NAPW: National Advocates for [Some] Pregnant Women


Yesterday I wrote about the efforts of natural childbirth advocates, lactivists, and attachment parenting advocates to police women’s bodies through pregnancy and the early childhood years.

Surely, I thought, there must be a women’s organization that defends against this attempt to control pregnant women’s bodies, and there is. There’s just one problem. They’re only interested in protecting women who make approved choices and — surprise! — the only approved choices are those championed by NCB advocates, lactivists, and attachment parents.

The organization is called National Advocates for Pregnant Women (NAPW), but they ought to include an asterisk in their name. They don’t advocate for all pregnant women, just a small subset.

NAPW describes themselves as follows:

National Advocates for Pregnant Women (NAPW) seeks to protect the rights and human dignity of all women, particularly pregnant and parenting women and those who are most vulnerable including low income women, women of color, and drug-using women. NAPW uses the lessons learned from the experiences of these women to find more effective ways of advancing reproductive and human rights for all women and families. Our work encompasses legal advocacy; local and national organizing; public policy development, and public education. NAPW is actively involved in ongoing court challenges to punitive reproductive health and drug policies and provides litigation support in cases across the country. NAPW engages in local and national organizing and public education efforts among the diverse communities that are stakeholders in these issues, including the women and families directly affected by punitive policies, as well as public health and policy leaders.

Consider their page devoted to birth issues: unhappy with your maternity care? unhappy with your C-section? committed to breastfeeding? They’ve got your back.

Denied a maternal request C-section? Forced to sign a waiver simply because you don’t want to breastfeed? Fuggedaboutit!

NAPW was front and center in the defense of the Florida woman who wanted to postponed by several days her medically indicated semi-emergent C-section for fetal distress.

NAPW has sent a letter to the hospital explaining that the threat of arrest lacks justification in both law and medical ethics. Farah Diaz-Tello, NAPW Staff Attorney explained, “Women do not lose their rights to medical decision making, bodily integrity and physical liberty upon becoming pregnant or at any stage of pregnancy, labor or delivery.”

Sounds to me like the right to medical decision making would include maternal request C-sections. But that’s not what you find when you search the site. The only reference to maternal request C-section (cavalierly referred to as C-section “on demand”) is this mention from 2006:

…organizations concerned about unnecessary and potentially risky c-sections, including NAPW, will be closely watching this week when the National Institutes of Health state-of-the-science holds its conference on ‘cesarean delivery by maternal request.’

So let’s see if I get this straight. An organization that supports a women’s rights to refuse C-section, citing the right to of women to control their own bodies, is staunchly opposed to women’s right to request a C-section, ignoring the right of women to control their own bodies. They have a word for that stance: hypocrisy.

If I understand NAPW correctly, they believe that women have the right to weigh the risks and benefits to themselves and their children of medically indicated C-sections, but somehow are incapable of weighing the risks and benefits to themselves and their children of maternal request C-section. And that, of course, makes no sense.

If NAPW is so concerned about the right of women to control their own bodies, why aren’t they front and center in opposition to new rules banning elective delivery before 39 weeks? Surely if a woman has a right to control her own body, she has a right to control how long she wishes to be pregnant. Surely if a women has a right to bring an abortion, which is the termination of a pregnancy before viability, she must have a right to terminate a pregnancy that will result in a healthy, live baby.

Surely if a woman has a right to control her own body, she should not be forced to sign waivers attesting to the superiority of breastfeeding when she chooses not to breastfeed. How is that any different from the many different hoops anti-choice forces want to impose on women seeking abortion?

The ultimate irony is that NAPW supports women in their choice to use recreational drugs during pregnancy:

Some of the starkest examples of the consequences of denying women full human rights involve the direct and severe punishment of pregnant, drug-using women. By combining claims of fetal rights with the war on drugs, new laws that punish pregnant women and families are being put into place… Like other applications of the war on drugs, the punishment of pregnant women is targeted at vulnerable, low-income, women of color; those with the least access to health care or legal defense.

In the last twenty years, over 200 pregnant women or new mothers have been arrested in a concerted effort to deny women liberty. At least nineteen states now address the issue of pregnant women’s drug use in their civil child neglect laws, and many of these states make it possible to remove a child from the mother based on nothing more than a single positive drug test. These cases and statutes are having a devastating effect on public health efforts, as well as women’s reproductive rights, drug policy reform efforts, and efforts for racial equality.

So if I understand NAPW correctly, they will fight for your right to use heroin while pregnant, but if you want to have a maternal request C-section to preserve your pelvic floor, you’re on your own.

Women do have a right to control their own bodies and that right extends not merely NAPW approved choices (having an abortion, refusing a C-section, or using heroin during pregnancy). It extends to ALL choices whether the women in NAPW would choose the same things for themselves or not.

NAPW is inappropriately named. They don’t advocate for pregnant women. They only advocate for pregnant women who make choices they approve, and that is hypocrisy of the worst kind.

182 Responses to “NAPW: National Advocates for [Some] Pregnant Women”

  1. Disgusted
    March 15, 2013 at 6:11 am #

    Thank you for this excellent post which outlines completely one of the things that has driven me away from the one-sided view of some self-described feminists. It’s as logical as their “we will fight for your right to prance down the street in a bikini, but if you choose to dress conservatively we will make fun of you”.

  2. Lena
    March 14, 2013 at 11:38 pm #

    OT: My cousin just had a baby. While she has no interest in NCB she really didn’t want a C-section because of a general fear of surgery. After 24 hours and still only 3 cm even after pitocin, she had CS. She cried when her OB told her a CS was necessary, but she had the surgery and her beautiful baby girl (with a knotted cord that was wrapped twice around her neck). When her OB went to see her in recovery and talked about the cord issues as well as her pelvis (very narrow), he said something like, “Now you won’t have to worry about needing surgery to fix your bladder.” (He said this after she made it clear she wasn’t at all distraught about the surgery, so he wasn’t being insensitive.)

    I’m a bit bothered by that. It’s just–she was terrified of having a cs throughout her pregnancy, and her OB was always very reassuring, saying that she’d have a c-section only if absolutely necessary, things like that. Why not also say that vaginal births aren’t all they’re cracked up to be, that they have risks, instead of mentioning it almost jokingly after the c-section? I don’t know, maybe it’s because I’m such a pessimist and I actually find it comforting to know every thing that can go wrong instead of being clueless, but I think that’s the kind of thing women need to know.

    • theadequatemother
      March 15, 2013 at 10:17 am #

      “Why not also say that vaginal births aren’t all they’re cracked up to be, that they have risks, instead of mentioning it almost jokingly after the c-section?”

      It is because in medical school students are taught that vaginal birth is the *better* option…that it is “safer.” It is seen as the default and because of that the consent discussion is framed as “cs have risks above and beyond vaginal birth” rather than “cs and vaginal birth have different risks.”

      Its false and misleading but unless you’ve spent a lot of time in the urogyne clinic on elective or have an OB preceptor during your rotations that questions the status quo you don’t get a different view point.

      I was taught that vaginal birth is safer for mom and baby. I was taught that cs birth made no difference for future risk of continence or prolapse and that the number of pregnancies was the more important risk factor. It was never mentioned that the cs risk stats inappropriately included both planned and emergency surgeries. It was never mentioned that the studies looking at future incontinence and prolapse were of post-menopausal women and that quite a different picture is painted if you look at women in their 20s and 30s. During my OB anesthesia rotations there was lots of discussion about the “accreta epidemic” that was looming on the horizon due to increases in the cs rate…except it hasn’t manifested! Now, I’m pretty sure my medical school OB curriculum was drafted by Dr Klein personally, so maybe this isn’t the norm. When I was pregnant, I had colleagues shake their heads at my OB choice, “He does more c-sections than anyone else in the city,” they said. My response, “then he’ll be practiced if I need one. And seriously, all solutions to obstetrical emergencies ARE surgical. A good surgeon is EXACTLY what I want.”

      Things started to change for me when I was in practice making idle chit chat with urogyne’s in the OR, after being present at many hundreds of cs that seemed joyous rather than dire and risky events, after my vaginal birth left me with activity-limiting urinary stress incontinence and after I made the acquaintance of Mrs. W. The outrage I felt at how she had been treated was the motivation I needed to take a closer look at the issue for myself.

      • LukesCook
        March 15, 2013 at 10:35 am #

        “He does more c-sections than anyone else in the city,” they said. My response, “then he’ll be practiced if I need one. And seriously, all solutions to obstetrical emergencies ARE surgical. A good surgeon is EXACTLY what I want.”


        • AmyM
          March 15, 2013 at 1:01 pm #

          Agree. Once, someone online who was planning an HBAC with a midwife told me “midwives are experts in normal birth.” I said “So what? I want an expert in abnormal birth in case something goes wrong, he/she will know what to do.” Having an expert in normal birth around won’t guarantee that the birth will proceed “normally” which to them means unmedicated/no interventions. I cannot understand how an entire group of grown women can’t see how stupid the “midwives are experts in normal birth” trope is.

          I got a pardon from this woman for the “abnormal birth” of my children, because even she could see the risk factors (mono/di twins, pre-term labor a few times, etc). I didn’t even have a Csection, but I did have pitocin and an epidural and constant monitoring of both babies, so despite the fact that they were born healthy and have remained so, they are somehow inferior because of their abnormal birth. Who gives a crap? Why do we need to categorize different types of birth?

          • The Bofa on the Sofa
            March 15, 2013 at 1:48 pm #

            Once, someone online who was planning an HBAC with a midwife told me “midwives are experts in normal birth.”

            As a baseball umpire, I am an expert in calling routine plays.

            However, because I suck at close calls, no one wants me to officiate their games. But that would only make sense. At least one would think.

          • Bombshellrisa
            March 15, 2013 at 7:22 pm #

            It is stupid. These are the people who get all excited about paying “experts in normal birth” to basically sit with them while they labor, but would get hysterical if someone just out of beauty school was their stylist at their salon appointment ((true story from a doula friend of mine. Her objections of “but this person doesn’t have a lot of experience” bordered on ironic in light of the fact that she had attempted a home birth with the midwife equivalent of the stylist she refused to let touch her hair)).

      • Becky05
        March 16, 2013 at 9:00 am #

        Hunh. I had understood that there have been substantial increases in placenta accreta, although it is still not common. And while overall risks for the first or second cesarean aren’t very much higher (if any) than for vaginal delivery, multiple cesarean deliveries do carry significant risks. I think that women should definitely be made aware of that, because intended family size makes a big difference in the long term effects of delivery mode.

        • theadequatemother
          March 16, 2013 at 12:33 pm #

          Of course accreta increases with multiple cs and of course a discussion of those risks is an important part of consent. I’m not disputing that. What I am saying is that I found the rhetoric about cs in medical school and residency to be alarmist and my personal feeling is that there is a bias against cs that is not based on the actual risks, but on inflated risks, that is part of the reason why physicans are reluctant to even open up any discussion about vaginal vs cs. This topic will not be broached by the physician…discussions tend only to occur when brought up by the pregnant woman…and in the OP I replied to, the question was why incontinence and pelvic floor damage were not addressed at all prenatally…well, IMHO the reason is that physicians do not want women to choose cs so they will not start a discussion that might end in a woman choosing cs.

          MRCS are a very small percentage of all cs and, Posh Spice aside, it seems that most women choosing them are planning small families or are choosing them because they are having a first baby at 40+ and have a higher risk for emergency cs. Certainly the most common referral to the consultation clinic wrt MRCS at the OB hospital where I trained is for women 40+ interested in the option.

  3. frequent reader
    March 14, 2013 at 10:19 pm #

    So, let me get that straight, a pregnant woman who is in a hospital screaming in agony because of her condition whilst the hospital refuses to give her pain meds contacts them and gets a “call you… Maybe” from them. However, when an ICan leader calls them up who is allegedly threatened by her OB to involve police as she is obese, one week overdue, with a full blown diabetes, and poor presentation the press has to be contacted immediately. I used the word “allegedly” because no one has seen the full text of the email and no one knows the extent of the interaction that Ms. Epstein had with Dr. Yarkowits who because of doctor-patient privilege cannot so much as say whether he really wrote an email to that extent. Whether we like it or not, the law in Florida apparently allows a physician who believes that a fetus is in imminent danger to compel a woman to undergo a ceserian. Quote: Tampa police couldn’t recall a case in which they were sent to bring a pregnant woman to the hospital for an unwanted caesarean. Spokeswoman Laura McElroy said the only possible legal grounds would be if the doctor established the fetus’ life was in immediate danger, which would be difficult under patient privacy regulations.

    And what a pathetic reply that they cannot get involved in an international case because they have no lawyers on staff with such expertise when they are involved in the Agnes Ghereb case in Hungary. Also, the same lawyer who contacted the press, if my memory serves me well, was involved with bringing a case before the UN representing women in Guatemala who have been denied abortion (again, the details may not be exact but a clear indication of international experience).

    • Disgusted
      March 15, 2013 at 6:19 am #

      “However, when an ICan leader calls them up who is allegedly threatened
      by her OB to involve police as she is obese, one week overdue, with a
      full blown diabetes, and poor presentation the press has to be contacted

      Oh lord, this describes an acquaintance of m perfectly. She was complaining the other day about doctors and her health and then went on into how evil they all were because when she had that silly little thing like GD they put her on a no sugar diet and just because she was incredibly obese they in fact put her on a pregnancy diet that had her weigh 50 pounds less after delivery than before! Oh and they evilly asked her several times if she wanted pain relief during labor. I wold have been rejoicing if I had been readily offered pain relief and ended up lighter after delivery than before.

      Her poor baby was born with some sort of brain problem.

  4. Friend of Lawyers
    March 14, 2013 at 10:08 pm #

    Has anyone ever contacted NAPW because they was legal action taken against them to prevent their choice to have a cesarean? Because NAPW gets involved when legal action is taken against pregnant women, such as being forced to have a cesarean through the courts or being held in jail because of addiction issues (rather than being offered treatment). If a woman was taken to court to prevent her from having a cesarean that she thought was in her best interest, or if the police showed up to take her to a birth center to force her to have an unmedicated childbirth, they would almost certainly get involved, but as far as I know, while not all doctors will perform a cesarean upon request, no court or other legal body has ever stepped in to prevent a woman from have a cesarean.

    • KarenJJ
      March 15, 2013 at 12:21 am #

      You might be interested in Mrs W’s case in Canada (I think her blog is linked on the right hand side).

      • Mrs. W
        March 15, 2013 at 2:10 am #

        I contacted them today – and their response is in the comments below (unsurprising). While no court or legal body had ever stood in the way of a woman wanting a cesarean, more than a few hospitals and doctors have (in Canada and the UK). Unfortunately, you may not know whether or not your right is going to be trod upon until it is too late.

  5. Rose
    March 14, 2013 at 4:59 pm #

    This morning (while checking a local direct entry midwife’s blog) I found this birth story.

    the midwife’s is here:

    This moronic behavior took place in my town – Moscow, Idaho. It is beyond disgusting that the author claims to be an R.N. The birth should have taken place at noon on Main Street – she clearly is more interested in her performance than the welfare of her baby. Noel (direct entry midwife) who played the role of 2nd midwife is the wife of a local evangelical preacher. Nancy is a local EMT.

    It is my profound hope that laws in Idaho can be changed to prevent these uneducated amateurs from pretending to be medical professionals.


    • Dr Kitty
      March 14, 2013 at 6:10 pm #

      Blink and you miss the 3 minutes of Shoulder dystocia, 1minute APGAR of 3 and PPH, but there are paragraphs and paragraphs about her struggle to Breastfeed.

      Talk about skewed priorities.

      • Jessica
        March 14, 2013 at 6:18 pm #

        Oh Good Lord. You read that story and it appears she decided to go for a HBAC because she thinks the interventions in her first labor ruined her chances to breastfeed. So she has a dangerous HBAC with baby #2, complete with low APGAR and PPH…and STILL has trouble breastfeeding. If the lactivists would quit associating all breastfeeding difficulties with labor interventions, how many women would be as quick to jump on the NCB/HB bandwagon?

        I had an induction with Cytotec and pitocin. I got a narcotic early in labor and then an epidural. My milk came in less than 72 hours after birth, and nine months later, I’m breastfeeding just fine. Read the breastfeeding boards on The Bump and elsewhere and there are many, many women who have had all sorts of interventions including emergency C-sections, and breastfeed without any problem.

        • quadrophenic
          March 14, 2013 at 7:19 pm #

          And plenty of women (like me) who had unmedicated intervention free births and still had problems breastfeeding. I’ve said it before so I’ll say it again: breastfeeding just isn’t that important to be worrying about when you’re deciding if you need a procedure to prevent injury/death to mother or baby. It’s just another distraction to try and blame women.

        • mollyb
          March 14, 2013 at 7:36 pm #

          I love how she describes her attempts to breastfeed as “giving her baby the best” despite the fact her baby would gain little to no weight for weeks at a stretch during her first 4 months. Worth it!

      • PoopDoc
        March 15, 2013 at 1:17 pm #

        I don’t get the obsession with not giving your child formula. She is giving this kid milk from at least 8 different people… Give me a good clean can of Similac any day. Oh, and I guess the big bad c-section had not a damn thing to do with her BF failure the first time.

        • The Bofa on the Sofa
          March 16, 2013 at 9:26 am #

          One of my best friends is currently in New Orleans picking up his (and his wife’s :)) new adopted daughter. I still wonder what the BF whackos would think of that, knowing that all formula is all she is going to get.

          Meanwhile, what I think is, how wonderful!

  6. anon
    March 14, 2013 at 4:40 pm #

    My husband mentioned today that one of his friends from college has the word “midwife” in her name on her Facebook page. I asked if she was a CNM or a lay midwife (that’s not exactly how I phrased it), and he just blinked at me. When I tried to explain the difference, he said, “OK, hold on. Some women have no medical training and just….deliver babies?!” And I said, “Yep. And when the babies don’t make it, they say, ‘some babies aren’t meant to live.'” Cue complete freak out. Which reminded me that I may be used to the bull crap they spew, but it doesn’t make it any less horrifying.

  7. fiftyfifty1
    March 14, 2013 at 4:21 pm #

    “…The only reference to maternal request C-section (cavalierly referred to as C-section “on demand”) …”
    I’m not crazy about either term:
    “C-section on demand” = strident bitch
    “Maternal request C-section”= “Oh pretty please I have this little favor that has to do, you know, with my longterm health and all, so I do hope you’ll consider my request ”
    I wish we had something more neutral like “Maternal Choice C-section” or maybe “Maternal Decision C-section”.

    • Mrs. W
      March 15, 2013 at 2:15 am #

      The terminology leaves a little to be desired. Most women who want to choose cesarean are neither strident bitches or wilting flowers. They are women who are aware that there is a choice, have considered the risks and benefits of their options and have determined which is best for them in their personal circumstances.

    • thepragmatist
      March 15, 2013 at 9:06 am #

      I like Pauline Hull’s “prophylactic c-section”. Because it is, in essence.

    • OnMon
      March 17, 2013 at 4:22 pm #

      I second like “Maternal Choice C-Section”, because “MRCS” also reads as “Multiple Repeat C-Section”. And because dangnabit, this is about being pro-choice!

    • JayDee
      March 22, 2013 at 8:34 pm #

      “Elective” works for me.

  8. Hannah
    March 14, 2013 at 4:18 pm #

    While this branch of their work seems to come from an NCBish bent, judging by the links on their site, but it’s disingenuous to compare compulsory or coercive medical treatment or deprivation of liberty via the criminal justice system with being unable to access a particular medical procedure. Now I think that MRCS ought to be available to women who have been fully counselled about the risks and alternatives, not least because psychological indications might be very real and feel very urgent for the patient. Nevertheless I don’t think there’s a right to receive a surgical procedure that the doctor determines is inappropriate or medically unnecessary. FWIW I think this elision is disingenuous when it comes to the abortion debate as well.

    • Mrs. W
      March 14, 2013 at 4:25 pm #

      If there isn’t a right, then a woman’s ability to decide what to do with her body is unjustifiably limited.

      • Hannah
        March 14, 2013 at 4:28 pm #

        To that extent what any of us, male or female, can decide to do with our body is constrained, at least in terms of medical intervention, by what the doctors think in medically appropriate, they are willing and able to perform and cost, availability and ethical considerations. None of us can insist on any and every medical intervention with our body.

        • Mrs. W
          March 14, 2013 at 4:32 pm #

          A baby must be born (if it is carried to term) there are only two ways that happens. MRCS isn’t like a nose job and is far more analogous to an abortion or choosing between treatment options for a specific condition.

          • Hannah
            March 14, 2013 at 4:40 pm #

            “A baby must be born (if it is carried to term) there are only two ways that happens. MRCS isn’t like a nose job and is far more analogous to an abortion…” Note the last line of my original comment. I don’t think you have an absolute right to medical intervention to arrest a natural process however unpleasant or burdensome. I believe you have a relative right to equitable access to such treatment as is available and medically appropriate, taking into account other societal (e.g. cost) and ethical consideration. I also thing it’s generally good that people get to make decisions regarding their care, but for example if I have a non life threatening tumour that nevertheless interferes with my quality of life, and the treatment costs millions of pounds, I can be legitimately denied that treatment if the money could provide more and more needed care to others. Equally if I need and want an organ transplant I can be prevented from having one if it entails buying or stealing an organ, even if that has profoundly negative consequences for my prognosis and quality of life.

          • Mrs. W
            March 14, 2013 at 5:08 pm #

            The cost issue on MRCS is entirely debatable – and as far as I am aware, there have been no quality studies looking at the cost effectiveness of vaginal birth and cesarean by maternal request. The limited amount of study on this subject has found that when longer run complications of vaginal birth are taken into account (like incontinence) that the difference between MRCS and planned VB is exceedingly small. It is entirely possible that MRCS is a better use of resources than a lot of other health expenditures.

          • Hannah
            March 14, 2013 at 5:47 pm #

            I’m not disputing any of that, as I’ve said above, I support in principle the concept of a properly informed woman being able to request a caesarean, my argument was that it wasn’t a right such that a comparison with forced treatment, or deprivation of liberty would be valid.

          • AllieFoyle
            March 14, 2013 at 6:02 pm #

            It does become an issue of forced treatment and deprivation of liberty when you think about it a bit. When you go to the hospital to have a baby you receive one of two “treatments”–the vaginal birth “treatment”, including everything that entails (tearing and repairs, intimate examinations, etc.) or the cesarean “treatment” and everything that entails (and yes, some people get both, etc. etc.). Neither treatment is significantly more expensive or dangerous. When intelligent women are not allowed to choose which method they prefer simply because of the fact that it’s a gender-specific situation and someone else’s bias toward “natural”, it does qualify as an issue of gender-based forced treatment. It’s also a deprivation of liberty in that it unduly restricts a woman’s right to determine what happens to her own body.

            Your argument would have some weight if a MRCS were anything like the expensive unnecessary operation you describe. It is not. It is a valid choice between the two necessary outcomes of any pregnancy. It is no less safe than a TOL, nor substantially more expensive when all costs are considered (and perhaps less so, if anyone bothered to do a thorough accounting). There is no humane, ethical, or practical reason to deny women the right to choose it.

          • Hannah
            March 14, 2013 at 6:39 pm #

            Vaginal birth isn’t a “treatment,” and that’s the central point, although there are treatments for complications of vaginal birth which you have the absolute right to accept or refuse. I’m defining deprivation of liberty here, to mean being not sent to prison for example, not in the wider sense of being enabled to make positive choices. And I’ll reiterate, women ought to have the choice of caesarean, but hospitals not providing caesareans on request is not a violation of an absolute right.

          • AllieFoyle
            March 14, 2013 at 6:50 pm #

            I don’t think you get to define deprivation of liberty or absolute right. Do you believe that restricting women from obtaining abortions is a deprivation of liberty? I do. And I believe that restricting women’s choices to determine what happens to their own bodies during childbirth is a gender-based deprivation of liberty.

          • Hannah
            March 14, 2013 at 7:05 pm #

            I was using the concept of deprivation of liberty, in the context of the article above, to refer to the incarceration of pregnant women for drug taking for example, i.e. the state physically taking you from your home and locking you up. It happens, but their have to be pretty major justifications for doing so and safeguards surrounding the use of this power. Liberty in the wider sense, could certainly encompass the ability to make any positive choice, including abortion, but all sorts of positive choices are interdicted or regulated in society, for all sorts of reasons, and I don’t take a libertarian position on this.

          • Amy Tuteur, MD
            March 14, 2013 at 6:59 pm #

            Vaginal birth isn’t a treatment, but vaginal birth is not what is being requested of the doctor. The doctor is being asked to take responsibility for the health and safety of the mother and baby. Everything encompassed by that is the treatment.

            It’s like saying to an oncologist: “I want to come to the hospital and have you care for me while I dose myself with laetrile.” Even if you are not asking the doctor to give you the laetrile, you are still asking for treatment.

            Here’s another obstetric example: what about the women who refuses a C-section for breech. Vaginal delivery of a breech baby is the default, but the patient is certainly expecting the doctor to perform the maneuvers necessary to safely deliver a breech baby.

          • Hannah
            March 14, 2013 at 7:13 pm #

            “The doctor is being asked to take responsibility for the health and safety of the mother and baby.”

            I’d disagree with that philosophically, although that may well be the position forced on them by the malpractice environment. I’d argue that the doctor is responsible for providing an appropriate standard of care within the limitations of their resources and expertise, and the patient’s assent to treatment. That would include providing the best care they can for someone taking Laetrile against medical advice, in whichever setting (ER or Oncology department) is appropriate, or who refuses a caesarean against medical advice. They’re not responsible for guaranteeing a good outcome in the face of fate or the patient’s bad choices.

            Also, in the context of this conversation, I’m talking about whether or not VB can be regarded as a “treatment” as set against MRCS, not about consent to medically indicated caesareans, although the principles would have implications for both.

          • Amy Tuteur, MD
            March 14, 2013 at 9:02 pm #

            “I’d disagree with that philosophically, although that may well be the position forced on them by the malpractice environment.”

            I suspect that would put you in a small minority. It is generally believed that obstetricians have both an ethical and a legal obligation take responsibility for the health and safety of both mother and baby.

            More to the point, the act of voluntarily going to the hospital implies that you are expecting that the obstetrician will take responsibility for the health and safety of you and your baby or why go at all? You want care if an emergency occurs, but the doctor has an obligation to prevent the emergency; treating it after it happens is less effective than preventing it.

            Should the Orthopedics Dept. let you bungee jump off the side of the hospital so that you will have immediate medical assistance if something goes wrong?

          • The Bofa on the Sofa
            March 15, 2013 at 10:48 am #

            I suspect that would put you in a small minority. It is generally believed that obstetricians have both an ethical and a legal obligation take responsibility for the health and safety of both mother and baby.

            That the OB has a legal obligation to take responsibility for the health and safety of both mother and baby goes well beyond “generally believed.” It is clearly established that is the case via our court system.

            Given that the doctor is liable for the outcome, should a bad one occur, that means they also have they responsibility that comes in preventing that.

          • LukesCook
            March 14, 2013 at 7:34 pm #

            “I don’t think you have an absolute right to medical intervention to arrest a natural process however unpleasant or burdensome.”

            Then you don’t have a right to medical treatment at all, unless you believe injury and disease to be something other than natural processes.

          • AllieFoyle
            March 14, 2013 at 7:37 pm #

            Exactly. If you accept that people have a right to appropriate and respectful medical treatment in general, including making reasonable and appropriate choices among available alternatives, then you can’t arbitrarily decide that that doesn’t apply when it comes to childbirth.

          • Hannah
            March 14, 2013 at 7:48 pm #

            Again, the operative words there are “reasonable” and “appropriate.” You’ve just introduced two qualifiers, so the right to medical treatment on request as a manifestation of personal self-determination is non-absolute, although personal self-determination may be a very valuable thing, and medical decision making, one aspect of that, it hinges on what is reasonable and appropriate. And if the doctor and hospital in question feel that, in their qualified opinion, caesarean is not appropriate then to an extent that’s their prerogative.

          • AllieFoyle
            March 14, 2013 at 7:55 pm #

            When their feeling that it’s not appropriate is based upon outdated, sexist beliefs about the superiority of natural birth, incomplete data, or politically motivated quotas instead of actual medical reasoning, then that is institutionalized sexism and it interferes with women’s rights to bodily autonomy.

            MRCS is a reasonable and appropriate treatment option, and denying it unfairly limits women’s right to control what happens to their own bodies.

          • Eddie
            March 16, 2013 at 9:27 pm #

            How is a belief about the superiority (or lack thereof) of natural birth sexist? I can see how such a belief can be unscientific, wrong, outdated, crazy, mean, politically motivated, and a lot of other things, but how can it be sexist? Are you suggesting that if men bore the child the beliefs would flip? I’m not arguing your point, I just don’t understand this one piece of it.

            Otherwise, in fact, I agree with your point, given that MRCS is indeed reasonable and appropriate in most circumstances.

          • AllieFoyle
            March 18, 2013 at 12:16 pm #

            Because it’s a belief based in biological essentialism–that women are defined by their natural reproductive functions and therefore natural must be better, even in the face of evidence to the contrary.

            There are a number of different reasons people believe natural birth is better, but I think many of them relate to a desire to maintain traditional gender ideals and roles, i.e. “natural birth is woman’s lot/highest achievement, and she shouldn’t be able to avoid it/miss out on it because of some artificial technology.”

          • March 18, 2013 at 1:37 pm #

            I’d agree that there are a number of reasons for the obsession with natural – but as far as I am concerned, all of them are suspect and/or morally dubious. It really doesn’t take a whole lot of thought or research to become very aware that at times and in places where birth is actually natural, rather a lot of bad things happen. What exactly is being said when anyone insists that “natural birth is a woman’s lot” except that the harm that is done to women is no big deal? As for it being an “achievement” doesn’t that also rest on the idea that there will be winners and losers?

            Generations of dedicated men and women put a lot of effort into ameliorating the “natural” carnage of birth – what kind of nonsense is it that makes a point of pride out of rejecting that?

            For those fortunate enough to get a natural birth without the jumping through hoops and pretence – well done, lucky you – you have reason to be pleased, relieved, grateful and proud that several complicated things went right. Doubt it had much to do with anything you planned.

          • Hannah
            March 14, 2013 at 8:00 pm #

            “Then you don’t have a right to medical treatment at all, unless you believe injury and disease to be something other than natural processes.”

            Injury and disease are absolutely natural processes and you don’t have an absolute right to be free of them. How could such a right exist in a world where injury and disease are an unavoidable part? I would argue that the right to medical treatment is relative. In a world where we have the knowledge and capacity to mitigate injury, disease and death, then it is a moral right that the fruits of that capacity should be justly and widely distributed, and that no-one should get sick and die because they have less means or some other arbitrary characteristic, or because other less important things are prioritised.

            The right is relative and a product of principles of justice applied to the capacity of modern human society to provide medical care. So it would be a violation of that right for someone to die young of TB in a world where antibiotics a cheap and readily available, but not to die a few months earlier of cancer because the latest expensive state of the art drug couldn’t be provided, although it would be good if cutting edge drugs could be provided to all.

            Similarly it’s a travesty if a woman bleeds to death because of lack of basic maternity care when we have the know-how to prevent it happening, but not if a woman can’t access a caesarean, as opposed to a natural birth (with optimal analgesia), when the caesarean isn’t medically indicated, and the natural birth safer, although maternal request caesarean, is all things being equal, a valid option.

          • LukesCook
            March 14, 2013 at 8:10 pm #

            Can you give an example of an “absolute” right?

          • Hannah
            March 16, 2013 at 1:59 pm #

            “Can you give an example of an “absolute” right?”

            There are very few truly absolute rights, but absolute or near absolute rights would include the right not to be deprived of your life. That wording may seem convoluted but it’s deliberate. Given that we’re all mortal we don’t have an absolute right to life, in the wider sense, but you cannot actively kill someone except in defence of another life- and in the corporate sense this might cover justified military action.

            More pertinently to this discussion another near absolute right would be (negative) bodily integrity, as in not having your body invaded or exploited by an external actor. This would cover medical treatment without consent. Caesarean, for example, like any surgery, is principally an assault. You’re cutting into and wounding a major organ and surrounding tissues. The justification is that it is beneficial to the patient, and that they give informed consent. Without consent it’s not legal or ethically justified. The right to withhold consent is absolute for a patient with capacity, even if the consequences are profoundly negative. So if a woman refuses a caesarean even if that means the baby might die, then she still has the right to withhold consent. There are exceptions if the patient doesn’t have the capacity to consent or withhold consent, as people with learning difficulties, mental health problems or children, might otherwise suffer from lack of appropriate medical treatment that they aren’t capable of understanding the benefit of.

            The right to not be deprived of your liberty, in the narrow sense, might also be a partial example, and relevant to NAPW’s work. This right is negative and held simply by being a human, and isn’t dependent upon the resources and capabilities of wider society, and the state has to provide major justification and safeguards for incarcerating you. Nevertheless there are a fairly wide range of circumstances in which this right can be suspended, and incarceration is used routinely within the penal system.

          • LukesCook
            March 16, 2013 at 6:21 pm #

            “you cannot actively kill someone except in defence of another life- and in the corporate sense this might cover justified military action…blah blah”

            In short, there is no such thing as an absolute right.

          • Eddie
            March 16, 2013 at 9:17 pm #

            @LukesCook: How do you jump from not having an absolute right to absolutely having no right at all? That seems like quite a leap to me. I am serious: I don’t understand that logic. Not everything in life is absolutes.

            Is society obligated to provide every person whatever treatment they want, whether it is indicated or not, whether or not they can afford it? Is every provider obligated to provide every asker for whatever treatment they want, even when it is not indicated or safe or appropriate? I think the answer to both is no, as long as they are absolutes. But I just don’t see a link from that to then saying you have no right to medical care at all.

            If you have an absolute right to something, that means other people have an absolute obligation to provide that, whether or not it agrees with their morals or scientific judgement.

            Getting to the specific case of VB after CS, if it was up to me, I’d change the law so that a mother’s refusal of a medically indicated CS would absolve the doctor of liability if anything went wrong, as long as what went wrong is something that would have been prevented by CS. And then provide nationally standard consent forms so someone cannot argue that they didn’t understand. If a mother wants to choose a medically risky treatment, that is one thing, but she should not then be able to sue if her choice is directly responsible for things going badly.

          • LukesCook
            March 17, 2013 at 4:00 am #

            You misunderstood. The issue is not about absolutes – there is no such thing as an absolute right, it’s a meaningless qualifier. The issue is the distinction Hannah was trying to make by in the words “medical intervention to arrest a natural process”, which is nonsensical because exsanguination, cancer and gangrene are all natural processes and what is medical care about if it’s not about medical interventions to arrest them?

          • Eddie
            March 17, 2013 at 12:50 pm #

            Now I understand your point. Thanks for clarifying.

        • suchende
          March 14, 2013 at 4:35 pm #

          I think when two courses of treatments have similar risks and benefits, patients should be permitted to choose between them, even when doctors think one is better than the other for whatever reason.

          • Hannah
            March 14, 2013 at 4:42 pm #

            I agree that they should. I would just contend that it’s not an absolute right.

          • AllieFoyle
            March 14, 2013 at 6:40 pm #

            So what is your position exactly? Is there a valid reason for denying women the ability to choose MRCS as a matter of course? Is there something specific about childbirth that distinguishes it from any other medical event in terms of decision-making? If I go to a physician for any other medical indication, and there are multiple valid treatment options, am I not entitled to determine which one I will accept?

            You seem to be arguing that access to MRCS shouldn’t be guaranteed because it’s excessively expensive or somehow on par with a frivolous or unnecessary treatment and neither of those things are true. If you believe that people have an absolute right to treatment for medical indications (the birth of a baby certainly qualifies, I would think), and you believe that people have a right to be treated with respect and dignity and retain autonomy over their own bodies, then how can you justify denying women the right to choose MRCS?

          • Hannah
            March 14, 2013 at 6:53 pm #

            I’m not arguing any of those things, explicitly the opposite, and I’m not sure how I can make this any clearer. I’m arguing that the same general principles apply to medical treatment surrounding childbirth as any other medical situation. That in general it is a good thing for people to be able to make positive choices around their care, and MRCS seems to be something that ought reasonably to be offered as an option, but that you don’t have an absolute right to specific treatments. There are legitimate reasons for medical professionals not to offer specific treatments- that it is medically unnecessary, as MRCS would technically be, or even in cases where it is “necessary” in one sense or another, if their are cost or ethical considerations, as in the extreme examples I posted below. To the extent that you have a right to medical treatment it is a relative right to equitable access to medical care that society can reasonably provide. Routine perinatal care would be very basic and hugely beneficial, care in modern society, and thus there is a right to universal access. MRCS is a good thing, with the right conditions, but isn’t a right.

          • AllieFoyle
            March 14, 2013 at 6:57 pm #

            We have already established that:

            1)MRCS is one of two valid and necessary outcomes of pregnancy

            2)MRCS is not significantly more expensive or dangerous

            What possible reason could there be to deny women this choice?

          • Hannah
            March 14, 2013 at 7:26 pm #

            The operative word there is “significantly.” If it’s more expensive and less safe, then they have no particular obligation to offer it- and unlike a natural birth it’s something they are actively offering rather than something that happens anyway in their absence. Nevertheless, I think it’s good to have that option there, but there’s no right to it and therefore no corresponding obligation for it to be provided.

          • AllieFoyle
            March 14, 2013 at 7:46 pm #

            “If it’s more expensive and less safe, then they have no particular obligation to offer it”

            This is just not the case. And again, there is no indication, once you really look at the data, that MRCS is actually more expensive or more dangerous.

  9. Becky05
    March 14, 2013 at 3:30 pm #

    I asked about this and got a response.

    Part of it, (but do read the whole thing), ” We have heard of women who wish to deliver prior to 39 weeks gestation and have been refused by their physicians, but unfortunately their recourse is typically to find another provider who will accomodate their needs, because there is a legal distinction between the right to demand a particular course of care versus the right to make medical decisions free from coercion or punishment. While there is a well-developed body of case law we can rely upon to counter claims that fetuses have separate legal rights enforceable against pregnant women that can be used to deprive them of physical liberty (including forced cesarean surgery), there is no legal framework for demanding procedures that providers refuse to perform.”

    • The Bofa on the Sofa
      March 14, 2013 at 3:53 pm #

      there is no legal framework for demanding procedures that providers refuse to perform

      So if the doctor refuses to do a VBACS, they are ok with that?

      • Hannah
        March 14, 2013 at 3:59 pm #

        A VBAC isn’t a procedure, it’s the (usual) natural endpoint of a pregnancy in a woman who’s had a previous caesarean. Also, my understanding is that there is a legal framework in the US to mandate hospitals to provide supportive care for women giving birth, after caesarean or otherwise: EMTALA.

        • The Bofa on the Sofa
          March 14, 2013 at 4:10 pm #

          A VBAC isn’t a procedure,

          So why does a doctor have to be present at all?

          Patients can force the hospital to monitor them at the endpoint their pregnancy?

          my understanding is that there is a legal framework in the US to mandate hospitals to provide supportive care for women giving birth

          Since when does “supportive care” require VBACS? If the doctor does not believe that a VBACS is appropriately safe (if, for example, the hospital cannot guarantee anesthesiology within 10 minutes), then having a VBACS is not proper care.

          • LukesCook
            March 14, 2013 at 4:20 pm #

            They don’t, doctors and hospitals can and do refuse to attend VBACs.

            Their reply is all humbug anyway. The practical obstacle to MRCS isn’t the doctors being asked to perform them (who are all scalpel-happy golf fiends, remember), it’s bean-counters and busybodies.

          • The Bofa on the Sofa
            March 14, 2013 at 4:28 pm #

            How can a hospital refuse to “attend” a VBACS?

            That doesn’t make any sense.

          • Laura
            March 14, 2013 at 6:16 pm #

            If a hospital doesn’t allow VBAC’s, then I suppose that’s a really sticky situation when the woman shows up in labor and refuses a c-section. I’m assuming her doctor wouldn’t be favorable to it, either, knowing the hospital policy. So, I am curious: how would a hospital handle that situation with an actively laboring, VBAC-desirous patient refusing a cs? Anyone have an answer?

          • Becky05
            March 14, 2013 at 7:05 pm #

            They can try to persuade all they want, but they can’t force a cesarean, nor refuse to provide other care. They have to allow the VBAC.

          • Sullivan ThePoop
            March 14, 2013 at 10:14 pm #

            They can transfer you to another hospital. I had a friend go into labor early when she was on vacation. The closest hospital only had a level 1 NICU so they decided it was best to fly her to a hospital with a greater level of care than wait for her labor to proceed and medevac the infant if need be.

          • Becky05
            March 15, 2013 at 9:30 am #

            Right, the ACOG statement does mention that, but also notes that it would frequently not be possible during labor. I suppose it depends on where the other hospital is, how far labor has progressed and how fast it is currently progressing.

          • The Bofa on the Sofa
            March 15, 2013 at 11:15 am #

            They can try to persuade all they want, but they can’t force a cesarean, nor refuse to provide other care. They have to allow the VBAC.

            So IOW, they are forced to commit malpractice.

            Let’s take the case that set this off, the one in FL where the woman was scheduled to have a c-section the following week, but things get messed up and an immediate c-section is indicated. The doctor tells the woman she needs a c-section NOW. She refuses. He begs her. He threatens to have the police bring her in. She still refuses. That is her right, yes? We all agree on that? They can’t force her to have a c-section even though they think it is critical. That’s what has been said.

            Now, in the current situation, the woman capitulated ultimately, but let’s say she doesn’t. She holds out and refuses to deliver until the next week. Unfortunately, it is too late, and, sadly, the baby that was alive last Friday is stillborn the following Wednesday.

            What happens next? The woman sues the doctor for malpractice. And she will win, it is obvious. There is no doubt that she will. The plaintiff’s lawyers will not have to look hard to find plenty of expert witnesses who will tell the jury that the standard practice would have been to do a c-section the week before, when things went pear-shaped. And the defense can’t deny it, and their only defense is that she refused.

            But that’s not an acceptable defense. The doctor is responsible for the outcome, and that is all that is too it.

            Patients cannot waive their right to sue, and the hospitals are forced to accept it. But you put that together with the patient’s refusal to let the hospital do what they need to do to adequately prevent a problem, and it’s gets really ugly.

            I don’t know the answer, but that is the reality. One consequence of the patient’s right to refuse a CS and insist that they be allowed a VBACS is that it forces the medical team to commit malpractice.

          • AmyP
            March 15, 2013 at 1:28 pm #

            That’s where Dr. Amy’s dead baby waiver comes in. I’m not sure that even that would work on a patient as obtuse as the FL woman, though.

          • The Bofa on the Sofa
            March 16, 2013 at 9:35 am #

            That’s where Dr. Amy’s dead baby waiver comes in. I’m not sure that
            even that would work on a patient as obtuse as the FL woman, though.

            While cute, the dead baby waiver is not legally binding. In fact, it’s easily seen that it would probably have no weight at all. By making it up into a card and handing it out, the patient can easily claim that “I didn’t think she was serious. This is just a card she gives to everyone to scare them.”

          • Anne
            March 15, 2013 at 4:17 pm #

            Is that really how the US legal system works? (Genuine question- I work in Australia).

            Providing for informed consent/refusal is part of the duty of care of HCPs- explain the alternatives; the risks and benefits thereof; document these in the patient record; ask the patient to sign that they understand (“the baby may die or suffer irreversible brain damage” etc); and leave the responsibility for the decision where it belongs- with the person receiving care.

            Our responsibility as HCPs is not to ensure an outcome, but to ensure the patient has all the information they need to make their decision. While most patients will take our advice to ensure a good outcome (eg live baby), this is not always the case, and cannot be the measure of good or bad practice.

          • Becky05
            March 16, 2013 at 8:44 am #

            Yes, sadly, it seems to be. There’s at least one case where a doctor was sued successfully because when giving information on VBACs, while she told the woman that she had seen a rupture, she didn’t tell the woman that the baby had died, although she DID tell the woman that fetal death was a possible consequence of rupture. The mother argued that had she known the outcome of the rupture that the doctor herself had seen, she would have made a different decision.

            Now, this case was eventually overturned on appeal, but at what expense to the doctor and her malpractice insurance? And I have heard of other cases where the argument was successfully made that although the woman signed a document listing the possible outcome of a rupture, she didn’t actually “understand” the risks. I haven’t been able to dig these up, honestly, other than the one I note above that was eventually overturned.

          • Hannah
            March 16, 2013 at 2:14 pm #

            Exactly, and this is the crux of my mini discussion with Dr Amy, above. A hospital, it must be emphasised, doesn’t “perform” a VBAC, they administer routine care in childbirth, in addition to any additional care that might be advisable, due to the prior caesarean. It would be incredible if an obstetrician providing competent labour care to a woman in labour after a previous caesarean, who rejects a repeat caesarean in spite of being appropriately counselled, was considered malpractice.

            The fact that malpractice cases in the US are decided by lay people, and often on emotional rather than legal grounds- and that plaintiffs and juries use the tort system to plaster over the cracks of the medical system in terms of long term care- is separate to the question of is attending a VBAC malpractice on principle?

          • Amy Tuteur, MD
            March 16, 2013 at 2:28 pm #

            The problem with the analysis is that women who want a VBAC aren’t asking to be left alone. They are asking for advanced medical care to save them and their babies in the event of disaster, will insisting that the doctor can do nothing to prevent the disaster.

          • Becky05
            March 16, 2013 at 8:41 am #

            Yes, I agree this is entirely messed up. However, the solution is some kind of legal change that makes informed refusal/informed consent something that is taken seriously.

          • The Bofa on the Sofa
            March 16, 2013 at 9:32 am #

            Yes, I agree this is entirely messed up. However, the solution is some
            kind of legal change that makes informed refusal/informed consent
            something that is taken seriously.

            The problem with that is that as soon as it happens, it will open the door for unscrupulous providers.

            Patients are not able to waive their right to sue, and this is a good thing, because, overall, it protects the patients far more than the providers. In particular, allowing them to waive their right to sue would unfairly punish patients who have been manipulated.

          • Becky05
            March 14, 2013 at 7:15 pm #

            The ACOG’s VBAC statement reads, “Respect for patient autonomy also argues that even
            if a center does not offer TOLAC, such a policy cannot
            be used to force women to have cesarean delivery or
            to deny care to women in labor who decline to have a
            repeat cesarean delivery.”


          • Hannah
            March 14, 2013 at 7:19 pm #

            That statement is essentially a nonsense. If they can’t force a caesarean or deny a woman general care in labour then they’re offering TOLAC (or more accurately, care in TOLAC).
            To claim to be withholding TOLAC as a policy- as opposed to setting out an appropriate referral policy to a better resourced facility, or being open about your own limitations and recommending ERCS in light of that- is a form of brinksmanship. It only serves to deny women properly co-ordinated anti natal care and preparation for delivery, or to use the threat (which they can’t carry threw) to browbeat her into assenting to caesarean, which is unethical.

          • Becky05
            March 14, 2013 at 9:39 pm #

            The statement does mention referral to other hospitals or providers, or simply relating the capabilities of the hospital and leaving the choice to the mother. However, there’s still the issue of what to do when a woman comes into the hospital in labor, yet is insistent on a VBAC and is refusing a repeat cesarean. That’s what this particular line is referring to. The hospital is obligated under EMTALA to provide care, is unlikely to have time to transfer the woman, but can’t overrule her autonomy and force a cesarean.

          • LukesCook
            March 14, 2013 at 7:28 pm #

            Not the most elegant turn of phrase, perhaps, but are you really confused as to the meaning?

          • The Bofa on the Sofa
            March 15, 2013 at 10:51 am #

            Not the most elegant turn of phrase, perhaps, but are you really confused as to the meaning?

            Yes. Help me out and say what you mean.

          • LukesCook
            March 15, 2013 at 6:52 pm #

            Hospitals can and do refuse to admit patients for VBACs.

          • Hannah
            March 14, 2013 at 4:24 pm #

            Supportive care doesn’t require a VBAC, because the doctor doesn’t provide a VBAC because it’s not a procedure, as I’ve said, but a VBAC, to be relatively safe, requires supportive care i.e, monitoring, and the ability to provide surgery if the situation changes, and the mother agrees to it. Any of the Obstetricians on this site will tell you that a greater degree of monitoring is the appropriate course of action in a VBAC. The doctor doesn’t “withhold” a VBAC because birth will generally take place, eventually, without their input, they withhold medically appropriate care, because they disagree with the woman’s choices, that’s philosophically a very different thing.

          • Amy Tuteur, MD
            March 14, 2013 at 4:46 pm #

            No one is preventing anyone from having a VBAC. Some doctors are refusing to attend women who are having VBACs and some malpractice insurers are refusing to cover doctors and hospitals who offer VBACs. That’s something entirely different.

          • Hannah
            March 14, 2013 at 4:50 pm #

            My understanding was that US hospitals are legally obliged to provide care for women in labour, but I’m prepared to be corrected on that, if that’s not the case.

          • Laura
            March 14, 2013 at 6:13 pm #

            But, in effect, VBAC-desirous patients are being prevented from attempting VBACs if their doctors and hospitals are refusing to do them. They either have to travel very far for a provider and facility that will do them, or have attempt a HBAC.

          • AllieFoyle
            March 14, 2013 at 6:15 pm #

            Lots of people have to travel to access the specialized care that they require or prefer. Why should VBACs be a special case?

          • Laura
            March 14, 2013 at 6:20 pm #

            I’m not saying it should be a special case. It’s more of an inconvenience. I know a very popular VBAC-friendly doctor smack dab in a very busy BIG city and women travel far and through horrendous traffic to have VBAC’s where he practices. He has a fairly high VBAC success rate and most women are quite happy with his care. To them, it’s worth it. And I’m happy for them!

          • Becky05
            March 16, 2013 at 8:53 am #

            The problem is that with about 30% of first time mothers delivering by cesarean, the number of women who could benefit from access to VBAC is not small. And while for some of these women a VBAC would be a bad idea, and for others it would just be a personal preference, for some women, based on their own medical history, planned family size, etc. a VBAC really might be the best choice medically. While not every hospital should offer a VBAC to every patient, across the board bans don’t take into account wide variations in risk, and they mean that many women realistically don’t have access to the best medical care for them. ACOG suggests regional centers for VBAC, which would require some travel, but whatever is done, I think it is really important that access to VBAC is available.

          • AllieFoyle
            March 16, 2013 at 12:12 pm #

            I agree and think that regional centers are probably a good way to increase access for those that would benefit from having it offered. But I think you can also make that same argument about many medical situations. I live in a rural area where access to more sophisticated care is often limited, and people are burdened by having to travel to access it. I don’t see an easy solution, unfortunately. While I’m sympathetic to people who have to travel to access VBAC, I’m honestly more concerned for people who have chronic conditions and have to make those long trips many, many times.

          • KarenJJ
            March 16, 2013 at 7:27 pm #

            Is it 30% for first time mothers where you live? I thought the c-section rate for first time mothers was much lower – around the 10-15% and the 30%+ rates were overall c-section rates that included repeat c-sections.

          • Becky05
            March 16, 2013 at 10:01 pm #

            The overall rate for first time mothers is around 30% for the US as a whole. With just a quick search, I found this document with data from 2007; 31.2% of first time mothers had a cesarean that year. This is actually slightly higher than the overall rate for the US for that year.

            The cesarean rate continued to increase after that and in 2010 the overall rate was over 32%, but I can’t find data for only first time mothers for that year.

            At individual hospitals, the primary cesarean rate may be around 10-15%, but for the United States as a whole it is over 20%. That rate has as a denominator all women who gave birth and had not previously had a cesarean, not just first time mothers. Women who have already had a vaginal birth are much less likely to need a cesarean than a woman who has never had a vaginal birth, so the primary cesarean rate tends to be significantly lower than the rate for first time mothers.

            The overall rate does include repeat cesareans, but how women have their first baby tends to be (not always is, of course) how they have their subsequent ones. There are many repeat vaginal deliveries as well as repeat cesareans each year. The rate in first time moms helps determine the overall rate.

          • Eddie
            March 16, 2013 at 10:18 pm #

            One thing I learned when my wife and I prepared for our youngest (as her other children were born in a different country with VERY different practices) was how little risk doctors are willing to take. I imagine this has a lot to do with malpractice lawsuits. My mother walked around for a week leaking water with me, because labor had not started yet after the water broke. Almost no doctor would be willing to take that risk of infection today, and it’s hard to blame them.

            My wife got induced when labor didn’t start quickly enough, although they were willing to wait so I could go home, be sure our other kids got off to school, and come back. I’m sure if my wife didn’t agree to be induced we would have had a choice. The hospital staff and my wife’s Ob made it very clear that they wanted our child to be born within 24 hours of the water breaking.

            My point? My understanding is that part of the “sky-high” rate of CS in the United States driven by this desire by the doctors to take the lowest-risk path possible for the baby. If ANYTHING looks like a problem, CS is a known path to quickly delivering a live baby.

          • Captain Obvious
            March 14, 2013 at 10:53 pm #

            If you want a specialized cardiac (or brain or whatever) surgery and you live in a rural area where it isn’t offered, you drive to that facility. You don’t try a home cardiac surgery. If you want a safe VBAC, you go where they are performed. You don’t try a HBAC. Continuos monitoring watching for changes in the fetal heart rate and immediate access to an OR and NICU. Or is a safe delivery for your baby not important for you?

          • Becky05
            March 15, 2013 at 9:30 am #

            Are VBACs as risky a procedure as specialized brain surgery? The ACOG has backed away from the “immediately available” terminology and has clarified that they did not mean to restrict access with that guideline. I agree that VBACs are safer in some hospitals in others and that this should be made absolutely clear to patients, but I also don’t think that blanket VBAC bans, especially those impose by insurance companies, are good medicine. Risk varies widely even among those attempting TOLAC. The woman who’s already had two successful VBACs and whose cesarean was for fetal distress or malpresentation isn’t the same risk as the overweight diabetic who has had a cesarean (or two!) for cephalopelvic disproportion. Some hospitals might be able to handle the risk of the first but not the second.

            Even given that not all hospitals are appropriate places for TOLAC, this is still often the most appropriate choice for a particular woman, and making it possible for women to access it in some way, even if that does involve travel, is important IMO.

          • Laura
            March 15, 2013 at 3:15 pm #

            Huh? Pregnant, conscientious women desiring VBAC’s DO travel to facilities where there is a doctor willing to meet all the stringent guidelines for a VBAC. Many of them do have VBACs and are quite happy about it. Some women, however, for whatever reason, don’t want to travel to facilities to VBAC so they choose HBACs. I don’t agree with it, but HBAC moms will cite the reason for their HBAC because their nearest facility only offered a repeat cs and they knew of no other facility or provider closer to them or that would accept their insurance.

          • The Bofa on the Sofa
            March 15, 2013 at 10:50 am #

            So go to a hospital that will do it.

            That’s what they have said to women who want a MRCS – shop around and find someone willing to do it. Why doesn’t that also apply to a VBACS?

      • Becky05
        March 14, 2013 at 7:12 pm #

        As Hannah said, women have a right to refuse a cesarean, while hospitals covered by EMTALA must still provide care during labor and delivery. A VBAC isn’t a procedure in the same way that a surgery is. Most of what they deal with, however, is fighting court ordered cesareans, or the threat of the same, or imprisonment because a woman is claimed to be damaging her baby, etc.

  10. ol
    March 14, 2013 at 2:45 pm #

    Have you seen it? about Dr. Jankowitz

    • Sullivan ThePoop
      March 14, 2013 at 10:15 pm #

      That was an interesting read. If what that woman says is true, and I am assuming it is, then the situation must be extremely dire for him to take that step.

  11. Becky05
    March 14, 2013 at 2:26 pm #

    I have heard them claim elsewhere that they supportive of all women’s choices, but yes their links etc. are overwhelmingly from one perspective. I commented on their facebook page, but maybe I’ll draft a longer letter on this.

  12. Charly
    March 14, 2013 at 2:07 pm #


    I just have a point to make. So, it is considered “selfish” for a mother to choose homebirth because she is doing it for her own comforts and not because it is what is best for the baby, because if something were to go wrong, being at a hospital would be best, yes? because the safety of the baby is the most important thing? But why is it not just as “selfish” for a mother to choose not to breastfeed and instead to use formula? I am NOT talking about instances where breastfeeding is difficult or impossible. I am talking about women who “simply choose” not to breastfeed, as it was phrased in the above blog post. Why is it okay for women to “simply choose” to use formula, but then it is selfish if they homebirth?

    You argue that a woman should be the one to have control over her body, but when there is a child growing inside, we can all agree it isn’t just her body anymore. Thus, where a woman gives birth can adversely affect the baby, ie a baby dying at home because the mother “simply chose” to have a homebirth. However, a baby also depends on mother for nourishment, especially the first months where she or he cannot eat solid foods. Isn’t it just as selfish for a mother to choose not to breastfeed just because she doesn’t want to? just because she does not want to use her breasts for their natural purpose? Again, I am not talking about extenuating circumstances here; I am talking about a woman who “simply doesn’t want to breastfeed.” In my opinion, that is selfish. You “simply don’t want to breastfeed?” Oh well. You had a baby.

    I guess I just can’t understand why the issue of breastfeeding is seen as such a simple choice. Do you want to or not? No. it’s not like that. There is a little baby involved. That little baby wants mother’s breast, under normal circumstances that is. So if you can breastfeed, if you have the ability and the time, you should, in my opinion.

    It’s like saying, “Oh,well, yeah I had a baby. But I simply don’t feel like raising it.”

    • Jessica
      March 14, 2013 at 2:13 pm #

      When good, safe, reasonable alternatives for infant nutrition exist, as they do in first world countries with adequate and clean water, it is not unreasonable for a woman to decide not to breastfeed. A baby wants to eat; he cares little whether it’s at the breast or from the bottle.

    • Becky05
      March 14, 2013 at 2:14 pm #

      Personally, I don’t think it is selfish for a woman to choose homebirth. I am strongly opposed to the misinformation on it, though. If women are going to make a choice, they have the right to fully informed consent, and to qualified health care providers.

    • GuestB
      March 14, 2013 at 2:17 pm #

      Calling all sanctimommies!!

    • PH Student
      March 14, 2013 at 2:18 pm #

      No. Your body, YOUR choice. There should be nothing or no one pressuring someone else to use their body in a way they don’t want to. Luckily, thankfully, we live in a country where using formula is not a life or death choice.

      Oh, and I was a LLL leader who breastfed for a really long time. By choice.

    • BeatlesFan
      March 14, 2013 at 2:27 pm #

      Homebirth is a good deal riskier than formula feeding. A baby is unlikely to end up dead or disabled from having formula instead of breastmilk; however, if a birth goes pear-shaped at home as opposed to in a hospital, death or disability (for baby OR mom) is much more likely.

      I understand the point you were trying to make, but it was a poor analogy. Formula feeding is worlds away from giving birth away from adequate emergency care, under the supervision of a “care provider” with minimal training.

    • Bombshellrisa
      March 14, 2013 at 2:54 pm #

      It isn’t selfish to choose home birth in every instance! There are places where midwifery is part of the health care system and women are cared for as long as they are low risk. There are options for home birth, even waterbirth with those midwives. The midwives are trained professionals with a lot of schooling and practice (unlike direct entry or certified professional midwives who practice home birth in the United States). There are strict protocols that risk women out of midwifery care and home birth, even one’s distance from the hospital is considered. There are back up physicians and a transfer plan.
      As for simply choosing not to breastfeed, what is so wrong with that? There is always a reason behind it, whether someone is willing to get into it with you or not.

    • AllieFoyle
      March 14, 2013 at 3:06 pm #

      Frankly, I think you should ask yourself why it’s so important to you to judge other women for the personal parenting choices they make.

    • claire
      March 14, 2013 at 3:33 pm #

      It’s like saying, “Oh,well, yeah I had a baby. But I simply don’t feel like raising it.” No, rearing a child and feeding are two very different things. You are still feeding a baby with formula, not raising it in your words would be to ignore the cries and not feed at all.

    • March 14, 2013 at 3:40 pm #

      So it is your considered opinion that not bf equals not bothering to raise the child.

      Exaggerated, much?

      There is contested research which says there MAY be negative consequences which MIGHT be down to not bf. Most women are quite capable of figuring out for themselves how this weighs in their own personal judgements. For myself, I would have liked my children to have had the marginal benefits of bf – they didn’t for reasons which are none of anyone’s business. They have still managed to grow into healthy adults, not particularly prone to ear infections or stomach upsets. They do not have asthma, diabetes, or anything else on the long list, they are not obese. I did not waste cuddling and playing time beating myself up about “failing”. You like it, you do it. Leave others alone.

    • LukesCook
      March 14, 2013 at 4:04 pm #

      “when there is a child growing inside, we can all agree it isn’t just her body anymore”

      No, I don’t think we can all agree that.

      Women who want to home birth are perfectly entitled to do so. It doesn’t necessarily follow that their choice isn’t selfish or stupid. Usually it wouldn’t be either polite or necessary to say so, unless the woman is either deceived or is helping to deceive others, or both.

      Formula feeding isn’t comparable firstly because both the risk and the magnitude of potential harm are an infinitesimal fraction of the potential harm of home birthing, secondly because women who choose formula base their decision on factors other than a misunderstanding of the risks and benefits, thirdly because I’ve yet to see a formula feeding mother launch an online career by spreading lies and fantasies about infant feeding, and fourthly because there are real benefits to formula feeding, such as allowing others to help care for the infant, allowing the mother to return to work or rest, sparing the mother pain or exhaustion, which are substantial enough to outweigh the benefits of breast feeding. The purported benefits of home birth are either entirely illusory or merely trivial in comparison to the potential,harm.

    • fiftyfifty1
      March 14, 2013 at 4:10 pm #

      There is more than 1 way to use the word selfish. You can use it in a neutral way, as in “The reasons behind my decision were based on factors that had to do with me”. Or you can use it as a judgemental word, as in “She was really selfish to ignore her child’s poopy diaper for hours while she was posting away on “The Skeptical OB”. The difference is in whether the choice harms someone else, and how much.

      An example from my own life: I decided on a Maternal Request C-section for reasons that had to do with me. Since my needs were the only ones that really came into play here and since the effect on anyone else would be negligible, you could correctly call it a selfish decision, but not in the perjorative way.

      On the other hand, homebirth can and does KILL babies. That’s a bit different. That would be deciding my personal comfort was more important that risking the death of my baby. Most people agree that that is Selfish in the bad sense of the word.

      When you look at breastfeeding, I think this should fall under the camp of neutral selfish. The best breastfeeding study we have, the PROBIT* study, shows that the difference between breastfed babies and formula fed babies is negligible, at least in developed countries that have a safe water supply and high quality formulas. That fact gives moms the freedom to do something selfish without it being Selfish. And I say that’s a great thing.
      *Third installment results just came out yesterday in JAMA, focussed on obesity this time. It found that in 11 year olds there was actually MORE overweight (18% more frequent, and statistically significant) and also a trend toward more obesity (17% more frequent, but not statistically significant) in the Breastfeeding promotion group than in the control group. I wouldn’t normally post these results as I’m not keen on results that aren’t robustly significant, except that I find the discussion section of this paper irritating. The authors dismiss this higher rate of weight problems among breastfed kids as being most likely due to chance. But in earlier studies when there was a small decrease in stomach flu or the one subset of the IQ test that was a couple points higher, they did not dismiss it because it went with the established dogma, not against it.

    • CarolynTheRed
      March 14, 2013 at 4:17 pm #

      Seriously, is there any instance where breastfeeding isn’t difficult?

      • fiftyfifty1
        March 14, 2013 at 4:39 pm #

        I think there are. Some women have a very easy time. They produce lots of milk and have large storage capacities, so don’t have to feed excessively often. They pump large amounts easily, so they have freedom to go out alone. They have flexible accomodating jobs. Their babies have normal sucks and predictable sleep-wake cycles. And it’s something they want to do and enjoy. Add all these factors together and breastfeeding will not be difficult.

        • Becky05
          March 15, 2013 at 9:44 am #

          Exactly. Breastfeeding wasn’t difficult for me, except for about the first six weeks with my first. Even then, although he had issues latching, I had overabundant supply and he put himself on a 3 hour schedule from the get go. For my other kids, breastfeeding was always easy.

          I was going to wean my youngest at 3 months so I could go back on a particular medication, and I found bottlefeeding to be such a pain that I nixed the idea. I’m still nursing him at almost 20 months, but limiting it to certain times so I can still take my meds.

          This is all luck. I absolutely would not do what some people do to make nursing work. I couldn’t do it and stay sane.

        • me
          March 15, 2013 at 10:39 am #

          Absolutely. Aside from getting the hang of things with my first child (and I’m only talking 2 weeks of very mild discomfort at latch-on) my nursing experiences were extremely easy. I was blessed with a large supply, babies that latched well, decent storage capacity, and I respond very well to a decidedly cheap pump ($30). I SAH so there is no logistical nightmare of pumping at work to deal with; when I do bother pumping it is solely for those times when I need/want to get away. My babies were not great sleepers, but cosleeping helped with that. My 3rd child is 9 mos old and bfing is just second nature at this point. Of course I fully recognize that my lack of difficulties is pure luck; I’m not “better” than anyone else. I have chastised my husband for commenting on how the wife of a coworker “gave up too easily” when she had switched to formula at about 6 weeks; I pointed out that it’s easy not to “give up” when nothing goes wrong. He had no idea how hard she tried, what obstacles she faced, or ow important it even was to her; all HUGE factors in decided what path to take. I think he was a little taken aback by my jumping on his case when he said it (I think he was trying to compliment me, lol), but having dealt with people’s judgement over NIP and “extended” nursing, I understand just how shitty it is to have people commenting on things that are none of their goddamned business. I’m just glad he didn’t say anything *in front” of her…

        • CarolynTheRed
          March 15, 2013 at 12:18 pm #

          I was being a smart-ass, more than anything, but thinking about it again, well, that’s a lot of ways it can not be easy. I was also thinking that most of the new mothers I’ve met have had some trouble along the way or needed a little supplementing at some time, and they’ve been motivated to breastfeed and in a land of generally long parental leaves with breastfeeding clinics and public health nurses who’ll come visit if you want help.

      • anonomom_LLLL_IBCLC
        March 14, 2013 at 9:17 pm #

        Formula feeding can be difficult too. Baby can have difficulty with one or the other, and the mom has to keep trying different ones. Plus it can be quite confusing with all the options of bottles and formula brands on the market. I do think FF is usually easier though, simply because anyone can feed the baby.

        • Sullivan ThePoop
          March 14, 2013 at 10:19 pm #

          In the US formulas claim to have one thing over others, but really they are so heavily regulated that no one is really better than the other, even generics.

        • Eddie
          March 14, 2013 at 10:51 pm #

          Our littlest DID have trouble with both. My wife initially tried exclusive BF with mixed success. Long story not worth going into, and anyway we knew we would supplement with formula at some point. It was just earlier than we expected. My wife pumped, because our littlest took milk better from a bottle. Even there, it was a struggle to find what worked best for her. We finally figured out that she just didn’t like the floppy collapsible nipples most bottles use. She *did* like latex ones, which are much firmer, so that is where we settled. It was a long journey, though, with more than one hospital visit. LONG story.

      • Wren
        March 15, 2013 at 2:27 pm #

        With my oldest, no, it wasn’t easy. He had a tongue-tie with an unusual presentation that went undiagnosed for 10 months, so until after he up and quit. With my second, the girl read the manual and we never had any problems breastfeeding for 35 months. She refused a bottle, despite it being offered at the same age as her big brother who never had an issue with them, but I was a SAHM and she was willing to go over 4 hours between feeds to avoid a bottle, so we were fine. Once she started solids she stuck to those plus water if I wasn’t there then spent a few extra minutes nursing that evening. Honestly, I found bottles and formula when my oldest needed them for a while a much bigger pain than nursing, but I recognise that was due to our particular situation and having a baby who found it all easy the second time.

    • mollyb
      March 14, 2013 at 4:17 pm #

      Why in the world would you compare homebirth, which has an appalling death rate, with formula feeding which does not? There are very small, trivial benefits to breastfeeding. The high death rate with homebirth is NOT trivial.

    • Kalacirya
      March 14, 2013 at 4:19 pm #

      Your argument might have some grit to it if it were the case that breastfeeding either resulted in significant benefits to a child, or that formula feeding caused measurable harm or had risk of death or injury attached to it. Neither of these statements are currently true. Your false equivalency remains false.

    • mimi
      March 14, 2013 at 4:44 pm #

      Babies want Mother’s love, as shown by the rhesus experiments some time back.

    • Sullivan ThePoop
      March 14, 2013 at 4:53 pm #

      I do think that a mother has the right to choose home birth if she is attended by at least 2 qualified practitioners with an emergency transfer plan and is truly low risk if she understands the risk. Even in that situation home birthing puts the baby at a far greater risk than having a baby in the hospital.

      Formula is appropriate nutrition in a developed nation and does not add a far greater risk when compared to breast feeding. So, your analogy is kind of like comparing apples to Volkswagens.

    • Eddie
      March 14, 2013 at 8:13 pm #

      I’ll assume that your question/post is earnest and genuine, and not a troll.

      Here’s the thing: Formula is almost exactly as good for baby as mother’s milk, and since baby honestly doesn’t care which of the two s/he gets, what is the big deal? The best scientific evidence available, which is nothing so solid as a double-blind test, by its nature, suggests but does not conclusively prove that there is a slight benefit for perhaps the first year. If I have mischaracterized the facts, please someone correct me.

      Thus, since the benefit is small, the harm done by consciously choosing to not breast feed is small to negligible, at least in the average case. The scientific evidence is compelling that there is a small benefit, but it is not, IMHO, conclusive. The risk to a child of choosing home birth is significantly higher than the risk of 100% formula-feeding. This is why you see people here defending the points they defend.

      The largest group of people here is swayed by scientific evidence, not by descriptions of “what is natural.” This is the year 2013. It is not the year 1800 where there are no good replacements for mother’s milk. Just because something is the “natural” way to do something doesn’t mean it is the right way, either. It’s more natural to walk than to drive. It’s more natural to grow crops without mechanization, and to only eat crops grown locally. But again, it’s not the 1800s. We have choices available to us now that were not available then.

      • Sullivan ThePoop
        March 14, 2013 at 10:17 pm #

        I think the benefits were only seen for 6 months instead of a year.

        • Eddie
          March 14, 2013 at 10:56 pm #

          I appreciate the correction. Thanks.

      • Becky05
        March 15, 2013 at 9:36 am #

        Nearly all of the benefits are just for the first year. There is conflicting evidence on longer term outcomes. Generally, even where there’s a suggestion of longer term outcomes, the effect is small (not even doubled) or the evidence is conflicting.

        PROBIT (a randomized trial of a program designed to increase breastfeeding rates) did find a long term significant effect on IQ and cognitive development. Other research has supported this, but some also refutes it. There’s some preliminary research supporting the idea that whether breastfeeding has an IQ effect is dependent on fatty acid processing phenotype.

        There’s also some evidence showing lower risk of celiac disease if mother is breastfeeding at the time that gluten is introduced to baby’s diet. Still preliminary there, but I think there’s considered to be plausibility.

        There’s a few other issues that suggest some possible long term effects, too, but the evidence isn’t nearly as strong as the evidence on reductions in GI infections, respiratory infections and pneumonia in infancy.

        • Eddie
          March 15, 2013 at 12:13 pm #

          I really appreciate this thorough reply. Thanks.

      • C T
        March 15, 2013 at 11:21 am #

        Working on partial weaning here, and let me tell you, babies often care QUITE A BIT whether it’s a bottle of formula or mommy milk! 😉 (I assume you’re male and have never had a baby pull desperately at your shirt to try to get to the bosom they know is underneath.)

        • Eddie
          March 15, 2013 at 12:06 pm #

          Sorry, I was unclear. My fault. I have definitely heard loud and clear that of babies that have tried *both*, some have a STRONG preference! I was referring to the statement in the post above, “That little baby wants mother’s breast,” which is not true at first. A baby that is exclusively FF, for example, doesn’t think, “Well, I’ll take this because it’s offered but what I *really* want is…” Infants just want to be fed.

          Ours, who never latched on properly, didn’t like the breast and was extremely picky about what bottle nipples she would use. When she was hungry she would eat, of course, no matter what, but with the wrong nipple, she would eat, stop. Eat, stop. Eat, stop. Once we found the right nipple, she would eat until done, then sleep.

    • KarenJJ
      March 15, 2013 at 12:58 am #

      “It’s like saying, “Oh,well, yeah I had a baby. But I simply don’t feel like raising it.””

      If you take a group of adults, it’s hard to say who was breastfed or who was formula fed. but those that were raised in loving homes versus those that suffer neglect and indifference – then yes, that can cause long term issues.

    • thepragmatist
      March 15, 2013 at 1:08 am #

      Well, I’ll bite. Because I have thought about this a lot as a feminist. I don’t share the view, necessarily, that homebirth with qualified midwives are selfish under most conditions, only when I am using it as an example of the hypocrisy of the NCB movement. But it is very dangerous under some.conditions, and those are mostly what makes this blog. Also, the question is valid: would women choose home birth if they knew the true risks of home birth? Should women be attended by underqualified attendants? And ultimately, should women be allowed to contribute actively to the death of a term infant, by choosing to birth unassisted or at home birth with unqualified attendants? I have thought about this a lot.

      I do not believe most women know the true risks of home birth… or even vaginal delivery. And I do believe that a woman has an absolute right to control over her own body, even if I do not believe it is safe or right or moral. I do not support the use of force, implied or coercive, to make a woman do anything with her body. Neither does Dr. Amy, as she made clear during the recent event in Florida! A woman should not be compelled to have a c-section by the police.

      But if she has an unattended birth and her baby dies? If she is attended by unqualified midwives and she is aware of it and continues anyway? Yes, I find that morally reprehensible. But mostly, women aren’t aware of the risk of either vaginal birth OR homebirth and there is an active campaign to tell women home birth is as safe or safer than hospital birth, while denying other women the right to say what they want to do with their own bodies: such as having effective pain relief of their choosing in labour or requesting a c-section, which carries much less risk to the baby than a home birth with an unqualified midwife, and apparently is about as risky as a vaginal birth.

      I have not seen Dr. Amy once call for the arrest of a woman who had an unattended birth or a homebirth resulting in death of her baby. She does, however, seek to counter the avalanche of misinformation available on the internet, uses those women’s stories of examples of how the NCB is wrong, and posts information as to the factual accuracy of those claims. Calling for an end to the misleading of women into making unsafe choices for their babies and the arrest and punishment of other women who exploit women for financial and personal gain is, as far as I can see, a feminist effort. Does a woman have the right to a homebirth? Yes, of course. She also has the right to know the risks and be attended by appropriate midwives. Anything less than that is not “being with women” but betraying women. At the end of the day, a lot less women and their partners would be willing to home birth if they knew that it increased the risk of death and morbidity, like hypoxia, to their baby.

      As for your comments about breastfeeding, they are simply offensive and trolling. In no way is choosing not to breastfeed equitable to choosing not to raise a child. However, letting your baby die for want of medical services like Ina May Gaskin did certainly is, no? Yet, WE are the hypocrites? Aye.

    • Disgusted
      March 15, 2013 at 6:22 am #

      Because not breastfeeding doesn’t kill babies. Doh.

  13. Mrs. W
    March 14, 2013 at 11:55 am #

    *claps* if I were American I’d love to see how committed they’d be in my case. My guess – not much.

  14. AllieFoyle
    March 14, 2013 at 11:41 am #

    Thank you for pointing out another example of “women’s rights” being equated with only a certain view of what’s best for women. Midwifery may be what some women want, and they should have rights to access it, but it don’t represent the needs and desires of many other women. It’s complete hypocrisy to defend a woman’s rights to one style of care, while ignoring (or fighting against) the rights of other women to access the care that serves them best.

    That organization may do good work, but by marginalizing the needs of women who don’t share their ideological basis and furthering the myth that women are best served by a one-size-fits-all midwifery approach, they are missing the boat.

    • PH Student
      March 14, 2013 at 12:57 pm #

      This was on their FB page. It suggests to me that they’re interested in addressing the rights of all pregnant women:
      I emailed you all about the treatment I’ve been getting at the hospital. 31 weeks pregnant with Crohn’s and I can’t eat without pain management (which they are refusing). I hope to hear back.
      Like · · January 24 at 12:37pm
      National Advocates for Pregnant Women Thank you [x], we have received your email and will contact you as soon as possible.
      January 24 at 12:49pm · Like

  15. CNM
    March 14, 2013 at 11:40 am #

    NAPW is a legal consultancy organization- they take on the cases that come to them. As far as I know they do not actively seek out cases, but women must call and ask to be represented. I bet if a woman called them because she wanted to request a c-section and was being threatened legally for doing so, NAPW would take them on.

  16. gf
    March 14, 2013 at 11:37 am #

    NAPW exists mostly as a litigation aid for lawyers who are defending women facing criminal charges or civil committment. The denial of early inducation or waiver for bottle-feeding doesn’t really reach their radar because women can avoid these issues without resorting to litigation. They don’t advocate for the use of illegal drugs during pregnancy, but they do provide excellent resources to criminal defense lawyers who are defending women charged with fetal endangerment for using narcotics during pregnancy– often the alleged effects of drug use are overblown.
    NAPW has a certain, hardline, civil liberties prespective, but it isn’t necessarily pro or anti- natural birth. Find a case where a women is facing a forced vaginal birth and I’d bet they would offer litigation support for the right of a women to choose a c-section.

    • theadequatemother
      March 14, 2013 at 11:48 am #

      Mrs W…have you contacted them about your forced vaginal birth after denied MRCS?

      • Mrs. W
        March 14, 2013 at 12:37 pm #

        They are American, but it might be worth a shot…

      • Mrs. W
        March 14, 2013 at 4:14 pm #

        I fired a message off to them via their FB page, we’ll see what kind of response it gets.

        • Mrs. W
          March 14, 2013 at 4:52 pm #

          Here’s the response:

          Dear Ms. W,

          I am very sorry to hear about the pain and trauma you have endured. We do not have anyone in our office admitted to practice outside of the United States, nor are we, unfortunately, able to take on malpractice cases either domestically or abroad or provide referrals to malpractice attorneys. I hope that you will consider filing a complaint with the relevant medical authorities in your jurisdiction, either through a hospital complaint system, the medical board, or your national health system. We have resources for people seeking to file complaints in the USA, but I am afraid they won’t be as helpful in Canada. While the group that has compiled this advice advocates for midwifery care, the general advice laid out here for filing a complaint with the medical board may be helpful in your case nevertheless.(

          If you are looking for emotional support as well, both Backline ( and Solace for Mothers ( are organizations that can provide support, regardless of the method of birth or how your are feeling about it. Backline offers a toll-free Talkline, but I am not sure whether international charges apply to calls from Canada to US toll-free numbers.

          Again, I regret that we’re unable to provide support outside of the United States. Best of luck to you and to your family.


          Staff Attorney

    • AllieFoyle
      March 14, 2013 at 11:49 am #

      “NAPW has a certain, hardline, civil liberties prespective, but it isn’t necessarily pro or anti- natural birth. Find a case where a women is facing a forced vaginal birth and I’d bet they would offer litigation support for the right of a women to choose a c-section.”

      I’m not so sure. Read some of the rhetoric on their site. Consider the links they provide to other organization. Heavily pro-midwifery.

      Women often don’t know they will be forced to have a vaginal birth or that they will be denied pain relief until it’s too late. Mrs. W. in Canada is suing, but I don’t expect that’s the sort of case they would take. Nor would I expect them to if it’s outside the scope of their practice. I would appreciate it though, if they embraced the needs and rights of ALL pregnant women, not just those who desire a NCB/midwifery approach.

    • March 14, 2013 at 3:46 pm #

      Presumably they are in some way a voluntary organisation – so they may be likely to attract those who are militantly interested in the NCB version of feminism. Defenders of choice, but more than a bit blinkered as to which choices are empowering or ideologically correct.

  17. PH Student
    March 14, 2013 at 11:15 am #

    I think we have to consider the political climate here. I believe in the right to request a c-section and I would be surprised if such an advocate for bodily autonomy as Lynn Paltrow doesn’t agree with that. But, at this point, no pregnant woman is being arrested for requesting a c-section. Whereas, right now pregnant women are being prosecuted for drug use, suicide attempts, etc, and judicial activism is forcing them into situations where they have no say over their bodies. If I recall correctly, Lynn Paltrow (head of NAPW) was counsel for the ACLU when they sued GWU hospital for forcing Angela Carder to undergo a c-section when her cancer came back while she was pregnant. Carder’s own OB team opposed the c-section at the time, and I read somewhere that they eventually had to get a general surgeon to perform it.

    Now, I’ll eat my words if anyone can find anything by Paltrow saying that women shouldn’t have the right to choose an elective c-section (not whether they should, but whether they should have the right), but I really think this is a case of defending women who are being literally prosecuted and persecuted for their desire to maintain bodily autonomy while pregnant.

    • JayDee
      March 22, 2013 at 8:32 pm #

      Yah, the women aren’t arrested, they are just denied. End of story. These women need advocates.

  18. Amy Tuteur, MD
    March 14, 2013 at 11:14 am #

    New policy for Alan only:

    Henceforth I will delete any posts from Alan that are merely attempts to divert attention to himself.

    • March 14, 2013 at 12:38 pm #

      IOW “I can’t defend my double standard, so I will delete his attempts to call me on it”. I will be sure to point out your hypocrisy if I see you trying to express dissent on another blog, as you often do. Until then, buhbye.

    • Mrs. W
      March 14, 2013 at 12:39 pm #


    • BeatlesFan
      March 14, 2013 at 12:53 pm #

      So all of them, in other words. Thank you.

    • KumquatWriter
      March 14, 2013 at 1:19 pm #

      Thank you! I have missed reading the comments – every time I have, I’ve been hopelessly enraged by the self-important question-dodging subjeckt-jacking mansplaining bs. If I want a man to plow past every point I make, talk over me and handwave away my words, I’ll go talk about my feelings in a sports bar.

      • KumquatWriter
        March 14, 2013 at 1:20 pm #

        Subject. Stupid carpal tunnel hands.

        • N.
          March 14, 2013 at 5:53 pm #

          That numbness in your hands is just a variation of normal. It’s a big pharma conspiracy to poison you with painkillers. Have you tried hypnotyping?

      • theadequatemother
        March 14, 2013 at 1:23 pm #

        thanks for the chuckle….

      • Bombshellrisa
        March 14, 2013 at 2:39 pm #

        LOVE IT!

      • Certified Hamster Midwife
        March 14, 2013 at 10:37 pm #

        Or on Reddit!

    • Awesomemom
      March 14, 2013 at 2:18 pm #

      I could kiss you!!!! That is the best news I have heard in awhile!

    • ratiomom
      March 14, 2013 at 3:43 pm #

      Thank you! I really got sick of scrolling through dozens of posts which had nothing to do with the subject at hand.

    • mollyb
      March 14, 2013 at 4:20 pm #

      Thanks. I know it’s important not to ban or delete those who parachute in and disagree with the majority—therefore avoiding the “echo chamber” of the NBC site but Alan was super distracting and brought down the level of discourse for everyone.

      • AmyP
        March 14, 2013 at 6:25 pm #

        Not to mention changing subjects with blinding speed.

      • Charlotte
        March 14, 2013 at 11:10 pm #

        Agreed. There is a world of difference between deleting a dissenting comment and deleting posts by someone who just wants to fight for the sake of it.

      • Victoria
        March 15, 2013 at 1:17 am #

        And he hasn’t even been banned or deleted – he has been given parameters/boundaries so he can choose to operate within them or not at all. He had a huge amount of leeway here. I think Dr Amy was just being helpful; Alan showed that he could not stop being a jackass all by himself so she helped him out.

    • Susan
      March 14, 2013 at 6:46 pm #

      I was getting really bored with the Alan show thanks. He should start his own website if he wants to set the topic.

    • anonymous
      March 14, 2013 at 9:34 pm #

      Yay! 🙂

    • Charlotte
      March 14, 2013 at 11:06 pm #

      Thank goodness. I had stopped reading most of the comment sections because his endless fighting and irritating arrogance was too much. I have a friend who acts like that as well, and everyone hates her because you can’t be such an insufferable jerk online unless you’re also one to some degree offline. When people enjoy being arrogant, condescending, and nitpicking at everyone, it’s just part of their personalities – they’re going to do it in real life too, although online they may feel like they can get away with showing their true colors more. I feel sorry for him in a way, because those sorts of people are frequently the most impotent and least respected in real life. I’m sure he’s rolling his eyes at this, but so did my friend until someone finally clued her in to what everyone really thought of her.

      • Sullivan ThePoop
        March 14, 2013 at 11:11 pm #

        I have only known one person who did strange things like telling people they got a high score on the SAT or that her children were somehow perfect at school. That same person never even took the SAT and most the other things she said were actually the exact opposite of the truth. So, it jades me to people like Alan. I do not believe what he says.

    • March 16, 2013 at 10:32 am #


    • March 16, 2013 at 12:06 pm #

      thank you so much dr. amy!!

  19. Renee Martin
    March 14, 2013 at 11:12 am #

    We should write them letters and twill them how we really feel about this. I am sure they don’t even realize what they are doing, they probably actually think they are defending all women.

    • AllieFoyle
      March 14, 2013 at 11:41 am #

      I think it is worth writing to them, but look at the links on their page. They’re pretty clearly allied with Midwifery, Inc.

  20. March 14, 2013 at 11:01 am #

    You are right, there are blatant inconsistencies there. But your outrage is a bit ironic given that you still haven’t owned up to your own inconsistency in rejecting diet studies because they are “associational” but embracing HB mortality research that is also “associational”.

    • Renee Martin
      March 14, 2013 at 11:11 am #

      I see why FFF and other sites have banned you, and I wish Dr Amy would do the same. You add nothing to the comments, but you run people off.

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