Gaskin has no training of any kind, that one of her own children died at homebirth when she refused to seek medical attention for him and that The Farm is a new age cult, but Shapiro gives Gaskin a pass on far more than safety data.

Shapiro does not mention (and perhaps does not know) that Ina May Gaskin is a feminist anti-rationalist. Feminist anti-rationalists dismiss science as a male form of “authoritative knowledge” on the understanding that there are “other ways of knowing” like “intuition.” Many are post modernists who believe that reality is radically subjective, that rationality is unnecessary and that “including the non-rational is sensible midwifery”

According to Gaskin:

… Pregnant and birthing mothers are elemental forces, in the same sense that gravity, thunderstorms, earthquakes, and hurricanes are elemental forces. In order to understand the laws of their energy flow, you have to love and respect them for their magnificence at the same time that you study them with the accuracy of a true scientist.

The invocation of mysterious forces, “energy flow” and intentional biologic processes marks her as a garden variety charlatan. Yet reporters like Shapiro are loathe to question her grasp of medical reality.

How much blood does Ina May Gaskin have to have dripping from her hands before journalists will think to ask about it? How many babies have to die at homebirth before it will cross the minds of Shapiro and her colleagues to investigate Gaskin as the deadly charlatan that she is?

I’m afraid that the only thing that will shake journalists out of their complacency is the death of a celebrity’s baby at homebirth. Sooner or later that is going to happen, and journalists will “discover” that babies have been dying preventable deaths at homebirth all along. Until then, they won’t ask the difficult questions; they’ll simply accept what Ina May Gaskin says and reprint it wholesale.

  • Michelle

    The alarmist language you have chosen here is disturbing. You are incorrect in your assessments despite your prestigious education. It is sad that you are a woman and doctor perpetuating fear of birth. I would venture to say she has helped many more women have a positive and healthy birth than you ever will based on your scare tactics. Shameful.

    • Stacy48918

      “You are incorrect ”
      Care to state in precisely which way, with documentation?

      Or do you prefer ad hominems that prove that you don’t actually know what you’re talking about?

    • Medwife

      The odds, for the majority of women, are for them coming out of childbirth alive themselves, without surgery, and with a live baby. (Are the majority happy with their unmedicated births? We don’t really know.) But there is a significant minority that will come out with horrible outcomes- stillbirth, HIE leading to permanent disability. So maybe more women have had positive and healthy births than Dr. Amy has saved lives, but she has SAVED LIVES. I really do think this and I started reading this blog feeling nothing but hostility. So, stick around. Really read. Ignore the emotional language parts. The data makes sense in a way that the “natural childbirth” papers and blogs do not.

      • Stacy48918

        “Are the majority happy with their unmedicated births? ”
        I wasn’t! I’d like an epi if there’s a next time please!

        • Medwife

          I was very happy with the unmedicated (by my choice, in a hospital, nothing crazy, etc etc) birth of my son, but I have met enough women and read enough data on PTSD and childbirth to know that not everyone is happy with birth au naturel, not by a longshot. I HATE reading about women who were begging to go to the hospital and get epidurals who were basically coerced into staying home. Liz Paparella’s story comes to mind, and of course she was one who also had a tragedy at her homebirth.

          I will rub backs and breathe and support a woman til the cows come home, but when she tells me she wants pain meds, she is going to get pain meds, and everyone else in the room can screw off. :)

          • Mishimoo

            Exactly! I opted out of pain relief after discovering that pethidine didn’t work for me (mildly dizzy + unable to focus my eyes) even though I had pitocin for 2 deliveries, because my contractions felt like gastro stomach cramps and weren’t a big deal to me. I will always defend my best friend’s right to and need of an epidural. I’m still angry with the CNM that delayed it and tried to block it, and I’m furious that her mother tries to make her feel guilty for having it and not birthing at home. (If she had, there is a fair chance we’d have ended up burying both of them)

  • Misis

    Your information about the netherlands is incorrect. Homebirth is as safe as birth in a hospital, recent studies pointed that out. But unfortunately in the netherlands birth gets more medicalised as in the U.S. and therefore more complications like extreme bloodloss happen but the perinatal deadth statisticus don’t go down. Women have to educatie themselves and each other more about birth and they should get coaching during the birth proces, also in the hospital. That is the only way to have more healthy birthings.

    • Susan

      Share the recent study you are referencing please. The regulars here are pretty up on these things and the most recent studies of homebirth have as far as I know have universally shown the homebirth has at least 3x the perinatal death rate of similar risk hospital birth.

    • Stacy48918

      “unfortunately in the netherlands birth gets more medicalised”
      Wrong. Low risk birth in the Netherlands at home with a midwife is more likely to result in a DEAD baby than high risk birth in a hospital with a doctor.

  • Dave

    As a first father who was considering homebirth I read this article with some alarm. I typed it CDC homebirth figures and the first article I found on the CDC website – the official government website – said this:

    “Home births have a lower risk profile than hospital births, with fewer births to teenagers or unmarried women, and with fewer preterm, low birthweight, and multiple births” (source: http://www.cdc.gov/nchs/data/databriefs/db84.htm

    Since the author didn’t provide links to her information, It appears that the she is making stuff up.

    • Trixie

      Welcome, Dave. Please stick around and learn.

      You seem to be confused about how the CDC is using the term “risk profile.” Home births have a lower risk profile than hospital birth, meaning that mostly low-risk women CHOOSE home birth. NOT that home birth is lower risk. The OUTCOMES of home birth, despite being mostly a phenomenon of low-risk, middle, class, educated, married white women, STILL are way worse than hospital birth.

      Multiple studies have shown that home birth increases the risk of death to the baby by at least 3-5 times compared to hospital birth among low-risk women. It also vastly increases the risk of brain damage due to oxygen deprivation.

      This study used CDC data: http://www.livescience.com/43050-home-births-newborn-death.html

    • Trixie

      Also, here’s a good summary of the issues by a doula who used to attend home births until she realized it was too risky. http://whatifsandfears.blogspot.com/2014/05/home-birth-in-usa.html

    • Young CC Prof

      This is a subtle point, let me try to explain it. The women who choose to home birth are low-risk. They tend to be healthy, in their twenties or thirties. And if they are diagnosed with multiples, or if they go into early labor, most deliver in the hospital instead, since premature babies need hospital care. So, home birth mothers are women who should have great outcomes no matter where they deliver.

      However, despite the fact that almost all home births are low risk, the actual outcomes are bad, in that more babies die during or after birth, and more are injured during birth. That particular CDC article does not refer to outcomes at all, perhaps because 2012 death rates are not yet available.

      There are several journal articles about home birth death rates by Dr. Amos Gruenbaum. I also invite you to click the link on the right side of this page near the top, “The doubtful father’s guide to home birth.”

  • CCg

    As research scientis who focuses on human Pathophysiology, I must state emphatically that the figures are 100% false and you have failed to provide a single cited published fact. You have done what you are accusing this other woman of doing. Your words are based on personal and emotional conjecture and lack even a tenuous foothold in reality. I have to say that you are extraordinarily uneducated in regards to midwives and what it is they do and the actual stats involved. You need to get your Cochrane Reports in a row.

  • noneofyourbusiness

    what is this? “created a model of care for women and babies that changed a generation’s approach to childbirth.”.. hmm.. so every female human or otherwise for the history of the species, gazillions of years, hasnt figured it out yet, but you have. uhu. eat healthy, let the baby come when it comes.. we get it. what about fathers then? oh sorry.. let the courts deal with them, righto. onwards and outwards. but may I ask before I go.. who is getting all these girls pregnant? YOD

  • dionPANGA

    stop worrying about others – let them do what they want without interference. if what they do does no impact on you or “society”, then get on with your life and leave em alone to do their thing yeah!? spend a year or two abroad in a remote country, see how poor people live, have babies, feed themselves and are HAPPY! imagine that. “americans” lost the plot literally weeks after arrival.

    • Amy Tuteur, MD

      Would you hire this midwife?

      “Don’t let the head suddenly explode from the mother’s puss. Coach the mother about how much and how hard to push. Support the mother’s taint with your hand during rushes. It helps the mother to relax around her puss if you massage her there using a liberal amount of baby oil to lubricate the skin. Sometimes touching her very gently on or around her button (clitoris) will enable her to relax even more. I keep both hands there and busy all the time while crowning … doing whatever seems most necessary.”

      And:

      “Sometimes I see that a husband is afraid to touch his wife’s tits because of the midwife’s presence, so I touch them, get in there and squeeze them, talk about how nice they are, and make him welcome.”

      And:

      “I might want to have a cunt one day and a twat the next. On the third day I might decide that pussy is my favorite word.”

      Would you hire this midwife?

      Her quotes make her sound immature, foul mouthed, and sexually inappropriate.

      Plenty of women have hired her. Her name is …

      Ina May Gaskin.

      The quotes come from Spiritual Midwifery, 3rd and 4th Editions.

      • CCg

        As I do my second Ph.D (this time in BioEthics) I am reading an Ina May Gaskin book. None of the colourful language you have described has presented itself and all her statements of fact are well cited pertaining to peer accepted scientific reviews, the opposite of your own writings.

        • Christina Channell

          Hold the phone. You are indeed saying then that these quotations DO NOT exist in Spiritual Midwifery, 3rd and 4th Editions?

        • Elizabeth A

          What was your first PhD in? What kind of research do you do?

          Why do you have such a hard time believing that an obstetrician might have better understanding of obstetrics than you, or than a self-trained, self-certified midwife?

    • freda

      you mean poor people in “downtown” usa dont you? plenty of people there, everywhere. do they have babies too?

    • Young CC Prof

      “spend a year or two abroad in a remote country, see how poor people live, have babies, feed themselves and are HAPPY!”

      See how poor people live, have babies, are terrified of birth and its complications, bury one child out of three in good times…

  • G

    There can be complications in any birth no matter where you have that child. I had the chance of experiencing a hospital birth and an out of hospital birth. My child in the hospital ended up in the NICU because of hospital staff causing my child distress. My second child was not born in a hospital, I used a midwife. I had no complications and had no interventions other than a doppler to check the heartbeat. And my child had no complications at all. Having no drugs in my system the second time around was not only better for my baby but for me as well.
    I think we need to see that midwives are for uncomplicated healthy pregnancies and ob/gyn are for high risk pregnancies. That can definitely determine the outcome.

    • yugaya

      “My child in the hospital ended up in the NICU because of hospital staff causing my child distress.”

      Oh please do explain exactly how.

      You did sue them for such gross malpractice, right?

  • Emer O’Cathaoir

    Hi,

    Just some concrete facts for you – you mention the Netherlands and homebirth. I’m not sure what the home birth rate is in the Netherlands but the Maternal Mortality rate for the Netherlands is 6 maternal deaths per 100,000 births. This data is from 2010.

    However in the US the figure is 21 maternal deaths per 100,000 births – more than 3 times the rate in the Netherlands.

    Instead of ranting about midwives maybe you and your colleagues need to catch up with the rest of the developed world?
    https://www.cia.gov/library/publications/the-world-factbook/rankorder/2223rank.html?countryName=Australia&count

    The Maternal Mortality Rate for Estonia is 2 deaths per 100,000 births – that seems like the safest place to give birth followed by Greece and Estonia.

    • Amy Tuteur, MD

      You appear to be unaware that African descent is a major risk factor for maternal mortality and the “whiter” the country, the lower the maternal mortality rate. You also appear to be unaware that most maternal deaths occur because of not enough technology, not too much. Maternal cardiovascular disease is the cause of death rising fastest.

      • CCg

        This statement is completely false and has no basis in fact. The US medical system does indeed have the highest infant and maternal mortality rate in the developed world, and is not sequestered to those of African descent.

        • Christina Channell

          You do know that infant mortality is not the correct statistic to use when assessing birth outcomes, don’t you? Right?

      • Lynnsey Sorrentino

        Poverty is related to not having the option of hiring alternative caregivers. Thus, they are forced to give birth in a hospital setting. The hospitals are not often too kind to those with lousy insurance.The impoverished are often people of color because we live in a racist and oppressive society. And middle-class, educated white women hire midwives, not poor black women! And it is know that the impoverished often equate good maternal health care with high-technology because they don’t have the time or resources to do their homework . How much do you get paid to be a propaganda machine?

        • Young CC Prof

          Precisely. The hospital takes all comers, rich, poor, women with no prenatal care at all, women who suffered terrible complications the whole pregnancy.

          The hospital’s outcomes are still better than those of midwives working outside the hospital.

    • yugaya

      “The Maternal Mortality Rate for Estonia is 2 deaths per 100,000 births – that seems like the safest place to give birth”

      In Estonia “100 percent of all births are attended by a skilled physician”.

      http://www.prb.org/pdf11/world-women-girls-2011-data-sheet.pdf

      THAT is why it is safe to give birth in Estonia you moron. BTW all midwives are formally educated at universities in accordance with EU regulation ( a law) and practice within strict scope of duties which is also regulated by laws.

      No CPMs, direct entry, lay or godknowswhat midwives allowed. Perhaps you could catch up with the countries you yourself cite as good examples too?

      • Young CC Prof

        Just looked up one other fact. Estonia also seems to have younger first-time mothers than most of the developed world. There just ain’t no way to make birth at 38 quite as safe as birth at 28.

  • don’tcareforstupid

    most ignorant person ever.. question how much blood do you think doctors have on their hands? especially those who perform abortions??

    • Sarah

      Removing a group of unfeeling cells is not the same a viable baby dying for any reason.

  • unbreak birth

    I haven’t seen any credible references for this article given. Only skeptical ob articles. Thisvideo is probably worth watching, skeptical ob. Can’t really argue with these facts. Hospital birth isn’t as safe as it seems.

    http://m.youtube.com/results?q=unbreaking%20birth&search_sort=relevance&search_type=search_all&uploaded=&sm=3

  • Gail Henriksen

    Here is a BBC article that finds home birth less risky than a planned hospital birth. For a nation that has so many hospital births tell me why we fall so high in infant mortality rate?

    http://m.bbc.co.uk/news/health-22888411

    http://m.nbcnews.com/health/us-infant-mortality-rate-drops-only-little-2D11763970

  • Guest

    Could you specify the data from the UK that you are talking about here?
    I’m not clear which data you are talking about. The very large study of place of birth in the UK most recently showed no increase in risk for home birth for second or subsequent babies. And although there was a result which suggested an increased risk for first babies, the confidence interval for the homebirth group overlapped the hospital group. And the lowest risk birth place for first babies? A stand-alone midwife birth centre, ie one which was not attached to a consultant unit.
    You are also not comparing like with like as the UK has professional midwives, trained and regulated in a completely different fashion. And they deliver the care whether in hospital or birth centre or home. I don’t think you can use the UK as an example to support your point.
    Before anyone wants to bash me as not knowing anything, I am British, I am a doctor and I have read the full UK study in the BMJ. It appears that article was not read properly before the “UK data” statement was made here.

  • annnoyed feminist

    I adore Ina …and I don’t think women give themselves enough credit …..stop being pussys and begging for pain meds and scheduling c sections gah what happened to women being strong?oh yeah forgot to mention I am having my first in a few weeks and am refusing any unnecessary interventions…and am standing by that

    • auntbea

      Be sure to report back on how that went!

    • Mishimoo

      Feminist but using a derogatory term meaning “vagina” to describe women that make different choices to you…I don’t think you quite understand the meaning of ‘feminist’.

    • Amy Tuteur, MD
    • Elizabeth A

      What ever happened to women being strong?

      You’re carrying that baby around right now using muscles you don’t get to practice with, and only a fraction of your usual lung capacity. You’re strong. We’re all strong. We don’t need to go through one last hazing ritual to prove anything to anybody.

    • Young CC Prof

      So what’s the deal with c-sections? Are they awful or easier? If they’re the “easy way,” then why are the doctors who do them evil? If c-sections are awful, then a mother who consents to a section in order to save her child is being heroic. You can’t have it both ways.

    • Dr Kitty

      Respectfully, I think it may be better to enter labour with an open mind as to pain relief and “interventions”.

      You may have a short, easy labour and cope very well without pain medication…you may have a long difficult labour with a baby in distress and find that you can’t cope with the pain and that the interventions are suddenly necessary.

      Going in with your attitude sets you up for guilt, shame and a sense of failure if the experience isn’t as straightforward, easy and tolerable as you expect.

      It is, BTW a lot easier to judge people’s choices if you have never actually been in the situation where the choice had to be made.

      Come back and tell us how it worked out once you’ve had your baby, best wishes for their safe arrival.

    • Trixie

      Labor hurts. A lot. You can do it without pain meds. I’ve done it. Anyone can! People do it all around the world every minute of the day. If you’re really a feminist, why not spend less time thinking about yourself and more time thinking about the women around the world who lack lifesaving access to the modern medicine you have the first-world privilege of refusing?

    • KarenJJ

      Good luck and let us know how you got on.

    • Captain Obvious

      As people have said below, you are not an “annoyed feminist”. More like a “ignorant judgemental Uncle Tom”.

    • T9e

      WTH happened in your life that caused you to believe enduring excruciating pain (unnecessarily) is a platform for you to insult other women who choose not to? What a weak minded female you are. I hope your first labor was a truly humbling experience for you. Not that I would ever expect a condescending jackass like you to admit if it was.

    • dave vogel landscaping

      have no fear.. women ARE strong, just not where you live. perhaps move yourself to another destination, with less governmental influence? or maybe just build a tree house in the ocean, somewhere away from Malaysia, apparently..

  • questioner

    http://www.fda.gov/Safety/MedWatch/SafetyInformation/ucm330991.htm FDA view on cytotec… bets on how many doctors don’t inform patients? Also 5 deaths in hb being more than in a hospital for a whole state I call bs. Proof please?

    • Young CC Prof

      Ah, another person who doesn’t know the difference between an absolute number and a rate. Let’s put it this way: Very few babies are born at home in North Carolina. The vast majority are born in hospitals. If five of those very few babies die, that’s an alarming RATE.

      Let’s put it another way. Last year, more Americans died in car accidents than motorcycle accidents. Does that mean motorcycles are safer than cars? Of course not. But most of us drive a great deal and spend little or no time on a motorcycle. Hence, taking a trip by motorcycle is much riskier than taking the same trip in a car.

  • AZmomma

    List of references? Manner in which data was collected? With the myriad of issues with accurate data collection, it would sure be nice to have the time to dig into the actual data. I am quite bothered by the large discrepancy between the midwife sources I have read (not all Ina May Gaskin by far), and the Skeptical OB. The following quote from the article above puzzles me to no end: “The latest CDC figures (publicly available on the CDC Wonder website)
    show that planned homebirth with a non-nurse midwife has a mortality
    rate 600% HIGHER than low risk hospital birth.” Why would you pay money to a non-nurse midwife? The whole point of a midwife is to have someone medically trained who trusts the female body to do the right thing most of the time and knows what to look for in order to spot when there are problems.
    I will be giving birth with a midwife at a hospital that has a c-section rate half the state average (Arizona being the state). Are low income, central Phoenix babies so unusual that they only require half the rate of c-sections? My primary reason for going with midwives in general was the longer appointment times with prenatal care. How on earth can an OB who has seen me once a month for 15 minutes or less be expected to make accurate decisions in such a critical time as childbirth? Much of the induction and c-section rate seems to be good old American rushing of things mixed with a bunch of fear.

    Before you jump all over me, know that I have a very real respect for the skills of OB’s when a real emergency is happening. Clearly my husband, born at 26.5 weeks gestation is here because of the skills of his OB and the nurses. I, on the other hand, simply needed someone to take the time to listen to and get to know my mother (who is not the most talkative and expressive woman in the world) before yanking me out with forceps.

    I am sure that both sides of the issue genuinely believe they are doing the right thing. Any woman who is pregnant or thinking about it should realize that humankind has been around a lot longer than hospital-kind. Give birth where you want to and insist that the people around you be positive and trained.

    • Amy Tuteur, MD

      “Any woman who is pregnant or thinking about it should realize that humankind has been around a lot longer than hospital-kind.”

      Apparently you don’t understand evolution, either.

      Evolution does not lead to perfection. Evolution is the result of the
      survival of the fittest, not the survival of everyone. Human
      reproduction, like all animal reproduction, has a massive amount of
      wastage. Every woman was born with millions of ova that will never be
      used. Every man produces billions of sperm that will never fertilize an
      ovum. Even when a pregnancy is established, the miscarriage rate is 20%.
      One in five pregnancies dies and is expelled and yet we
      are still here. Human reproduction is perfectly compatible with a
      natural neonatal death rate of approximately 7% and a natural maternal
      death rate of approximately 1%.

    • Amy Tuteur, MD
    • Young CC Prof

      The overall c-section rate of a hospital has nothing to do with the probability that a particular patient at that hospital will get a c-section. The biggest factor in a hospital’s c-section rate is how many high-risk women they manage. In fact, the best hospitals may have the highest c-section rates, because they take all the highest-risk women from the entire region.

      And what is this “15 minutes once a month?” I’ve had plenty of time to talk to my obstetrician and get to know her.

  • Kaliaunna Rose Bonnell

    My very first birth was one that, honestly, HONESTLY!! I could have done at home if I simply had someone to pull my baby out. My first and only birth involved no complications, no interventions (that’s right, no epidural, induced labor or any medication whatsoever) and was finalized on my hands and knees. It was, despite the leeches that call themselves nurses trying to chain me to a bed to ask countless questions about my medical history, was the best experience of my life. I read and respect Ina May Guide to Childbirth, and if I have another child and have the money, I will opt to have a home-birth, damned straight, because I do trust my body. Women are not faulty machines. If we really want to talk about blood on hands, you can get me started on all of the epidemics, mistakes, mortality rates and under reporting of the CDC, which isn’t just word of mouth, it has been proven, and the numbers are there. If I must, I’ll dig up the reliable sources on which I have found said stats. Fuck the hospital chasing you around pounding you with questions, one contraction after the other that should have been asked before labor! It isn’t just Ina May, I’m sure plenty of women feel that birth should not be treated like a dangerous illness that must be carefully monitored and tweaked in a controlled, hospital setting. Women are DESIGNED to give birth! And the body is not a faulty machine, take care of it and keep it clean and watch how no chemical injections and interventions are usually necessary.

    • Wren

      Yawn. Women aren’t designed. Birth fails regularly, for both the baby and the mother. The body is not any kind of machine and can frequently go wrong. Being somewhere help is available when you don’t need it beats the pants off being somewhere help is not readily available when you do.
      And yeah, my second birth went easily and well. We were both fine, but I was still glad we were there just in case we weren’t.

    • Awesomemom

      Wow thanks for that, so all we need to do to stay healthy is to eat right and take showers. Huh who would have thought it would be that easy? /sarcasam

      There are plenty of people out there that do everything you say and end up with disease and illnesses. There are plenty of people that do what you say and end up with childbirth complications. Life is not as simple as eating right and keeping clean, if it was then there would be so much less hassle in life.

    • MaineJen

      Wow, your ONE birth sure has made you an expert. And damn those medical professionals, bothering you with questions about your medical history. It’s not like it’s important for them to know if you’re on any medications or have any medical conditions, or anything. Please, please do dig up those bothersome facts for us, if it isn’t too much trouble. And while you’re at it, please explain how 100 years ago, before antibiotics and C sections and gasp! pitocin were readily and easily available in the first world, no women or babies EVER had any problems surrounding birth.

    • The Computer Ate My Nym

      My first and only birth involved no complications, no interventions (that’s right, no epidural, induced labor or any medication whatsoever) and was finalized on my hands and knees.

      So it is possible to give birth in the hospital without interventions. As you just admitted. Your worst complaint was that you were asked questions about your medical history? The horror! The horror!

      If I must, I’ll dig up the reliable sources on which I have found said stats.

      You must, if you want to be convincing.

    • DaisyGrrl

      I’m glad your first birth was free of complications. I’m amazed that you were able to see the future well enough to know that you wouldn’t need any of the medical expertise at hand. Tell me, how can I harness your power of foresight? I’d like to win the lottery this week.
      I’d also love to see the reliable sources on the underreporting of mortality rates by the CDC. That should be interesting.

    • http://kumquatwriter.wordpress.com/ Kumquatwriter

      Well whoop-de-fucking-do, aren’t you just so much more WOMAN than the rest of us! Hooray! You’re so special! You’re the specialest snowflake EVER!

      • Awesomemom

        We need to make a medal to mail to all the special snowflakes out there. They seem to crave the attention.

        • thin_red_line

          it’s actually spelled Sneauxflayyke lmao!

    • Sue

      I gave birth to my super healthy daughter at home and it was the most amazing experience of my life. I have to thank my NHS home birth midwife for doing nothing because she didn’t need to, and for allowing the process to take place naturally as it should, producing a healthy child and happy family. Unlike many friends who went for the safer option of hospital who ended up traumatised and unwell, even some with PND, I was lucky for sticking to my guns. Most births go ahead naturally and should be allowed to do so. Unfortunately people like our sceptical OB here like to plant fear in womens minds, and fear counteracts the natural process of birth causing a need for ceasarians, etc. Big business! Ina is about respect for women and nature and our lady here is missing out on that element which is shame and why so many women are traumatised by birth experiences and this should not be happening. It’s why people want home births.

      • Stacy21629

        “Most births go ahead naturally”
        And the ones that don’t? Too bad, so sad?
        “natural process of birth”
        Post-partum hemorrhage, placenta previa, prolapsed cord, shoulder dystocia…those are all natural too. As is death.
        “Unlike many friends who went for the safer option of hospital”
        At least you acknowledge that the hospital is safer.
        “It’s why people want home births.”
        I’ve had one home birth and one hospital birth (transfer). I do not ever want to have a home birth again. How many hospital births have you had exactly?

      • yugaya

        ” I was lucky for sticking to my guns”

        You were lucky, full stop.

    • thin_red_line

      Then maybe you should have pre-registered if you didn’t want to be asked a ton of questions during labor, most OB offices and hospitals recommend it to their patients and it saves the “leeches” time that could be spent with other patients! And sometimes situations arise where a baby or mother needs medical intervention to ensure an optimum outcomes, bet those nurses wouldn’t be leeches if they saved you or your child. For your next delivery why don’t you try an unassisted water, lotus birth at home and tells us how it works out?!

  • MomInformed1st

    Because I am carrying a baby, my issue lies within the context of natural birth and being against the use of Cytotec. I have done research pertaining to my personal concerns. I have come to conclusions from that research, as well as, from having known a person who died- along with her baby- from the drug being used to induce her labor. I, as a pregnant woman in America, have the right to state that I am against it and to make my own choices just as you do if you give birth to a child of your own. That is if you can… assuming you have the female parts to do so. Which, I highly suspect you do not.

    • Karen in SC

      I’m sorry you lost your friend. Was she given Cytotec in a hospital. What adverse reaction resulted in her death?

    • Wren

      What on earth was the purpose of that last bit?

    • Meerkat

      Nobody on this blog is advocating for women to close their eyes and give up their care decisions to their doctors. The whole point of this blog is to give women science based information and debunk fear mongering. If you are afraid of Cytotec, why not ask your OB if there is an alternative should you need one?
      My heart was set on natural childbirth in a hospital. Good thing I started reading this blog, and by the time I was due I decided to just trust my doctor. Good thing, too. I was handling labor fine, but my son wasn’t. I had to have an emergency C- section. Here is the thing, nobody forced me to have it. My situation was pretty clear to me—I was just 3 cm dilated, and it would take too long to get to 10 cm. Induction would take too long too. I wanted him out as soon as possible because he was suffering, maybe suffocating. I realize that he might have been fine if I didn’t have a C-section, but there is a real chance he would not have been fine, suffering brain damage or worse. Neither my doctor nor I wanted to take that chance.
      You know what? He was 15 months yesterday, and both of us are great.

    • Ainsley Nicholson

      I looked very carefully at Cytotec before my baby’s birth- some of the things I read scared me also, and I knew that I was likely to be induced. However, my independant evaluation of the primary scientific literature reassured me that it was safe and effective. As safe as any medication can be, anyway…I am close to someone who almost died due to an adverse drug reaction (not Cytotec), so I’m very hesitant to take medications of any sort. Here is one good article about cytotec (misoprostol): http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2760893/

      It’s conclusions about safety of cytotec use for induction of full-term labor: “There was no difference in serious neonatal or maternal mortality between women receiving misoprostol and women who received prostaglandin E2 or oxytocin; however, most studies were underpowered for this assessment.”
      Hopefully more studies on larger groups of women will be done to settle the question.

    • Karen in SC

      Haha, Mominformed1st wasn’t anonymous for you?

  • MomInformed1st

    And lots of medications kill people, too.

    • Wren

      Going without needed medication is pretty damaging. Compare the average age at death now with 300 years ago, or even 100 years ago.

    • The Computer Ate My Nym

      All medications have risks and benefits. That’s why you get counseling by everyone from the doctor to the pharmacist when you start taking one. However, a medication used properly should have greater benefit than risk. That’s the point. Insulin can kill someone if given in overdose, but it is also life saving for diabetics. In contrast, home birth really serves no one. It isn’t safer to use than not use in any context.

      • Captain Obvious

        Water can kill. College hazing pranks with hyponatremia can kill. Are you going to stop drinking water?

    • http://kumquatwriter.wordpress.com/ Kumquatwriter

      So no one should ever seek medical treatment or take any medication ever. Right.

      • Wren

        Obviously. Well, herbal medicines of unknown strength and homeopathy are both OK, but nothing Big pHARMa has touched.

        • T9e

          Big pHARma (so clever aren’t you?). Well, here in the REAL world, if it weren’t for the evil pharmaceutical companies some of us would not be alive. The medicine I HAVE HAD to take 3x’s a day-every day-my whole life doesn’t come in herbal form. Of known or unknown strength. My genetic condition would have killed me before I was a year old if it weren’t for this medicine. Honestly, people blessed with good health sound like idiots when trying to preach on something they have no experience with.

          • Young CC Prof

            Wren was being sarcastic. (Around here, it can be hard to tell sometimes). She is pro medicine.

          • Wren

            You missed the sarcasm there. Sorry.

          • Wren

            Sorry, I guess the sarcasm wasn’t heavy enough. It’s hard when there are people who truly take that stance, but I am definitely not one of them.

      • dion pangallo

        go get your papsmear fatty. and afterwards have fun in the american jungle, of course! :))

  • MomInformed1st

    I am talking about the elevation of babies being born, more often, Monday-Friday due to the current methods used in hospitals for deliveries. That you can look up. I no longer have the energy, nor the time to do it for you. I have an appointment with my midwife.

    • Young CC Prof

      Um, we all know more babies are born during weekdays. We’ve also discussed why, and the definition of medically necessary non-emergency procedure.

      Your argument seems to amount to “Using Cytotec to induce labor is off-label, OBs sometimes do it, therefore they are evil tools of Big Pharma who hurt women for no reason.” You’ve stated this over and over without making any effort to actually respond to others’ arguments on the matter.

      Why don’t you look up how many drugs are routinely used off-label, and how few ever get their off-label uses approved? Find out just how much it would cost to get the off-label approval, and what the profit margin on one dose of Cytotec is. You’ll soon see: Genuine re-approval is just too pricy, except on massively expensive new drugs. That’s why there are so many drugs being used off-label, some to save lives.

      I’m not asking you to do this for me, since I already know the answers. I’m asking you to do this for you, so you understand the issues.

  • MomInformed1st

    If you lost a friend- who died because of it maybe you would! I am against Cytotec. I will remain being against it. No more to be said.

    • Karen in SC

      Then in cases where labor has not begun and there is a danger to the baby remaining in utero, you are all for going straight to a c-section, right?

      That is what these medical procedures are used for, helping the mother’s labor progress toward a vaginal birth.

    • The Computer Ate My Nym

      I will remain being against it. No more to be said.

      “My mind is made up. Don’t confuse me with the facts.”

      • Captain Obvious

        My cousin died in a car accident, I no longer drive.

        • Siri

          My grandmother died of old age. I’m not having any more birthdays.

    • Captain Obvious

      Cytotec. Label uses for NSAID GI ulcer prevention. Off label uses for chronic constipation, cervical ripening, and early pregnancy termination.

  • MomInformed1st

    I am not arguing. I am stating that Cytotec was NEVER approved, by the FDA, to be used in the induction of labor. I will, however, argue this: you cannot even spell!

    • PrimaryCareDoc

      Just because something was not approved by the FDA for a certain use does NOT mean that that use is not valid. Lots of medications have valid off-label uses.

      • http://kumquatwriter.wordpress.com/ Kumquatwriter

        My understanding (please correct me if I’m wrong!) is that off-label uses for medications are supported by medical trials/testing, but lack of FDA-approval means the drug manufacturers cannot *advertise* the off-label uses?

        • PrimaryCareDoc

          Yes, that’s correct.

  • MomInformed1st

    Your point? Is the picture of the pregnant woman marked with the red line through it just because it should not be used for pregnant woman who have ulcers? Or might it be because the original manufacturer of the drug knew of the risks of uterine rupture? So, drugs can be used “off label” it does not mean they are safe. Plenty of woman had to learn the hard way when Cytotec was used for them and now they cannot have children. Emergency hysterectomies are not what they bargained for when they signed in the hospital to deliver their babies. The FDA does not have specific trials on Cytotec for labor induction because the company that makes the drug did not apply for the approval. They may not have to because it can be used “off label” but it seems a little too easy to bypass the system and be able to avoid people finding out how bad the drug can be. Especially those who just take other people’s word without checking for themselves. Woman and babies have died from it. Uteruses have ruptured. That is enough for me to AVOID having any doctor administer it to me for the delivery of my baby.

    • Durango

      From the beginning of time, women and babies have died from birth itself. Uteruses have ruptured. Is that enough for you to avoid having a baby altogether?

    • Dr Kitty

      It is marked “not for use by pregnant women” because misoprostol causes uterine contractions, so if taken by a woman in first or second trimester it will cause a miscarriage.

      That DOESN’T mean it is unsafe or cannot be used by pregnant women and has nothing to do with the risk of uterine rupture.

    • thin_red_line

      That sign is mainly for pharmacy use, as many pregnant women work in pharmacy’s and many women who have ulcers take cytotec. It like telling the pharmacist, “Hey don’t forget to tell the patient or remind pregnant tech to not touch this med when she does her nursing home refills, just in case because it jump starts labor and causes miscarriages in early pregnancy.”

  • MomInformed1st

    I never mentioned it being used to treat ulcers in pregnant women. Not sure why that was brought up? I mentioned that what the drug was approved for, by the FDA, was for the treatment of ulcers.
    So , it softens their cervix- that just supports what has been said about it being used when it comes to medical abortion (another “off label” use of the drug).
    Furthermore, I cannot continue to repeat that the FDA has yet to approve the drug Cytotec for the use of labor induction.

  • MomInformed1st

    Approved for the use of ulcers, yes. That is true. However, not for the use of labor induction or medical abortion. Let us not confuse the two. Some parties are “gullible” enough to believe that because it is approved by the FDA for ulcer use it is also approved by the FDA for the use of labor induction; which, clearly it is not! And that is a point which I have been making. I suppose the FDA trials do not matter when others show their independent trials to be sound. Why even have the FDA if their trials do not matter?

  • MomInformed1st

    The FDA trials.

  • MomInformed1st

    Just as I would not injest any liquid or chemical with a caution warning on it by the company that manufactures it, I am not fool enough to injest ANYTHING that has a picture of a pregnant woman with a circle and a red line through it on the original label either!
    But, yet, you call me names because I would rather be cautious then accept that it is okay because you tell me it is. Well, tell that to the families that lost loved ones or the ability to have children when their uteruses had to be removed because they ruptured.
    I will have a natural birth. I will have my CNM there, along with my Doula, and that is my choice. I am not an “uneducated” woman as you claim woman whom want natural birth are. I am well informed on the risks involved and I will be in a birthing center, but I will not be getting any potential harmful drugs like Cytotec. That is stated in my birthing plan. I am not ignorant to the fact that complications do occur in birth which require medical intervention. But, I do think that, in many cases, those interventions can/could be avoided.
    I appreciate you taking your time to answer my questions. I do not, however, appreciate you calling me a fool. But, I should have expected it seeing how you insulted Ina May Gaskin in your original article.

    • Amy Tuteur, MD

      It is not approved for use in ulcer treatment of pregnant women specifically because it softens the cervix. It can be used and is completely appropriate to use it in pregnant women for the express purpose of softening the cervix.

      • Young CC Prof

        Indeed, it does seem logical that a drug that augments labor would be contraindicated in a pregnant woman who doesn’t want to give birth yet.

        Kind of like putting the towel IN the swimming pool. It’s just not the right place and the right time.

    • Wren

      I was absolutely set on a natural birth with no drugs with my first. He then taught me my first lesson in parenting by being in the footling breech position, discovered after my water broke. Yes, I had regular checks and yes, he turned at term. Increasing my risk slightly and decreasing his risk by a whole lot meant a C-section was totally worth it.
      I hope you get the birth you want, but more I hope that your baby and you are both healthy after the birth. That really is the most important thing, and what Dr Amy is trying to help.

    • MaineJen

      “But, I do think that, in many cases, those interventions can/could be avoided.”

      I really hope things go the way you want them to go. But…real birth has a way of taking all of our carefully-laid plans and turning them on their ear. It’s easy to say in retrospect “Oh, I could have avoided ABC by just doing XYZ,” but when you’re there in the moment, in pain and just wanting your baby to be OK…sometimes your plans have to go out the window. I think women who have been through labor and delivery at least once are far less likely to make blanket statements like that with any authority.

  • Noyb

    This “hate-on” Amy has for homebirths is simple. It comes down to “I’m right and you’re wrong.” She’s an ob and has her training and knowledge. If you believe in midwifery or homebirths you are saying she is wrong and she can’t handle it. It’s one of our flaws as humans. It’s the same as “my religion is right and yours is wrong.” There are risks no matter what you choose for your birth. It is up to you as an adult with a functioning brain to do your own research and do what is best for you.

    • Wren

      Well, you got the first sentence right. It is simple. Babies die that could be saved, women are given high amounts of misinformation and flat out lied to and myths are spread that encourage these practices and deaths to continue.

    • Amy Tuteur, MD

      Please don’t assume that my motivations are the same as your. Yes, for YOU the “safety” of homebirth is an article of faith, like religion. I, on the other hand, deal in facts, something conspicuously lacking from your comment.

      • MomInformed1st

        Just curious? What is your take on drugs like cytotec? I would think that would be a better subject than knocking a “certified” Midwife who has more experience delivering babies then a good portion of practicing doctors.

        Also, have you read her book? Or do you just follow the literature you learned in your medical training; which can be very skewed- just as all the statistics you shot off in your rant. A rule of thumb would be to be objective as MOST statistics are bias to the party or parties that founded/applied the research.

        Gaskin is a person who recognizes the obvious flaws in drug interventions used to rob women of their natural right to give birth the way God intended! Faith or no faith- a proven fact is that hospitals and doctors across this country put women at risk- far more often- by using the drug Cytotec (which has yet to be approved, by the FDA, for the use of inducing labor- and continues to HARM)!

        Where is the rant about that? Why is that not a topic of interest? Because it is widely accepted in mainstream hospitals and army bases because it is cost effective?

        I think there needs to be more focus on such things as this and not on attacking ONE woman, who IS educated in natural child birthing methods and blaming her for infant deaths.

        If she is to blame for mistakes others made- then any infant death could be blamed on the Obstetric institutions that are teaching doctors like yourself!

        • Young CC Prof

          “A rule of thumb would be to be objective as MOST statistics are bias to the party or parties that founded/applied the research.”

          Great rule of thumb. Read the details of the study and come to your own conclusions. I assume you have the background in both statistics and biology to do so? Awesome. I look forward to a meaningful textual analysis of one of the several recent studies showing that home birth increases the risk of perinatal death. That’s meaningful textual analysis, specific details of errors in methodology or conclusions.

          • MomInformed1st

            My comment was in direct correlation to her original comment regarding MANA and pointing blame toward ONE individual:

            “Let’s get something straight: Ina May Gaskin has blood on her hands, and not merely the blood of her own child sacrificed on the altar of homebirth. Gaskin presides over a large multi-faceted business empire comprised of trade, propaganda and lobbying organizations, all with one purpose in mind: allowing uneducated women like herself to provide substandard medical care to pregnant women while ignoring the growing pile of tiny bodies”

            My mention of the drug cytotec should have been a clue to the things that SHOULD warrant such discussion.
            And, furthermore, why not focus on the “statistics” of the babies born on The Farm? Ina May is actually involved in THOSE at home births! That was my point!
            If you read the whole comment you may understand that when I say to blame ONE person for ALL the deaths is like blaming the good doctor, herself, for ALL the babies who have died during childbirth when accepted” practices; like drug or surgical intervention were orchestrated in hospitals by Obstetricians!
            I need not include my educational qualifications to PROVE anything to the “Young Professor.” I, will only say this: Yes, I DO have a background in Biology, Microbiology, Statistics, Anatomy, etc. Along with 18 years of experience as a Surgical Nurse!!!
            Why some were studying things on paper I was actually working in a hospital setting!!!
            I know, firsthand, the dangers of drug intervention and unnecessary surgical interventions that are common practices in American hospitals!!!

          • Young CC Prof

            Again, specifics. So Cytotec is bad. What else are obstetricians doing wrong? Current accepted practice only, please, and provide evidence.

          • MomInformed1st

            I am sure you are intelligent enough to find the research and “statistics” on your own. After all, I found them. Just a few things you may want to look at: The fact that the drug Cytotec is used “routinely” in hospitals to induce labor, as well as to abort babies, even though it is not approved for these uses and NEVER was by the FDA!!! Nor does the original manufacturer of the drug recommend it for pregnant women! But, it is cheaper than pitocin… So why not?
            The fact that cesarean surgeries are accepted as common practice and used far more often than necessary: and the correlation between “scheduled” c-sections and the days of the week. Ex: Less babies are born on the weekends since the inclusion of these “routine” surgeries. Just coincidence, I suppose? Hmmmm… some things to ponder. Or you could find out for yourself… like I did!
            My argument is not against Obstetricians- it is against the institution that exists to control women’s choices and the allowance of pharmaceutical companies to sway the pendelum even when it puts women at risk for such things as ruptured uteruses, etc.
            I need not include a medical journal in my comment. The evidence exists for itself. And, it is not hard to find!

          • Amy Tuteur, MD

            In other words, you have no credible data, just junk from natural childbirth/homebirth websites. I’m not surprised.

          • MomInformed1st

            There is plenty of “credible” data just as you posted all of your numbers/stats- they are out there. I have read them. I have researched them, just as you have researched yours. Sorry if I did not present it to you as a scholar would do. I did not realize that you, being a doctor, would not be aware of it have knowledge of the drug Cytotec. I challenge you to spend more time looking at my comments, seeing as you ignored my original question. The one that was directed specifically at you… Not the rest of the people willing to engage with me over your article. Am I wrong to say that Cytotec is used routinely to induce labor? Am I wrong to say that it is cheaper than pitocin? Am I wrong to say that the FDA has not approved it for use in pregnant women? Am I wrong to say that it is used routinely in medical abortions? I mean, you are a doctor- are you not able to answer my question or do you avoid it because you do not want to?

          • Young CC Prof

            If you want to persuade anyone HERE of anything at all, you will need to present it as a scholar would do. Facts and specifics, not insinuations.

          • MomInformed1st

            My goal is not to “persuade” anyone! My goal was to get some answers from the M.D. That wrote the article in the first place. Nice assumption on your part though:)

          • MomInformed1st

            PS: It is not an insinuation to say the drug Cytotec has not been approved by the FDA to be used by/for pregnant women- it HAS not been approved! Look that one up yourself just like any good scholar would do. You do not have to take my word for it. You will find out exactly what I am talking about when you do the research on it.

          • Amy Tuteur, MD

            Newsflash: reading books and websites written by other homebirth advocates is not “research.” Research is found in peer reviewed scientific journals and obviously you have no clue what the actual scientific evidence shows.

          • MomInformed1st

            Still, you avoid my original comment and question regarding the drug Cytotec. I specifically asked you of your opinion of the use of a drug for labor induction that has not been approved by the FDA. Your answers back are concentrated on my lack of ability to present scientific data from a medical journal. If you rely so heavily on these journals, are you not then concerned about the medical communities use of Cytotec without the drug having been approved by the FDA? Where are the medical trials for the use of Cytotec in labor induction? Oh, they do not exist because the FDA did not approve Cytotec for labor induction, it approved the drug for ulcer treatment.

          • Box of Salt

            MomInformed1st “Where are the medical trials for the use of Cytotec in labor induction?”

            They’re indexed on PubMed (this is database which covers medical literature in case you didn’t know). I just searched “cytotec induction” and found 845 hits, including clinical trials. Some of the papers are even free to read.

          • Amy Tuteur, MD

            I already answered you. Cytotec IS approved by the FDA. There is nothing wrong with using an approved drug for an off label usage. Marsden Wagner relied on the gullibility of homebirth advocates to trick them by insinuation that off label use is wrong.

          • fiftyfifty1

            Do you seriously think that Cytotec is used because it is “cheaper than pitocin”? Do you know how Cytotec functions? Do you understand Bishop’s score? Do you really think that using an approved drug for an off-label use is wrong? Do you have a problem with Prednisone being used for brain tumors? What about for lumbar radiculopathy? That’s off-label too. Can you understand why Cytotec would be helpful for both abortions and cervical ripening? Is it a problem for you that it is used in both procedures?

            I guess I just don’t get your point.

          • The Bofa on the Sofa

            There is plenty of “credible” data just as you posted all of your numbers/stats- they are out there.

            You claim they are out there, and you have read them. So why not share them with us all? Instead of just telling us they exist, tell us the data so that we can see for ourselves?

            If not the data itself, at least tell us the sources.

            Be prepared, however, to discover that whatever you bring is not new, and has been discussed already. But hey, we’re willing to listen, assuming the data are actually credible.

          • thin_red_line

            those are all the reasons why it should be used instead of pitocin for managing inductions in otherwise healthy women needing to be induced. If you don’t want to use cytotec than don’t use it, but that doesn’t mean other women shouldn’t choose to use it. What shouldn’t be an option is home birth and using a CPM, with no medical training, like Ina May Gaskin

          • Eddie Sparks

            The question of scheduling c-sections was dealt with in another thread recently. A key point was differentiating between emergency c-sections, and the scheduling of medical necessary but non-emergency c-sections. Thus leading to the non-random distribution throughout the week.

          • Young CC Prof

            Okay, you’ve got nothing. The idea that a surgical procedure can be scheduled in advance and still be medically necessary is alien to you. I didn’t think you could offer anything interesting, but I wanted to check.

            And given the minimal cost of Cytotec, I’m really not impressed with the Big Pharma conspiracy angle. Save that argument for drugs with a profit margin high enough to make it plausible.

          • MomInformed1st

            Being the scientist that you are, I am surprised that the drug having not been approved by the FDA for the specific use of labor induction would not have you raising at least one eyebrow. Surely you know what it takes for a drug to be approved for a specific use? Trials! Somehow, they are able to use it for labor induction and medical abortion… Oh, I know how- because hospitals save money by using it and doctors do not care. How ironic that doctors and scientists and statistics majors require me to attach links and info in my research, but have no thought about where the research trials exist for approving the use if cytotec in labor induction!

          • Amy Tuteur, MD

            Being the fool that you are, I’m not surprised that the fact that Cytotec is used off label seems suspicious to you. There’s nothing wrong with off label use of medications. It’s just another insinuation that impresses the gullible.

            You also do not seem to understand that there is plenty of research on both the safety of and the side effects of Cytotec. Lack of FDA approval tells us nothing about what research exists.

          • Captain Obvious

            You can’t have it both ways, either big pharma is a problem or it isn’t. Cytotec is cheap and not recommended for pregnant women by big pharma or is big pharma charging high costs and pushing their meds onto pregnant women? Which one is it? You can’t even be consistant with your own arguement.

          • PrimaryCareDoc

            I don’t understand. Why would a non-emergency surgery be scheduled on a weekend? Of course scheduled sections will be during the week.

            Remember- medically necessary does not mean the same as emergency.

            Let’s look at when hip replacements are performed. I’ll bet none are done on the weekends. Doesn’t mean they’re not medically necessary.

          • Siri

            I don’t think it’s possible to be a surgical nurse for 18 years and not know that most scheduled procedures take place during the week.

          • Dr Kitty

            I don’t think it is possible to be surgical nurse and not understand the concept of “off label use”.

            Misoprostol is a safe, cheap synthetic prostglandin. It works and is used all over the world to ripen cervixes, induce labour, and control PPH. There is a wealth of data about it, because it has been used for these indications for many, many years on millions of women worldwide.

            It was first used because the pharmacological MOA suggests it was a plausible drug choice, which was likely to work.

            Just because the manufacturer doesn’t want to spend the money on the research needed to apply for licences for those indications doesn’t mean that doctors are doing anything wrong by using it for those indications, when the experiential data is that it is both safe and effective for IOL and PPH.

            Of COURSE the manufacturer tells pregnant women not to take it- it causes cervical dilation and can cause premature labour or miscarriage if you don’t want the cervix to dilate at that point in time!

            Do you have the same issue with Gemeprost, Carboprost and Dinoprostone? Or just Misoprostol, which is a drug from the same class.

            Of course there have been adverse incidents with Misoprostol- all drugs have side effects and risks. that doesn’t mean that for the vast majority of women the drugs isn’t safe or appropriate when prescribed by a physician.

          • thin_red_line

            Exactly, they already know it works, why spend the money on research? Plus, you don’t see too many pregnant women beating down the door to volunteer for medical research studies and if I”m not mistaken pregnant women cannot be included in pharm research studies.

          • theNormalDistribution

            If you use three exclamation marks it makes what you’re saying more true.

          • Susan

            OT since you are a surgical nurse. How would you count the vaginal yarn?

          • Eddie Sparks

            “And, furthermore, why not focus on the “statistics” of the babies born on The Farm? Ina May is actually involved in THOSE at home births! That was my point!”

            I don’t understand this part of your comment.

            The quote that you put in your comment from Dr Amy seems, to me at least, to me making two points:
            - Ima May Gaskin is responsible for more than one death during a home birth.
            - Ima May Gaskin has a vested financial interest in promoting home birth and under-qualified midwives.

            I don’t see any attempt to blame all home birth deaths on this one woman. But maybe you meant something else?

          • Siri

            Careful, you’ll run out of exclamation marks. ..

        • rh1985

          What about my right to give birth the way I think is best for me and my child? I want a medically managed birth with pain relief and if indicated, induction or c-section, not a natural birth.

          • MomInformed1st

            You, just like I, should be able to do with your body what you “choose” to do. Women deserve the right to have home births or midwives- just as they deserve to have Obstetricians or have drugs if they want to.
            Again, my comments were and are DIRECTLY related to the article written about Ina May Gaskin.
            If, for some reason you felt it was a direct comment toward you, you are sadly mistaken. Nothing personal!
            Just as you should be allowed to choose your birthing plan, I should be allowed to speak my mind and share with the good doctor what I think.

        • The Computer Ate My Nym

          A rule of thumb would be to be objective as MOST statistics are bias
          to the party or parties that founded/applied the research.

          98.354% of people reading this statement agree that it is idiotic. And, yes, that is one of the 58.4% of statistics that were made up on the spot.

          There is a grain of truth in what you say: Statistics can be used to lie or mislead–sometimes even unintentionally. But simply saying, “la, la, la, I can’t hear you!” when confronted with statistics like the 300% (or more) higher perinatal mortality rate for home birth makes no sense either. Take some statistics courses, learn to interpret papers, and then you’ll be in a better position to say that this statistic does or does not make sense.

        • yugaya

          “interventions used to rob women of their natural right to give birth the way God intended!”

          God if his intention was to promote natural childbirth then also intended maternal mortality rate to remain unchanged during last century:

          “At the beginning of the 20th century, for every 1000 live births, six to nine women in the United States died of pregnancy-related complications… the maternal mortality rate declined almost 99% to less than 0.1 reported death per 1000 live births.”

          I would pay money to see your God of natural childbirth refute that statistic, or you explain to me how it is “skewed” and why exactly we should have left everything to divine intentions that robbed so many women in the past of their life?

  • Nbfl

    No shit non nurse midwives lose more babies. What about the CNMs who have sucessful home births all the time?!
    And when someone talks with their OB is one of their first questions “how many babies have you lost in your whole practice?” I’m sure you would be reluctant to answer. My many women even question that when it comes to hospitals because there is a false sense of hope that hospitals are the best place I birth.
    And don’t lie to ladies saying that hospitals births for healthy low risk women are great. You make low risk high risk by simply not letting mothers move with contractions and eat and drink during labor. Hugh risk women are another story and should be highly educated about the hospital system and birth within those walls while having a birth plan and a doula.
    And let’s not start with all the shit you do to newborns that is unnessisary and disrupts the bond of mother and child as well as Breast feeding… But ignorant people who don’t know their options will inevitably give birth in a bright, dirty, loud, fear mongering hospital.
    So, I would love to know how many mothers and babies this women has lost during her entire practice.

    • Amy Tuteur, MD

      The death rate at CNM attended homebirth is double the death rate of CNM attended hospital birth.

    • Karen in SC

      Already discussed on this blog is the fear that NCBers have about bonding. Come on… if you can’t bond with your baby immediately there are NO lasting problems. Get real!! Bonding can and does happen during a long window of time.

    • thin_red_line

      Omg like vitamin K shots and antibiotics?! That life saving shit total interferes with bonding for like 10 minutes and traumatizes the baby horribly! Plus, they get anti-bodies from colostrum, like DUH, breast milk can cure GBS infections and herpes transmission!

  • Cass

    Regarding Colorado mortality rates: Statistics are often misleading, as we all know, in this case they MISREPRESENT your point regarding danger of midwives/homebirth. Please read before accepting this trickery: http://www.coloradomidwives.org/component/content/article/45

  • Celeste

    Where are your sources on this? MANA looked at 24,000 planned home births, not 24,000 deaths that occurred at home. You completely misunderstood what she said in her quote. Have you thoroughly done your research? 600% just sounds like a made up statistic, especially when it isn’t backed by any links or sources. The farm teaches self sustained farming and how to build Eco friendly buildings. That hardly qualifies as a cult. Ina May got her training from a male medical doctor in her early days, so I don’t believe she sees “science as a male form of authoritative knowledge.” And last but not least, Ina May is the ONLY prenatal health care provider who has shared a complete scientific study (not just the abstract like on pub med) with the public and put her own words and thoughts on the information throughout it in italics. I could go on and on about how everything in this article is misinformation but that would take too long and I don’t have time to dig up every link I have. I hope your readers are smart enough to take no one’s word for it and do their own research to form their opinions.

  • Lily

    Dr Amy, I think you’re trying to dissuade women from home birth and midwives because you don’t think it’s safe. However, you’re coming across as “anyone who disagrees with me is stupid and part of a home birth cult”. You are very actively working against yourself, because not only are your articles not helpful to women trying to make this decision, they dissuade those women from reading anything else that’s pro-hospital birth.
    You’re peeing on your own feet, is what I’m trying to say.

  • kaatya van Nederland

    I think I need to clarify my earlier comment – sometimes we need to look at numbers, rather than just statistics. For example, if we look at deaths per 1000 live births, Netherlands has a much lower rate than the U.S.
    So the number of births where the baby dies are small and then we are distributing the percentage of this small number.
    Similarly, in the Netherlands, Midwives attend the vast majority of pregnant women. There are many more low-risk than high-risk pregnancies. This makes it less surprising that they also encounter more baby deaths.
    It is not right to compare the Dutch system, where highly-trained midwives lead the majority of birth care, with the US, where most births are attended by obstetricians, and untrained midwives able to practice. Also, in the US, an ob/gyn is basically a ‘woman Dr’ whom women visit for all sorts of problems. In other countries, an Obstetrician is a specialist in abnormal birth, who is also a surgeon. (A gynaecologist specialises in other problems with the female reproductive system)
    To say that midwives in the Netherlands have more deaths than Obs without understanding all this gives a very false impression to someone thinking in terms of the US medical system.
    Most of the world recognises that the midwife-led model of care offered in the Netherlands is one of the very best in the world, and other countries seek to emulate it.

    • Young CC Prof

      The perinatal mortality rate is a better measure of maternity care than the infant death rate, since babies who die during birth are not counted in “deaths per 1000 live births.”

      You also say: “Midwives attend the vast majority of pregnant women. There are many more low-risk than high-risk pregnancies. This makes it less surprising that they also encounter more baby deaths.”

      You aren’t reading correctly. The statistic is that a higher PERCENTAGE of babies delivered by midwives die. Not just a higher number, a higher percentage, hence proving that the midwives are not delivering optimal care.

      It’s easy to misinterpret numbers, many people do. I’ll gladly explain anything else you are unsure of.

  • Kaatya van Nederland

    In the Netherlands, Obstetricians do NOT routinely attend low risk birth. They are called in to assist when medical intervention is required. The Netherlands has either THE best or close to the best stats on all mortality and morbidity rates associated with birth. They also have a Homebirth rate of 30% of ALL births.
    Compare this to the stats coming out of US hospitals and you might want to move to the Netherlands and have a homebirth!
    Being sceptical is one thing, being just plain wrong is another altogether.

    • Amy Tuteur, MD

      You are woefully ill informed about midwifery in the Netherlands. The Netherlands has one of the worst perinatal mortality rates in Western Europe. Moreover, midwives attending low risk births have a higher perinatal mortality rate than obstetricians attending high risk births. That’s a terrible indictment of the midwifery model.

      • slinky jets

        curious if Kaatya is from the netherlands, and how many of you commenting on her comments are from the netherlands? just a thought that someone who lives there might have a better idea about the quality of care than people reading stats on websites.

    • Susan

      “Being sceptical is one thing, being just plain wrong is another altogether”
      This is funny not just because of the spelling error but because you are the one who is wrong. Look up the stats Dr. Amy quotes on the WHO website, the Netherlands IS NOT the birthing land of perfection you think it is and in fact has WORSE perinatal mortality than the US. I looked it up for myself, and you should too!

      • S

        I think the spelling difference is a regional thing — “skeptical” is the preferred spelling in the U.S. but not everywhere.

        • Susan

          That could be, there are so many words like that. I actually make so many typos and spelling errors myself that I shouldn’t comment on them! The outrage tone to the post with the factual errors is the more important issue.

        • PJ

          Yes, “sceptical” is the British spelling; also used in many Commonwealth countries.

    • The Computer Ate My Nym

      Actually, per the WHO’s statistics, the Netherlands’ numbers are pretty bad compared to most of northern/western Europe. They do considerably worse than, for example, nearby Germany.

    • Young CC Prof

      Nope, sorry. Want to be the best? Try being more like Sweden. The combination of a highly effective public health system and a low poverty rate give them a perinatal mortality rate of 5 babies per thousand. The Netherlands’ rate is 8, the same as Chile. The USA, despite our large numbers of poor people with limited access to preventative care, is 7.

      What is perinatal mortality? The best international measure of obstetric care. It’s all babies who are stillborn after 28 weeks PLUS all babies who die during birth PLUS all babies who die within one month of birth.

  • Christie

    More babies die in hospitals if you look at some real stats. Educated she is. Do your homework

    • http://gamesgirlsgods.blogspot.com/ Feminerd

      Sigh. Higher numbers of babies die in hospitals because the vast majority of babies are born in hospitals.

      The rate of death in hospitals, though, is much lower in hospitals. If there are 10 homebirths and 2 babies die, and there are 1000 hospital births and 20 babies die, more babies died in a hospital. However, being born in a hospital is still safer, because the chance of dying is so much lower. Now, these numbers are made up, but they do illustrate the point.

      Math. It is your friend.

  • Drea

    http://www.homebirth.net.au/2008/06/homebirth-vs-hospital-statistics-to-die.html

    Just reading around on the subject. This is interesting.

  • Fiddler

    Wow. Strong statement to make that an individual has blood on their hands. I’m grateful that Ina May has re-inforced my beliefs that there is nothing wrong with the woman’s body and that we are in fact more than capable of delivering a baby. As with anything, if you did not find yourself a qualified individual to assist you and provide you with care, you are running a risk. Just like in hospitals. Except hospitals have a way of circulating fear, creating a more stressful environment to deliver in, forcing drugs that are truly not necessary… etc. etc.. I have far too many friends that have horror stories of their hospital deliveries. I’m not against doctors and nurses. We need you! You are vital in times of need. But childbirth is not an illness or an injury. It’s not a disease. Our bodies are incredibly well tuned. We just need time. Stop forcing women to deliver their babies in 12-24 hours. Or assume that every woman is overdue just because she exceeded the 40 week timeframe.
    But you know, everyone is entitled to their own opinion, right? Freedom of speech and whatnot?
    I just fear this Author will seriously misguide someone.

    • auntbea

      “I’m grateful that Ina May has re-inforced my beliefs”. But you do realize that fact is not a matter of belief, right?

    • Kerlyssa

      She may push your buttons, but at least she won’t molest them.

    • Young CC Prof

      Definitely freedom of speech. Gaskin has the right to say what she wants, and other folks have the right to disagree with her, or to point out that what she’s saying is just plain wrong.

    • PJ

      But many women AREN’T “more than capable of delivering a baby.” If not, why would anyone bother having a birth attendant (Gaskin or anyone else) at all?

      • slinky jets

        we are “more than capable”. having an attendant is a backup for the possibility that something could go wrong. it doesn’t mean a woman can’t give birth on her own, just that she’s smart enough to accept that no matter how much you plan, shit happens and it’s better to be safe than sorry. an ounce of prevention and all that. and, sometimes a woman in labour on her own might just want a hand to hold and an encouraging word.

  • Hmmm

    “Interestingly, if you look at page 243.e3, the authors did a sensitivity analysis. In this analysis, they excluded the studies that had home births that were not attended by certified midwives or certified nurse midwives. In this analysis, they found that there were no differences in neonatal deaths between the home birth and hospital birth groups. This means that in the studies in which midwives with certification of some kind attended home births, the outcomes were the same except there was no increase in the neonatal death rate. In my opinion, we have to pay attention to results of sensitivity analyses because this allows us to see the results based on studies which were definitely known to be eligible or clearly described their methods and outcomes.”
    From an unbiased review on the Wax Home Birth Meta- Analysis. Home birth is just as safe as hospital birth low risk women as long as they have a trained, certified and qualified health care provider.

    • Amy Tuteur, MD

      We’re not talking about the Wax study.

  • A London University researcher

    “Studies from the UK show that homebirth increases the risk of poor perinatal outcomes. ” This statement is incorrect and shows Amy Tuteur has not even researched the latest piece of evidence properly seeing that she wrote this in 2012, and the UK study was published in 2011.

    A major study published in the UK (Birthplace in England Collaborative Group, 2011) has examined the risks of planned home births, comparing them against planned deliveries in hospitals and midwife units for low risk women.

    The overall rate of negative outcomes (a composite of outcomes of death or serious complications) was 4.3 per 1000 births (95% confidence interval [CI] 3.3 to 5.5) and there was no difference between non-obstetric unit settings compared with obstetric units. This indicates that as a whole, PLANNED home births are as safe as ones in medical settings.

    The previous studies (that perhaps were used by Amy Tuteur) included NON-PLANNED homebirths which were either not attended by any healthcare professional or were planned hospital births where the delivery happened so quickly that they did not have time to transfer the women to hospital. In these cases, there would be no preparation or proper attendance by healthcare professionals, and therefore, would lead to a higher risk of poor outcomes. These studies were dismissed by the medical community as the data was deemed inaccurate and not valid.

    It is not only important to study the latest piece of research but to also analyse it for validity, objectiveness, and thoroughness.

    For more information see:
    Birthplace in England Collaborative Group (2011) Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort study. BMJ, 343:d7400

    Sandall et al (2013) is the most recent Cochrane Review and conclude that most women should be offered midwife-led continuity models of care, although caution should be exercised in applying this advice to women with substantial medical or obstetric complications.

    • Guesteleh

      Amy has discussed the Birthplace study in detail. I suggest you look at her articles. Planned births at home are only as safe as hospital births when women with risk factors are excluded from giving birth at home–including ALL mothers giving birth for the first time. Those conditions are almost never met in the real world, especially here in the U.S.

    • Amy Tuteur, MD

      “Amy Tuteur has not even researched the latest piece of evidence properly
      seeing that she wrote this in 2012, and the UK study was published in
      2011.”

      Let me guess: you didn’t bother to check what I wrote back in 2011 when the study was published. And you call yourself a researcher? What a joke.

  • jezzebel

    I would like to point out for anyone reading this that Amy Tuteur no longer has a medical license, it lapsed in 2003. She has also been banned from many scientific sites for her rude and obnoxious behaviour in addition to her lack of evidence. The scientific evidence she uses are papers that have been dismissed by the scientific community as being biased or inaccurate. The figures she quotes are often portrayed in misleading ways, for example 600% increase is actually an increase from 0.001 to 0.006. Im not advocating for or against homebirth, instead I’m advising people to look elsewhere for more accurate knowledge.

    • Antigonos CNM

      And I would like to point out that you are simply indulging in malicious slander. Amy Tuteur is an MD but is not currently practicing and therefore is not keeping her license to practice current. The only sites which ban her are those which are inaccurate or downright misinformation; she has never been banned from ANY authentic scientific site — in fact, she is due to address ACOG this month. Her explication of the statistical method, and the way she shows what a scientific paper really shows is the correct scientific method. She exposes the assertions of the “homebirth is safe” lobby for the lies they are–something you’d understand if you weren’t motivated by personal animus.

      You are an ignorant troll. Go crawl back into your hole.

      • Captain Obvious

        Also Jezzebel, notice the change in Homebirth comments regarding Homebirth lately. They used to say that Homebirth is as safe or safer than Hospital birth. But lately they have been saying the absolute risk in Homebirth is small compared to the slight increase in relative risk, and is worth considering. I have to believe this change in narrative has something to do with Dr Amy.

      • Tim

        By the logic these people use, should we stop using life saving surgeries once the inventor of said surgery stops practicing? Is the knowledge they have discovered somehow now null and void because their license is no longer good to practice?
        The MOST amazing and hypocritical part of all this, is that the very same people who act like birthing a baby is “no big deal” and “totally predictable and natural process that needs no help” , simultaneously act like if someone hasnt been doing it for a while, all their training and knowledge is somehow null and void.
        So which is it folks? Is birth so crazy complicated, difficult and unpredictable that no longer attending them makes you a lay person, or is it just a totally predictable , easy process that anyone with a HS diploma can be an expert in it?

        • The Bofa on the Sofa

          Moreover, it’s not like Dr Amy is some rogue OB out there, positing extreme positions. Everything she is saying is perfectly in line with the views of the ACOG – it’s the MAINSTREAM position of OB!

          Dr Amy’s license may have lapsed, but that doesn’t apply to the millions or whatever of practicing OBs in the US that are practicing exactly as Dr Amy describes.

          • slinky jets

            mainstream doesn’t mean better, or right.

    • Elizabeth A

      Well, it was certainly helpful of you to post the status of Tuteur’s medical license here, on a blog entry over a year old, for the benefit of the people who couldn’t interpret the word “retired” in the bio at the top of the page, but would, presumably, discover your helpful paragraph down among the comments on very old entries.

      I have seen a lot of papers discussed here, and more then a few practicing physicians, and I haven’t seen a lot of time or thought given to papers that dismissed as biased or inaccurate (although there has been a lot of discussion of bias and inaccuracy). Which papers were you objecting to?
      As to objecting to describing a 6x greater chance as a 600% increase – well, we can play spot the math error all day, but what would it be more appropriate to call it? “A larger, but still statistically tiny, chance that something unfortunate might happen to you or your baby”? Or do you prefer “Nothing to worry about, dear, certainly not a reason to be in the hospital where they can help you”?

    • Captain Obvious

      Wow, insecure paranoia at its best. Well Jezzabel, did you know ACOG District VII is having Dr Amy speak at their annual meeting in Maui? You that many Doctors who are not practicing anymore ( and other professionals) continue to read contemporary medical literature and serve on Boards and Committees providing their expertise? And yes the absolute risk is small despite the slight significant relative risk. But more significant is the consequence of that slight significant risk, permanent brain injury or death! If the consequence was the difference between a CS or vaginal birth, both giving you a healthy baby, I would take that risk. I am not ready to take an increased risk for my baby.
      Come back and comment how ACOG wants to hear from her despite you stated all scientific sites ban her. Maybe biased crunchy sites, but not truly scientific sites.

    • The Bofa on the Sofa

      She has also been banned from many scientific sites

      Name 2. Remember, they have to be SCIENTIFIC sites.

    • Box of Salt

      Where did you cut and paste this comment from? I’m curious, because I’ve read the same thing (including mostly the same wording) sprinkled throughout old comment threads several times over the past few months.

      jezzebel, what was the highest level math class you passed? I’m only asking because you don’t seem to understand what percents mean. Rising from 0.001 to 0.006 is just as much 6 times higher as rising from 100 to 600.

      • PJ

        It’s only misleading if you don’t understand basic maths!

      • Captain Obvious

        If only Homebirth deaths were .0006

    • PJ

      I’m just smiling at the irony that this comment was placed after a post on Ina May Gaskin, the utterly unqualified icon of the anti-Dr Amy brigade.

    • The Bofa on the Sofa

      BTW, an increase from 0.001 to 0.006 is actually 500% increase, not 600%.

      I’m advising people to look elsewhere for more accurate knowledge.

      Whoops.

      BTW, to me, a 1/150 chance of my baby dying sounds very, very scary. 1/1000 is also scary, but much better.

  • Rose

    What a stupid arrogent article! Where are your resources? How on earth did humanity ever survive before you magical meddling OBGYNs started cutting everyone’s offspring from their bodies!!! I just delivered my 3rd baby at home and thank goodness that we had a planned home birth! First off, my labor was just 2hrs so I’d have had him in the car alone had we been headed to the hospital. Secondly he got a little stuck from being quite big so I was able to move into a position that allowed him to become unstuck (unlike a woman who has an epidural and can’t move).

    • Amazed

      Ah the arrogance of vagina. All hail Rose and her wombyn powers!

      • slinky jets

        and why is it wrong to be proud of birthing children? it’s an amazing process and women’s bodies are very good at it. you’re right, millions and millions of women have done it and i bet the vast majority are proud of it. what’s a wombyn, by the way?

        • Wren

          Why is a biological process something to be proud of? I am proud of my children, but not terribly proud of their births. Actually, I’d be more likely to be proud of the C-section I had to save my son’s life than the VBAC I had with my daughter.

  • Hannah S

    Amy-
    I respectfully disagree with some of your statements regarding Ina May Gaskin. To your point that she is a “feminist, antirationalist”, what makes you say this? I’m not sure Ina May has ever claimed to be a feminist. You also claim she/ other feminists “dismiss science as a male form of “authoritative knowledge” yet she has been very vocal and appreciative in her books and lectures about learning from a male OB (Dr William, if I remember right).
    Maybe you should read her books before making comments.

    What did home birth or having faith in a womon’s body ever
    do to you?

  • Captain Obvious

    Judith Rooks, CNM, testified her research about Homebirth safety.
    https://olis.leg.state.or.us/liz/2013R1/Downloads/CommitteeMeetingDocument/8585

  • http://www.facebook.com/carolin.frank Carolin Frank

    Why don’t you link to or cite the studies you mention? Ina May Gaskin does, you know. I’m a scientist, and I did a lot of research before switching from an OB to a highly experienced home birth midwife. I gave birth to my first child in Sweden, midwife assisted, in the hospital. The OB here in the US was a nice man, but his lack of knowledge about, safe, natural, evidence based birth practice horrifued me. I devoured the literature on home birth, read dozens or hundreds of papers, in detail. I came to the conclusion that it is perfectly safe for a healthy woman with a normal pregnancy to deliver at home with an experienced midwife. Being a scientist however, I’m happy to reevaluate, so please point me to the literature.

    I have to say though, that the anger and emotionality in your posts does not instill much confidence!

    • http://www.facebook.com/ainsleyclare Ainsley Nicholson

      Caroline, in the USA we have a very differant situation from Sweden. While we do have highly trained and experienced midwives (CNMs, or Certified Nurse Midwives), most of them focus on attending hospital births. The home birth “midwives” in the USA have can have as little formal education as a high-school diploma and a self-study course. Their rates of neonatal mortality are shockingly high. The CDC wonder site that she references (http://wonder.cdc.gov/) tracks all causes of death in the USA, and it has a section on infant deaths. You can crunch the numbers yourself (I did) and it confirms what she says. And those numbers underestimate the true numbers of homebirth deaths, because deaths from a botched home birth that was transferred to a hospital end up in the “hospital birth” category. A recent data collection effort by the State of Oregon includes the planned site of birth, and the death rates are even higher. I think Dr Amy’s anger comes from reading story after story about preventable deaths, and preventable permanent injury to infants, month after month, and having the home-birth advocates here in the USA simply ignore the very real risks of homebirth with an uneducated “midwife”.

    • yentavegan

      You chose a homebirth because you wanted that experience. You did not choose a homebirth because your Ob/gyn lacked knowledge of natural childbirth. Do you realise how ridiculous your claim is?

    • Captain Obvious

      MANA won’t release their mortality rates of over 27,000 homebirths, why you suppose? Judith Rooks a CNM took on the job in Oregon to investigate this and testified that Homebirth has a 6-8 times higher mortality risk.
      https://olis.leg.state.or.us/liz/2013R1/Downloads/CommitteeMeetingDocument/8585
      The Netherlands has one of the highest maternal mortality rate in Europe. And this paper in the BMJ suggest low risk moms with midwives at home have a higher mortality rate than all the high risk moms in hospitals.
      http://www.bmj.com/content/341/bmj.c5639
      Colorado statistics and now Arizona statistics show an increased risk with homebirths. Links found here on threads. Common sense really, Homebirth in America with undereducated unlicensed CPM with no malpractice and no doctor collaboration or transfer plans who take on high risk “variations of normal” cannot be compared to nurse midwifery that practices in other countries.

      • Anonymous

        The Netherlands had 6 maternal deaths per 100,000 live births in 2010. The United States had 21 per 100,000. The majority of women deliver with OB in the US. The worst country in Europe is better than the US. I’d rather deliver with a midwife in the Netherlands than an OB here.
        And yes, Gaskin may have blood on her hands. So do plenty of OBs.
        apps.who.int/gho/data/node.country.regionAMR?lang=en

        • PJ

          Um, do you actually know anything about maternal mortality in the US? Like have you ever actually bothered to look up what women die of?

          Here’s a newsflash for you: high maternal mortality in the US is driven by racial inequality. If you haven’t considered that, then nothing you have to say about maternal mortality in the US means a thing.

          • Anonymous

            Really?! Not everyone is treated equally!? Some people don’t have access to healthcare!? Some mothers don’t have access to prenatal care!? In the United States!? Preposterous! Thanks for the newsflash!

            And I didn’t know they cured heart disease in the Netherlands! Amazing!

          • PJ

            You’re the one implying that maternal mortality in the US is driven by poor obstetric practice. It’s not (although if you want to make a case for systemic discrimination against African American women as a factor I might listen–clearly, though, this is not what you’re getting at). If you bothered to look at the evidence (for example, the actual causes of maternal mortality) even just a tiny bit you would be aware of this.

            And do you really not grasp the fact that for a variety of reasons–many of which are linked to high levels of social and economic inequality, and none of which have anything to do with the skill of obstetricians–heart disease is more prevalent in the US than the Netherlands?

          • PJ

            One thing that indicates the skill of American obstetricians is the fact that–despite maternal and infant mortality rates that are high among developed countries–the American neonatal mortality rate is so good. In other words, obstetricians are faced with a population that suffers poorer health than other developed countries, yet manage to save the lives of the babies under their care at a comparatively higher rate.

            Critical thinking does not appear to be a feature of NCB advocates.

          • Anonymous

            The United States also has a higher neonatal mortality rate than the Netherlands. I didn’t read the the rest of your posts, I didn’t expect to find much critical thinking there either.

          • Amy Tuteur, MD

            According to the World Heath Organization, the best measure of obstetric care is perinatal mortality and the US has one of the lowest rates in the world, the same or lower than that of the Netherlands.

          • PJ

            Well, you obviously COMPLETELY missed the point of what I said.

          • Tim

            It’s infant mortality that the US suffers in, not perinatal/neonatal (eg; very shortly after birth) – and surprise surprise, it’s pretty much for the same reason we have a high maternal mortality – in the US, poor people can’t/don’t have access to skilled health care until it’s an emergency , because then they can’t refuse you. Is it a wonder so many people die of preventable/treatable things in the US?
            There are two very important differences between other first world nations and the US
            #1 – The others offer health care to all their citizens
            #2 – The others are geographically much denser than the US, so more people live reasonably close to skilled health care.

          • PJ

            But also #3–high levels of inequality and poverty, with particularly high levels of deprivation among African Americans. Poverty leads to a range of issues that impact upon health outcomes, including access to healthcare, poor diet, poor housing, vulnerability to violence and so on.

            Nothing gets my goat more than privileged white NCB advocates who think a problem of racial and economic inequality is all about THEM.

          • kaatya van Nederland

            Since when have Australia and New Zealand been ‘geographically dense?

          • kaatya van nederland

            There are plenty of other ‘developed’ countries with racial and social inequality and poverty-related health issues. Third world diseases are alive and kicking in the first world – the US of A does not win prizes for being more excessively disadvantaged than the rest of the developed world

          • Anonymous

            And I never said poor obstetric practice. I said despite the majority of birth being in hospitals, we are losing more mothers than other countries.

          • PJ

            Come on, we aren’t stupid. You said, after comparing maternal mortality rates in the US and Netherlands, that:

            “The majority of women deliver with OB in the US. The worst country in
            Europe is better than the US. I’d rather deliver with a midwife in the
            Netherlands than an OB here.”

            You clearly meant to imply that obstetricians in the US do a poorer job than midwives in the Netherlands. You seem to now be trying to backtrack. I note that if you think there is some other factor about the Netherlands that would automatically make giving birth there safer for you, you haven’t divulged.

        • Young CC Prof

          Do me a favor. Find out how many of those 21 actually went into labor reasonably healthy and died during delivery in a hospital. Hint: It’s almost entirely unheard-of.

          • Anonymous

            Have you heard of an amniotic fluid embolism? Or postpartum hemorrhage. These conditions don’t just affect unhealthy women.

          • Young CC Prof

            Yes, of course they can happen to anyone, that’s why we have hospitals. However, most deaths that the US authorities classify as “maternal deaths” are NOT due to labor complications in healthy women. They are due to the physical stresses of pregnancy exacerbating other serious illnesses, from heart disease to food poisoning. Other countries may define “maternal death” more strictly.

          • Anonymous

            So then why, in a country where most births take place in hospitals, are mothers dying more frequently than other countries? If hospitals are the safest place to be, why are we still losing mothers? Is food poisoning that hard to manage? Obviously we need hospitals, but even with them, some women do not get the care they need. We continue to lose mothers.

          • Young CC Prof

            I’m answering your question over and over again, and you’re ignoring me.

            a) Many women lack access to healthcare, at least until things are already in crisis. It’s a social and economic issue rather than a failure on the hospital’s part.

            b) We are measuring maternal mortality differently, and possibly more broadly, than other countries.

          • PJ

            That’s the problem with starting off with such a pompous and antagonistic tone. You might find it difficult to backtrack if you’re found to be mistaken.

          • Anonymous

            You truly believe that other countries are not as thorough at reporting maternal mortality as the United States? So you don’t find the WHO a credible source for the statistical data it publishes?
            Obviously it is system failure, you can’t blame hospitals and you can’t blame home birth. We lose women in both.
            I do not need you to answer my question. First of all, it is rhetorical. Second of all, if you are so wise, get out there and attempt to change the system instead of defending it by saying we over report maternal death and that other countries under report it.
            Certified midwives are affordable, and therefore more accessible to underserved populations. The Director of Medicine at the hospital I work for refers to certified midwives as being an important factor to reforming health care and increasing accessibility to care. It would be nice if other doctors would take on this same belief.

          • Young CC Prof

            I’m not saying other countries under-report, I’m saying we DEFINE IT DIFFERENTLY. In the USA, any time a pregnant or recently postpartum woman dies of any medical causes, the coroner is supposed to consider whether pregnancy was a factor in the death, and, if so, classify it as maternal. Other countries don’t necessarily do that, and may only count deaths that were clearly caused by pregnancy, such as pre-eclampsia or postpartum hemorrhage. This is one of many reasons it’s tough to make international comparisons of vital statistics.

            And if you don’t want your question answered, go someplace else. Here, we have this nasty habit of assuming people are interested in the complicated and messy real facts.

          • PJ

            I believe c-sections (those nasty old interventions) REDUCE the risk of haemorrhage.

        • Amy Tuteur, MD

          Most women cases of maternal mortality are due to too LITTLE intervention, not to much. At this point, the leading cause of maternal mortality in the US is cardiac disease. Is it your contention that OBs cause women to develop heart problems? I didn’t think so.

          • Anonymous

            Too little intervention….the majority of women in the US deliver in hospitals. So what you are saying is too little intervention…in hospitals.

            “Most women cases of maternal mortality”…. Are there men cases of maternal mortality too? Thanks, doc!

        • Captain Obvious

          Maternal mortality is based on how it is coded. Dr Amy has a good post about how the USA has updated or adjusted what maternal mortality entails. In two separate years, I believe 2003 and 2007 updates to the requirements of what entails maternal mortality, and it “appears” the maternal mortality rates have increased after these years. The actual rates haven’t changed but the associated deaths linked to maternity have expanded. I don’t think foreign countries made the same adjustments to their statistics.

    • http://www.facebook.com/lizzie.dee.71 Lizzie Dee

      I am not a scientist, I haven’t read hundreds of papers, and I think homebirth is a very bad idea regardless of the skill of your attendant. But I agree with you: homebirth is safe for a healthy woman with a normal pregnancy. When it is over and the woman is still healthy and everything has stayed normal. I started off very healthy, and eventually went back to being very healthy, and without the machines that go beep and the resources of a hospital the fact that my pregnancy hadn’t stayed normal would not have been that clear, and I would have been one of the healthy low risk mothers that ended up dead. Did you read about those? The insoluble problem about birth is that it is largely safe, but the disasters come out of the blue to the unsuspecting and unprepared, and you have to decide whether THAT risk is one you are happy with, without the pretence that appearing to be low risk is a guarantee or a certainty.

  • Been there

    Well I worked at the hospital where we get the “farms” bad out comes. They should not be delivering babies!!

    • Captain Obvious

      I met one woman here in Illinois who had gone to the Farm for delivery years ago… … … She had a cesarean! What are the chances? With their “low” CS rates, the odds of me meeting one person who had a transfer CS from the Farm should be rare. Makes me wonder about Ina’s statistics.

  • Denise

    Why do we entrust our reproductive health to surgeons? I do believe that is a lot of womens blood on your hands. How many times did you cut a women open when you did not really have to? And really, how many women are having low risk births in hospitals? The norm is inductions and c-sections…high risk indeed. Woman are capable of no intervention home births, and you hate that fact.

    • Captain Obvious

      OB/GYNs are primary care docs taking care of women from adolescence to death. Annual wellness visits and prescribing medicines and therapy. We do perform surgery when necessary, but we are not surgeons. Surgeons do not have a regular patient base that visits annually. Low risks births happen all the time in the hospital, are you really believing all that crunchy BS about cold strap down deliveries in hospitals. Your ignorance is showing.

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