Another devastated homebirth loss mother

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I’m grieved to point out a new and growing genre of mommy blogs: blogs set up specifically to recount the death or serious injury of babies at homebirth and the aftermath for their devastated mothers and families.

I came across a new one yesterday, Dreams That You Dare To Dream.

As the mother explains:

I once dared to dream that I could have a family of my own. I, who was told I could not get pregnant, astoundingly did. My dream was shattered on October 2, 2012 when my daughter died at birth. I now write about how life, love and who I am has changed to my very core.

Every one of the blogs in this new genre are deeply moving. Some are deeply infuriating. This one is particularly eloquent. The author has a gift with words such that her story has a raw immediacy and her pain is almost palpable.

I will remember the way it felt when I delivered my child’s head. The sense of relief knowing that just another push or two and I would to hear my baby cry, hold my baby in my arms, and watch my baby suckle at my breast… I will remember the moments of anguish that followed as my body betrayed both myself and my child. The moments when I was forced to pivot onto my hands and knees in hopes that my body would release and my beautiful child would be born into this world pink and bewildered. I will remember the intense yet defeasible [sic] pushing, my midwife’s profanities, the impenetrable words NINE-ONE-ONE. I will remember the sirens, the voices of the rescue team…

You feel as if you were there with her in the hospital ER:

I will remember the entry to trauma room, the extreme abandon I felt for my own safety, and my focus on my daughter’s wellbeing. I will remember having to deliver my placenta and attempt to be stitched without proper anesthesia all while a curtain was drawn between myself and my daughter…

And you shudder as the mother recalls hearing the words that she (hopefully) was not supposed to hear:

I know the first words I remember after coming out of … anesthesia were from the lips of [my husband’s] mother “She robbed everyone of this baby,” she accused.

Finally, you read how she was forever changed. The person that she was before her daughter died no longer exists.

Looking at the picture of her beautiful daughter you can see how easy it is to imagine that the baby is sleeping, soon to wake crying for her mother’s breast. Instead she will never awaken, a deeply wanted child inadvertently sacrificed to a strange cult-like philosophy that denies that childbirth is inherently dangerous and thereby denies babies the emergency assistance they need when things do go wrong.

Another homebirth, another shoulder dystocia, another dead baby and another homebirth midwife who will never be held accountable for presiding over the preventable death of a beautiful baby girl.

Ricki Lake, Ina May Gaskin, Melissa Cheyney, the Midwives Alliance of North America, the Big Push for Midwifery and other homebirth advocates and organizations have blood on their hands. With the possible exception of Ricki Lake, they know that homebirth increases the risk of perinatal death and they are doing everything in their power to hide that information from women considering homebirth.

When will it stop?

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  • Minerva

    Dr Amy,
    I saw a post on a website of a mother asking about HBing.

    I responded about how my daughter was born with an apgar of only 2 because of a nuchal cord that was so tight it compressed her oxygen during delivery and it was a team of neonatologists who were able to run the code seconds after birth that saved her life. I was told how HER midwife is a specialist in “baby recesesutation” and she doesn’t have to worry about it because in 17 years she’s only had “1 emergency” and she saved the baby herself. Also, “birth emergencies are rare, and the cord around the neck is never a problem.. People think that because doctors take the baby and give them oxygen they saved their lives but really they didn’t need it”.

    Those are actual quotes. It makes me want to bang my head against a wall because that seems like its the only way their reasoning would make any sense.

    • Amy Tuteur, MD

      I saw that. You tried to warn them, but they refuse to listen to anyone who tells them anything other than they want to hear.

  • Alicia

    I have a medical question for those here who are qualified: With SD, can oxygen be given to the infant while medical personnel are trying to get the shoulder out? Or would it not work because the chest is too compressed in the birth canal?

  • Alicia

    From what little has been written, it appears the father wasn’t really involved. The mom was planning being a single mom, and the father isn’t even mentioned in the story of the birth, only his mom. So I would say that in this case, yes, no one wanted the baby more than her.

  • Alicia

    Not all women who chose to homebirth that ends up in tragedy are willfully ignorant and more concerned with themselves than their baby. If you actually read what this mom has written, you would see that she was more concerned with her baby, and it’s clear she already blames herself. There’s a big difference between moms who think they’re doing the best they can because they’re lied to by the people they trust, and the moms who are only self-centered twits who think their uneducated, unqualified CPMs/DEMs can do no wrong and don’t care about their baby’s health. This particular mom is the former, and is in extreme pain. Have a little compassion for the ones who were duped because no one’s perfect.

  • Laura

    Andy, if you have had experience with competent midwives and conscientious obstetricians then I am very glad. If you have a pediatrician who has been supportive and helpful as well then that is good, too. Unfortunately, that is not always the case. Many people here are reporting things they’ve witnessed, experienced firsthand, or read about that defies logic and sound reasoning with birthing practices. There are several “loss moms” who post here at times, too, who have had very traumatic experiences. I do believe you when you say that the home birth exposure you have had has not included any of these negative experiences. And again, I am very glad for your good experiences. .

  • Ashley

    I had a homebirth. Our Midwife was a labor and delivery RN before she went on to become a CPM. She was NOT willing to deliver a baby before 37 weeks or if the mother had gest. diabetes, an ultrasound was set up for an anatomy scan and to check my placenta position. I was also tested for GBstrep and if it came back positive I would have been given antibiotics during labor (at home), she also would not offer a water birth if there was any sign of meconium once my waters broke. I just want you to know that we are not ALL quacks. Some of us chose to do so because the local hospitals push very risky unnessesary interventions and we felt in a healthy situation this was our best choice. (I had delivered before at a hospital and we do not have birthing centers where I live)

    • Captain Obvious

      Did she carry pitocin, cytotec, methergine, hemabate, a Bakri ballon, and blood products if you bled? Did she have oxygen and a bag and mask set up? When was her last NRP recertification? Can she intubate? does she have a ventilator? Did she have back up help if a shoulder dystocia occurred? Extra hands to help with SD manuevers? Can she repair a cervical laceration, or a fourth degree laceration? Can she open and repair an expanding vulvar hematoma? If you had a velamentous insertion of the cord to the placenta, could she perform a manual extraction of the placenta? Would you tolerate a manual extraction of the placenta? If you needed an urgent or emergent D&C how could she do that? Can she perform a vacuum or forceps if the FHR dropped while pushing and you needed an expedidated delivery? Could she perform an emergent cesarean? Then you really took a risk with your baby, because these things are not that uncommonly needed with low risk deliveries.

    • fiftyfifty1

      “she also would not offer a water birth if there was any sign of meconium once my waters broke”
      Just as a point of comparison, in England you would be transfered to the hospital if the fluid showed meconium, not just risked out of the waterbirth part. So yes your CPM sounds less risky than the average CMP, but that isn’t saying much.

    • MikoT

      Our Midwife was a labor and delivery RN before she went on to become a CPM.

      A labor and delivery nurse is not the same as a CNM, and does not have anywhere near the same level of training.

      push very risky unnessesary (sic) interventions

      Oh here we go again.

      Firstly, the interventions themselves are very low risk despite what the crystal gazing crowd will tell you.

      Secondly, they are done in response to known risk factors to reduce risk. There is no way of knowing after the event which interventions were necessary and which ones weren’t, only that fewer babies die overall.

      we felt in a healthy situation this was our best choice

      The truth is not a matter of opinion, and all the handwaving in the world is no substitute for rigorous empirical analysis.

      I suppose this is the part where you tell me that all mothers are different and that we should put aside a hundred years of obstetrical knowledge in favour of a midwife’s intuition.

  • fiftyfifty1

    Great! So a mom on her 5th baby with a BMI of 39.5, a hematocrit of 31%, and a blood pressure of 139/89, who went off her antidepressants just so she wouldn’t risk out would be an acceptable candidate! Yikes!

    • Bombshellrisa

      You have a point there-I would also like to add that just because they *say* on the website that they won’t accept women with certain conditions, it doesn’t mean that they won’t. Seriously, the midwives that delivered my husband knew that my mother in law had Hodgkins lymphoma-it didn’t stop them from taking her money and helping her plan a home birth. The midwife was the first CPM in WA state, what an example of practice she left for the other midwives to follow.

  • fiftyfifty1

    ” A monster episiotomy and a vaccum would’ve most likely saved this baby”

    No, not at all. Shoulder dystocia is a bony problem not a soft tissue problem so an episiotomy in itself doesn’t help. It’s true that an episiotomy is often cut with a S.D., but that’s just so you have enough room if you have to resort to the internal Shoulder Dystocia Maneuvers (e.g. reaching in and pulling out the posterior arm, intentionally breaking the clavicle, wood’s screw etc.). A vaccum is not useful when a baby’s head is already out. Vaccums can be useful if the baby is not coming down due to maternal exhaustion, but they should not be used in cases of anticipated bony obstruction.

    What would have saved this baby is a provider who knew the Shoulder Dystocia Maneuvers, and an immediately available team to do the resusitation.

    I do find it interesting that the EMTs were able to unstick the shoulder dystocia but the midwife wasn’t. This speaks very poorly for the training of this midwife. Probably no experience beyond McRoberts and the “infallible” Ina May position.
    I feel awful for this mother, this father and those poor EMTs.

    • I don’t have a creative name

      Really? Interesting. Just going by what she told me. 🙂

      Man, am I glad I am done having kids. So much can happen.

      • fiftyfifty1

        A vaccum and an episiotomy can save a baby for sure if the baby is in the birth canal and not getting enough oxygen and you can’t safely wait for spontaneous delivery. Then yeah, cut an episiotomy and use the vaccum (or forceps) and get the baby out. This is likely what happened to your friend. But that’s totally different than a shoulder dystocia. A shoulder dystocia is a bony impaction of the baby’s shoulder against the mom’s pubic bone. The head is already out. Yanking on the head of a baby impacted bone-on-bone is a very bad idea….

  • CitrusMom

    I am 36 weeks pregnant so I *really* don’t want to read this story if I could find it, but am curious, did they have indications of heightened risk for SD? I am a proponent of hospital birth (this will hopefully by my 3rd) so don’t misunderstand my question. I’m just wondering if this particular danger was heightened here and ignored, or they didn’t test for size, or if it was just bad luck to have an SD. BTW this was the thing I was most scared of with DB1 because it seemed like even in a hospital it was not a 100% guaranty that they could resolve it.

    • Alicia

      From has been shared of the birth story (the birth was only a few months ago so the mom is still very fresh in her grief – not a lot of medical details are written about), there seems to have been no indication that there would be a problem with SD or anything. The baby’s head was delivered and the next thing the mom knew, there was a problem. Delivery was attempted at home with the help of EMTs, then (from what I understood) the baby was born in the ambulance. But since not a lot of details of the pregnancy hasn’t been shared, there’s no mention of any risks.

  • I have four children, all of whom were born in the hospital. However, the first and third (with my ex-wife and current wife, respectively) were attempted homebirths that were transported (not, however, in a pell-mell emergency fashion). I have even had Ina May Gaskin stay at my house for a couple nights when she and Stephen visited our town and needed lodging.

    My interest all along has been in following the most prudent evidence-based approach; I am not the type to go after something because it is flowery “woo”. From the time my oldest was born in the year 2000 to my youngest in 2012, I have seen a sea change in the approach used in hospitals: rooming in, encouragement of breast-feeding, etc. have replaced the old retrograde approach that was still in place here in the Midwest a decade ago. It said something, I thought, that so many of the approaches favored by midwives were being adopted by hospitals, doctors, and nurses.

    But I am always willing to change my mind if the evidence points me there. In that respect, the statistics I have seen on this blog relating to perinatal mortality are very interesting food for thought. However, when the mortality risks we are trying to prevent are described as being rarer than one in 600, I wonder if the use of hospitals is overkill based on a sentimentality around babies. Is it not perhaps true that rare conditions could be prevented from killing anyone if we all lived in hospitals all our lives? Particularly in the case of older or higher risk people with health conditions, this must be true; yet, we as a society understand that we cannot afford to do this, nor do we want to subject everyone to this extreme a precaution to save a relative few.

    So even if choosing homebirth creates additional risk, is that additional risk commensurate with the level of additional risk we allow in other ways, like taking our children with us on car rides? Even car seats and seatbelts are not foolproof, after all. And we allow them to ride bikes, skateboards, swim at the lake, eventually drive cars themselves…see my point?

    My youngest child was born last year by scheduled C-section. A controversial choice for the crunchy members of our social circle to be sure; but after experiencing three children with head circumference beyond the 99th percentile, my wife and I did not feel any other option was reasonable at that point in our situation–and sure enough, his head was the largest of all four, and in fact he was the largest baby ever born at that hospital in its decades-long history. But my wife chafed at being required to submit to continuous fetal monitoring while waiting for the C-section to be prepared. The nurses and administrator insisted on it, chalking it up essentially to “better safe than sorry”. But remember: this was a scheduled C-section. Whatever might have happened during that hour or two of waiting would have been statistically much more likely to happen in the many hours and days that preceded our arrival at the hospital.

    Follow this to its logical end, and the only way to really be safe would be to have pregnant women spend their entire pregnancies, or at least the last trimester, in the hospital with continuous fetal monitoring. Of course, this will never happen: it is too expensive, and women would not put up with it. So we have to tolerate some level of risk beyond what we could conceivably achieve with modern medicine; the difficult trick is deciding where to draw the line. If a family draws that line somewhere a little higher than you would, but still within a level lower than a one in 600 mortality risk, are they really being so monstrous?

    • Dr Kitty

      Alan…some of what you have written comes off as a little…eugenicist, or “don’t worry, you can try again”.
      Not helpful, respectful or even true for many people.
      It is not sentimental to want all of your children to survive and thrive.

      If a family knows they have a one in 200 chance of UR and still choose HBAC, personally I think they’re crazy, but entitled to their choice. The problem is that without MANA releasing their statistics NO ONE has any idea what the risk of HB in the USA, as currently practised, is. With almost 30,000 HBs on the books we should have some idea, the fact that we don’t….I’m guessing the risk is higher than you think.

    • KarenJJ

      “If a family draws that line somewhere a little higher than you would, but still within a level lower than a one in 600 mortality risk, are they really being so monstrous?”

      If that’s all it was then it’s really not such a problem. People make different choices and choose different risks for themselves and their families. Such is life.

      Instead, there are people calling themselves ‘midwives’ when they really aren’t trained in anything much recognisable as midwifery any where else in the developed world, websites egging on women in to ‘stunt’ birthing their VBAC breech twins and enormous amounts of misinformation along the lines of sucking on a cinnamon candy and blowing on a hemorrhaging woman to stop the bleeding.

      The vast majority of reasonable people would call that bullshit. Except the type of midwives that don’t and are either silent or actively encouraging this mindset and are making money off of it at the detriment to decent care for women and children.

      Homebirth is available where I live, with strict risking out criteria (no VBAC, breech or twins for starters), clients must live within 30 minutes of the major maternity hospital, two university trained and registered midwives attend the homebirth and it is all paid for by the government. If the ‘homebirth advocates’ were advocating for a similar system then I probably wouldn’t see a huge issue (homebirth is still not very popular where I live), but they’re not. They want less regulation, more freedom to practice whatever batshittery they decide is ‘in’ at the moment and more money from insurance/government to essentially provide a non-service. That is what I am against. It’s all the trimming of professionalism with non of the responsibility and women and children suffer for it.

      • It sounds like we are not that far apart. I find myself not really being accepted by people on either side.

        I still believe there are too many interventions, too many C-sections, and too much of making low risk birth happen in a commoditised (and expensive) environment of green drapes and IVs and monitors and uncomfortable, non-ergonomic labouring and birthing positions; too much pitocin and aesthetics, etc. Hospitals have at least improved over the last few years in not trying to take babies away to the nursery so much; but there are still too many bothersome and unnecessary actions in the middle of the night, and too many needle pokes disrupting early bonding. And there’s the mother of all such disruptions: here in the Midwest, neonatal circumcision is still practiced almost universally (whatever you think of circumcision–and I think it is abhorrent–there is no reasonable argument for why it needs to be performed in the neonatal period). And although their grip is weakening, formula companies still have worrisome financial leverage over the practices in maternity wards.

        But I also think things like VBAC homebirths are insane, unatttended homebirths are insane*, and there are a lot of very poorly qualified midwives out there. The midwife we use was fantastic, however. Throughout the pregnancy, she used a number of laboratory tests, but still gave us that “cozy midwife experience”: lots of time at appointments, homey surroundings, a gentle manner, etc. She made the decision to recommend transport to the hospital (which was a quarter-mile away), not stubbornly waiting until it was an emergency. She then stayed with us at the hospital; the labor and delivery nurse, who was initially very skeptical of this woman who represented something alien to her, was ultimately won over and impressed by the level of her knowledge about women’s bodies and pregnancy.

        Unlike many homebirth advocates, I would support making uniform and stringent standards to qualify to be a midwife; however, those should not be so stringent as to be a cover for essentially banning midwifery altogether.

        *I also send my kids to public school, let them watch TV, vaccinate them (though I do think there are too many of those), reprimand them for misbehaviour and use timeouts (no spanking though), and other such heretical things. 😉

        • Amy Tuteur, MD
          • Comparing midwifery to the highway-robbery wedding racket is just so far off, at least as I experienced it. Our midwife charged about $1000 for the entire pregnancy, which ultimately included not only a great number of lengthyappointments along the way, but 48 hours or so of near-continuous attention around the time of the birth, plus breast-feeding support afterwards. How much does $1000 buy you in the wedding industry? For that matter, how many minutes, or seconds, does it take for an OB to make $1000? (A high school friend of mine used to take me for rides in his own private plane, which his father, an obstetrician, had bought for him on his 16th birthday. He was a dutiful son, always taking pains to point out that his father spent hundreds of thousands of dollars per year on malpractice insurance; but somehow there was enough left over for that private plane and an opulent home, fancy cars, etc.)

            I believe three of my four children would not be alive today without obstetrics (something my crunchy friends do not like to admit); for that matter, neither would I, my father, or even my grandfather. But OBs could earn half of what they do, and still be wealthy. Our midwife was not wealthy.

          • Bombshellrisa

            That is a very good price. The rate here is between $3600-$4600, depends on if you want to birth at home or the birth center. Also doesn’t include any tests that have to be sent out for. If a hospital transfer is required, the midwife charges a fee for that, also charges an extra $750 to stay at the hospital as a support person. The midwives I apprenticed under all live in the most affluent areas, and their birth center is in the most affluent city in the county. I don’t know many people who can afford million dollar homes, but all six of the midwives own them (some are also single parents with at least 3 kids). None of them are the higher trained CNMs, all are CPMs.

          • I can believe that people who cater to affluent clientele inflate their prices accordingly. But those same people are still going to pay a lot more for a wedding, because those prices are inflated compared to average people as well.

            So you are a midwifery apostate, I take it? Interesting.

          • Bombshellrisa

            But they don’t cater to just affluent people-they accept state insurance and private insurance. Even the midwives in non affluent areas charge this, but most of them are willing to barter things like gold and silver too if you don’t have the cash up front.

          • You can’t just say the price is the same in non-affluent areas, implying all such areas, because in my non-affluent part of “flyover country”, it is not.

          • Bombshellrisa

            I am not implying anything, I was referring to midwives in my state who practice in rural and non affluent areas. There are people who comment on this blog who have used CPMs and would know how much they paid for those services. $1000 is not the going rate. Doulas are charging at least half that, and that is not care through out a pregnancy.

          • Susan

            You need to share where it is OB’s can make this kind of money as I have OB friends who really want to move there!

          • Duluth, MN, 1980s.

          • Susan

            Ok I’ll tell them to thime travel on over 🙂

          • Because, what, while health care costs have risen faster than the rate of inflation, OBs have had a massive reduction in pay? That seems unlikely.

            http://work.chron.com/average-obgyn-salary-6923.html
            ——–
            Nine of the 15 surveys reported average OB-GYN salaries of between $270,000 and $300,000 per year…The Jackson & Coker study also reports an average of $59,859 per year in other benefits for OB-GYNs, giving total compensation of $359,153 per year.

          • Susan

            Not seeing private planes etc around here. Not even especially fancy cars. Maybe they will move to Duluth…..

          • Susan

            I was curious about a comparison of physician compensation and inflation because I suspect strongly that the increases in health care costs are not reflected in an proportional increase in MD salaries ( my guess is doctors are making less proportionate to their 1970s or 1980s counterparts) and I found this instead. It’s a pretty interesting discussion of male OB gyn discrimination and it’s defending it. It’s interesting. I don’t think there is an area of medicine that has all male patients. So you can’t really compare a urogology group advertising for a male urologist. I think they have a compelling argument, despite the fact I know male labor nurses and CNMs.
            I suspect we nurses are making more than our 1970’s or 1980’s contemporaries, as well we should ( and we should have made more then as well). Of course my opinions may reflect living on the west coast and having a strong labor union.
            .http://digitalcommons.pace.edu/cgi/viewcontent.cgi?article=1301&context=lawfaculty

          • Utterly fascinating article, thank you. I agree with its conclusions. I also agree that nurses deserve to be well compensated, and were underpaid in the past.

            It would be interesting to see some hard numbers about obstetricians, and physicians generally, in terms of their compensation over time relative to inflation. Anecdotally, I just the other day watched the film The Apartment, directed by Billy Wilder and starring Jack Lemmon and Shirley MacLaine. Many message board commentators indicated that it portrayed very realistic view of life in New York in 1960. But although the main character is, at the beginning of the movie, a lowly white-collar drone sitting at a desk in a vast sea of others, his modest one bedroom apartment is down the hall from the apartment of a physician and his family. That would seem an absurd detail in a movie of today.

          • Bombshellrisa

            So all the schooling that they pay for and the years that they are residents means that they ought to do the job for free or minimum wage? Here are some examples of what midwives are charging.

            http://www.birthingway.com/ ” I am a Traditional Midwife with a small homebirth practice in north Georgia”

            “How much does it cost?The fee is $2800.00 for everything except your supplements. This fee includes your prenatal care, a pregnancy information binder, the book Birthing From Within, your birth kit, a Giving Way Blessing Ceremony if desired, the birth and post partum care. If you have insurance we will try to get you re-imbursed after the birth using a billing company. The fee can be paid in installments during your pregnancy.” http://www.birthingway.com/feesandservices.htm So this is assuming that someone has $2800 extra dollars through out a pregnancy and that they will be able to foot the bill for all other tests that they have to refer out for along with the supplements they want you to take (looked at the list, not cheap). 4 patients delivering a month=$11,000.

            http://www.northidahohomebirth.com/ “As of January 2012, I’ve attended 500+ births, primarily home births and birth center births in Idaho, Colorado, Ohio, and West Africa, and also some hospital births. I have served as primary midwife for over 300 of the families with whom I’ve worked. I have been a Certified Professional Midwife (CPM) since 2007 and have been a Licensed Midwife (LM) in Idaho since 2010. Prior to moving to Idaho in 2009, I was a Registered Midwife (RM) in Colorado. I am a Christian and hope that the manner in which I provide midwifery care is pleasing, not only to you, but to the Lord.I live in Athol, Idaho and serve the communities of
            Sandpoint, Coeur d’Alene, Kellogg, and every home in between!”

            “The cost of midwifery care in our area ranges from $2000 to $4000, depending on how each midwife charges and what is included in the care provided. You can learn about my fees by downloading the document below.”

            http://www.oakgrovemidwifery.com/about-us.php

            This is a CPM practice in Southern Oregon “Cost : $3500

            Timely Payment Discount is offered of $3300 if payments are completed by 36 weeks. Payment plans are available

            Insurance: OHP open cards are accepted. We bill some insurance.” Rachelle Canady currently is “anticipating” being licenced by the state. But meanwhile is collecting money catching babies while unlicenced.

          • Hyperbolic much? I never said anything about “free” or “minimum wage”, so please put away your straw man. I said HALF would be plenty (still several times more than my family’s income). College professors like my parents also spend many years in school. My dad got his Ph.D. at Stanford, but didn’t make anywhere near that kind of dough.

          • Bombshellrisa

            No, merely three examples of areas that are not affluent, not “flyover” but drive through and charging an large fee for a minimal amount of care. Who are you to decide that half the amount an OB makes is plenty?

          • Who are you to decide that it is not?

          • Bombshellrisa

            Someone who has performed the duties of midwife in an out of hospital setting. I don’t care what OBs make, but I care VERY MUCH that CPMs are charging thousands for services that amount to sitting for an hour and talking to their clients every visit. I care VERY MUCH that they are billing insurance and getting money from the state to do this.

          • LukesCook

            She isn’t.

          • Susan

            Seriously though, most OBs have 8 years of postgraduate education. These days they often graduate with huge loans. They have incredible malpractice insurance. I am far from saying those salaries are anything to complain about, and there are regional differences. No one I know has a lifestyle like your friend’s father BUT I believe that was more common among doctors of that generation. I don’t think the skyrocketing costs of medical care have translated into proportionate increases in pay for doctors. I suspect that doctors today are less wealthy than 3 or 4 decades ago.

          • Bombshellrisa

            I have noticed this discussion with Alan is more about who is making how much money and how we can reduce how much health care costs. I imagine, in a moment, someone is going to start talking about how cancer care is a huge scam and that “THEY” don’t want to find a cure for cancer because treating people is a “bigger money maker”.

        • Anonomom

          You might be right about some of those things…but it’s much easier to sit on the sidelines and criticize, than make actual decisions that impact people’s lives, like OBs do every day.

          • The Bofa on the Sofa

            Moreover, Alan may not think the extra risk of homebirth is any big deal, but I gotta tell you, don’t think for a second that I consider it insignificant.

            Alan knows the risks, and chooses to accept them. Fine for him. But don’t for a minute suggest that the risk is not significant for others, nor that they should be advised as such.

            Give people the real information – birth is thousands of times more risky than driving drunk for the baby, and birthing at home is three times more likely to result in death of the baby than in the hospital.

            Know that and make your choice. Alan doesn’t care. Others will.

          • I agree that everyone should be properly informed about risk. That doesn’t mean, however, that I think our collective healthcare dollars should be used to mitigate every risk. Also: if you get a baby drunk and let him or her drive, you are pretty much certain to crash. 😉

          • The Bofa on the Sofa

            The problem is that society does not agree with you. A patient can be completely informed of the risks, and agree to do it anyway, but if something goes wrong, they still can sue, and they will win. That’s because society has expectations that OBs, as experts, will serve to do what is reasonable to protect their patients, and patients cannot absolve them of that responsibility.

            You ask how much is reasonable? Ask our society. We have established standards of practice that doctors are expected to follow. Whether you or some panel agrees with them is irrelevant. The OBs are subject to the requirements of our society, and they will act in that way. If they don’t, they get punished.

            This is the difference between midwives and OBs. OBs are professionals, and bear responsibility. Midwives get to play the game with no consequences. There is no recourse for a patient they wrong, and that it is absolutely appalling.

            When homebirth midwives are fully insured against malpractice, then I’m fine letting them try to practice. Of course, it won’t last, because what they do is so often so far outside the realm of standard medical practice that it’s not even funny, and they wouldn’t stand a chance in a malpractice suit. Consequently, they would not be insurable, because they are too high of a risk, and the circle starts all over.

        • Bombshellrisa

          The thing is, many times the idea that there are too many interventions is one formulated in hindsight. The argument about interventions really seems to focus on pregnancy and labor, I have yet to see anyone complain that the biopsy/colonscopy/ect they underwent was an unnecessary intervention, the mole/lump/tissue was perfectly fine.

          • An individual may not complain that those tests are unnecessary, but expert panels (which I suppose Sarah Palin would call “death panels”) have determined that many of those tests are unnecessary. Or at least, that they are not cost effective. That is, they may catch the occasional case of cancer, but at too high a cost to the medical system. If you are the one whose life is saved, that cost will of course not seem too high to you; but again, we cannot afford to save everyone from everything.

            And even ACOG admits that the C-section rate is far too high, and motivated by CYA medicine:

            http://www.nytimes.com/2010/03/24/health/24birth.html?emc=tnt&tntemail1=y&_r=0
            ——–
            The continuing rise “is not going to be good for anybody,” said Dr. George A. Macones, the chairman of obstetrics and gynecology at Washington University in St. Louis and a spokesman for the American College of Obstetricians and Gynecologists. “What we’re worried about is, the Caesarean section rate is going up, but we’re not improving the health of babies being delivered or of moms.”
            […]
            An expert panel convened earlier this month by the National Institutes of Health said there were too many barriers to vaginal birth after a Caesarean and suggested ways to reduce them.

          • Bombshellrisa

            “we cannot afford to save everyone from everything.” And not everyone wants to be saved, I have cared for enough of those during my career. I just don’t think that we can apply this principal to pregnant women and their babies.

        • KarenJJ

          “however, those should not be so stringent as to be a cover for essentially banning midwifery altogether.”

          The only way to be a midwife where I live is to have a university degree and registration. It is not possible otherwise, although some midwives have tried to get around this by handing in their registration. It’s not doing them much good though and it looks like there will be legal restrictions on practising midwifery without a license in the future. Anyone trying to practise outside of the midwifery standards should be banned, certainly. My mum’s a nurse and did her midwifery training in the 70s, she had standards she had to follow. All professionals do.

          In terms of hospitals and interventions, a lot of stuff in hospitals is easy to say ‘no’ to.

          Here’s some that I did:

          Nurse: Do you want something for the pain?

          Me: No thanks

          Obgyn: Are we circumcising him?

          me: No

          There is no way to say yes to a c-section at home if the proverbial were to hit the fan..

          As it was I did end up with interventions. It’s fine. I was very happy with the outcome. My obgyn was happy too (I’d been a very reluctant patient). I’m thankful that I had access to them.

          Oh and don’t get too caught up on the ‘early bonding’ stuff. I feel enraged when someone tells me that there is no chance of loving my baby ‘fully’ because of some sort strategy that I am meant to follow exactly on schedule. ‘Give them cuddles, you’ll work it out and it’ll be fine’ should be all that really needs to be told to women and men with regards to loving their kids in the early days.

          • I don’t agree. When my oldest ended up being born in the hospital, I had to fight tooth and nail with the nurses to keep him in our room (but I did so). Fast forward a decade, and the hospitals in our region encourage, strongly encourage, rooming in. Beyond that, they even strongly encourage skin to skin contact in the neonatal period. A decade earlier, we were seen as weirdo hippies for considering those things important. I am happy to see the hospitals have caught on to the importance of these things, so I’m glad your type of attitude is increasingly outmoded.

          • Sue

            “your type of attitude is increasingly outmoded.” Alan, you seem to have no idea of what Karen’s “attitude” is. There is no evidence that rooming in or “immediate skin to skin” are important factors in bonding. Are most of us not “bonded” to our parents? Even if we spent a night or two in the nursery so our mothers could get some precious sleep?

            You seem to have some strong attitudes but not much knowledge in this area.

          • Are we all so bonded to our parents? I spent more than a night or two in the nursery while my mother recovered from her c-section, and as of right now I have not spoken to her since last summer sometime…I don’t even remember when (it has been on average, in my adult life, several months at a time between each communication). My wife was raised in the traditional non-AP way, and though she is in contact with her parents more frequently, they have a terse, tense relationship to say the least.

            Her aunt freaked out when my wife breastfed our four month old baby in front of her (the aunt’s) four year old son (the aunt did not herself breastfeed, and had earlier recommended to my pregnant wife all kinds of “detachment gizmos” like swings and exersaucers). But this aunt seemed to have no problem leaving that son behind when he was just three years old, to go on a months-long sabbatical to an African country–something we would find inconceivable when a child is that young.

            My own father was raised in a wealthy Northeastern WASP household that stereotypically showed little physical affection for each other, and he was packed off to boarding school in his teens. His mother died (a possible suicide) while he was away at school, and it was clear to me even as a young boy that he was not close to his father, and he struggled with depression and anxiety for years.

            So, thanks all the same, but I will take my chances with the AP style!

            Now, once again you have attempted to take a supercilious attitude toward me with your claim that I “seem to have some strong attitudes but not much knowledge in this area”. Earlier in the post, you claimed there is no evidence for the importance of rooming in or “skin to skin” contact in the neonatal period. But it is in fact precisely because there IS plenty of such evidence that hospitals are changing their policies; hence my reason for calling the old ways “outmoded”. Perhaps you are the one who needs to do a little research before you comment. You might start here–lots of citations:

            http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1948089/

          • Box of Salt

            It’s probably too late in the day in my time zone for me to present a well written rebuttal.

            Alan’s citation is a position paper “Care Practice #6 No Separation of Mother and Baby, With Unlimited Access to Breastfeeding,” published in The Journal of Perinatal Education: Advancing Normal Birth, a Lamaze International Publication.

            Plenty of references, but also plenty of rhetoric.

            My own disclaimer, for Alan’s benefit: both my kids were born via c-section, skipped the immediate skin-to-skin contact in favor of closing the surgery, roomed in, and were breastfed without any formula.

            That doesn’t mean I can’t call bias when I see it, and your citation is loaded with it.

          • The paper has a clear POV it makes no effort to conceal. In that way, it is almost like a legal brief. But also like a good legal argument, it is well supported with ample evidence in the form of citations to peer-reviewed research. If a significant amount of countervailing evidence exists, you are more than welcome to present it as a rebuttal.

            What I posted was already itself a rebuttal of an earlier statement by Sue, namely that “There is no evidence that rooming in or ‘immediate skin to skin’ are important factors in bonding.” That was obviously far too sweeping, and I would hope you would agree that it has been utterly demolished. After all, to rebut such a claim, all I would need to present would be a single piece of such evidence. Instead, I provided a great deal of such evidence. Even if there is counterevidence out there (and I have seen none as of yet), no reasonable person can deny that Sue’s categorical statement has been refuted.

          • Two daughters. Two CS. Neither roomed in. Number one 3 months or thereabouts in NICU. Haphazard skin to skin somewhere along the line – but certainly not immediately after birth. Second handed to me straight away, first one I didn’t get to meet for a while. Both now adults. The one that still lives at home, I think we might go an hour without contact from time to time. Other one, with her own family, more or less daily contact.
            But, presumably I am supposed to regard this as an inadequate bond because I deviated from the approved procedure.

            It will do for me though.

          • This is always the problem when discussing these subjects (that includes breast-feeding, circumcision etc.) Parents who didn’t (or couldn’t) do what was optimal at some point along the line understandably get defensive, even angry. That’s unfortunate; but it shouldn’t get in the way of conveying the latest and best information to new parents, health care providers, and public health authorities about what is optimal. It would be like refusing to mandate seatbelts or car seats because it might hurt the feelings of the previous generation that did not use them or even have them.

          • Amy Tuteur, MD

            But it’s not optimal, no matter how much you would like to pretend that it is. The differences are minor or in some cases non-existent, but they have been grossly inflated by those anxious to pat themselves on the back for their self-proclaimed excellent parenting skills.

            Get back to me when your kids are grown ups, Alan, or better yet have your kids get back to me and let them tell me about whether you are as wonderful a parent as you think you are. Everything in the meantime is simply preening.

          • I’ll concede that you are an undeniable expert when it comes to preening!

          • KarenJJ

            Well of course not. Those of us with potential issues with some AP practices know our limitations
            I did not sleep with my babies in my bed. It made me far too anxious and I am hearing impaired and a heavy sleeper – I knew it was dangerous for us.
            I did not ‘baby wear’ for very long because I have arthritis and it became too painful to me. I did wear a sling at times it was convenient for us, but didn’t really ‘baby wear’.
            I did ‘baby led weaning’ with my eldest because she hated spoon feeding, but not with my youngest because he looovvved being spoonfed (and loved his older sister feeding him – cute).
            I comp-fed my eldest due to supply issues and a lack of weight gain, but formula fed my youngest because I was on medication.
            I don’t use cloth nappies because I seriously CBF.

            So every single one of these choices we made was what worked best for my family and was the optimal choice for us. The problem I have with the promotion of AP is that the downsides to not doing AP are so flaky – so unable to be measured and so dire if it is not followed. Apparently it is not possible to ‘bond’ with my babies as well as with other people who have done AP. This is enormously insulting – not just to fathers (who can’t breastfeed either), to people with disabilities like myself, to carers such as grandparents and to those who have adopted children.

            And to those of us with disabilities, with adopted children or for the fathers it’s just not true that we can’t bond or that our bond is comparably weaker.

            AP is not the answer to preventing mental health issues in adults, it’s not the answer to having a more peaceful and sensitive world and it’s not the answer to having happier children. Responsive parenting that can take into account the modern research and then apply it to an individual family’s circumstances is MUCH more likely to have a happier and functional family that can act as a foundation for the future of the kids.

            It’s perfectly possible to choose between breastfeeding/formula , cosleeping/baby in a cot, carrying baby in sling/using a pram, giving baby finger food/spoon feeding etc etc WITHOUT trying to prescribe to some sort of ideology about raising your children the ‘AP way’. I personally see AP as a checklist of items in how ‘good’ you are as a parent. I believe it should be seen as adding options to the table that parents can choose from to see if it works for their family. More Dr Spock than Dr Sears.

          • CBF? I don’t think I’ve seen that before.

            We don’t use cloth either because they are a PITA. That’s another thing I reject, that using cloth (or the more far-out “elimination communication”, that sounds like a nightmare) has anything to do with AP.

          • KarenJJ

            Can’t be fucked. Same as PITA, just ruder.

          • Amy Tuteur, MD

            The paper is a position paper created by a lobbying group. Quoting it is the intellectual equivalent of quoting an oil company position paper on climate change.

            There is precious little evidence that rooming in or immediate skin to skin have any long term benefit. Period. If you’d like to prove otherwise, and it is YOUR job to prove otherwise, then you have to produce the relevant quotes from the relevant peer review journals and put them in context of all the research in the field.

            Science is hard. Books for laypeople is easy. Easiest of all? Convincing gullible lay people that books written for them contain “science.”

          • Nearly every corner of science out there is backed by some interest or other, and you are being disingenuous to suggest otherwise. My uncle, a professor of chemical engineering, did important work on fuel cells that was mostly funded by profit-making entities. That did not invalidate his research.

            It is however rather spurious tunicates Lamaze international than welcome. HeyTell, where are the billions of dollars in profits that Memaws receives from skin to skin contact?

            There are plenty of cites in that link, and it is nonsense to set the bar where I need to quote each one and put it in context. After all, I too have a POV, and so you could just dismiss me as not having approached it with the pure unbiased attitude.

            And what are YOU, if not a lobbyist? By your own standards everything on your blog should be disregarded. You make me laugh, you are so transparent in your fury. What happened, Dr. Amy? Did someone hurt you?

          • I doubt you would reject an article with collected research like this if it supported your point of view. Hypocritical much?

            Of course we are all inclined to believe what we want to believe – but that is not hypocrisy, it is human nature. Anyone with any respect for science factors that in. Can’t quote chapter and verse, but I have seen Dr. A accept conclusions that don’t always fit her thesis. Sadly, I do not have the background to ever be totally convinced – research is not, cannot ever be the final word, it is cumulative, and a lot of the time I am just left thinking …Yes, but… and wishing I could know more.

          • It is just confirmation bias (human nature as you say) until it rises to full blown hypocrisy when Dr. A attacks others for their confirmation biases.

            No doubt it has become clear that I have a tendency to pat myself on the back, a tendency I will not deny. So I am going to do so again here by noting that I consider myself unusually immune to confirmation bias. When I saw some of the presentations on this blog about Dutch data that seem to undermine previous claims about the safety of homebirth in the Netherlands, I immediately took them seriously, and forwarded on some of the links to friends and acquaintances of mine who are heavily involved in midwifery to elicit their comments. Their responses tended to be “oh that’s just Dr. Amy Tuteur, you can’t take her seriously”. But that was not good enough for me. I wanted to see this dealt with factually: rebutted, confirmed, with caveats, whatever.

            My point is that Dr. Amy could do well to adopt a similarly open-minded attitude. But I do understand that lesser beings than I struggle to overcome confirmation bias, or don’t even try. It’s a real shame, because it really holds us back as a species.

          • Durango

            Are you saying that your poor relationships with your parents are due to the manner of your birth and first couple of days as a newborn? The intervening years mean nothing? How do you suppose adoptive parents manage?

          • The research clearly shows that adoptive parents have a tough time managing.

          • Durango

            What research? I can’t get full text studies, so please c & p the relevant sections of the studies you quote. Thanks.

          • Sorry…just got critiqued for addressing too many different topics, so I think this is probably a good tangential thread to drop. If you insist on believing adopted kids do as well as biological ones, I doubt you would be deterred from that belief by pesky things like facts anyhow.

          • Durango

            My goodness, you do like to jump to conclusions based on nearly no evidence, don’t you? Bless your heart.

        • Susan

          I have dealt with home birth midwives who impressed me as well. ( I am another homebirth apostate ) . I agree with you that there need to be uniform and stringent standards to be a midwife and I see no reason why a midwife delivering a baby at home should have less education than a CNM. I don’t think a midwife has to be a nurse ( there are great midwifery programs in Europe) but I think she should have a masters equivalent education. I agree that homebirth should be legal ( as do most of the posters here and Dr. Amy). I mostly think it should be legal because the idea of dragging women by force into a hospital is…abhorrent But I also belive women are either choosing homebirth because they have bought into a false belief about how safe it is or they are choosing an experience over safety. I was in the former group when my daughter was born; it was a great birth and healthy baby. I have simply learned too much since then and seen too much to believe homebirth is a safe choice.

          • Fair enough, reasonable well argued position. Not abhorrent either!

        • LukesCook

          They circumcise babies against their parents’ will? Wow, that is awful.

          • Against their own will. Parents do not have the moral right to cut off healthy, functional body parts against a child’s will.

          • Amy Tuteur, MD

            But according to you they have the right to let those babies die for lack of medical care at homebirth. Does that make any sense?

          • Apples and oranges, given the percentages. Everyone who is chosen to be circumcised gets circumcised. Only a very very tiny fraction of homebirths end in death.

            You are also inverting the choice of whether to positively do something as opposed to choosing not to do something else. You call it choosing to homebirth; I could just as easily call it not choosing to go to the hospital. After all, people are already at home–that is the default.

            So you do presumably believe my sisters friend let her baby die because she didn’t stay in the hospital for her third trimester…right?

          • Amy Tuteur, MD

            In other words, you can’t find a logical reason why mothers should be prohibited from choosing circumcision, but allowed to risk the baby’s death at homebirth. Didn’t think you could.

          • So you believe both should be banned? I could live with that.

          • LukesCook

            The point is that you presented “near universal” circumcision as one of the risks of hospital birth. If parents don’t want their sons circumcised they don’t have to risk their unborn’s life by giving birth at home, they can just not sign the form authorizing the procedure.

            Speaking of apples and oranges, why do you think that tenuous (if not spurious) risks to “bonding” are remotely comparable to proven and quantifiable risks of death?

          • Not one of the risks, but one of the signs that hospitals were (and still are to a lesser extent) not smart about the way they deal with babies and new parents. And just a decade ago, they treated RIC as something that was just “done”, not an optional thing they offered.

          • Sue

            Alan – you seem to have this bit confused. Did your sister’s friend’s baby die of a preventable – or even detectable – cause? Do you know that foetal monitoring is done during labor because the uterus is contracting and the baby is squashed in a tight space, where the cord can be compressed?

            Maybe think again about all this stuff – read about fetal demise during pregnancy as opposed to intra-partum, think about preventable vs non-preventable causes. Then come back to us.

          • Sue, I will just let you know that if you continue to use patronising verbiage as you have in several replies to me (“you seem to have this bit confused”; “your reasoning has a way to go”; etc.), I will no longer engage with you. Another blog I like to frequent has as one of its few commenting rules “talk about the subject, not each other”. Good advice, which I commend to you.

            And foetal monitoring is not only done during labour. As I noted in a different post, when my wife came in last summer for a scheduled C-section, they insisted she be continuously monitored for over an hour while she waited, although she was not in labour (scheduled caesareans are, as I’m sure you know, scheduled before one’s due date to avoid labour). We found this ridiculous, but the staff there argued for a “better safe than sorry” approach, which–as I keep pointing out–would logically extend to the entire post-viability period of pregnancy.

          • Box of Salt

            Alan: “Another blog I like to frequent…”

            May I point out that while *you* are new here, Sue is not.

            What you are calling “patronising” I’m reading as Sue being polite.

            Here’s some good advice I’ll commend to you:

            What if you consider what Sue is trying to say, instead of complaining that her tone doesn’t conform to your expectations based on other forums?

            Think about it.

          • I get it: you’ve got Sue’s back. Her views represent the majority, mine the minority. But there’s nothing “polite” about her tone, except in the most superficial veneer. That’s okay, though: I will probably keep attempting to combat her disinformation (like her spurious claim that there is no evidence for the utility of rooming in and skin-to-skin contact in the neonatal period, debunked elsewhere in the thread) despite my irritation with said tone.

    • It makes a nice change to have someone who argues a logical case rather than using invective.

      If I understand you right, in essence you are asking about the lengths it is reasonable to go to maintain life – an extremely difficult question that each individual would answer differently. Now, if this debate about childbirth was conducted on that level, there would be arguable positions – but it isn’t.

      I do find your comment “a sentimentality around babies.” a bit gobsmacking. I don’t find it particularly sentimental to argue that an unborn child has a right to a reasonable chance at life. I find it particularly abhorrent when that right is sidelined in favour of a much less appealing sentimentality about childbirth. Your wife “chafed” at the idea of a cEFM belt – why, exactly? There may have been a small lapse in common sense if there was no reason for concern, but not that big a deal, surely?

      No-one is arguing that strenuous efforts should always be made to keep alive children with no serious prospects of quality of life – but regarding healthy infants as disposable to protect a mother’s comfort is not all that logical. Some of us might feel it was barbaric.

      My main argument is that your friend Ina Mae and her sympathisers are extremely dishonest in their insistence on the safety of birth, so that women are seduced into a false sense of security – both in and out of hospital. We do all, indeed have to decide for ourselves where we will draw the line, and it is possible that many of those who choose homebirth do regard their babies as disposable, while claiming hypocritically that they are only thinking of the baby. Rather a lot though are taking risks with no idea of the possible consequences.

      Your argument is in essence a reductio ad absurdum. Life, to be sure, is not free of risk. But do you think the mother we recently discussed would have baulked even at spending the last few weeks in hopital suffering any indignity if it would have saved her child?

      • LukesCook

        Dr Amy has frequently stated that the single most dangerous day of the first 18 years of a child’s life is the day it is born. Of all the things that you can ever do to keep your child safe, choosing the safest possible birth is the most effective for the least cost and inconvenience.

      • Perhaps not. But I would balk at paying for it; we should all balk at collectively paying for it. It sounds harsh, but we cannot afford a medical system that prevents every risk, even to children or babies.

        • Amy Tuteur, MD

          Sure, we can’t afford to prevent every risk, but since:

          1. Birth is the biggest risk of childhood

          and

          2. The economic cost of birth related disabilities is astronomical

          hospital birth is extremely cost effective.

      • BTW, I’m not sure if I should thank you for complementing the reasonable, logical nature of my argument (I try); or be offended that you called my argument “abhorrent”. Which is it?

        • Amy Tuteur, MD

          Both, obviously. They’re not mutually exclusive.

          • Reasonable and abhorrent are not mutually exclusive? Huh.

          • Amy Tuteur, MD

            Don’t pretend you don’t understand as a way of avoiding the important issues that Lizzie Dee raised.

          • Anonomom

            Of course. What is so surprising about this? It would be reasonable to euthanize everyone over 90. But obviously abhorrent.

          • I don’t agree that it would be reasonable.

        • I said it was logical, not reasonable, I think. I find it abhorrent, and so would the majority probably.

          • You started with a friendly sentence (“It makes a nice change to have someone who argues a logical case rather than using invective”) that would I think generally lead a reader not to expect you to call that case “abhorrent” in the same comment. You are right that it is nice when people can debate without using invective–something I pride myself on–so why not practice what you preach?

          • You seem a bit tender for someone making such a tough-minded argument. In my book abhorrent is a perfectly respectable negative adjective – doesn’t count as invective. I respect the logic of the argument that not everything is possible or affordable in health care – but I am sometimes suspicious of those who make it. I also think you are eliding two arguments – the abstract value of life, which, as Bofa points out is a social decision to some extent, not one to be imposed, and the chances of survival of a baby born at home when survival would be unproblemmatic in a different setting.

          • ab·hor·rent
            /abˈhôrənt/
            Adjective
            Inspiring disgust and loathing; repugnant.

            in·vec·tive
            /inˈvektiv/
            Noun
            Insulting, abusive, or highly critical language.

            ——–
            Hmmmm…

            And now I’m “tender”, which strikes me as a sexist comment (in a “reverse”-sexist mode, of course, gender policing my masculinity by casting aspersions on my toughness).

          • I don’t have a creative name

            Your notion of “more babies dying so that we can save money on health care is not such a monstrous thing” is morally repugnant to me. I’d also use the word abhorrent. I just don’t see the problem with this language. Your ideal reeks of the same eugenicism that we so often see from homebirth advocates. But hey, as long as it’s not YOUR baby dying to save money, it’s all good, right?

          • “Your notion of ‘more babies dying so that we can save money on health care is not such a monstrous thing’ is morally repugnant to me.”

            Then you do really think we should save every possible baby right up to spending 90+% of GNP to do so? For instance, as I keep saying, admitting all pregnant women to the hospital by 25 or 30 weeks gestation at the latest and hooking them up to CFMs?

            Of course you don’t, even though that would have saved my sister’s best friend’s baby. So you too will sacrifice the lives of a small number of babies, including hers, to save money; but you just won’t admit it and continue to insist doing so is “morally repugnant”.

          • KarenJJ

            Sure, the line gets drawn somewhere. Some women do go on bedrest for the last few weeks/months in hospital due to worrying symptoms. Some of us are at work trying to finish off a project days before the due date. People have different levels of risk they are willing to take with their lives and the lives of their children and they present with different symptoms.

            Easy to understand?

            You decided that the 2-3 times chance of your baby dying was worth it to give birth at home (and whatever risk of brain injury – not sure if there are statistics on that). You had your reasons. I’m pretty sure that the same reasons wouldn’t have persuaded me to give birth at home but we’re different people.

            I decided that giving birth in hospital was a simple way (relatively – had some major trust issues with doctors and hospitals to get past first) to reduce the risk for myself and for my child. I had a fantastic experience at the hospital and I have a happy and healthy baby from it. I’m very sentimental about my babies and want them born with the most amount of medical help available should they need it.

            You choose differently but you acknowledged the risk, so be it. I suspect you’d feel rather flat if the risk hadn’t paid off, but you got lucky.

          • You did catch that all four of my babies were born at the hospital, right? And only two were transports from planned homebirths, one with a M.D. and one with a CPM. One was planned to be a multipara vaginal birth with an OB that ended up as a C-section; the final one, last year, was a scheduled, elective* C-section.

            “You decided that the 2-3 times chance of your baby dying…”

            From an extremely tiny chance to a larger but still tiny chance. Very disingenuous to leave that out. Which reminds me: are all of you hard-core lactivists? Because the mortality risks involved with formula feeding are surely higher by far than what we’re talking about here.

            * Both our crunchier friends and even the OB tried to talk my wife into at least trying for a VBAC; but she had had enough, and was convinced our babies are not genetically designed to be born vaginally, which raises somewhat troubling evolutionary questions.

          • LukesCook

            What are the mortality risks involved in formula feeding, exactly?

            Any number of people on this thread have pointed out that the cost benefit ratio of maximizing safety at birth is actually very favorable. It’s also practically much easier to be scrupulous about safety for a single event, lasting no more than a day or two, than measures which must be implemented consistently for extended periods of time (such as exclusive breastfeeding) and involve repeated and protracted inconvenience, discomfort and cost.

          • Then you do really think we should save every possible baby

            More or less, yes. Though I don’t think the only way to do that is to hook them up to machines that go ping at vast expense. You say your sister’s friend was fine at a routine appointment, then the baby just upped and died. Not knowing much about obstetrics, I will concede that CAN happen – and that baby could not be saved. But how fine was “fine”? The problem with birth is that subtle, or even sometimes blatant, signs that perhaps everything is not quite as fine as all that get ignored as “variations of normal” – and I think that could be improved without vast expense if the dominant discourse was not that birth is natural and unproblematic and every healthy woman is automatically low risk. You imply that we demand heroic, unrealistic measures, and I am arguing that common sense, and a dismantling of a childish resistance to “interventions” would do to be going on with. The secondary strand – that people have a right to decide what level of risk they are comfortable with I don’t argue against – so long as their eyes are truly wide open to the consequences. Take chances, and your baby may not be so obliging as to die. You are also risking lifelong, expensive disability. Bit hard to live with that and say proudly It was worth the risk.

          • I don’t have a creative name

            Let’s take it a step further. Let’s have everyone in the world live in the hospital their entire lives, with daily full body scans to look for cancer, and hourly CBCs to check for infection or other issues.

            Oh wait. Let’s go to the other extreme. Let’s save money by not having anyone get any medical care ever, and who gives a crap who dies.

            Or, we could use common sense and seek hospital care mostly just during very dangerous times in our lives – like after being shot, after accidentally drinking poison, or while in labor.

            All of your children were born in the hospital. So you obviously didn’t have a problem spending money to ensure their safety. But all those OTHER kids out there – well, their parents are just being sentimental. If some of them die unnecessarily, it’s ok, since we’ll be saving money!

          • I didn’t personally spend the money: society collectively did, which is part of the problem I am pointing to (those C-sections are very costly; though obviously I am not one of the extremists who see them as never necessary, when even ACOG sees the rate as way too high, we clearly have a problem.

            You sensibly note a continuum, then insist common sense dictates that everyone must fall on the exact same place on the continuum.

            And do you really not see the logical problem in insisting every labour is akin to being shot or poisoned? (Hint: do the majority of women seek at some point in their lives to be shot and/or poisoned, then receive widespread congratulations when they succeed?). That is as ridiculous as the extremists on the other side who refuse to see that high risk pregnancies do fit that analogue, clinging to a gauzy myth that every birth is a flowery, even orgasmic, walk in the park (and so who needs even a midwife?)

          • Way off beam on both counts: you cannot insult an argument – which is what I find abhorent, not you for positing it. And tender is gender neutral. As is tough, come to think of it. Unless you have some fairly rigid views on masculine/feminine qualities.

            In plainer English: you are entitled to your opinion, and I am entitled to disregard it.

    • Playing Possum

      From a completely mercenary standpoint, measures such as hospital birth and interventions at the start of life are cost effective because the desired outcome is years of functional life. Let alone the ethics of refusing a voiceless, vulnerable individual (the baby) the best chance at life, and the duplicitous trope of the unnecessary intervention – how can one say that it was definitely unnecessary if there was a good outcome?

      And with regards to staying in hospital for all of your life, that’s not cost effective. But being in hospital when you are at high risk of serious illness is cost effective. Like mandatory observation periods after surgery, or serious head injury. The single most dangerous day of a males life, his birthday. And the most dangerous days in a woman’s life – the day she is born and the days she gives birth.

    • The Bofa on the Sofa

      Alan

      If you think that 1/600 sounds like no big deal, try 2 in 1 million. That is the risk of dying in a car accident if you drive drunk.

      So given that you are so casual about the risk of a baby dying, I trust that you also think drunk driving laws are unnecessary, and due to the sentimentality of friends and loved ones?

      It’s a pretty disgusting attitude, if you ask me. The threefold increase in the mortality at homebirth that you so casually dismiss is only maybe 4000 times greater than the risk of drunk driving. No big deal, eh? And that is the extent of INCREASED risk.

    • I don’t have a creative name

      “However, when the mortality risks we are trying to prevent are
      described as being rarer than one in 600, I wonder if the use of
      hospitals is overkill based on a sentimentality around babies.”

      This is appalling on so many levels. I don’t even know what else to say.

      • So why not have expectant mothers check into the hospital as soon as their fetuses are viable? My sister’s best friend had several children born from low risk pregnancies (hospital births). One, however, sadly stopped kicking one day a week or so before her due date. Everything had checked out fine just a couple days earlier at her OB appt. By the time she got it checked out at the hospital, her baby was dead. That baby almost certainly would have made it had she stayed in the hospital with CFM. Is it “appalling” that I don’t want our already out of control health care costs to balloon even more by covering such a precaution?

        • I don’t have a creative name

          Do you see any other replies to your post, other than mine? Because I don’t. There were several excellent posts that addressed you, and they were all here earlier, and now they’re not. Stupid frickin’ Disqus.

          And the answer to your question is that their birth is the most dangerous day in a person’s life. This nonsense started by NCB that “birth is as safe as life gets” has cost a lot of little lives. We can’t prevent every fetal death during pregnancy, sadly. But by having trained medical care at the ready during the most dangerous time – labor and delivery – we can reduce such deaths greatly.

          Cancer is dangerous. Most of us would want the best of the best to do our treatment if we received such a diagnosis. It’s sick and wrong to deny the same – the best care we can get – to our children and to mock such efforts as mere sentimentality. Sentimental is saving the tickets stubs from the first movie you saw with your now-spouse. I would hope that what most of us feel towards our children goes a lot further than that. I would die for my children. The notion that in order to save money, I should be willing to put them at unnecessary risk is revolting.

        • Sue

          “So why not have expectant mothers check into the hospital as soon as their fetuses are viable?” Easy – because the risk to the baby is massively greater during labor and delivery. Like you seem to be suggesting, target the resources to the risk.

    • Sue

      Alan – I’d advise you to read a lot more information here and think again about what you are saying.

      Are you seriously saying that a morality risk of 1 in 600 is acceptable, and doesn;t merit use of hospital resources? Think again – you have four children – what is four goes at 1 in 600?

      Bikerides, skateboards and swimming at the lake have nowhere even remotely like a mortality of 1 in 600 – just imagine if every 600th child swimming in the lake died of drowning – how would you react then?

      You also mistake ongoing life from the duty of care of the service provider. The hospital applies its own risk management principles while you are under their care, during a time of heightened risk (that doesn;t mean that everyone should spend their lives in hospital – that’s a straw man argument).

      Read more and think very carefully about all this stuff – your reasoning has a way to go yet.

      • LESS than one in 600 is what I was responding to (which I do not take to be one in 601).

        You say spending one’s life in the hospital is a straw man argument. How about the last trimester, then? As I say, my sister’s best friend’s baby would have survived had she done so.

        And what about breastfeeding? Are you willing to denounce those who choose to formula feed the way you denounce homebirthers? A 30 percent increase in mortality risk is nothing to sneeze at either.

        According to “Freakonomics” author Steven Levitt, one young child drowns annually in a swimming pool for every 11,000 residential pools (http://scienceblogs.com/deltoid/2001/07/27/levittpoolsvsguns/). When you consider the average lifetime of a pool is several decades, and the fact that not all–perhaps not even most–of those pools are ever accessible to children at the greatest risk of drowning (1-4 years old), one could argue that the risk is in the same ballpark. Certainly the death toll is far higher than for homebirths. Should backyard pools be banned?

  • Natalie

    There’s an on-going count for us during our 4 week rotations in OB/Gyn. So far the #1 spot goes to a gentleman who delivered 48 babies in his 4 weeks.

    If he stayed on pace (and only rotated on OB, which doesn’t happen) that would be 1000 babies in about 83 weeks (or 20 months). And this is a 3rd year medical student in a rural setting. I’m assuming residents see much, much more.

    • Bombshellrisa

      Thank you! I can only go by how long it takes a CPM to see 30 births and that sometimes takes years.

  • fiftyfifty1

    That picture with the baby on the scale is really sad. It made me mad about that stupid saying “Your body won’t make a baby too big for you to birth”. As if the size of the pelvis and the size of the baby are the only things that determine whether a baby will get stuck! This baby was an average size baby as shown on the scale, but it still got badly stuck. That is why shoulder dystocia is so very very scary. You can have even a smallish baby and a totally normal pelvis and if the baby comes down with its shoulders positioned “just so” at the wrong moment, it can be fatal.

  • None of your posts are being deleted. You aren’t accustomed to using this comment system.

  • You’re shallow and pedantic. Use something other than a straw man argument.

  • Siri

    Passive-aggressive? Just plain aggressive? Or simply pathetic?

  • DiomedesV

    “At least”? What could possibly be the merit of stating such a thing at that moment?

    • yentavegan

      When mothers and fathers lose an infant at birth they usually are comforted by the warm embrace of their own grieving parents and in-laws. When a baby dies during a homebirth, they are blamed for eschewing modern safe technology . The grandparents are hurting and angry and often time have no sympathy for their children who freely chose to put the grandchild in harms way.

      • I can’t imagine what I would have done if my daughter had embraced the woo. I do think a woman has a right to make her own decisions, and would not have found it easy to influence her. (Don’t really get mothers who think the role of daughters is to produce grandchildren for them) Fortunately, she was more level headed and responsible than I was. My stance for her was birth is natural, birth is not fearful, tra, la, la, what happened to me will not happen to you. Then it did, and I was very upset. My main concern was for her, though. I was out of the room when my granddaughter was actually born – unproblemmatically, easily, peacefully. Her MiL, informed me in the corridor it was a girl, and I have never been clear who my gasped “Is she alright?” was referring to. MiL was a nurse, and as far as she was concerned, all right was a given, and I was being over anxious. Weird.

  • Becky05

    Yes, I think respectful posts like this will do far more to cause people to think twice about OOH or to take another look at what research we have.

    • The Bofa on the Sofa

      Then again, there is a good reason why this post comes across as more “respectful” – it’s because the mother in this case has earned that respect. She made a terrible choice, has suffered from it, and now has learned from it.

      Contrast that with those HB disaster stories where the mother goes to all extents to defend the MW and the decision to HB. Dr Amy is not near as “respectful” in that case.

      The lesson that comes about is that it is not people’s decision to HB that generates criticism, it is their unwillingness to admit their mistake in making that choice.

      • Becky05

        I think every loss mother is deserving of respect. It often takes time for these grieving parents to have a different view on home birth and how likely it was that it contributed to their tragedy, but attacking them simply puts them on the defensive and makes it less likely that they’ll realize that in time. In any case, when a mother defends homebirth and her midwife, she is doing so because she really believes that being in hospital would have made no difference, because she’s been told that’s the case.

        • The Bofa on the Sofa

          I think every loss mother is deserving of respect.

          Depends what you mean by respect.

          The mother might deserve respect, but her views might not. If someone says something wrong or that would cause further damage, their comments do not deserve respect, they deserve to be criticized.

        • I think every loss mother is deserving of respect.

          I am not sure I know what that means, exactly, or whether I agree.

          Common human decency would dictate that we do not gratuitously add to another’s distress. Face to face, one can only listen and console and if necessary stay away from the contentious.

          But away from the personal? Here, for instance? Is it respectful not to comment when someone says things which perpetuate attitudes that we normally attack? Is it possible or reasonable to be objective or dismissive about someone else’s subjective views and feelings? Don’t know that any of us don’t feel rather uneasy about it – but is it our responsibility to protect the raw feelings of strangers, or is it theirs? Don’t make your views public, don’t read things that will make you feel worse. None of us like the idea of being judged, or a subject of curiosity, but that is the real world. As the most recent mother makes clear, even a polite request from a dental nurse becomes a minefield. One of the side issues of having a disabled child is that your life becomes public property to an extent, and you have to learn to live with that. People gossip, the world turns, and you had better get used to dealing with it. I don’t demand respect – and to be honest sometimes people’s attempts at tact or sympathy are not all that welcome.

  • thepragmatist

    Yep, right here… two years in and I’m still suffering a complication of pregnancy that is damn right crippling at the moment! Rare or not. Pregnancy is tough on the human body and evolution really doesn’t give two shits if we survive to live another day, just that enough of us do, and enough babies do. I read once pregnancy lowers a woman’s life expectancy by 5 years! I don’t know how true that is, but pregnancy has left me crippled at this point. 🙁 We live in such a fantasy land. I had NO IDEA that pregnancy could do to my body what it actually did, or that 2 years later I would just be beginning to heal from it/understand it. Nobody told me!!! I could feel it happening but there was nothing I could do.

  • thepragmatist

    I have had the displeasure now of meeting some women who are big fans of Gloria Lemay– these women, indeed, are well aware that there is an increased risk of death and brain damage. They are well aware that the chance of life-threatening outcomes are higher at home. They tell me it is their right to make that choice for their bodies and their babies. Gloria Lemay, of course, doesn’t think anyone should be risked out of homebirth and is a supporter of breeches at home. When I challenged these proponents, they said flat out that they would take even a 5% neonatal death rate at home vs. 0% from c-section. I can’t wrap my head around that. I think it is theoretical until it is you.

    They are not the normal NCB advocate however: those ones are passionately deluded about “normal birth” being safer at home. Scratch the surface of the movement and you get to those who are willing to play pretty horrible odds (5%!!!) to avoid the hospital for a score of personal reasons or out of political principle. I try very hard to understand all women but I have a very hard time understanding betting on those odds, yet some will. And some will freebirth/UC. I’m usually pretty good at putting myself in the shoes of my opponents but I have hard time there.

    • Because it is theoretical until it is you, and it is perhaps human nature to grasp at any straw that bolsters the belief that it won’t be. NCB provides a whole lot of straws – a set of false beliefs, an attitude of superiority, a pretence of personal control. Sadly, clutching at straws won’t stop you drowning if you end up out of your depth.

  • Charlotte

    To the mom: I am so sorry for your loss.You have the deepest sympathies of my heart.

  • thepragmatist

    Well, personally, we’ve advocating for years for our own local NICU in my rural community. I think it’s terribly irresponsible to not have one, but it’s not cost-effective to staff a NICU in a rural area. Perhaps if that is important to you you should move closer to a tertiary center or start fundraising. Meanwhile, you’re not going to get an NICU OR a c-section in your living room, and it makes it even worse when you live in a rural area, because from the time something goes wrong to the time your hospital can get their OR up and going (or transfer you by life-flight), you have wasted an enormous amount of time. At least where I live midwifery is integrated with the health care system and we have a transfer rate of something like 40% (!!!)… I live in an area where homebirthing is very, very, very safe. Still wouldn’t do it and part of the reason is because I’ve seen how slow things really move in an emergency.

    I’ve been first responder to the scene of two accidents– life-threatening, terrible accidents– and both times it took an ambulance about 15 minutes to just show up while the cops and me and passersby did first aid, waiting desperately. Then another 10 to get the victim loaded. Then another 10 to get to the hospital… Imagine kneeling in the snow in -10C weather with a semi-conscious woman in shock with god knows what injuries, in a destroyed vehicle leaking gasoline, trying to keep her from falling unconscious and knowing she is bleeding out… while you wait… Can you imagine if that was your wife in your living room, except it is a PPH, and she is bleeding to death and nothing the HB midwife is doing is working, and the ambulance is tied up somewhere else? Because I can after the experiences I’ve had waiting for ambulances… So you move her yourself or you wait. And you will probably wait. And she may die before the ambulance even hits your driveway. Never mind getting to an OR. Sure you may get fire on the scene right away, some guy roused out of bed in his own truck, or someone on the way home from a friend’s house (that’s how it rolls in our town) but it’s a long time before real help arrives. Geez, even in a huge fire! (Been there too!) People have some seriously rose-coloured glasses on when it comes to response times in under-resourced areas.

    So, really, living in an under-resourced area is just even less reason to homebirth. I’d rather be in my rural hospital, where they can call the life flight and get me to the nearest NICU or tertiary center in 30-60 minutes the MOMENT things go sideways, then in my living room where it’s probably going to take me 30 minutes JUST to get to the damn hospital, in a true emergency… then never mind another 30 for assessment, waiting, calling for help or OR readiness… or worse, the transfer time out of town, by air, to a tertiary center. Add that on too… So really, having a poorly resourced hospital is even more reason to not homebirth.

    Like one poster mentioned… do not take home birth advocates to a casino because they just can’t assess the odds.

  • thepragmatist

    Yes, and let’s not forget what happens when you speak up and dare to challenge any of the misinformation with adequately sourced, science-based risk assessment… BANNING!

  • Becky05

    Yes, but then the mother feels horrible because their bonding was disrupted and the cesarean caused problems with her breastfeeding. In the More BOBB documentary, this mom VBACs and gushes about how she feels a strong visceral love for the baby born by VBAC that she never felt for the baby born by cesarean.

  • Visit any of the hundreds of facebook pages dedicated to homebirth to see what insane risks they are taking and recommending to everyone that asks for advice. If you listened to their “advice” you would be homebirthing preterm babies, breech twins, placenta previa, gestational diabetes, VBA4C, and every other complication you can think of. In their world everything is a variation of normal and the only thing any woman needs to do is trust birth. Here’s a few to start you off. Birth without fear, The Birthing Site, Bring Birth Back Home, Birth Freedom for Oregon, In Search of the Perfect Birth, Midwifery Today, Naturally Born, Made to Birth, Spirit of Illythia…and so on. As an experiment, maybe you could offer the opinion that those complications warrant intervention and see how quickly the admin bans you from commenting. And we get our “ideas” from reading this nonsense every day and attempting to warn people that what they are being told is false and highly dangerous. We also see how midwives are revered and homebirth loss mothers are told to own their own outcomes. We visit dozens of pages dedicated to fundraising and supporting midwives accused of negligence while their victims are shunned and ridiculed. Here’s a little advice that the homebirthers love to give…”go do your research” Then come back and discuss it with us.

  • areawomanpdx

    MDC is not so much a blog as it is a conglomeration of thousands of women trying to out-crunch each other. The attitude that Dr. Amy is talking about is ALL OVER the internet, certainly not just one blog. If you haven’t seen it, this is either your first day in the world of birth blogs, or you’re purposely putting your head in the sand.

  • Lisa from NY

    They are salespeople, the best. And you are gullible.

  • Bombshellrisa

    Well, I never said she was the brightest bulb in the pack!
    It also is a good example of why being “an expert in normal birth” cannot ever compare to the well rounded, science based education and training an OB/GYN receives and the care that one will get from said OB.

  • Aunti Po Dean

    ” Somehow, all my preparations, all my imagery, all the support I had received could not protect me from the trauma of this labor”
    these words indicate she was led to believe that nothing would go wrong if she prepared and believed

  • Aurora Borealis

    Andy is the guy who panders Russian Roulette as a safe game because HE didn’t blow his brains out.

    Good on him if he and his family had a (presumably) consciencious midwife and his son’s birth went without incident. Unfortunately, his tunnel vision prevents him from seeing that many others are not so “lucky”. In hindsight, he claims discerning judgment, lol.

  • Chi-Town_MotorCity

    Nicely said. The risk of complications doesn’t increase whether your wife gives birth inside a hospital or in a wheat field. The risks hold constant and are based on her age, health, is it first pregnancy, etc.

    It’s like a woman’s risks are turned into a big pair of 100-sided dice for her to roll once. Let’s say for the sake of argument she has a 1/1000 chance of the dice roll combo coming up as “prolapsed cord”. When it’s your wife’s time to roll the dice where do you hope she will be: In a hospital or on the way to the hospital where life-saving (and body-saving) teams are, or at home?

  • Chi-Town_MotorCity

    Andy, your posts are all here. You can refresh the page, or select “show newest comments first,” or do what NormalDistribution says and click on your name. This site uses the Disqus commenting system which can be sluggish or do odd things temporarily.

    Opposing comments are never deleted here because this community welcomes dissent, opposing views and good debate. Whether people will agree with you or not is another matter. But we believe in fairness and most of us refrain from launching personal or snarky attacks, (right people?).

  • SarahSD

    I hope that she reconsiders her plan. Failing that, I hope that she is among the lucky ones, or that her midwife acts cautiously enough to transfer her at the first sign of trouble. But if this midwife has taken on a 50 year old VBAC mother for homebirth, I have no confidence in her ability to assess risk. So I sincerely wish your friend luck.

  • BlogLurkMom

    “She should know that her baby WILL die if she refuses the antibiotics.” Please don’t tell a pregnant woman this. There is a small chance that group b strep positive women will pass it to the baby during delivery and the baby can develop a potentially deadly infection. The percentage is very low. I did not make it to the hospital in time for even one round of antibiotics (fast labor, 45 minute drive) when I had my son last summer and they simply kept us for two days instead of one and sent in a sample of his blood to be cultured to check for the strep. It came back negative and we had peace of mind going home.

    • Karen in SC

      But you did pay attention to the risk and had your baby tested. If a baby born at home doesn’t get that blood test …. the worst can happen. Low risk doesn’t mean zero. So glad your baby was fine!

    • TheHappyPappy

      You’re right, I realize now I overstated. It’s just that every time I think of Wren, all I can hear is the sound of that awful, rattling wheeze caused by the infection settling into his lungs. Half of me doesn’t want to use fear as a tactic, while the other half wants to find this woman and shake her and scream “PLEASE, don’t make this mistake! Look at the picture of his tiny coffin, listen to the sound of him fighting to breathe, listen to what his parents have to say and then please, please, please don’t make the same mistake! Your baby loves you, she trusts you, don’t let your logic fail her now when she needs it most!”

      I know I go overboard sometimes (it’s a personal failing I work on every day) but I won’t apologize for trying to save another mother from what Teeny had to go through. Someone needs to tell this woman that the outcome her doctor is warning her about is real and has happened to other people. Statistics may not convince her but I hope the visceral gut-punch of Wren’s story might.

      • Lisa from NY

        But “I am a saint. I believe. Therefore, it won’t happen to me.”

    • Amy

      Your story is identical to mine! I was also lucky my son was born without my water breaking, so chances of infection were next to none. However, I was still grateful for the extra day of professional observation!

  • A heart of stone would ache for this mother. Her dream was not extraordinary, and should have come true – came so heartbreakingly close to being true – but yet another blog on the subject of the safety of homebirth that sets out to educate the unenlightened and makes birth sound oh so simple – yes, maybe you could wish that for her but it only deflects on to the next mum persuaded to believe it.

  • Captain Obvious

    For more examples, check out oregonmidwifeinfo.com, homebirth thread on babycenter, and sisters in chains.

    • Lisa from NY

      They promote home birth, despite the fact that with certain complications — such as placental abruption — only a hospital will suffice.

      “Unfortunately, studies which have not differentiated between planned and unplanned home birth or attendance by qualified versus unqualified attendants, and/or that do not clearly define appropriate inclusion criteria, have been used to discredit all home birth. The evidence indicates that appropriate client selection, attendance by a qualified provider, sound clinical judgment, and transfer to a receptive environment when
      necessary, promote safe outcomes.”

  • What I would like to see is figures on how much of the morbidity/mortality occurs in low risk women. Indeed, how many of the avoidable poor and bad outcomes are a consequence of women being regarded as low risk. “low risk woman” is a category that doesn’t exist in reality except in retrospect. You can categorise a birth as low risk when it is over, and I suppose it is necessary to go along with the notion of “no immediately obvious or concerning risk” because most women will fit into that category and stay there. But, based on my experience – one low risk disaster, one high risk success, there needs to be a re-think of what counts as avoidable, and clearer definitions of “low risk”.

  • PoopDoc

    I suppose what it distills down to is: Are you an optimist or a pessimist. I had a super easy pregnancy. I was a bit old, but otherwise healthy. I was planning on an un-medicated delivery. My CNMs were very supportive and optimistic. And also waaaay off about the position of my baby. I suspected she was a breech. They were very reassuring she was not. If I had not been in the hospital my super easy un-medicated low risk delivery could have been a disaster. The whole reason for going to a hospital is that when it hits the fan you want that OB who can help delivery your baby safely.

  • Amazed

    Oh. OK. I’m scratching my head thinking….

    DISCLAIMER: I am a moron and I admit it. I don’t admit to being an idiot. To my fellow morons: you know, maybe you need to find out how a site works before you post? That’s something even a moron like me knew to do before I first posted, not to mention it saved me from looking like an idiot, so I could be just a moron.

    Will this do?

  • anonomom, LLLL, IBCLC

    You’re right of course, and I should have said “mother and father.”

    • anonomom, LLLL, IBCLC

      Also, I need to take my own advice and stop feeding the trolls. This is not the time or the place for shit-stirring. Have some respect.

  • MikoT

    to many people share waaaay to much info on their little bundles

    Just to run on with this point – it infuriates me that any parent would be prepared to violate their child’s privacy to gain validation without regard to the potential harm.

    I was reminded of this recently when a fairly histrionic FB contact posted about her 7yo son’s trip to the hospital to remove a foreign object he had inserted into himself.
    There are now a few hundred people that know this fact, and this could cause him a lot of social problems when he reaches high school in a few years.

  • Victoria

    Their style of writing is actually quite different. Well done, again, on the research . . .

  • Isilzha

    Your “belief” has no impact on how risky something is.

  • Amy Tuteur, MD
  • Isilzha

    It’s like you’ve never read an NCB blog or read MDC. Googling the phrase “your body knows how to give birth” returns 559,000 results. The phrase “trust birth”, 43,400; “birth is as safe as life gets”, 109,000 results.

  • Amy Tuteur, MD

    Testing