Let’s review: Twelve things you shouldn’t say to Dr. Amy … unless you want to appear very foolish

This piece has received more comments than any other I have written, 1000+ and counting. It first appeared 2 years ago, but rarely a week goes by without someone asserting one or more of the following in the comments sections. Clearly, some people need a review.

It seems like every day a new visitor parachutes in to this blog and attempts to “educate” me. Inevitably, the visitor finds that almost everything she says is false. Indeed, almost everything she thinks she “knows” is false. So to spare these visitors embarrassment, and to reach those who are attempting to “educate” me on other blogs, I have compiled the following list. Here’s what you should not say to me, and why you should not say it.

1. The US does very poorly on infant mortality.

Infant mortality is the WRONG statistic. It is a measure of pediatric care. That’s because infant mortality is deaths from birth to one year of age. It includes accidents, sudden infant death syndrome, and childhood diseases.

The correct statistic for measuring obstetric care (according to the World Health Organization) is perinatal mortality. Perinatal mortality is death from 28 weeks of pregnancy to 28 days of life. Therefore it includes late stillbirths and deaths during labor.

The US has one of the lowest rates of perinatal mortality in the world.

2. The Netherlands, which places the greatest reliance on midwives, has low mortality rates.

No, the Netherlands has, and has had for some years, one of the HIGHEST perinatal mortality rate in Western Europe. It also has a high and rising rate of maternal mortality. The Dutch government is deeply concerned about these high mortality rates and a variety of studies are underway to investigate.

A study published in the BMJ is early November 2010 revealed and astounding finding. The perinatal mortality rate for low risk women cared for by midwives is higher than the perinatal mortality rate for high risk women care for by obstetricians!

3. Obstetricians are surgeons.

I never understand how anyone has the nerve to say this to me. I AM an obstetrician. No one knows better than I what obstetricians are or are not. I went to college. I went to medical school. I spent four years in obstetric training. I delivered thousands of babies. I have cared for thousands of gyn patients. That some doula who is a high school graduate thinks that she can possibly know more than I about the nature of obstetricians defies belief.

Obstetricians do surgery as part of their practice. That does not make them surgeons. If it did, ophthalmologists and dermatologists would be surgeons too, since they do surgery as a routine part of caring for their patients. Is anyone seriously suggesting that you cannot go to an ophthalmologist for an eye exam because he or she will recommend unnecessary surgery?

4. Homebirth is safe.

No, all the existing scientific evidence and all national statistics indicate that homebirth triples the rate of neonatal death. Even studies that claim to show that homebirth is as safe as hospital birth, like the Johnson and Daviss BMJ 2005 study, ACTUALLY show that homebirth with a CPM has triple the rate of neonatal mortality of comparable risk women who delivered in the hospital in the same year.

The Midwives Alliance of North America (MANA) is well aware that homebirth is dangerous. That’s why they are hiding their own mortality rates. They spent almost a decade collecting information on more than 18,000 CPM attended homebirths, announcing at intervals that they would use the data to show that homebirth is safe. So why haven’t any of us seen it?

The data is publicly available, but ONLY to those who can prove they will use the data for the “advancement” of midwifery. MANA is quite up front about the fact that they will not let anyone else know what they have learned. Obviously, if homebirth had been anywhere near as safe as hospital birth, they would be trumpeting it from the mountain top. It does not take a rocket scientist to suspect that their data shows that homebirth dramatically increases the risk of neonatal death.

5. Homebirth midwives are experts in normal birth.

This one always makes me laugh. Experts in normal birth? That’s like a meteorologist who claims to be an expert in good weather.

I guess they’re trying to make a virtue of necessity. Homebirth midwives know virtually nothing about the prevention, diagnosis and management of pregnancy complications. That’s a problem when you consider that the only reason you need a birth attendant is to prevent, diagnose and manage complications. You don’t need any expertise to catch the baby and make sure it doesn’t hit the floor. Ask any taxi drive; he’ll tell you.

6. Childbirth is safe.

No, childbirth is INHERENTLY dangerous. In every time, place and culture, it is one of the leading causes of death of young women. And the day of birth is the most dangerous day in the entire 18 years of childhood.

Why does childbirth seem so safe? Because of modern obstetrics. Modern obstetrics has lowered the neonatal mortality rate 90% and the maternal mortality rate 99% over the past 100 years. What has the contribution of midwifery been to lowering those mortality rates? Zero? They’ve invented nothing, discovered nothing and tested nothing that has had any impact on perinatal or maternal mortality.

7. Childbirth used to be dangerous but that is only because sanitation was poor and women were poorly nourished.

No, the great advances of sanitation occurred in the 1800′s and the early years of the 1900′s. Not surprisingly, this had a big impact on deaths from infectious causes. However, rates of perinatal and maternal mortality did not begin to drop appreciably since the late 1930′s and the discovery of antibiotics. In the intervening years, easier access to C-sections, epidural anesthesia, newer and better antibiotics, blood banking, and neonatology led to dramatically lower mortality rates.

8. C-section increases the risk of maternal and neonatal death.

No, women who die in pregnancy are most commonly women with serious pre-existing medical illness (heart disease, kidney disease) or serious pregnancy complications (pre-eclampsia). C-sections are often done in an effort to save the lives of these women. Sometimes it is not enough. The C-section is what is known as a “confounding factor.” Both the C-section and the death can be traced back to the mother’s health status; the C-section did not cause the death.

MacDorman and colleagues have attempted to show that C-sections for “no indicated risk” increase the neonatal death rate. Their papers have been roundly criticized because they used birth certificates, not hospital record. Unrelated investigations of birth certificates have shown that, while they are highly reliable for data like weight and Apgar scores, they are highly unreliable for risk factors. Indeed, unrelated studies have shown that up to 50% of women who have serious medical illnesses like heart disease, have those risk factors missing from the birth certificate.

9. Induction harms babies.

No, induction lowers perinatal mortality. The yearly CDC data on births shows that as the induction rate has risen, the rate of late stillbirth has dropped by 29% and the neonatal death rate has not increased.

10. If childbirth were dangerous, we wouldn’t be here.

This represents a profound lack of knowledge about evolution as well as a profound lack of knowledge about childbirth. 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%. That’s right. 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%.

11. US maternal mortality is rising.

Despite a rather histrionic political report from Amnesty International making that claim, US maternal mortality is not rising and has even dropped in both of the past two years. Why does it look like it has risen? Because the standard death certificate has been revised twice in the past two decades in order to more accurately capture maternal deaths. The new death certificate has revealed maternal deaths which otherwise would not have been counted. It is not clear that maternal deaths have increased; it’s merely that reporting of those deaths has improved.

12. Women are designed to give birth.

Women are not “designed”: they have evolved and evolution involves trade offs. Babies with big heads tend to be more neurologically mature, so having a big neonatal head has evolutionary advantages. A small maternal pelvis makes it easier for a woman to walk and run, providing her with an evolutionary advantage. Those two advantages are often incompatible. The woman with a small pelvis may have been able to survive by outrunning wild animals, but when it came time to give birth, she was more likely to die because that small pelvis could not accommodate a large neonatal head.

***

The above statements have two things in common. First, they are wrong. Second, they are passed back and forth between natural childbirth advocates who “teach” each other they are true. That’s why it is impossible to become “educated” by reading natural childbirth books and websites. Most of their information is flat out false, and they are entirely insulated from scientific evidence. Natural childbirth advocates make up their “facts” as they go along. They don’t read the scientific literature. They don’t interact with science professionals. Indeed, professional natural childbirth advocates take special care to never appear in any venue whether they might be questioned by doctors or scientists. They know they’d be laughed out of the room. That’s okay with them as long as there is a large pool of gullible women out there who will believe them and buy their products.

It is important that those who are parachuting in to “educate” me understand that they literally have no idea what they are talking about. Most of what they think they “know” is factually false. And they demonstrate that every time they write one or more of those twelve statements.

  • April

    So let’s say we have a completely low-risk woman, hospital minutes away, not anemic, no pre-eclampsia, full-term, healthy, measuring perfect..etc TRULY LOW-RISK planning a homebirth with a CNM. CNM’s are equipped to deal with a bleed (pitocin + cytotec if needed) and also fully equipped to deal with a resuscitation (O2, equipment, assistant with them, etc.) and this CNM is also capable of recognizing when things have escalated, monitoring HR, vitals, etc…what would keep you from considering a homebirth? The CNM I work for has been delivering for 30 years at home/birth center and hasn’t lost a mom or babe. We transfer at the first sign of a problem (haven’t really had to do that much and I’ve yet to do an emergent transfer with her) and risk out anyone that shows signs beforehand. What is wrong with homebirth in this scenario?

    • Amy Tuteur, MD

      According to the Malloy study, homebirth with a CNM has double the risk of death of hospital birth with a CNM.

    • FredFuchs

      So you won’t trust an OBGYN with the entire birth process, but if something goes wrong, you’re running there begging for their help?
      That’s a bit hypocritical and idiotic.

    • http://www.chapmancentral.co.uk Guy Chapman

      That’s a bit like saying that you have two cars outside your house, one a brand new Volvo and the other a junker with dodgy brakes that you dearly love despite it being unreliable and unsafe; you’re only going to the corner store, so why would you not take the junker?

  • SG

    I do have some honest questions: What do you make of iatrogenic prematurity (I don’t mean when it is medically indicated; I mean the relatively small percentage that is thought to be without clear medical indication)? Do you think it’s a good trade off for the lower perinatal mortality rate associated with medically-indicated iatrogenic preterm births? How is a mother to decide, or should she, as to whether her caregiver might be in that small percentage of OBs or MWs if she is still unsure about the reason for her induction before term?

  • Lynn Ratcliffe

    https://www.npeu.ox.ac.uk/birthplace/results Very different results in the UK where midwives are recognised as professional equals

    • Young CC Prof

      1) UK birthplace study applies in the UK, it cannot be used as evidence towards the safety of home birth in the USA, where the safety measures are all missing or inconsistent.

      2) UK outcomes overall (home or hospital) are not as good as US hospital outcomes. In particular, stillbirth rates are substantially higher in the UK.

    • Stacy48918

      Really? Midwives are equal to OBs in the UK? So they do C-sections?

      • Lynn Ratcliffe

        in the same way the anaethetists are professional equals; they don’t do caesareans either!
        Uk midwives are educated to degree level, and they are the lead professional for all pregnant women. IF a woman needs extra care because she or her baby have complications they THE MIDWIFE referrs the woman to the obstetrician. The woman can of course decline & remain under midwife-led care if she chooses.

        • Stacy48918

          Except of course that anesthesiologists are DOCTORS, just like OBs and NEITHER would overstep into the medical area of the other because OBs are not trained in anesthesiology and vice versa.

          • Lynn Ratcliffe

            Like I said, Midwives in the UK are the lead professional & refer on if a woman needs extra help. I’m not going to engage in this ridiculous argument anymore.They are regarded by UK obstetricians as professional equals. It is a very different system in the UK.

    • http://www.chapmancentral.co.uk Guy Chapman

      They are not professional equals, that’s a bit of a silly claim to make. You would not claim that a nurse practitioner, an analogous role, is professionally equal to a doctor. That doesn’t make nurse practitioners useless, unvalued or dangerous, just not as equals. It’s not a point of shame.

      However, we did have a trial scheme where the community midwife travelled into hospital with the mother and performed the delivery, in the hospital with all the paraphernalia (and backup) readily to hand in case it went wrong. That genuinely was a good thing in my view: familiar face plus backup care in depth if it was needed. This was of course stopped – I don’t know why for sure but was told it was down to costs, which I guess has truthiness.

      Even then, there were those who you felt comfortable with and those you did not. We were lucky: ours was excellent, and clearly kept well up to date on the literature.

      There’s also an elephant in the room. A lot of midwives (though less so in the UK) spread folk myths and there are even records of them promoting dangerous nonsense such as anti-vaccine activism. There are many records of midwives promoting homeopathy, reiki and other ludicrous fantasies. Not all midwifery bodies are robust in their response to this.

      Aside: I like midwives; our midwife, Ruth Moynes, later moved to Haverfordwest in Wales, and delivered my sister’s fourth (who was named Ruth after her).

  • sameguest

    Is it time to update the MANA statement (Number 4), now that they have published their disastrous results?

  • Steph

    This is amazing. Thank you Dr. Amy. You might not get any thanks from the angry mob, but you’ll have fewer deaths on your conscience than they; and that alone makes me glad people like you who are brave enough to speak out exist.

  • Sue

    So what of your ‘false’ beliefs, no doubt, that ‘every woman must have active management of third stage’ or she will bleed to death? Or that it was ‘research evidence’ that suggested that baby’s were removed from mothers at birth and kept away from mothers with no adverse effects? Many aspects of medical management claim to be evidence based, yet the evidence seems to evolve…

    • Stacy21629

      “So what of your ‘false’ beliefs, no doubt”
      Do you have any documentation, whatsoever, that Dr. Amy holds these “beliefs”? Or are you just making stuff up so you can ignore what she says?

  • Lisa

    Just spent probably an excessive amount of time looking for the outcome of Carolyn Gall AAHCC’s pregnancy.

    http://www.natural-motherhood.com/why-home-birth.html

    Based on the comment at the end of this article it seems that she was diagnosed with pre-eclampsia at some stage and voluntarily went to a hospital to give birth. No mention of anything going wrong (other than a general sense that it wasn’t enjoyable) so can hopefully assume both mother and baby are doing okay.

    • Karen in SC

      She’s the 50 year that was freebirthing with only her husband in attendance? I have wondered what happened. Thank you for updating.

  • deb

    I had two wonderful uneventful home births. I understood the normalcy of birth and took care of myself and had a positive outlook. Since I w o r ked in maternity and saw first hand the reasons for most complications (drs and their interference mostly) I was very confident. It was wonderful!!!

    • Trixie

      So, people who have life-threatening complications in childbirth — it’s their fault for not having a positive enough outlook?

    • fiftyfifty1

      If home birth works so well, why is the death rate for babies 4 times that of hospital birth?

    • MLE

      Alternative title: “Mom discovers one weird trick to wonderful home birth.”

      • Squillo

        “I’ll take post hoc ergo propter hoc fallacy for fifty, Alex.”

        • Something From Nothing

          I LOVE saying post hoc ergo propter hoc!

    • Young CC Prof

      Congratulations! You are one of the 90% of healthy moms who delivered without a major complication!

      Good thing you weren’t in the other 10% of equally healthy moms who have random problems that will seriously damage or kill themselves or the baby without major interventions.

    • Captain Obvious

      And a higher rate of Homebirth moms say “I understood the normalcy of birth and took care of myself and had a positive outlook”, and had a bad outcome than hospital birth moms. Having a Homebirth doesn’t guarantee you a bad outcome, you just have a higher rate of having a bad outcome. I don’t like to gamble.

    • Mer

      I’ve worked in maternity and seen major complications as well. I also had very healthy pregnancies, 3 of them in fact and normal deliveries all except that last one. It was lovely, I took care of myself and had a positive outlook, waited for labor to start naturally and had absolutely no pain relief meds, in fact I used hypnobabies! And guess what, my 10 lb (we expected a big baby as his older brothers were each over 9 lbs) baby got stuck with a shoulder dystocia AND a freaking Nuchal cord. With the intervention of my midwife, OB and the nursing team they got him out in 2 minutes, even with that speed he still had an apgar of 4 at 1 minute and needed O2 and assessment by pediatrician and needed to be observed for 48 hours to make sure he continued to be alright. On top of all that, the poor little guy had low blood sugar, but thanks to my decision to supplement him early it was never a problem. On the bright side, thanks to my midwife and OBs management, including IV pitocin, I only lost 450 ml of blood.

      So yes birth is totally normal, as normal as the complications that I’ve witnessed and experienced. I don’t even spend that much time caring for pregnant women much less helping with labor and delivery and I’ve still seen some hair raising complications,

    • Something From Nothing

      So deb, are you implying that if we understand the normalcy of birth (whatever that means) and we take care of ourselves and think positively, there will be no complications and no mothers and babies need die?

    • ngozi

      Was my gestational diabetes, lousy pregnancy history, elevated maternal age, 4 miscarriages all caused by doctors and their interference? Those are complications, and you say complications are caused by doctors.

      • ngozi

        Could all of those things been cured with positive thinking?

    • Amazed

      Says the cleaning woman?

      You are clearly neither an OB, nor a CNM, or a L&D nurse, otherwise you would have said so. Sorry, Debbie dear, but your fellow maternity care worker who boasted about her experience that supposedly made her a competent midwife and was later revealed to be a cleaning woman already gave us an idea of just how competent you “maternity workers” are.

  • Lisa

    You should be shot in the fucking face for the way you write these articles. not only are you the rudest and most vicious woman i have ever come across, but in most of these, you’re a downright cunt. Who the hell are you to tell a woman that she is “uneducated” for making an informed decision to have a CPM deliver her child?? IT’S HER CHOICE NOT YOURS!! and frankly, it’s not your place to discourage a woman, only to priovide the facts. Which you have done.. but in a completely unneccesary and rude manner! I would rather have a baby in the middle of a forest completely alone in the middle of no where before I would even consider letting you (or someone like you) touch me or deliver my child. and follow the money??? I am following it right to the hospitals where OB’s main focus is to get women in and out to fill the beds and keep the dollars flowing. Go to hell you fucking bitch

    • http://www.antigonos.blogspot.com/ Antigonos CNM

      Dear me. Language.
      You really are pathetic, my dear. Please do go have your baby wherever you choose. And good luck to you, and your baby.
      Foul language is often used as a refuge when you don’t have any justification for your viewpoint — and you know it. Reasoned argument may convince; vulgarity never does.

    • http://whatismyreferer.com/ MikoT

      I upvoted this because it made me laugh, and because she used apostrophes properly.
      Good for you Lisa, getting on the internet.

    • Trixie

      Thanks, Lisa, for the new insights you brought to the discussion. Stay klassy!

    • Jessica S.

      Lisa concedes that Dr. Amy has provided women with the facts to make an informed decision. But Dr. Amy didn’t do it THE RIGHT WAY!!! She was MEEN!! Lisa offers an example of how one SHOULD conduct themselves in such discussions: she doesn’t like how Dr. Amy is RUDE, so she suggests that Dr. Amy “go to hell you fucking bitch” and offers that the doctor is a “downright cunt” [Lisa demonstrates her proficiency in anatomy - it is, in fact, right down there.]; she takes issue with Dr. Amy’s viciousness, so she recommends being “shot in the fucking face”.

      Unlike Dr. Amy, who seeks to advocate the safest place to deliver babies (i.e. in an fully equipped and competently staffed facility), Lisa clearly CARES about the well-being of women and babies, demonstrating this by declaring she’d “rather have a baby in the middle of a forest completely alone in the middle of nowhere” before she’d even consider letting Dr. Amy or someone like her – by implication, a trained professional – care for Lisa or deliver her child. What a model of selflessness and concern for others! Certainly not a dogmatic obsession with ideology. (BTW – are some forests not in the middle of nowhere? Perhaps one located directly behind a hospital?)

      Thank you, Lisa, for showing us how not to discuss things on the internet and how one supports the health and well-being of human beings. We can all learn something from you.

      • fiftyfifty1

        “(BTW – are some forests not in the middle of nowhere? Perhaps one located directly behind a hospital?)”

        I just returned from vacation in a small town where the forest, although not literally DIRECTLY behind the hospital, does start only about 200 meters away. I would strongly suggest that Lisa avoid this sort of forest if she truly is looking to deliver “in the middle of nowhere” and avoid the possibility of even being touched by “someone like” Dr. Amy, because the hospital, although not staffed by any OB, does have emergency c-section capabilities due to an FP with c-section training and a general surgeon who share coverage duties.

      • Monique Davis

        I have tears rolling down my face from trying not to wake my husband up with my out of control laughter, thanks!

    • Melissa

      If it isn’t Dr.Amy’s place to discourage women from homebirth, does that mean it is also not the place of NCBers to discourage women from hospital birth? Should these sites just be lists of statistics (which I think we’d be fine with if the NCB side also had the same position of not encouraging or discouraging anything, only giving facts, because the facts are on the hospital birth side).

      Also, I don’t particularly care if my doctor/nurse/professional is a nice person. I want them to be good at their profession. This seems to be a major disconnect between NCB and the real world. I hire a professional because of their expertise at a profession, not because I want to be bff with them. I don’t give two craps if my doctor is rude on the internet (another issue if they are rude to me as a patient, but that is very different).

      Finally, I always love the idea that OBs are inducing labors, having c-sections, and generally being evil in the pursuit of money for the hospitals. Think about it logically. If turning over hospital beds was the sole criteria wouldn’t hospitals push natural child birth since it leads to shorter stays than c-sections? If it was about increasing medical bills wouldn’t they be banning c-sections so they could get more money for their NICU? It also misunderstands the supply and demand of a hospital setting. It isn’t like they clear out one patient so another one can come in. The patients are coming in (or not) no matter the bed availability. It isn’t like they are telling laboring women to come back next week when they are open.

    • Susan

      These foul mouthed tirades always make me wonder about what sort of rage lurks beneath some of these alternative health sorts… ( and lack of self awareness )….

      • Something From Nothing

        Yeah, but you are referring to someone who would risk their babies life and their own by delivering in an isolated forest rather than with a Harvard trained obstetrician. There’s no sense in that.

    • ngozi

      I don’t think Dr. Amy or other doctors like her are going to cry in their beer (kool-aid, milk, or whatever they like) because they lose a patient like you.

    • Steph

      ‘You should be shot in the fucking face for the way you write these articles…you are the rudest and most vicious woman i have ever come across’

      I can only assume you’re trying to take her title with an opening statement like that. Jeez.

    • FredFuchs

      Hey there slut. You’re the one coming off as a rude cunt, not Dr. Amy. You are uneducated, and trust me, opinions like yours don’t bother OBGYN’s one bit. Go give birth in the middle of a forest, and if it comes out dead, just kick some dirt over it and tell yourself you did the best you could. Stupid neo hippies. You’re the ones who should drop dead. Society does not need nor do we want you around. Cunt. See I can call you a cunt too.

  • Jjacmac

    Hello..
    I am not sure why I’m wasting time writing here but alas,
    I have had both a hospital birth and a home birth and for myself in my humble opinion the home birth was the least invasive, most comfortable and best option out of the two. After the induction of my first child and the unceremonious grabbing and handling of my perfectly healthy child I was left with a fourth degree tear.
    My home birth on the other hand left only a first degree , and it was the most relaxing experience.

    I’m sorry you disagree with home births but I don’t think invoking fear in others is a good idea. To each their own!

    • http://www.antigonos.blogspot.com/ Antigonos CNM

      Did you stop to consider that your pleasant, relaxing homebirth was due more to the fact that this was not your first child than because it was at home? Second, third, and fourth births are very often easier than first ones. Labor is shorter, muscles and tissues have been stretched, second stage is shorter.

      • Jjbmac

        Either way..to each their own. Instilling fears in what should be a mothers choice is not the way to go

        • ngozi

          Instilling fear or stating facts?

        • Steph

          But that’s the thing. It isn’t just a mother’s choice any more. There’s another human being in the equation. A mother should do what is best for her baby. And that should surely be giving it the best chance at survival.
          Would I prefer comfort and relaxation surrounded by whale music, dimmed lights and scented candles? Of course. Are bright lights, medics swarming, and the scent of antiseptic anywhere near as soothing? No. But would I consider the latter a small price to pay for a healthy baby with the greatest chance at safe delivery, and thus put my own comfort aside? Yes, absolutely.

    • Trixie

      Yeah, you were wasting your time.

    • ngozi

      I think a homebirth that goes well IS more comfortable and happy than a hospital birth. But if a true emergency comes up, comfortable and happy kind of go out the window. I am glad your homebirth went well, but you can’t always know when an emergency is going to happen. Most emergencies cannot be handled at home.

  • MM

    Oh you’re an OB? That’s funny, I thought your license lapsed over a decade ago… And “skeptical” you are not. More like hateful extremist with an agenda. Let’s change the blog name to “Former obstetrician who hates midwives.”

    • http://www.antigonos.blogspot.com/ Antigonos CNM

      Yes, Dr. Tuteur is still an MD, hate to tell you. Not maintaining active registration does not wipe her brain clean of 8 years of med school, an internship, 4 years of residency, and a number of years of practice, as well as keeping up with recent developments in medicine. Nor does it mean she no longer has the degree she worked for.

      Grow up, or at least, become educated yourself.

  • LookingForTruth

    I have a question about infant mortality, or rather first-day mortality. According to a chart on page 55 of Save the Children’s 14th State of the World’s Mothers report (www.savethechildren.org.uk/sites/default/files/images/State_of_World_Mothers_2013.pdf), US has the highest first day death rate in the industrialized world. Wouldn’t it contradict your first point?

    • Young CC Prof

      Two reasons for that:

      1) The US has a higher rate of premature birth, perhaps for genetic reasons, perhaps partly due to poverty, but unfortunately the world’s current obstetrical technology can’t do much to prevent prematurity. The US is very good at saving those preemies, week for week our survival rates are near the top, but there are so many of them, and sometimes they slip away despite everything we can do.

      2) Reporting differences. In the USA, a baby who draws breath counts as a birth (and possibly a death.) In other countries, a baby born severely premature or with dire birth defects who breathes only for a very short time might be counted as a stillbirth instead of a live birth and a death.

      • LookingForTruth

        Just trying to play devil’s advocate here, but homebirth advocates could use this statistic, and then they would be right to say that US does very poorly on first-day mortality. I realize that first-day mortality is not the same as perinatal mortality (28 days of pregnancy+28 days of life), but if we are looking at deaths during the first 24 hours after birth, we aren’t doing that well. I wonder if there is a statistic of premature birth in the US versus other industrialized countries.

        • Young CC Prof

          Read this: http://www.cdc.gov/nchs/data/databriefs/db23.htm

          It’s an article by the CDC analyzing exactly why the US fares more poorly on certain measures than Europe. The one key fact it doesn’t mention is that the increased prematurity mostly occurs among African-Americans–and there’s some evidence that it’s actually genetic!

          It’s a subtle and complicated question. People who don’t understand statistics can pick whatever they want to misuse, but you seem to want the real answers.

          • LookingForTruth

            I do want real answers, not for me though, because I am done having babies. I have friends, who are avid homebirth advocates and some who are undecided. The topic of homebirth often comes up in conversation, and I want to be armed with real information when it does.

          • Young CC Prof

            Here’s another talking point for you: Break out infant or neonatal mortality by state. If a lot of your friends like home birth, you almost certainly live in a state with fantastic outcomes. (And no, it’s not because people home birth. Even in Oregon, home births are a tiny percent of the total.)

        • Box of Salt

          Here are two links from the WHO:
          http://www.who.int/mediacentre/factsheets/fs363/en/
          http://www.who.int/maternal_child_adolescent/documents/born_too_soon/en/
          The second one is a 126-page report from 2012 which I did not download.

        • Captain Obvious

          Many countries use 28 weeks as the cut off between miscarriage and stillborn as well. Have a baby at 27 weeks and it dies in America equals perinatal death, in other countries it is a miscarriage.

    • Amy Tuteur, MD
      • LookingForTruth

        Thank you!

  • Brett Longworth

    Is there data to support “epidural anesthesia… led to dramatically lower mortality rates” in #7? My wife will make the final decision, but this would help. I haven’t found anything convincing on benefits of anesthesia beyond pain relief (which is a big one). There are some relatively minor drawbacks, which together put epidurals into category 3 below.

    I am a scientific-minded soon-to-be father who’s trying to make sense of all the data on birth to come up with a best-practices evidence based birth plan. It’s tough to do this when every source has bias. Even the WHO best practices are sometimes not supported by data! The <15% C-section recommendation comes to mind here.

    My order of reasoning for thinking about things goes like this: 1) Choose things that have clear evidence supporting them. 2) If evidence does not clearly support either option, use logic to choose. 3) If 1 or 2 don't provide a clear choice, pick the option that involves less intervention. Good prenatal care is an obvious (and not contentious) example for #1. Choosing hospital birth because of easy access to emergency measures is my example for #2. Yes, the data on homebirth are fairly convincing, but this logic solves any question about data ambiguity. Delayed cord clamping and avoiding unnecessary ultrasounds are an example for #3.

    • Amy Tuteur, MD

      Epidural anesthesia dramatically lowered mortality rates because prior to its advent, the only alternative for surgery was general anesthesia, and the only alternative for pain relief was systemic medication like twilight sleep.

      The WHO withdrew their C-section rate recommendation in 2009, acknowledging that there had never been any data to support it.

      When it comes to scientific evidence, obstetricians are the ones who research it and apply it. Midwifery claims that obstetric practice is not based on science are usually bald faced lies. For example, there is NO scientific evidence that delayed cord clamping benefits terms infants.

      • Brett Longworth

        Amy, thanks for your answer and for the blog.

        I haven’t come across the data showing this, but twilight sleep and/or general anesthesia was clearly a terrible idea. It raises an interesting point though. At the time, this was considered to be the best practice for birth, but was later shown not to be so. While medicine is far better and more evidence based today, it seems reasonable that certain common practices today could later be shown to be detrimental to maternal or fetal health. To me it seems that avoiding procedures that have not been well studied and shown to have clear benefits would be the wisest course of action. The key then seems to establish whether things are beneficial, detrimental, or neither using the best available data.

        An easy example seems to be cord clamping. There’s no evidence of benefit or detriment, so what’s the harm in delaying for a minute? Assuming mother and baby are in no distress, of course. A similar case would be prophylactic erythromycin. If the mother has tested negative for bacteria that typically cause ophthalmia neonatorum, and the condition is treatable with good neonatal care, why use antibiotics if they’re not needed?

        I’m not trying to be confrontational, just trying to see whether this approach makes sense.

        • AlisonCummins

          Brett, in general your wife’s OB should be able to explain her reasoning for various decisions. You aren’t going to be able to cram eight years of training into eight months of internet research, so you can be releived that the OB has done it so you don’t have to. These are *exactly* the kinds of questions that clinical practice is all about and the OB will address them if you ask.

          There are a lot of things that OBs just don’t care about that much in most cases. Cord clamping is one of them. If you want to wait a minute the OB will be fine with that unless there’s a problem of some kind.

          http://www.skepticalob.com/2013/07/delayed-cord-clamping-much-ado-about-nothing.html
          http://www.skepticalob.com/2011/05/ncb-stupid-pulsing-umbilical-cord.html

        • Box of Salt

          Brett Longworth, please forgive me for butting in, but since you did start out saying “My wife will make the final decision, but …”

          My suggestion is you let your wife make the decision when the time comes. It’s not going to be your pain – let your wife figure out for herself what she can tolerate.

          No “buts.”

          (Yes, tongue in cheek; no less true because of that)

        • Young CC Prof

          “While medicine is far better and more evidence based today, it seems reasonable that certain common practices today could later be shown to be detrimental to maternal or fetal health.”

          Good point. It’s extremely difficult to show that something is really safe. However, one CAN say that scientists have looked pretty hard for evidence of harm and failed to find any. And yes, sometimes it does happen that initial trials showed something to be reasonably safe and harm shows up later, but in that case, the harm it tends to be minor, indirect or rare.

          Twilight sleep was implemented without a lot of research, and during the 1960s and 70s, obstetricians were able to demonstrate that it led to more breathing problems in newborns. Before epidural anesthesia was brought into general use, researchers carefully looked for evidence of poor newborn outcomes.

          So, twilight sedation for normal labor is out. General anesthesia is still used occasionally, but only for dire-emergency cesarian births where either an epidural is not available, it’s contraindicated in the mother, or there isn’t time to administer one. (This is one reason why it can be safer to have an epidural in labor: if things go wrong in a hurry, you can get into surgery faster, without the risks of being knocked out.)

          As for delayed cord clamping, the benefits are small, but most OBs have no problem doing it. The only reason NOT to delay cord clamping is the rare case when a baby is born blue or otherwise in need of immediate medical attention and resuscitation. In that case, the cord must be cut immediately so the baby can be carried over to the work table.

    • Maria

      Hi Brett, I just wanted to steer you to a blog you might appreciate. The Adequate Mother is written by an anesthesiologist and she does a great series of posts on epidurals (with links to sources you can read on your own). http://theadequatemother.wordpress.com/epidurals/

      I found her info well balanced and a refreshing change from the drama found on so many other discussions of choices afforded to women/families during labor and birth.

  • Christa – OB nurse

    You are awesome!

  • Hollie

    Gosh, you don’t do anything in moderation do you? Like the medical care you provide by the looks of it. You focus on the illest of the ill of women, the most extreme of maternal decisions which happen rather infrequently, and you seem to not really reason anything.

    I wouldn’t hazard at you being very good in a debate about childbirth, if simply for the fact that you seem to think that those with thoughts and feelings about childbirth fall into two distinct categories: “Earth-mothers” who refuse all and any maternity care and rely 100% on how they “feel”, and those who believe that any semblance of normality in childbirth is unsafe, unreliable and totally undesirable.

    I’ve actually considered that this blog is some deliberate, ironic reaction to the above Earth-mother type. You’re so morbidly focused on the wonders of intervention that it surely has to be a joke.

    I know you also probably think I’m one of the Earth-mother types. As opposed to a truly flexible, knowledgeable, balanced practitioner.

  • Natural and Informed

    It makes me angry when homebirth centers fill the heads of well meaning Moms who only want what’s best for their baby, with false surety and then to see the faces of those Moms, disillusioned and in painful shock as they walk into the NICU to see their precious baby because the “Home Birth” went tragically wrong. Now looking at the Physicians and hospital staff with imploring eyes instead of distain.

  • slinky jets

    i feel sorry for you dr amy. why are you so angry? it’s ok for people to have a different perspective and i think that’s what this comes down to. i am an advocate of homebirth but more of an advocate of informed decision-making and being comfortable with one’s choice. reading your articles and replies to posted comments i can’t help but feel you’re missing out and it’s sad to see someone so well-educated have such a stilted view. the best part of learning is understanding that we can never stop learning unless we choose to. it seems as though you’ve chosen to. i’m certainly not trying to educate you, only open your mind. when i first started reading your stuff i got a little angry, but the more i read, the more i just feel sorry you.

    • moto_librarian

      If you are truly interested in engaging with Dr. Amy and the other commenters, why don’t you try commenting on a current post?

    • Amy Tuteur, MD

      Why am I angry? Because innocent infants die preventable deaths when their mothers are so gullible they believe the crap broadcast by homebirth advocates. Why aren’t you angry about these deaths?

      I notice you can’t manage to rebut a single factual assertion in this piece, but I’m not surprised. No other homebirth advocate can, either.

  • Harper

    It’s appalling that you are spouting this information in such a vitriolic way. Instead of uselessly trying to force your hand, why don’t you advocate for making safer options to those who are seeking home birth and/or midwifery? It reminds me very much of the anti-abortion debate. People who want to take away safe, legal abortions are creating a market for highly dangerous procedures. As far as I can tell, that’s exactly what you are trying to do to home birth. You can not convince the world that your way is the right way, because every person is different. What you can do is facilitate safety with your knowledge and expertise. When things like this are made illegal, they are made dangerous.

    • Young CC Prof

      Dr. Tuteur has never ONCE said that home birth should be illegal, not in this post or anywhere else, and most posters here believe that outlawing home birth is not a practical solution. Instead, women should be made aware of the real risks of home birth.

      The only thing that should be illegal is for people with minimal training and no malpractice insurance calling themselves midwives and charging money to assist with planned home birth. It would be far better if women who were determined to home birth sought care from certified nurse-midwives who had a good relationship with the nearest hospital, instead of grannies who have an adversarial relationship with local hospitals, the way so many do now.

  • Bethany

    I know you wrote this over a year ago, but I just want to stand up and applause. This subject is something I feel strongly about, not only as a supporter of science and women’s healthcare, but also because a friendship was ruined over it.

    One of my best friends became pregnant (she didn’t know that women’s actual time of ovulation can vary from the 2 weeks before menstruation model), and though she was always a crunchy type, she reached entirely new levels of ridiculous. All she ever talked about was how hospital births and OBs are terrible, homebirth is best, vaccination hurts babies, all scientific studies are bought out by Big Pharma etc. I was studying Biology, and scientific thinking is important to me. Reasoning with her accomplished nothing. She ended up with a healthy daughter thankfully, though she ended up giving birth alone without any support since her midwife did not get there in time.

    It enrages me that she put her daughter at risk over this unscientific BS. She isn’t taking her daughter for well-baby visits, she had Group B strep yet still had a homebirth, she and her boyfriend do bedsharing

  • TC

    Ultimately at the heart of each issue you raise, the message is, I am uncomfortable with others challenging my training in patriarchal western medicine. I am insecure with my role as mother as a career choice and in order to prove to myself and others that I am in fact contributing(intellectually, because that is what I value most) I will work against what I perceive as a threat to my title, MD. And by the way, if it wasn’t already obvious, I really would like you to remember that I have a comma after my name with an MD following it. God forbid; I have little to no identity without it.

    That being said, Amy, this blog would be much more tolerable, perhaps even readable if you came to this conversation with humility and a willingness to learn from another–even a labor assistant/Doula.
    Furthermore, it is silly to state that labor assistants have ‘just’ high school educations.
    Many labor assistants have Masters level educations and beyond. This blog only polarizes the conversation even more than it already is polarized.

    • Captain Obvious

      Well I hope if these Masters level educated labor assistants are assisting as a part time gig. I would hate to pay for that level of education and only get paid at the level of a doula.

    • Young CC Prof

      TC says: I am uncomfortable with others challenging my preconceived notions. I cannot accept the idea that not all sources of knowledge are equal, and that training, experience and the scientific method allow others to speak with authority that exceeds mine, derived from armchair speculation and casual reading.

    • The Bofa on the Sofa

      Yeah, I guess whining is easier than actually addressing the content.

    • Amy Tuteur, MD

      In other words, you can’t rebut my factual statements so you’ll attack me personally. Welcome to the club of homebirth advocates who cover their own ignorance with ad hominems! You have plenty of company.

      • ngozi

        Ok, so now the complaint is that you use MD behind your name?? And OMG you do it with a COMMA! Shame on you!!
        *eyeroll*

  • ophelia

    I understand the Netherlands may have a higher neonatal fatality rate than other Eu countries, but how does it compare to the US? Everything I can find shows their rate is lower than the US (by 2 deaths per 100,000) despite 1/3 of the women doing homebirths…. I seriously can’t find anything that says otherwise.

    And having childbirth be a “leading cause of death” doesn’t mean childbirth is inherently dangerous. The risk of death for women of child bearing age overall is very very low, period. There has to be *something* that is going to be “the leading cause of death” at ANY age & in any group and that does not mean that thing is “inherently” fraught with danger. Car accidents are the leading cause of death in children from 1-14 yrs old last I knew….I don’t see my car as a death trap though every time I take the kids to the park. I feel extremely confident that when we get into the car we will arrive safely & most people think the same thing if they are honest. We all know accidents can happen, yet we have the good common sense to realize that it probably won’t, otherwise we’d all be stuck at home paralyzed with fear to load the kids up & go. So yes, some children will die in car accidents while the majority will actually make it to adulthood without ever having been in a car accident at all. I do find it troubling to see someone who is educated fear monger over a medically normal event. Pregnancy & birth are not an illness…they are a normal thing that all mammals undergo. If we are experiencing a high rate of complication that creates an unsafe situation then we would be best off to address the overall health of our population rather than to assume that interventions at the end of pregnancy are the best course of action.

    • Becky05

      The Netherlands has a slightly higher perinatal mortality rate than the US. Perinatal mortality looks at stillbirths and neonatal deaths, both.

      The WHO estimates that childbirth has a natural (ie, without any medical intervention at all) maternal mortality rate of 1 -1.5%. The natural perinatal mortality rate is even higher. This certainly counts as inherently dangerous in my book. And many mammals also have high rates of wastage in reproduction; childbirth is dangerous for many species of animals.

    • Becky05

      Also, I think most people ARE well aware of the dangers of driving or riding in cars, and work to mitigate those dangers. They wear seat belts and use child restraints for their children. They look at safety records of the vehicles they purchase. We require those who drive to have demonstrated a certain proficiency with driving and to be licensed to drive, we require all drivers to have insurance to cover liability in the case that a collision requires despite the steps taken to mitigate the risk. Various agencies from local governments to insurance companies support additional defensive driving education to further limit the risk of driving. We teach pedestrians to constantly look out for vehicles, etc.

      Dr. Amy isn’t saying, “Be terrified of and anxious about childbirth!” because that isn’t going to help anyone. She is saying, “Childbirth has inherent risks and it is only through awareness of those risks that we can work to reduce risk.”

    • Young CC Prof

      I love that you are asking the right questions. Let me keep giving you clear answers.

      First of all, your last sentence was brilliant: “If we are experiencing a high rate of complication that creates an unsafe situation then we would be best off to address the overall health of our population rather than to assume that interventions at the end of pregnancy are the best course of action.” A large number of pregnancy complications are related to pre-existing health problems or lack of prenatal care, which in turn is related to poverty and lack of access to care.

      However, the US is really not doing that badly overall. As Becky said, the relevant number is not neonatal deaths, but perinatal deaths. Listen carefully: Just like I told you about maternal mortality, our infant mortality numbers suffer from a reporting problem. You see, in the US, a baby who is born horribly premature or with hopeless birth defects and breathes only a very short time is more likely to be classes as a newborn death. In Europe, that baby might be listed as a stillbirth. The perinatal death rate controls for this reporting error, and in fact, if you look up the numbers, the USA and most of western Europe have similar perinatal death rates, but in Europe, more babies are “shifted” from neonatal deaths to stillbirths.

      This WHO report has all the relevant data: http://whqlibdoc.who.int/publications/2006/9241563206_eng.pdf

      As you can see, the Netherlands have a perinatal mortality rate of 8 babies per thousand, while ours is 7. (Sweden is one of the best in the world, at 5 per thousand. Why are they better than us? Probably because their poverty rate is so low.) Like you said, if we want to lower our rate further, we need to address poverty and poor health throughout the lifespan.

    • Paloma

      To compare the mortality rates of two countries there are many factors to take into account. I haven’t compared the mortality rates for the Nederlands and the US, but I have compared them each to my own country (Spain). In both cases, Spain has the lowest. It is no coincidence that homebirth here almost never happens, both because mothers have their childs life as a priority and also because, like in most european countries, healthcare is free, unlike the US. This might not seem important, but when not everyone has healthcare coverage mortality raises, just because not having access to a doctor when needed is obviously a cause of death.
      Birth is dangerous, there are many things that are more dangerous, as you pointed out cars are too, which is why there are traffic laws to prevent accidents, and seat belts. Hospitals are the seatbelt for a birth. You expect everything to develop with no complications, but if something were to happen, you have trained and prepared professionals to deal with it. This doesn’t mean it is impossible to die in a hospital, but does make it a lot less likely.

  • ElizabethJ

    The strident tone of this piece unnecessarily masks its intelligent content and retards productive conversation rather than furthers it. If you want to keep preaching to the converted, then the tone of this blog is perfect. If you actually want to change minds and perhaps save lives, consider treating your adversaries with a modicum of respect.

    • JT

      Honestly ElizabethJ, I don’t think Amy wants to do anything other than scare and undermine. The bitterness woven through her blog is sad. You are correct in saying that a modicum of respect would be good – problem is it doesn’t appear Amy has any respect for her fellow women. More’s the pity.

      • theNormalDistribution

        Respect… I don’t think that word means what you think it means.

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

        I thought respect included respecting your audience as mature human beings who could read information and process it. Silly me, I guess it means coddling people and hiding (highly appropriate) anger at people who would be so foolish as to write off the unnecessary deaths of both infants and adults.

        Oh wells, learn something new about vocabulary every day, I guess.

      • Eddie Sparks

        I haven’t read everything that Dr Amy has written, but I have just read the above article twice. Could you please quote the specific passages that you thought were disrespectful to women, because I am not seeing it.

      • ngozi

        Do you hold the NCB websites to such standards? They can be pretty mean too.

  • Ellie San Martin

    How do inductions affect mothers? Are there any posts considering the birthing mother as a human being rather than a potential dangerous environment for the baby?

  • blinkered27

    one other thought – If we surgically removed all the breasts of women over 50, we’d have far less women die of breast cancer.

  • blinkered27

    ‘the only reason you need a birth attendant is to prevent, diagnose and manage complications’

    you really think that? So the huge percentage of women who don’t have complications during childbirth don’t benefit from having a birth attendant present? Of course medical intervention is necessary for some women. Of course it saves lives. Of course obstetricians do an amazing job. But I don’t want a unnecessary interventions any more than I want my bladder catheterised if I can still pee naturally.

    There are different kinds of birth attendants who have different roles to play in making birth a safe and positive experience. There is no need to hold one profession in higher esteem than another. Yes, it’s annoying when other people try to tell you that you’re a surgeon because they think they know more about what they do than you do. It’s equally annoying to tell a different kind of birth attendant that what they do doesn’t matter, just because it’s different from what you do. Let’s try listening to obstetricians about why obstetrics is important, and midwives about why midwifery is important, and nurses and doulas and mothers and electricians and gardeners. Perhaps then we might stop offending everybody under the sun and accept that we are all doing different jobs and don’t actually need to compete with each other.

    • Captain Obvious

      That would be nice, except too many bad outcomes come from the Homebirth midwives. There is nothing wrong with CNM. You do understand the difference Dr Amy is pointing out between well trained CNM and self appointed birth junkies like DEM and CPM.

      • Susan

        Aye Aye Captain. Dr.Amy has always spoke highly of CNMs calling them “real midwives”. It’s so important to note in Europe that CPMs would not qualify as midwives at all.

        • blinkered27

          thank you for pointing that out. I don’t know as much about the american system and would agree that birth attendants need adequate training or they do more harm than good! Contentious question is how much training is ‘adequate’.

          • DaisyGrrl

            At least one four-year university degree plus practicum. The US is the only developed country that accepts less than that.

  • Carrie

    Regarding #11, if maternity mortality is indeed rising (and, like you said, this is not clear), I wonder if it would have more to do with the rise in other things like obesity, diabetes, heart disease, etc., along with the fact that there are more “older” (and therefore higher risk) mothers in recent years. I don’t know why that would have anything to do with obstetrical care per se, and certainly not why home births would be the answer to this alleged problem!

    Dr. Amy, I don’t always agree with what you say or how you say it, but I must thank you for this information. Some “natural birth” circles are very loud, very forceful, and very bullying. While home birth would never have been an option for me, I WAS sympathetic towards it, and your information has helped bring me to a more sane state of mind about it.

  • eribra

    I don’t even remember how I was directed here but I really, really enjoy your blogs Dr. Amy. Great statistics, no nonsense truth. Glad I found you!

  • Rachael

    Doctors like you are the exact reason I have a midwife! Birth is over medicalized by doctors need to control situations rather than trusting a mom to know her own body.

    • Amy Tuteur, MD

      Ptients like you are the exact reason why midwives have patients even though they are not as knowledgeable, skilled or effective at saving lives. They’ve managed to convince you that “medicalizing” birth is a problem (although it has lowered the neonatal mortality rate 90% and the maternal mortality rate 99% in the past 100 years) and they’ve managed to convince the gullible that “trusting” has any impact on anything.

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

      Fuck no I don’t trust my own body! Excuse my language, but my body tries to cause me to want to self-hysterectomize (yes I know that’s not a word) myself every few months with incapacitating menstrual cramps combined with severe nausea if I don’t have hormonal birth control. It has tried to kill me by failing to fight off infections a few times. My mom has had two very easy births and one “sunny-side up” one where she got an epidural because she wasn’t progressing due to the pain. Can you imagine how horrible that one would have been without being in the hospital?

    • Karen in SC

      I had two unmedicated births in a hospital, and there was no “knowing” about it! The pain was mind-numbing and I was barely aware of anything outside of the pain. I had special doula-led prep classes too, and had a doula to help.

      Second birth was a week late, mec aspiration, blue baby, so thankfully I was in the hospital and happy for the medicalizing that helped him. How come I didn’t “know” that in advance???

    • Mishimoo

      Knowing my own body is why I chose to deliver in a hospital. Trusting that I know my own body, coupled with the readouts from CFM, meant that I received the interventions that we needed and I had requested. I had midwives, they do practice in hospitals too.

  • Red

    Hi Dr. Amy, I just “parachuted in” to “educate” you on the fact that you seem to have a huge chip on your shoulder. Did you go to medical school just to prove how much better you were than everyone else? Maybe cut the caffeine.

    • Dr Kitty

      Did you not go to medical school because you just weren’t smart enough and realised it was better not to apply, or because you were this rude and obnoxious in the entrance interview and they decided not to let you in?

      • Red

        I’m certain I am smart enough for medical school, but that’s never been one of my interests. I do, however, have several degrees in Internet trolling. The efficacy of my technique is evidenced by your replies. Thanks!

        • I don’t have a creative name

          Efficacy being troll-speak for “I have nothing of real substance to contribute to any conversation, so I’ll pretend to feel smugly satisfied that I got people to answer my inane attempts at insult.”

          • Red

            Sure, if that works for you.

    • Amy Tuteur, MD

      I went to medical school because the practice of medicine is fascinating, intellectually challenging and offers countless opportunities help others.

      I didn’t go to feel superior to anyone else. When it comes to sanctimonious self-aggrandizement, I couldn’t possibly compete with NCB and homebirth advocates who like to pretend that how they give birth is an achievement.

    • ngozi

      That was immature, to say the least.

  • Dizzle

    I would never purport to say that c-sections are unnecessary; but is it true that the rate of c-sections to vaginal births has/continues to increase? What is responsible for the increase? Should we be concerned?

    • Sullivan ThePoop

      The increase is because other instrumental deliveries have decreased. C-sections have a more reliable safety rate than other instrumental deliveries.

  • AlwaysAsking

    Why does everything have to be one way or the other? Where is the balance? I am currently pregnant with twins, I see my regular OB, a Maternal Fetal Medince OB, and a chiropractor. I love them all. They all have their place and their abilities. Plus, yes, I have a doula, because I want to do this without any drugs or interventions, and yes I need someone to remind my I am capable when it hurts like hell. But I will still deliver in the Operating Room at a hospital, because I understand there are risks, and some are not worth taking.

    • Young CC Prof

      And there’s your balance, and that’s fine for you. You are doing what makes you comfortable while keeping you and the babies safe. No one here objects to you planning a natural birth, in a hospital with emergency help right on hand if necessary. (Of course, there are a few mothers who have known risk factors that make safe natural birth impossible, like placenta previa, but that presumably doesn’t apply to you.)

      Dr. Amy’s beef (and mine) is with people who would charge you money to deliver those twins at home and try to tell you this is totally safe and nothing could possibly go wrong. Or people who would try to shame you if you wind up needing interventions.

    • Tim

      There is such a thing as legitimate, responsible chiropractors who admit and practice to the limit of what their training can provide (eg; the same kind of relief and treatment a physical therapist could provide) – there is also a whole lot of quacks who tell people that having proper spinal alignment can make them not be/get sick. Nobody here has a problem with the former I’d wager. The latter.. well..

    • Ainsley Nicholson

      You seem to have found a good balance. I had my twins in the hospital with a doula, just like you are planning to. I wanted to avoid pain meds if I could, despite being induced, and my labor was quick enough that it’s a good thing I didn’t want pain meds, cause there wasn’t time for them anyway! (I did have some dark moments during transition….) So it can be done!
      I am curious why you pose the question about balance in response to this particular blog post, which addresses the hyperbole surrounding certain of the NCB movement’s claims. What is not immediately obvious to visitors of this blog is that the “Natural Childbirth” being promoted by the NCB movement is very differant from what you or I might think of as “Natural”. To me, “natural childbirth” always meant maximizing my chances of having an uncomplicated vaginal delivery- I choose to go without pain meds and hired a doula in hopes that doing so would help acheive that goal. The NCB movement, on the other hand, seems to be anti-science and anti-medicine simply for the sake of being anti-science and anti-medicine. How do you find a balance with that?

  • carolyn Gall AAHCC

    You know it occurred to me that this is like talking politics here. Like the Republicans vs. the Democrats. You have your reasons for your belief’s I have mine. Each side is convinced they are right. We could argue all day long. The fact remains that I have the right and the freedom to birth at home. No one can take that right away from me. Sorry if you don’t like my choices. I have spent a great deal of time reading information on the subject and I am comfortable with my choice. It’s pretty common for people who are using statistics to present them in a favorable way. Or a way that promotes their side. Heck, politicians do it every day. Like I said. I will come back here after my birth and let you know how it went. I have faith in my body to birth my baby without any medical interventions. If you continue to disagree with me then I will have to post links to all the information I found online that supports my choice.

    • ngozi

      I don’t think that anyone is kicking your right to have a homebirth. This is America (I assume you live in America, if you don’t, I apologize for jumping to conclusions). But people who support homebirths and natural births have sites that bash hospital births with or without medical interventions. I don’t agree with everything Dr. Amy says, but she has a RIGHT to say it. If people have a right to present the problems that can arise from having a hospital birth, then why can other present the problems–the very real problems–that can arise from having a homebirth. A birth performed anywhere under any conditions still has its risks, no matter how small. What is wrong with discussing the opposing viewpoints?

      • Carolyn Gall AAHCC

        Good. Normal dialogue. Sane discussions. Now we are getting somewhere.

        • ngozi

          I’m being called sane! Write me a reference letter!

    • Durango

      All the links you’re thinking of posting that “support your choice” have already been posted to the blog by others in the past and have been thoroughly deconstructed by those who actually can unpack and interpret statistics. You have nothing new to offer. How do I know? Because all you homebirth advocates spout the exact same thing every time and somehow think that you have this special knowledge.

      It’s fascinating to me, actually, that you all come here spouting your NCB-talking points, completely unaware that that is what they are. It’s as if you all have a form letter to fill in for commenting here, so similar are your posts, complete with meaningless letters after your names.

      • Carolyn Gall AAHCC

        The letters after my name are for The American Academy of Husband Coached Childbirth. I take exception to your saying they are meaningless. It means a lot to me to be able to teach natural childbirth to couples who seek training. You are insulting me. I have credentials to teach.. not medical credentials. I don’t practice medicine.

        • Amy Tuteur, MD

          Your credentials are about as meaningful as a degree in astrology.

          By the way, “husband coached childbirth” is completely unnatural. There is no evidence in all of recorded human history that male partners were ever involved in childbirth, and there are no mammals that I know of in which male partners are involved with childbirth.

          • ngozi

            I can go for husband coached childbirth a lot better than I can homebirths. But that is because of personal experience, not anything scientific.

          • a Homebirther

            Dr. Tuteur, Your credentials are as meaningless to me as a token in a box of Cracker Jax. You aren’t even a practicing OB Dr. You hate women, you don’t even think we can birth our own babies without surgeons and hospitals and drugs up the wazoo. You are a complete quack and everyone in the community knows it. Why don’t you give it a break and go back to your home where you can bake pies and be a good homemaker. Since you seem to live in the 1950′s era. Thank God you don’t practice Obstetrics anymore. Think of all the babies and mamas saved because you aren’t in any hospital drugging them up and cutting them up!

          • The Bofa on the Sofa

            Bingo!

          • ngozi

            Have you talked to any of her former patients? Not to defend her (she can probably do a better job of that than me), but why doesn’t she have the right to present an opposing viewpoint?

          • Amy Tuteur, MD

            Carolyn, stick to your original screen name.

          • The Bofa on the Sofa

            Sock puppetry: #1 sign you’ve lost it.

          • homebirthers rule

            No. I’m sure half of these responders are you in disguise

          • Amy Tuteur, MD

            Carolyn, this is your second warning. Next time you’ll be banned.

          • Homebirthrocks

            Ah ha! I finally got to the old hag. She’s going to kick me off of here because she doesn’t like my user name! LOL! When half these people are most likely her with various names as disguise! What a joke you are. I bet this doesn’t even get posted because I was *banned* from here. Bye idiots. Bye quack Dr. Nice knowin ya

          • Karen in SC

            But but but how will you be able to come back and trumpet your homebirth success?

          • Poogles

            “She’s going to kick me off of here because she doesn’t like my user name! ”

            Or because sock-puppetry is generally frowned upon by bloggers and most decide not to allow it to run rampant in their comments. It’s disruptive, misleading and confusing.

          • LibrarianSarah

            Is it just me or did Carolyn’s entire tone change with the change of the username, even after she was called out on being a sockpuppet. Creepy…

          • Bombshellrisa

            She probably realized that a simple google of her name brings up her website and on that she links to a newspaper article about herself, one that gives personal info. She probably thinks we are going to ruin her homebirth by showing and protesting on the lawn. Then again, she thinks that we are all Dr Amy so that would be only one person protesting on the lawn

          • LibrarianSarah

            I hope that is what it is but it is still as creepy as hell to see someone go from “I am here to have a discussion and have a right to my opinions” to “You are all stupid old hags fu fu fu!!!!1″

            Usually we get one or the other seeing both in one person is pretty un-nerving. Her using different “handles” between the two persona’s gives it a shade of “Hollywood Multiple Personality Disorder” that adds to the creep factor.

            Or maybe it’s me. Today has been a rough day and I am exhausted.

          • Bombshellrisa

            It’s not just you. There is something running rampant today, some strange vibe everywhere.

          • LibrarianSarah

            I’ve had “Don’t fear the Reaper” stuck in my head all day as well. If I believed in omen’s I’d be scared right now.

          • The Bofa on the Sofa

            I hope that is what it is but it is still as creepy as hell to see someone go from “I am here to have a discussion and have a right to my opinions” to “You are all stupid old hags fu fu fu!!!!1″

            She may have came in pretending to wanting to “have a discussion” etc, but it was pretty transparent. She may as well have given up pretending, because she wasn’t fooling anyone.

            I don’t think it really is multiple personalities. Her true self was pretty apparent from the beginning.

          • Squillo

            I suspect that’s true. She wanted it both ways: Carolyn Gall AA-whatever is the name under which she does business, so she probably thought arguing “rationally” with Amy would be good for her image–or at least, wouldn’t hurt it.

            When she ended up embarrassing herself under her business name, she resorted to the predictable tactic of sock-puppetry, not understanding that she’d be called out. So now it’s doubly embarrassing. Like Kim Mosny. (Hey, wasn’t she going to sue Amy for butthurt in the first degree or something?)

          • LibrarianSarah

            I don’t really think she has Multiple Personality Disorder (we’re talking about a condition so rare that thereis a debate among medical professionals on whether or not it exists here.) I wouldn’t have said anything if I did. I think less than 1% of the people coming here to have a “conversation” actually want to have a civil conversation but most don’t drop the pretense so quickly. It might have been less jarring if I read it in “real time” but alas I had too much shit to do yesterday.

          • anion

            Creating sockpuppets is excellent practice for all the obfuscation of facts she’ll be doing when one of her oh-so-safe homebirths goes wrong and the police ask her what happened.

          • An Actual Attorney

            If we’re all Dr. Amy, does that mean she needs to break it to her husband that she’s really a lesbian, or do I have to tell my wife I’m really a doctor?

          • Durango

            And, like all the NCB nutters before her, she flounces.

          • Captain Obvious

            No, you didn’t “get” Dr Amy, and your adolescent posts are still here demonstrating what an idiot you are. You must have been the smartest one in your class with comments like those, :-P

          • Karen in SC

            That’s a good one. These commenters are so varied, multi national, blog owners themselves in some cases. There’s a few FB pages where we hang out, real pictures, real babies, real families. No commenter is Dr. Amy in disguise.

          • Amazed

            Hey, I am! I am Dr Amy Number Seven!

            Who might you be?

          • An Actual Attorney

            But are you Seven of Nine?

            My geekery amuses me.

          • Amazed

            Well, I’ll admit that… I am not sure who I am. You need to ask Carolyn.

            But don’t tell.

          • Squillo

            I’m Brian, and so’s my wife. Or maybe I’m Bonnie Offit. Is it Tuesday?

          • Jackie

            Didnt dr. Amy have 2 unmedicated births? Just pointing out how truly ignorant you are. And age is a risk factor.

            This is a serious though, did you get pregnant naturally at 50?

          • carolyn Gall AAHCC

            Yes I did.

          • Captain Obvious
        • attitude devant

          Made-up credentials to teach a totally made-up brand of NCB indoctrination. Nobody recognizes your stupid acronym because in the real world it IS meaningless.

          • The Bofa on the Sofa

            It’s not just that nobody recognizes the acronym, or that it is meaningless in the real world, it’s that the crap that she is spouting is clearly wrong to the extent of being dangerous (a 50 yo is a high risk patient, and denying that is dangerous).

            Her spouting her supposed credentials has made it a lot of fun to mock her, sure, but the reason she is treated like a fool is not because of her credentials, but because of what she says.

            The same happens with Jay Gordon, who signs everything MD, FAAP. Now those are absolutely legitimate credentials. Doesn’t stop him from being a fool. It’s not the supposed credentials that matter here (there are a lot of highly credentialed people here in lots of areas), you are judged on what you say.

          • Carolyn Gall AAHCC

            see below

        • Captain Obvious

          If you trust birth, then why do you have to teach the husbands? Can you use your “letters” and get a job with them in any other country? Will the UK or Canada hire you?

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

        I’ve found the same from religious apologists, actually. They come in waving various arguments about as if these are new and special arguments, and the people who are regulars on the boards sigh and prepare to debunk Pascal’s Wager for the eleventy-millionth time.

    • Lizzie Dee

      Do other people have to like your choices? You make them, you live with the consequences of them, what difference does it make what other people think of them?

      If you choose to paint every room in your house a particularly virulent purple, people may wonder about your choice, but are not really going to care much. If, on the other hand, you try to argue that purple is absolutely the best, the only choice, and that people who paint their homes purple have a much better quality of life and are ever so, ever so admirable then that might be provocative. Most people don’t choose purple. Most people don’t choose the extra risk of homebirth.

    • Karen in SC

      Yes, it is your choice and it seems you have taken care to minimize risks, although the risk is not zero. Lisa from NY, a regular commenter, has a 50 yr old neighbor that had a homebirth last spring. Almost bled to death, transferred to the hospital and spent some days in the ICU. A close call and who knows what aftereffects to mother?

      I hope you and your baby have healthy birth, wherever it happens.

    • Some Lady

      Some of these are not about “beliefs” though. You can not “believe” home birth is safer if the scientific peer reviewed studies prove the opposite. You cannot claim that induction harms babies if the scientific peer reviewed journals prove the opposite. A person presented with facts cannot say, “Well, you have your belief’s [sic] and I have mine.” It’s not like politics. And even in politics, especially in politics, the cognitive dissonance is appalling.

    • Captain Obvious

      No, what your analogy should be is a parent talking to their 10 year old child. You won’t believe the evidence and you want to come back and prove to us that you can birth at home without complications. Yep, no politics analogy there, just a parent and a child.

  • Carolyn Gall AAHCC

    Obviously you are mocking me. Well, at least I know where to find you if I need cherry picked data and fear mongering. And a heavy dose of guilt. BTW, I am 50 years old too. Does that make me.. shudder… a high risk home birther?

    • The Bofa on the Sofa

      You are high risk anywhere.

      Wake up, Carolyn. On-line discussion is a game. Your baby is real life. Stop playing around and take it seriously.

      • Carolyn Gall AAHCC

        I have had nothing but sarcasm since I started this discussion. If you were really concerned you would be more serious with me. I am always researching information online and came across your website. How can I take you seriously with your comments?

        • Amy Tuteur, MD

          I’ll be serious with you.

          You have no idea what you are talking about. You are willing to risk your baby’s life for bragging rights. You are a fool.

          Is that serious enough?

          • Carolyn Gall AAHCC

            Dr. Tuteur. I am so sorry that I came to your discussion board only to be mocked and tossed around like a toy doll. I have been patient in trying to have a real dialogue with you but it is not possible. I have heard rumors of you and now I have come across your page. I am sorry I did. You don’t respect woman. You are creating fear in woman and you are dangerous. I am not looking for bragging rights by having a home birth. In fact, I haven’t told anyone about it. It’s just that I don’t like the interventions in the hospital. Yes. I believe in natural childbirth. Yes. I believe that woman were designed to give birth. No. I am not taking risks by having a homebirth. I noticed everyone shut up when I told them who was going to attend. She has an excellent track record and has not lost a baby in her career. Have a good day.

          • Box of Salt

            Good luck Carolyn. I didn’t “shut up when I told them who was going to attend.” I’m simply not impressed with your midwife’s 1000 births as you are, but you aren’t listening anyway.

            You clearly think that risk does not apply to you.

            Again, good luck!

          • Amy Tuteur, MD

            Oh, please, Carolyn, you’re not trying to have a dialogue with anyone. You are boasting about what you think you know (which merely confirms your ignorance) and proudly proclaiming that you plan on defying medical advice, the truth be damned.

            Of course you were mocked. You sound like a fool. Too bad your baby may have to pay the price for your arrogant ignorance.

          • Carolyn Gall AAHCC

            Dr. Amy, You are boasting of your knowledge too. Cherry picked statistics. I see you as a woman hater and fear mongerer. You sound like a complete quack. How can anyone take you seriously? I certainly don’t. Good bye

          • The Bofa on the Sofa

            You want to have a discussion of the statistics? I’m sure Dr Amy will gladly have that discussion with you. I’d love to watch. I’m sure I will learn something.

            However, I have to say, “I don’t believe in your statistics” doesn’t help me learn much.

          • Carolyn Gall AAHCC

            “I don’t believe in cherry picked statistics that have no merit” I have my own statistics that I have researched thoroughly. Thankyou

          • The Bofa on the Sofa

            So do I. And my Sooper Secret Statistics contradict yours.

            You really are a fool, that’s for sure. And you talk about not taking Dr Amy seriously?

          • Amazed

            Your own statistics? That you can actually discuss using your non-existing credentials? Forgive me for being skeptic. Your ability to compare apples to apples leaves me somewhat unconvinced.

            I wish you all the best. I hope you don’t get on the wrong side of ‘consumer should research her midwife’.

          • Kalacirya

            What are your statistics, Carolyn?

            I have another honest question. I am a statistician. What do you think I do with myself? What do you believe I am trained to do? Can you tell me what you think my training entails?

            People like you are so flippant with the term statistics, and it makes me think that you fail to understand the depth and complexity of the field. That you think that you can perform your own analysis without any education on the subject (real education, taught from actual mathematicians), or that you can evaluate what makes a “good” statistical inference or a “bad” one.

          • The Bofa on the Sofa

            People like you are so flippant with the term statistics, and it makes me think that you fail to understand the depth and complexity of the field.

            Kal – I am not a statistician, but I have presented a paper at the JSM. Do I gets my bona fides?

          • Kalacirya

            LOL, I’m sure you’re fine.

            I just get bothered when clearly very ignorant people use the term like it doesn’t have anything behind it. As if the extent of the issue mean, median, and mode, or just tallying up numbers and doing some division.

            There are guys at my gym that think just because they’re fitness enthusiasts and they like to exercise, that they’re equivalent to physical trainers. And sometimes I’ll get a comment from one of them, that goes directly against what my actual physical trainer told me to do. But the lunkheads don’t seem to realize that the man actually went to school to do what he does. I could train for this man twice a week for a year and I still wouldn’t be able to design my own workouts half as effectively. I try not to be flippant about what other people have spent hundreds and thousands of hours to do.

            But I’m somehow doubting that it took hundreds of hours for Carolyn to become a Husband Coached Childbirth “expert”.

          • AAHCC Certified Awesome

            You have to write a few book reports, breastfeed a baby, have a drug and intervention free birth, and attend a 3 day workshop. (and pay the AAHCC of course)

            Then you get to say outlandish shit to pregnant women and their partners for a few hundred bucks a pop, such as

            “Ultrasounds are RADIATION. That could be dangerous for your baby – we just don’t know! Do you really want that risk??? Would you expose your baby to URANIUM?”

            “The chances of having something like phenylketonuria
            are like 1 in 50,000 – do you really want your baby to have to suffer through BLOODY HEEL STICKS at the hospital for that state screening?”
            “If they have to deliver with forceps your baby might get CP.”
            “If you show the nurses and OB your ‘certified childbirth coach’ card, they will respect what you have to say a lot more during the birth!”
            “You can pay me another 500$ and I’ll be your doula”
            “Feel free to take this class again for 300$ with your next pregnancy because you really need a refresher”
            “Nobody really needs vitamin k shots, do you really want your baby TRAUMATIZED by needles?”
            “We just don’t know whether or not vaccines can cause autism – better safe than sorry!”
            Yes, the benefits of AAHCC certification are endless and wonderful. You too can masquerade as a medical expert once a week after you’re done teaching fifth graders american history.

          • Certified Hamster Midwife

            So, I take it you didn’t like your Bradley method class.

          • AAHCC Awesome

            That’s putting it mildly :)

          • I don’t have a creative name

            You’ll never get an answer to this. She doesn’t understand actual statistics. However, she did make a snotty comment that she would come back and let me know that she and the baby are fine after the birth. I hope she does.

          • Kalacirya

            I just can’t imagine which midwife would tell a 50 year old woman that she is low risk. I hope that Carolyn is actually a Poe.

          • The Bofa on the Sofa

            It’s like someone drives drunk, and doesn’t have any problems, and writes MADD a letter boasting about.

            Who would be impressed?

          • ngozi

            She is accepting the statistics she likes, and ignoring the ones she does not. It is the same thing people do with the Bible.

          • The Bofa on the Sofa

            You commented on a post that said, “12 things not to say unless you want to look foolish,” you basically say exactly that, and then you whine that you get treated like a fool?

          • Carolyn Gall AAHCC

            Well, I guess I am going to take my toys and leave. I don’t need this abuse and bashing anymore. Didn’t know this was a discussion group to mock fun at mothers? Sorry. My mistake

          • The Bofa on the Sofa

            We don’t mock mothers. Shoot, most of the people here are mothers themselves.

            We have no qualms about mocking fools, but then again, we don’t do that unless you have actually established yourself as one.

            Say something that we can take serious, and we will do it.

          • ngozi

            I am about to have my 6th baby in December. I mock and piss off everyone, but heck, I have been doing that since preschool.

          • Amazed

            So being a mother automatically gets you out of being a fool? Nice. Because it’s fools we mock here, not mothers. Not specifically, at least. We don’t give exemptions to fools who happen to be mothers.

          • The Bofa on the Sofa

            Besides, nothing we are mocking her for is mother related. When it comes to her pregnancy and childbirth, it has gotten serious, but she is mostly being mocked for her nonsense about being a childbirth instructor and being educamated and her own statistics. These things are all irrespective of being a mother.

          • Amazed

            She knows it, Bofa. But she draws upon the ‘we mothers should support each other and we should accept each other’s choices’ mentality that’s prevalent among her circles. After all, it’s so cruel when people attack a mother. A. Mother. It isn’t half as cruel when people attack a fool for demonstrating that she’s a fool.

          • ngozi

            Ok you couldn’t read a few titles of the articles and know what was going on?

          • Kalacirya

            I think a woman who is pregnant at 50 should have a healthy dose of fear about the realities surrounding her pregnancy and childbirth. And that reality includes a high level of inherent risk.

          • Jocelyn

            Humans are designed to eat. Doesn’t stop people from choking on food.

            Human bodies are not perfect, and we cannot always predict when something is going to go wrong.

          • ngozi

            You do know that you can avoid a good many interventions in the hospital by saying one of my favorite words…”no.” A lot of hospitals don’t force unnessary interventions on a patient, but when they offer them and the patient says yes, or nothing at all, then that is what the patient gets.

        • The Bofa on the Sofa

          Because I distinguish between the game of on-line vs real life. You want a serious discussion, then let’s get serious. Unfortunately, nothing you have said so far can be taken seriously.

          Come you, you actually asked me if I had heard of the “American Academy of Husband-Coached Childbirth.” Of course not. My response is, literally, “You can’t be serious?”

          • Carolyn Gall AAHCC

            It’s been around for 40 years. It is in California and it is the company I work for and promote the practice of Natural Childbirth. I am serious. Go look it up http://www.bradleybirth.com

          • The Bofa on the Sofa

            The American Astrological Society has been around even longer.

            Still a bunch of loons.

          • ngozi

            I’d be more willing to go for husband coached childbirth as long as it is happening in a hospital.

          • Carolyn Gall AAHCC

            Almost all of my students have hospital births. And that is their choice. I have had 2 couples choose home births and in both cases they had great experiences. One couple actually had 2 home births and have 2 sons.

          • ngozi

            I don’t mean to say that just because someone chooses a homebirth that they are just automatically going to die. I am aware that many homebirths turn out great. What makes me nervous is the chance that something could go wrong (and that chance is probably small) and the mother and baby would not make it to the hospital in time.
            As I have said before, a lot of hospitals don’t force interventions on patients unless it is a life or death situation. Patients for the most part can say no. Satisfying births can happen in hospitals.

    • I don’t have a creative name

      Please, please do not do this.

      This baby needs access to immediate high level care at birth, as your risk of complications is much higher than someone 20 years younger. What other risk factors do you have?

      Why is your desire for “no interventions” so much more important to you than being in an environment where your baby can receive immediate life saving care if you have a complication? I ask this honestly. Women were designed to give birth, and heads were designed to grow hair. But neither of those processes always works correctly 100% of the time, and the older you get, the less likely they are to work correctly.

      • Carolyn Gall AAHCC

        I don’t have a creative name. I don’t know why I am bothering to respond but here goes. Being fifty is not a risk factor. It’s a risk factor because Dr.’s say it is but their is no evidence to support that notion. Especially since you have to factor in other things. I don’t have gestational diabetes, high blood pressure or any other previous risks or complications in my obstetrical history, All my previous pregnancies were intervention free (for the most part) and vaginal deliveries. I have a proven pelvis, As the pregnancy continues I will have testing done for things like GBS. I follow the Brewer diet and exercise almost daily. The odds of something going fatally wrong at my home birth are 2%. I think those odds are pretty low and I am comfortable with that. That’s all that you need to know. Nothing more.
        Post Note: Also, I said “my research” in a previous post. I meant the research that I have conducted. Not my own research. Don’t try to second guess me. Don’t try to talk me out of doing something that I feel comfortable doing. You can rest now, you must be tired . Have a good day

        • I don’t have a creative name

          So you want to come to a blog that is with odds with what you are planning to do, announce your plans, then order people not to argue about it. Got it.

          Last comment from me. If a civic organization in your community came to your house selling tickets for $5 for a new car, and every two out of 100 people would win, you would think those are pretty good odds; much better than the average lottery. Be honest- you would think there was a good enough chance that you’d probably buy a ticket. Yet those same odds – 2 out of 100 -apply to the death of your baby from preventable homebirth issues, and you think the risk is really low.

          All I can do at this point is shake my head. There are no catastrophic complications that will be prevented by exercise or any diet. Be healthy, great – but it won’t increase the amount of power you have over this process, which is really very little.

          I truly do wish you the best, and I hope that neither you nor your baby has to pay a terrible price for your foolishness.

          • Carolyn Gall AAHCC

            Well how about I write back after the birth and tell you all about it? Being healthy and low risk puts me in another category. I have more choices. If I was considered high risk (if that should be the case) then I would opt for the hospital birth. Still good odds. Still good enough for me and my baby. Especially since I have a trained Midwife in attendance. Your the one who is the fool. Now go ahead and take a break. You must be tired trying to run my life for me..

          • I don’t have a creative name

            So you come to a blog that is at odds with your beliefs, argue, and then when people argue back, they are trying to “run your life”. Got it.

            Just FYI, words alone are not enough to claim that someone is trying to run your life, whether you like the words or not.

          • The Bofa on the Sofa

            Of course. She came her to educate us. She is an AAHCC certified instructor, you know, and so therefore, that makes her an expert in childbirth.

          • ngozi

            There is a risk that there are complications that can happen while giving birth that no one could have known about before hand, no matter what age you are, what diet you eat, or how well you handled birth in the past. Some serious complications come up all of the sudden and you won’t have time to go to the hospital before it is too late.
            The risk of this happening is low, but is still a risk. I hope you can write back after the birth and tell us a happy story.

          • Carolyn Gall AAHCC

            No I would not buy a lottery ticket if my odds were 2 chances out of 100.

        • Carolyn Gall
          • Amazed

            Of course it’s good enough for a NCB crank.

            You’re welcome to take risks with your life and your baby life/quality of life. I shudder at the thought of those mothers who can believe your nonsense and try it but alas, there’s no law prohibiting fools from procreating and searching the services of quacks.

          • Tim

            “Posting links to Dr Mercola’s website” needs to be added to the list of ways to look foolish. That guy is the king of internet “natural” crackpots.

          • The Bofa on the Sofa

            Joe Mercola? Seriously?

            Major, major crank in pretty much everything he does.

            Wow.

          • tim

            There is two kinds of DO’s – ones who practice medicine and don’t say bullshit like “unlike ALLOPATHS, osteopaths treat the ‘whole patient’ with a holistic approach” , and ones who are chiropractors with prescription rights. Guess which “Dr.” Mercola is (oooh, i used their favorite tactic against them!)

          • The Bofa on the Sofa

            Mercola’s picture is in the dictionary under the term “crank magnetism.” If there is some crank position in medicine, Mercola espouses it.

            That’s why it makes me laugh. I had never heard Mercola’s name mentioned in a homebirth discussion before, but it doesn’t surprise me in the least. I know of him very well from other areas. Major crank.

          • tim

            Like I said, he’s a chiropractor with prescription rights. :) Total crackpot in every way

        • ngozi

          I think I am going to faint…

  • Carolyn Gall AAHCC

    I am a Bradley TM Method Affiliated Instructor. The AAHCC stands for the Academy. American Academy of Husband-Coached Childbirth. I’m sure you have heard of it?

    • The Bofa on the Sofa

      You’re funny.

    • The Bofa on the Sofa

      I’m a PCM – a Pablo Certified Midwife. I’m sure you’ve heard of it?

      I’m also the Pablo Volleyball Rankings Originator (PVRO), and a member in goodstanding of the Anti-Acronym Society (AAS). I also have a Master’s Degree…in SCIENCE! from Dr. Science. I have the diploma to prove it.

      • Carolyn Gall AAHCC

        Sounds good. I hope that you have a rewarding career with all your credentials.

        • The Bofa on the Sofa

          Back at ya.

  • Carolyn Gall AAHCC

    Sorry. it posted without finishing… Those incidents of homebirth deaths sound dreadful. Like MD’s there are also incompetent midwives. They do exsist unfortunately. My pregnancy is low risk and I am receiving prenatal care through a regular practice in addition to seeing my midwife. I am very confident in her training and expertise. She has delivered over 1,000 babies. I have been privy to some of her most recent home births through communication and I am very impressed with her knowledge.

    • Poogles

      “My pregnancy is low risk ”

      You’re FIFTY, your pregnancy is NOT low risk, no matter how strongly you might want to believe it is.

  • Carolyn Gall AAHCC

    Also, I think that once we license and regulate midwives in this country incidents that took place (Huffington Post

  • Carolyn Gall AAHCC

    PCM, PVRO, AAS Explain please?

    • The Bofa on the Sofa

      Why does it matter?

  • Carolyn Gall AAHCC

    I have read the statistics and they come from this source http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2742137/

    • Box of Salt

      Carolyn, do you live in British Columbia? That’s where the women in your study lived when they gave birth. If you are in the US instead of Canada, you are not part of their system and their safety record does not apply to you.

      • Carolyn Gall AAHCC

        It works for me.

        • Box of Salt

          I take it that means you are going to give birth in British Columbia then. Because that’s the only way “it works.”

          • Carolyn Gall AAHCC

            No. I am giving birth with a well qualified Certified Nurse Midwife in my home. Do you have a problem with that?

          • Carolyn Gall AAHCC

            So really I am comparing apples to apples here. Matching your STATS by using someone who is properly trained.

    • theadequatemother

      That BC study was underpowered to detect differences in perinatal mortality, but hey, its more important to have a lower risk of episiotomy or instrumental delivery than a live baby, right? There were trends towards badness as well – more ventilator days and NICU admissions for babies after planned homebirth. Followup wasn’t long enough to look at HIE/ CP. When that data is pooled with the data from Ontario (also 4 yr midwifery degree, hospital priv for RMs and smooth transfer) perinatal mortality with planned homebirth was 2-3x that of planned hospital birth.

      So that study actually leaves lots of unanswered questions regarding homebirth safety.

      And you can’t say it applies to your CNM and your homebirth. The 4 year midwifery degree in BC might be equivalent to CNM training. Or it might be better or worse. How do you know? BC also has a completely different health system…universal publicly funded insurance which influences health outcomes across the board and is very different than the health system in CA where you are from.

  • Carolyn Gall AAHCC

    I am having my 2nd homebirth and 5th baby. I could not deliver in a hospital unless I was physically dragged there against my will. I believe in the natural process and I don’t believe in your statistics that are just meant to create fear and doubt.

    • The Bofa on the Sofa

      You “don’t believe in” the statistics? What does that even mean?

      Oh, I forgot, I need to add the letters after my name

      The Bofa on the Sofa, PCM, PVRO, AAS

      • Amy Tuteur, MD

        It means that she doesn’t understand statistics. It’s too hard so she just ignores them.

        • Carolyn Gall AAHCC

          No. The British Columbia Statistics are for home births. Like anything not regulated by the government, there are variations. It is up to the consumer to research her Midwife and make sure that she has all the training to be qualified to attend a home birth. We call it consumerism. A home birth is not a hospital birth. Our country is starting to have more CNM deliver home births. In my state there is one in Shelton.

          • Carolyn Gall AAHCC

            I hope someday we will have licensing for midwives in our Country. But it’s OB Dr.’s like you who want all the business and the $$ who want to stop it. Saying it’s dangerous. I know all the facts on my risk of having a home birth and I prefer it to a hospital birth. Thank you

          • Amazed

            Oh my. Are you as naive as you sound, Carolyn? I’ll spell it out because well, you might be this stupid. Drs are OB/GYNs. GYNs, Caroline. They make their money mostly by being gyns, so births are no big profit for them. Births are, though, the only source of income for homebirth midwives and natural childbirth educators like yourself. I’d like to see you take your greed elsewhere and not using mothers and babies but there will always be fools who will line up to fill your incompetent pockets nicely.

          • Amazed

            And then, when something goes wrong, of course it’s the consumer’s fault for not researching enough. How very convenient.

            I fear for the mothers you teach. I can’t believe someone gives yopu money to sprout such criminal nonsense.

    • Carolyn Gall AAHCC

      I have looked at the statistics and understand them. I teach natural childbirth classes and most of them go on to have fantastic births in the hospital. It’

      • Amazed

        Carolyn, would you mind sharing with us what your credentials are? Are you a MD? A CNM? A RN? What makes you qualified to teach anything related to childbirth?

        • The Bofa on the Sofa

          She’s an AAHCC, didn’t you see? Sheesh. She was sure to tell us.

          • Amazed

            I saw, Bofa. That’s all I saw, so I asked about credentials. I mean, real ones. Like PCM… don’t you think I have forgotten how the governing body refused to bestow it upon me.

          • The Bofa on the Sofa

            See above. You haven’t heard of the America Academy of Husband-Coached Childbirth? Apparently they are ….

            sorry, I got nothing.

          • kumquatwriter

            I love this board.

          • Carolyn Gall AAHCC

            I think you have the letters mixed up. Did you mean CPM Certified Practical Midwife?

          • Amazed

            No, I meant PCM – Pablo Certified Midwife.

          • The Bofa on the Sofa

            Don’t listen to Amazed – she is just bitter about not getting her certification. Understandable, though.

          • Amazed

            OK, Governing Body. If I take an online course, will I get my certification? Pretty please?

          • The Bofa on the Sofa

            Your problem has always been with the practical. You need to establish your ability to provide the appropriate pop culture references.

          • Amazed

            Not true. Mother Goddess, Isis, Ina May, TBOB.

            See?

          • The Bofa on the Sofa

            Sigh.

            “And this is why you fail.” – Yoda

            Come on, she set you up above with her “you’re mocking me” comment. It was the perfect place for a Toy Story reference, and I let you have it. You didn’t pull it off.

            As Tom Hanks said to Evelyn in A League of their Own, shakingly “….That….is something….I want you to work on….for next year….”

          • Amazed

            OK, I’ll try again next year *sigh*

            What on earth is a/the Toy Story?

          • The Bofa on the Sofa

            The first Pixar movie.

            This is why you are having troubles with your PCM certification. You don’t know Toy Story? What next, you don’t know who Kajagoogoo is? 80s music knowledge is also a very big part of the PCM.

            Great tidbit about Toy Story: when they stop at the gas station, the tanker truck that is there is a Dinoco truck. Dinoco is, of course, the company that sponsors the King in Cars. But Toy Story came out 10 years before Cars. That’s some serious foreshadowing.

          • Amazed

            Ah, so it’s the 80s music. I’m afraid that in the 80s, my tastes in music varied from ‘Little white rabbit’ to ‘Two little hands’ and all other children’s songs. But I’ll try to make up. Truly, I will. I want this certification, damn it!

          • The Bofa on the Sofa

            No one said it would be easy. However, music videos are available on youtube, and so provide a great source for study.

            80s music are necessary, but not sufficient. It will help to have some good tv references, and they don’t just have to be 80s or older. Although I will say, all this talk of mocking reminds me of the episode of Happy Days, where the gang was sharing a cabin with three girls, and they pretended to be foreingers and Ralph said he could speak “mock Swedish” which consisted of him saying, “Mock mock? Mock mock mock mock mock mock…”

    • ngozi

      If you were to develop serious complications during your homebirth, would you go to a hospital? I am just asking.

      • carolyn gall AAHCC

        I would follow the direction of my midwife. If she told me that I had to go.. I would certainly go to the hospital. I have already had one homebirth. He was born perfectly healthy. There are inherent risks to home birth and the key to success is knowing how to spot a situation that needs a hospital. 97% of all births go completely normal and smooth. It is the interventions that cause birth to go poorly.

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

          You do know the historical record, right? 1% maternal mortality and 9% infant mortality. That doesn’t count the permanent injuries to women and babies either, just the deaths.

          Where is this 97% no-problem births figure coming from? Have you ever been in an old graveyard? There’s a lot of itty-bitty tombstones in there, and a lot of women who died in their twenties and thirties. Most of those women died of childbirth-related causes.

          If I offered you a piece of delicious candy, and said there was a 1% chance it would kill you, would you eat it?

          • ngozi

            My grandmother was one of those women who died. It probably had to do as much with a lack of prenatal care as it did not delivering in a hospital.
            I also would like to point out the complications that don’t result in death. My mother wasn’t induced when needed in the late 60s and ended up having a hospital birth that lasted almost 3 days. By the time she had my brother, my aunt thought my mom was dead! My mom’s next birth took over 2 days and she caught a severe case of the flu afterward that almost killed her. Who wants that for the sake of a natural birth?

        • Amy Tuteur, MD

          Do you repeat every bit of stupidity you read?

          It is interventions that cause birth to go poorly? Then why has it been a leading cause of death of young women and the leading cause of death in EVERY TIME, PLACE and CULTURE.

          Do NCB advocates really have so little common sense that they believe complete idiocy?

        • ngozi

          But would you not agree that there are interventions that save lives of babies and their mothers?
          Sure, I’d like to have a homebirth with the water, candles, and music. But due to my age (I am not quite 40) and my history of pre-enclampsia (my blood pressure was 200s over 100s with my first child), I have to make a decision that respects my health. Plus, I don’t like the idea of something going wrong during the homebirth and not making it to the hospital in time.
          A lot of us would not be here today if it weren’t for inductions, c-sections, etc.

  • ngozi

    I think that childbirth is safer nowadays because of the prenatal care that women receive, not so much because women are giving birth in hospitals (even though I am aware that there are problems that come up during delivery, which would make a hospital birth safer than, say, a homebirth). A lot of the complications that would arise in labor and delivery can be found and treated while receiving prenatal care. My grandmother, who was a poor, black, farmer’s wife living in the delta of Mississippi during the 50s died during childbirth. From what has been pieced together by the family who was there and remembers what happened, she probably had a health condition that contributed to her death. I believe that prenatal care would probably have saved her life (of course, no one could know now).
    And no I am not some homebirth advocate (but I don’t knock people who consider it).

    • LibrarianSarah

      “I think that childbirth is safer nowadays because of the prenatal care
      that women receive, not so much because women are giving birth in
      hospitals”

      Because it absolutely can’t be a combination of the two.

      • ngozi

        I think that prenatal care is saving more lives than delivering at the hospital. I don’t think all hospital births are bad things, and there are hospital births that are certainly saving lives of mothers and infants. I just think that good prenatal care is saving more lives than delivering in a hospital.

        • LibrarianSarah

          But a lot of the things that are screened for prenatally need to be treated in a hospital/require you to give birth in a hospital. I mean let’s break down the list Anj posted above.

          gestational diabetes-Treated with insulin or diet depending on severity-home

          pre-eclampsia- induction or c-section-hospital

          preterm labor-duh hospital

          Group B strep- requires IV antibiotics

          low amniotic fluid- pretty sure this would require an induction or c-section so hospital.

          Pre-natal screening is pretty much worthless without having the technology to treat what it finds. Without hospitals it the result for pre-natal screenings would be “now that we know that you have pre-eclampsia we can sit here an wait for your baby and/or you to die.”

          • ngozi

            Those things would not be discovered, or discovered only when the condition is very serious, if good prenatal care is not sought. The technology (if technology is even needed, sometimes it is lifestyle changes) to treat what prenatal screening finds can often be done before labor ever starts.

          • LibrarianSarah

            Again going with my “combination of both” both thing. What good is it to know when you can’t do anything about it?

            It doesn’t do much good to know you are positive for Group B Strep if antibiotics aren’t a thing. It doesn’t do you much good to know you have pre-eclampsia, or low amniotic fluid if their are no inductions. It doesn’t do you any good to know your baby is breech if you can’t have a c-section. Most of the things we screen for require medical intervention a.k.a hospitals. What good is it to know that you are going into pre-term labor if their are no drugs to stop it or NICU’s to save the baby?

            I am not even mentioning the various conditions that can’t be discovered prenatally. Such as uterine prolapse, uterine rupture, shoulder dystocia etc.

          • ngozi

            I am certainly not saying that hospitals are unnecessary for all births. When I developed pre-enclampsia and my blood pressure was 220 over 115 (and I was walking around not KNOWING it was that high) my condition was discovered at a prenatal appointment. Of course, I was then rushed up to maternity to have an induction ( I could have had a c-section, but I like as little intervention as possible). I just happen to believe that prenatal care is the first line of defense to healthier deliveries, but certainly not the only line of defense.
            Personally, I think that hospital births (even though I do believe women are often forced into interventions that are unnecessary) are on average safer than homebirths because of the conditions that can happen all of a sudden, even though some would say those conditions are rare.

          • LibrarianSarah

            The first line of defense is just that the first line. The first step in a process. Yes a few (only one that I can think of) conditions that can be easily managed with a change in lifestyle but many if not most can’t. You need to go on and take other steps in the process. I am not saying pre-natal care is bad or useless. I am saying that their is no reason to believe that it is the primary reason perinatal mortality has gone down. Again using the list Anj gave which I admit is not a nearly complete list, 4 out of 5 of those conditions need intervention that is difficult to impossible to do at home.

    • Anj Fabian

      Common complications that can be screened for and treated prenatally:
      gestational diabetes
      pre-eclampsia
      preterm labor
      Group B strep
      low amniotic fluid

      In addition, contraception and family planning have led to women carrying far fewer pregnancies than two or three generations ago, which means better health over all.

      • Ngozi

        My grandmother was pregnant just about every year once she started getting pregnant. My mom and her older sister are 11 months apart. She had a total of 11 children (8 who survived to adulthood).

  • http://robot-heart.tumblr.com heartbot

    Do your arguments about midwifery extend to certified nurse midwives who typically work in hospitals and work with obstetricians? I was under the impression they have a great deal of education and often do research that contributes to current standards of obstetrical care.

    • Bombshellrisa

      She actually talks about that in her interviews and her video. She doesn’t view Certified Nurse Midwives (or UK, Canadian or Australian midwives who are university trained) like she does direct entry/CPM/traditional birth attendants.

      • http://robot-heart.tumblr.com heartbot

        Thank you. :)

  • Medwife

    Dr Tuteur –
    As a new nurse midwife/nurse practitioner, I have to say that I love your website! While a lot of what you say is tough to hear, it’s true. I trained in a hospital setting and I firmly believe that certified nurse midwives have our place and are very useful in the healthcare setting, BUT I also know that many women are not well informed about the bitrth process and the dangers involved.
    There’s a reason the United States is the best country in the world…because we have the best medical training and the best physicians in the world. As a nurse midwife I love delivering babies, but I also love the fact that if something goes wrong I know I have the in-house OBGYN & NICU team close by. This is not an option with home births!! I wish more midwives would be honest about the benfits of our professional role in healthcare and our limitations.

  • melissa

    I just got it. This website is “fake” – the opposite of the truth, to show how good normal childbirth is and make people pro-homebirth! Haha cool idea, even if it rocks the boat.

    • Amy Tuteur, MD

      I got it. You don’t have a clue how to rebut my claims.

    • Lizzie Dee

      Yep normal childbirth is good, and homebirth is bliss, so long as you manage to avoid the normal complications ranging from incontinence to death. Most do, and you stand a reasonable chance of being one of them.

      • Ngozi

        And c-sections are just as safe as cotton candy….HARF!

        • LibrarianSarah

          What an awesome takedown of an argument that nobody made.

    • suchende

      I was wondering, is it exhausting to go through life as a moron? Are daily tasks difficult for you? Like pumping gas, cashing out at the grocery store, etc?

  • Fariq Al-Abbud

    I hate arrogant, lesbian atheists with degrees…

    Do your patients read this, Amy? Or do you work exclusively with Medicaid patients giving abortions?

    • The Bofa on the Sofa

      Damn, Amy, after doing this for all these years, finally someone has figured it out!

      • Fariq Al-Abbud

        I’m sure I’m not the first. BTW why do you two always support her? Sounds like she is just replying to her own blog with other accounts…

        Sad.

    • Squillo

      Translation: I am terrified of smart women.

      • Fariq Al-Abbud

        How does that make any sense at all? She is clearly an idiot.

    • PJ

      A heads up: I don’t think you got quite the effect you were after with that statement …

  • KatieDid

    Wow, I’ve never seen an OB/GYN that believes so little in the mother. It’s disgusting. You just keep making money though, I suppose.

    • Amy Tuteur, MD

      Because homebirth midwives and doulas work for free, right?

      • KatieDid

        Never said that, but at least they have some faith in a mother.

        • Amy Tuteur, MD

          Why? What does faith have to do with anything?

          Do you wear a seatbelt when you drive, or do you “have faith” that you won’t get into a car accident?

          • KatieDid

            That’s an irrelevant point. Telling a newly pregnant woman that she might as well be neglecting to buckle a seatbelt while driving by being pregnant is pretty ridiculous. While I was pregnant, my OB was very kind, He spelled out possibilities, but never made them seem inevitable. I choose to receive care from an OB, but I respect midwives and I respect the choice to use one. I don’t know what I would have done, had my OB been as much of a naysayer as you. I was paranoid enough as it was, with a little life inside of me. Faith has so much to do with it, believing in yourself, that you can carry this child to term and be a good mother. If you don’t think so, I question if you’ve ever had a child.

          • EllenL

            So, when women miscarry or experience a tragic stillbirth, the problem was a lack of faith in themselves? Because with faith “you can carry this child to term”?

            I’m a mother of two, and I don’t think faith got them here safely. Doctors and hospitals helped a lot, though.

          • KatieDid

            Is that really what you’re taking out of that? Of course that wasn’t the problem. Saying that a woman’s feelings during pregnany are irrelevant is just stupid, though. That doesn’t mean that feelings are the only thing that will get you and your child through safely, but they are still very important.

          • The Bofa on the Sofa

            So after your comments today, I reiterate my statement above: I have no idea what that means, “faith in the mother.”

            Nothing you have said seems to have anything to do with that, or makes any sense in that context.

          • KatieDid

            Sigh. You people make me sad. This woman is a quack, pushing her own agenda as an OB by trashing on midwives and women who make the choice to use one.
            Bofa, if you don’t know what it means to have faith in a mother, I am very sorry for your wife.

          • Amy Tuteur, MD

            I understand that you wish that faith plays an important role in birth, but you haven’t presented any evidence that faith plays a role in birth. Why should anyone believe your claim?

          • Box of Salt

            Dr Amy, you have a logic fail here: “but you haven’t presented any evidence that faith plays a role in birth.”

            Of course she doesn’t! That’s the whole point of faith – no evidence needed.

            It might be more appropriate to pose the question: why should anyone else share your faith?

          • Lizzie Dee

            … trashing on midwives and women who make the choice to use one…

            But as you are bursting with faith, why do you care? Not to mention, why do you share?

          • The Bofa on the Sofa

            I know what _I_ think it means to have “faith in a mother” but it is very clear that you don’t agree with it, since I have never seen any indication that it is not present here.

          • Jenn

            Sanctimommy! You’re so “sorry” for people who don’t do things your way. This woman is not a quack. She is merely trying to shed some light on the other side of home births. It’s NOT all happy and joy. Lots of people die: both babies and mothers. ALL mothers want what is best for their children. Sometimes we mess up, but we make amends. Am I less a good mother because I had hospital births, in one case, saving my life because I bled out? Does that make me a bad mom? To save my own life? If so, I’d rather be a bad mom than a dead one.

          • Amazed

            Oh I see. So, are they EQUALLY important?

            Most women’s rightful negative feelings do abate with time. Mommy’s hurt little feelings at being told that she needed to take this (fake!) vitamin, have this (unneeded!) C-section, feed this (not starving, just slim!) child, being delivered by this (unfriendly!) obstetrician are as important as leaving dreaded hospital with a living child? Ha!

            I am on the opinion that most of the mommies with their hurt little feelings that cannot heal with time are just whiners who strive to find reasons to be victims and heroic martyrs.

          • S

            What’s funny to me is, i feel that providers who treat me like a competent adult instead of protecting my feelings ARE showing respect for me as a human being. I am not sure whether or not that’s what she means by “faith” in the patient. (Is it, Katie?)

          • Amazed

            Well, I am the same way. The fault lies with us, S. Don’t you see? We’re women and not birth goddesses who are entitled to a dream experience and no problems at all.

          • The Bofa on the Sofa

            As has been pointed out a zillion times, no one actually needs help for a non-eventful birth. By definition. The only reason you need a doctor is to prepare for complications.

            As such, why shouldn’t a doctor then be focusing on preparing for those complications?

            If you REALLY “have faith” or “believe in yourself” then you’d just UC. The fact that you would choose a caregiver in the first place is an acknowledgement that that you have some doubts. Of course, there’s nothing wrong with that.

          • Anj Fabian

            A woman’s mental status or distress is best evaluated and treated by a mental health professional.

            Period.

            OBs know their limits. It’s usually the lay midwives, doulas and birth attendants who fancy themselves the experts on everything from pregnancy, birth, mental health and theology.

          • Box of Salt

            KatieDid, it’s not irrelevant – you just missed the point.

            Do you operate your whole life on the principle that if you have faith everything will always turn out fine no matter what you, or do you take safety precautions, such as buckling up every time you get in the car, or looking both ways before you cross the street?

          • KatieDid

            Like I said, I chose to use an OB for my pregnancy. Faith and believing in yourself as a mother may not be the only thing, but it is most certainly something. Something big.

          • The Bofa on the Sofa

            I just don’t understand it. When the doctor says, “We need to be prepared in case something bad happens,” how is that not having faith? Or not believing in her? How is it causing “something big”?

            The reason I believed my wife could handle pregnancy is because I knew she would avail herself of help if there came to be problems. Denying the existence of problems doesn’t do any good. Being prepared for them is the key.

            How is that not having “faith in my wife” or believing in her?

          • Box of Salt

            KatieDid, that doesn’t actually answer my question. I’ll rephrase it for you: how far do you test your faith when dealing with every day life?

          • S

            “Faith has so much to do with it, believing in yourself, that you can carry this child to term and be a good mother.”

            Sorry, it sounds like this belief is important to you, but it doesn’t make sense to me. Of course i believed that i could be a good mother; otherwise i wouldn’t have had a child. But faith that i could carry my child to term? All i could do was practice reasonable self-care and hope for the best. I could not prevent my baby from knotting up his cord, or from having an undetected congenital condition, for example. It might be reassuring to you to believe what you do, but it will not change the outcome of your pregnancy.

          • Lizzie Dee

            What has carrying a child to term got to do with being a good mother?

            I don’t have much of a problem with women having faith in themselves, especially if it serves to encourage a responsible approach to proper care and information about their pregnancy – but the idea that it somehow equates to some form of agency over what actually happens is a bit dim. We all hope – and to some extent expect – that we will carry a child to term and most do of course. But do you really believe that problems are CAUSED by lack of faith? Like those idiot midwives who believe fear stalls labour, despite abundant evidence that it does nothing of the kind?

            As for whether faith in the sense of trusting one’s judgement makes for a better mother, it might. Maybe. It might just make you an insufferable sanctimommy, but your children probably won’t care.

            Still, the belief that bad birth=bad/failed mother smacks a bit of a closed mind to me. And I suspect may lead to believing you are a good mother as much as actually being one.

        • The Bofa on the Sofa

          Shoot, I don’t even know what that means “faith in a mother.”

          • The Bofa on the Sofa

            I’m thinking about my comment. My wife is a very safe driver. Never had an accident in more than 25 years and hundreds of thousands of miles driven, got one ticket for passing back when she was 16, but has never been pulled over even since (learned her lesson, although to be fair, the place she got a ticket was deceptive). Never a crash, never been re-ended, no tickets. IOW, a lot safer driver than me, and safer than most drivers on the road.

            So, am I insulting her by wearing my seatbelt when I am riding in the car? Am I not trusting her enough? Do I not have enough faith in her?

            Think about the answer very carefully, KatieDid, lest you talk yourself into a deep, deep hole.

  • Jess

    The “don’t disagree with me unless you want to look foolish” attitude is quite arrogant. Arrogance doesn’t teach people. Your condescending manner is aimed at homebirth activists, but is really just proving to lay-people (most significantly, the moms who stumbled here by accident, like myself) that your blog is serving one purpose: to push your own agenda. You are not here to support or educate anyone. I choose to find objective information that is not serving one person’s personal vendetta. I’m not finding that here. I see “Homebirth is bad.” “Breastfeeding is bad.” “Midwifery is bad.” I’m not learning anything except that you have some strong opinions and want to shove them down my throat.

    • Ainsley Nicholson

      Dr Amy does a lot of educating; support, not so much. She is definitely not supportive of people who make decisions that endanger their lives and their babies’ lives and brain function. If you read thru the archives, you will see that her message is more nuanced than what you describe as her agenda. “Homebirth is bad” – yes, because it kills and injures. “Breastfeeding is bad”- definitely not. She states that there is good evidence for a small benefit to breastfeeding. However, what she advocates against is the exageration of this benefit, and the shaming of women who formula-feed for whatever reason (medical reasons or personal choice). “Midwifery is bad”- not exactly. What she rails against primarily is the system in the USA that lets just about anybody call themselves a midwife, even if they have no medical training and haven’t even taken biology 101.

    • The Bofa on the Sofa

      I see “Homebirth is bad.” “Breastfeeding is bad.” “Midwifery is bad.”

      Can you please point me to where Dr Amy has said “Breastfeeding is bad”? I don’t recall seeing that ever, regardless of context, so I would appreciate if you can show me.

    • Lizzie Dee

      There is nothing wrong with disagreeing with opinions, or disliking what you see as arrogance; the foolishness comes from failing to differentiate between opinions and facts.

    • DalilaM

      Thank you Jess, well said

    • jenn

      Where on EARTH does she say that breastfeeding is BAD? OH MY GOD. All she said was that it is no one’s business but the mother’s whether she breastfeeds or not! I breastfed both of my children, but saw other mamas struggle and feel horribly guilty that they did not have the supply to feed their children. Would you rather they had let them STARVE TO DEATH than supplemented with formula? Is that what a “good mom” does? Starves her baby instead of supplementing?

  • Very Pregnant

    All I really want is unbiased information based on sound scientific study and a little respect that I am a human being with the ability to weigh and compare various risks. I appreciate the medics’ expertise and concern, and I appreciate the humanity of the ‘opposite’ approach. I really do think these battles between two models of care need to be overcome. I don’t want my baby’s birth to be a battleground, I don’t want to be reckless – I just want mine and everyone else’s birth to be as safe and sane as possible. Sometimes the natural birth advocates seem to have the sanity, while the obgyns have the safe. Maybe one day we’ll find the best balance. Thanks for your links.

    • Anj Fabian

      I can’t go with “sanity”.

      I’ve read too many stories where midwives ignored concerning signs and/or failed to respond to them to consider midwifery approach “sane” especially the “no intervention, hold the space” approaches.

      If a woman giving birth wants personal support, she should hire a doula. She might consider going to a therapist both before and after birth if she finds herself in emotional distress. Mental health issues SHOULD be addressed by specialists.
      (Doulas, midwives and OBs are not mental health specialists.)

    • Lizzie Dee

      Your first sentence is perfectly sensible, and a reasonable thing to want. But after that, it is my opinion that you set up a very false dichotomy. The idea that there is some kind of clear choice between a medical model devoid of humanity or a “reckless” choice with a nurturing midwife just doesn’t hold up at all. As is pointed out here time after time it is perfectly possible to have a “natural” birth in hospital. I think you should reconsider your definition of humane.

      As far as I am concerned, the only way a “balance” could ever be achieved would be if it became possible to be absolutely certain that a woman who starts out low risk will stay that way – and it is not possible. Putting energies into improving hospitals, changing things there, makes a lot more sense than pretending there are special advantages to staying at home.

  • Pat

    Informed choice and awareness of options make birth a better experience, and safer for mom and child. BUT it doesn’t always prevent death, stillborn, miscarriage (early and late).

    Birth isn’t ‘safe’. neither is sex ever ‘safe’ But we can make it safer. and Homebirth CAN BE as SAFE AS Hospital birth. Hospital birth can be just as safe as homebirth.

    midwives and Ob/Gyn’s NEED TO WORK TOGETHER. This midwives vs. doctors needs to stop. for the health and welfare of mothers and children everywhere.

    • Poogles

      “Homebirth CAN BE as SAFE AS Hospital birth.”
      I’m sorry, but no, it can’t. It’s a matter of logic – a home can not be equipped with a blood bank or an operating room or a NICU. There are complications that can develop very quickly, even in low risk women, that need immediate access to those resources which are only found in the hospital. When that happens, even being next door to a hospital is not close enough.

      The argument can be made that, with very strict criteria, very knowledgeable/experienced providers and a well-integrated system, that HB can be made almost as safe as hospital birth, or at least “safe enough”. This is not the current scenario in the US, however, and the accumulating dead and damaged babies and mothers are the result.

      • The Bofa on the Sofa

        Homebirth is just as safe as a hospital, except when it isn’t. By definition, a complication free birth can pretty much be done anywhere just as successfully.

        The problem is knowing ahead of time whether it will be complication free or not. Which we don’t.

        Therefore, that there are, in retrospect, births that could be just as good at home or in the hospital is meaningless. Unless you can determine ahead of time which those are going to be, it is worthless.

        Driving drunk CAN BE just as safe as driving sober. All you have to do is to look at all the times it has been done without incident. That doesn’t make driving drunk a reasonable idea.

    • Poogles

      “midwives and Ob/Gyn’s NEED TO WORK TOGETHER. This midwives vs. doctors needs to stop.”

      They already do! CNM’s are well integrated into American obstetrics, there is no turf war between OB’s and CNM’s. There is only opposition from experienced, qualified maternity care providers (OB’s and CNM’s) against inexperienced and unqualified maternity care providers (CPM’s, DEM’s, LM’s etc.) and the horrible care they deliver.

  • Tihamer

    It is reassuring to read a blog with reasoned explanations for many of the positions it believes. Thanks Dr. T for giving scientific reasons and literature references that back up your claims!

    The only thing that jumped out on this page was the definition of perinatal mortality. Why is it from 28 weeks of pregnancy to 28 days of life? The selection of the number 28 (and especially it’s repetition in both directions) looks like numerology to me. There are even two zombie movies that use those same time periods. Isn’t viability generally viewed (in the U.S.) as 24 weeks? And won’t that view change as technology improves to the point of artificial wombs?

  • Skeptical of your conclusions

    AMY, was there an autopsy on the mothers day case? If so what were the findings? Are there cases that the mother dies from amniotic embolism? What is the rate of survival in those cases? What basis did you claim that the woman died as a result of hemorrhage?

    • Box of Salt

      You know, I’ve been waiting for the critics to come and drop drive by comments on Dr Amy’s post about this case. But I had assumed you’d manage to add your comments at the post which actually discusses it.

      • Truth or consequences

        Drive by comments? Questions her with legitimate questions are drive by? Your only retort is condemning where I post the comment? Very nice! I guess you are intelligent enough to find the article. She did absolutely no fact finding on this article and she used this tragedy to further her ideology of claiming midwives are homeopathic knuckledraggers.

        • Box of Salt

          “Truth or consequences” or “Skeptical of your conclusions”

          I apologize for the fact that I was unable to post my response to your (singular or plural?) reply in more timely manner.

          First of all, I wonder if you realize you were posting your questions on a public forum, not a direct email to the blog host (whose email address is published in the sidebar).

          As you complain that the blog host is making assumptions that go beyond publicly posted statements, consider this: I responded only to the facts regarding the comment posted by “Skeptical of your conclusions.”

          It’s a comment from a new poster, whose name I do not recognize from prior reading of this blog and its comment sections.

          The comment consists of a series of questions completely unrelated to the blogpost above.

          A month from now, when someone else decides to click on a link to this page, that reader will have absolutely no idea what you are asking about.

          I didn’t make any claims – I only pointed out that your posted comment is misplaced.

          • Truth or consequences

            Box of salt is a perfect name for you! Box of hammers may be more appropriate! Is your name Amy? I believe I asked her a question. Keep your insults to yourself and answer me when I respectfully ask you a question! Or not……

          • Box of Salt

            Truth or consequences, my name is not Amy.

            Reading comprehension isn’t one of your strengths, is it?

            If you are a relative or friend of the deceased, I offer my condolences.

            I will offer you this suggestion, regardless of who you are:

            Posting comments in anger on public blogs isn’t doing you any favors.

          • LibrarianSarah

            Don’t feed the troll and it will probably go away.

  • skepticat

    So… I bounded over here after reading that Time article on the “Lactation police” the doc wrote. So then I got interested in homebirth too, and I also read the Wikipedia article on it for comparison to the material summarized here. Dr Amy you do make good counterarguments against some of the misinfo that is out there probably, but I think the Wikipedia article is probably also well researched (I tend to trust their review process when it is not life or death for me, and many doctors contributed, presumably with good reputations). The Wikipedia article seems to in balance say that that homebirth vs hospital birth isn’t a big deal in the scheme of things as long as good prenatal care is done so higher risk cases are cared for appropriately and some other qualifiers, and a lot of national governmental bodies seem to agree with this.

    So, is this all a tempest in a teapot? Should the goal just be good prenatal care and if low risk cases give birth in a qualified home environment no big deal? Or can you take on the Wikipedia article and maybe get it modified?

    • Susan

      Gosh, I only read Wikipedia for entertainment and it’s worst abuses are when something has a cult following with endless zealots fighting for a cause who will undue every criticism of their cause. I would never spend my time trying to fix a Wikipedia article on something with a cult following either… I think Dr. Amy’s time is far better spnt ignoring Wikipedia! My kids learned in school never to use it as a reference…. I won’t let my son quote it in a debate either.

      • http://twitter.com/UltraVenia Jules

        I edit Wikipedia regularly. For certain scientific subjects, it’s fine. But unless the few, overworked,(99% male) scientific skeptics are diligently watching the page (and no, NCB is not really on their radar), it will be overrun by single issue promoters.

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

      Good prenatal care – VERY good prenatal care – would make a difference at spotting when “low risk” can no longer be taken for granted. But it isn’t consistent with the Trust Birth attitude that NCB promotes, and it wouldn’t make any difference to the problems that occur in labour.

      The current politically correct mantra of “Homebirth is safe for low risk women” is correct, but that doesn’t mean it isn’t any kind of big deal, because what it translates to is: “It will likely be disastrous for those who turn out to not be so low risk after all, but that is the price you pay for “choice”.” NCB rests on denial of real risks and wants to claim that homebirth is not just safe if you are lucky, but safer – and they have to lie and bamboozle to sell that. Is THAT a big deal worth arguing against? The stakes are rather high. Homebirth in places with safeguards in place increases bad outcomes.

  • Birth “professional”

    You’re not just a “skeptical” OB, you’re a pompous, one-sided, dangerous, crisis-monger with a clear and erroneous ax to grind. This list is total bunk and a disservice to women and neonates.

    • Dr Kitty

      Yo, wanna come over to today’s post and talk about crisis-mongering?

      It’s about maternal mortality, specifically women bleeding to death at home. You can even educate us on how you’d manage a massive PPH at home if you’d like.

      Do you want to post anything that actually refutes any of Dr Amy’s points above? Anything resembling actual evidence?

      Or are you just another parachuting “Dr Amy is MEEEN- Trust Birth and no one gets hurt!” troll?

  • Ana

    As a medical student who has participated in both forceps deliveries and urgent/emergent c-sections, I think I would rather have a crash c-section than a forceps delivery, if it came down to it. I also would want an OB who is very liberal with medio-lateral episiotomies. The OBs at the hospital that I trained at were quite hesistant to do episiotomies, and I have seen several nasty tears (including a 4th degree tear following a forceps delivery) that most likely would have been prevented by an episiotomy.

    • Susan

      As someone who has cared for a lot of women with fourth degrees and mediolateral episiotomies ..mediolaterals appear to be very painful. I disargree too on crash c/s…if my baby were. in trouble I’d take the fourth degree even if it was a certainty over a longer period of oxygen deprivation to my baby. If the forceps were for a no emergency indication I agree.

      • Ana

        I think the pain of a mediolateral is without a doubt worth avoiding the risk of a fourth degree tear. More than half of women who have a fourth degree tear suffer from permanent issues with bowel control and fecal incontinence. I saw one woman who had struggled with total loss of bowel control, had had multiple surgeries to try to correct it, and eventually gave up and asked for a colostomy.

        I would much rather deal with the pain of healing from a mediolateral episiotomy than risk permanent loss of bowel control.

  • Rachel

    There are no sources cited in your post. At least others back up with relevant, reliable, peer reviewed studies.

    • MLE

      Read some mo posts and you might find what you’re looking for.

  • Rebecca Szajkowski

    I am not seeking to educate you, only ask for a little bit of empathy. I am only even looking on the internet right now for answers, because my own OB will not provide them to me. When inquiring about the Rhogam shot, was simply told that if I do not get it babies die. That’s it. No inquiry into my husbands blood type to see if it is even necessary (which it is,) no information on what the shot is, and what it is made from, and why I even need it at all. I was simply confused as to why I have not needed a shot up until 28 weeks, and found out via my mailbox that I needed to get some arbitrary shot I have never hear of or been informed of. I am not trying to be an expert, however, with an array of virtually unheard of medical problems (including malignant hypothermia, and erythropoetic protoporphyria) I do not take injecting things into my body lightly, as my entire organ structure is a little differently. I find often times people look to the internet because they are not informed, not because they are out to prove their doctors wrong, or to pretend to get a PhD. I greatly admire all of the years all doctors have spent learning on how to save the lives of the rest of us. However, with this being said, while I’m sure my OB is knowledgeable about what she is doing, and clearly has her own reasons for wanting me to get certain courses of treatment, without sharing this information with me, I have no where else to turn except to the internet for answers.

    • Dr Kitty

      Rhogam is a blood product. It prevents haemolytic disease of the newborn due to rhesus iso-immunisation of a rhesus negative mother by a rhesus positive foetus.
      The only contra-indication to its use is the treatment of ITP in Rhesus negative or splenectomised patients.
      None of your medical conditions are reasons not to have it.
      If you want to prevent future babies suffering from potentially fatal haemolytic anaemia, you should get it.
      If you have questions for your OB- why not ask her directly?

    • Amy Tuteur, MD
  • christine

    I’ve stopped reading after #2 bc of the outrageous misrepresentation of the facts! For those who wish to read real statistics and not just Dr Tuteur’s cherry picking to fit her extreme bias, here is the link to the OECD report that shows that France has a higher perinatal mortality rate then the Netherlands. http://www.oecd.org/els/health-systems/Item7ZeitlinPresentationOECD.pdf …And yes, France is a country that medicalizes births almost as much (if not more) than the US. In France, doulas and home births are almost unheard of (in fact, doulas are not allowed in hospitals) and most hospitals have epidural rates of 90% or more.

    Finally, the US has a higher mortality rate than the Netherlands. So using them as an example is funny logic. Here is a recent report so you can verify for yourself. … http://www.cdc.gov/nchs/data/nvsr/nvsr60/nvsr60_08.pdf

    • Box of Salt

      Apparently christine didn’t read #1, either.

      • christine

        Apparently Box didn’t click on my links. The links were for reports that cited perinatal mortality rates, not neonatal rates. So yes, obviously I read #1.

        • Expat in Germany

          The links you put up were good, but you need background info to understand the implications. You can’t just attribute all of the differences between countries neonatal mortality rates to birth attendant. The mother’s health and race play a not insignificant role as does the cut off for low gestational age. See slide 20 where the us data compares much more favorably with Swedish data if the cutoff difference is taken into account. France an the Netherlands have different demographics and comparing neonatal mortality tells you something about maternal health and race, but it doesn’t tell you much about the quality of the birth attendant. Perinatal mortality tells you that. You need different links for that comparison.

          • christine

            I agree — you can’t attribute all the differences of mortality rates to birth attendants. this is why, unlike Dr T, I didn’t make any claims. And in fact, I made it clear that I was still undecided on the issue but obviously leaning towards an integrated model of care. I thought that it was clear that I was replying to Dr T’s manipulation of the stats (see my first few posts). She singled out the Netherlands because they have a significant percentage of their births attended by midwives at home and they have one of the highest perinatal death rates in Europe. Yet she doesn’t say that France has a similar rate but different model of care and that the US has an even higher perinatal death rate then the Netherlands. You also didn’t address this.

            And … I was aware that there are a lot of yahoos in the US, I’ve read the horrific home birth stories of incompetent midwives. I find it appalling that there are some midwives who are practicing without proper equipment, training, or insurance. This still doesn’t negate the fact that the majority of studies conclude that home births are just as safe as hospital births. However, the perinatal mortality rate can and should be decreased. It may be helpful for the US to look at the other OECD countries for answers, as I briefly explained above.

            What would potentially be great for the well-being of moms and babies is a concerted effort to properly regulate midwifery in the US, to ensure that they are all properly educated, equipped, insured, and/or integrated into the hospital systems. Wouldn’t that be a better use of everyone’s energies? Trying to bully and shame moms out of the home birth option, as Dr T is currently doing, is not going to accomplish any good.

          • Poogles

            “What would potentially be great for the well-being of moms and babies is
            a concerted effort to properly regulate midwifery in the US, to ensure
            that they are all properly educated, equipped, insured, and/or
            integrated into the hospital systems. Wouldn’t that be a better use of
            everyone’s energies? Trying to bully and shame moms out of the home
            birth option, as Dr T is currently doing, is not going to accomplish any
            good.”

            I think everyone here agrees we should get rid of the CPM “credential” so that only “properly educated, equipped, insured” midwives (that is, CNMs) are licensed to attend births. As they are already integrated into the hospital system, that isn’t an issue. Now, there are not all that many CNMs willing to do homebirth, usually because they find it too risky or the insurance rates are too high (again, because of the risk), or there isn’t an OB and/or hospital willing to provide back-up (real back-up, not the CPM version which usually just means “this is the hospital where I will dump you if you need a “transfer”).

            I don’t find Dr. Amy to be bullying or shaming. I have been reading her for ~5 years now, and originally came to her writing as a strong advocate for homebirth. Sure, she pissed me off (and occasionally still does, lol), but that doesn’t mean she was bullying or shaming me. After learning so much more about birth, learning so much about the statistics and studies done, I can no longer support homebirth. I consider that a “good” that Dr. Amy has accomplished, and there are many here who are in the same boat as me. If a woman truly, truly understands the risks she is taking, I think she should be able to make that choice (so does Dr. Amy), but I do not think CPMs should be attending her.

          • Poogles

            ” It may be helpful for the US to look at the other OECD countries for answers, as I briefly explained above.”

            As Expat touched on, there are various differences between countries that make it very difficult (and sometimes, downright impossible) to directly compare perinatal mortality rates in any meaningful sense.

            For one, a lot of the countries with a lower rate than the US have some form of universal healthcare. Their populations are usually more “white”. They may have different cut-offs for their statistic definitions. We may be able to implement things other countries do (like universal healthcare) that could, possibly, help our rates. There are other differences, however, that cannot be changed (like the ethnic diversity of our culture).

          • christine

            sigh.

            There is ethnic diversity in Europe. Yes, not in the exact proportions as the US but I doubt the gap is wide enough to consider it a factor in the above discussion. Shall we take the example of the US and the Netherlands? I’ll look up the stats for you and come back in a second. …

            Well, here we go: Whites in the US’s equal 78% of the population http://quickfacts.census.gov/qfd/states/00000.html

            In the Netherlands, it’s 80%. … http://www.indexmundi.com/netherlands/ethnic_groups.html

            do you really think a 2% difference is worthy of comment?

          • Dr Kitty

            Christine, you’re rude and hostile, aren’t you?

            I don’t think you’re reading your own cites, dear.

            The 20% non white Dutch population is 5% EU (meaning mostly white Europeans), with Turks, Surinamese and Moroccans accounting for another 7% or so, with less than 1% being Carribbean (one would assume mostly from the Dutch Antilles) and 4.8% being other.

            Meaning that LESS THAN 7% of the Dutch population is African or Afro-Carribbean, and most likely much more like 3-5%.

            Moroccans generally being Berber or Arab, Surinam being a country in South America ( where the population is mixed between Indigenous people 2%, East Indians 37%, Chinese 8%, people of African descent 10%, Javanese 15%, White 5%, Creole 31%) and the population of Aruba (as an example of the most populous Dutch Carribbean Island) having a population which is 80% mixed white/ Arawak.

            Dr Tuteur’s point was that women of African descent are at higher risk of obstetric problems compared to other ethnic groups, that 1 in 6 women giving birth in the US is of African descent, and that this may explain disparity of outcome to some extent.

            Your choice of cites about the ethnic makeup of the Netherlands doesn’t refute that point in the slightest. Would you like to try again?

          • christine

            Yes, I guess the disingenuous replies (show me the bullying; show me the studies that show that home birth is safe) started to wear me down. … and now you. You compared apples and oranges. Your own government would consider Americans with Turkish, Surinamese, and Moroccan backgrounds to be in the non-white category. did you not check out both of the links? btw, I wasn’t replying to Dr Tuteur’s claim re African descent. I wasn’t even aware of this claim. I was replying to Poogle’s claim that European countries are more white.

          • Dr Kitty

            Yup. Rude and hostile.

            Whether or not someone is considered “white” or not by a government is irrelevant.

            Being of Black African descent is an independent risk factor for obstetric complications. I can’t help that you didn’t know that, or that we are discussing demographics specifically because of that.

            By “more white” I think that Poogles meant “less Black”, and in that she is perfectly correct, the USA has a much higher proportion of people of Black African descent than any European country.

          • Siri

            There ARE two of you Christine’s, aren’t there? You aren’t just two radically opposed personalities in the same body?

          • Dr Kitty

            Not my government Christine.

          • Poogles

            “I was replying to Poogle’s claim that European countries are more white.”

            Dr. Kitty is correct, that by “more white” I meant more specifically “less black/African descent” – apologies for the confusion. I would also like to add that I was referring specifically to “a lot of the countries with a lower rate than the US” (not ALL countries with lower rates, and not ALL European countries). It is one of many variables that can effect a country’s perinatal mortality statistics.

          • Poogles

            “Yes, I guess the disingenuous replies (show me the bullying; show me the studies that show that home birth is safe)”

            Well, you mentioned more than once that “the majority of studies conclude that home births are just as safe as hospital births”. Since the vast majority of the readers here (and Dr. Amy herself) obviously disagree with that assesment of the literature, I do not think it was disingenuous in the least to ask you to list the specific studies that led you to that conclusion, and how they did so. You give us nothing to go on except “I simply assumed that you and your followers, before coming to such definitive conclusions, would have already come across the same studies that I have”. So we’re left with not much choice but to conclude you did not understand the research or didn’t read it, since people who understand statistics, researching, and the field of obstetrics have come to vastly different conclusions than you.

          • christine

            see above. In fact, governments around the world have come to vastly different conclusions as you.

          • Kalacirya

            Turkish people are white Christine. They absolutely consider themselves white, and they list as white on the US Census. Unless Dr. Kitty is from another country, and I didn’t think she was, this is the case. Moroccans, if they are not black Africans, are also listed as white. The end.

          • Dr Kitty

            Sorry, I’m not American.
            Irish.
            Living in the bit of Ireland that is British, and hence only too aware of the current demographic boxes.

            It’s why I post at odd times (GMT time zone) and use weird spellings (foetus, paediatrics, etc).

          • Kalacirya

            I think I must have confused you with someone else, because I thought I recalled you talking about being in the USA. Sorry about that. I glaze over the spelling because half the graduate students and professionals I know are expats and don’t use American spellings either. Either way, my point still stands. I’m not sure where Christine is from, but if she thinks that the Netherlands demographics are easily comparable to the USA’s.

          • christine

            Why are you arguing this? I never said otherwise re Turks. and see the above post. You are asked to choose on the census whether or not you consider yourself as “white”.

          • Kalacirya

            I misread something, I apologize. You are still incorrect on your other claims though, not sorry about that.

          • Dr Kitty

            I’ve just looked at the French Wiki page.
            France is 85% white, 10% North African, 3.5% Black African, 1.5% Asian.

            Black African women in France have, on average, 2.8 children, compared to White French women who have 1.7 children.

            Immigrants to France from Africa come from the Maghreb (Tunisia, Morocco, Algeria) or from Subsaharan Africa (mostly Mali, Cameroon, Senegal and Congo).

            France has a better infant mortality rate than the Netherlands.

            Just for completeness.

          • Siri

            Clearly non- white people all look the same to Christine..

          • http://twitter.com/SlackerInc Alan

            “women of African descent are at higher risk of obstetric problems compared to other ethnic group”

            Just inherently, regardless of their income level? Again, this seems wrong. “African descent” is so broad, genetically speaking: two sub-Saharan African women may have a greater difference between their genomes than that between a Swedish and a Japanese woman.

          • Dr Kitty

            Higher incidences of non gynecoid pelvis, sickle cell disease, obesity, rdiabetes, pre-eclampsia and pre-existing hypertension in people of African descent. Some studies have also shown highe rates of infection, ante partum haemorrhage, prematurity and fetal demise. Not all of that is completely explained by socio-economic and health disparities.

            I will post cites when I have time.

          • http://twitter.com/SlackerInc Alan

            Thanks. I would like to see studies that focussed on African Americans who are multigenerational “Jack and Jill” members, although that would perhaps not completely override potential epigenetic effects of hundreds of years of slavery and Jim Crow.

          • Dr Kitty
          • Dr Kitty

            The last study is a British one, which accounted for socioeconomic factors, age, parity, smoking and BMI and still found an elevated risk of adverse maternal outcome for African and Carribean women.

            Anyway, there you go.

          • http://twitter.com/SlackerInc Alan

            Thanks. It sure does appear more work needs to be done.

            The first link goes to an abstract, with no mention of potential confounding factors. The second mentions many possible confounders, but does not appear to have controlled for them. The third (from ACOG) states outright that the disparities “largely result from differences in socioeconomic status and insurance status”. The Dutch study’s abstract says “Low socio-economic status, unemployment, single household, high parity and prior caesarean were independent explanatory factors for SAMM, although they did not fully explain the differences.”

            The last link addressed the issue best, I thought: “The increase in risk of severe maternal morbidities in non-white women seems to be independent of differences in age, socioeconomic and smoking status, body mass index, and parity between ethnic groups.” However, it also states:

            “A recent national survey of women’s experience of maternity care in the UK reported that women from black and minority ethnic groups were more likely to recognise their pregnancy later, access care later, and consequently book later for antenatal care than were white women.”

            Controlled for level of education? That’s a key question; either way we could be drifting uncomfortably close to “Bell Curve” territory, if you catch my drift.

            Plain old racism is another possibility though:

            “Additionally, these women reported that they were less likely to feel that they were treated with respect and talked to in a way they understood by staff during pregnancy, labour and birth, and postnatal care. Their options for care were perceived as more limited, and fewer had the contact details of a midwife available during pregnancy. “

          • The Bofa on the Sofa

            Note if it were just socio-economic, you would expect to see similar problems in the hispanic community in the US, right?

          • Dr Kitty

            Alan, I know that genetically Africa is more diverse than anywhere else, and that arbitrary assignations of race are not necessarily based on genetics.

            However, even when comparing various groups of women of colour with the same socioeconomic backgrounds, and first or second generation immigrants, it still seems that women of black African origin or descent have higher risks for adverse outcomes. Compared to Hispanic, Asian, South East Asian, middle Eastern and European women, women of African origin (whether Afriacan American, Carribbean, or subsaharan African) appear to be at a disadvantage.

            At the moment we don’t know if race is a surrogate marker for the real underlying causes, of if there is something genetic going on. What we do know is that the association has been shown over and over again, in the USA and Europe, and appears to hold true even when accounting for access to healthcare, poverty and immigrant status.

          • http://twitter.com/SlackerInc Alan

            Even when accounting for access to healthcare? The links you posted were interesting reads, but if they demonstrated that point I missed it. Can you quote for me?

          • DiomedesV

            Except that “African descent” is not a random category. Slaves were not imported to the New World randomly with respect to African geography.

            Also, different ethnic groups have different risks for heart disease, diabetes, etc. In some cases, we can actually trace that increased risk to actual alleles that segregate at different frequencies in different populations (eg., diabetes in Native American populations).

            The situation for preterm labor is not as well understood, but there is nothing a priori wrong with suggesting it may have a genetic component.

          • http://twitter.com/SlackerInc Alan

            But we got into this because France’s having more black people than the Netherlands; so the geography of New World slave importation should be irrelevant. And while I agree that “there is nothing a priori wrong with suggesting it may have a genetic component”, the great genetic diversity of sub-Saharan Africa would suggest that if this is true, it would almost have to be an *advantage* that developed among the group(s) that forayed out beyond the horn of Africa and whose descendants populated Eurasia. That’s certainly possible, but it would be extraordinary and deserving of specific attention IMO.

            Interesting discussion!

          • DiomedesV

            Also, while it is true that Africa is the most genetically diverse, that does not preclude positive or purifying selection acting on very specific alleles, including those related to childbirth, across the continent, or across wide swathes of the continent (the latter being more likely). More importantly, immigrants are not randomly selected with respect to geography, nor are they randomly selected with respect to their economic status in their own country (thinking specifically of Europe). In short, they’re not a random sample, even though Africa is the most genetically diverse.

          • http://twitter.com/SlackerInc Alan

            All good points!

          • christine

            thanks for the correction, yes, I had missed the 5%. btw, it wasn’t clear that poogles was saying that Europe is less black. but thanks for launching an interesting discussion

          • Kalacirya

            Lol,

            For one, Turkish people are white people, I would know. In the USA, Turkish people are white people on the Census. So that’s 2.2%. That other 5% EU group is probably all white. The North Africans are probably fairly white (again, on the Census, North Africans and people with Arabic heritage are considered white. There are a lot of Indonesian folks there as well, they’re also notably not of African descent.

            The Netherlands are not a bastion of ethnic diversity, sorry. 15% of African descent versus 5% or less is a wide gulf.

          • christine

            you weren’t reading in chronological order. my reply was in response to poogles claim that there’s very little ethnic diversity in europe. it was before the conversation turned to perinatal stats and mothers with African descent. … but yes, much to laugh about: i lived in Morocco for two years, Egypt for one, in Palestine for 6 months, and can tell you that they and other Arabs would never check the “white” box on a census form. My guess it that same goes for Indonesians. But perhaps you have different experiences? … more importantly, why did you feel it necessary to correct me on the above post? Why not address the more important questions of home birth vs hospital safety?

          • Kalacirya

            I am talking about the US Census, because this blog is focused on USA homebirth. North Africans and middle easterners check white, they are counted as white people in the USA and in our health statistics. I am middle eastern myself, I am white, I check white on the Census. The Census specifically calls for us to classify as white. Good to know that you know some North Africans, it doesn’t change the fact that if they were of Arab descent and not considered black, they would check white on the Census. This is not too hard, is it? I targeted your statement about the Netherlands, because it was painfully wrong. 80% of the population of the Netherlands is Dutch with no other ethnicity, more than 80% is white. In the USA, the number is in the 70s, but you’re grouping together all types of white people, including white hispanics. There is far more ethnic diversity in that USA 70 something percent than there is in the 80% ethnic Dutch in the Netherlands.

            As to why I don’t address your points on homebirth: I have no interest in arguing with you about your “research”. You don’t know what you’re talking about, that’s obvious from your claims; you post some bibliographical salad without any critical statements as to why you cite the studies. You have nothing of substance to say, yet you claim to be well read on the topic. Somehow you talk in circles with few hard references to your untold amounts of research. You openly say that you don’t care to put the time in to present something more detailed. I am a statistician I don’t care about your opinion, not even a little bit. Condescension from someone such as yourself, with an inferior knowledge base, is not entertaining.

          • christine

            Race and ethnicity in the United States Census, defined by the federal Office of Management and Budget (OMB) and the United States Census Bureau, are self-identification data items in which residents choose the race or races with which they most closely identify, and indicate whether or not they are of Hispanic or Latino origin (the only categories for ethnicity).[1][2]

          • Kalacirya

            What is your point? Do you think I’m talking out of my ass here? About my own country, with data that I look at daily in my job?

            ““White” refers to a person having origins in any of the original peoples of Europe, the Middle East, or North Africa. It includes people who indicated their race(s) as “White” or reported entries such as Irish, German, Italian, Lebanese, Arab, Moroccan, or Caucasian.”

            http://www.census.gov/prod/cen2010/briefs/c2010br-02.pdf

            If you are Middle Eastern, European, North African, and you are NOT black African, Central-Southern-Eastern-Southeastern Asian, Native American, or Pacific Islander, odds are you are going to be considered white on the census. Those that report “other” are next to nothing.

          • Poogles

            “poogles claim that there’s very little ethnic diversity ”
            Errr….not quite what I said, though I admit my wording may have been a little unclear. I was simply saying that some of the European countries that have better perinatal mortality rates than us are not quite as “diverse” as the US, and this is not something we could try to emulate to bring our rates down.

          • Expat in Germany

            Home birth is not -just as safe-. The birthplace study in the UK tells us that for first-time moms, the rate of homebirth birth injuries was several times higher than for those who went to the hospital. For 2ond or 3rd time moms without so much as a whisper of a risk factor, you might be able to claim -just as safe-. Nevertheless, it doesn’t matter what the stats say if you are the one with a severe post partum hemhorrage or a baby that needs to be intubated.

          • Expat in Germany

            You were making claims about Finland. They struck me as misguided. France and its large population of west Africans aside, it isn’t unreasonable for Dr. Tuteur to point out that the home birth paradise of the Netherlands isn’t a shining star amongst its neighbors.

          • The Bofa on the Sofa

            And remember, this is not about claims that Dr Amy is making, it is about claims that OTHERS make that are wrong.

          • http://twitter.com/SlackerInc Alan

            Is it really true that race in and of itself makes such a big difference in mortality rates, independent of SEC? That would surprise me and if it is true I’d like to understand why.

          • Poogles

            “Is it really true that race in and of itself makes such a big difference in mortality rates, independent of SEC? That would surprise me and if it is true I’d like to understand why.”

            From what I recall, studies that have controlled for SEC factors (as much as possible) still find an increase of complications among mothers of African descent, though I don’t think anyway really understands “why” yet…
            Hopefully someone with quick access/references to the relevant studies can chime in here….

    • Poogles

      “here is the link to the OECD report that shows that France has a higher perinatal mortality rate then the Netherlands.”

      And? This does not change the fact that “the Netherlands has, and has had for some years, one of the HIGHEST perinatal mortality rate in Western Europe.” One of the highest, not the absolute highest.

      • christine

        reread my post

        • Poogles

          I have. Perhaps your point is that because France has a higher perinatal mortality rate and they (according to you) “medicalize births almost as much (if not more) than the US” than obviously that means the “medicalizing” is what causes a higher perinatal mortality rate than the Netherlands? I will disagree again if this is the case.
          If this is not your point, could you please clarify?

          • christine

            It’s not my point. sorry I wasn’t clear. What I had meant to say was that if Dr T is going to use the Netherlands as an example to support her claim that home birth is not safe, when France has an even higher perinatal rate (with an almost non-existent home birth culture), then she’s cherry-picking her stats and misleading her readers.

          • Poogles

            “if Dr T is going to use the Netherlands as an example to support her claim that home birth is not safe, when France has an even higher perinatal rate (with an almost non-existent home birth culture), then she’s cherry-picking her stats and misleading her readers.”

            I disagree. The Netherlands are specifically trotted out by homebirth advocates as a shining example that homebirth with a midwife is as safe as hospital birth; yet, the statistics do not support that HB in the Netherlands is, in fact, as safe as hospital birth with an OB. To refute this obvious mistruth, she is pointing out what the science actually says – that the perinatal mortality rate for low risk women cared for by midwives, whether at home or at hospital, is higher than the perinatal mortality rate for high risk women cared for by obstetricians in the hospital. It’s not cherry-picking to refute a specific claim of the HB movement by showing the statistics that prove that specific claim is wrong.

          • christine

            Can you please post a link to this science that you’re talking about? because I’m very curious, having done research myself and still personally undecided re homebirth vs hospital. The research (more than a dozen studies) that I have found concludes that HB is just as safe, if not safer than hospital births. I’m a bit skeptical of Dr T’s site bc it seems as if she and her followers are extremists. As well, the logic in many of the articles and posts is questionable. Without links to actual studies, I find it difficult to digest someone’s arguments that appear to be more like ranting and bullying (I’m referring to Dr T’s posts, not your above one) than proper analyses of scientific research.

            And in fact, if you would just reread her #1 and #2 points and then click on my links to the statistics, you’ll see how she’s wrong. She claims that the US has one of the lowest perinatal/neonatal mortality rates in the world. The fact is, that it has a higher rate than any of the 20+ OECD countries listed in the above report, including that of the Netherlands. To me that seems to support the notion that perhaps the Netherlands is handling births better than the US. Of course, there is room for improvement but you can bet that the Dutch won’t be looking at the US for answers. They are probably looking at Slovak Republic or Finland, as they have one of the lowest perinatal mortality rates in the world; in fact, more than a third of the US’s — that’s quite impressive, no?

            Shall we look at Finland for a second? Do you know that almost all births there are attended by midwives? However, midwifery is fully integrated into the hospital system. In fact, the research (and common sense) seems to support that midwifery that is fully integrated with hospital obstetric care may be the best option and most countries are moving towards this model of care.

            Unfortunately in the US, a fully integrated system between midwifery and obstetrics seems next to impossible. The US is (as it seems with every other issue from your economics to climate change to gun control and healthcare) a highly polarized nation, a nation of extremists. The middle ground is anathema to most of you, which is quite unfortunate because in most cases the middle ground saves lives.

            I’d love to see Dr T adapt and use her education, time, and energy to truly helping improve the mortality rate in the US. As is stands now, she’s part of the problem.

          • Expat in Germany

            If you knew the difference between what the us calls a midwife (cpm, dem) and what the rest of the world calls a midwife, you might have a tiny bit of credibility. Attributing a country’s mortality rates to whether or not they use midwives is so stupid it boggles the mind. It doesn’t matter who is providing the health care as long as they are appropriately trained (and the moms are healthy to begin with). CNM midwives in the US are well trained and they tend to work in hospitals where they get enough experience to know better than to “trust birth” to any old homebirth yahoo who learned all she needed to know through apprenticing with another yahoo.

          • christine

            “It doesn’t matter who is providing the health care as long as they are appropriately trained” what are you talking about? it seems that you’re saying that the training is universal? is it or is not correct to say that a midwife’s training is different from an obstetrician’s training? did you read my entire post? without bias? because I don’t claim to have the answers. stats show that perinatal death rates vary from country to country, which include countries on the spectrum of home/hospital birth care. Research does seem to support integrated care as a preferred method, something similar to what you described above re CNMs working in hospitals. However, it was my understanding that this type of care is very limited in the US and that there is great opposition by the obstetric community to fully integrate properly trained midwives.

          • Gene

            “…it was my understanding that this type of care is very limited in the US and that there is great opposition by the obstetric community to fully integrate properly trained midwives”

            Incorrect. CNMs are well respected members of the obstetrical community. I’ve been in quite a few hospitals in multiple states where OBs and Midwives work side by side, on the same team, and in concert. In fact, during some of my training, I actually did my L&D rotation ON THE MIDWIFE TEAM instead of the physician/resident team. Imagine that, a doctor learning from the midwives… One of my attendings from medical school (he was the head of OB/Gyn) has all four of his children delivered by midwives.

            But what you are doing is trying to compare a CNM with excellent training in a hospital setting to uneducated people with made up credentials who attend births at home.

          • christine

            I am not. Please see my reply below.

          • christine

            Btw, Dr T must be constantly boggling your mind.

          • Expat in Germany

            Dr. T isn’t comparing midwives to obs where she brings up the Netherlands, she is comparing home birth to hospital birth. Big difference. Hospital midwives aren’t magical, fear and pain dissolving, hand holding soul mates (as some in the us like to believe) they are just regular hospital workers like obs. If it makes you feel better to worship at their altar, go ahead.

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

            Would you like to point to examples of ranting and bullying? This is a fairly common accusation,especially the bullying bit, but I find it puzzling. Sure, this is an issue that people can have strong feelings strongly expressed, and those at opposite ends of the spectrum of views on NCB or midwifery may feel that a defence or an attack may read like a rant, but that doesn’t make it one.

            Like many others who come here, you say you have done your research and are undecided. I can sympathise with
            that. For anyone who comes at this topic with a completely open mind, knowing which information to trust must be
            completely bewildering. The appeal of the positive, empowering version of birth is so very seductive. What a lovely start to one’s journey into mothering. What a pity that the other side has such a very sad tale to tell – of grief and bitter regret at worst to disillusion and feelings of failure at best.

            For me, it isn’t a question of who produces the most convincing set of statistics, though. It is about whether
            you can reliably figure out your personal risk.

            Birth is safe for low risk women. I believe that. It doesn’t mean I believe all these lovely stories of the wonders worked by supportive midwives. If you are among those who, arbitrarily, have an uncomplicated pregnancy and birth, you could be watched over by your pet cat and it could still be blissful. What I would very much like to know is EXACTLY what proportion of women are low risk in that sense. In the cautious Brit system, I believe 40% are risked out of homebirth. Some of those may still have an uncomplicated birth – but some of those who are not risked out may not. Now, if I were reading stories of heroic midwives who could actually make a difference when things go pear shaped, in a way that hospitals could not, I might be impressed. But that simply doesn’t, cannot happen, can it? And as far as I can see, not many want to highlight that inconvenient fact – instead, demonise hospitals, and imply that bliss isn’t possible there.

            Your common sense conclusion that midwives in hospitals is a good option is,I think, what happens in most of Europe.
            Which would be fine for those who really are, and stay, low risk. The problem with it is a trend in midwifery to prove something or other – the superiority of natural, perhaps, the problems with “medicalising” birth, some struggle for status, maybe – that leads to a denial that low risk is not a guarantee and variations of normal should not be treated quite so lightly.

            You say the middle ground is anathema. But to which camp? No-one here would argue against natural births in hospitals, as intervention free as is consistent with safety. It is NCB and
            homebirth midwives who argue against that. My own concern is fetishing a natural birth and avoiding interventions on ideological grounds makes some trained midwives as potentially lethal as their amateur counterparts.

            Again, birth is safe when your luck holds. When it doesn’t, ideologies of natural and nice are no substitute for speed and skill.

          • christine

            You wrote: “Would you like to point to examples of ranting and bullying? This is a fairly common accusation,especially the bullying bit, but I find it puzzling. Sure, this is an issue that people can have strong feelings strongly expressed, and those at opposite ends of the spectrum of views on NCB or midwifery may feel that a defence or an attack may read like a rant, but that doesn’t make it one.”

            … really? Are you serious? I guess you haven’t wasted much of your time reading the other incredibly obnoxious posts by Dr T? because I still feel sickened by her post in which she, very much like a schoolyard bully, insulted and tore apart a poor mom who had gone through a traumatic home birth. Her post (and the replies of her followers) were void of compassion and humanity and screamed hate and extremism. I’m always turned off by extremists, aren’t you? Not just for their inhumanity and hate-mongering that seems inherent in their paradigm but because I doubt that their extreme bias can allow them to reason properly, to see the facts as they are, and not manipulate stats and arguments to fit their agendas. And this was confirmed for me after reading her #1 and #2. She manipulated the stats to fit her agenda.

            And no: not just those on the opposite end of the NCB spectrum will feel that her posts are rants and examples of bullying. I, as I have stated clearly a number of times (perhaps in every post), am not on the end of the spectrum. I’m right in the middle and I can tell you: she is a bully who rants. And anyone with a desire for good science and/or any real understanding regarding meaningful education/advocacy work can tell you that a person who bullies and rants is doing a disservice to their agenda. The focus should always be on sharing good science-based research with respect for those you are aiming to help.

          • The Bofa on the Sofa

            So Christine, can you please get around to answering Lizzie Dee’s question, “”Would you like to point to examples of ranting and bullying?”

            “Are you serious?” is not the same as pointing out an example of ranting or bullying.

          • christine

            i answered. do you want a specific link? Here you go … http://www.skepticalob.com/2013/01/thank-goodness-i-chose-homebirth-for-the-shoulder-dystocia-that-nearly-killed-my-baby.html … There are many other examples on this site, don’t ask me to post more links as you can find them yourself. If you are going to retort that that wasn’t an example of ranting and bullying, then we clearly define those terms differently.

          • The Bofa on the Sofa

            Please explain how that link you provided constitutes ranting or bullying

          • christine

            Let me guess: you’re on the opposite end of the spectrum, aren’t you? If you truly felt compelled to ask me for an explanation, you’re blinded by your bias or … you’re just not clear what the terms mean.

          • The Bofa on the Sofa

            Let me guess: you’re on the opposite end of the spectrum, aren’t you?

            What spectrum? I don’t know what you are talking about.

            If you truly felt compelled to ask me for an explanation, you’re blinded by your bias or … you’re just not clear what the terms mean.

            OK, so explain to me how it is bullying AND ranting. I mean, it’s apparently very obvious to you, so you should be able to help me out.

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

            Don’t think I am blinded by my bias. I would say I am very well aware of it – I think safe trumps nice any day, that birth is unpredictable and you need both reliable information and proper resources – i.e., a hospital.

          • Gene

            Well, I basically said that the mother was living in a different version of reality if she thought the midwife saved her child’s life as opposed to the EMTs, the NICU docs and nurses, the vast number of people who have researched cooling techniques as a way to save brain anoxia, etc. So I suppose that would be ranting.

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

            Well, it is certainly scathing, and an unpleasant read for a rather wide eyed and innocent mother but in my opinion it is much too controlled to constitute a rant, and in what way is it bullying? I would have thought that bullying would by definition have to be a first person address?

            You are right, we have different definitions – not uncommon – and sadly you are on dodgy ground insisting that yours is definitive.

            Same with extremists, really. Seeing yourself as occupying the middle ground, you seem to imply that it is anyone whose view is at a distance from yours is one. As far as I am concerned, one end is occupied by those who insist that birth is to be trusted, and have some rather strange arguments to support that view, and those like me, Bofa and Dr. Amy who believe that birth is hazardous, who, naturally, I believe can make a rather more solid case.

            If you want to argue that you do not like these posts, fine, not surprising. Don’t read them, or argue a better case against them. Wouldn’t argue that they can be problematic – but they don’t prove a case for bullying.

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

            Yes, it was a serious – though not terribly important – question. I understand quite well that Dr. A’s manner
            is acerbic and not to everyone’s taste and that people may well feel insulted and upset – I just don’t get the ranting and bullying bits. And with this post, I would have to add that
            I don’t see screamed hate…hate mongering…extreme bias…either.

            I think the posts that castigate mothers who have suffered greatly as the result of foolish choices do trouble most of us.
            But being critical of the choices, or appalled by the consequences, does not automatically indicate that one has no compassion for the suffering of the parents. If the comments made here were addressed directly and personally to these mothers then that would indeed be wrong. If they choose to come and read them here, then just possibly it MIGHT bring it home that prioritising some abstract ideal of birth over the life of one’s child is not likely to result in universal approval of that choice, but personally I think they would be well advised not to read them. But I find that it is despair at human folly and a desire to stop others making similar bad choices that informs most of the discussions.

            What would you suggest? A tactful silence or complicity that obscures the realities? It isn’t hard to garner a chorus of “So sorry”s that does not serve much of a purpose. When it comes to the wasteful death of a viable child, I am not sure that ranting is entirely without justification, though I think I would claim that a wringing of hands and a level of frustration is just as common here. And nothing that is written here stops those who believe honey works better applying it.

          • Poogles

            “The research (i.e., well-known, respected studies and not the ones like
            the BMJ one cited above) that I have found concludes that HB is just as
            safe, if not safer than hospital births”

            Which studies do you feel were properly done and manage to show (not just conclude, but actually show) that HB is safe or safer?

            I think the closest I’ve seen was the Birthplace study done in the UK, which showed, for ultra low-risk women in the UK who had a previous vaginal birth, homebirth could be almost as safe as hospital (first-time moms had higher incidences of perinatal mortality and neonatal brain injuries). Important points though – homebirth is completely integrated into their hospital system (unlike the US), their transfer and risk criteria are much more stringent then pretty much all CPMs/DEMs/LMs, their midwives are all properly trained (though, I think there are still some rogues out there?). So Americans can’t just look at a study like that and proclaim “Look! Homebirth is just as safe” because homebirth in the UK is nothing like homebirth in the US, and most homebirth midwives in the US are actively fighting against having a system like the UK, because they don’t want the medical education, they don’t want to follow standards of practice, they don’t want to be held responsible for their actions and outcomes.

          • Amy Tuteur, MD

            “And in fact, if you would just reread her #1 and #2 points and then click on my links to the statistics, you’ll see how she’s wrong. She claims that the US has one of the lowest perinatal/neonatal mortality rates in the world. The fact is, that it has a higher rate than any of the 20+ OECD countries listed in the above report, including that of the Netherlands. To me that seems to support the notion that perhaps the Netherlands is handling births better than the US. ”

            To you, but not to anyone else who understands the statistics. First, the most common causes of perinatal death are prematurity and congenital anomalies. Healthy term babies rarely die. Therefore, perinatal mortality statistics reflect, in large part, two things that have nothing to do with homebirth midwifery: prematurity rates and the ability to care for severely compromised infants.

            Second, in order to compare countries, you must correct for confounders. African descent is a risk factor for prematurity. It is not a coincidence that countries that have lower perinatal mortality than the US are whiter than the US. If you don’t correct for that, and you haven’t, you can’t make comparisons.

            Third, and most importantly, we don’t have to compare countries, nor should we, to evaluate midwifery care. In the Netherlands, Dutch midwives caring for low risk women (home or hospital) have higher perinatal mortality rates than Dutch obstetricians caring for HIGH risk women. That’s a stunning indictment of Dutch midwifery philosophy and skills.

            Fourth, you keep referring to the research that you have done, yet you cite no scientific papers in support of your claims, which suggests to me that you have done nothing more than read the propaganda written by other homebirth advocates. If you wish to have us believe otherwise, please quote the relevant passages of the relevant papers.

          • christine

            Well hello! do you see that your above post can be directed at yourself? I.e., pretend that you’ve written it starting off, “Dear Amy” … I wasn’t citing any papers because I simply assumed that you and your followers, before coming to such definitive conclusions, would have already come across the same studies that I have. It’s easy to find them. However, a bit time consuming to copy the links to the more than two dozen studies that I accessed. But I do remember that one of the sites that I came across had a fairly extensive list of studies … one second, I’ll go find it. …. Here it is copied below for you.

            But I see that you rarely offer the same courtesy to your readers. There was only one link to a study in your above post. And it was a study that has been widely dismissed as being seriously flawed. In their own abstract, they write: “An important limitation of the study is that aggregated data of a large birth registry database were used and adjustment for confounders and clustering was not possible.” … can you reread what you just wrote above about confounders?

            My primary point Amy that nobody seems to pay much heed except for Lizzie Dee (much appreciated her comments) is that I think you could and should be doing important work to regulate the midwifery industry in the US and to also educate mothers about the current risks in your system. However, imo, you’re going about the wrong way. Please reread my other posts regarding tone, respect, and meaningful education/advocacy work.

            I’m sure I’ve just wasted a perfectly good day off. However, it was worth a shot.

            Janssen PA, Saxell L, Page LA, Klein MC, Liston RM, Lee SK. Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician. CMAJ 2009;181:377–83.

            Hutton EK, Reitsma AH, Kaufman K. Outcomes associated with planned home and planned hospital births in low-risk women attended by midwives in Ontario, Canada, 2003–2006: a retrospective cohort study. Birth 2009;36:180–9.

            Janssen, P.A., et al. 2002. Outcomes of planned home births versus planned hospital births after regulation of midwifery in British Columbia. CMAJ 166: 315-23.

            Ackermann-Liebrich U, Voegeli T, Gunter-Witt K, Kunz I,Zullig M, Schindler C, et al. Home versus hospital deliveries Zurich: follow up study of matched pairs for procedures and outcome. BMJ 1996;313:1313–8.

            Lindgren HE, Radestad IJ, Christensson K, Hildingsson IM. Outcome of planned home births compared to hospital births in Sweden between 1992 and 2004. A population-based register study. Acta Obstet Gynecol Scand 2008;87:751–9.

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            Wiegers TA, Keirse MJ, van der Zee J, Berghs GA. Outcome of planned home and planned hospital births in low risk pregnancies: prospective study in midwifery practices in The Netherlands. BMJ 1996;313:1309–13.

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            Evers AC, Brouwers HA, Hukkelhoven CW, Nikkels PG,Boon J, van Egmond-Linden A, et al. Perinatal mortality and severe morbidity in low and high risk term pregnancies in the Netherlands: prospective cohort study. BMJ 2010;341:c5639.

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            Tew M 1990. Safer Childbirth: a critical history of maternity care: London: Chapman and Hall.

            Shearer JML. Five year prospective survey of risk of booking for a home birth in Essex. BMJ 1985;219:1478-80.

            MacDorman MF, Declercq E, Menacker F, Malloy MH. Infant and neonatal mortality for primary cesarean and vaginal births to women with “no indicated risk,” United States, 1998-2001 birth cohorts. Birth. 2006 Sep;33(3):175-82.

            Anderson RE, Murphy PA. Outcomes of 11,788 planned home births attended by certified nurse-midwives: a retrospective descriptive study. J Nurse-Midwifery. 1995;40:483_92.

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            Lindgren HE, Radestad IJ, Christensson K, Hildengsson IM. Outcomes of planned home births compared to hospital births in Sweden between 1992 and 2004: a population-based register study. Acta Obstet Gynecol 2008;87:751-9.

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            Landon MB. Predicting uterine rupture in women undergoing trial of labor after prior cesarean delivery. Semin Perinatol. 2010 Aug;34(4):267-71.

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            Landon MB. Predicting uterine rupture in women undergoing trial of labor after prior cesarean delivery. Semin Perinatol. 2010 Aug;34(4):267-71.

          • Amy Tuteur, MD

            How nice for you, Christine, that you know how to cut and paste. How sad that you think that cutting and pasting is the equivalent of “research.”

            This is probably going to come as a major shock to you, but most of what you quoted is crap. For example, Janssen was forced to publicly retract the claims in the 2002 paper because it actually showed that homebirth increased the risk of death.

            Christine, you are just another ignorant layperson prattling about your “research” when you’ve done no research at all and apparently don’t have a clue how to do research. Thanks for proving the point of my post.

          • christine

            Oh Amy. You lose credibility every time you respond like that. The ONE and only study that you cited in your above post is a well known joke. The list in my above reply contains more than 4 dozen studies. You picked out one.

          • Amy Tuteur, MD

            “You picked out one.”

            And you didn’t read any … which means that you have no credibility at all.

          • christine

            You’re a mind reader? You have spyware on my computer? how the #$% would you know what I’ve read and not read? That is the most ridiculous thing that I’ve ever been told in my life. In fact, I feel like I’ve been conversing with Glen Beck. Do you really exist, Amy?

            Good luck to you.

          • Poogles

            “how the #$% would you know what I’ve read and not read? ”

            Granted, there is no way Dr. Amy could actually know what you have and have not read. However, you have not demonstrated in the least that you DID read any of them. And if you did read some (or even all) of the above listed studies, you again are doing nothing to demonstrate that you understood those studies. Anyone can read, but understanding is a whole other ball game.

            If you want to show you have read and understood the studies, then actually discuss them – the methods used, the populations studied, the results, the analysis of those results, the limitations of the studies and the meaning of those results within the larger context of the entirety of the literature on the subject. Be warned though, most people cannot do that in anything more than a very superficial, cursory way, unless they are in the field themselves, and keep current on the research. I know I can’t.

          • christine

            I may just one day feel silly enough (today I’m in serious work mode) to spend more of my time off replying to all of you and I promise that the first thing I’ll do is write down my analyses of each of the 2 dozen studies that I’ve read. For now, you’re just going to have to take my word for it Poogles that I’ve read and understood them. If only you could see my earnest face, lol. … I was going to leave it at that but just in case you’re truly burning to know more about these studies, but bc you’ve said that you find them difficult to analyze, there’s a well-balanced wikipedia article that you may be interested in that is well referenced and super easy to understand, and includes most of the studies that I’ve accessed (a good comprehensive one is the NICE report – you may wish to take a look at that one if you’re feeling like reading more). Here’s the link to the wiki article … http://en.wikipedia.org/wiki/Home_birth#Research_on_safety
            … Enjoy! Cheers.

          • Amy Tuteur, MD

            “For now, you’re just going to have to take my word for it”

            No, your word is worthless. You clearly haven’t read these studies in their entirety (not the abstracts) or if you read them, you didn’t understand them. You have offered no analysis, no relevant quotes, nothing. Why lie, on top of everything else?

          • christine

            Sigh, more insults. My armor is staring to chip, oh no! ;) If my replies bother you so much, why don’t you just delete them? You’re certainly not enlightening anybody with your insults and crazy assumptions.

            Anyhow, I’m also a bit perplexed as to why you haven’t explained why the more than 40+ studies that I’ve listed on this page should be dismissed. You only commented on one of them. I need to analyze all of them first before you can comment on them, is that it? I’m guessing that since you’re the expert that you should be able to recognize them right away and give a quick summary as to why you’ve dismissed them when the majority of experts and governments around the world have used them to inform their policies.

            As well, I’m wondering why you haven’t organized your research into a scientific report, one that can be peer-reviewed?

            Btw, you know, negativity is not a healthy way to live your life. Don’t let that be too much woo for you — studies support this claim — shall I link them for you? ;)

            Cheers!

          • Poogles

            “why the more than 40+ studies that I’ve listed on this page should be dismissed.”

            I don’t believe that Dr. Amy is saying all of the studies listed should be dismissed out of hand, but more that they are mostly not of high quality and/or do not support your claim that HB is as safe or safer than hospital birth. By listing them as proof, you’re showing that you either can’t recognize poorly done studies, can’t recognize when a study does or does not support your argument or you haven’t even read the studies you listed.
            At least, that seem to me to be the point Dr. Amy was trying to make.

          • christine

            over and over and over again the same ridiculous line of attack. I’m starting to think that no one here on this site is real and that Dr A simply has a software program that automatically replies with the same old insults. Or i can only hope that that’s the case. ;)

            why don’t you or Dr A read those studies first before commenting? not one reply to me has analyzed those studies to enlighten us as to why they’re poorly designed.

          • Box of Salt
          • Durango

            For my part, I do not have the background to properly interpret the studies; my intro level statistics is completely inadequate for the task. Therefore, as in every other topic where I don’t have expertise, I rely on experts. I had a home birth, and I was woefully uninformed. It took a long time to change my mind. I had no idea that CPMs were undertrained. I had no idea what obstetric complications could occur in even a healthy young mother. Fortunately, my child did not suffer as a result of my choice.

            I follow Dr Amy’s blog because she walks the reader through a study’s strengths and weaknesses. She doesn’t make money by having women choose hospital birth. She’s seen the train wrecks ( and other OBs and peds docs on this site have contributed their own stories of transfers gone horribly wrong). She doesn’t get get a thrill when women make the same choice as she did (in stark contrast to the self-proclaimed birth junkies). As far as i can tell, she doesn’t ban dissenting opinion. All of the above are reasons I trust the information here. The tone is unique and many find it off-putting but I think it serves its purpose: it makes people pay attention. Given the strong propensity of NCB advocates to sweep all negative outcomes under the rug, I’m glad someone is putting this information out there.

          • Poogles

            “I’m starting to think that no one here on this site is real and that Dr A simply has a software program that automatically replies with the same old insults.”

            I’m not aware of having aimed any insults your way. And I am most definitely a real person, LOL.

            “why don’t you or Dr A read those studies first before commenting? not one reply to me has analyzed those studies to enlighten us as to why they’re poorly designed.”

            You came here and started making the claims about the safety of homebirth and the mortality statistics surrounding birth, so the burden of evidence for those claims lie at your feet, not ours. It is inappropriate to arrive in someone else’s space, say “X is true! All the evidence says so! Prove me wrong!” Now, if you had come here and said “My understanding of studies x, y, and z is that they show such-and-such through abc methods, which has led to me to this conclusion. I see you have reached a different conclusion, can we discuss these studies further?”, it could have lead to a fruitful and interesting conversation.

          • Box of Salt

            Christine, “You only commented on one of them”

            Why don’t you try looking through the archives on this blog? You will find more detailed analysis of papers about birth there.

            P.S. You were right: I didn’t click on your links. I was reading over coffee before leaving for work. My interpretation of your comment was it was an poorly informed knee jerk response to Dr Amy’s post, and I responded in kind.

            I am glad that there has been so much continuing discussion. But the comments you’ve added still leave me to feel that you are not as well informed as you think you are.

            If you’d like to change my mind, please do post your comments on some of those studies.

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

            I may just one day feel silly enough….

            Wow. One of the other defining characteristics of those into NCB seems to be a nice line in condescension. But I suppose that is a character trait that comes in handy if you are wedded to the belief that bad things happen only to those who deserve it, and an easy birth is a well deserved personal triumph.

            Christine, we will not hold our breath. Your desire to educate us ill-informed sheeple is likely to be wasted. Especially on those of us who did not reach our conclusion that homebirth is for idiots simply by rejecting the “…is safe for low risk women…” line with blinkers on but learned from bitter experience that relying on that is a wee bit iffy.

          • christine

            Oh la la, more incorrect assumptions: I am not wedded to those beliefs. I’m a hospital birth type of a gal; however, I decided to do research for my #3 after an OB acquaintance told me that she herself for her own children gave birth at home. So questions popped up when I read some of those studies that actually showed a higher (although barely but still a higher) perinatal rate with hospital births. With those questions in mind, I found myself here on this site, learned a bit more but was quite a bit turned off by the tone, thought to share my opinion and now regret it — as Dr T and others on here clearly have no patience for anyone not vehemently anti-homebirth. Sigh, I’m exhausted and it’s been quite an unexpected experience, to say the least. As you clearly view me as a troll, I’ll leave you all to be in peace (cue: applause). I’m now off to see my trusted OB.

          • Amazed

            “an OB acquaintance told me that she herself for her own children gave birth at home”

            Each profession has its quacks. Obstetrics is not any different. It speaks volumes about you that out of all OBs in your area, you managed to find the quack.

            I never take someone’s word when asked to provide evidence, said someone says, “just take my word”.

            Good luck with the quack.

          • christine

            Hilarious that you made the assumption that I was only talking about one OB and not two. Your reply is a perfect example of how you can be blinded by bias. Reread my post while pretending you wrote it yourself and I think you’ll come to a different conclusion. … or to make it simple for you: the first OB was (again) “an acquaintance” whom I met at a cocktail party and with whom I spoke to for less than 10 minutes. Afterwards I started doing research thinking that it wouldn’t take me long to confirm my original assumption that hospital birth is the only sane option. However, I was surprised to learn that the large majority of research and experts do not support that claim. This site is in the minority.

            Despite the research that I’ve done, I’m still going ahead with my original decision to stick with my amazing OB (the second one that got mentioned in my above post) whom I’ve known for more than 8 years and who delivered my previous two children.

            I have to turn off my disqus notifications because this has become too weird.

          • Siri

            Sorry Christine, you only get one go at flouncing off.

          • Amazed

            Actually, I thought you might be talking about two different OBs but I dismissed this possibility because I couldn’t imagine that anyone could be so influenced by a casual acquaintance. You knew someone for less than 10 minutes and she’s already talking to you how her children were born? To me, that’s a red flag screaming “quack”.

            How did you do your “research?” Let me guess: you sat in your cosy home in front of your computer and read abstracts. And you fell victim ty the most common journalistic mistake: presenting the two sides as if they were equally valid. Something like Wakefield’s fraud. The sides are not equally valid.

            By your posts, I gleaned you are like most of us: a lay person who, honestly, lacks the expertise to properly interpret medical studies. There’s nothing wrong with that. I, however, have the experience from my unrelated specialty that if a study is: full of mistakes that the authors themselves admit to; founded by a party that has vested interest in the outcome; being widely dismissed in scientific circles; is done by someone who hid a conflict of interest – then the study is not to be trusted. This is the case with literally all papers supporting homebirth as a safe choice.

            Hell, Colorado midwives themselves admit that 1-2 deaths for 600- 700 births for full-term babies of low-risk mothers are expected for homebirth. Anyway, the most recent Oregon study showed hospital perinatal mortality to be 0.6 per 1000 births, including congenital anomalies!

          • Poogles

            “there’s a well-balanced wikipedia article ”

            You’ll have to forgive me if I don’t trust a wiki article for a “well-balanced” look at the evidence for such a contentious topic. I can only imagine how often the HB brigade goes in and edits it to their liking.

          • christine

            do you know how wiki works? bc your people can do the same. if some quack comes in and makes an unsubstantiated claim, it gets flagged and taken care of appropriately. why don’t you read it first before commenting on it.

          • Poogles

            “why don’t you read it first before commenting on it.”

            I did. And I don’t trust it precisely because anyone, on either side, can edit the article to lean one way or the other at any time. Since I do not have the time nor inclination to look back through all the edits and try to piece together a more “balanced” or “whole” version of what has been in that article, I will stick to more reliable sources. Wiki has it’s place, but not on this topic.

          • The Bofa on the Sofa

            how the #$% would you know what I’ve read and not read?

            “By their works, you shall know them….”

          • Kalacirya

            I put 2 whole dollars on you only reading the abstracts, if you read them at all. And if you did in fact read them, I doubt you understood their results.

          • Poogles

            “I think you could and should be doing important work to regulate the midwifery industry in the US and to also educate mothers about the current risks in your system. However, imo, you’re going about the wrong way. Please reread my other posts regarding tone, respect, and meaningful education/advocacy work.”

            Do you realize how obnoxious it is to come to someone’s blog and post something like this? Dr. Amy is fully aware of what she is and is not accomplishing and her tone is a deliberate decision she has made (it is not a mistake that her blog banner says “The SOB” as an abbreviation for “The Skeptical OB”). You are, obviously, completely free to disagree and feel you would go about it a completely different way. That does not mean it is the only way, or that others should heed your admonishments that they should be doing things the way you think they should be done.

            Personally, I think Dr. Amy IS doing important work, between this blog, articles on other sites and various interviews she has done. She is getting the information out there that counter-acts the lies, myths, and distortions put forth by the Homebirth “movement”, trying to ensure that women are fully informed before they make their choice on place of birth.

            If you think there is much more important work to be done and you think you know the best ways to go about doing that, no one is stopping you.

          • Susan

            Christine are you undecided on the topic in general or as to where to choose to have your baby?

          • Becky05

            “The research (i.e., well-known, respected studies and not the ones like the BMJ one cited above) that I have found concludes that HB is just as safe, if not safer than hospital births.”

            What research is this? There is some research showing that homebirth that is fully integrated into the medical system and attended by qualified providers is about as safe as hospital birth, as long as you are not a first time mother and as long as complications don’t occur. On the other hand, for a first time mother with no complications at the start of labor, the Birthplace Study found a nearly 3 x greater risk of intrapartum/neonatal loss, and the data from the Netherlands suggests that although the rates aren’t high enough to affect the overall perinatal mortality rate, there are greater risks out of hospital if a complication does occur. http://sigo.it/pdf/planned_home_births_vs_ospital_births_obstet_gynecol2011_24_10.pdf

            There isn’t any data showing that home birth is safer, unless you mean data that interventions occur less frequently. That’s true.

          • Becky05

            They don’t, in fact, have a higher perinatal mortality rate.

      • http://twitter.com/SlackerInc Alan

        Technicaly true. But if a populous, neighbouring advanced industrialised country (that one report said had the best health system in the world) where HB is rare has a higher mortality rate, that does cast doubt on the assertion (or implication) that the disparity can be blamed on midwifery/HB.

        How do you explain France’s higher mortality rate?

      • Becky05

        Actually, the data she posted don’t prove that France has a higher perinatal mortality. It shows that France has higher fetal mortality, but a lower neonatal mortality. The Euro Peristat report says that later term abortions, of which there are a high number, are counted in the fetal mortality rates in France. http://www.europeristat.com/images/doc/EPHR/european-perinatal-health-report.pdf

        I don’t think that bringing up the Netherlands is arguing that they’re bad, though, so much as undermining a common NCB argument, and there are many countries, including the Netherlands, that have homebirth and midwifery led care and better mortality rates than we do. That’s not true.

    • Susan

      The last time I looked this up the WHO stats had US with a lower perinatal mortality than the Netherlands. Since the Netherlands is held up a homebirth Holy Land in so much of the homebirth literature I think it’s very valid to point out that their perinatal mortality rate isn’t that great. Singapore had the best stats. They are probably more “medicalized” than France. It would be foolish not to look at other forces at play in perinatal mortality such as smoking, obesity, advanced maternal age, and access to health care. The Oregon stats were interesting because they teased out intrapartum deaths. And they were terrible for homebirth.

      • christine

        can you pls provide a link to support your claims? because it appears as if the WHO hasn’t recently published anything on perinatal mortality rates. Maybe you’re confusing what you looked up with infant mortality? if so, you may wish to go back and read what Dr T has to say about that.

    • Amy Tuteur, MD

      So far, Christine, you are batting zero. You haven’t identified even one misrepresentation of fact in my post.

    • Kalacirya

      The day a homebirth advocate comes and shows me “real statistics” whatever it is that “real statistics” means (not a technical term, Christine), is the day I cut off all my hair and eat it.

  • http://twitter.com/Crankyasanoldma Crankyasanoldma

    Bless you, Doctor Tetuer.

    It’s about time someone sorted the fact form the fiction in this area. I’ve been an OB-GYN nurse for 20 years and even I have had a hard time processing some of the information available about homebirths.
    Having had a completely normal, full term delivery followed by a completely disastrous case of everything-that-can-go-wrong-did-go-wrong two years later, I have a uniquely personal view of how quickly things can go south. I’m sure that there are appropriate cases and willing participants for home or birth center deliveries, but why do some women fetishize delivery? Delivery, in my view, is the smallest part of parenting.

  • WicketKitty10

    Wait a minute now. Are you insinuating that evolution is real?!

  • J from Chi

    First and foremost, I am appalled at the vitriol being spewed in this comments section. Most of the things that have to do with reproduction are highly personal choices made for highly personal reasons. Can we all at least agree that we wouldn’t want anyone else telling us “You’re stupid.”?

    How about a well-reasoned, rational explanation of your personal choices instead of bashing and berating?

    Second, what I’d like to know from Dr. Amy is: How many totally natural (without any interventions except maybe the prep they do in case you need IV) births have you attended? How many times did you decide in the thousands of babies delivered that the mom/baby were doing just fine and didn’t need any assistance? And finally, without giving exact details (I know you can’t) what about times when the parent’s insist on ‘natural’ and you thought you knew better? I can’t imagine how that conversation takes place.

    Just so you know… Personally- I had one birth with complications (eclampsia) that almost cost me and my son our lives (no c-section though it was in a hospital. We had great nurses.) and with my daughter no complications at all… except that my husband was so panicked he ok’d an epidural for me when I was in the middle of a strong contraction and couldn’t contradict- still laughing over that one.) – J

    • Bombshellrisa

      Dr Amy gave birth “natural” twice. Why does everyone who parachutes in ask that question “How many natural births have you attended? As for “knowing better”, people seek care from an OB precisely because they DO know better how to care for pregnant women and any complications that may arise than a lay person does.

      • Durango

        How many times should a person drive drunk in order to know it’s a bad idea?

    • Guestl

      I’m going to go out on a limb here and say that Dr. Amy has attended many more natural births than you have, J. Most obstetricians in the developed world attend many thousands of births over the course of a career.
      I insisted on natural, and guess what, my providers knew better. That was their job. They weren’t OBs, either, but RMs (Canadian midwives). I can tell you how that conversation took place, since you can’t imagine it:
      ME (41+5 weeks pregnant, 100% effaced, 5 cms dilated, still not in active labour, and almost 40 years old): But I don’t understand why you want to induce. Some babies just bake longer, right, and gestation can theoretically last up to 42 weeks. Besides, I’ve passed the BPP and NST with flying colours!
      THEM: *recite SOGC guidelines for induction after 41 weeks, cite data showing an increase in the risk of stillbirth after 39 weeks, particularly amongst older mothers, me with a narrow pelvis, a first-timer carrying a posterior baby estimated at 9.2 lbs, BPP/NST only a snapshot of what’s happening right at that moment and while a bad BPP/NST is unequivocally a poor sign, a good BPP/NST is not always indicative of zero issues* And then they played the dead baby card. Hard.
      I agreed to induction (AROM) and my daughter arrived safely 9 hours later…eight and a half pounds, after 2.5 hours of horrific pushing, skinny, dry skin, long nails, and my placenta showing marked signs of deterioration.
      What would have happened had I insisted on my natural homebirth? Would the outcome have been the same had I insisted on waiting for natural labour to start? I don’t know, and neither did they. Because you can only know if the decisions you made were correct with the benefit of hindsight. And with so much at stake — namely, the lives of a mother and her child — they played it safe.
      Most OBs don’t think they know better — they do know better. Most patients don’t think they know better, but some do, and they don’t.

    • Guestl

      J, another point I fear you’re missing here is that most women giving birth don’t want “natural” birth. The natural birth crowd is a small but extremely vocal minority. Let’s focus on an “unnatural intervention” — epidural anesthesia.
      At the hospital where my daughter was born (Baby Friendly designation, attracts a crunchy crowd) fewer than 30%, of women deliver without epidural anesthesia. For the overwhelming majority of epidural anesthesia is done at the patient’s request (including mine) for pain relief. Their challenge lies in ensuring adequate anesthesia coverage for L&D (I waited over an hour for mine), not in cajoling women into accepting an intervention she doesn’t want.

  • Jamie

    Huzzah!

  • Jamie

    I’d like to try and understand your argument, but cannot when there are no sources present. Dr. you state yourself “Most of what they think they “know” is factually false”, yet provide no evidence of the claims you make with biting immaturity and no scientific proof or evidence to back any of your claims up. Where are your sources? How can you make such broad claims without citing relevant sources, Dr.? The real danger to women is medical professionals such as yourself who try to portray your opinion as fact without trying to educate your patients objectively.

    • I don’t have a creative name

      Keep reading. There is article after article here with reference after reference to various studies and surveys.

    • suchende

      What I find even more troubling is people with no scientific credentials whatsoever citing to a few studies that may or may not be well-designed, may or may not have been replicated, may or may not represent the scientific consensus. CIting to ONE study and pretending it proves your claim is the mark of an amateur.

  • Beyondallelse

    Fantastic truth! The truth of things has been seemingly replaced with delusional ideology and conspiracy theories. Thank you for the truth.