Birth workers

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Homebirth midwives, doulas and childbirth educators like to refer to themselves as “birth workers.” I find it an apt description that betrays the focus of their work and the massive gulf between them and obstetricians.

Obstetricians are health care providers. Specifically, they provide healthcare for women throughout the reproductive years, including, but not limited to: well woman care, contraception, sexually transmitted disease treatment and prevention, pregnancy care, childbirth care, care for pregnancy and childbirth complications, gyncologic cancer prevention, diagnosis and treatment, and care during menopause.

Most obstetricians, in keeping with the ethics of any profession, provide health care regardless of the beliefs of the patient. Moreover, professional ethics requires providing care in keeping with the patient’s needs and values, and disregards the provider’s values and philosophies.

Homebirth midwives, doulas and childbirth educators are not healthcare providers. They evince little or no interest in the health of mothers or babies. They typically provide no care outside of pregnancy, and very little care within pregnancy. Their purpose is to create a very specific type of birth experience, regardless of whether that experience is compatible with the health and safety of their clients. Their purpose is create a birth experience that the provider will enjoy and that will validate the provider’s needs and preferences.

They are the childbirth equivalent of wedding planners with one very important caveat. They will only plan the wedding of their dreams, not the wedding of your dreams.

If the childbirth experience of your dreams happens to coincide with the childbirth of their dreams, they’ll help you. Otherwise, tough luck; you’re on your own. They enter the relationship with primary purpose of entertaining and validating themselves. They are invariably “birth junkies,” women who enjoy the process of birth, and they are “workers” because they want you to pay them for entertaining them, and validating their personal choices. Indeed, some birth workers are quite candid about their lack of interest in the baby.

“Birth workers” ignore the responsibilities of real professionals. They don’t bother with a real education; self-study and a few seminars all the educational and financial investment they are willing to make in their training. They created credentials for themselves without the input of anyone else. They reject oversight of any kind. They reject regulation. They refuse to carry insurance. In short, they begrudge anything that might interfere with their ability to enjoy themselves and profit from the experience.

To give them their due, however, we should acknowledge that although they are ignorant of childbirth, science and statistics, they are brilliant at public relations. Like tobacco companies, they have managed to convince a segment of the public that paying them for their inferior and deadly products is a matter of “freedom” and “human rights.” And like tobacco companies, they are willing to lie and obfuscate in the effort to keep the profits flowing.

Birth workers are an industry, an industry devoted to their own profit and entertainment. They are not healthcare providers and they are not professionals. If you are worried about the health and safety of your baby and yourself, you would hire a healthcare professional, like an obstetrician or certified nurse midwife (CNM), who has years of specialized education and training, and is governed by state regulation and professional ethics that place your well-being above their profit and their preferences.

If, on the other hand, you care more about your experience than about the health of your baby or yourself, feel free to waste your hard earned money on a “birth worker.” She’ll enjoy the experience and hopefully you and your baby will survive it.

  • Anderson

    That moment when a Harvard-educated obstetrician forgets that midwives in multiple high-resource countries around the world are regulated, educated, and integrated into the health care system…and that this works well for obstetricians in those countries, because they can focus on providing the high-risk care they were actually trained to provide….so…awkward…

    • Azuran

      That awkward moment when someone parachutes into a post 4 months later without actually knowing the subject.

      Those midwives from other high ressource country you are talking about, those who are integrated with the health system, do exist in the USA. Those are CNM. They do work in hospital with OBs. This post does not apply to them.

      The midwives Dr. Tuteur is talking about are the CPM. People without any proper medical training who created a credential out of thin air for themselves.

    • SporkParade

      I live in one of those countries. The CPM credential is not recognized, and CPMs aren’t eligible for licensing. Any CPM attending a homebirth would be charged with practicing medicine without a license.

    • Roadstergal

      Even those midwives – the well-trained, integrated-into-the-system midwives, the midwives who are trained to a standard that the US CPMs could never meet – even they are causing problems. Midwives in love with ‘natural’ birth have a mounting body count in the UK, and a recent paper showed that low-risk women cared for by midwives in the Netherlands (home or hospital) have worse outcomes than high-risk women cared for by OBs. I would call that ‘tragic’ rather than ‘awkward,’ but you can pick your term.

  • Jacinta

    I’ve never read such non analytical writing, lacking of so much scientific evidence…guess because it is signed by MD and in a corner says Harvard, people will take seriously …. oh Drs and power issues. here they come again…

    • Young CC Prof

      Do you have a specific rebuttal to a specific point, or did you just show up to complain?

    • sdsures

      It’s her blog, not a medical paper being submitted to a journal. She can write whatever she wants to on it.

  • Disgusted

    “Most obstetricians, in keeping with the ethics of any profession,
    provide health care regardless of the beliefs of the patient. Moreover,
    professional ethics requires providing care in keeping with the
    patient’s needs and values, and disregards the provider’s values and
    philosophies.”

    The exceptions to that, of course, are the doctors who are pushing the no contraception/no abortion agenda. (This includes a small percentage of pharmacists and nurses as well.) Many people are appalled by such behavior, as they should be. Yet the same people often go along with seeing American lay midwifery as a free choice thing – even when it is a drearily common story to see midwives refusing to transport to hospital a woman laboring at home who is screaming in agony for relief. They even joke about it. If the first instance appalls people, the second should as well!

  • The not so natural doula

    Wow, I am a doula has has been reading your stuff for a long time. Sometimes I agree, sometimes I disagree.

    You see I am a doula who is shunned by other doulas because I am too medically minded and shunned by the health community for simply being a doula.

    I am a military wife who has delivered a baby on my own and recognize the need for a companion who will be with you through the entire experience, whatever that experience is. I feel as a doula it is my job to help the laboring woman and not push my own agendas. If you want an elective c-section, that is great, if you want to be induced early because of scheduling that is super cool. What you don’t want to breastfeed?! That is fine with me, I didn’t either- if it stresses you and your baby it isn’t worth it…

    I understand when you are a part of a group you represent them and get lumped in with them, I also understand that I am the minority. But I get really tired of the stereotype that all doulas push the natural agenda too far.

    • MT2

      You’re the kind of doula I would have hired if I thought they existed. But I feel like you’re about as rare as a unicorn!

  • Bomb

    I have a question for all you medical folks. My hospital (Summerlin in Las Vegas) is probably starting a new thing where there will be Drs in L&D 24/7 just in case. My OB says that the way they plan to pay for this is to make it so every patient *has* to see the hospital Dr when they come in. Dr they have never met, and charged an undisclosed amount for the privilege. So if you come in at 36 weeks with contractions, but they go away with fluids, the nurse can’t call your doctor and go home, you have to see the on call person.

    I can see the benefit when you think of stories like JenniferG’s, where having a doctor check on things instead of leaving it to the nurses would have made a world of difference, but it is also basically saying “Our nurses are incompetent and can’t be trusted to call in the Dr when necessary. My OB is against it, saying that it is unnecessary and just drives up healthcare costs (and he specifically had a problem with them not disclosing the cost to patients).

    What are your thoughts?

    • Karen in SC

      Don’t all hospitals have to have an OB on the premises? A few women may deliver before their doctor can arrive. Maybe a few have had no prenatal care and have no OB. Years ago, a friend’s brother who was an OB took extra hours “in house” to help pay for his med school debt. I was OB-less for about ten days late in pregnancy and didn’t worry; I assumed the hospital would have one there. (maybe I was wrong)

      More directly on your comment – there is a trend in the US is for care to be given by Hospitalists. My doctor had a falling out with our major hospital here since he was losing the billing for his patients that were in the hospital. The hospital wants that money, I guess they must mark up. He switched to the other hospital in town and when I was admitted overnight I was happy that he was the one evaluating me in the morning. Some advantages could be quicker response and treatment and coordination of records. And I believe the hospitalists (and their families) appreciate the set schedule and less on-call time.

      • Bomb

        I don’t know how it works. I thought they all had OBs on call, I’m not sure how this would be appreciably different if that is the case, but he made it sound like having them there 24/7 was new.

        • Karen in SC

          I had my boys in St Louis quite a few years ago and already OB practices were combining with other practices for weekend call. So in that area, you could very well get a stranger for your delivery if it was on the weekend. I chose a practice of 3 OBs for my second birth that didn’t do that and was able to meet them all beforehand. Perhaps the combined call rotation is an unspoken reason for some inductions and elective c-sections…pressure from the mothers so they will be sure to get a known OB.

          • Bomb

            As far as I can tell my OB would still deliver, but I’d also have to see the random hospital Dr in addition to him.

          • An Actual Attorney

            I don’t understand though — don’t nurses always have to practice under the supervision of doctors (with some small exceptions)?

          • Becky05

            Many community hospitals do not have an OB on site all the time. If there’s an emergency, the OB needs to be called in.

          • Guestmama

            My sister delivered an IUFD at a small community hospital and newly bled to death. She had a retained placenta and there was no OB on site. The nurses notified the OB that she’d delivered and asked him to come in, but they apparently didn’t think it alarming when the placenta hadn’t delivered an hour later, and she was periodically gushing large amounts of blood. I’d left the room and came back to find my sister pale and losing consciousness. I asked the nurse what her blood pressure was and she slapped a cuff on – she hadn’t even been monitoring it! And it was dangerously low – something like 60/35. Had to yell at them to get that OB in there stat…thank God he arrived moments later and did an immediate D&C right there in the room, no anesthetic. The whole thing makes my blood boil. That hospital gave the illusion of safety – it was worse than nothing, because people trusted them to handle OB emergencies. A small, negligent nursing staff with no oversight (sound familiar?) plus no OB on site was a recipe for disaster. They did eventually shut their L&D department, thank God. Personally, I chose a tertiary care center with a laborist model of care, and I couldn’t have been more pleased. Safety trumps all.

          • Guestmama

            Nearly, not newly. And sorry for no paragraphs – I’m on my phone and it’s being ornery.

          • Dr Kitty

            This I don’t understand.
            The NHS is run so differently.
            If you have a labour ward you have junior doctors on site 24/7. You may not have a consultant 24/7, but you have a Registrar who can do an emergency CS and the consultant on call has to be there within 30mins if called. The idea of having a L&D without a doctor on site at all…very odd.
            I much prefer the idea that a Dr has to cast an eye over a patient before they can go home, than that the nurses ring their OB at home to rubber stamp a nursing decision to discharge.
            From GP (where we do a LOT of telephone consultations), I know that seeing a patient is very, very different to speaking to them, or a nurse, on the phone.

          • AmyP

            Remember the US has way lower population density than the UK. The first number I saw on the internet had the UK being nearly 8 times denser than the US (650 per square mile versus 84).

            My home town in the US delivers babies, but my mom went to the town 60 miles away to deliver her three kids because she didn’t have confidence in the local hospital. That seemed a bit weird when I was a kid, but more and more, I think she was right. (Home town has a population in four digits and the city with the better hospital is in five digits–hometown probably doesn’t deliver enough babies to be good at it.)

            Now, if you needed to be fixed up after an unfortunate chainsaw accident, our local ER would be exactly the right place to go. They see that stuff all the time.

          • Dr Kitty

            Northern Ireland has population of 1.8million, of whom about 600,000 live in greater Belfast, and covers an area of 5000 square miles.

            Outside of greater Belfast we have five maternity hospitals(Causeway, Daisy Hill, Altnagelvin, Antrim, Craigavon) and one of those is still less than 20 miles from the city centre.

            If you decide your hospital is delivering babies it makes more sense to staff it properly, because one malpractice suit would pay a doctor’s salary for 20 years.

          • AmyP

            I was just looking this up. Apparently, Northern Ireland’s density is something like 133 per square mile. If my numbers are correct, that’s 50% denser than the US. Also, our averages cover everything from Manhattan to Northern Alaska.

            In the case I was mentioning upthread, the hospitals were literally 60 miles apart, and in the opposite direction the nearest hospital was 99 miles away. That’s a lot when you’re having a baby or some sort of obstetrical emergency.

          • Dr Kitty

            And why not having a doctor on site 24/7 makes no sense to me. if you can’t transfer to another facility in a timely fashion, you need someone THERE.

          • Disgusted

            Yeah… my mother was a nurse for years in our small town/rural community. When a baby was born there with a problem, it had to be airlifted to the city, which was an hour and a half drive away (without traffic) and the helicopter was much faster. I’m not sure any place so rural exists in the UK – maybe northern Scotland?

          • Bombshellrisa

            In a hospital setting, the nurses are under the supervision of their nurse manager.

      • Becky05

        Many community hospitals do not have an OB on site 24/7.

    • Becky05

      I personally think an OB on site is very important for safety reasons. It can make the difference between life and death in a time sensitive emergency. I think the OB hospitalist/laborist movement could have some very real benefits. But maybe I’m spoiled by delivering in teaching hospitals where this is just standard?

    • Becky05

      This has an overview of different ways of setting this up, how it might work and how it would be funded. http://www.acog.org/About_ACOG/ACOG_Departments/Practice_Management_and_Managed_Care/The_Laborist___A_Flexible_Concept

    • fiftyfifty1

      I personally would always choose to have my baby in a hospital with 24/7 OB (and anesthesia) coverage. I’m not sure about this “undisclosed sum”. But I do know that most insurance plans in the US don’t charge women any co-pays or fees for visits prior to birth, because they want to promote prenatal care. My guess would be that this money will be coming out of your OB’s pocket, not your own. Also, I personally don’t care that much who delivers me and if I’ve met them beforehand. I would rather have my baby delivered by an unknown but rested OB than to be delivered by a known, but potentially sleep-deprived OB.

      • LovleAnjel

        Ahhh, that’s why I have one $40 copay for everything. They also let me pay it whenever, didn’t have to be at the first visit. I was wondering about that.

        Personally, I have no problem seeing a doctor I have never met. I have no problem taking my cat to a vet I/he has never met, my car to a mechanic I/it has never met, ect. To me, getting seen and taken care of is more important than familiarity.

        • The Bofa on the Sofa

          There is actually a good argument for _non-familiarity_, especially in something like OB/Gyn.

          Think about how comfortable you are talking with a friend about issues with your private parts. A lot of people express concern about having a total stranger looking up your wazoo, but I have to wonder, would you REALLY rather have a friend doing that instead? Sure, you might want a spouse to do it, in a sexual context, but that’s not what you want from a doctor. Moreover, it is very important with a doctor that you can talk open and freely about yourself and your body.

          Personally, I don’t want to be friends with my proctologist. I want him to be a complete stranger. Knowing s/he is going to forget about me after I leave the office actually makes it easier to be honest with him/her.

          • Disgusted

            I think some of these first time moms think that’s going to be much worse than it is. There’s this effect that is usually referred to as “loss of modesty” about the time baby is coming out. In other words you simply don’t care if 2, 10, 30 people are staring between your legs. You just want the whole thing over with!

        • Dr Kitty

          There is another issue with familiarity.

          Think of the family members who see their teenage daughter everyday, but don’t notice her gradual weight loss, until a friend, who hasn’t seen her in a while remarks on it.

          If you see your doctor every week, they may not notice your gradually worsening pallor or jaundice or weight loss, in the same way.

          I cover maternity leaves, sickness, annual leaves etc. I don’t know the patients, which, while sometimes problematic, means that I HAVE to be thorough, and sometimes looking at things with a fresh pair of eyes is a good thing.

          I don’t have issues seeing Doctors I don’t know, and I don’t see Doctors as a patient that I know socially if I can possibly avoid it.

          • The Bofa on the Sofa

            Well, even if the doctor is a friend, at least they should be charting your weight, right?

      • Bomb

        The fees are in addition to anything my OB would charge. He wouldn’t lose any money.

    • Captain Obvious

      Have you seen how much autonomy has been taken away from nurses? Doctors are reprimanded for given verbal it telephone orders. Doctors have to write specific orders now for prn meds. Cannot write prn with giving a diagnosis reason or if it is a pain med, you have to assign a level of pain that the nurse can give it. Cannot write 1 or 2 pills or 4-6 hours on prn meds, you have to be specific. All this makes the nurses look incompetent that they cannot use their nursing skills to make decisions. There are more rules that take away from nurses clinical judgement, just in a hurry this am.

      • Lori

        Yes, this is becoming an issue in our area too. For instance, I used to be able to give a one time dose of certain PO meds during the night shift and flag the chart with a note so the attending is aware and can write orders for it. They did away with that now and I am getting pretty tired of taking attitude from the on call doc who is pissed about being woken up for prn Tylenol or Gravol. Likewise we now have to phone an md within 1 hr of a critical lab result being posted. Have gotten sniped at for that too, but my employer doesn’t ask me to cosign on their policies. And if I sound bitter it’s because I very much am. We have working brains for crying out loud, let us use them!

        • Eddie

          I’m curious, what do you think is driving this? Do you think it’s fear of malpractice, so just going crazy on overdocumenting and overauthorizing everything? Or do you think it is some different motivation?

        • Bombshellrisa

          I am in the same boat-and I know what you mean too about calling critical labs. Remember when there was a such thing as “nursing orders” and you could write one?

          • Durango

            “Nursing judgment” seems to be falling by the wayside. Don’t need much schooling if we have no leeway.

          • Lori

            Well I graduated in ’05 and I remember discussing such a thing but no, sadly, I have never actually done the nursing order thing in practice. When I worked in critical care there was the expectation to do certain interventions without calling, for example, it was sort of the unwritten rule that you never paged a doc for hypotension unless you had first given a “nursing bolus” but that was not sanctioned by the hospital. Anyway, to the person above, I in part blame the shift for the hospital to save money by cutting on staff. Where I work they have upped beds but not RNs meanwhile cutting out our support staff meaning nurses have an increased workload and, as expected, incidents increase. That combined with the fact new nurses are under tremendous pressure to accept full patient assignments ASAP with what I consider to be woefully inadequate orientation time has I think pushed the hospitals to attempt to reduce (or at least make themselves less complicit in) serious errors by invoking all these, “doctor may I?” policies.

  • Certified Hamster Midwife

    Reddit AMA with an OB nurse. Guess what the top-voted question is?

    http://www.reddit.com/r/IAmA/comments/1ayjfg/iama_nursery_rn_i_go_to_vaginal_deliveries_and/

    “[Homebirth is] too risky. Midwifery is great.”

    • Susan

      The questions there are kind of funny and sort of pathetic too ( all the paternity stuff ). Pretty new nurse answering them all too.

      • Certified Hamster Midwife

        Yeah, well, that’s Reddit for you.

  • I don’t have a creative name

    Just seen on FB:

    Doctors say “I’m a doctor.” Nurses say “I’m a nurse.” Technicians say “I’m a medical tech.”

    People who say “I work in the medical field” have probably not gotten
    any closer to a patient than shoving their records in a fax machine and
    then dialing the wrong number. This doesn’t stop them from giving advice
    on Internet forums.

    • Sarah

      Actually I say ‘health’ because my job is specialised and sometimes I don’t want to go into details. I do work in a clinical role but it can be hard to explain what I do

      • Guestll

        My sister says, “I work in the medical field” sometimes. She’s a PhD level epidemiologist specializing in women’s reproductive health and there are times when she doesn’t want to go into detail.

    • Gene

      I saw, “I work at the hospital” or “I work in the ED”. People act differently around me (sometimes) when they find out I’m a doc.

      • Sue

        Same

  • Charlotte

    OT, but a new crunchy trend has infiltrated my social circle and now I’m starting to get judged for not doing “baby-led weaning.” It’s where you don’t start your infant on solid food with “unnatural” purees, spoons, or fruit/veggie combos, but give them huge chunks of adult food to chew up and eat. Preferably hard, because soft pieces they can gag on when they gum off a big piece. All I can find out about it is message boards with people asking if it’s okay that baby-led weaning makes their baby gag multiple times per feeding, and people responding that frequent gagging is safe and good because it prevents actual choking, thereby making it safe to give your baby uncooked carrots and apples. The only scientific study I found said it could lead to nutritional deficiencies in babies who develop late (like mine). Anyone else just now hearing about this? Is it woo? Is it silly but harmless? Am I wrong for being skeptical of it? Anyone have any personal experience with it or actual facts about whether it’s really beneficial or safe? The whole “gagging is safe” thing sounds too woo-ish to me, particularly when every other baby book i have ever read said uncooked vegetables are a choking hazard. Maybe it’s the fact that these people are just as outlandishly judgey as believers in other woo that’s throwing me off.

    • anonomom_LLLL_IBCLC

      I think this is yet another case of something normal being twisted around into some kind of fetish. I never did purees, but I didn’t know that was a “thing” and I just used my judgment about what foods my baby would be safe with and enjoy. If my child gagged on something, there’s no way I would have given it again. I mostly did it this way (a) because I’m lazy, and (b) because I think purees are expensive and gross.

      • thepixiechick

        Amen to this.

    • Rochester mama

      Some parts of baby led weaning are definitely woo in my opinion. I’m all for soft mashed and not puréed to death food and baby eating close to what the family eats, but giving hard chucks of apple etc… seems nuts and goes against common sense. Trust your health care provider or a well researched baby book, not random strangers on a message board.

    • Rabbit

      Do they throw in a bunch of “before one, it’s just for fun!” proclamations? Drives me nuts. Also the insane judgment when you reveal that you did not wait until 6 months to start solids. My daughter was greedily eyeing solid foods around 4 months. She gobbled up any and all food except green beans when we actually started giving her purees and mushed up soft foods at 5 months. She didn’t have the coordination to bring the food to her mouth until much later.

      Baby led weaning would have led to a hungry, frustrated baby in my house. And gagging would have scared me too much to keep letting her try the foods that she clearly couldn’t chew up enough before swallowing. Also, am I the only one with a baby who is upset by gagging? Gagging scared her as much as it did me. I can’t imagine encouraging more gagging.

      • Olga Mecking

        I am with you on gagging. My younger girl is 2, and can still gag on food sometimes, especially when she has a cold. It is still scary

      • Sullivan ThePoop

        They started my nephews on solids around 4-5 months and they also told her to give them yogurt at 6 months and peanut butter as soon as they are physically able to eat it. It has to do with all the new information we have on allergies.

        Also babies have a weaker immune response in general because it has not been built up yet. Since allergic reactions are aberrant immune reactions they are also weaker.

        Another thing that was recently discovered is that even allergy prone children develop less food allergies the sooner different foods are introduced.

      • Jen

        How interesting – all I’ve heard from medical professionals (our paed, the local maternal and child health nurses) is that food under one is for fun. I just take that to mean not to get too stressed if he didn’t like something or some days he was keen for food and other days not so much.

    • Lisa the Raptor

      You can’t do anything right with these people. My daughter was grabbing food at 4 months–should I have given her a pizza?. On the other hand I once saw a woman who was bitched out because her daughter weaned at 14 months. The other lady said that kids never wean on their own until two. She stated that the reason the 14 month old had weaned was because the woman “Must have had snacks and cups of milk around her house” If breast milk is all there is to eat then of course the kid will eat that. Baby led weaning to me is when a kid makes the choice to eat other foods instead of breast milk…but that’s just too damn logical I guess. .Which is sad because by that age kids are so into being “big” and are so proud of themselves when they do big things like their parents and siblings. It’s sad that some parents won’t let this happen.

      • auntbea

        Every. single. person. who I know who did baby-led weaning gave their baby pizza as the first food.So, yes, you should have let your baby have that pizza.

        • Jessica

          This made me laugh out loud. My son resisted solid foods (we started with purees at six months) so much that I began to wonder if I would be breastfeeding until he started kindergarten. Then in the space of three days he showed an interest in our food – lunging for the nachos my husband had picked up at Taco Bell one night, and then a few days later, lunging for the slice of pizza I was eating while holding him at my husband’s work party.

      • EllenD

        Of course, you only should give your daughter that pizza if the crust was either whole grain or gluten free, topped with sauce made from the bounty of organic heirloom tomatoes harvested from your backyard and cheese made from your own breastmilk (or donor breastmilk). Otherwise, that pizza has no business even passing your lips.

    • I don’t have a creative name

      Oh yes, all the sanctimommy a-holes are big into BLW and sneer at those of us who do – gasp – those filthy purees. I LIKE knowing my kid isn’t going to choke, and getting to more solid foods a little later certainly hasn’t held my kids back in any way.

    • JenniferG

      We all want there to be one true way to have a child who loves healthy food but you know, there isn’t. So whatever these people are telling you is just their opinion. It’s like the paleo diet…really hard to tell how great that diet was for people when they didn’t live past 40 anyway. It’s the same for whatever people used to do with babies when they didn’t have blenders or were having to put their energy into subsistence level farming or surfdom, and when babies were seen as lower on the totem pole for food resources, not being productive members of the family yet in a pre-birth-control world. Maybe literally tossing the baby a bone wasn’t some kind of idealistic naturalistic understanding of The Way Babies Learn but rather the fact that other kids were really hungry first.

      Well that was a rant.

      I think it’s fine to let a keen baby have stuff that isn’t going to block his or her windpipe if that’s what you want to do, but there’s no benefit to taking risks.

      • Anon

        You really make an excellent point about wanting one true way to so things with babies, and I don’t think that’s restricted to eating. I think it’s a combination of needing to know you’re doing things “right” (bc even on my third child, babies are seriously neurosis-inducing) and because, also? Dang, babies are a lot of work. Don’t we want to believe something we’re doing will have lifelong benefit? When, realistically, as long as we’re meeting their basic needs, there’s really nothing we do that will make them any more likely to go to Harvard or play in the NBA than nature already granted them.

        • anon

          OH, and also? I made my kids’ baby food because I think it’s fun and because in a lot of ways, it was more convenient than buying jars. They quickly transitioned to eating overcooked/unpureed chunks, which they fed themselves, especially my second. And now, at two and four years old, they are just as awful about eating as any other kid their age. last week I made a veggie casserole I found online and my two year old walked into the kitchen yelling “dinner!!!”, saw what was on the plate, and literally ran from the table crying. Sooooo, yeah.

          • Amy M

            hahahaa!! I made some of my children’s baby food–I had a food processor so it was easy to do fruits and veggies. We also bought some jars. I never understood why people insist that jarred baby food is full of crap. I read the ingredients. It was fruit/veg of choice and water. That’s it. No added sugar, salt, food coloring….I also read the ingredients on the formula box, and there was no corn syrup of any type in it. Where do people get this stuff from?

            Anyway, my boys ate mashed/pureed starting around 5mo and they got those puff cereal thingies and softer food (like steamed carrots/peas) soon after, eventually working up to being able to eat small pieces of regular food. Now they are 4 and I lament that they now refuse veggies, when they used to eat most of them, incl green beans, with gusto.

          • Kalacirya

            Well for certain people, they think that because it’s not organic, it’s toxic. Then you have the people who think that the heating in the canning/sealing process destroys all the nutrition in the food. Those are the two main threads of logic I see as to why regular baby food is somehow verboten.

          • Jen

            I used to buy the organic baby food – because it was cheaper than the other stuff!

          • The Bofa on the Sofa

            I never understood why people insist that jarred baby food is full of crap. I read the ingredients. It was fruit/veg of choice and water. That’s it.

            Yep. And if you taste it, it tastes like whatever it is in the jar. Pea taste like peas. Green beans taste like green beans. Carrots taste like carrots. Etc (my favorite was the prunes)

            I tasted every baby food before the kids ate it, because I said I would never make them eat something I wouldn’t be willing to eat myself. It’s been tough, since there are things I don’t like, and it’s not like I eat them all the time or anything, but I tasted it all.

          • fiftyfifty1

            Because baby foods commonly did have other ingredients in the past (salt, sugar, starches etc). Now they don’t.
            The prunes are good, but the pears are even better. My kids both loved the green beans.

          • The Bofa on the Sofa

            But this just kind of highlights the point. The pears taste like pears, the prunes taste like prunes. Since I like prunes but not pears, that is reflected in my preferences for baby food. Similarly, I find the baby food peaches just as obnoxious as I find regular peaches (although without the nasty texture, so better in that respect).

          • auntbea

            Even the pureed meat?!? DO NOT WANT.

          • The Bofa on the Sofa

            I agree with auntbea. I TRIED the meats. They were awful. Consequently, I did not hold it against the kids if they refused to eat them.

          • Josephine

            Haha! Well a small secret, Josephine isn’t my real name (I just prefer it A LOT to my given name and I use it around the internets), so I don’t get a pass on anything. And okay, the meat is…the least delicious of jarred baby foods. I’ll concede that much!

          • Josephine

            Oh good, I’m not the only one. I thought I was being a bit weird, but I didn’t want my baby to eat anything gross. I even tasted some of the meat ones and though obviously I prefer my meat in its original cooked texture, it wasn’t bad at all.

          • EB

            I made my kids’ baby food, too. It was fun and cheap and healthy.

          • Dr Kitty

            I think the idea of mashed and pureed food as a transition to solids makes a huge amount of sense.
            It must be a huge shock to go from bland milky liquids to being given a piece of raw carrot and left to get on with it.

            I bought good quality baby food and my kid loved it. At the time she was 6-9 months old I was working in a Paediatric ER with long, unsocial shifts, and coming home at 2am and making baby food was not on my agenda. I liked online shopping and having my groceries delivered weekly, knowing that there was always something she could eat in a cupboard. My husband does not cook- he can heat up in a microwave or oven, but he can’t cook. BLW would not have worked out for us.

    • kumquatwriter

      My son flat out refused most soft/pureed foods. He ended upneatonf whole apples happily before he was even 1. Drove me crazy with worry.

      • auntbea

        I tried to figure it out, I really did..but, upneatonf?

        • suchende

          up eating only?

      • kumquatwriter

        My phone had some kind of … Episode. I couldn’t make a second comment to fix it. He ended up eating was what that was supposed to say.

    • mimi

      If your baby is at least 4 to six months and is hungry or reaches for food, feed it, even if it is pablum or mashed. You eat and enjoy mushy food like mashed potatoes and pudding, babies can eat mushy baby food too. There was actually a doctor in the 1800’s who used to make a living extracting various foods from the throats of small children. http://en.wikipedia.org/wiki/Chevalier_Jackson

    • I think some of the ideas expressed by the book (do lots of different textures from the start, don’t worry about “stages,” do real foods when possible) are good. However, the “spoonfeeding/mushing-up-food-is bad” thing is horse manure. People have always mushed up food for babies–like prechewing in societies with no blenders. It makes sense to offer foods in various ways. Also, “food before 12 months is just playtime and it doesn’t matter how little they eat” is crap. Once babies are much past 6mo it starts to become important that they eat nutritious iron-rich food as well as breastmilk/formula.

      • Olga Mecking

        Yes, but you know what? We sometimes eat mashed food as in cream soups and pudding! Why wouldn’t our children?

      • auntbea

        My friend asked her pediatrician about baby led weaning. The doctor said, “Sure. You can feed her any non-pureed food you want. Just as long as you puree the shit out of it first.”

    • theadequatemother

      The pedi nutritionist that came to talk at the mom drop in group run by the public health office encouraged us to serve both finger foods and purée type textures right from te start. If you wait for 6 mo most babies can handle some finger foods. I started with things like bean burgers (like a purée in texture but grab able) and peeled cucumbers. Once chunks got bitten off we didn’t offer things that could lead to choking. BLW is fun, but I think combo feeding with some stuff that you spoon is better…because then stuff actually goes down and you don’t have to worry so much about iron deficiency etc.

      I’ve done enough anaesthetics for rigid bronchus in babies and toddlers for the removal of various items that I think it’s best to be cautious. Otoh you can’t always predict what is going to cause a problem. My friend the pedi we doc’s last bad case of choking was a large wet bread blob that obstructed the entire trachea!

    • Oh…. and when offering chunks, I applied the “tongue-squish” test. If you can squish it against the roof of your mouth with your tongue, they can eat it on their gums. If it’s harder than that, then grate it, hash it with a fork or blender it.

    • antigone23

      What annoys me about it is how the crunchies have now decided that baby food is akin to “junk food” and insult everyone who doesn’t want to do BLW. Standard purees have nothing in them besides the fruit/vegetable and water and possibly some vitamin c to prevent browning. It’s ridiculous to act like they are equivalent to junk. I have no interest in BLW. My daughter did start eating some table foods at 9 mo, but I always selected carefully and gave her things that were quite soft in amounts that she could actually eat. When I see BLW people proudly giving their infants whole heads of broccoli or chicken legs, only for most of it to end up everywhere, I am really horrified. I can’t afford to waste food like that, nor do I have time to clean up that kind of mess every meal. Give me spoon feeding any day.

      • Klain

        A friend just had an operation which restricted what she could eat, so she bought baby purée sachets of vegetables and complained that they had been sweetened with apple juice.

        • CarolynTheRed

          We’re starting solids soon, and noticed the percentage of the purees that had pear in them is pretty high. Not a horrible thing, but the fruit/veggie mixtures seem to be aimed pretty sweet. I haven’t decided how I feel about that.

          • EB

            If you buy a butternut squash peel and cut it into small chunks and steam or boil it until soft (about 20 minutes total work, make it 30 if you do three different veggies), throw it in the fridge, you have your veggies for the week. (Leave in soft squishy pieces for finger food, run through the food processor for puree.) No added sugar (pear juice, corn starch) and they will eat it cold and it travels great (toss it in a little tuperware thingy, no waste). Costs about $1 for the week.

          • LovleAnjel

            Any winter squash, actually. After you puree, put it in a colander over a bowl for a day to strain out excess water. If your kid doesn’t like it, make a pie with it instead.

          • Jessica

            The first thing that came to my mind is that babies starting solids frequently become constipated (my son did) and I wonder if the pear is meant to counteract that while still tasting sweet enough to get baby to eat.

      • thepixiechick

        I did it with both my kids, but more so my youngest out of simple necessity. The child would.not.eat.from.a.spoon. No how, no way. Unless it was self service, he would not participate. He was totally uninterested in solid food until about 9 months anyway, despite my futile attempts. I did it with my daughter to a lesser degree I probably should have fed her more puréed/mushed up food as it was a bit frustrating for both of us at times. It worked out fine in the end for both of them.

    • EB

      I fed babies large chunks of stuff they could gnaw on (carrot and apple, plus hard-toasted multi-grain bread, starting about age five months). I just did it because, I never had a name for it. Worked for us. There are as many right ways to raise kids as there are kids. Honestly, I see pretty judgey stuff on this board, too. We all have our opinions.

    • quadrophenic

      Question, how do you feed table food with little or no teeth? My daughter is 9 months with no teeth. I started her with purées at 5 months, then at 6-7 months she refused solids altogether. About 7.5 months she picked up with purées again and loves yogurt most of all. Because she still has no teeth I’m wary of anything that’s not mashed. So yesterday I decided I’d try those puffs that dissolve so maybe she’d start practicing mashing with her gums for when her teeth come along. Well she still wasn’t interested. Picked it up (pincher development ok) and plays but no interest in feeding herself. I’m scared to try anything else for fear of choking, but she has no teeth and I don’t want her delaying learning to feed herself.

      She also never latched so I wonder if she’s just weird about eating or if there’s a mouth issue. The ped said if no teeth at 12 months to go to a dentist so we’ll see. It’s just weird. Luckily she loves her bottles and is 90th percentile in weight so it’s not like she’s starving if she doesn’t pick up on her solids.

      • Awesomemom

        I just fed soft things like canned veggies and pasta. Stuff that could be gummed with out too much trouble. I chopped stuff up into smaller chunks and let them go to town. If they ate a ton great, if not no biggie.

      • Josephine

        Eh, you’d be surprised how well they can gum things if they’re reasonably soft. A section of whole wheat toast with a little butter, soft-cooked carrots, scrambled eggs, avocado, banana slices, etc. At that age my little guy enjoyed sucking the juice out of orange segments too (though you have to watch that more closely). Anything carby can be broken down reasonably well with enough gum mashing and drool, like Cheerios or pancakes. Those yogurt melt things are loaded with sugar, but using them to get her interested for a short time or as an occasional treat isn’t a bad idea, either.

        • quadrophenic

          I’ll have to try with bananas since she eats those mashed and will be used to the taste.

          I thought eggs were a no no before 1? Or did that change? I can’t keep up.

          • theadequatemother

            As I understand it, unless you have a family history of food allergies, the only things off limits are choking hazards (ie whole nuts, grapes, hard pieces of veg like carrots). It was suggested that parents wait to feed allergenic foods like eggs and peanuts and treenuts but that strategy hasn’t decreased food allergy. In some countries these foods are given to young babies and there is less allergy (peanuts in israel for example).

            My kid’s second food was challah. He could eat his weight in challah.

      • auntbea

        Have you tried those transition jarred foods that have the bigger chunks in among the puree?

        • quadrophenic

          I was going to pick some up next time I’m out. I don’t cook at all so I need to investigate what gerber has to offer.

      • VeritasLiberat

        My 9 month old liked those goat cheese crumbles you put on salads. Also baked beans and steamfresh peas, well cooked. One week she ate almost nothing but watermelon chunks.

      • Eddie

        My youngest got her first tooth at about 15 mo. At one year, with no teeth, her ped said no rush, wait, although I forget if she said wait to 15 or 18 mo before investigating. At 19 months she only had 6 teeth. All her baby teeth did come in, and they’re all fine. I’ve read that it’s hereditary … if parents got their first teeth later, their kids are likely to as well. My first teeth also came in after 1 year.

        I’m surprised to hear a pediatrician would say at 1 year, investigate “no teeth yet,” but I guess I’m only surprised because our youngest’s ped was so unconcerned about it. I’m not telling you what you should do, just giving my experience.

    • Minerva

      When I was breastfeeding I asked my best friends sister (with 3 kids, follows the NCBing circle) when she started with solids because my LO was hitting 10 months and I wanted to get an idea. She emailed me back “at around 2 weeks, LOL” and was dead serious. Makes me want to bang my head on the wall.

      • The Bofa on the Sofa

        I was talking to my aunt after our first was born, and was about to start solids in the 4 – 5 mos range. I asked her, when did her kids have their first solid food? She said, she gave them mashed potatoes in the first week.

        Then again, that’s what they did back then (see, my aunt was 90 years old at the time, and her youngest was somewhere around 50).

        • Minerva

          Yes but this was last year and her oldest is 6 years old. With everything we know now I will never understand putting your kid in any danger for brownie points with your NCBers, eg: home birthing, anti vax, pushing solids, etc.

    • Renee Martin

      They actually think that the baby will “learn to chew before swallowing” only if it’s BLW, but not if you use purees. Because there are so many people out there that never chew food before swallowing it….. they really believe this will protect their baby from choking!

      They also say BLW is “so easy”, which is how they frame lots of their time intensive practices (baby wearing, BF). I was going to try BLW simply for this reason, then I saw how much work it took, plus all of the scary stuff about gagging. Yeah. Nothing simple about it, the way it’s suggested, with many different food choices and textures. You have to make complicated mini meals, nothing easy about it. We usually just give the baby whatever we are eating, squished up, plus some purees and small finger foods, but I think this is too boring for the crunchy crowd.

      Like most things in this subculture, they take a common sense idea many people already do (carry fussy babies, feed when baby is hungry, feed baby the food you eat) and take it to a whole ridiculous level, with lots of misinformation and justifications why their practice is best.

      • Amy M

        I remember when I heard of BLW, and I thought it meant giving baby solid foods (incl purees, soft, etc) when baby showed an interest in eating it. As in, waiting for the baby’s cues that he/she wants real food as opposed to breastmilk or formula all the time. So, when a crunchy online acquaintance mentioned BLW, I was like “well, yeah of course I’m doing BLW, I wouldn’t shove food down the kid’s throat if he showed no interest in eating it yet”. Mine children showed interest around 5mo, so that’s when we started offering solids. I couldn’t understand what the big deal was. Then she posted a pic of her baby with a giant stalk of broccoli and I was thinking “really? Do you honestly think your daughter will eat any of that, and get any nutrition out of it?” Letting her gum it, sure whatever, but I agree with someone’s earlier post: what a waste of food.

    • Olga Mecking

      Don’t get me started on that. I tried BLW at six months, convinced that it is the way to go! Ad you know what? She wouldn’t touch it! My younger daughter has sensory processing disorder and would choke on the smallest things for a long time. So what to do? Exclusively brestfeed until they’re a year old, which could lead to iron deficiency?And you know what? Now my girls eat more or less anything, are not picky (although my youngest daughter sometimes is), and are fine. If BLW worked for some people, great, but I am so tired to hear how much superior it is!

      • Charlotte

        My oldest has SPD as well, and was also two months premature so she gagged or choked multiple times per feeding (even formula or breast milk) until she was over a year old. Choking to death was a daily fear and a very real threat, since I have two other preemie mom friends who had to call 911 and go to the hospital because theirs choked. I have such a hard time imagining how BLW could be safe even though I can’t find any reports of a baby actually dying from it.

    • Lori

      I sort of did this before finding out it had a name. I never read the books on it so I can’t comment there but I was following the standard BF/formula for 6 months from the doctor when at 5ish months she became a snatcher, so I let her snatch and gum soft foods, then at 6 months she wouldn’t eat purees at all. We wasted so many opened but uneaten jars of baby food I just said forget it and mushed up whatever we were having and she ate like a horse. It makes life easier in one sense because they feed themselves so my hands are free but the mess is of course worse, so there’s your trade off. I never heard about spoons being bad or not mushing the food for them but that may be because I never read the book.

    • Guestll

      My mother did Baby Led Weaning with me. Except she called it, “I Have Three Other Children And a Husband To Feed And I’ll Just Put Whatever We’re Eating On The Baby’s Highchair Tray And See If She Eats It.”

    • Jen

      I did a mix of purees and BLW – but my son didn’t gag too much. It’s been around for a while and about half the Mums in my mother’s group did it, but I’m more of a ‘whatever works that day’ kind of Mum. I started him on rice cereal mixed with breast milk at 4 months. By 10 months my son was eating whatever we ate.
      Although I would draw the line at raw veggies – everything I’ve heard and read recommends lightly steamed pieces of veggies.
      Unless there’s a specific issue – and your little one being a late developer might fall into this category – I’ve heard so often from our local maternal and child health nurses that ‘food under one is for fun’.

    • Elaine

      I don’t think that purees are evil, but I was way too lazy for them. I did BLW because I was lazy. And yes, she did gag a lot for a while. But I do think the explanation of the difference between “gagging” (coughing on something, doesn’t bother them after they dislodge it) and “choking” (something actually gets stuck) has some truth in it. And after we had been doing BLW for a little while, she seemed to get the hang of how much she could fit in her mouth at once, and very rarely gagged after that. She’s now 21 months old and doesn’t jam everything down her throat like some kids do, and she still eats carefully. I can give her whole grapes and she will bite off half and chew it before swallowing it. I think this is related to BLW. Although, to be fair, I don’t know if she would have been this fastidious anyway. Bottom line–I think it gets taken to extremes, but I don’t think it’s a bad technique.

  • theadequatemother

    One of the things I really enjoy about my job, and this is probably strange for an anesthetist given that it is one of the most paternalistic specialties out there (after all our pts are generally unconscious and unreachable), is counselling patients about their options…you know, GA vs regional vs neuraxial…options for post op pain management (PCA, epidural, nerve block, opioids, NSAIDs or a combo). Unlike what the OBs see, most of my patients don’t realize they have a choice until we talk and by going through the risks and benefits and tradeoffs, I really get to know them and what’s improtant to them. And this keeps my job from devolving into being a technician.

    My old school family doc used to say “be a physician, not a technician” to me everytime he saw me when I was a medical student. Patient centered care does just that – it allows me to care and to be a physician.

    During medical training we had countless conversations with mentors and teachers and patient advocates where we were encouraged to reflect on what biases we brought to treatment encounters and were guided towards developing tolerance and empathy for our patients. I hope these repeated moves towards guideline based care and guideline adherence remuneration practices don’t destroy us and turn us all into technicians.

    • fiftyfifty1

      Oh, that’s so funny. Where I trained “technician” was a complement. We used it for docs with great procedural skills. As in “She is not only caring and smart, but also a total technician.”

  • Lisa the Raptor

    I think there are science based doulas and birth educators. But they are few and far between. And some schools that are legit require women to see some births before entering into their midwife programs.

    • Lisa the Raptor

      So they take gigs as doulas. Sorry, I didn’t finish that.

      • The “doula track”. I’ve seen it mentioned, but I’ve yet to see someone admit to being a doula specifically in order to become a midwife.

        • Lisa the Raptor

          I think areawoman is doing so to get some births, but she also works only in a hospital and is on call for free to moms who might be single and alone.–in which case I can see a doula being helpful.

          • Renee Martin

            That hospital provides doulas to anyone that wants them, for free, nit just moms that are single and alone.

  • “They are invariably ‘birth junkies,’ women who enjoy the process of birth, and they are ‘workers’ because they want you to pay them for entertaining them”

    I’m sure plenty of such women exist, but to paint them all the same broad brush is wrong. You didn’t see how hard our midwife worked, nor how exhausted she got after over 24 hours of attending labour. The Doula perhaps even more so with how much massaging she did over hours and hours with and of course less pay than the midwife.

    It’s one thing to assert that midwives have neither the technology nor the training to make birth as safe and experience as it is in the hospital, or call them out of their depth; but character assassination like this comes across as a personal vendetta and undermines your credibility.

    • anonomom_LLLL_IBCLC

      For a while I was into gardening. You should have seen how hard I worked to dig holes, plant saplings, and haul compost. That didn’t make me a farmer.

      • Not really the best analogy. I know farmers (this is the heart of bean and corn country), and believe me: they know less about growing different kinds of things then a gardener does. Farmers know how to run a giant industrial monoculture operation in a certain exacting way, and that’s it.

        • anonomom_LLLL_IBCLC

          I think you know what I meant.

        • That’s like saying that a neurosurgeon isn’t a good GP. One is a specialist, one is a generalist.

        • I don’t have a creative name

          “they know less about growing different kinds of things then a gardener
          does. Farmers know how to run a giant industrial monoculture operation
          in a certain exacting way, and that’s it.”

          Didn’t you just jump on Dr. Amy for sweeping generalizations and how it undermines her credibility?

          I grew up on a farm, with farmers, our neighbors were farmers, our relatives were farmers, I was put to hard labor from a young age doing farm work, and I can tell you that your statement above is pretty much sewage.

          • Suzi Screendoor

            Absolutely. Alan has “farmers” mixed up with “Monsanto employees”. On our cattle farm, we had to know a lot about how cows gestate, give birth, and nurse. And, of course, the most important knowledge of all was knowing when to call the vet.

          • Manduca Sexta

            I don’t think he can even make that assumption about Monsanto employees. I doubt the cell and molecular biologists modifying the crop plants are only knowledgeable about exactly one species. One graduate-level cell biology class will analyze several cell lines. Even if your farm only uses Monsanto-purchased transgenic corn, you have to switch out lines, maintain a refuge of non-GMO corn, and practice crop rotation just to stave off the evolution of pest resistance. So, he’s still wrong.

        • moto_librarian

          Jesus, Alan, is there nothing that you aren’t an expert on? I was raised on a farm, and in addition to growing corn, soybeans, winter wheat, and sunflowers, my Dad always put in quite a large vegetable garden. He also adopted a lot of environmentally-friendly farming techniques (like no-till farming) way before they were trendy.

          And yeah, some doulas are actually worth their salt and support whatever a mother’s decisions are, but there are also an awful lot of them who are in it to get in their birth fix and only support choices that conform to their views of what constitutes the right way to give birth. Guess what? My CNM and L&D nurses worked damned hard too – the difference is that they can actually do something when the birth starts to go sideways. Nobody was working harder during my pph than my midwife, the nurses, and eventually, the attending OB and anesthesiologist.

          You know what I find insulting? Pretending that hobbyist midwives who have not met the same rigorous clinical and educational requirements as CNMs deserve to be called birth “professionals.”

        • Zen

          And here you are, criticizing others about painting everyone with the same brush. This daughter of a farmer objects to your way-off-base assessment.

          • What I meant was “inherently as a consequence of their being farmers”. Some farmers are also gardeners, sure. But if I wanted advice about growing something other than a large monoculture operation, I would go to someone who is a gardener, not to a farmer.

            But this is getting rather beside the point. I was just trying to say that it was not a good analogy. My main point is that it is unfair to dismiss all birth workers as being dilettantes who are out for their entertainment, leaving no allowance that some are hard working and perspicacious. Our midwife and doula stayed with us at the hospital (after the midwife recommended transport), and when my wife asked their opinion, they both endorsed first the pitocin, then the epidural, then the c-section (there was never an emergency situation, so that was always her option).

            BTW, nothing I am saying here should be construed in any way as a disparagement of labor and delivery nurses or obstetricians. I see no conflict in liking both! I have met one CNM I really liked and one whom I strongly disliked. The OB who delivered three of my children is a lovely person, as is his wife, a L&D nurse. In fact, while there were two problematic nurses involved in my oldest child’s birth, in the subsequent three experiences with the rest of my kids every nurse but one was wonderful (the one was horrid, but that does not taint the others).

          • Bomb

            Yeah, I also call BS on expert Alan. I come from a long line of farmers. Everyone we know in western Montana plants a variety of grains depending on prices. Our farm is traditionally wheat, but they’ve done barley, mustard, and others. They also have expansive flower gardens for personal pleasure, and a full acre of vegetables to feed the giant family, plus cows, pigs, chickens eaten by the fam and sold locally ( mostly for 4h).

            But hey, when your whole livelihood is tied up in knowing what to grow what year and at what time, of course you know less about it than folks that grow a few roses and tomatoes for fun.

        • Petanque

          I know a few farmers too, and some of them even have a vegetable garden close to home – yes, they do seem to be successful in growing veges.

        • Kalacirya

          You do realize that farming exists in contexts outside of the gigantic corn and soybean mono cultures of the midwest?

    • I get the generalization.

      Personal philosophy is huge. It’s dangerous. Especially for midwives. For doulas, I just think it’s mean moreso than dangerous (unless it’s a midwife working under the doula title). I recently had a gal get in touch with me wanting to potentially hire me. I’m stepping back from being a doula right now b/c it’s just too hard getting away with two little ones at home. So I offered help in finding her another doula. In talking to her, she told me she was a little nervous about who to seek out b/c the last doula she talked to rubbed her the wrong way. I asked what happened. She said she told the doula that she felt really uncomfortable with certain holisitic practices and didn’t want them to be a part of her birth (like reiki and such). It just made her uncomfortable so she just wanted to put it out there so the doula would know. That shouldn’t be a big deal and is by know means a tall order. The doula told her “good luck with your birth and finding a doula.” That’s it. What the heck? How cold and harsh.

      Darn “dontas” out, pushing their own personal agendas and philosophies, giving the rest of us a bad name.

      • You reminded me that I am 1-1 in my experience with doulas too (I guess I had blocked out the awful one). BTW are you the “DaniDoula” I remember from years ago on AOL or somewhere?

        • I don’t think so… since I became a doula, I’ve always been “Doula Dani” and I don’t know if I’ve ever been on AOL. And I haven’t become really vocal about things like this before about a year ago (ish).

          There is another doula named Dani out there??!!! I’m not a fan. I’m the ONLY Doula Dani! hahahahaa

      • Renee Martin

        Plenty of doulas won’t even take you if you aren’t planning to BF. Period. It’s even on some of their websites.

        I guess its better to know this, before you hire a zealous one that pushs their own agenda.

      • I googled “deal breakers doula” and found multiple doulas who won’t take clients who plan to circumcise.

        It made me wonder about how flexible they would be on anything else.

    • JenniferG

      You know, when I was pregnant with my son, after Emily died, my new OB and his nurse worked hard to establish some trust with me, both just because and also because eventually he wanted to recommend that I try for a vaginal delivery again (I came in saying I wanted a c-section at 39 weeks on the nose). I bemoaned the fact that now OBs work as a team and you kind of get who you get when you arrive at L&D.

      My very wise nurse talked to me about the days when they didn’t do that; how OBs came in for a patient even though they’d been at a party having a drink or two, or stayed for very long shifts, or came from a funeral, or all kinds of things, and how it led to bad decisions at times.

      When you say your midwife stayed and got exhausted over 24 hours, to me that reads as “someone who was getting sleep deprived and stupid.”

      BTW they worked out a way for me to meet every single OB on the team during my last trimester, but one because of her holiday schedule. Of course that was the one who delivered my son, and she was brilliant.

      • attitude devant

        Thank you JenG. This a thousand times over. A midwife who stays with her patient for 24 hours is not in any condition to think clearly about what is happening or deal with an emergency. Would these women get in a plane piloted by someone who’d been flying for 24 hours?

        • What about the long tradition of having hospital residents work for 72 hours straight? That is being reformed now, but it was an essential part of the development of modern medicine.

          • fiftyfifty1

            That is long ago reformed, not “being reformed”.

          • It hasn’t gone far enough, so I will stick with “being”. And the 72 hour deal was still in place into the 21st century, until after my first two kids were born. Not exactly ancient history.

          • Eddie

            I think the important take-away is that the medical system *did* finally realize that the excessive hours that residents were forced into was not only counter-productive, but provably causing deaths.

            The medical system is not perfect. I’d be surprised if anyone here argued that it was. It’s composed of people; groups of people tend to develop religious opinions about things. Dogma. Even physics has been wrong about things for generations before the weight of the evidence finally caused a change.

            I won’t be surprised if the medical system course-corrects again in a decade or so, further reducing the number of hours that residents are required to work. It’s not a perfect system, Alan, but the important thing is that it is ultimately evidence based.

          • fiftyfifty1

            You’re so full of bullshit Alan.

          • Gene

            The 80 hour work week, one full day off per week, and no more than 24hrs on call (with an extra 6hrs for non-patient care for a total of 30hrs) has been in effect for almost a decade (this summer). First year residents (interns) are now restricted to no more than 16 hours for any single shift. So your information is quite a bit out of date.

          • Eddie

            FYI, Alan, there are currently 58 posts, nine of which are yours. I’m sure both numbers will be different by the time I post this, but this means that one in seven posts so far are yours. That combined with a tone that comes across as combative (which may or may not be your intent, but probably isn’t) generates strong reactions in people. For the past few days you’ve done a better job of posting thoughts that can generate productive conversation, but you’re starting to go off the rails on this one.

          • Charlotte

            He just wants to fight because he enjoys it and needs the ego boost because offline he’s just an average guy and that makes him feel impotent. I know plenty of his type IRL. He is absolutely loving the opportunities the preen and show off how smart he thinks he is, no matter how many times people point out that what he says is false or just plain idiotic.

          • DiomedesV

            They weren’t working alone, far from the advice and assistance of more knowledgeable practitioners.

      • JenniferG

        And just to expand on this, that’s one of my biggest issues with US non-CNM midwifery, and to some degree Canadian midwifery if it’s at home or insufficiently backed up. Obviously I have had the experience where a less experienced staff person did not call in someone more experienced (who should have been looking in anyway), with tragic results. But I think true professionals are not about being there for the whole experience or doing it alone…they not only are glad to work with others, they are glad to learn from others and while no one likes to be criticized, they would rather get critique and improve rather than not.

        The current state of US midwifery seems to go nearly opposite to that, systemically, with its lack of oversight and true apprenticeship and laughable professional standards. If you have not read up on the MANA process, you should. Basically someone can train with someone in a very minimal way, study up on things online, pass a test and practice. The person doing the training also needs minimal experience. Over time, you can imagine what happens…you probably get whole ‘lines’ of midwives with bad ideas or misconceptions. That is what, for me, keeps them from being professionals. Some of them may behave professionally but there is a reason that most medical training for people who are decision-makers requires multiple practical experiences in different rotations.

        How does that relate to your comment? You bought into the idea that an exhausted midwife demonstrates her care and professionalism by sticking it out, probably in contrast to a hospital changing shifts. That’s how an amateur thinks.

        • Renee Martin

          The other thing bad about the PEP process is that it makes the current crop of HB MWs into gatekeepers. If you want to be a HB MW, you have to find someone to take you on as an apprentice, and that means agreeing with their philosophy. HB MWery is heavy on ideology- if you think they don’t tolerate any dissent online, imagine what they are like IRL. This means that a science minded, or even critical thinking, person may never find a preceptor. In this way, the beliefs harden into religious dogma.

          Then, they train the apprentice in their way of doing things. Since there are no standards, this means every MW is limited to what her preceptor knows, plus any extra reading/classes she may pick up (or not). There are huge holes in their already limited knowledge, because of the way new Mws are “trained”. This means one awful HBMW can produce a whole line of like minded, same thinking, ignorant, HBMWs. There is no system in place to correct the holes in info.

    • Karen in SC

      It’s great that you and your wife had a competent midwife who presumably transferred care to an OB since IIRC your children were all born via c-section. However, what if you had a birth worker that felt that a woman’s body couldn’t grow a baby that she couldn’t birth, etc?

      Since CPMs don’t have the education, or the regulation of a properly trained health care provider, they are just being birth workers like this post explains.

      Also, since this post is part of Dr. Amy’s “body of work”, she shouldn’t need to explain that she does support the trained CNM credential. That is not what she is talking about here.

      • “It’s great that you and your wife had a competent midwife who presumably transferred care to an OB since IIRC your children were all born via c-section.”

        Yes, exactly. She did that and subsequently endorsed an epidural, induction, and ultimately a C-section. Even though the OB was fine with my wife continuing to push, and even though those endorsements would lose this midwife a lot of street cred with some in the granola sisterhood if word got out. She had been spending a lot of time with my wife during pregnancy, and she could tell it just wasn’t in the cards before I or the OB could. I have a lot of respect and affection for her.

        “However, what if you had a birth worker that felt that a woman’s body couldn’t grow a baby that she couldn’t birth, etc?”

        That would be bad! But I was the one who said I am sure there are many who are like that. It is Dr. Amy who used the word “invariably” in her description of birth workers. That is what I take issue with, not the assertions about risk, insufficient or inconsistent standards, etc.

        • fiftyfifty1

          The fact that midwives are even considering their “street cred” rather than completely focussing their efforts on a safe outcome for mom and baby makes me nervous.

          • My point was that our midwife did NOT do that. But it is certainly a problem out there for many others. I would think it would not need to be explained, but “not all midwives are like that” is not the same as “no midwives are like that”. My position is much less extreme than is Dr. Amy’s.

          • fiftyfifty1

            You said your midwife was in danger of losing street cred with some others in her “profession” if word got out that she endorsed the interventions. My point is that even though your midwife apparently did not bow to the peer pressure, the fact that is *even coming up as a consideration* is a serious problem. Obviously “losing street cred” is a problem endemic to homebirth midwives or you yourself wouldn’t have found it remarkable that your midwife bucked the trend.

    • mamaellie

      I had one midwife seem almost angry when I had her out of bed at 4am to have a baby, and another who was nice enough, but sat in another room, or with her back to me for most of my labor. I have since had a planned hospital birth with an OB. My OB seemed very tired also. I think it just comes with the territory. It’s hard to be up with laboring women all night no matter your qualifications as a provider. I do agree with Dr. Amy just because I don’t believe that it takes all too many births for a CPM to realize that what she knows isn’t nearly enough. My daughter’s heart rate dipped towards the end of my labor and I was bleeding enough to require pitocin after she was born. I think that in order to be a CPM delivering babies at home you have to deny to yourself the real risk. The risk that is right before your eyes. This is a selfish thing to do and the women who make up the profession deserve the term “birth junkies.”

      • Jessica

        You know, this makes me a think of a point regarding the interventions that OBs are sometimes accused of using to speed up a labor so they can get to their golf game. Have these people criticizing doctors for not wanting to deliver in the middle of the night never considered whether it’s SAFE for an exhausted physician to be monitoring and delivering a woman or having to perform an emergency C-section in the middle of the night? I know that lack of sleep comes with certain jobs, but that doesn’t mean it’s good for the doctor, the woman in labor, or the doctor’s OTHER patients.

        EDIT: And of course I see this very point was made downthread. HA!

    • Durango

      The hardworking and passionate don’t get a free pass to lower standards of practice. The hard work that matters is getting the proper training so that you can perform the standard of care. A person who chooses to not get a proper education/training is a dilettante, no matter how many hours their massages last.

      • Amy Tuteur, MD

        Exactly. There’s simply no excuse for substandard education, substandard training, a professional body (MANA) that eschews any and all standards, and no professional accountability. All those policies are for the benefit of the pretend “midwives” and pose unacceptable risks for mothers and babies.

        • That’s a defensible argument. But that is not at all the same as saying they are “invariably” birth junkies who all are just out to get paid for being entertained. You complain that when challenged, NCBers move the goalposts; but that is just what you did here.

          • fiftyfifty1

            You are misquoting her. Try again.

          • “They are invariably ‘birth junkies,’ women who enjoy the process of birth, and they are ‘workers’ because they want you to pay them for entertaining them”

          • Box of Salt

            “They” in the sentence you’ve quoted refers to those women who like to refer to themselves as “birth workers.”

            Re-read the first sentence of the post for comprehension, please.

          • I still think I understood it fine all along. What I don’t understand is what, exactly, you think I didn’t understand. Or, more simply put: what’s your point?

          • Dr Kitty

            Alan, you seem to have issues with reading comprehension- perhaps you need to slow down, and re-read everything. You seem, in particular, to have issues working out when people are talking about a sub-group, or generalising to the whole.

          • Sue

            Alan seems to want to take everything to the absolute – whether it’s food, working hours, what Amy did or didn’t say and to whom she refers. I think that’s what irritates everyone, and hampers productive conversation.

          • You presumably realise I have no such issues and are trying to irritate me. (It was in this kind of context that I defended myself by pointing to my test scores, not just bringing them up out of the blue as people try to imply to the latecomers).

            Perhaps Dr. A. and others are being (purposely?) vague, or you are just failing to comprehend *my* comments. Box of Salt tells me, as though it is a revelation: “‘They’ in the sentence you’ve quoted refers to those women who like to refer to themselves as ‘birth workers.’ Re-read the first sentence of the post for comprehension, please.”

            But in what comment did I say or even imply that “They” referred to anything *but* “those women who like to refer to themselves as ‘birth workers'”? I obviously understood that was the antecedent of “They”, so the only thing I am having trouble comprehending is WTF you two are nattering on about.

      • Bombshellrisa

        Speaking of passionate, remember the “birth visionista”?
        http://bootcampforbirthvisionaries.eventbrite.com/

    • Kalacirya

      Marathon runners work hard, and are likely exhausted at the end of the run. But their running is a hobby, for the sake of their own entertainment and personal validation. Working very hard at something, even to the point of exhaustion, does not necessarily mean that this person still isn’t pursuing a hobby for the sake of entertainment and personal validation.

    • EllenD

      Yes, your midwife and doula worked hard and were up for many hours, which in reality only proves their judgment was impaired and had an actual emergency happened, your wife and baby would have been at additional risk.

  • Papanicolau’s daughter

    Recently saw a young HB mom (late twenties) with advanced cervical cancer. None of her HB providers had ever recommended a pap.

    • The Bofa on the Sofa

      Wait – how many kids did she have?

      • Papanicolau’s daughter

        Two.

    • Guestmama

      That’s horrible. 🙁

    • Certified Hamster Midwife

      I thought one of the advantages of seeing a CPM is that they aren’t always poking at your cervix!

      Are you a gynecologist?

      • Captain Obvious

        They don’t need to perform a cervical exam, they can tell by external ques and woman’s symptoms whether her lap smear is normal. Have you heard of the red/purple line up the crack of the buttock in determining how far dilated a woman is in labor, maybe they can look for this line and tell if the Pap smear is normal or not as well?
        http://www.scienceandsensibility.org/?p=5547

        • Karen in SC

          I clicked and noted that the author could find no pictures of this incredible technique and no one in the comments supplied one either. Do us all a favor, CO, and try to get an image for us.

    • guest

      Or an HPV vaccination, because vaccines are such killers. Poor woman. Poor kids. I would like to scream. They won’t vaccinate to cut down on HPV, they won’t circumcise to cut down on HPV, and now they won’t recommend PAP smears? That’s just great.

  • Bombshellrisa

    Yes, a million times. Beth Coyote, CPM even echoes this. Of an incident where someone was having dizziness and irregular heartbeat at a dance she was at, this is her take: “Lordy, I’m only a midwife and not a full service provider. At least I thought to call someone who would know what to do. I’ve had to call ambulances plenty of times in my midwifery life but I’m in control of the situation, or at least I know exactly what needs to happen. I can be awfully bossy so don’t cross me”. http://becoy.blogspot.com/ This is where the “other stuff” that isn’t part of being “an expert in normal birth” comes in.

    • I read the post, then immediately wished that I hadn’t.

      • Bombshellrisa

        And she is a more experienced midwife, she has been part of the homebirth scene for a very long time.

    • Victoria

      Her web address is “be coy” – that has to be some form of irony.

    • ratiomom

      Apparently she doesn’t know the difference between a cardiorespiratory monitor and cardiotocography. What a consummate professional.

      “We followed behind and trailed her into the ER, where they hooked her up to many machines attached to computers (seen it in the labor and delivery floor) “

  • Lady_B

    This, this, this, a thousand times this. For as ‘coldhearted’ as the Woo side claims OBs to be, I sure don’t hear physicians talking about birth as selfishly as lay midwives or the nuts who use them.