Stupidest excuse for homebirth deaths ever

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Logic has never been the strong point of homebirth advocacy. That’s not surprising, since the central premise, that giving birth at home attended by a pretend “midwife” is as safe as giving birth in the hospital, defies both common sense and basic fact. Therefore, I’m used to goofy, illogical excuses from homebirth advocates confronted with appalling death rates.

Apparently desperate times call for desperate measures, however. Homebirth midwifery is entering a period of desperate times because homebirth midwives can no longer hide their hideous death rates. States are starting to collect the statistics on planned homebirth attended by licensed midwives and the results are nothing short of appalling. In Colorado, licensed homebirth midwives have a perinatal death rate more than double that of all hospital birth in the state (including premature babies). Most recently, the Oregon homebirth death rates have come to light. Planned homebirth with a licensed homebirth midwife in Oregon has a death rate 9X higher than term births in the hospital.

I brought up this point in a the comment section of the latest post by homebirth advocate Jennifer Margulis. The post is entitled When Obstetricians Hate Homebirth Midwives, Birth Becomes Less Safe For Everyone and it is the usual amalgam of mistruths, half truths and outright lies favored by all homebirth advocates. The fundamental problem with the post is that is has the cause and effect relationship entirely backward; obstetricians hate homebirth midwives (to the extent that they think of these fringe “providers” at all) because they are incompetent clowns who have horrifically high death rates.

The post itself is the worst kind of “journalism,” with its unsourced claims (“The government official (who spoke to me off the record)”), ignorance of childbirth (“Doctors in America are trained to believe that birth, even low-risk birth, is dangerous.” A glance at homebirth death rates confirms that even low risk birth IS dangerous), and outright lies (“Most American obstetricians have never even seen an unmedicated childbirth when they finish their residencies;”).

When I challenged Margulis to defend that lie, she could not. Then I moved on to the heart of the issue:

I’d also like to know why Ms. Margulis fails to acknowledge the hideous death rates at planned homebirth with licensed homebirth midwives in Colorado (4x term hospital birth) and Oregon (8x higher). No less an authority than Judith Rooks CNM MPH publicly testified that Oregon homebirth midwives are not safe providers.

And Margulis responded with the stupidest excuse for homebirth deaths I have ever heard:

Amy, Oregon has some of the safest best homebirth stats in the country IF YOU DON’T COUNT PORTLAND…

Duh. Homebirth is apparently very safe if you just remove the dead babies from your calculations. And what reason does Margulis provide for removing Portland from the calculations? None, of course. She hoping that homebirth advocates are stupid enough to be persuaded by that inane excuse, or, worse still, perhaps she actually believes that it is a valid excuse.

My response:

You’re joking, right? That has to be one of the most inane excuses I have ever heard. Of course Portland has most of the deaths; it has most of the homebirths. You can’t exclude it no matter how much you’d like to pretend that you can…

Homebirth midwives are not professionals. What kind of professionals, when confronted with an appalling death rate at their own hands, try to hide it and make absolutely no effort to improve their education and training? Homebirth midwives are lay birth junkies who lack the education and training of ALL other midwives in the first world. Their hideous deaths rates are evidence of their gross incompetence. Why are you defending them?

Margulis reponds with a nonsensical non-sequitur:

Good question. If you ask Marsden Wagner, MD, a perinatologist and perinatal epidemiologist from California and director of Women’s and Children’s Health in the World Health Organization for 15 years, he will tell you: Doctors.

And then goes on to share a McCarthy-esque claim

I have a binder of over 1,000 pages of evidence about the safety of out-of-hospital delivery in Oregon. I suspect you will discount this as evidence.

As if we should accept the blustering of “an award-winning travel, culture, and parenting writer” over the epidemiological analysis of Judith Rooks, CNM MPH.

She insists:

Dr. Melissa Cheyney is a careful and scrupulous researcher. I have a high regard for her work…

Melissa Cheyney has behaved with an appalling lack of ethics, professional or otherwise. She has known for YEARS that homebirth midwives in Oregon and across the US have horrific death rates and she has done everything in her power to hide that information.

Margulis concludes:

Let me try one more time: I would like for everyone who cares about birth in America, as you and I both do, to try to remember that we all want the same thing: the best possible outcome for mom and baby, a safe and happy birth, and a good start in life.

Actually, we don’t want the same things. Homebirth midwives and homebirth advocates couldn’t care less about the best possible outcome for mothers and babies. When babies die they ignore them, try desperately to hide the evidence, and make absolutely no effort to improve their education and training or hold responsible midwives accountable. When it comes to homebirth, midwives profit and babies pay the deadly price.

I am used to stupid excuses from homebirth advocates, but when confronted with the appalling death rate in Oregon, Jennifer Margulis offers the goofiest excuse yet. I had expected something more from Margulis than the intellectual equivalent of covering her eyes, putting her fingers in her ears and pretending that the deaths of these babies don’t count. My mistake.

Addendum: Surprise! Jennifer Margulis forgot to mention that her husband James di Properzio is a lay member of Oregon’s Board of Direct Entry Midwifery. Did she get her 1,000 pages of documents from him? Does this mean that she is publicly challenging the analysis of Judith Rooks, CNM MPH? I wonder what Rooks’ would say about Margulis’ pathetic attempt to excuse the hideous homebirth death rate in Oregon, and the blithe dismissal of Rooks’ conclusions.

  • pecker shaft

    I stumbled across the story of Dr Piwoz and his daughter Miriam Piwoz, as I read the story about Miriam I grew very sad by the time I was done I was sobbing, this was the saddest story I have read in years maybe ever

  • Box of Salt

    FYI (crossposted on March 29 post)
    From Margulis’s latest comment under her post this evening:
    Jennifer Margulis March 30, 2013 at 8:28 pm
    “Any future comments on this thread that do not show respect towards myself and other commenters will be deleted, and the commenter will be blocked from commenting on this blog in the future.”

    • Amy Tuteur, MD

      English to English translation:

      Jennifer Margulis been caught fabricating claims, ignoring relevant data, and being incapable of defending her published work. She’s going to fix it all.

      No, Margulies is not going to withdraw her fabricated claims. No, she is not going address the hideous homebirth death rates that she prefers to ignore, And she has absolutely no intention of defending the crap she’s already written since it is indefensible. Therefore, she simply won’t publish any comments that point out the fact that she has no idea what she is talking about.

    • …hmmm…

      I called her out, but I don’t think I was disrespectful. Should I refer to her as Doctor Margulis?

    • Kalacirya

      How am I supposed to respect someone who when asked for evidence, cites her personal binder with 1000 pages of evidence? Come on.

  • Captain Obvious

    Obstetricians are making Homebirth more dangerous by not collaborating with Homebirth midwives is like saying the police are making the streets more dangerous by not collaborating with vigilantes.

  • Disgusted

    “The second-time birthing woman whose obstetrician—who had been paged
    more than a dozen times and showed up in a Tie-dye shirt with wet hair”

    I thought most midwives looked that way. Anyway, since birth is so safe, why should the OB show up at all? I thought doctors being there at all were the problem according to her.

    • Bombshellrisa

      What does it matter what the OB was wearing anyway? And really, have these people taken a good look at the women that call themselves midwives? From Lisa Barrett’s hair to Brenda Scarpino’s “High on Jesus” shirt, there is plenty people could start tearing apart.

    • Captain Obvious

      At least a qualified L&D nurse is with the patient during the entire labor. OBs work with nurses as a team so someone is always with the patient. Do Homebirth advocates forget that? It is not that the woman is alone in a hospital room until the doctor shows up. And as I recall, so many Homebirth midwives leave their clients completely alone at home during labor so their can go sleep, shopping, or whatever.

  • “And then goes on to share a McCarthy-esque claim

    I have a binder of over 1,000 pages of evidence about the safety of out-of-hospital delivery in Oregon. I suspect you will discount this as evidence.””

    This makes me think of Joseph Welch’s reply to McCarthy: ” Have you no sense of decency, sir? At long last, have you left no sense of decency?”

  • Dr Kitty

    Completely OT: Jeevan’s latest post made me hungry for all the food I ate in India (Idli, dosas, dhoklas, kheer and “mutton” curries especially).

    Also, his youngest is getting SO big!

    It is good when he posts about food or scenery, it means they haven’t had any maternal deaths recently.

  • Becky05

    I can’t believe the misuse of that Cochrane review. That isn’t what it said, at all, even a little bit. Do they really believe that this is what it says?

  • God, these people. I suppose the fact that Ms Margulis is willing to throw someone, anyone, under the bus should be taken “as evidence of a learning curve of sorts,” but still. Nice flounce though.

  • SDB

    One of my patients who originally desired a homebirth told me about this site. Lots of interesting comments here. I am an ob/gyn working at a hospital that cares for women who have attempted a homebirth in our area and who need tranport to the hospital when things don’t work out as planned. I am also the supervising physician for certified nurse midwives (CNMs) and my first 15 or so deliveries were taught by CNMs. I believe that the majority of deliveries do not require a physician, but I also read several hundred medical journal articles a year, and it is clear that home deliveries are much less safe for the baby than hospital deliveries. Physicians are taught to look at the medical evidence, and change our practices based on the evidence. There are a number of issues that hospitals (and physicians) need to fix in order to make birth experiences more pleasant for patients, but physicians and hospitals are held to a standard that requires the safest delivery for both the mom and baby, with the ultimate birth experience a secondary goal. I have had several patients throughout my career tell me that they do not care if the baby dies; they just want the best birth experience. As shocking as that sounds, it illustrates a problem that doctors and hospital have with home birth advocates. Sometimes the birth experience seems to overcome concern about the health of the mother and baby. We have had several home birth babies die in our community over the past year, and looking at the medical records it seems very unlikely that any of them would have died had they been born in a hospital. All were born under the care of “licensed” midwives. I applaud objective evidence regarding home, birthing center and hospital deliveries, and would like to see hospitals work towards providing a safe and comfortable environment for women to deliver.

    • Amy Tuteur, MD

      Welcome!

      • SDB

        Thanks! I wanted to respond to the comments about “not caring if my baby dies.” Sadly, this has happened several times during my career. Thankfully it is rare, but it’s shocking when you spend all day with moms (and dads) who are doing everything possible to have a healthy baby, then have someone tell you that their birth experience is more important than a healthy mom and baby. I assumed this was due to distrust of the healthcare system, fear of medical interventions or the loss of control with surgery, but it has always been about the “birth experience.” I use the wedding analogy: the goal is get married, and if it rains, or Uncle Joe shows up drunk, or the videographer runs out of film, then it’s not the perfect day you imagined, but you still achieved the goal of getting married. Almost everyone understands this, except those few patients who don’t care what happens to their baby (or babies, in the case of multiples) and are after the “perfect” birth experience. They are extremely challenging to care for and in some cases have left experienced labor nurses in tears because they refuse to allow interventions that will save their babies. And, even worse, some have made choices that led to stillbirth or brain damage. Ob/Gyn physicians have an ethical obligation to care for both the mother and unborn baby, which makes this a real challenge. Thanks.

        • My mom is a teacher and although her experiences aren’t as extreme as yours, she has had her share of run-ins with horrible parents. I’ve often heard her say half-jokingly that she believes people should have to get a license to have children. After reading your comments, I’m convinced she is right.

        • Maybe this just links into the idea that the “dead baby card” is just some kind of ploy, and the I didn’t know it could really happen reason for sueing when it goes bad.

          I guess denial could carry you through the “Some babies are not meant to live” rationalisation – but denial won’t get you too far with some babies are not meant to have a functioning brain.

          The MDC stories of marathon labours or “I showed that doctor how a real woman does it” triumphalism terrify me.

          Such innocence masquerading as knowledge!

    • BeatlesFan

      Patients have actually told you they don’t care if their baby dies?! Why in the nine hells would anyone GET pregnant if they don’t care about having a living baby?! I know you can’t answer that one, but here is a non-rhetorical question: how did/do you refrain from slapping “parents” who flat-out tell you something like that?

      • I don’t have a creative name

        To add an additional layer of sadness to this, think of those babies that DON’T die, and how they are raised by these soul-less women. How must THEIR lives be??? The statement sounds so crazy as to be made up, yet so many of us have seen the awful death stories on mommy boards where there was no remorse for the child’s death, only thankfulness for an “awesome” natural birth experience. What are we as a human race becoming???? Scary.

        • I don’t think this is altogether a new thing – there has always been a kind of distinction between women who love babies, and women who love having babies – the drama, the attention, the sense of triumph, presumably. A minority, who do not always make poor mothers. What has changed is the NCB project to turn this somewhat idiosyncratic view of birth into the dominant narrative, so that even quite normal women are beginning to believe that the “experience” has to be thrilling and defining.

          Given that rather a lot of them figure out that it is nothing of the kind, I don’t think that you need despair just yet.

      • Captain Obvious

        Document document document. MD documents conversations, have the RN witness and document in the nursing record. There is so much crazy out there, you do your best, give informed consent, R/B/A (risks, benefits, alternatives), and document as verbatim as possible without showing too much judgement.

        • Dr Kitty

          I quite enjoyed working in psychiatry because I go to write a lot of things down that I wouldn’t have had the chance to otherwise. You can write almost anything if you put quotation marks around it.

          “The patient reports that everyone in his family is really a lizard monster who can only be defeated using a magic chant consisting entirely of obscenities. He tells me the chant is….”

          “Coming back from her day pass into town, patient has a new tattoo. It reads “tie me up and @&£@ me”. We discussed why this was not an example of healthy decision making”.

          • Susan

            Ah the lizard monster strikes again! It should be the Alien lizard monster from the CIA who is really Jesus as I recall.

        • Susan

          I went to a course once that where the speaker suggested in extreme cases to write down what your plan is and the patient’s refusal and ask the patient to sign it. I suggested it to a doctor and we did ask the patient to sign it. There was something about seeing it in writing that made her change her mind and consent. So it’s an idea for those situations.

      • BCurtis MD

        A parent who says ” I don’t care whether the baby dies.” Needs an IMMEDIATE psych consult! I can’t believe how often I hear ob docs report this but do NOTHING.

        Good grief man! Do YOU care? Then get the psych consult for Post-partum depression (with/without psychotic features) AND get a thorough psych history BEFORE YOU LEAVE THE ROOM TO GO GET THE PSYCHIATRIST OR TO DO ANYTHING ELSE!

        Do not let that person leave with the child before a psych eval has been done.

        Not caring about the existence one’s own baby is shocking to those around. WHY? Because it’s outside the norm AND dangerous. Why would a parent say it? Because that person is VERY sick and needs HELP NOW!

        • Susan

          You try getting a psychiastrist to see an OB patient! Actually, I am kidding, I did and I was very grateful to the doctor who didn’t see it as someone else’s problem and was willing to give really excellent care to the patient. It’s an important point, no matter how the parents respond when you make the call. It’s not hard at all to get a social worker but the times we have needed to get a psych consult when the patient didn’t already have one it’s been damn hard to get one to see her. The one that came in is the best in town as far as I am concerned though so I was glad all the others said no. He actually cares and it shows. I suspect this varies according to the town, but generally, not OB, anesthesia or peds docs seem like they need a psych consult for pregnancy phobia. The exceptions we are very grateful to!

        • Obviously a woman who is indifferent to the welfare of a born and living child does have PPD or some other form of mental disturbance – but I am not sure that it is quite so clear-cut when the child is still some kind of abstract not quite real person.

          NCB hammers away at the idea that if your “birth experience” is not ideal, your relationship with that child is doomed anyway. Death is quite abstract until you are faced with it. Those completely steeped in woo seem to be capable of a kind of double-think. Lisa Barrett and her arguments about personhood, rights, choice, and all the rest of that blather, the “angel babies” so prominent on MDC. Maybe these mothers simply do not believe that their babies will die if they surrender their experience, maybe their is a lot of ambivalence – I have no idea what is going on when women are persuaded that a birth experience is worth any sacrifice. I do believe that it is a very suspect ideology that badly needs to be deconstructed not reinforced – but the opposite is happening with official sanction.

        • SDB

          This may be a different depending on where you practice, but in our state judges are reluctant to give the fetus rights that would supersede maternal rights. I would guess that I have had less than 10 patients in my career tell me that they are willing to sacrifice their babies. About 50% of my deliveries are “high risk” so that may make that number different than other obstetricians. We always obtain a psychiatry consultation, and in almost all cases the psychiatrist agrees that the patients’ comments are outside the norm, but unless the patient is psychotic they do not advise medications or involuntary hospitalization. Some patients say “I don’t want to endanger my life with surgery” or “I believe God will save my baby.” Other posters here have mentioned postpartum depression. These patients are still pregnant: they do not have postpartum depression. The worst case I witnessed was a mother who refused all intervention for her baby that had a persistent Category 3 tracing (for many hours) and finally developed an agonal fetal heart rhythm. A psychiatrist and judge refused to intervene, and we had to watch her baby die on the fetal monitor, unable to intervene without being charged with assault. She was a very “bossy” patient and her poor husband finally begged her to allow us to do something after he was the nurses, students, and myself crying over the situation. Again, these are extreme (and rare) cases, but my original point was that some patients seem to want (require/demand) the “birth experience” as their primary goal. Thx.

          • BCurtis MD

            Thanks doc.
            Do want to add though that post-partum depression CAN occur in a pregnant woman if that depression occurred after her previous delivery.
            Also, going by the typical rule of a third (1/3 of people with clinical depression need no meds, 1/3 need meds tempoarily, 1/3 will always need to continue the meds) and coupled (no pun intended) with the knowledge that a diagnosis of post partum depression may actually represent a pre-existing psychialtric problem, we must be vigilant. We frequently see stories about mothers who suddenly kill all of their children, when when simple intervention could have saved them.

        • R T

          Um, slow your roll! As long as abortion is legal you’re on a slippery slop. A woman has the right to make medical choices for herself, even when those choices may endanger her unborn child.

          • BCurtis MD

            I was referring to children after delivery.
            Do want to add though that post-partum depression CAN occur in a pregnant woman if that depression occurred after her previous delivery.
            Also, going by the typical rule of a third (1/3 of people with clinical depression need no meds, 1/3 need meds tempoarily, 1/3 will always need to continue the meds) and coupled (no pun intended) with the knowledge that a diagnosis of post partum depression may actually represent a pre-existing psychialtric problem, we must be vigilant. We frequently see stories about mothers who suddenly kill all of their children, when when simple intervention could have saved them.

          • Actually, that makes more sense. If some forms of PND are caused by trauma or disappointment (because of unrealistic expectations) and they have bought into the “healing birth” stuff , or you have women with no other way of feeling empowered, or the other various pernicious rituals centred on bonding are taken seriously, then risking the baby’s life might start to seem like it makes sense.

            All the more reason for undermining practically everything NCB says and does. It is an ideology of enslavement, not liberation. Talk about Orwellian! Blissful birth experiences not only have bugger all to do with good mothering, getting fixated on one can be lethal.

          • unfortunately the Abortions laws have made the whole entire situation about the womans”choice”, my question is what about the daddy, and unborn child, and friends and family??? If a woman is so into herself that her “experience ” is more important than her child’s life….???What a rotten selfesh mother!!!

          • Sooo many things wrong with this.

            1) Well, since the zygote/embryo/fetus is growing inside the woman, she gets to decide if she’s OK with hosting a parasite for nine months or not. If she’s not, no one has the right to tell her she has to, including the father. He can have input in the decision, but in the end it’s the woman’s body and she gets to decide what happens in it, no one else. Friends and family rightly have no say, because it’s not their body.

            2) If you’ve been reading this blog even a little, you know that pregnancy and labor are dangerous. They probably won’t kill you, but there are a lot of potential complications and many of them have long-lasting side effects. If a woman doesn’t want to risk her health for another (potential) person, she doesn’t have to. The end.

            3) What a rotten selfish mother for wanting an abortion instead of a baby she can’t feed or doesn’t want? Isn’t that kind of the point of abortion- to not become a mother? If you think the woman would be a terrible mother, why would you ever want to force her to have a baby? That just doesn’t make sense.

            4) I presume, based on your comment, that you feel life trumps all. In that case, you’re absolutely fine with mandatory living organ donation, right? I mean, livers grow back, and you only need one lung or kidney to live. You clearly don’t think bodily autonomy is as important as a stranger’s life; thus, you won’t mind being forced to donate organs other than uteruses to other strangers to keep them alive, right?

            5) Some women have minimum wage jobs or are in the midst of school or both when they get pregnant. They know they can’t handle pregnancy and/or a baby and still keep their life together. What good is it to the fetus to lose your job and be evicted, especially if one already has other children who could starve? For the good of her already-existent children, many women abort the one that will push them over the financial edge. That’s being responsible, not selfish.

            6) A woman also isn’t being rotten or selfish if she knows she can’t handle a child or another child right now (or ever, for that matter). She’s being responsible. She’s not bringing an unwanted child into the world. That is mercy and maturity, not selfishness. And before you bring up adoption, remember that there are millions of unwanted children in orphanages around the globe, many of them here in the United States. No one is obligated to bring a baby into the world for those people who only want infants, especially considering the health risks of doing so (see #2 and #5).

        • if you were a midwife it would just be a “variation of normal”…

      • BCurtis MD

        They get pregnant because they didn’t care.
        This next statement is not in response to the above poster, but I wanted to remind people that as tempting as the idea may be to whack them upside the head, we refrain by getting that child and parent help by getting that parent immediately into a psych consult before he/she can leave the building.

    • MaineJen

      “I have had several patients throughout my career tell me that they do not care if the baby dies; they just want the best birth experience.”
      Um…..WHAT? This absolutely does not compute for me. In what crazy, mixed-up world could a *mother* possibly feel this way? The only way I can understand this attitude is if the person has been so brainwashed as to believe that nothing could ever, ever possibly go wrong with her personally; bad things only happen to other people. Is this the case? Or is it really, truly as chillingly callous a statement as it sounds?

      • Captain Obvious
        • I don’t have a creative name

          I just don’t get it. Still being shook up at one’s self and baby NEARLY DYING, 5 weeks after the event?? Of course. But the main source of the upset being not getting a homebirth?? Hey lady, how about the fact that if it weren’t for the skill of trained medical personnel, you and and your baby could be laying 6 feet under the ground right now?? Perspective, people, perspective.

  • suchende

    “He wasn’t paying attention to the case, wasn’t asking me any questions. Both the labor nurse and I were trying to speed things up, I was literally hopping up and down on the balls of my feet, saying, ‘This baby doesn’t look good. This baby needs to come out. This baby looks like crap.’ The doctor just had such distain for homebirth and midwifery, and he probably had a fat bias, which a lot of doctors do, that he wouldn’t listen to us.”

    What the actual fuck. I wouldn’t take professional advice from a layperson either. What could she possibly be thinking. If you want your professional opinion to matter, be an actual professional.

    It’s not the doctor’s fault this patient had a bad outcome. It’s the midwife’s failure to educate herself to the extent necessary for her opinions to be relevant in an emergency situation. Does she seriously think MDs should just section every time a layperson birth junkie recommends it?

    • Dr Kitty

      The doc was listening to the mother. He talked to her (not the HB MW) and she said she still really wanted to try for a VBAC, he said in that case he’d try some IV fluids and see if the variability improved.

      Frankly, I don’t blame him for ignoring the woman ranting that the baby “looked like crap” in front of its mother.

      You don’t say things like that in front of patients. Ever.

      • suchende

        Well, since she’s not a real medical professional, is it still inappropriate to say it in front of her “patient?” IMO lay midwives have as much standing in the hospital as an opinionated aunt. Say whatever you want but don’t expect the MD to give a shit.

        • I don’t agree with this one at all (though I get the general point about doctors not listening to idiot midwives, and needing to do their own tests.)

          I’m not any kind of medical professional, nor a birth junkie – but if, say, my granddaughters heart trace had looked bad and a doctor wasn’t reacting, I’d have been jumping up and down as well. Two hours to figure out whether a baby in trouble needs to come out seems a bit excessive to me. (And to the judge who awarded my daughter damages.)

          As usual with these stories there are large chunks missing – like not knowing why the baby died. As far as I am concerned, gambling a baby’s life for a VBAC is as bad as gambling for a home birth, and I have a few problems with the ideas of “This one is too far gone to save” as well. Unless there was some congenital problem. Doctors should not play God, and a mother’s choice is not some hallowed principal to be defended with the life of another being. Babies dying in hospital when they shouldn’t stems from the same root as homebirth deaths, and “I don’t blame anyone” is just as bad.

    • auntbea

      BUT SHE WAS HOPPING UP AND DOWN!

    • Bombshellrisa

      Why would a doctor listen to a self educated birth junkie who didn’t have the sense to risk that woman out of homebirth in the first place?

      • Of course the doctor doesn’t have to listen, and of course he has to use his own judgement – but, given that the baby died, I am not sure that defending everything that happens in hospitals is helpful. Mistakes happen, things do get covered up sometimes when they shouldn’t. The fact remains that hospitals are accountable and hb midwives aren’t.

        This mother wanted a VBAC, her choice was respected, the baby died. Not sure I see that as a victory for anything much.

        • Becky05

          Right, and in this case you’re talking about a licensed midwife in California. I don’t believe their training is adequate, but the state does.

          I do agree that homebirth will be much safer with a less adversarial relationship between homebirth midwives and doctors, but ending that (IMO) also depends on more competent midwives.

    • Is it possible that the doctor in this anecdote had determined that the baby had been deprived of oxygen for so long before it even arrived at the hospital that it had no chance of survival no matter how it was born? If that were the case, going along with the mother’s desire for a VBAC instead of pushing for a C-section despite ongoing evidence that the baby was struggling would indeed be the compassionate thing to do. Could someone here with medical training comment on how much a doctor can determine about a baby’s chances of survival when first arrives at hospital after a homebirth transfer?

    • quadrophenic

      I wouldn’t be surprised if there were a LOT of additional facts missing from that story. I mean really, why would the OB wait 2 hours for a c-section when he could have done it immediately and then go play a round of golf? Doctors are apparently ready to section all moms against their will EXCEPT homebirth transfers that actually need sections?

  • Bomb

    Homebirth is extremely safe if you exclude home birthed babies from the statistics.

  • Dangerously deluded. that one. Funny how she (and Mitt Romney) lay personal claim to their ‘evidence’, whereas Dr. Amy (and anyone with a clue about science and statistics) can just say, “There is the evidence” and cite sources.

    • Just more proof of their arrogance.

    • AmyP

      What the heck is Mitt Romney doing in this sentence?

      • Somewhere earlier in the comments, someone compared the “1000 pages of evidence” to Romney’s “binders full of women”.

  • Jade

    It seems that Margulis is censoring comments she doesn’t like. I’ve watched comment after comment get posted while mine has been “In moderation” for hours. This is what I wrote:

    “As a new transplant to the United States, there are two things about the American maternity system that seem to me to be of actual, urgent concern. First, there is the fact that a developed country can allow midwives who are neither properly trained, regulated, accountable nor integrated into the rest of the healthcare system. Not only this, but they are not even required to report their outcomes (and as a consequence conceal them)! Why is this not a concern to you? As an outsider it’s shocking.

    Second, while there is certainly a problem in terms of maternal outcomes in the USA, it is a problem of a shocking racial disparity. Your article, much like every thing I have ever read by a homebirth advocate, completely ignores the issue of race. Probably not surprising, given that women who choose homebirth tend to be white and of a relatively high socio-economic class. Nonetheless, it’s a joke that anyone can discuss outcomes during childbirth in the US without mentioning race.

    The complete blindness that you demonstrate to these two issues just makes me think that you are more interested in finding evidence that supports homebirth as a choice than in actually improving outcomes for woman and children during childbirth. The reality is that there are no accurate statistics available with regard to the safety of homebirth in the USA, because homebirth midwives refuse to release them. Those few states where they have been compelled to do so show horrendous outcomes. I urge you–and all other homebirth advocates–to try to put your personal biases aside and take a clear eyed look at the statistics, even if you don’t like what they say.”

    • Becky05

      “The complete blindness that you demonstrate to these two issues just makes me think that you are more interested in finding evidence that supports homebirth as a choice than in actually improving outcomes for woman and children during childbirth. ”

      This, this, this. It makes me think of Ina May’s maternal mortality quilt. There is an assumption that it is the lack of midwifery care or the rate of interventions that causes the US to have a higher maternal mortality rate. Yet, when you look at what public health and obstetrical researchers are saying, they are actually looking to determine why deaths are occurring and what can be done, and not just assuming that it is one particular thing.

      • ratiomom

        Maternal mortality quilt!? Do enlighten me!

        • Bombshellrisa

          http://www.rememberthemothers.org/

          “The Safe Motherhood Quilt Project is a national effort developed to draw public attention to the current maternal death rates, as well as to the gross underreporting of maternal deaths in the United States, and to honor those women who have died of pregnancy-related causes since 1982.”

          • Amy Tuteur, MD

            I asked Ina May about it, but she refused to answer.

            From http://www.skepticalob.com/2010/12/ina-may-runs-away.html:

            “You represent yourself as shocked at the current rate of maternal mortality. Yet as far as far as I can tell, direct entry midwives in general and you in particular have done NOTHING (no research, no education, no fund raising) to reduce the incidence of maternal mortality. In contrast, modern obstetrics has lowered the maternal mortality rate 99% PERCENT in the past century…

            Anyone who visits your “Remember the Mothers” website will notice something rather curious. There is NO information about the causes, treatments and research into maternal mortality…

            … You want to leave the impression that maternal mortality is caused by obstetric interventions…

            The reality, as you OUGHT to know, iatrogenic deaths represent a tinyfractions of maternal mortality. The most common causes of maternal mortality are complications of pregnancy and pre-existing medical conditions.

            You should be embarrassed at the way that you have deliberately misrepresented the issue for your own personal ends.”

        • Dr Kitty

          Sorry, my mistake there are stories.
          And all of them have the not so subtle message that “interventions are bad, mmmkay”, including lots statements like “her friends say she was given too much pitocin”.

          The quilt includes deaths that can only tenuously be related to direct complications of pregnancy.

          Such as:

          A ruptured brain aneurysm (Christine Bolden/Bridget/Olivia Torres)

          Medical malpractice (Robin Rodgers/Elena Lord Collis/Jasmine Gant)

          Heart Attack (Constance Filho/Miriam Piwoz)

          Stroke (Libby Forsberg/Kristin Marlowe/Jessica Rios)

          Asthma (Eutisha Rennix)

          Ruptured Thoracic Aortic Aneurysm (Nalini Tannir/Kathy Robison)

          Aortic dissection (Karen Boyd)

          A woman who appears to have died 18 months after her youngest child’s birth (Victoria Carr)

          Bowel obstruction 25 years after CS, and possibly unrelated to it (Karen Flaherty)

          What I notice in reading the stories are a lot of grand multiparas leaving behind 5 or more children (in 2 cases, 11 and 15 children) and several cases where women have died because of religious beliefs about avoiding medical care.

    • Box of Salt

      It has been posted now.

      • Jade

        Yes, I see now–coincidentally right after I posted this comment.

  • anne

    The Portland Metro area has half the population of Oregon.

  • I don’t have a creative name

    “Amy, Oregon has some of the safest best homebirth stats in the country IF YOU DON’T COUNT PORTLAND…”

    As much illogic as I’ve seen from homebirth advocates, this is actually kind of shocking to me still. Amy, our numbers are excellent IF YOU REMOVE THE VAST MAJORITY OF THEM!

    And I made a point recently about HBA’s basing their entire belief systems on statements that start with the word “most”, with nothing else behind it. “Most people believe” “Most doctors don’t” “Most women are” etc etc. There are a bunch of examples of that above as well. It gets so tiresome. Don’t they ever get tired of looking stupid? Oh, what am I saying. They don’t get tired of babies dying needlessly, so shame is clearly not as issue for them.

  • AL

    “Doctors in America are trained to believe that birth, even low-risk birth, is dangerous.” That statement cracks me up because it sounds like we should fear it. My friend who is a pediatric anesthesiologist said that they are always taught to think “WORST CASE SCENARIO.” So of course you’re going to think all birth is unsafe because worst case scenario is that baby and mom die of a complication. Any doctor who thinks otherwise should NOT be practicing. I can go further that this friend who is planning to have a baby soon is not just having a baby in a hospital, she also refuses to choose a hospital that does not have a level 3 NICU.

    To add, I had a very “low risk” pregnancy, only gained 25 pounds, had perfect blood pressure, no gestational diabetes, pretty perfect pregnancy. I went into labor at 38 weeks, which typically is “low risk” for meconium in utero since most mec babies are overdue, but happened to have a baby covered in meconium anyway. As scary as it was when the NICU team came rushing into my delivery room, I cannot imagine how scarier it would’ve been had we had to call 911, and had waited 20 minutes to help get my baby breathing, as opposed to the 2 seconds it took for the team to rush up after the pediatricians attending to my son knew that he needed help.

    • LukesCook

      A “low risk” pregnancy means it is low risk in comparison to other pregnancies, not low risk in absolute terms.

      • Charlotte

        Exactly. Midwives and homebirthers seem to think the low-risk label is some sort of protective amulet that prevents any complications from occurring.

    • LovleAnjel

      I’m like your friend – Ipicked a large hospital with a level 3 NICU that is twice as far from my house. Cause I’m going to b there when things start, not after they go sideways.

    • Charlotte

      Same here. Despite a low-risk pregnancy, I went with the hospital with the level 3 NICU and the OB practice that specialized in high-risk care just in case. Then I suddenly developed pre-e and HELLP and had a 3 pound preemie. You just never know.

    • Captain Obvious

      “Hope for the best but prepare for the worst” motto is used by every profession. Could you imagine if the military didn’t follow this motto, but rather “trust your opposition” motto as they drive down mine ridden roads with snipers?

  • Aunti Po Dean

    to the comments section on the linked article “When Obstetricians Hate Homebirth Midwives, Birth Becomes Less Safe For Everyone” all that needs to be said is BINGO

  • anon

    I think laypeople need to understand how medical professionals see the word “dangerous”. To us, it does not mean, “HOLY SHIT OMG EVERYONE PANIC!!” It means, “this could have a bad outcome. I should pay attention.” I wish they understood that. Or cared to.

    • The Bofa on the Sofa

      As I often say, the point of intervention is to prevent emergencies, not to deal with them.

      From a medical professional perspective, if you have reached the point where it is an emergency, then it is too late.

      Dangerous means it could result in an emergency. An emergency means HOLY SHIT OMG EVERYONE PANIC!!!!

      • kdgd

        my mom is a doc. when i was in kindergarden i peed my pants becuase when the teacher asked me if it was an “emergency” i said no, thinking “worst thing that can happen is ill pee my pants…”
        #drkids

  • Sorin

    The stupid. It burns.

    My SIL almost went down this ridiculous homebirth path. She was determined to deliver her first at home with a CPM in a rented tub. Oh, and she’s over 40 and has a cyst the size of a kiwi growing on the outside of her uterus. It took everything I had not to say anything to her (for fear of ruining our relationship) but I trotted out facts and stats to my MIL until her ears bled. MIL and FIL were totally against it, too, but they were afraid to say anything because SIL is the kind of person who would be more determined to do it if people told her not to. (Stupid. I know.)

    Fortunately, after a week overdue and irregular labor pains, she had sense enough to go to the hospital. About 36 hours later and a manual (!) dilation attempt by the OB, my nephew was born healthy and by C-section.

    Her birth experience snapped her to her senses. She doesn’t regret her C-section one bit (and she shouldn’t! My healthy breech baby came out through the window, too.) And I am so glad that my nephew is here and did not suffer the inevitable tragic consequences that would have happened if she had attempted this stunt birthing at home. His head never even came into contact with her cervix, so I shudder to think how a CPM would have gotten him out of there.

    Homebirths are always risky, even if you are “low risk.” Because a healthy, laboring woman is only low risk until she’s not. And that “not” moment can happen within seconds.

    And when people like Margulis sweep stats under the rug, she not only puts mothers and babies lives at risk, but she also attempts to erase those poor infants who died all for an ideology.

    • I don’t have a creative name

      That’s the best possible outcome for an NCB’er. Healthy baby, snapped to their senses, AND don’t view as everything having been ruined by having gone to the hospital. So glad nephew is ok and congrats to everyone!

      • Sorin

        Yes, I was having silent fits worrying about mecomium aspiration and if the CPM carried oxygen, pitocen, knew CPR, etc. I’m so happy SIL’s eyes were opened with no consequences.

        The happy outcome is even enough to make me ignore the fact that she’s eating her placenta. *ugh*

  • Aunti Po Dean

    Amy, Oregon has some of the safest best homebirth stats in the country IF YOU DON’T COUNT PORTLAND

    Even if this were true how does she know? The Oregon stats as presented dont separate out Portland. So either she has some insider knowledge or she has gone to MANA data?! Maybe this is another prequel of how MANA will present their data

    • The Bofa on the Sofa

      Even if this were true how does she know?

      It’s in her binder, duh!

  • melindasue22

    I can’t stand the statement “Most American obstetricians have never even seen an unmedicated childbirth when they finish their residencies;”. I mean does she realize how many deliveries they see? According to the Listening to Mothers II survery 14% of women did not get pain relief during labor. You are telling me that the residents missed all of those ones?

  • Squillo

    Let me try one more time: I would like for everyone who cares about
    birth in America, as you and I both do, to try to remember that we all
    want the same thing: the best possible outcome for mom and baby, a safe
    and happy birth, and a good start in life.

    Translation: Safety, shmafety. What matters is that homebirth midwives mean well, so stop asking us about outcomes.

  • Squillo

    This is very good news.

    All OR has to do to save babies’ lives is ban homebirth in Portland.

    Problem solved.

    • The Bofa on the Sofa

      Too late. I already made that proposal.

      • Squillo

        I’m a day late and a dollar short, as always.

        • The Bofa on the Sofa

          Oh come on, just say great minds think alike, and then we can sing kumbayaa.

  • Squillo

    Dr. Melissa Cheyney is a careful and scrupulous researcher. I have a high regard for her work

    Wait… Cheyney has published quantitative research on homebirth safety?

    • Dr Kitty

      Cheyney isn’t publishing her data, so we can’t judge it (or her research ability). Margulis allegedly has data, but can’t (or won’t) publish it.

      If you don’t/can’t/won’t publish your data, we are left with no option other than to think your data, your methods or your analysis are flawed.

      Publish it and prove us wrong.

      Dare you.

      Because Margulis is right, all i want is safety for women and their babies.

      If I saw a big, reliable study showing HB with a CPM, as currently practised in the USA was “as safe or safer” than hospital, I’d go home and sleep easy knowing that no women were unnecessarily risking their lives or the lives of their babies.

      I don’t WANT these women and babies to be at risk, I want them to be as safe

      • Dr Kitty

        Disqus… Damn you.

        …I want them to be as safe as they think they are. I want HB to be a safe option, because I know some women will always choose it.
        If there was evidence it was safe, I’d be thrilled!

        But the evidence is that HB isn’t safe that people are dying and being injured because no-one is making HB safer.
        Which makes me sad, angry and upset.

        Do the HB/NCB nuts not get this?
        I don’t want to think babies are dying unnecessarily, but I haven’t seen anything to convince me otherwise.

      • The Bofa on the Sofa

        As I tell my students, the #1 job of a scientist is communication. Scientific results that are not communicated are no better than not having any results at all. In fact, they are worse, because they are a waste of time.

        This is even moreso the case for results that affect public policy. If they are not communicated with the public properly, then they are worthless.

    • I don’t have a creative name

      Oh yes, the same Missy Cheyney who is so desperate to discredit Dr. Amy’s work that she makes a complete fabrication alleging that Dr. Amy had to quit medicine due to PPP, with ZERO evidence, but presenting it as truth? “Shoot the messenger because I can’t rebutt the message” Missy? “Insult the entire mental illness community while I’m at it” MIssy? Scrupulous indeed. I’m sure her data is just neat-o!

      • Squillo

        I’ve said several times that Melissa Cheyney is Amy Tuteur’s greatest ally because every time she opens her mouth in public she inserts foot and twists to lock. It looks like we can extend that maxim to Cheyney’s admirers.

  • Amy Tuteur, MD

    Where did Jennifer Margulis get the “1,000 pages of evidence”? Is it evidence that her husband James di Properzi had access to as the lay member of the Oregon Board of Direct Entry Midwifery?

    If so, Margulis has drawn entirely different conclusions that Judith Rooks. Is Margulis publicly challenging Judith Rooks’ analysis? I wonder what Rooks would say about Margulis’ dismissal of her findings.

  • Lisa the Raptor

    Polio is totally eliminated if you don’t count places other than the Americas. Duh.

    • mollyb

      I actually had a fellow student in my anatomy class last week give a presentation on polio wherein she made the comment “There hasn’t been a naturally occurring case of polio since the 1970s. . . ” When I pointed out that polio is still a huge problem in much of the world, she was very surprised.

      • Lisa the Raptor

        That’s sad 🙁

  • The Computer Ate My Nym

    Wow. A lot of dishonest statistics and undocumented assertions in that article. For example, she states that 68,000 women “nearly died” in the US from pregnancy in 2004-05. Ok, I’m not sure where that number came from, but the number that actually died was two orders of magnitude less.

    And the “25% of patients are harmed by hospital errors” quote which she attributes to the NEJM? Hello, can we have a volume, author, year of publication, and maybe page numbers to go with that? I _think_ she’s referring to a study from the early 2000s. A study which provoked an examination of care in hospitals and a number of changes in protocol (i.e. alcohol based hand sanitizer outside every room, specific checklists to prevent wrong procedures/wrong side errors, etc.) In other words, when problems were found in hospitals changes were made to improve safety. What changes is she proposing in midwifery care and specifically home birth to make it safer?

  • The Bofa on the Sofa

    Amy, Oregon has some of the safest best homebirth stats in the country IF YOU DON’T COUNT PORTLAND…

    This comment has some interesting implications. First, recognize that it is merely an assertion, and she hasn’t provided any evidence that it is true. Second, it is not even clear what she means by “safest best (sic) homebirth stats.” Is she claiming that they are the best stats (I’ll ignore the most safestest bestest error) for homebirth in the country? IOW, compared to other homebirth stats, or to hospital births, or what? So I don’t even know what she is trying to claim here.

    Third, what is the implication of homebirth outside of Portland being the best in the country? Well, given that the outcomes in Oregon are overall completely awful, and the stats outside of Portland are some of the best in the country, then that means that stats IN Portland must go even beyond “completely awful.” Now, how far beyond depends on the absolute numbers of how many are done in and out of the city, but if 90% of the HBs are done in the city, then the results for the city would be around 10% worse than that for the state overall.

    So even if it is true that HB outside of Portland is the best in the country, that does not change the fact that what is going on in Oregon is completely unacceptable. Therefore, what we can do is propose a compromise: fine, allow HB midwives outside of Portland practice, and let’s just agree to stop those who are practicing IN Portland. And no, they aren’t allowed to just move outside the city and practice there, because it is not their location in Portland that is causing the problem, it is them.

    That’s my proposal: immediately suspend the activities of all the midwives working in Portland. Those midwives who are currently practicing outside the city are allowed to continue for now.

    If it is true that midwifery in Portland is the source of the unacceptably bad performance for the state of Oregon, then Margulis should not have any objection to getting them out of business, right? I can think of only a couple of reasons why she wouldn’t…

    1) She doesn’t think that the results for Oregon are unacceptably bad, or

    2) She doesn’t care

    2a) She knows that midwifery in Portland constitutes far and away the bulk of the practicing midwives in the state, and if they are suspended from practicing, midwifery in Oregon is more or less done for. That is merely a variation on point 2, though, that she cares more about midwives than outcomes

    Shit, I don’t even care if she wants to blame it all on 1 midwife or clinic. If that is the case, then she MUST agree that that person or clinic has to be stopped, right?

    • Aunti Po Dean

      i think its also interesting that of all the excuses she could come up with she chose to say this.
      I would have thought she’d go with the more tried and true ‘babies die in hospital too” especially as she could have tried to claim that most of the Oregon babies died in hospital and that it was therefore unfair to blame intended OOH for their demise
      Shows home birth advocates are getting desperate if they are willing to slice and dice the data in completely nonsensical ways to still try and make their point that OOH birth is safe.

      • The Bofa on the Sofa

        “Other than that, Mrs. Lincoln, how was the play?”

    • AlexisRT

      She also tries to backtrack by placing all the blame on ONE birth

  • PrecipMom

    Yeah, that really is one of the stupidest excuses I’ve ever heard. That rationalization is sporting some pretty significant mental contortionism.

  • AllieFoyle

    Is anyone else kind of disappointed that Lynn Margulis’s daughter writes such crappy articles?

    • fiftyfifty1

      Wasn’t Lynn Margulis a little wooish herself?

      • PH Student

        Yes. Believed there was no evidence that HIV was an infectious virus.

    • Courtney84

      It never occurred to me that she as Lynn Margulis’s daughter! I am sad… 🙁

  • Elle Bee

    Melissa Cheyney is a doctor? I had no idea…

    • The Bofa on the Sofa

      Missy Cheyney has a PhD, and has earned the title of Dr.

      • Elle Bee

        Oh, of course. I guess I just ASSumed medical doctor from the context. My fault. Carry on…

      • Aunti Po Dean

        so whats the time frame for calling yourself Dr if you earn a PhD? Wait what you can use it for the rest of your life ? Really well MDs cant

  • MLE

    That’s some masterful avoision right there.

  • Amazed

    Hey, on the thread about the safety of homebirths on MDC I saw an interesting link. Obviously, Colorado midwives, after removing from their data all premature babies and those with congenital defects – who had no business being born at home, honestly – are very pleased with themselves because “1 of 2 deaths in 600 or 700 homebirths isn;t outside the range of expected for low-risk women attempting homebirth.” Lovely.

  • quadrophenic

    The author is a paragon of logic. Here’s another shining example, starting at around 5 minutes: http://www.pbs.org/wgbh/pages/frontline/vaccines/view/

    • LibrarianSarah

      Two things:
      1. That documentary was awesome and almost makes up for all the things PBS has dropped the ball on.

      2. There was a lot of stupidity in that comment section.

    • Eddie

      Wow, she would rather her kids get “natural diseases the way people have gotten them for 200,000 years” and that getting sick is not a bad thing? How ignorant. She forgets that kids used to *die* (or be paralyzed or permanently injured) from many of these diseases! Truly “first world stupidity.” What irritates me about the anti-vax people is that they put everyone at risk, not just their kids.

  • ratiomom

    Wow… It’s like saying ‘there’s hardly an AIDS problem in the world if you don’t count Africa’.

    • ..or Asia..

    • auntbea

      Or a crime problem if you leave out any city with a population of more than 100,000 people.

      ETA: Oops, someone already made this analogy.

  • Gene

    Why oh why does the homebirth community think that unmedicated births do not happen in hospitals? Most of the women I delivered AS A MEDICAL STUDENT received no pain meds. Of course, this might have been because most of the women at this hospital were uninsured (undocumented immigrants are not eligible for Medicaid) and pain meds were expensive. I think one of the worst things was seeing a woman crying from pain but refusing an epidural because of the cost.

    Regardless, lots of women forego pain meds for a variety of reasons. One of my friends had three unmedicated births in a hospital, all by choice. And the idea that an OB/Gyn resident hasn’t seen one is just ludicrous.

    • AllieFoyle

      And they just repeat that one over and over without any evidence. I guess if you hear it enough it sounds like a fact.

      But I always think “even if that were true, so what?” It’s ascribing some kind of special value to unmedicated birth that I don’t think it deserves. If 100% of the women you serve want and benefit from pain relief and that means you never see an unmedicated birth, who cares? Is anyone bemoaning the fact that residents don’t see a lot of unmedicated kidney stone passage anymore?

    • quadrophenic

      I had an unmedicated hospital birth. But maybe they don’t count it as natural since I had an IV, EFM, vit K, eye ointment, hep b shot and didn’t eat my placenta.

      My mom gave birth unmedicated at the Air Force Academy hospital. She says they had like 4 residents just standing around watching.

    • Bombshellrisa

      I don’t know what the point is of even asking the question “have you seen an unmedicated birth?”. Maybe they mean “have you seen a spontaneous vaginal delivery?”. Everyone loves those. But if that is all you were seeing, then all you could call yourself is “an expert in normal birth”.

      • A familiarity with statitistics, medicine and biology is clearly an advantage in figuring out what is safe. But I think much more accurate use of language – or awareness of shifting signifiers if you like – is needed to figure out what is sensible. “Normal” “unmedicated” “spontaneous”, and my favourite “low risk” what DO people think they are meaning when they use these? Presumably, the woman with the premie had a spontaneous vaginal delivery, and it was certainly unmedicated – it didn’t turn out too well. How about just choosing words like “easy” or “straightforward”? Then when the would be birth goddesses articulate their desires as “I am planning on having an easy birth” they might grasp how ridiculous that sounds.

        What is the point of an expert in normal? Normal when allied with rejecting all the expertise that has managed to reduce the harm that nature is indifferent to is pretending that normal=easy, and it doesn’t.

        • Elizabeth Abraham

          I’m gonna hit this a little – it’s a stereotype that all preemies are spontaneous vaginal deliveries, and that stereotype is a problem for preemie moms. It causes people to fail to understand the scope of difficulties that we go through while our babies are hospitalized.

          C-section may be less stressful for babies then labor and vaginal delivery, and there can be considerable urgency to delivering a premature infant, so induction and surgery are common.

          If you alreafy realize this, I apologize for pedantry. It’s just super important to me that these misconceptions, which can cause incredibly cruel judgment of preemie parents, get shot down when they come up.

          • auntbea

            Wait, I don’t understand. Why would a belief that preemies are spontaneous lead to judgment and other problems? Legitimate question.

          • Elizabeth Abraham

            A lot of people assume that, if you have a baby in the NICU, and you’re a good mother, you’ll be in the NICU all the time, every day, as long as you possibly can, kangarooing like crazy and pumping breastmilk every spare second. These people have a tendency to be dismayed at how few moms ever seem to be in the NICU with their babies. Don’t they love them? Those poor babes!

            If you consider the realities of surgical recovery a little, you’ll understand why those moms aren’t there. (Then, move on and consider the realities of maternity leave in the U.S. You haven’t seen exhausted until you’ve seen a woman with a ten day old preemie stop by the NICU after work to drop off the milk she pumped during the day.)

          • Those poor babes!

            Poor mothers! It is the ghastliest start. I assume (hope) things have improved since my day – but I never got used to it – it was the scariest place I have ever been. What they do is amazing, but what new mother can feel anything other than awful and inadequate.

          • Elizabeth Abraham

            I don’t know when your day was. My DD was in the NICU for 32 days, three and a half years ago. Here’s what’s awesome: my baby was born nearly two months early, and she’s fine. More and more treatments are available for common problems faced by preemies, and neonatalogists and NICU staff have, in my experience, been very interested in minimizing discomfort to babies wherever possible and consistent with necessary care.

            I’m really glad that it was my second baby in the NICU and not my first. I already knew my way around a breast pump, and I wasn’t seeing this as some kind of referendum on my parenting. I was mostly terrified, and then exhausted, and then fried. I think PPD is basically unavoidable in the NICU.

          • AmyP

            “A lot of people assume that, if you have a baby in the NICU, and you’re a good mother, you’ll be in the NICU all the time, every day, as long as you possibly can, kangarooing like crazy and pumping breastmilk every spare second. These people have a tendency to be dismayed at how few moms ever seem to be in the NICU with their babies.”

            That’s so dumb. If there’s a reasonable expectation that the baby is going to live, surely it makes more sense to rest up and be fully prepared for the baby’s coming home? New mothers have a predictable tendency to overdo it–a lot of times what they need is to be told to stop doing stuff. (I’ve never had a preemie, but I know that my first reaction to coming home from the hospital with a new baby is frenzied housekeeping.)

            Also, lots of mothers of preemies would have older children to care for.

          • auntbea

            Geez. Who are these people wandering around the NICU on the lookout for parents who aren’t doing enough? Don’t they have their own babies to take care of?

          • Dr Kitty

            The same people who complain that people aren’t visiting their elderly relatives with severe dementia who are no longer able to recognise or communicate with them.

            They aren’t visiting their elderly relatives because it is distressing to see someone you love like that, and being there isn’t helping them, or you.

            It is really upsetting to be told over and over again that some strange woman is your daughter when you don’t recognise her, and it is really distressing when your mother doesn’t know you, for example.

            There are some people with dementia who find visits from relatives disorientating, upsetting and confusing- NOT visiting is therefore the kindest thing to do because the person with dementia can be settled in their daily routine.

            I imagine NICU can be the same- if your baby is too ill to be held and is sedated and ventilated so that it can’t even hear your voice. If you have other children to care for or need to work to pay for medical bills, then NOT being in the NICU 24/7 feeling helpless and being distressed looking at your tiny, sick infant may be the best thing you can do for your baby and yourself.

          • I do realise it of course – but no need to apologize, you are quite right, and there is a whole lot of confusion and false assumptions. 35 and 37 weeks myself by CS – because they needed to come out. First one did 3 months in Special Care, but mainly for the consequences of not being born sooner! Second was fine. But as the baby I was referring to (the one from the post the other day) was born at home, I assumed a premature labour for that one. And the term premmie is misleading too. Not much in common between 26 weeks and 36.

    • auntbea

      In the comments, she (someone?) explains that a natural birth has no interventions, and since hospitals and doctors are interventions, cannot by definition be witnessed by a doctor. Unless he was hiding behind a screen behind the living room birth pool, I guess.

      • me

        I had two unmed births in the hospital, and one of them didn’t include so much as a heplock. Intermittent monitoring, was able to move around, eat and drink as I saw fit, pushing position of my choosing, no “coached” pushing, etc, etc. The whole crunchy nine yards. Granted, no residents were present (only a CNM), but it is more than possible to have a “low tech” birth in a hospital. Okay, this was a smallish hospital in a heavily Amish populated area (so low tech birth wasn’t exactly a big request), but still.

        • The Computer Ate My Nym

          But…bright lights! Strangers! Totally unnatural! (The bright lights and strangers thing is taken from a comment in the original thread.)

          • Bombshellrisa

            And it probably wasn’t cozy and filled with candles and the sounds of whale music!

          • Petanque

            And the ever-present danger of hatting!

        • PH Student

          Me too! In a hospital! With a Level 4 NICU! No residents, either, though. Probably because it was at 10:30 at night. But if it had been earlier and they’d have been there, I’d have totally had a party up in that piece.

      • The Bofa on the Sofa

        Of course. It’s merely an application of the principle if doctors do it, it’s an intervention, but if midwives do it, it is not.

        By definition.

  • The Computer Ate My Nym

    I have a binder of over 1,000 pages of evidence about the safety of out-of-hospital delivery in Oregon.

    I have a secret plan to end the Viet Nam war.

    I have a list of 100 known Communists in the US government.

    Show us the evidence.

    • AllieFoyle

      I’m thinking she borrowed Mitt’s binders full of women.

      • The Bofa on the Sofa

        Damn, Allie beat me to it by 3 minutes. I must downvote her for doing that, and downvote myself for being too slow.

        • auntbea

          You have not, in fact, downvoted yourself. Liar.

          • The Bofa on the Sofa

            Well I DID. I blame Disqus. And you. Another downvote.

      • VeritasLiberat

        Naah. The women in Mitt’s binders were actually competent professionals. I’d rather have one of them around when going into labor than a CPM. They’d probably have the hospital address programmed into the GPS and have prepared a useful checklist of stuff to pack, plus they would organize a phone chain of friends and family for news and support, plus somebody to cook meals. You know, stuff that would actually be helpful.

    • The Bofa on the Sofa

      I’ve got a binder of women

  • Kalacirya

    Also, I couldn’t believe her “I have a binder of over 1,000 pages of evidence about the safety of out-of-hospital delivery in Oregon.”. I can’t handle this, is she for real? How about some citations? I guess we should all cave to her 1,000 pages of evidence in a binder somewhere. Unreal.

    • theadequatemother

      It’s triple spaced, size 32 font with 5″ margins all around.

    • auntbea

      How long would it take you to gather 1000 pages of crappy epidemiological research? 20 minutes? 10?

      • quadrophenic

        Hit “print” on the MDC forums?

    • Dela Luna

      Both she and Mitt have binders of women.

    • Squillo

      I have thousands of pages of evidence that I am a writer of staggering genius and unlimited commercial potential.I think Random House should just take my word for it and offer me a six figure contract.

      • The Bofa on the Sofa

        Paperback writer…(paperback writer…)

        It’s a thousand pages, give or take a few, I’ll be writing more in a week or two. I can make it longer if you like the style…

    • JenniferG

      Binders! Full of homebirths!

      • Frequent Guest

        That is the first thing I thought too, you beat me to it! HA!

    • Eddie

      If you have over 1000 pages, each recording a single safe home birth, and you discount or find a reason to exclude most of the deaths, then in an absolutely non-scientific fashion you’ll have just what she says she has. Unless she shares this evidence with someone qualified to judge its value, it’s worthless. e.g., “Peer reviewed science”

    • melindasue22

      All I can think of is how outdated the majority of that info in her wonderful binder probably is too. Meaning none of it matters anymore anyways.

    • Petanque

      What is this obsession people have with binders? I have binders too, with pages and pages of information stored in them. Tax returns, recipes, old correspondence, but together it doesn’t carry any weight as a body of evidence!

      • suchende

        Dude, you should see my binders. Full of all manner of information. I pretty much should have an honorary PhD in SCIENCE.

      • Renee Martin

        But binders are so official!

  • AlexisRT

    My head is exploding at the level of stupid there. One, it is not possible that it’s just that one birth center, as she now claims. Two, WHY do people insist on calling Marsden Wagner a perinatologist? Last time I looked his fellowship was neonatal-perinatal medicine–it misleadingly makes people think he’s an MFM. Which he’s not. His Cytotec article is an embarrassment, BTW.

    I also hate the inevitable anecdote of “I knew this woman who wanted a VBAC and no one in her state would do it.” I’ve known more than a few women who wanted a VBAC… and no one would do it because they had risk factors. Without any further information, how do I know it was a simple refusal to do VBAC and not a refusal for her?

    • areawomanpdx

      I can guarantee you it’s not just one birth center. But looks like they’re looking to throw Andaluz under the bus. Not that Andaluz doesn’t deserve it, but LOL.

  • Meganomics

    Oregon has some of the safest best homebirth stats in the country IF YOU DON’T COUNT PORTLAND…

    This just kills me. It’s like saying, “New York State has the best crime stats in the country IF YOU DON’T COUNT NEW YORK CITY.”

    • Kalacirya

      Well did you know, our AIDs death rate is practically nothing if you leave out NYC. We don’t have an AIDs problem here, no interventions required.

      • Meganomics

        Nice!

        See, this is one of the problems with living in DC. We’re “all city”, so we always compare unfavorably in state-to-state rankings on crime, spending, education, etc. Not especially germane to to the original post, but still a pet peeve of mine.

        • Kalacirya

          Direct comparisons without an understanding of the context are essentially meaningless. Comparing DC to an entire other state, and not another major metropolitan area, is pretty silly. And even simple comparisons between similarly-sized cities are not necessarily that useful. We do it because it’s easy and tangible.

    • The Computer Ate My Nym

      Actually, NYC has fairly low crime rates. Considerably lower than, say, Buffalo. But, because it’s large, it has the largest number of crimes. So I suppose it depends on what stat you mean. This doesn’t affect your larger point, but as an ex-New Yorker I couldn’t let the assertion stand unchallenged…

      • Gene

        But rates don’t mean anything! It’s all about absolute numbers, doncha know!

        (babies die in hospitals, too!)

        • The Computer Ate My Nym

          Suggested alternative that actually fits both: There are practically no murders in Michigan–if you don’t count Detroit.

      • Meganomics

        Yeah, it occurred to me that NYC’s crime *rate* is actually pretty good compared to a lot of other cities. But I think it’s a good parallel for trying to exclude a population center that’s such a large percentage of state population that any state-wide stats become meaningless without it. Your Michigan/Detroit example is another good one.

    • Shut Up, Leonard

      2012 had the lowest average temperatures on record IF YOU DON’T COUNT JULY AND AUGUST.

      • auntbea

        There aren’t many saltwater drownings in America IF YOU LEAVE OUT HAWAII AND THE COASTAL STATES!

        • Redheads aren’t cool IF we don’t count Doula Dani….. amiright?!

          • auntbea

            And my sister, of course.

  • Kalacirya

    Oh man, what a parade of nitwits. It embarrasses me that these people exist. I guess the bright side is that they’re a fringe, but it angers me that the media writes on the topic without a critical eye to the claims, and that they continue to press their influence and overstate their own importance.