The real appeal of homebirth advocacy is that it flatters the ignorant

I'm educated about childbirth

On it’s face, homebirth advocacy, makes no sense. Anyone with even a modicum of knowledge of science and statistics, let alone a basic knowledge of history, knows that childbirth is inherently dangerous, that life threatening emergencies can occur without warning, and that giving birth at home leads to preventable perinatal deaths.

Nearly every day there is another example in the media or on homebirth blogs and message boards.

Today’s iteration is the completely preventable death of Joseph Thurgood, who died because his mother chose to attempt a VBA2C at home, ending in the exact complication doctors warned her about: her uterus ruptured.

The Coroner’s Court was told that the midwife, Fiona Hallinan, is guilty of a gross breach of her duties. And, of course, the mother “educated” herself about homebirth:

A “high risk” pregnant woman who mistrusted doctors and did her own medical research was repeatedly warned of the dangers of a home birth, an inquest on her baby heard yesterday.

Kate Thurgood had delivered two children by caesarean section and was “determined” to have a child naturally and at home.

After doing her own research on the internet she dismissed concerns raised by doctors about the position of her baby and complications raised by her earlier caesareans.

“(She was told) she should not labour or deliver at home and she should have an elective caesarean section at hospital,” Dr Paul Halley, of Southern Health, told the Coroner’s Court.

Mrs Thurgood did her own web-based research on the risks, questioned several doctors’ advice, and sought out midwife Fiona Hallinan to help her deliver the child at home, the inquest heard.

So why do women like Kate Thurgood choose homebirth? I would argue that its real appeal is that homebirth advocacy, like all pseudoscience, flatters the ignorant.

In the real world, the majority of people recognize that science and statistics are difficult, specialized subjects and that medicine, including obstetrics, requires years of study and years of experience to master. In the world of pseudoscience, there is no need for hard work. All you need to do to be qualified to argue with your doctor, advise anonymous people on message boards, and set up your own website to “educate” others is to do “research” on the web.

Don’t worry, “research” on the web is not nearly as difficult as it sounds. It’s not as if you are expected to actually READ any scientific papers. Merely cutting and pasting their titles and abstracts is enough. Then you cherry pick the statements that you like from relevant professional organizations, while simultaneously ignoring any statements that you don’t like. And finally, you rely heavily on the Dunning-Krueger effect.

What’s the Dunning-Krueger effect? The classic paper on this phenomenon is Unskilled and Unaware of It: How Difficulties in Recognizing One’s Own Incompetence Lead to Inflated Self-Assessments by Kruger and Dunning published in Journal of Personality and Social Psychology in 1999. The paper reports on a variety of experiments that were used to evaluate individuals’ actual performance compared to predicted performance.

As the chart below demonstrates, those that knew the least about the subjects under discussion thought that they knew the most. In other words, those who knew the least were also the least capable in understanding how little they knew.

Dunning Krueger graph

Dunning and Krueger explain:

… [I]ncompetent individuals may be unable to take full advantage of one particular kind of feedback: social comparison. One of the ways people gain insight into their own competence is by watching the behavior of others… However, [our study] showed that incompetent individuals are unable to take full advantage of such opportunities. Compared with their more expert peers, they were less able to spot competence when they saw it, and as a consequence, were less able to learn that their ability estimates were incorrect.

Homebirth advocacy leverages the Dunning-Krueger effect to flatter the ignorant into believing that they are educated, as if being educated were merely a matter of defying authority and reading websites and books written by other laypeople.

The Dunning-Krueger effect is pretty powerful. Hence the perverse persistence of those who parachute into this blog to “educate” me. They are impervious to reason. Point out to them that they have not read the scientific literature they are quoting and they are unabashed. Point out to them that they cherry pick the statements of professional organizations, brandishing those they like and ignoring everything else and they are unembarrassed. Point out to them that there are specialists with years of training and experience, people who actually DO the research on childbirth, who have reached conclusions the opposite of theirs and they are unmoved. Why? Because to acknowledge the relevance of actually reading the literature, and following the recommendations of professional organizations and clinicians undercuts their insistence that they are “educated.”

Homebirth advocates, like advocates of vaccine rejection and other forms of pseudoscience, cling desperately to their beliefs in the face of both evidence and logic, not merely because they need to believe the foolishness that they believe. At its heart, the promotion of pseudoscience gives the ignorant the delusion of being educated without any of the hard work that really being educated requires. And that flattering delusion of being knowledgeable, when in reality they are ignorant, is too precious to give up, even for something as important as the life of your own baby.

  • Linn

    After having my IVF twins by Caesarian section, I was determined to have my next baby by vaginal birth as it’ll be my last pregnancy and I wanted to experience it. My gynae compromised and said we’d give it a go but have to have a c-sect if I’m overdue or any other complications arise. I laboured for 6 hrs without pain relief but wasn’t dilating. CTG also showed my baby’s heart beat dipped whenever I had a contraction. I was advised to have an emergency Caesarian and I didn’t hesitate. Turns out the cord was around my baby’s neck so thank goodness. I’m just glad I at least experienced what labour felt like and I was glad my gynae gave me a chance to go natural. In this case, I was glad for medical intervention as I now have beautiful twin sons and a daughter.

  • Marie

    Anyone who takes an ob-gyn’s word for how home birth and midwifery work is the one who is truly IGNORANT. Why? Because ob-gyns are almost completely ignorant themselves of how a home (or natural of any kind) birth works and have never actually witnessed one, let alone performed one.

    If the average ob-gyn was put in a situation of having to perform a birth without unnecessary interventions, they would likely be completely unable to do it. They openly admit that almost none of them have ever witnessed a home birth. Very few of them have even witnessed a completely natural birth in the hospital.

    Hospital birth as a first option is not about protecting a woman. It is about getting people’s insurance money and it’s about doing what makes it easier for the doctor, not what is best for the woman. Some ob-gyn’s even schedule c-sections (unnecessarily) because they don’t want the birth to interfere with the holidays. It’s ridiculous.

    As for the “what if something goes wrong” questions, most people who do natural births actually aren’t doing home births. They are going to birthing centers, where there are strict requirements of 5 minutes or less to get to a hospital if it’s necessary. Furthermore, licensed midwives who do home births have guidelines as well regarding quick transport if necessary… which by the way it almost never is. We’re talking like 1 in 150 or so women that have any true issue that can’t be resolved at home or in a birthing center.

    Women just don’t understand or trust their bodies and think they need to be injected with a million things in order to do something that is natural. It’s a culture of maternal cowardice.

    • Amy Tuteur, MD

      ” Because ob-gyns are almost completely ignorant themselves of how a home
      (or natural of any kind) birth works and have never actually witnessed
      one, let alone performed one.”

      How would you know? Are you an obstetrician? Have you done an obstetric residency?

      Oh, wait, let me guess, you read all about it on the internet.

      Thanks for dropping in and proving my point for me!!

      • Squillo

        Seriously. It’s just as you’ve said: they do your work for you.

        The comments of folks like Marie could easily do more to convince people that homebirth advocates are morons than anything you could ever say.

    • Holly

      There are some very good ob-gyn’s and the one I have visited is very kind and also does not badmouth midwives. But there is also a culture within the industry in the United States that bodes toward FEAR… SCARING people out of home (or natural) birth with references to unusual situations.

      This retired ob-gyn can rant on all she wants. I still would bet $1000 that she has never witnessed a home birth herself. I’d bet $10,000 that she would not be able to perform one. And I’d bet $100 that she has never performed a truly completely natural birth, even in the hospital.

      Ob-gyn’s in the US are taught to do the things that make the birth easier and quicker for THEM and for the HOSPITAL. They are not taught how to properly assist an actual natural birth. Other developed nations have the majority of their births done in birthing centers with midwives, and they have FEWER complications. Coincidence?

      • Amy Tuteur, MD

        “But there is also a culture within the industry in the United States
        that bodes toward FEAR… SCARING people out of home (or natural) birth
        with references to unusual situations.”

        It never ceases to amaze me that NCB advocates are so ignorant about the origin of natural childbirth. Grantly Dick-Read, the father of natural childbirth, fabricated is because he was afraid of “race suicide” of white women of the “better” classes.

        He knew that they feared the pain of labor and they feared dying in labor, so he decided to trick them into believing that the fear was all in their heads, and that primitive (read Black) women didn’t fear childbirth and had painless childbirth.

        He made the whole thing up and you have to give him credit for understanding his target audience. More than a half-century later, and long after his theories were shown to be fabricated and untrue, there are still ignorant people like you who believe it.

      • Dr Kitty

        What is to “perform” at a home birth?
        You watch someone scream in agony for hours until they push a baby out of their vagina.
        You suggest some positions she might like to try while pushing.
        You occasionally check the FH with a Doppler. You “hold the space” and say encouraging things.

        In a straightforward labour and delivery a birth attendant doesn’t have to DO anything. That is the point.

        • Amazed

          But Dr Kitty, “performing” is just what a homebirth is to lots of these women. They want a performance and they want to be the star of it. Of course, the doctor should also be able to perform accordingly, not ruining the moment with those boring, overrated things like safety and outcome.

      • Amazed

        There are some wise nature-oriented people and then there are the idiots who are willing to risk their baby’s life in a homebirth, And the idiots are those who sprout all this nonsense about the beauty of a natural homebirth and are shocked, shocked to see the ugly side of it. And they spread blatant LIES about the majority of births in other developed nations being at birthing centres with midwives and having better outcomes because they are either liars or too dumb to think to check the shit they are fed by their NCB “healthcareproviders”. Coincidence?

      • Bombshellrisa

        ” And I’d bet $100 that she has never performed a truly completely natural birth, even in the hospital.” Can you up the ante? Since Dr Amy experienced natural childbirth more than once, I guess that means I have some beer money!!! Woo hoo! And, oh yeah, BINGO Y’ALL!
        Midwives in other “developed nations” are well trained, university grads. Those birthing centers are part of the national health services and always have regulation and oversight.

        • Victoria

          Should be getting $200 as she ‘performed’ a natural childbirth twice. Does it count as “performance’ even if you didn’t live stream it?

      • Daleth

        It’s also unusual for a drunk person at the wheel of a car to have a catastrophic accident that kills or maims someone. But we still dissuade people from drinking and driving, and even make it illegal, because in our “cowardly” fashion we decided that we didn’t want people to die just because some fool thought he could drive drunk–even though most of the time drunk drivers do actually get home safely or with minor dents in their car.

    • Dr Kitty

      If the birth doesn’t require interventions, the MW sits in a corner an knits. If a birth is going well, you DON’T need to do anything, that is the point. An OB is as capable of doing nothing as a MW.

      A MW, sad to say, is not as capable as an OB of doing SOMETHING

    • theadequatemother

      ah, I see. Anyone that doesn’t want a vaginal birth without pain medication of any sort is a coward. Anyone that wants people around to help out in a pinch (like a pediatrician to resusc a flat baby or a team to treat a significant PPH) is a coward.

      Thank you for clearing that up. NCBers often claim they just support “choice” but I always suspected there was a significant current of “I’m better than thou.”

    • Dr Kitty

      Incidence of PPH=5%
      Incidence cord prolapse=0.5%
      Incidence of meconium passage during labour=5-25%
      Incidence of shoulder dystocia=0.9-9% depending on birthweight
      Incidence retained placenta=0.1-3%
      Incidence 3rd or 4th degree tear=0.5%(UK)-7%(Canada)

      The Birthplace Study in the UK had a transfer rate of 40%.

      Did you pull “1 in 150” out of thin air?

    • Eddie

      most people who do natural births actually aren’t doing home births. They are going to birthing centers, where there are strict requirements of 5 minutes or less to get to a hospital if it’s necessary.

      Can you give a reference for that?

      Women just don’t understand or trust their bodies and think they need to be injected with a million things in order to do something that is natural. It’s a culture of maternal cowardice.

      *blink*. Really? Do you understand that death in childbirth is also natural? Maternal cowardice? Do you have your dental work done without pain relief? If you use pain relief in dental work, are you a coward?

      • Karen in SC

        Or pain relief for a broken bone? My son was in such pain after breaking his arm, it was horrible! Should I have denied him the morphine? Or had the doctor resolve the dislocated elbow without putting him totally under?

      • The Bofa on the Sofa

        Do you understand that death in childbirth is also natural? Maternal cowardice?

        Call it cowardice if you want, but I fail to see the problem with being afraid of mom or baby dying.

        If the best that Marie can do is to call women cowards, then it is pretty lame.

        Just as I said about being a wimp yesterday, so what if you are?

        • Squillo

          I’d rather be a coward with a living child than a fool with a dead one.

        • Eddie

          I fail to see a problem with being “afraid” of even a 0.1% or 0.01% chance of mom or baby dying, as long as it results in sensible steps to avoid that risk. I also fail to see a problem with “being afraid of” driving drunk, playing in the road, and other potentially risky activities.

          Reminds me of a roommate I had who thought that driving while drunk proved that he was in control, proved what a manly man he was. Too many NCB advocates seem to think that way — let’s SEEK OUT the risk so we can brag about it and say we’re not afraid.

          • The Bofa on the Sofa

            As I’ve noted recently, I gave up worrying about the “tough guy, manly” thing probably 20 years ago. Interestingly, it was the result of an on-line exchange. I did something like call some guy an asshole, and he is all like, “Say that to my face and I’ll kick your ass.” I was like, “You probably would, but I’m not sure how that is going to get me (or anyone) to think you aren’t an asshole.”

            Maybe it was after My Cousin Vinny…”I haven’t had a good ass-kicking in a long time…”

          • EB151

            “You will be executed for this!”

            “More like chewed out. I been chewed out before.”

            — Inglorious Basterds

    • KarenJJ

      Culture of maternal cowardice? Sure, I didn’t want to die in childbirth and I wanted my children to be born safely. Some freaking coward I am. I even took one for the team and let the doctors slice open my abdomen in order to grab them out when things weren’t looking good. I hated doctors, hated hospitals and hated medical procedures, but I sucked it up and got over myself in order to do the best by my kids, but you call me a coward. You’re a real charmer.

      • Tara Coombs Lohman

        You are SO right! No one in their right minds actually LIKES hospitals and medical procedures, and it is not on anyone’s list of favorite chores to visit a doctor. But we “hospital birthers” do it for one reason, and one reason only–we want a live, healthy baby and we want to be alive and healthy ourselves to rear said babies to a healthy and productive adulthood. To me that is the height of bravery and good motherhood, to be willing to endure something we are not comfortable with to ensure the best for our kids.

    • Ann

      Here’s another coward. I want a healthy baby, I want to stay healthy and continent of urine and feces, and I don’t particularly get off on excruciating physical pain. You are aware that the point of the whole exercise is the baby, and keeping yourself as healthy as possible so you can take care of said baby? This may come as a surprise to you but to most people, the Internet bragging rights to the coolest birth video are not priority nr one.

      • AmyM

        Me too. I cowardly decided to go through with IVF because I couldn’t get pregnant the usual way. And then, cowardly carried twins and listened to my doctor so they would be as healthy as possible (and me too). I sure am a coward because I don’t let them play in the road either. I am too terrified they’d get run over. That makes me worse than the cowardly lion. Oh well.

    • Bombshellrisa

      ” They are going to birthing centers, where there are strict requirements of 5 minutes or less to get to a hospital if it’s necessary” There may be a hospital five minutes or less away, but that doesn’t mean that this is the hospital that the midwives will transfer the women to, or that said hospital will have a bed and enough staff to take a transfer.

      “licensed midwives who do home births have guidelines as well regarding quick transport if necessary… which by the way it almost never is.” Of course not, they aren’t going give up control of that birth. Why else did the midwives take away a laboring woman’s cellphone, send her worried family home and let her labor for DAYS? And there is a clause in content of care contracts with midwives (even those who carry malpractice insurance) that they aren’t required to accompany a woman to the hospital upon transfer. Calling 911 or trying to help a woman in agony to a car isn’t “quick”.

    • Squillo

      Anyone who takes an ob-gyn’s word for how home birth and midwifery work is the one who is truly IGNORANT.

      No one needs to. Home birth midwives are perfectly content to let everyone know how they work.

      Since you think listening to an ob-gyn’s word about homebirth is ignorant, I assume you have evidence to back up your claims about hospital birth.

    • UKlass

      Totally agree!

      I am shocked and horrified when I see how medicalised birth has become in America. Unnecessary inductions just because the woman is fed up of being pregnant! Constant monitoring and epidurals. In the UK the NHS very much supports women using natural pain relief and deliveries are attended by midwives only shock horror no Drs! Only women who are deemed low risk labour at home.

      • The Bofa on the Sofa

        In the UK the NHS very much supports women using natural pain relief

        In the US, doctors also very much support women using natural pain relief…if they want to. No one is forced to get an epidural. On the other hand, they also aren’t prevented by getting an epidural, nor even dissuaded from doing so, as a cost cutting measure.

        Unnecessary inductions just because the woman is fed up of being pregnant!

        What’s wrong with that?

        Constant monitoring

        Or that?

        I fail to understand your shock and horror.

    • Daleth

      Can I just explain why you’re wrong that an OB wouldn’t know how to assist at an intervention-free birth? I mean in addition to the fact that OBs regularly do assist at unmedicated vaginal births…

      So here’s why. I’m not even a doctor–I’m a lawyer–but if I were “put in a situation of having to perform a birth without unnecessary interventions,” I’d be just as good at it as the average home-birth midwife, for two reasons:

      1. Most births are uncomplicated, so even a taxi driver could catch the baby. I can do that too! Heck, my dad did it, and he was a 25-year-old carpenter. Why’d he have to do it? Because the home birth midwife they hired decided, based on her “professional judgment,” that I wasn’t going to be born for at least another 6-8 hours so she WENT HOME, promising to come back after breakfast. Oops!

      2. When births do become complicated–when the baby and/or the mother are actually in danger–there’s nothing a home birth midwife can do but call 911. Again… I can do that too!

      Common sense suggests that an OB would be at least as good as me, a taxi driver, my dad the carpenter, or a home birth midwife…

  • Northstar227

    There is a pervasive lack of critical thinking among the women who engage in all this homebirth nonsense. The cringe-inducing stupidity and ignorance of “this is what your body was designed to do” is like a mantra to them. Point out that our bodies were not designed at all, and they stand their ground. Point out that vaginal birth is an evolutionary adaptation necessitated by being upright and that it is a major compromise (much like our knees and lower backs, which also are prone to real problems), rather than a perfect design that nature “intends” you to use—you don’t get anywhere because the HB movement is anti-knowledge. Never mind that nature does not care on whit how or if you reproduce. It’s not like nature bludgeons you to death if you don’t reproduce at all. Because nature is not an active agent and it does not care. Full stop.

  • I love Dunning-Krueger! Their findings have explained so many of my interactions since I first read about their results almost 7 years ago now. At the same time, it’s a very old finding. One of the benefits of the pursuit of knowledge is an increased awareness of how much more there is to know.

  • Gretta

    The problem with the Internet is that if subconsciously or even consciously you already have an answer in mind you can ALWAYS find someone who will back your decision. It’s especially dangerous because you are free to ignore by not even opening up sites where people may have information showing you are wrong.

  • Sue

    YESSSS! This is the thing in common amongst all the science-deniers – experts are “biased” by their training, how dare they think they are superior to me, I have a brain, I can do my own research, doctors get it wrong, people DIE from medical mistakes…bla bla bla

    If you know what you are looking for, and can assess evidence, the internet is the richest source of information ever imagined. If you don’t know what you are reading, and believe anyone with a view that you like, and who appeals to your sense of importance, you can be easily misled.

    Oh – and those populist BOOKS. Written by journalists, born-again diet or exercise nuts – all those people with simple answers that appeal to our need for certainty and simplicity.

    “The doctors couldn’t find anything wrong with me by my (homeopath, iridologist, naturopath…) knew what it was straight away!” (and sold me the “remedy”)

    “I’m not one of those sheeple who believe people, or the government, just because they have letters after their name – I do MY OWN RESEARCH.”

    • But there are also non-woo patients who out-research their doctors. After all, a patient can focus like a laser on their own specific condition, while the doctor needs to be able to treat a plethora of conditions suffered by a variety of patients, even within their specialty.

      • Mac Sherbert

        Very True Alan…but those patients normally seek out options from multiple doctors that are experts in their fields and they are not reading random internet sites and calling that research. They are not going to less qualified providers and getting answers. Going from an OB to CPM for a 2nd opinion is like…

        • Bombshellrisa

          Exactly-if a patient asks about a course of treatment for cancer and states that they were reading about it on the Sloan-Kettering website, that sounds very different to me than if they were asking about a treatment like Hoxsey or Laetrile, which would only be talked about on websites run by woo types.

      • cardiomom

        Alan, I’m a cardiologist and many of my patients do A LOT of research before coming to me. They read guidelines from the major professional organisations, sometimes medical journals, and most of them go for second (or even third) opinions before deciding about things like valve surgery, angiography etc.

        Never in 10+years of practice have I met a patient who valued information from the internet written by a layperson over the opinion of his or her cardiologist. This is really a special kind of nuttiness reserved for obstetrics, and I blame the whole ‘natural childbirth’ philosophy.

        • DirtyOldTown

          Just wait until the heart-attack doulas set up shop, cardiomom. They’ll be offering natural angioplasty alternatives, and vilifying the way you cardiologists needlessly medicalize heart conditions when everyone knows that humans have managed to keep their hearts beating without cardiologists for thousands of years…

          • Clever! Good burn.

            I could counter though that

            (1) doulas are “crunchy” (usually)

            (2) “Crunchy” people often advocate eating a variety of natural, minimally processed foods, going outdoors and getting exercise, and meditating to reduce stress.

            (3) Following the “crunchy” advice from (2) would do more good for more people’s hearts than cardiologists ever could;

            (4) Angioplasty is a particularly poor example for your joke as it appears to be vastly overused, with a whopping price tag that helps drive the out-of-control medical cost curve in the U.S.: http://articles.latimes.com/2011/may/11/news/la-heb-angioplasty-medical-therapy-05112011

          • Box of Salt

            Alan,
            Regarding your point (2)
            GPs/PCPs often advocate eating a variety of natural, minimally processed (i.e., the whole grains you yourself are so fond of) and going outdoors and getting exercise. At least mine does. She hasn’t tried to talk me into meditation, however.

            As you have already pointed out, it’s mainstream medical advice now. Why put a “crunchy” label on it?

          • The mainstream is catching up, but as with “baby friendly hospitals”, I think it is only fair that the “granola” set gets credit for being ahead of the times.

            Still, somewhere I was reading (in the Berkeley Wellness Letter, maybe?) the complaint that far too often PCPs give bland, ambiguous advice to “eat a balanced diet”, which is going to mean zilch to most of the people who really need to change their diets. Physicians need to learn about, and then really push, diet/exercise as an active intervention.

          • Box of Salt

            Alan, while as a child of the 70s whose parents bought in I agree with you that the granola crowd was ahead of the game, I am compelled to point out that claiming now that the “mainstream is catching up” is inconsistent with your defense of bringing your own food when you visited your relatives (I’m summarizing for clarity and will not engage in a nitpicking argument about this here). You can’t have it both ways – if it’s not quite yet “mainstream,” yeah, you were a total PIA. So which is it?

            “PCPs give bland, ambiguous advice to “eat a balanced diet”
            Allow me to clarify: every time I go in to see the PCP (likely more often that you do, given that I have breasts and a cervix which are more cancer-prone at earlier ages than male parts), the doc stresses eating whole grains and getting exercise. Every visit! My husband (who sees his PCP less regularly) gets the same schpiel. Maybe it’s because we’re in the same state as Berkeley. Or maybe it’s because the complaint you read is dated.

          • That’s great (sincerely); but notice Becky upthread has a different impression.

            I don’t buy the premise of your question: why is it necessarily “I was a PITA” *or* “the mainstream is catching up”? Why can’t it be neither, or even both if you prefer? Can you flesh that out?

          • Eddie

            I think this (what kind of advice, if any, given by PCP) depends critically on where you live. In the past when I was quite a bit overweight but otherwise healthy, my PCP never gave any real specific advice about diet or exercise. Now that I’ve lost approaching 50 pounds (diet and exercise, the last two things anyone tries), my PCP said, “Great job” but otherwise didn’t really speak to it.

          • Becky05

            PCPs don’t necessarily have the time to be a dietitian, but they should be referring to sources that do have that time, such as websites with official diet recommendations. Quite frankly, one reason that doctors don’t push diet and exercise is that it is ineffectual. Most patients don’t follow through. And the doctors that DO push diet and exercise get complained about for being judgmental and not just passing out pills.

          • Right–it can’t just be a change on the individual physician level; it needs to be a massive, multifaceted shift in public health, education (both of laypeople and of medical professionals), tax incentives, compensation paradigms (perhaps paying more for prophylactic, and less for palliative, care). No escape for the patient! (The Tea Partier’s nightmare, LOL) And we need to wrestle the medical sector away from profit-seeking capitalistic entities like Big Pharma that have a disincentive to support preventive medicine, and put it firmly in the public sector where it belongs.

          • Sterrell

            I’ll not be giving designated”baby friendly” hospitals credit anytime soon.

            http://www.skepticalob.com/2012/12/a-cardiologists-experience-with-a-baby-friendly-hospital.html

          • Ah, so “old school” (homebirth) is no good; but the latest thing (“baby friendly”) also gets no credit from you. The only birth environment that cuts it for you, then, is what: somewhere that’s eternally in a late 20th century time warp? Or is it even narrower than that?

          • Eddie

            in the mainstream medical system, a primary physician will probably refer to a nutritionist, especially if there is any underlying condition that needs special care. My wife’s OB referred her to a nutritionist for gestational diabetes, for example. The nutritionist was able to give very specific, detailed, and useful advice.

            But to your point, the “crunchy” people are probably more likely than average to actually FOLLOW the advice to eat healthier food and to exercise. The average American attitude is still, “I’m too heavy, doc? Can you give me a pill for that?”

          • DirtyOldTown

            Oh wow. You can Google angioplasty. Colour me impressed.

      • KarenJJ

        Sure. One of my specialists joked that I now know more about my particular syndrome than 99% of the doctors in my country. And it’s probably true of those that I’ve met. Unless they’ve recently taught immunology to medical students or have been to a conference where it was discussed at grand rounds, they’re highly unlikely to have heard of it. Mostly if I go see a new doctor, they start reading wikipedia and google and then put a call through to the immunology department.

        Of all this though, I do have some sympathy. It’s extraordinarily rare and recently discovered, so it’s not surprising that they don’t know anything about it. Those that do know about it are experts in their field and have been an enormous resource to my family of information, advocating for drug access and also raising awareness through presentations, papers and surveys.

        Of the alt-med practitioners which I also saw (prior to diagnosis and while waiting for IVF to get going), they were full of answers and reassurance and treatments. But it was bogus information, bogus treatments and the sort of reassurance that makes you feel good about them as a practicioner but is ultimately useless at achieving anything helpful.

        When I finally walked into the office of the Immunology Professor that was to become the person that ultimately diagnosed me it really showed me the difference between someone that doesn’t have all the knowledge but knows where to look and how to find out – as opposed to someone that does “know” a lot but doesn’t have the tools to thoroughly investigate or even recognise that something is far beyond the regular.

        Since the diagnosis, I’ve often thought it would be interesting for a doctor with knowledge of chronic or rare diseases to go through the records of a naturopath and see what they might find.

        • It is generally acknowledged that mothers of disabled children are the “experts” on how that child is affected. I could write a very, very long post on the number of times doctors have made predictions – or even treatments – that were wrong. But I would have to be very foolish to believe that I actually know more than they do.

          My daughter’s epilepsy turned out to be the most intractable problem – but I don’t do a whole lot of research. Sometimes I think I should, but the things I can access on the internet may complicate and confuse as much as they enlighten. PATIENTS are individuals, research is, kind of, general. Not easy to get all this right.

          Alan’s policy statement on bf was very convincing. Who would dare not to bf after reading that? Was it true. or helpful, for the individual mother?

          • Not my policy statement, the AAP’s. Sorry to nitpick, but someone else came in late and thought my wife went for a HB after three C/S, so I don’t want someone else to think I’m issuing policy statements, LOL (now *that* would be hubris of the first order!).

          • BCMom

            A very important point, and a reality some people don’t get – what you read on the internet and elsewhere is generalised. One of the benefits to seeing a professional is that they look at the treatment options based on your individual case. While treatment protocols are fairly straightforward, there can be many confounders when it comes to treating the individual.

            The latest example of this in our office was a woman who flew up to B.C. from California absolutely convinced that her father’s cancer was not being treated correctly. She had been told by a HCP who is a friend that “x” therapy is indicated in her father’s type of cancer and she came armed ready to do battle with printouts from the internet. Problem was, “x” therapy is only recommended for locally advanced disease, the father has metastatic disease which warrants the “y” therapy he is on.

            This is just one simplified example of what HCP’s deal with all the time. Yes, I would definitely educate myself but there could be key considerations you won’t be aware of just by reading up on it as a lay person.

  • Bombshellrisa

    Found it interesting that Southern Health (which has THREE hospitals with maternity options, Monash Medical being the one where the high risk women are sent) piloted a homebirth program

    http://www.southernhealth.org.au/icms_docs/6473_Casey_Hospital_home_-_birth_pilot_evaluation_report.pdf

    • Sue

      Thanks for posting this. Interesting to see how few of the women managed to remain at home, even with some meconium and hypoxia complications. This would be about as safe as it gets at home – hospital-based MWs, strict risking-out and transfers, strict protocols which were audited. Very different to the lay and renegade approach of Barrett or the US DEMs/CPMs.

      Interestingly, they say nothing about cost. It seems that setting up a system for such a small number of people to successfully complete might cost a lot., but they didnt evaluate it.

      • Bombshellrisa

        I found it interesting too. There was an article about this program that talked about how there was interest in homebirth in the area but that a private midwife would have to be hired, with the patient having to carry all the cost. This was supposed to be an answer to both cost and the idea of the comfort of birthing at home.
        I noticed that other medical centers in Australia offer homebirth with their midwives, but there is still a strict risking out process and no hesitation with transfers.

      • thepixiechick

        Yes I think it is a pretty good homebirth model as it has stringent risk-out and transfer criteria. As far as safety goes I think they have done what they can to maximise safety and this is substantially different from what is available from independent midwives here. As an insurance geek it is the only form of homebirth I would endorse in Australia as it is currently the only way possible to have a planned homebirth in this country attended by insured providers. Mind you it is certainly not safe enough for me but I can see how it may seem adequately safe to some people.

    • araikwao

      To clarify, the pilot was run via their low-risk maternity hospital, but the director of the programme is based at Monash (where the high-risk mothers go). I still can’tbelieve the government funds it, though

      • KarenJJ

        Similar program in Perth, with KEMH as a backup. It seems a way to give options for women that want it. KEMH also has a birth centre but it is on the grounds of the hospital. Government funding is pretty good in my experience as a patient (there’s a lot of media beatup about it, but my experiences of public health care here have been largely positive).

        • araikwao

          I agree we have a great system here, although it is increasingly stretched (I work in it, and have had both my children in public hospitals), I just don’t know if I agree with the govt funding homebirth. I guess this pilot at least applied stringent eligibility criteria, unlike most of what we read about here.

          • theadequatemother

            “I just don’t know if I agree with the govt funding homebirth.”

            I think that funding something is a powerful policy lever. If the gov funds, the gov can control (ie NOT pay for HBACs, twins, breech, first babies at home, homebirths for moms over 40 or with BMIs over 35 etc). These programs could be aimed at harm reduction rather promoting homebirth as a mainstream option.

          • This sounds good to me.

          • araikwao

            Very good point,

          • Sterrell

            I’d add that homebirths can only be funded if attended by a CNM (no CPMs or traditional midwives), and that they must follow standard protocol (no garlic douches for Group B Strep).

  • Anonymous

    It’s a darn shame I gave up swearing for lent.

  • Laura

    Dr. Fogelson had a very compelling blog post about this very issue. http://academicobgyn.com/2012/09/08/you-know-nothing-john-snow/

  • Mrs. W

    I do not blame those who fall for the garbage that is out there – some of it is very convincing. Even the BC Minister of health seems to have fallen for it. Perhaps it is because there are too few Dr. Amy’s out there – sounding the alarm over the counterfeit care that is being passed off as the real thing. We live in a world where just about anyone can publish anything to an audience of millions instantly – and until we also live in a world where not just literacy, but information literacy (the ability to tell quality information apart from information pretending to be quality information) is the norm – more people are going to get hurt. In this context, now is the time for stronger regulations not weaker – women and their babies deserve protection from being sold a dangerous product without adequate warnings.

    • Charlotte

      It definitely is convincing – I fell for tons of woo when I was pregnant with my first, because if everyone around you (including what appear to be experts) is saying things like epidurals are risky or that cesarean rates are too high, you don’t have any reason to doubt it at that point. Woo has become mainstream thought in the pregnancy world, and if you’re new to that world you don’t know enough yet to realize that it’s woo.

      • Jessica

        Not only do you not realize it’s woo, but your physician may not be doing anything to counteract that. In an uncomplicated pregnancy, the first, oh, seven months you only see the doctor once a month, and the appointments are relatively brief – urine sample, blood pressure, weight check, quick discussion. Reading The Bump I note how many women complain about the cursory nature of these checks. (I can only wonder whether they have jobs or a life to get back to, because the last thing I wanted to do was sit in the OB’s office talking about my chakra or something like that). I didn’t get any handbooks or literature, which meant for months I was free to roam the internet or watch any old crappy documentary I liked. That’s a lot of time to spend on message boards reading, believing, and repeating terrible advice, and misinformation on childbirth, labor, breastfeeding, etc. The seventh month or so seems to be when I see a lot of women The Bump suddenly fretting over how unfriendly their OB is to NCB.

        • thepragmatist

          I think it would make more sense for OB clinics to hire a counselor and run support groups out of the office, if practical. There is a lot that could be done to make it a better experience for women. It is not enough to make it out like women are weak for needing or wanting the kind of care midwifery offers in prenatal visits. Some do. Some are anxious with first pregnancies. Some could really used that 1-1 support. Such a person could provide support to higher-risk women who needed to have longer appointments and support/due dates clubs and so on could make the experience more social. Because, it is having a baby– far different than most medical experiences! There is a lot to be said for the support midwifery offers. OB/GYNs also need to start handing out resources too, that are friendly and caring. I know they have no time for this kind of thing, but I wonder how much a difference it would make if there was more emphasis put on the community of women, like midwifery does. I feel like we are losing the PR war. Especially around here. The midwifery clinic regularly runs workshops, offers 1 hour appointments, do home visits, and have parties. They’re on FB. They’re offering a lot more to patients on a social level. I feel like some of these things could be happening at OB clinics… why not? Why not make it more friendly? It IS having a baby! Anyway you want to look at it, it’s a huge, life-changing event for women.

          • Rochester mama

            I did my prenatal care on a Centering Pregnancy format. It was a group of about 8 all due around the same 4 week window. We each would have our brief one on one check in with either a CNM or the OB and then there was a discussion or sometimes a speaker, it was in the evening and basically took the place of a separate prenatal class plus the check ups. It was great.

          • PH Student

            I was going to say–that sounds a lot like Centering Pregnancy! I helped my CNM get a grant for it a few years ago. The participants really enjoyed it and I know at least one patient who went through actually experienced her first term delivery after 6 previous preterm deliveries. Unfortunately, the OBs were unsupportive of the program and my midwife ended up having to stop it. It’s a shame; I live in a city with some very low-resource areas and poor outcomes and not much is being done about it.

          • Josephine

            Yes! Centering Pregnancy is an amazing program! I would strongly recommend it to anyone. Mine was run by an amazing non-woo CNM and it put me so much more at ease than regular old appointments would have. It was a really nice, supportive, and fun environment. I would have never taken a pregnancy/birth class, so being in a place where I learned exactly how epidurals and other things worked took a lot of mystery and fear out of the whole birthing process.

          • suchende

            I totally agree with you. While I was never really deep in the woo, I was deeply unsatisfied with my OB care. I felt my intelligence wasn’t respected and resented my MD’s unwillingness to talk about the research behind certain recommendations.

          • Renee Martin

            Of course they can do all the fun stuff, they have the time, the money, and patients who want to, and are able to, take advantage of it!

            They are mostly free from high risk patients with special needs (or the needs are ignored), free from handling obstetric emergencies (Crash CS needed? You’re not calling a MW), and in many cases, free from caseloads of Medicaid/Insurance low fees (out of pocket and up front payment for HB!), and free from the cost of malpractice insurance (and all the things that make OBs *need* to take a lot of patients.) If a patient is a lot of work health wise, they get sent to an OB (ideally). Oh, and OBs and CNMs have to be extremely careful what they say online and in public, unlike LDEM/CPM, which hampers their social networking.

            Where I live, even the busiest CPM birth centers and MW groups only see around 6 patients a month. The majority of LDEMs only have 1 patient a month or less. They are the busiest socially because they are birth junkies. Plus, they are always in need of business (many do herbs, teach classes on the side), and are busy finding new patients and spreading their woo. They have tons of time, even with one hour appointment.

            The busiest of the MWs at the hospital owned, CNM run BC, had 147 births last year, among all the MWs there, but they don’t do as much stuff as the HB MWs socially. They aren’t running into social groups like HB MWs do, even if they do offer longer appointments.

            I think it would be great if OB groups hired a part time person to do some social events, as many moms are basically all alone in pregnancy, with family far away, or friends that are busy. I think there could be a job in this, where an independent contractor could handle these things for several practices in town. I’m sure some do this already, but I wouldn’t know because that’s not what I go to an OB for.

          • Anka

            I love this idea! I just had a frustrating OB appointment yesterday. This is my first pregnancy. I’m mildly high-risk and will most likely have a C-section (reading woo-filled articles and googling “c-section and asthma” while terrified is what lead me to this blog–yay!). I have one official high-risk OB who hasn’t come to any of my appointments (maybe too fancy, though he’s apparently supposed to), and one really nice unofficial high-risk OB with whom I’m comfortable, and whom I have been seeing.

            For this last appointment, they had me take the glucose test at the same time as my appointment was supposed to be, which meant I had to do the appointment second, and by the time I had gulped the stuff down it was their lunch time and all the staff were itching to get out of there. I was expecting to see my unofficial OB–he had asked me about my birth plan last time and I had a bunch of questions regarding c-section policies for him this time–and the unknown-to-me OB that I did see, while nice enough, was clearly not in the mood for questions and said he had to go after a few minutes. He told me I should read a pregnancy book (as if I haven’t! But they don’t contain any info about c-sections at THIS hospital, duh, or any really detailed info about the process other than variations on “they cut you open.”) and brought in a nurse to answer the rest of my questions. Most of her answers were along the lines of, “no, you can’t do that.” Or, “I don’t know–ask when you get there.” (Where? To the actual surgery itself?) “Yeah.” After answering my questions, mostly with negatives, she noted that she didn’t actually know how things were done in this (generally very progressive, large, best-in-the-country) hospital, since she’d only ever assisted at c-sections in a different hospital. Then a colleague appeared at the door and she said, “Oh, are we done here? Thank G-d, I’m STARVING!” and they bolted.

            I feel like I should add that I’m completely aware that if something goes wrong with the c-section it’s out of my hands and not worth feeling bad over, and that my birth plan is not a set-in-stone kind of thing, and that’s something I made clear to the nurse, but her general attitude was, “birth plan? BIRTH PLAN? It’s SURGERY. WHO DO YOU THINK YOU ARE and why are you asking these questions?” When it’s my first pregnancy, I’m living in a foreign country, I have no familial support anyway except for my husband (and toxic family of origin in a different country, and my mother is dead anyway), I have a complication that is rarely accurately covered in all the standard pregnancy books or websites I can get my hands on (large fibroids in challenging places–books and websites just tend to say “fibroids cause infertility and miscarriage” and that’s it if they mention them at all). I had subchorionic bleeding in the first trimester (also not covered in those books or websites, only in comments and user boards, and trying to extract accurate scientific info from lots of anecdata doesn’t calm the mind), and a terrible former family doctor who refused for the first trimester to send me to an OB and instead got angry at me for bleeding when she didn’t know why, even when all the ER doctors said I needed an OB pronto for the fibroids and bleeding together.

            Anyway, this is a really, really long-winded way of supporting what you said–I’m one of those anxious first-time mothers with complications and no support system, and I’d really like not to be treated like I’m weak and a problem patient just because I want to see the same OB whenever possible and also want to know what’s going on. (My unofficial OB even expects me to have a birth plan!) Thanks to my experience with the terrible former family doctor (who was actually a nurse acting as a doctor since my regular doctor was getting fired), I don’t feel comfortable just sitting back and NOT asking questions, and I don’t think needing information in this situation is a bad thing. I’m glad that my complications and the midwife shortage in my city led me away from midwifery and woo where I originally wanted to be, but I’d really like to get answers from the source I trust (hospital, non-woo, real medicine) and not just sit back for the next couple of months and wonder.

          • Good illustration of some of the ways medicine generally, and OB/GYN specifically, needs to reform (though to be fair it has started to happen in some places). If Dr. Amy focussed more on that, she might reduce the allure of HB enough to make serious progress toward her presumed objective.

          • Anka

            Thanks! I find Dr. Amy’s focus extremely refreshing, though, and her writing was part of what eliminated the remaining traces of HB allure for me. (HB advocates themselves shaming c-section moms and vilifying people who don’t like pain had already taken care of the vast majority of it.) Incidentally, the OB’s office explained (when I called and asked a little while ago, and they were nice about it) that this was all sort of accidental carelessness on their part. Apparently, most patients don’t want the longer appointment that seeing their official OB would entail, prefer to be in-and-out as fast as possible (in a high-risk clinic? Different strokes, I guess), and don’t care who they talk to, and the office assumes that’s the default preference instead of asking first, but they said that now that I indicated my preference, they can definitely accommodate me with no problem, both in seeing my official OB and in opportunity to ask him questions. I do like thepragmatist’s idea of support groups as part of the OB office experience, though. If that were a feature of most offices, I’m sure the HB movement would have much less of a leg to stand on.

          • Eddie

            I’m glad to hear you have a supportive OB’s office. As I mentioned, my wife’s OB was not a great doctor (by many measures; he was selected by the language he spoke) and my wife is not outspoken. I went with her to be sure she was always taken seriously.

            Definitely do not let anyone bully you into not asking questions. Don’t leave the office until you are absolutely comfortable with the answers you get. You are your best advocate. You are the only person who knows your full history, don’t be afraid to remind doctors, nurses, if they appear to forget. This is YOUR birth (and your husband’s and baby’s), not theirs.

            With my wife’s OB’s office, I was always polite and respectful, but I was also always *absolutely* persistent in pursuing her interests and willing to be impolite if necessary. (It never was, fortunately.)

            I wish you the best of luck.

          • DirtyOldTown

            I don’t buy it. A good portion of women will choose woo every time because it makes them feel special, different, and smarter than other women no matter how many ceremonial sage burnings their doctors include in their check up visits. And because there is a very lucrative market that is heavily invested in keeping women unhappy with their OB. “What? your doctor didn’t spend half an hour going over the pros and cons of delayed cord clamping? You should fire that loser and hire a midwife!”

          • Eddie

            I think you and Alan are both right. There is a significant group of people who are exactly as you say. There are also a significant number of people on the fence, who are swayed away from science-based treatments by the flaws of the medical establishment, or at least that portion of it they interact with.

            My wife’s ObGyn was terrible, but she wanted a doctor who spoke her native language and there weren’t a lot of choices. I think it was ultimately better for her that a different MD in that practice was on call the day our youngest arrived. But at least during her prenatal care she got questions answered in her native tongue. (I always went with her to be sure that this MD took her seriously. His favorite thing to say about every concern was, “Don’t worry about it.” Feh. Give me a scientific reason to not worry about it.)

          • Becky05

            What kind of birthing classes does your hospital offer? The standard classes at my hospital only briefly cover cesareans, but there’s a specific class for women planning cesareans.

          • Anka

            There are only standard classes, one of which I signed up for, because that’s what they have, and there will be some postpartum and parenting info as well. They don’t have any classes for women planning cesareans–I wish they did!–which is why I had so many questions for my OB.

          • Becky05

            Hopefully your regular OB will be able to answer your questions. My own OB always took as much time as I needed, but that’s why he tended to run late, too. Not taking the time to answer questions or being unhelpful isn’t just about an OB vs Midwife, I actually preferred my doctors for quality, compassionate AND competent care.

          • AmyP

            That’s terrible. I hope the situation improves. If you have a list of unanswered questions, maybe keep asking them at visits until you get satisfactory answers? Be friendly but persistent.

            It’s a good idea to see a number of different doctors in a practice, as you never really know who is going to be delivering your baby. I can’t remember the name of the OB who delivered my middle child, as I got hospital potluck. And it was totally fine.

            I feel like it’s not unusual to wind up with an unsatisfactory first OB. I love my current OB/GYN but found my first OB high-handed and an undercommunicator. I’ve told the story here before, but I asked my first OB, “How is this labor thing going to work?” She answered, “The baby decides!” A more helpful response would have been to say, we’ll put on monitors to do X, Y and Z, we’ll give you an IV with fluids, we’ll give you antibiotics in the IV, we’ll give you pitocin if labor isn’t fast enough, if it hurts too bad, you can get an epidural and a catheter, after the baby is born, we’ll do A, B and C, etc. That was totally predictable (indeed, totally standard), but I didn’t know it at the time. Oooh, was I ticked off. She didn’t do anything medically wrong, but she really dropped the ball on patient education. (The hospital childbirth class we took was not much of a help.)

            The problem is, they don’t know what you don’t know, because they do it every day, and they don’t see how unfamiliar and scary this all is and how hard it is for the laywoman to get non-garbage information off the internet.

            Keep asking!

          • Anka

            Oh, I have no problem with seeing the actual OBs–any of them–who might actually be delivering the baby. It turns out–after I was friendly but persistent and called yesterday–that my “unofficial” OB is actually a fellow and, unless you specifically say that you want to see a delivering-the-baby-type OB every time (and then get a longer appointment, which apparently most people don’t want), you’ll just see a fellow, who won’t be delivering the baby, and if you haven’t seen him/her before, s/he will just say while sweeping a cursory glance over your file, “OK, so who are you? What’s your deal? Everything OK?” and expect to be out of there in five minutes or preferably less (though the fellow I’d been seeing was a lot more thorough and didn’t seem to mind taking more time). And yes, the “we’ll do X, Y, Z” is exactly what I want, but I was reassured that now that I made it clear to them that I want to see OBs who have a chance of delivering the baby, and I don’t mind having a longer appointment, I will get all the detailed info I want. So it’s not as dire or frustrating as I thought.

  • Expat in Germany

    I think it is the people who are most afraid of birth that get so drawn into the -stick your fingers in your ears, close your eyes and sing – mentality. The whole industry is designed to reinforce this reaction. – Here, you are special, one of the chosen few who understand the truth, let us provide a cosy little cocoon where you can pretend that the pain isn’t real and there is no danger. We’ll call it a birth center and tell you that a doctor endorses our practice and that the hospital is just a few minutes away. You will believe it because the alternative means that you have to face your fear and acknowledge that you are just like everyone else. –

    • attitude devant

      funny…I read “cosy little cocoon” as “costly”
      It is both, I suppose

    • TiffanyEpiphany

      Facing one’s fear…I really like what you’ve said here.

      My “conversion” to anti-homebirthing brought with it an understanding that there’s a difference between a healthy fear and a foolish one.

      The fear of childbirth is a healthy one. Trick people into thinking that there’s nothing to be afraid of, and you have yourself a loyal, ignorant following.

      The fear of hospitals/doctors/interventions is understandable but foolish. Trick people into thinking that everyone is against them, and you have yourself a grand conspiracy. And a lot of dead people (innocent babies included) who didn’t have to die.

    • Bombshellrisa

      Oh wow-you nailed it!!!
      http://www.birthcenter.com Pretty birthing suites, all complete with “the midwife’s epidural” aka a soaking tub. The birthing suites double as the rooms you get to have your famous hour long prenatal appointments in. Where you get to talk to your midwife who makes you feel “empowered to give birth where you want, as you were DESIGNED to”. With candles and music and antique lace curtains. Because you are special and empowered and these “wise women” are birthkeepers and you are welcoming your precious angel earthside with their care. Sounds so much better than saying gave birth sitting around in agonizing pain in a poop filled tub with people who can’t help you if something goes wrong.

      • Renee Martin

        “…sitting around in agonizing pain in a poop filled tub with people who can’t help you if something goes wrong.”

        THIS.IS.PERFECT

  • Jessica

    It seems to me that if you are putting your life and your baby’s life on the line with birthing decisions, you shouldn’t make those decisions based on research abilities that your average 8th grader has mastered.

  • Charlotte

    Reminds me of my mom who is always trying to tell me which doctors to see and which medical facilities to go to because she has done her “research” and knows which ones are best. This, of course, means she spent 15 minutes googling the doctor’s name and someone on yelp or a message board said the doc was nice to them and the waiting room had pretty flowers. It wouldn’t be so bad if I could ignore her advice without consequence, but she takes it extremely personally when anyone doesn’t follow her unsolicited advice.

    And this is OT, but since the folks who went facebook-free for Lent appreciated my Feminist Breeder update the other day, you may be interested to know that after a couple of weeks steadily declining numbers, she suddenly gained almost 3,000 new followers in the space of a few hours. Some readers have accused her of buying “likes,’ especially since her “advertise with TFB” page was updated the day before to reflect the higher number of likes. That’s not suspicious at all, nope. The page, of course, has since been deleted, which is probably for the best since every last one of her advertisers has dropped her and it’s unlikely any will replace them as long as she’s running a ghost town of a blog behind a pay wall. She now only has a list of “brands I endorse” where ads use to be.
    I am almost embarrassed to say how fascinating it has been to watch this train wreck.

    • GuestB

      Facebook free Lent observer here – once again appreciating the update!

      I agree – as sad as it it, I enjoy the train wreck. I spent way too much time on her page and also Banned by the Feminist Breeder (even though I never was). She just rubs me the wrong way.

      Anyone know what’s up with the lawsuit? She still think she’s got it in the bag? (TFB, that is).

      • Amy Tuteur, MD

        Gina was supposed to respond by Feb. 19. Her lawyer has asked for 2 extensions so far and the response is supposed to be submitted by Monday, March 4.

        • The Computer Ate My Nym

          What’s the significance of asking for an extension? It sounds to me like an attempt to prolong things until the other person gives up in frustration, but IANAL and may be being overly cynical.

          • Amy Tuteur, MD

            Extensions are pretty common.

          • Sue

            Sounds familiar. Over in Oz, anti-vax group AVN has been ordered by the Office of Fair Trading to change their name to something reflecting their purpose or be de-registered. Name change due last week, but extension granted.

            Meanwhile, anti-vax homeopath Fran Sheffiled appears in court for directions hearing for promoting “homeopathic” vax.

          • I’m YOUR sanctimommy!

            What’s a “directions hearing”? (Not in Oz, so I’m not familiar with the terminology.)

            Also, I think Gina has a new attorney who is stricter with her. If you notice, she hasn’t really been talking about the lawsuit too much, so she might actually be taking it seriously at this point. But that may be too hopeful for her to actually be sane.

          • Sue

            A directions hearing is a preliminary hearing, held in front of the judge or tribunal chair before the full hearing, so that the court or tribunal can give directions to the parties about how the action should proceed.

          • PH Student

            Is Jake Marcus still her attorney?

          • Amy Tuteur, MD

            No. She hired a Massachusetts lawyer.

        • Charlotte

          How many extensions is someone allowed to request? My law experience doesn’t extend much farther than getting a traffic ticket and attending a wedding at a courthouse.

          • Amy Tuteur, MD

            I don’t know if there is a limit. Hopefully we won’t have to find out.

      • Lemongrass

        Can someone send me a link to information on the Gina lawsuit? I googled and only got hits from the one nearly 3 years ago. Is this something different?

  • theadequatemother

    I am reminded of The Life of Pi…ie people will choose what they see as the better story.

    The “birth is safe, beautiful, natural and empowering” narrative seems like a damn nice story and this is where I think most of the mothers are coming from. I don’t think they are consciously or unconsciously over-assessing their ability to digest the obstetrical, pediatric and midwifery literatures.

    It seems to me that many DEMs are unconsciously incompetent and that when they become consciously incompetent (like the NGM) they retire. Then there are those that just can’t be explained who have presided over multiple perinatal deaths and who probably have pathologic personality disorders.

    • Renee Martin

      Some moms are unconsciously over assessing in most cases, some really do think they are educated.

      DEMs think that they are competent and doctors are not. when they wise up- often after a death- most quit. The rest go on to be serial killers.

  • The Computer Ate My Nym

    Though looking at DK’s original paper, I’ve got to say I’ve got a few doubts…

    1. The study population was 65 Cornell undergraduates. People who have reason to believe that they are relatively good at logic and grammar (which were used for the test subjects in 3/4 tests). They may have been rating their perceived ability compared to the average person in the US population, rather than considering their ability compared to their immediate peers.

    2. One of the tests was on sense of humor. We’re on very shaky ground here, since I’m not sure that there’s an absolute value for humor. But that aside, this is the one area where the average Cornell student might feel themselves to be no more likely than average to be good at the subject. And figure 1 shows a correlation between perceived and actual competence, i.e. the less competent did perceive themselves as less competent (though they still significantly overrated their own competence and the most competent still underrated themselves.)

    3. The students got extra credit for participating? Who approved this protocol. That would be called coercion now.

    I’m not sure extrapolating from a few dozen Cornell undergraduates to all of society is a reasonable jump to make.

    • The Computer Ate My Nym

      Also, has this effect been independently validated?

      • Renee Martin

        Of course it has- everyday there are examples of it online 🙂

        • KarenJJ

          Good questions 🙂

      • theadequatemother

        we talk in medicine about the trajectory of becoming an expert in something from unconsciously incompetent to consciously incompetent to consciously competent to unconsciously competent….I don’t quite recall where this idea comes from but I am under the impression it predates D-K.

        • Donald Rumsfeld?

          • theadequatemother

            That’s funny because his characterization of known knowns, known unknowns and unknown unknowns has been coopted by the people that do evaluations of health programs.

          • I’m a Democrat, obviously; but I always thought that was a fairly incisive observation that he was unfairly maligned for.

  • Mrs. Thurgood and her midwife were stupid, and grossly negligent. That is not fair in describing all homebirthers and midwives however.

    “As the chart below demonstrates, those that knew the least about the subjects under discussion thought that they knew the most.”

    The chart does not demonstrate that. It shows that those who had the poorest scores on a test of logical reasoning ability* (not of content knowledge) had impressions of their ability that were wildly disparate (which is to say inflated) from their actual ability level as measured by the test; but those with the actual highest scores still had the highest self regard.

    Now go ahead and try to tell me, someone who sought homebirths for my first and third children (but opposed the suggestion of attempting VBAC for the fourth), that I would fall on the left end of that chart had I been one of the study’s subjects. I could use a good laugh!

    Point being: there are plenty of dipshits involved in the HB scene. Plenty. But also more than their share of highly intelligent, well educated people. You refuse to acknowledge the existence of the latter group, and I am here to stick up for them (us).

    *The paper indicates tests of grammatical skills and “humor” were administered as well.

    • The Computer Ate My Nym

      Grammatical skills are pretty clearly knowledge based.

      • Debatable (I would call it a skill like logic), but yes: one could argue that. Still, this is not what the chart shows; and Dr. Amy used “subjects” plurally. Her assertion remains sloppy and inaccurate in multiple dimensions, more broadly casting doubt on her ability to accurately characterise research findings:

        “As the chart below demonstrates, those that knew the least about the subjects under discussion thought that they knew the most.”

        • The Computer Ate My Nym

          On the contrary, I’d say you have to have a pretty good knowledge base to be able to do logic puzzles correctly and that humor is a social construct and therefore “learned”. (Incidentally, I hated their “very funny” joke, whatever that says about my skill at “humor”.)

          FWIW, I have found some data looking at actual versus perceived skill in various medical procedures and areas of medical knowledge among physicians and a very similar effect was found. Clearly medical knowledge of thyroid disease and joint injection skills are knowledge based, so there is some evidence available that supports a DK effect in undebatably knowledge based areas. (This also answers my earlier question about whether the results had been independently replicated…though does still leave a number of questions about generalizability and significance in every day life and decision making. Not to mention etiology and potential for change.)

          • Reasonable points and an interesting read.

            OT, but I would be interested in your thoughts on the “checklist revolution” in medicine if you have any.

          • BTW, that joke is a lot funnier in context, though I’m not sure the context was provided to the study participants. I recognise it as one of the “Deep Thoughts With Jack Handey” short films aired on SNL in the ’90s. The schmaltzy tinkling piano, the cursive-y words scrolling on the screen, and the vocal affect of the unseen announcer all contribute to the effect, which is akin to one of those parodies of motivational posters.

          • Sue

            Interesting comments, Nym. One of the areas of assessment of junior medical staff that is thought to be most crucial in their performance is their ability to recognise their own limitations and seek advice when appropriate.

            One of the most worrying species is the newly-promoted resident who thinks they know everything. Luckily hospitals have a graduated system of supervision and responsibility that is not available in the average home.

        • Expat in Germany

          Eye roll. She knew what she meant and so did we. I don’t trust anyone with perfect writing. It shows a level of self regard that cannot be healthy. Has anyone else noticed this correlation? Egomaniacs and extra fastidious writing?

          • “I don’t trust anyone with perfect writing.”

            LOL! BTW, I would not claim to have perfect writing. I am addicted to parentheses, and should use shorter sentences. I do think there is nothing wrong with attempting to write well, though.

          • Poogles

            “I don’t trust anyone with perfect writing. It shows a level of self regard that cannot be healthy. Has anyone else noticed this correlation? Egomaniacs and extra fastidious writing?”

            LOL. Well, I don’t know that I would ever actually consider my writing “perfect”, but I am a bit of a perfectionist when it comes to my writing and I am about as far from an egomaniac as you can get, I think. I don’t know if it’s because I am just a “word person” or because of my tendency towards perfectionism in general(which is driven by feelings of inadequacy, not high self-regard). Interesting idea, though – not something I’ve ever noticed before, myself.

          • You left out a space before your left parenthesis. 😉

          • Poogles

            “You left out a space before your left parenthesis. ;-)”

            LOL! 😛

          • Glad you took that in the spirit in which it was intended . 🙂

          • E151

            Comma belongs inside the quotations around “perfect.”

          • Only in American usage. In Commonwealth countries it would go outside, and that is the usage I favour.

        • Expat in Germany

          Also, I just looked at the chart and within what I would estimate as error bars, what she said was accurate. Take the average of the top 50 percent and the bottom 50 percent and you’ll see what I mean.

          • Fair point.

          • CanDoc

            @Alan – I’m glad you’re here. I may not agree with you about many things, but I think you bring a respectful and curious tone to the conversation. Comparing Dunning-Krueger to the NCB movement is admittedly a stretch worthy of nowhere but the blogosphere, but it shines an interesting light on the idea of self-awareness, and the lack thereof that seems so over-represented in the rejecters of mainstream medical care and embracers of woo, including NCB.

          • Thanks once again, but I hope you know you are signing the blogospheric equivalent of your own death warrant by being nice to me! LOL

          • Renee Martin

            People have no problem being nice to you when you aren’t saying crazy or offensive stuff. So far, all your posts here today have been good and thoughtful, so there’s no reason to write negative stuff back.

          • Thanks…I think. LOL

          • anonymous

            Actually, Alan, that is not true. As you may have noticed, you have not been banned. And even though I do not share CanDoc’s willingness to tolerate your smug belligerance, I do appreciate CanDoc’s knowledge and hope that by tolerating you, you may learn more about this topic and change your dangerous views.

          • That’s the second time I have been called “belligerent” here, which I dispute and find an odd accusation. (Smug? Sure, okay.)

    • JenniferG

      “there are plenty of dipshits involved in the HB scene. Plenty. But
      also more than their share of highly intelligent, well educated people.
      You refuse to acknowledge the existence of the latter group, and I am
      here to stick up for them”

      Serious question: Why?

      I know why I engage: I lost a child to both natural childbirth advocates and incompetence and after a number of years and getting some space about it I decided that as one of the people whose child felt into the 1:1000 ratio, telling my story and sharing my perspective would have some benefit. Because most babies who are born could be delivered by the taxi driver. It’s when you do have a complication that you care.

      But why do you feel like you have to justify your decisions?

      • It’s human nature to wish to do so, illustrated by the reactions people have when I bring up breastfeeding.

        • disqus_61tNDsHTqn

          Many of us who take issue with your comments on reastfeeding are women who have breastfed our children. Most of us are able to see past our own experiences. – S (edited in a likely vain attempt to keep Alan on topic)

      • Forgive me for not saying this before, and I apologise for my insensitivity: my deepest condolences for your loss. I can’t conceive of how painful that must be and I hope I never find out.

        I have trouble understanding though the appeal for you of a blog that essentially constantly berates you for being a credulous sort who should have known better.

        • fiftyfifty1

          JenniferG’s story is different than the average loss mom who posts here, so the “should have known better” part doesn’t really apply. But the other loss moms here seem to take Dr. Amy’s tone in stride. No one could possibly berate them more than they are already berating themselves. They want to save other families from the same pain.

          • fiftyfifty1

            I myself am here for a variety of reasons but one of them is that I came very close to losing my baby sister in a homebirth. I was a teen, so I remember it all well. And yes, with distance, I can say that my parents were credulous sorts who should have known better. That, and self-preening. (many of your comments actually remind me of my dad when he was younger, Alan)

          • I would think another type of loss blog with a different tone would be less toxic, but I won’t presume to tell them how to feel.

          • Renee Martin

            Its true that some loss moms don’t like the way Dr Amy deals with them, but some also agree that they were lied to and just want to ensure it doesn’t happen to others.

            There is NO shame in having been wrong, or having been misled. we understand that jeer and are very sympathetic to moms who felt duped (which are many).

        • Poogles

          “I have trouble understanding though the appeal for you of a blog that essentially constantly berates you for being a credulous sort who should have known better.”

          I think you are assuming that JenniferG had a homebirth, but that is not the case. She lost her baby at the hospital, where the drive to lower CS rates and push “natural” birth led to the entirely preventable loss of her daughter.

          We do also have homebirth loss mothers who frequently read and post here, but JenniferG is not one of them. From what I have gathered, the appeal for most of them is lifting the veil of lies around homebirth and sharing their stories in the hope that other parents never have to experience what they have.

          • Thanks for clarifying.

        • JenniferG

          Thanks Alan. As people have noted I lost my baby in a hospital dead-set on simulating a home birth (I participated; at one point I was talked out of fetching the OB to ask about c-section.)

          But also, I don’t find Dr. Amy’s approach disrespectful to most loss moms. I have gotten into arguments on NCB-friendly online forums and groups that upset me, mostly because people were asserting that nuchal cords do not kill babies (oh?) and a lot of tripe about positive thinking and instinct. I was extremely positive; in fact it never even occurred to me really that people even have intrapartum issues any more that are not immediately dealt with, until my “instincts” kicked in when the fetal heartbeat dropped off the monitor (i.e. my daughter’s heart stopped. She was revived; her story’s on the site under Emily Hope.) I find _lying_ to women (whether intentionally or not) with phrases like “your body won’t grow a baby you can’t birth” and all that crap incredibly disrespectful.

          I don’t find Dr. Amy disrespectful for the most part (the odd time I might not wholly agree a post) because I have seen the faces of the neonatal team that had to test my baby and deliver the news that she was incredibly damaged, a team that deals every day with things that can’t be prevented — preemies in dire straits, genetic disorders etc. — who were beyond angry on my daughter and family’s behalf, although they were also professional. I guess in summary I get where she is coming from. I wish I had had the information she presents in 2004; I would have known better what to ask.

    • T.

      I can’t for the life of me understand why you are here. Have you good data to show that HB is as safe as hospital birth? Good studies?

      No because there isn’t any 🙂

      And about the fact that ignorant people aren’t often aware of their ignorance… Well. That is pretty much a moot point. It is pratically a truism.

    • theNormalDistribution

      Thank you for demonstrating the Dunning-Kruger effect so eloquently.

      • TiffanyEpiphany

        Oh, it feels so good to laugh out loud!

    • TiffanyEpiphany

      Alan, no doubt you are in the “highly intelligent, well educated people” category.

      But don’t you understand that there are ZERO people in that category who would support a HOMEbirth? CNMs and OBs don’t do HOMEbirths because they know and understand the true risk.

      Why would you stick up for “them (us)” if there’s nothing but nothingness to stick up for?

      And what are your qualifications for claiming that HOMEbirth is an okay risk to take? Male intuition? Credentials you haven’t shared yet? Do tell. I am genuinely interested.

      • “Alan, no doubt you are in the ‘highly intelligent, well educated people’ category.
        But don’t you understand that there are ZERO people in that category who would support a HOMEbirth?”

        Is this not contradictory? I do support the right of parents to take this relatively small risk.

        “CNMs and OBs don’t do HOMEbirths because they know and understand the true risk.”

        Do CNMs really not do them even in places like New Mexico? That would surprise me but I will admit to not knowing (and being too lazy to look it up, LOL).

        My oldest son’s attempted homebirth was attended by a physician (albeit not an OB) of the “integrative medicine” variety, including after transfer as she had hospital privileges. He was delivered (after an induction, and six hours of pushing) vaginally, the only one of the ten descendants of my paternal grandfather (himself a caesarean birth way back in 1903) to have made it through the birth canal. This physician has attended many homebirths.

        As for credentials, no doubt Dr. Amy and most of ACOG would wish for a society oriented around a priesthood of physicians who get to pass judgment on all matters medical. But that is not how it works in our society, which I believe is a good thing. Noncredentialled juries decide malpractice and wrongful death cases. Politicians without medical degrees decide public health policy, as ultimately and indirectly do voters–both aided by the reporting of journalists, who also usually do not have medical degrees. And individuals and families make health decisions all the time without being told by doctors what their every move must be.

        You and Dr. Amy are free to bemoan this state of affairs, and wish society were organized differently; but in my book that would make you no different from the Ron Paul, tea party cranks who want us to withdraw from the UN and return to a gold standard. Not going to happen–deal with it.

        • TiffanyEpiphany

          Thank you for answering none of my questions. Your willingness to evade direct questioning says a lot.

          “Is this not contradictory?” Now you see my point, don’t you?

          I should have said *responsible* and *ethical* CNMs and OBs don’t do HOMEbirths. I’m not talking about “natural birth” in general. But fine, I will need to look up more info on this as well. You got me there.

          So, since you can’t answer the “what are your qualifications” question, then who/what do you base your “I’m for the right to choose homebirth” stance?

          Of course every person has a right to birth their child where and how they want, but NOT if that right infringes on the right of others (namely, the right of the BABY to be brought into this world ALIVE and HEALTHY). Homebirth ignores the rights of babies. Don’t you see that? Or are you the only person in your universe that matters?

          I’m still interested in hearing what you have to say. I think you’re used to getting off easy because you’re hoping people get confused or give up when they dialogue with you. I really want to know the real reason why you, an obviously bright person, is choosing to remain dull in the area of homebirth.

          • You are deft at packaging insults and compliments together! Somehow I like that, LOL.

            I feel that I have addressed this many times, beginning with my first post here. In short: the increased risk (insert caveats of low risk mothers, qualified midwives, proximity to an ER) is not of a great enough magnitude to bring in “the rights of babies” any more than is formula feeding by choice, living in a messy house or near a busy road, etc.

          • Sterrell

            So you chose homebirth because the risk was not too great? Come on, Alan, be genuine. What were the reasons you chose homebirth, knowing, even in your terminology, that there was an “increased risk?” Clearly you felt there was some elusive benefit worth the increased risk of your child’s life.

          • It was not “elusive” in particular when my oldest was born and the hospital here was pretty much the opposite of “baby friendly” (I had to fight tooth and nail once we did end up there postpartum to keep him in our room, a constant, exhausting battle; and the recovery nurse actively tried to discourage my wife from breastfeeding).

            At this point I would say they have evolved to become enlightened enough that it would no longer be a significant enough difference for the risk to be worth it to me. But I don’t believe in making that choice for everyone else; additionally, midwife-assisted HBs are far less expensive and that matters too.

          • anonymous

            So the need to control your food…is worth risking your baby’s life, your wife’s life, and your family’s good will (back to the white bread discussion).

          • To control my food? No, to avoid having our newborn baby taken from us.

          • PrecipMom

            I understand that. I had nurses messing around with my access to my newborn when I was having my second child, and it was extremely upsetting. However it was nowhere near the trauma of being in the back of an ambulance with my youngest daughter wondering if she was going to stop breathing again before I could get her to a NICU. The two are not comparable, and I got off light. My daughter is alive and fine. Other mothers? They have not been so fortunate.

          • Right but it is a comparison between a 100 percent chance of one thing compared to a fraction of a percent chance of the other. As I noted in (I think it was) my first post here, we take risks, small risks, of mortality when we bring the baby in the car to go visit grandma and grandpa three states away.

            I am not generally a violent person by nature, but if someone on the hospital staff had tried to take any of my newborns away, they would have had to do so by force and it would have gotten ugly. That’s not a cold-blooded plan I would have had, just the fundamental primal reality of what would have transpired.

          • Sue

            Alan, for a person who claims to be intelligent and educated, your decisions seem a bit foolhardy.

            Threatening violence towards a nurse wanting to take a baby to the nursery for a few hours? For what purpose? DO you REALLY believe that those few hours make a difference to your life-long parenting relationship?

            You also seem to misunderstand the difference between childbirth and car rides – not just in risk but in PURPOSE. The purpose of childbirth is to get the baby out of the mother in as good a condition as possible. The purpose of travel in a car is to move from one place to another. The risks of childbirth are mitigated by birthing in hospital with a team of professionals and equipment. The risks of riding in a car are mitigated by road rules, speed limits, driver training and child restraints.

            Do you choose to drive without any of these things because you recognise but choose to take the risks? IF not, why would you do so for childbirth, which serves no purpose other than getting the baby out of the mother?

          • I do not now have a car, but when I did have one I often exceeded the speed limit, even with kids in the car. Bad, bad me.

            I don’t think you really understood what I meant by “primal”. It would not have been “I believe this is Important to bonding, so I must now Inform you that I shall commence acts of violence if you do not accede to my wishes in this matter”. More like “RRROOOOWWWWRRRR!!!” The calm foresight in the equation was in avoiding putting myself in that position.

          • Sterrell

            I hate the word primal as it relates to birth/birth culture. It’s a convenient semantic excuse to disguise try intentions; i.e., primal cries in labor rather than the more colloquial screaming-in-pain, primal birth, and, apparently, primal fatherly rage at someone taking their newborn away. Can’t you just say that you didn’t want your newborn taken away without attributing it to some vague, evolutionary notion?

            I have to wonder at these so-called “primal” urges as I’ve never had one after childbirth nor in real life that lead to some incapacitated mental state.

          • CanDoc

            @twitter-14982184:disqus , I’m a frequent lurker and occasional contributor who comes here to find solace when dealing with the epidemic of unreasonable (semi-delusional) types to who try to tell me that condition “x” is a “variation of normal” and then proceed to reject safe options for care and delivery. I DO however respect that women and their families should be informed (honestly) and be free to choose where/how they deliver, and, being in Canada, I do agree that there are settings (genuine low-risk multips in particular) with highly-trained providers, where a home birth is not an unreasonable decision. Not the only decision. Not the “safest” decision by a very small fractional increase in risk, but a reasonable decision. (In much the same way in which attempting vaginal delivery is, I suspect, marginally more dangerous for the fetus than elective term cesarean delivery, due to the perils of labour, but that’s a different discussion.)

            And yes, I completely understand the primal urge to not be separated from one’s newborn baby.
            I guess I’m just saying that I’m a Dr. Amy fan but I think you’ve been crucified a bit unfairly here. Stick around.

          • Thank you! Wow, talk about a voice of reason.

          • anonymous

            Alan totally deserves what he’s getting–even Dr. Amy has supported the right to an informed decision for homebirth. But he wouldn’t know that, since he doesn’t read. So intead it’s smug, misinformed confrontation all day long.

          • And I don’t think it counts as “crucifiying” to hold a different opinion, or sometimes dislike his way of making his points.” Control freaks can be rather good at playing the victim if their first, preferred strategy of putting everyone straight doesn’t work.

            He is entitled, like everyone else, to make his own choices and follow his own beliefs. Not entitled to insist they are superior to everyone else’s – and everyone but he is wrong.

          • I don’t have a creative name

            “Control freaks can be rather good at playing the victim if their first,
            preferred strategy of putting everyone straight doesn’t work” Wait, when did you meet my mother???

          • The Bofa on the Sofa

            Not entitled to insist they are superior to everyone else’s – and everyone but he is wrong.

            Oh, he’s entitled to that, too. However, we are similarly entitled to mock him for it.

          • TiffanyEpiphany

            anonymous, yes, thank you. I wasn’t sure if I was missing something or if I, myself, am misinterpreting what people, specifically Alan, are saying (though, admittedly, I have difficultly reading sarcasm, and I’ve tried to directly apologize to those I’ve been an idiot to).

            I think Alan–and, yes, Alan, I am confident that you’ll be able to find this thread and jump right in, as I hope you will; I’m not trying to talk about you without your knowing–has had many opportunities to see that perhaps his views, though welcomed, are not always completely informed. And his ways of expressing those views, though passionate, are not always “respectful and courteous [in] tone.”

            Now, if Alan can directly answer the “what are your qualifications” question, then maybe he’ll gain more ground (with me, at least) in his attempt to convince his readers that he is right and everyone else is wrong. Of course there is a balance to be sought with everything (is anyone ever 100% right or wrong?), but I have noticed that Alan thinks that he is always right, to the extreme, with little attempt to concede that maybe someone else is able to offer something of worth to *his* conversation.

            I am not a medical professional; I am a layperson. I do hold advanced academic credentials in another professional field, but at the end of the day, I am not qualified to make blanket statements about obstetrics. I rely on medical professionals, such as Dr. Amy, to correctly inform me in the area of homebirth, specifically, because I choose to trust her.

            She has allowed herself to be transparent enough to be trustworthy–something we’ve seen little of from Alan, though I do appreciate his sharing about his family history and his attempt to explain where he is coming from, though I do not appreciate his attempts to avoid direct questioning, side-track conversations, or split a dialogue into multiple subjects (these responses of his are concerning). Dr. Amy has also earned my respect because she has made it evident that she actually knows what she is talking about.

            And one more thing. The night before last, when I couldn’t sleep yet again, I took the liberty to gloss over a few conversations I had missed so that I could get to know the “regulars” here. Alan is the *only* one who sticks out as outright belligerent, though I credit him with having a high intellect. He loves argument for argument’s sake, and I say bring it on since the world would be a boring, bland place
            without differing opinions.

            But what is unacceptable is for Alan to continue his tirades acting like HE is god and then go around accusing others of being god when others have actually offered something of merit. Hence, the “what are your qualifications” question. If none, then fine, he should admit it and then proceed to direct us to his sources of info. We are all eager to learn.

          • TiffanyEpiphany

            Hi CanDoc, I am interested in learning more about how the homebirth midwife system works where you are. What kind of training are Canadian homebirth midwives required to have? In the US, it’s rather pathetic.

            I will say that I have been leaving out the “in the US” from my comments on homebirth. My oversight.

            Participating in homebirth in the US is a foolish, reckless endeavor, largely because of the incompetence of the homebirth midwives (CPNs, DEMs, and “traditional” midwives). Other countries, like Canada, Australia, and the Netherlands, seem to have a stricter licensing process for homebirth midwives; although, preventable deaths during homebirth still occur in those countries as well (and I thank Dr. Amy for pointing that out in many of her posts).

            What I have gathered, it is very risky business to attempt to deliver a child in the absence of *immediate* emergency equipment and qualified doctors, regardless of country. Though, I can see how the decision to do it may be less unreasonable in Canada, as you have described, than in the US.

            What I am hung up on is that, sure, “only” 1 in 1000 babies
            might die at a “low-risk” homebirth in the US (actually, I don’t know if that stat comes from a national or state study), so the risk is relatively “low.” But 66% of the time, those deaths didn’t have to happen—and they WOULDN’T have happened had the birth been performed in a hospital. And we aren’t even talking
            about injuries or other “non-normal” things that can happen.

            As a US woman and mother, it is my responsibility to make sure that my child will never be one of the 2/3 who died at homebirth who could have been saved in a hospital. And the 1
            baby out of 3 who would have died regardless of being at home or in a hospital still deserves the dignity to die in a place where a real and fair effort was able to be made to save his or her life.

            I can’t see how homebirth will ever be able to give babies a respectable death. With childbirth comes the possibility of death, and that possibility is minimalized to its greatest extent in a hospital setting. The goal of birth is life. So it doesn’t make
            sense for women in the US to gamble with their babies’ lives thinking that they are “low risk” when our whole homebirth midwife “system” is crumbs compared to what other countries have available.

          • theadequatemother

            http://www.canadianmidwives.org/midwifery-education.html

            in Canada midwifery training is a 4 year program at the university level. There are 7 training programs in the country and they have pretty competitive admissions.

          • TiffanyEpiphany

            This is great, thank you.

          • Renee Martin

            I do think it’s reasonable to prioritize lesser risks that are more common, over more life threatening risks that are less common. Knowing that home is not as safe, but feeling it is worth it to avoid the issues inherent to the hospital (at that time anyway), is a position I can appreciate, even though it isn’t the choice I would make.

            I have no problem with fully informed people choosing HB (or even UC), my issue is telling people “but HB is as safe, or safer!” and those hurt because they believe this wholeheartedly, and make choices based on this belief.

            My friends that lost babies at HB all thought what they were doing was the safest, and they had been told this by their MWs repeatedly. This is not OK. Informed consent means you are aware of the added risk, not that no one tells you, even actively misinforms you.

            I think the response to your saying that you know the risk is higher, but it’s worth it to avoid being separated from your baby (etc) is one of curiosity. Most people here (NOT all) cannot fathom anything worse than the chance of a dead or damaged baby, and do not understand why anyone would take this chance over the lesser evils during a very short hospital stay. I would say we^ are more risk adverse than you, which is a personal thing.

            I also think some people (including myself) wonder if it was easier to accept the risk because (subconsciously) it wasn’t YOU at risk of bleeding to death (PPH), or having other scary complications at home. YOU weren’t ever going to die or be disabled, nor were you the person who had to go theough LnD with no pain relief. *You benefitted from HB without any of the personal risk to your own body, or the personal sacrifices (and pain is a personal sacrifice IMO), so of course it was worth it- especially in retrospect.*

            I do know you love your wife, and that its extremely hard to see a loved one in pain, but it *is* easier than being in pain yourself (with the exception of your kids, which I think hurts the parents worse). Please don’t think I assume you were uncaring towards your family, I am not saying this. I am asking if the decision looks different 1) as the non birthing partner and 2) in retrospect. (Some dads/partners are terrified of HB, while their women are not, so I know it goes both ways. )

          • I have no dispute with your first four paragraphs. As to the last part: I did not and would not push HB on a reluctant wife. If you saw her Twitter feed, which to this day is chock full of HBers (sometimes making her feel “less than”, unfortunately),, you would be quickly disabused of that notion.

          • auntbea

            But it is not just the risk that matters. In statistics/social science, we calculate the expected VALUE — which is the probability of the event multiplied by the value of the event. That way you can take into account the fact that something with a high probability of occurring does not have to factor heavily into our calculations if it is not particularly costly (e.g. paper cut) and a high-cost event needs to be considered more carefully even if it is rare (e.g. stroke). What you have here is a high probability of a bad event and a low probability of a terrible event.

            Let’s say the risk of death at home-birth is 1 in a thousand (a very low estimate). That is one thousand times less likely to happen than the 100% chance you gave for being separated from the baby. This lower risk, despite being lower, is only acceptable if you believe a dead baby is less than 1000 times worse than a baby taken to the nursery. That may be what you believe, but the rest of us think that’s nuts.

          • I am very familiar with EV, both from economics and from being an expert poker player.

            Combining the 2/3 figure with 1/1000 brings up 1/1500, correct? So that is roughly equivalent to the mortality risk of driving 40,000 miles. How long does it take you to rack up 40,000 miles on your car’s odometer?

            I don’t own a car.

            IOW, pick your poison: no one is free of guilt at putting their family at risk in one way or another.

          • auntbea

            I think you meant to suggest by this that homebirth is not very dangerous in absolute terms. But what you have succeeded in illustrating is that the risk of preventable death to your child in one day of homebirth is equal to the risk faced in about three years of driving a car.

            And, actually BTW, the NHSTA indicate that the risk of dying in a car crash is 1.1 in *one million* miles traveled. So, in other words, about 60 years of typical driving. But, you know, who wants to quibble about details.

          • Uhhhh…If the mortality rate were 1.1 per million miles driven, it would only take about 600 miles of driving to equal the HB 1/1500 increased mortality risk, which would of course even more strongly support my position. But that can’t be correct, although I don’t feel like going back to check right now.

          • theNormalDistribution

            Apparently you’re not an expert at calculating fractions.

            According to a cursory Google, the average american drives 33.4 miles per day. That means that the probability of dying in an accident on any given day that you decide to drive is on the order of one in ten million. Birth doesn’t happen over a period of years; it happens in a day.

            In other words, your baby is almost 2000 times more likely from a preventable home birth death than she is to die in a car crash.

            How you figure those risks are remotely comparable is beyond me.

          • I am very good at calculating fractions, thank you, as indicated by my perfect SAT score. Hmmph.

            Birth can only happen once in a person’s lifetime; therefore as parents a more germane comparison would be however many miles we drive our kids places before age eighteen. This “just one day” business is disingenuous horseshit.

          • theNormalDistribution

            If it were true that somehow you undertake some act that would guarantee that you drive for a lifetime, then maybe you would be correct. But getting in to a car is an discrete incident. It’s not possible to simply decide to get into a car for a whole lifetime. Each time you drive, you are taking a calculated risk. You can’t just compound all the times you decide to drive into one incident and compare it to something like deciding to give birth at home.

            On an unrelated note; I noticed that you often feel the need to tell people how intelligent you are. I for one, am not impressed. People who are actually smart don’t feel the need to talk about it, in my opinion. Plus, I’ve been witness to your Gish Gallop of specious arguments for the last few days.

          • I was defending myself against a slanderous (or libelous, depending on your view of message board communication) accusation regarding my mathematical abilities. Not just wandering around, whistling and casually dropping “hey, 1600…funny coincidence that it’s the president’s street address, and also my SAT score!”

            (And now you are comparing me to a creationist…how incredibly inapt as I am a hard atheist.)

            You are right of course that birth and driving are not precisely congruent or even close analogues. But neither are most things. The fact remains that you can choose, as we have, not to even own a car and be confident that this will over time translate to a mortality risk reduction as great or greater than that achieved by birthing in the hospital instead of at home (especially if you factor in the increased exercise).

            I mean, are you really going to assert that a risk reduction you can only “cash in” once, on one single day, is fundamentally superiour than one you can build over time to a greater magnitude? Does that mean you would shrug off the sight of a toddler crawling around the front seat of a car because on that one trip, there is such a low risk of an accident? Or if you see a grossly obese kindergartener sitting with her equally obese parents at the DQ drive-in, no big deal because after all, one trip to DQ doesn’t really matter over the long run? I reject that logic.

            And I counter it by framing it this way: if we as parents who attempted homebirths in so doing added X amount of “-EV” to our kids’ lives, fine–I will cop a guilty plea to that. But if we balance that with nutrition and exercise and avoidance of car travel such that our kids end up with a longer statistical life expectancy than the vast majority of kids who are born in the hospital, than where do any of you get off judging us? How do you have a leg to stand on?

          • theNormalDistribution

            Click.

          • KarenJJ

            I recently came across the saying “a high IQ and 50c will still only buy you a 50c cup of coffee”. I’ve been musing over it and decided that I really like it.

          • Ha, true dat. I have not monetised mine! Not everything is about money though (crazy hippie talk, I know).

        • Poogles

          “Noncredentialled juries decide malpractice and wrongful death cases.”

          I would like to point out, though, that those juries rely very, very heavily on the “expert witnesses” (doctors or other health professionals that specialize in the relevant medical field) that are called to the stand to explain the medicine to them, when making their decisions.

          • Indeed, and that’s how I see the policy statements I quote. Whereas Dr. Amy is more like the “expert witnesses” who get called up over and over by lawyers on the weaker side of the case because they are so rare in having credentials and being willing to testify on that side. I know whom I would find more persuasive were I on a jury; other “jurors” here are free to see it differently.

          • Susan

            Stop comparing Dr. Amy to Dr. Shifrin or I will have to stop giving you the benefit of the doubt.

          • thepixiechick

            If a jury gets it wrong it can be rectified on appeal. If a CPM gets it wrong during a homebirth – well some things can’t be rectified.

    • thepragmatist

      I’m just curious Alan. Has it been asked before? I noticed you said your wife has 3 c-sections… was this before the homebirth? If that is the case, indeed, you weren’t being intelligent or safe.

      • No, I think HBAC is an insane idea. This is the chronology (each time an OB is mentioned, it is the same one btw):

        1st child: ex-wife, attempted HB with family practice M.D. attending; transported to hospital for induction; child born vaginally in hospital.

        2nd child: ex-wife, induced by OB in hospital, C-section.

        3rd child: current wife, attempted HB with CPM, labour failed to progress, transported to hospital, induction, pushing stage, no dice, C-section.

        4th child: elective c-section despite OB’s urging to try for a VBAC.

        All four were 9 lbs.+, with head circumference beyond the 99th percentile.

        • Susan

          Just curious. With your second, it’s not unheard of to have CPD with a second baby when the first was born vaginally but it’s pretty unusual. Was that the reason for the C/S or something else?

          • The first involved six hours of pushing; with the second I don’t recall the initialism CPD being used (more like “failure to progress”), but it seems pretty clear to me. Keep in mind that all four of them were born with head circumferences between 15 1/2″ and 15 3/4″. My sister’s two kids were similar, both born via cesarean, as were my sister and I; my father and his brother; and my father’s father (no birth records, but his head looks enormous in his wedding photo).

            It would appear modern obstetrics has allowed a trait that would have been lethal until little over a century ago to continue to replicate in my family tree (my oldest son seems an exception, but let’s not forget he was induced and barely got through). This may be a peek into the future; if so, we had better hope we never descend into a dark ages, or the human race will die out. On the bright side for y’all, it will be the slow inexorable death of midwifery. 😉

          • KarenJJ

            It’s this eugenicist side of advocating for homebirth that I find very distasteful. If a baby can’t be born vaginally then it is somehow polluting the gene pool. Breeding for pelvis size instead of head size. None of it seems a very good reason for an individual to choose homebirth and if we were to descend back to the dark ages for some reason and lose the collective knowledge and tools of the past century or two, we’re going to have massive issues aside from giving birth.

          • You did catch that I am the one “polluting” the gene pool, right? I am not calling for someone to euthanise or sterilise me, LOL.

          • KarenJJ

            Sure, me too, polluting away. Why did you bring it up and do you think it is helpful to make health care decisions based on this?

          • Just musing.

    • Bombshellrisa

      I have to ask, how did the decision come about to seek practitioners willing to attend a homebirth? Was this a cherished idea of your ex wife’s and you support her? Did you feel that homebirth was the best possible idea and she agreed with you? I ask because my late father in law was the one who insisted that his wives seek midwives and have home births. Neither of the wives really wanted to go that route at first but in the end agreed.

      • As best as I can recall (this was 14 years ago) it developed mutually as we tried to find a way to prevent our baby from being taken away postpartum. First try was a birth plan with an OB (different one) but he shot that down. So we continued to explore other alternatives and found the HB doctor.

    • Sue

      ” there are plenty of dipshits involved in the HB scene. Plenty. But also more than their share of highly intelligent, well educated people.”

      Yes, nice, highly intelligent, well educated people can make irrational decisions too. That’s why we mostly engage professionals for decisions outside our areas of expertise.

    • Renee Martin

      If you actually read the current research, you would know that HB for the first baby is more dangerous and has excess mortality, transfers, and complications. You would be safe enough for the 3rd baby, if it was after 2 uncomplicated VBs, and was with a qualified MW who followed strict transfer protocols, had hospital back up, and was not to far from the hospital. (this is based off of several studies- Birthplace UK, the last accredited BC study- none of which address US HB! No stats on US HB are good. NONE.)

      I don’t think anyone is even saying that Hbers in general are dumb, they are saying that they over state (over believe) their knowledge of pregnancy, labor and birth. You can be a genius in IT, or another topic, but be wholly ignorant of obstetrics. Very smart people fall for lies too. There are also people who know the risks and do it anyway, which is fine.

      • Solid points.

  • The Computer Ate My Nym

    It’s interesting that the DK effect apparently works in reverse too: the highest quartile estimated their score/ability at about the same level as the lowest quartile. Apparently, absolutely everyone believes themselves to be just a bit above average.

    • Sue

      Wasn’t it Socrates who said that the key to wisdom was modesty?

    • Certified Hamster Midwife

      That part should be called the Lake Wobegon effect.

  • Are you nuts

    The phrase “confirmation bias” comes to mind. I don’t buy for one second that these women even did cursory Google searches to weigh the pros and cons of a home birth. Google “home birth safety” and the top headlines that come up ar “Home Birth Not as Safe as Previously Reported,” “Home Birth: Increasingly Popular, but Dangerous.” More neutral articles state that home birth can be safe IF the mother is low risk and IF under the care of a CNM, and acknowledge that safety studies are limited, and that if a complication arises during home birth, there would almost certainly be a more favorable outcome in the hospital.

    Of course, if you keep scrolling, you can find references touting the safety of home birth and the evil of hospitals and OB/GYNs. I’m certain that when these women say they have educated themselves, these are the only articles they have chosen to read. It really gets good when you happen upon a message board where these “educated” people lie to their providers to avoid “unneccessary interventions,” since of course our bodies were designed for birth, so we should completely trust the process.

    It’s perfectly fine to rely on a message board or blog when deciding which craft project to do for your Pinterest-inspired toddler birthday party, or which bento box you should make for your first grader’s lunch. But when it comes to how I bring another human being into this world, I would strongly prefer to take the advice of someone whose CV includes more than a screening of BoBB and attending a handful of births.

    • anonymous

      Yes…this is a serious issue…lots of ifs to consider…is it a risk for homebirth? No, IF you’re low risk, IF you are under the care of a CNM, and then there are the other IFs you forgot, like IF there are no further, unforeseen complications, and IF the mother manages to expel the placenta fully. My wife had a flawless birth in a hospital with our first, she was low risk and the like, delivered like a champ, but bled like a sieve. It was scary as hell to me, the OB was sweating bullets. I think when the dust settled they’d transfused a good amount of blood to her. Thankfully she was actually in the hospital.

    • They’ve educated themselves by reading only positive birth stories and watching videos on youtube. And by reading the multitude of happy-go-lucky birth blogs and facebook pages. Anything negative(like reality) was vehemently ignored.

  • Irène Delse

    (Delurking, here. Hi!)

    This is such a depressing story. I agree that Dunning-Kruger looks like a perfect fit for the attitude of the midwife, but as for the mother’s decision in the first place, I wonder. This looks so much like plain old denial, total mental block of the thing you’re afraid of, to the point of avoiding to prepare for the contingency of it happening. Like the people who are so disturbed by the idea of cancer that theya don’t do reasonable screening, or even ignore the lump on their breast until it’s too late…

    And sadly, it’s probable that her opposition to hospital birth was fueled at least in part to feelings of inadequacy linked to the pro-HB propaganda and its portrayal of unmedicated vaginal birth as the One True Birth (TM)! If you adhere to this ideology, having had two previous CS puts you in the position of a sinner in need of redemption, and a likely candidate for martyrdom.

    • jessiebird

      Good analogy!

    • Yes. I feel that my wife has to suffer from being subtly or tacitly shamed for her two caesareans (the second, “elective” one in particular), and that does irk me.

      • Optimistic Gues

        It irkes you? Not as much as dead baby or dead wife would.

        • Uhhh….yeah, so?

      • Anonomom

        Oh really? Perhaps this blog is hitting a nerve 🙂

        • Ausduck

          I think Alan is saying that he is irked when his wife is being shamed for having c-sections, not because she had the c-sections.

      • I don’t have a creative name

        What’s worse is women who buy into that shame. I’ve had 3 sections, never a vaginal birth, and I couldn’t be prouder of my beautiful scar that marks the place my babies came into this world. Women need to stand up to those who would try to present this as lesser birth, and worse, the babies born by it as lesser citizens. It has made no difference to us as a family at all. I’d like some of these people who make the snotty comments on FB, because, oh, I do see them in the newsfeed from time to time, to explain exactly what would be different or better about our family if I’d risked my children’s lives by attempting a vaginal birth.

    • I don’t have a creative name

      Great comment. There is definitely a cult-like attitude for so many of them.

  • Karen in SC

    It’s so frustrating to see examples of this, I don’t visit MDC or Babycenter any more. I remember a few occasions where Captain Obvious copied comments where people were insistent about giving medical advice that went against doctor recommendations. At least once, the baby was lost at term. A tough real-life lesson.

    • I don’t have a creative name

      I assume you’re referring to the diabetic whose idiot babycenter friends urged her to ignore her midwife’s advice to have a caesarean at 39w, and the baby died in utero at 39+2 or +3. I still feel nauseous when I think of that. Those idiots helped kill a baby, and they’ve gone on with their lives like nothing happened.

      • I thought Babycenter was super mainstream?

        • Durango

          Isn’t “super mainstream” the equivalent of “extra medium”?

          • Lol, ok: how about “solidly mainstream”? Better?

          • Durango

            Ha, yes.

        • Captain Obvious

          For those that missed it…

          http://community.babycenter.com/post/a34977562/might_not_get_my_vbac

          haleysmom1
          Pass a note
          Doctors are used to the 90% of women who will just fall in line and do what they say. Doctors think they are in control and they are not used to being told, “No.”
          Just say, “No.” Tell them you are educated and you understand the risks and benefits of doing a c/s for GD at 39 or 40 weeks and you choose to wait for labor. And then tell them it is not your place to “let” you do anything. It is their place to advise you of your options, and it is YOUR place to decide what is done to and for your body and your baby.

          http://community.babycenter.com/post/a35553793/my_daughter_passed_away_at_39.6_weeks

          haleysmom1

          I’m very sorry for your loss. There are no words.
          08/09/2012

          • Captain Obvious

            Forgot this thread were even the midwife wanted her delivered by 39 weeks. So much for BBC support.

            http://community.babycenter.com/post/a35312476/decision_by_tomorrow.long

            Decision by tomorrow.(long)
            monieday

            So my vbac friendly doctors i feel are not so friendly any more. They all are telling me different things and its frustrating. Background history. My water broke on its own with my first they induced me started over contracting at 3cm got epi, dd started going into distress end result csection. Never got past 3cm. This pregnancy i switched from an ob practice to a midwife practice. 1st appt with them was everything i was looking for. But when i found out i had GD they act like they couldn’t let me vbac at all. One midwife the one i liked scheduled my c section for me without me and it’s on my due date. Another midwife said i can’t go past 39 weeks. Another says we can’t do anything for you. Smh i want a vbac but i feel like just throwing in the towel i don’t think I’m dialed and i don’t think she’ll b here before the 9th. Ladies please help me!!!

    • Captain Obvious

      That same Haleysmom is giving out ridiculous advice. If she only knew how stupid she sounds and how dangerous her advice is.

      http://community.babycenter.com/post/a40328827/my_body_does_hate_me

      haleysmom1

      Your body does not hate you. Your baby does not hate you. Your doctor is putting you on a deadline. Your doctor knows full well that the stress of that deadline will actually stop you from allowing yourself to go into labor. Seriously…..you are full of stress horomones right now. What does baby interpret that as? Right…..danger….don’t come out now.
      Do yourself a favor. Cancel that c/s on Wednesday. You are not post dates until you reach a full 42 weeks. You can tell the OB directly that you don’t intend to have a scheduled c/s, that you intend to wait for spontaneous labor before even thinking about whether or not you will need a rcs, and that you will come in for NST in the meantime. OR….just call the hospital and say that “something came up” and you can’t make that appt that day. Then just be “unavailable” for any other scheduled day. Tell them you will have to get back to them. Then don’t until you are in labor.
      Then, just hang in there and relax. Do your spinning babies, start EPO if you haven’t already, get a chiro adjustment, get a pedicure, have a glass of wine, eat some spicy food, have some sex, do nipple stimulation, and bounce on a birth ball. All good things to do while you wait. Stay active, but get plenty of rest too. And just ENJOY each last day of being pregnant. You can do this. Don’t doubt yourself. You WILL go into labor if you give your body time to do it. No woman has been pregnant forever.

      • Dr Kitty

        Oh good grief, “have a glass of wine” and be “unavailable” for NSTs….totally safe.

        Someone should just follow her around and post “the last time someone listened to this nonsense from her their baby died”.

        • Has anyone confronted her about this?

      • “Do your spinning babies, start EPO if you haven’t already, get a chiro
        adjustment, get a pedicure, have a glass of wine, eat some spicy food,
        have some sex, do nipple stimulation, and bounce on a birth ball….”

        Blissfully indifferent to the idea that your child might be struggling to survive?

        Reasonable chance you will get away with it, I suppose. But how can you live with your own smug stupidity if you don’t? (If you are avoiding the cs, you are presumably also avoiding the checks on your child’s wellbeing.

        Is there no chance of good, accurate placental function tests being devised?

      • Captain Obvious

        Haleysmom is still in the 1990’s with 42 weeks is post dates, so wait til then. Yes, 42 weeks is post dates and some homebirthers feel there is no expiration date on their baby. But ACOG and other studies show nothing good happens after 41 weeks, especially in high risk patients.
        The recent ACOG Practice Bulletin on Preterm Birth 10/2012 states “the risks of perinatal, neonatal, and infant morbidity and mortality are lowest for infants born between 39 0/7 and 40 6/7 weeks of gestation”. References listed in the Practice Bulletin. And people like Haleysmom claim doctors are not practicing evidence based medicine.

  • attitude devant

    Interesting that the midwife’s defense is that she was there because otherwise mom would have tried a freebirth. A common justification, IME.

    • The Bofa on the Sofa

      Then again, it is also common to hear of stories where they would have been better off with a UC, because then they presumably would have called the doctor when things went downhill, instead of relying on bad advice to stick it out from a clueless MW.

    • Anonomom

      Sounds good to me. I’d much rather have a lay cardiologist massage and comfort me through a heart attack than have an unassisted heart attack.

      • The Computer Ate My Nym

        I keep reading this as “have a lay cardiologist do cardiac massage on me.” The image that brings up is…not pretty.