Even an insurance executive can be hoodwinked by homebirth midwives

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I’ve written a great deal about the way that homebirth midwives trick lay people into believing that they are exactly the same as midwives in the rest of the world. They’re so good at confusing people that an insurance executive was hoodwinked to the extent that he posted a paean to birth at a birth center on a health economics website without ever realizing that the birth center was unaccredited, the midwives weren’t real midwives, and they were essentially having a homebirth in someone else’s house.

David Overton wrote A Tale of Two Births for The Health Care Blog. It is a typical rhapsody on the joys of a non-medical (second) birth as compared to the medical annoyances of a previous (first) birth:

I have two sons, both healthy happy boys, both brought into this world in very different ways. I work in healthcare and like many readers of THCB, the business of healthcare is often viewed through the business lens. When we become the healthcare consumer, and are knee deep in the conundrum that is our healthcare system, the perspective changes dramatically.

Overton and his wife had planned a natural birth for their first child, but they were getting their care through the military and had to put up with evil medical interventions like a postdates induction:

The induction was the beginning of the end of my wife’s “natural” experience. The induction led to administration of Fentanyl, which led to an epidural, which led to Oxytocin, which led to contractions so powerful they resulted in fourth degree perineal tears and ultimately the arrival of Ezra…

Of course everything was so much better for baby number 2 born in a “birth center”:

By now, we were out of the military and my wife welcomed the idea of having her real “granola birth” experience. We went out of our network insurance to use a birthing center that was staffed by Licensed Midwives. We paid $4,000 out of pocket because our insurance would not cover due to “liability concerns”. Given that I work for the company that is also the insurer (yes, I work for an insurer), I was able to discover how much a delivery would cost at a hospital in our market; $7,500.

Each visit with the midwife lasted between 45 minutes and an hour. The assessments were very thorough, our questions were answered, and Ezra accompanied us on the visits. We were introduced to a new world of naturopathic healing (this was new to me) for headaches, backaches, and sleeplessness. We had options where we wanted to have the delivery, at home, the birth center, in a warm tub. Birthing positions and techniques were reviewed (on your back with feet in the air was not on the list of suggestions). We were given choices of what vaccinations we wanted, literature was shared on what research has shown on the risk of exposure to group B strep, and we made the decision on how we wanted to proceed. Only two ultrasounds were done, 6 weeks and 24 weeks cutting down on utilization. Emergency procedures were reviewed in case something went wrong, the on call physician would be notified or we would go to the emergency room.

Cue the “uneducated” friends:

40 weeks approached and my wife became concerned, friends and co-workers admonished her for putting her baby at risk. “It’s dangerous” they would say, “this is not good for your baby”. The midwife was never concerned, “your baby will come when he is ready”. We went to 42 weeks before Silas arrived…

The birth was everything they had wanted:

My wife labored for 4 hours with the gentle guidance of the midwife and no medications. She stood up, she lay down, she lay on her side, she walked around, and she was never tied to an IV, nor confined to a bed or birth monitor. At 4:00 am a bathtub was filled with warm water which eased the intensity of the contractions and at 4:30, Silas was born. We had previously decided that the newborn screening and Erythromycin eye ointment were all we wanted him exposed to, vaccinations could wait. By 10:00 am, we were home with the second addition to our family.

What did Overton learn from this experience:

Our healthcare system is broken but it is our own behavior as providers, payers, and consumers that have allowed it to happen. Why would any provider want to induce a mother at or prior to 36 weeks? Who decided elective Cesareans were a good idea? Since when did uncomplicated child birth have to take place in the hospital? Why don’t payers reimburse care that is delivered by mid-levels in a safe environment at a lower cost? I don’t claim to have the answers to these problems, but I do know that until we change our own behavior, we will continue to see the same results.

There’s just one teensy, weensy problem. Overton is clueless that his wife was not receiving care delivered by mid-levels in a safe environment. His wife received care from a lay person with a made up credential, not a midwife; it was not a safe environment because it was simply someone else’s house not an accredited birth center and because homebirth midwives have hideous death rates; and it costs less because it always costs less when you dispense with educated providers and life saving equipment.

Overton and his wife, both nurses, apparently had no clue that this is what they had chosen.

After a great deal of back and forth between Overton and myself in the comments section, he had this to say:

I have enjoyed the commentary on our choice to use a midwife. I am not impervious to fact and it has given me a lot to think about. With that in mind, I will concede to the assertion that it might not have been the safest choice. Touche! We chose to see a midwife because we chose NOT to experience what happened with our first son. Right or wrong from a scientific point of view, it was what was right for our family.

There’s nothing right or wrong with their choice to use a pretend “midwife” and have a homebirth at someone else’s house if that is truly what Overton and his wife were choosing. The problem is that two nurses, one of whom works for a health insurer, had literally no idea they were choosing a second, inferior class of midwife that wouldn’t be considered qualified in any other first world country; they had no idea that they weren’t in a real (accredited) birth center; and they had no idea that in the event of a life threatening emergency, their baby may well have died.

The ultimate irony of the piece is that in attempting to “educate” the rest of us, Overton got a lesson in how truly uneducated he was about homebirth midwifery. If he can be hoodwinked by homebirth midwives, anyone can.

  • homebirth is great

    I had my first baby at home in a birthing pool and will be doing it again in a few months. You should stop all this scaremongering. There is no way my NHS midwifes would have allowed my homebirth to happen if there was even a sign something was likely to go wrong. I had two midwifes with me the entire time, and would have been transferred to hospital if needed. As it went, the midwifes were not needed and just let me do my thing. I birthed my dauguter and picked her straight out of the water. She was so alert, but not crying, and the atmosphere was so relaxing. She scored 10 on Apgar and within the hour the modwifes had left the 3 of us, I got breastfeeding established straight away, neitjer of us have been to hospital since. Was such a great experience, much better than a hospital birth where an over zealous doctor would have pumped us both with drugs and tried to give us all sorts of medical intervention which was not needed. Not everyone is suited for a home birth, but the professional know what to be looking for and would also recommend a hospital birth for higj risk mums.

    • AmyM

      Sure–you are in the UK. Most of this blog refers to homebirth in the US which is nothing like what you had. You had trained midwives, with a transfer plan and (hopefully) strong risk-out criteria. In the US, there are no standards. Untrained/undertrained women can call themselves midwives, they will take any kind of case including things considered high risk where you are (breech, twins, post-dates, etc) and they have no transfer plan. We often hear the women here who advocate for homebirth (or who plan homebirths) say that the hospital is just 10 minutes away. But, even if that’s true (not likely in real time), that could still be ten minutes too long for a breech with an entrapped head, or an hbac where the uterus ruptured.

      I can’t speak for hospitals in the UK, nor can I speak for ALL hospitals in the US, but I don’t know where you get this idea that women are pumped full of drugs upon arrival at the hospital. That would certainly depend on the birth, and informed consent would be necessary before anything is administeed. And most women WANT epidurals and ask for them.

      • I can’t speak for ALL hospitals in the US either, but I can testify that the two hospitals in the US that I have delivered in were totally supportive of my decision not to have any pain medications during labor.

    • LukesCook

      “There is no way my NHS midwifes would have allowed my homebirth to happen if there was even a sign something was likely to go wrong.”

      How do you know?

      “much better than a hospital birth where an over zealous doctor would have pumped us both with drugs and tried to give us all sorts of medical intervention which was not needed”

      How do you know?

    • If your post was headed “Homebirth was great for me” none of us would feel inclined to argue. But the smugness of your contribution as it is does ask for some response. It is possible that you don’t mean it to sound quite so self-satisfied, but as this was your first baby, how did you arrive at the conclusion in advance that it was bound to be suitable for you? It appears your confidence was justified, but it is also clear that you do not get that problems do not always advertise themselves well in advance. You had a nice easy birth and stand a reasonable chance of having another. You would have been just as likely to have a nice, easy, intervention free birth in a hospital too, as a cash strapped NHS was unlikely to waste all those drugs on someone who didn’t need them.

      You gambled and won – and no-one begrudges you that. But even those in the medical profession who support homebirth don’t recommend it for first time mothers. If it was that safe a bet, it would never go wrong.

    • fiftyfifty1

      The UK Birthplace study showed a baby death rate 2X the rate in hospital for first time mums. And this is in women with absolutely no risk factors, like yourself. And nearly half of all first time mums needed to be transferred to hospital during labor. I am glad it ended well for you. You beat the odds.

      Here is info from the Royal College of Midwives web site:

      “For women having a first baby, a planned home birth increases the risk for the baby.
      For nulliparous women, there were 9.3 adverse perinatal outcome events per 1000 planned home births compared with 5.3 per 1000 births for births planned in obstetric units, and this finding was statistically significant.
      For women having a first baby, there is a fairly high probability of transferring to an obstetric unit during labour or immediately after the birth”
      For nulliparous women , the peri-partum transfer rate was 45% for planned home births”

    • auntbea

      Since you have never had a baby in the hospital, how do you know what would have happened there?

    • I’m glad everything worked out for you. I’m glad you had a good experience. Some births do go well and don’t require any interventions, and it’s always nice to be one of the lucky ones.

      But that’s all you were- lucky. Your next baby could be breech, or get stuck on the way out due to being face-up instead of face-down, or come too early or too late, or have any number of things go wrong. If something were to go wrong, where would you prefer to be- in a tub of water, or in a hospital with an OR?

      Also keep in mind that this blog is US-based. The NHS has much higher standards for midwives. In the US, the CPM license does not require a high school diploma nor any sort of medical training. Homebirth will always be less safe than hospital birth, but homebirth with unqualified attendants is really stupid, and in the US that’s what usually happens. NHS midwives are approximately equivalent to CNMs, who do have a lot of medical training (they’re nurses who then become midwives) and much better outcomes than CPMs, though still less good than OBs in a hospital. Many of the horror stories on this blog wouldn’t be as likely to happen in the UK, because you require midwives to be actual medical professionals.

      • theNormalDistribution

        Would a CNM allow a waterbirth?

        • I don’t know. Water labor probably, but not actual birth into the water.

          • LaDd112

            Sorry to post late. I found your blog in researching for a related topic. Some CNMs do allow patients to give birth in water. Mt. Auburn hospital and Cambridge Birth Center, both in Cambridge, MA, as well as some others do it. CBC transfers to Cambridge Hospital in emergent situations. Mt. Auburn is already in a hospital, and the Ob/Gyns assist the CNMs with waterbirth rather than the inverse, but only when they have extra staff available.

  • vdl

    Yeeee for home births, my next baby is going to be a home birth after 2 c-sections.

    • Awesomemom

      Good luck with that. Hopefully your baby will not pay the price for your obvious stupidity.

      • vdl

        Thank you for good wishes, and is not a stupid decision, I will be stupid if I believe and listened to all the bs, this “lady” published.

        • Karen in SC

          You don’t know what you don’t know. Have you evaluated your risk of uterine rupture after two c-sections? If so, is that a risk you are really ready to accept? What can a midwife do to save your baby’s and your life if your uterus does rupture? Does she know that the first sign of a UR is a change in the fetal heart rate, not just strong pain? etc etc

        • Awesomemom

          It is completely stupid. You have a uterus that is ripe for rupturing and you have decided to birth in a place where you absolutely can not get the help you would need should you have a rupture. You have guaranteed that should there be any trouble that your baby will die and yet you feel like you are making a safe choice?

        • theNormalDistribution

          All of the “bs” that Amy posts in her blog can be independently verified. She even makes it easy for you by always citing her sources. You can decide what to believe by how it makes you feel, or you can assess the facts for yourself. Wishful thinking will not protect you or your baby.

        • Captain Obvious

          When you due? Keep us posted.

    • KarenJJ

      What you mean is that your next baby will hopefully be born at home, but if circumstances are not looking likely then you will transfer to hospital. Because you are not ‘low risk’ and obviously your baby’s life means more than having a home birth experience.

      • vdl

        Of course my babys life means a lot more than anything, but will I have to be transfer? Im not sick I will have a baby, why would I have to be in charge of people than dont care about me, and just want my money? I will have a hba2c and everythins is going to b

        • vdl

          Going to be fine.

          • Durango

            Probably, but its still a bad idea. I had a mostly successful hbac. Bled like a stuck pig afterwards while both midwife and student worked feverishly to stop it. Lost enough blood that I needed to transfer to the hospital. Husband was pretty freaked watching the blood pour out of me. Thankfully the baby was fine, because no one could have helped her since they were trying to save my life.
            I dodged a bullet. If anything had compromised our daughter’s health I would have never forgiven myself. But somehow, I just figured it would be safe. It did in fact work out, but it doesn’t make it a good idea.
            In the NCB community, a vaginal birth is made to seem like the Ultimate Thing, a near holy grail for women. It isn’t. I feel like a chump for being so uncritical of birth outside of a hospital. Way too many families have paid a horrendous price. You don’t want to be one of them.
            My kids are teens now, and the way they were born is something I never think about.

          • Durango

            Switching to my computer…

            Once it was clear that I needed to be transferred to the hospital, the midwives surprised me by needing to call around to various hospitals. Turns out, midwives taking on HBAC are frowned upon (I am embarrassed to say I did not know this at the time. Yeah, I sure was “educated”!) and they didn’t want to risk *their own careers* by transferring me to an unfriendly place. I was surprised that there wasn’t a transfer hospital already in place. We certainly didn’t go to the closest hospital.

            These were the best midwives in the area; they founded midwifery here. They’d been practicing for years. And yet they took on a high-risk HBAC. They had properly risked us out for our first, who was breech. They were lovely people and I loved spending time with them. But they compromised the safety of my baby and me.

            Trust me, even a successful HBAC is not worth the risk to you and your baby. It’s just a day, a very dangerous day for your child, and why not do it as safely as possible? Good luck.

          • Eddie

            I didn’t know it was possible to predict the future. This feels like arguing with my son about why he should wear a bike helmet. He just assures me that no accident is going to happen, apparently because the people who got into bike accidents just hadn’t decided not to.

        • Here is a quote for you:

          “Where nothing effective is done to avert maternal death,“natural” mortality is probably of the order of magnitude of 1,500/100,000.”

          (http://www.jsieurope.org/safem/collect/safem/pdf/s2929e/s2929e.pdf)

          Most of those weren’t sick either, and it hasn’t changed much in places where modern obstetrics are not available.

          Taking your chances with “natural” may be only marginally daft if you take the precaution of being in a place where you can change your mind if things go pear-shaped – the majority of women still think it is not a great idea.

        • Amazed

          Great! Now, would you mind sharing the names of those angels, I mean, midwives, who would attend you for free? I am sure other mothers could use them. Hey, who doesn’t love providers who don’t want money?

          C’mon, have a heart!

        • Bombshellrisa

          News flash-unless your midwife is doing this for free, she wants your money too.

    • The Bofa on the Sofa

      Are you going to drive drunk before then, too?

      (What’s more dangerous? Driving drunk, or having a baby? Come on, see if you know the answer….)

      • auntbea

        Given the odd syntax, I think this poster may actually be driving drunk as we speak.

    • Good luck not bleeding to death!

    • Captain Obvious

      Not recommended by ACOG or AAP. But, you go girl.

  • kearsty

    this birth actually sounds very pleasant and i am so happy to know they got what they wanted out of the birth of their child and i dont see why displaying their wonderful experience just to slaughter it for your stupid needs to feel good about the choices you may make. just very hateful people

    • It is quite hard to avoid the conclusion that the main qualification for a homebirth is stupidity, isn’t it? Somehow or other, the desire for a “wonderful experience” blinds them completely to the bleeding obvious, and the assumption that anyone who demurs only does so because they are jealous that they didn’t have one is both insufferable and pathetic.

      Like the only reason one would object to someone driving obliviously drunk is resentment at the idea that you stayed sober. They made it home – this time.They had the wonderful experience of not being inconvenienced, or troubled by any other considerations. Being appalled at the irresponsibility is just being hateful.

    • Bombshellrisa

      Our stupid needs? They were the ones stupid enough to need an experience that catered to their whims and were ready to slaughter their own baby to get it. There are posters here who have had homebirths, were homebirth midwives and had natural births in the hospital (Dr Amy for instance, had two natural births). When we speak up because out of concern for safety, that is hardly about hate
      AND BINGO! (It’s been at least a week since I got to call that out. It has quite a hollow ring to it)

    • Because this guy works for an insurance company, where he might actually have influence on policies and what gets covered or not under his company’s insurance plans. If he were to push for including homebirth, while excluding coverage of common prenatal care and hospital deliveries, that would be bad. Really, really bad.

      Also it’s an indication that even people who should know better often fall for the pseudo-science and reassuring miens of midwives. If these people were fooled, how can we claim that lay women should know better and place the responsibility on them? It is the responsibility of the profession and the individual midwife to be competent professionals, and right now, they’re failing horribly.

  • Bystander

    Well, that’s an illustration of just why it’s so critical to prevent these so-called midwives from gaining legal recognition. They cannot help but betray the people who have put their trust in them and recognition implicates society in that deception.

  • Twila

    Seeing the baby’s name is Silas gave me a cold chill. The blog elmcitydad.com tells of a homebirth death (shoulder dystocia). So sad. Mama was a primip. Her 2nd baby was born alive and well by c-section without TOL.

  • Dr Kitty

    Mr Overton as “introduced” to naturopathic healing for headaches, backaches and sleeplessness= expensive, non-evidence-based placebos for minor, self resolving conditions.

    I don’t think you should be in charge of commissioning services.

    • Eddie

      Hear hear. I noticed that as well.

  • Disgusted

    I’m afraid that when people’s minds are made up, they won’t let anyone “confuse” them with the facts. Someone I know is a rabid pro-NCB advocate. She is not in any health care profession at all, but she does some research on old herbal things. Recently she was going on in her blog about how midwives were pushed out of the birthing profession and into hospitals in the 18th and 19th century but after various things were adjusted for, the death rate in hospitals seems like it may have actually been higher! She’s very proud of having found this. She really seems to feel that vague collections of death rates from 200 years ago in hospitals proves hospitals NOW are a dangerous place to give birth.
    Meanwhile, another friend has decided that “science is bullshit” because one “friend” she has “is a scientist” and said so.

  • Renee Martin

    I also love how it’s made out like the big difference was just the healthcare delivery, instead of just a second VB…..

    His wife was a perfect candidate for an OOH birth, but this doesn’t mean an unaccredited center with CPMs is safe. part of the good stats for 2nd time moms are the providers, its not all mom/baby health.

  • Eddie

    The more I think about it, the more I realize that that blog post is by someone who had a bad experience, and needed A Reason Why It Happened(tm) so a repeat experience could be avoided. Confirmation bias then took hold. This explains how someone who clearly should be able to know better fell for so many untruths. He already “knew” the medical system was bad. Thus, when the second experience went better, it wasn’t because it was a second delivery. It wasn’t luck. It was because they were outside the hospital.

    I continue to find it surprising how many people say, “It was right for my family” even when confronted with evidence that they took increased risk. Just more evidence that people are not rational creatures who have emotions as well. People are emotional creatures who happen to have the ability to reason. It is very common to see people emotionally decide what truth is, and then use their intellect to reason backwards from that decision as justification.

    • Sue

      Yes – combined with the time-old “”It was better the second time” thing. Clue: IT’S ALMOST ALWAYS BETTER THE SECOND TIME, NO MATTER WHAT YOU DO. (shouting intentional – sorry)

      • And, to my surprise, that can apply to your second CS as well.

        Question: Can you get a 4th degree tear because a labour was mishandled? I would have thought it would take something a bit more complicated than that, something that may have contributed to her first bad experience.

        • FormerPhysicist

          Oh my, yes. A scheduled c-section is SO much easier than an emergency c/s after labor. My first: Induction, labor for 6-9 hours, c/s because she was stuck. My second: scheduled, no labor. My third: scheduled, labor started 2 days before scheduled c/s due to pre-eclampsia,labored for 4 hours, emergency c/s. Guess which was the easiest recovery? Guess which was the worst recovery?

          • The Bofa on the Sofa

            Our first was a scheduled c-section, but he showed up 3 wks early, after my wife’s water broke and she spent the night having contractions. She never did a TOL, and they got her in for a c-section, but it was after about 12 hrs of, what I think would be technically considered “mild labour,” but don’t tell my wife that.

            Our second was also a scheduled c-section, but that waited until the due date. It was certainly easier in terms of going to the hospital and whatnot (although we didn’t really get a good night’s sleep the night before, but that was jitters). Moreover, the c-section recovery went a lot better because of her experience with the first, so she knew that she needed anti-nausea medication in recovery.

            The only problem with the second was that, because of our experience with the first, we were extremely paranoid for about the last month, just waiting for something to happen to send us to the hospital.

          • Sue

            Right – that’s almost self-fulfilling. #1 – emergency c/s – scary and horrible. #2 planned c/s – calm and easy

  • auntbea

    I once got an ear infection, and drank some tea, and it cleared up. Isn’t it stupid that my insurance covers antibiotics, when they could just pay $2.50 for some tea?

    • Bombshellrisa

      I have friends who were posting pics of their wrists on Facebook yesterday. The reason why? They had been doing “cupping” on their wrists to “release wrist toxins”. Apparently that is what is causing everything from menstrual cramps to what one thinks is carpal tunnel. They were claiming that the symptoms they had experienced were “cured” by the cupping. Insurance pays for chiropractors, but think about how much cheaper it would be to just give people those cup things.

      • auntbea

        Have you suggested that they also try cutting small holes in themselves to release the excess blood and imbalanced humors?

        • Guestmama

          Better not – they might actually do it. :/

          • Bombshellrisa

            And the sad thing is they really might!

  • Eddie

    We were fearful for our sons safety, not because he was now “group B unknown”, but because he was now entering deeper into the labyrinth of our healthcare system where 90,000 people are still killed every year due to medical errors

    Wow. That’s a very negative attitude, and acts as if those deaths (I’ll take 90,000 at his word for the sake of argument, since I don’t know) are randomly distributed across the hospitalized population rather than being concentrated in certain sub-populations that his son did not belong to. Shouldn’t a nurse, let alone someone who works in the insurance industry understand this pretty basic fact? He started out with a significant bias, which colored everything.

    • AmyP

      I really don’t want him working for my insurance company.

      • Susan

        Me either. Well, she’s only three times more likely to die, and it’s SO much cheaper, and more comfortable….DENIED.

    • If X people die every year in hospitals due to medical error and Y people are saved in hospitals who would otherwise have died, its only an argument against hospital interventions if X > Y. (That is, on a societal level. Obviously death is still tragic and X should be minimised.) However, for an insurance company every X death is expensive. Whereas every Y person who doesn’t receive care and dies outside of hospital doesn’t cost them a cent.

      • Eddie

        You also have to take into account — of the people who die from medical errors, what fraction of them were so ill that they were close to death anyway and thus doctors were trying treatments that were inherently riskier. This doesn’t say that medical errors can be OK. But it’s a necessary part of the context, and of being able to generalize where one might personally experience adverse medical errors.

        • auntbea

          You guys are different Eddies and not just Eddie talking to himself, right?

          • Eddie

            LOL, I am not above talking to myself, but we are not the same person.

        • theNormalDistribution

          I’m not sure that scenario would qualify as a medical error.

      • Box of Salt

        Eddie Sparks, this doesn’t make sense. If Y people happen to die later, that doesn’t change the fact Y people already received hospital paid for by the insurance company according to your original premise.

        Insurance paid for both X people (died at hospital) and Y people (treated at hospital and lived).

        • Sorry if I was unclear. I was referring to the costs borne by insurance companies for medical errors above and beyond the treatment costs (ie. medical negligence payouts, compensation, etc). As you rightly point out both X and Y groups have treatment costs borne by the insurance company.

          However, if an X patient dies as a result of an “in-hospital-medical-error”, the additional costs are more expensive for the insurance company than if a Y patient dies from an “out-of-hospital” error for not seeking life-saving hospital treatment. Those costs are borne by the patient’s family.

          I was attempting – albeit unclearly – to suggest that there is a financial benefit for insurance companies to generally promote the idea of “unnecessary interventions”.

          PS: Although I wouldn’t mind taking credit for some of “original Eddie’s” posts, which I usually admire, we are different people. Although I’ve been reading here for a while, I’ve only posted a few times recently.

    • fiftyfifty1

      And his story of the tests done on his son are very biased. He makes it sound like the doctors ordered a lumbar puncture on his son for no other reason than that the negative group B strep test was timed out. But if you read the GBS algorithm you see that a lumbar puncture is only done when a baby is displaying *signs of sepsis*, not just because mom’s GBS status is unknown. Actually even when Mom’s GBS status is known positive, the baby doesn’t get a lumbar puncture unless it shows signs of sepsis. The issue is that early sepsis in a baby is subtle to the untrained eye. The parents can think that the baby looks totally normal, but it may be showing risk signs like a mildly high or even mildly low temp or a subtle abnormality in the breathing pattern or white blood count. Docs don’t do spinal taps on babies just for fun.

      • Eddie

        His whole, “This lead to that which lead to that” is highly suspect. I completely believe that is how it appeared to him and his wife. That doesn’t mean it is so simply true.

        There are times when I was right in a diagnosis and the doc I was dealing with was wrong. This happened twice with my youngest with two younger docs in the pedi practice. This also happened once with my wife and her ex-Gyn. Each had an ER visit as a result of the doc being wrong. That this happened more than once doesn’t mean I should ever trust my own judgement over a doctor’s judgement. I just don’t have the training or experience.

        Both of the cases that lead to an ER visit happened because the doc entirely dismissed my concern and didn’t even investigate. What I learned is not to trust my judgement over a doc’s, but instead if I have a serious concern, to be more assertive to push the doc to investigate and not just dismiss. While having the humility to know that because I was right a couple times does not mean I am always right! There’s a balance.

        I know there are times when a nurse is right and the doc is wrong. It seems some nurses overgeneralize this and lose respect for doctors’ judgement and start to substitute their own. I think the insurance exec has done this, without awareness — as you point out — of what he doesn’t know.

  • I don’t have a creative name

    “I will concede to the assertion that it might not have been the safest
    choice. Touche! We chose to see a midwife because we chose NOT to
    experience what happened with our first son.”

    I will never get over people KNOWING that this is not what is safest for their baby, but being so hellbent on their own experience that they just don’t care. How can you call yourself a parent and genuinely not give a rip about what is safest for your child?

    • auntbea

      Because it’s already happened and you have to justify it somehow?

    • mamaellie

      It’s hard to admit to yourself that you put your family at risk. I had a couple of birth center births. I think of myself writhing around in that tepid bathwater now and it feels like it was a stunt. It took me a long time to get here though.

    • Charlotte

      I agree. The selfishness of such people makes me angry. They don’t see it as selfish to put their experience over their baby’s safety, but it is.

  • Lyette Reback

    Another great article. Thank you.

  • LibrarianSarah

    ““there is NO ONE who provides safer care for American women than
    American obstetricians” said the status quo. Shame on me for expecting
    more for my health care dollars. I should have fallen in line like a
    good little lemming, despite our first experience which very much was a
    “Whew! Got away with that one” experience.”

    I rolled my eyes so hard at that they almost got stuck in my head. Oh you outspoken rebel without a clue. You really showed those doctors with all their “degrees” and “science” who is boss. *eyeroll* Oh god they’re stuck now! Help!

  • Captain Obvious

    Again, I love those easy deliveries that even a teenager could deliver. Seems so wonderful, so serene. Too bad that is not the guarantee. You need someone experienced to recognize and treat problems if they arise, and they do arise. I am glad the Overton’s had a “good” delivery. But like all the commenters here already know, they don’t really know what they don’t know. It will be an eye opener when some family takes the Overton’s advice to do the same and the baby dies.

    • Vaginal birth number 2… who would have thought it’d be quicker and easier?? Just who. would. have. thought…….

      • Bombshellrisa

        For all the talk that CPMs give about how “every woman is unique, every pregnancy is unique, every birth is unique” you would have thought they would have picked up on that.

  • thankfulmom

    “Our healthcare system is broken but it is our own behavior as providers,
    payers, and consumers that have allowed it to happen. Why would any
    provider want to induce a mother at or prior to 36 weeks?”

    Did you say this guy is a nurse? How would someone who has gone to nursing school not know there are life threatening situations in which inducing is mom & baby’s best option?

    Glad everything worked okay for them.

    • areawomanpdx

      Seriously. There is no legit doctor out there who would induce for the hell of it at 36 weeks. This is one of those NCB lies that gets repeated over and over again so many times that it becomes “truth” to the general public.

      • Amy Tuteur, MD

        In the comments section, Overton acknowledged that he had mispoken and that inductions are not routinely occurring as 36 weeks. He says he was railing against routine inductions at 39 weeks.

        • Awesomemom

          Which again also doesn’t generally happen with out an actual reason. You would be hard pressed to get a doctor to induce then just because you are tired of being pregnant, if that was the case then I am sure they would be inundated with women wanting inductions.

    • BethC

      Absolutely, there are nurses who believe this. Most of them work in orthopedics and cardiac care. They don’t generally work in obstetrics or neonatal, where they might have to actually see the results of their folly.

  • LovleAnjel

    “We paid $4,000 out of pocket because our insurance would not cover due
    to “liability concerns”. Given that I work for the company that is also
    the insurer (yes, I work for an insurer), I was able to discover how
    much a delivery would cost at a hospital in our market; $7,500.”

    That sounds like a hospital delivery cost without insurance. If his insurance covered it like mine, well…my prenatal care, tests, delivery/CS and next-day stay in hospital will amount to $40 out of pocket. $40. They paid $4000 for the pleasure of delivering in the house of someone who once took a correspondence course. Not the kind of cost savings I would go for, personally.

    • Therese

      No, he’s saying $7500 is what it would have cost his insurance company. He’s trying to make a point that the insurance company would have paid $7500 for a hospital birth but wouldn’t pay $4,000 for a birth center birth, so obviously the system is broken.

      • LovleAnjel

        Ah, I see. So, he’s an insurance guy who doesn’t understand actuarial tables then?

        • Therese

          He’s a director of patient management, which I don’t know exactly what such a person would do but it certainly doesn’t sound like it includes risk analysis.

          • LukesCook

            Complaints department.

      • suchende

        You would think an insurance exec would know that it’s not just the sticker price of the birth the insurance company has to pick up, but the sticker price plus the costs of any adverse outcomes.

        • Squillo

          As an insurance exec, he should also be aware that his midwives very likely had no med-mal coverage, unlike the expensive hospital and the wicked OBs. So the entire cost of any adverse outcome, even if caused by professional negligence, would be borne by his family.

          • The Bofa on the Sofa

            Squillo’s comment makes me think of a junk bond. Cheap, so high yield, but high risk, and failures are catastrophic. OBs, however, are the safer investment, but with the lower return per event.

            I don’t know why that comparison jumped in my head, but I think it is correct. Someone who understands finances better could help me out.

          • Eddie

            Apt comparison. With a junk bond you are far more likely to lose your principle investment (e.g., have to go bankrupt due to unplanned high medical expenses). It can happen with any bond, but it is far, far more likely to happen with a junk bond.

            FYI: For those outside the US, approx 2/3 of personal bankrupcies in the US are said to involve medical expenses. But there it’s not a lack of medi-mal but primarily a lack of insurance coverage.

          • The Bofa on the Sofa

            Actually, the majority of medical expense-caused bankruptcies are insured, just that the expenses outstripped the insurance coverage.

          • Eddie

            I stand corrected. I should have said a lack of adequate insurance coverage.

    • Jessica

      My hospital delivery before insurance paid was about $16,000 (my charges and the baby’s)- I was induced and stayed there two nights. The baby only stayed about 28 hours. That doesn’t include the charge from the anesthesiologist for my epidural.

      My OOP cost ended up being appx. $3,000.

    • Aunti Po Dean

      “Liability concerns” didnt give him a clue then?

      • suchende

        If home births/CPM attended births ACTUALLY were cheaper after you take into account treating adverse outcomes, does anyone really think money-grubbing insurance companies would deny coverage for them?

        • Bombshellrisa

          Exactly. That $1000 emergency transfer fee the midwife charges isn’t covered by insurance, that is out of pocket.

          • LukesCook

            The midwife charges a transfer fee? For what, dialing 911?

        • Guestmama

          Ya know what the NCB response to that one is? “Well, insurance companies hire DOCTORS to make these decisions of what birth locations and providers to cover, and we all know that they HATE homebirth and midwives!! So jealous, you know!”

          Don’t you know, folks? It’s ALL a big conspiracy.

  • auntbea

    Is this guy really an “insurance executive”? His job description looks like middle management, largely HR, to me.

    • suchende

      Well I think we can be fairly confident he isn’t an actuary, anyway.

  • Antigonos CNM

    I think there’s more than one “teensy” problem. Apparently no one thought to tell this guy that second labors are much more likely to be quicker and less difficult than first labors. During the years I taught the Lamaze method it was borne in on me that most of my clients were primigravidas — in fact, just about the worst sort of women to try for unmedicated births. Untried pelves, long prodromal labor so that by the time active labor was established the woman was exhausted, a second stage of up to 2 hours instead of literally only a few minutes…of course, there are exceptions to the rule, but what I found was that after “failing” at Lamaze with a first baby, most of my clients didn’t even want to try for an unmedicated birth with #2.
    So whenever I hear a story about a “traumatic” first birth followed by an easy [or easier] “natural” one, which implies the “natural method” used was what caused the absence of “traumatic interventions” I wonder how much this is true and how much is simply the difference in the way a primigravida and a multigravida labor.

    • Jessica

      It’s shocking that more people don’t know the difference between labor and delivery with a first baby versus subsequent babies. EVERYTHING I read on l&d differentiated between first and second babies and made it clear that a first baby was likely to be a longer labor with a longer second stage.

    • suchende

      I was all about the epidural with baby #1. If we have another, I might skip it, because I really disliked the process of getting it. But if I had it to do over again with baby #1, I’d do it again. Thanks to the pain management, I felt I could totally control my pushing stage and slow it down to avoid tearing. Also, I was EXHAUSTED from many days of prodromal labor. After the epi, I got a nice, long nap.

      • Sue

        I’m still struggling with Overton’s “administration of Fentanyl, which led to an epidural,”. Is he really a nurse?

        • Guestmama

          Actually, I can understand this. I had fentanyl during one of my labors, and it instead of relieving the pain it made me feel horribly out of control and unable to cope with the contractions. I could definitely see someone wanting an epidural after receiving it. Not that I think that’s a bad thing. 🙂

          • And wanting an epi or choosing a better hospital is a logical response to a bad experience. Opting to try woo, not so much.

    • Captain Obvious

      And if the Overton’s tried their first birth at the birth center and had a long labor and transfer to the hospital for delivery with their second labor in the hospital, I am sure they would be supporting hospital birth. I agree, I would love to avoid delivering women’s first babies and know all my laboring moms have a proven pelvis. :-/ Unless the second baby is much bigger or OP, the second deliveries are so much easier!

    • BeatlesFan

      I think the same thing… purely anectodal, of course, but my first labor was 46 hours from first contraction to birth, with an hour of pushing. My second was 6 hours from first contraction to birth, with 20 minutes of pushing. I gave birth both times in the same hospital, with pain meds. My second was easier because she was my second, that’s all I chalk it up to.

  • The dangerous thing is when insurance executives decide that because they could do without intervention that everyone else should try to do without intervention as well, as interventions are expensive AND viewed as unneccessary. Right in his love letter to Homebirth he expressly states that he thinks elective cesareans are not a good idea. Then, everyone is forced to make the same choices (it’s the natural birth of the insurer’s dreams and screw your desire for an epidural!). For an example see the NHS.

    • theadequatemother

      Especially since the costs of many sequlae of traumatic natural birth are privately borne by the woman and her family, and not by insurers.
      – incontinence products
      – pelvic physiotherapy
      – loss of time in the workplace (esp if due to anxiety, PTSD, emotional trauma)
      – loss of self esteem secondary to urinary/ fecal/ flatus incontinence
      – problems within the marriage, divorce, etc.

      • Captain Obvious

        Case in point. Recent post after a NUCB, finding a cystocele.

        http://community.babycenter.com/post/a41546962/bladder_prolapse

        First NUCB led to a cystocele already. More vaginal births are only likely to worsen the prolapse and aggravate stress urinary incontinence.

        • Dr Kitty

          Saw a lovely lady today.
          5 children, all NVD, all over 8lbs, last 2 planned HB with NHS midwives.
          She is in her early forties with the largest rectocele I have ever seen. As well as severe stress and urge uarinary incontinence.

          I foresee some major pelvic surgery in her future. Big picture, it isn’t just about birth.

    • T.

      Well in Italy we have a NHS and a very high percentage of MRCS. So I do not know about that. Epidural actually depends more on the size of the hospital you birth in. It is the availability of anaestethologists the problem.

      However, the problem with insurance is very real.

      • Renee Martin

        Another poster from Italy said that many women have MCRS because its the only way they can guarantee they will get pain relief!

        • Guestmama

          Italian birth rates are quite low too, so most women requesting MRCS aren’t planning to have large families which might otherwise influence their choice to deliver vaginally vs MRCS.

        • T.

          It depends hugely on where in Italy. We have big differences from region to region. In the South, sanity is generally worse than in the North, and there are less anaestethologists.

          To explain: not all hospitals have all around the clock anaestethologists. So, if you want pain relief, you can either choose one of the hospitals that does have them (biggest hospitals, more common in the North, but you may have to travel a lot to get there) OR hope you go in labor when the local anaestethologist is in the hospital OR choose a MRCS. Since many are afraid to go in labor when the anaestethologist is not present (and not otherwise busy) and don’t want/can’t travel to a far away hospitals, they choose MRCS.

          As Guestmama says, we have a low birth rate, and very very few people wants more than two children, so MRCS makes sense.

          I am personally all for MRCS, if the woman wants it. Why not? Her body, her business (and a logical way to respond to a problem -lack of doctors- too, in my opinion)

  • KarenJJ

    I can actually see how an insurance executive might fall for the ‘unnecessary interventions’ idea.

    • True, because many interventions have risks associated with them….

      …however, an intervention free birth also has risks associated with it, so avoiding interventions trade one set of risks for another. There are still risks.

      • KarenJJ

        The information on risks for out of hospital birth seem to be surprisingly muddied. Hopefully MANA will have more comprehensive information for us soon..

        • ..any year now…

        • Antigonos CNM

          From your mouth to God’s Ears. But I’m not holding my breath. The only encouraging thing I see is that more states, and the CDC, seem to be collecting their own data.

      • Leaving out paranoia and the risks to one’s self image as an all natural, virtuously low risk mother, what exactly are the risks of ultrasound and FHM? What kind of care did this mother get between 26 weeks and 42? Apart from the reassuring chats?

        While glad to see that ignoring the real risks of childbirth doesn’t always lead to a bad outcome, I find reading this kind of “system is broken” stuff really depressing. It reinforces the idea that hospitals cause complications instead of being rather good at dealing with them. Fine for those who stay low risk, but a rather substantial number are running risks they just blind to.

        • mamaellie

          I almost fell for the bit about ultrasounds causing autism. That’s probably what he’s talking about. I ended up having quite a few ultrasounds because little guy parked his placenta too close to my cervix. So far he seems just fine.

        • antigone23

          yep. Even low risk women normally get NSTs and fluid checks when they pass their due date. But I’m sure this idiot would consider that unnecessary intervention and pretend like the risks of going post dates do not exist. I’m just a little sensitive about this because my mom seems unable to go into labor on her own and without ultrasound and induction i would certainly be dead.

        • Guestmama

          I jut have to jump in here and say that while I regret choosing a CPM now that I know better, I don’t think EVERYTHING they do is useless. Perhaps mine was the exception, but my prenatal visits consisted of the usual height/weight/blood pressure/urine check, and a lot of nutrition and healthy lifestyle counseling. Not kooky stuff either. I actually really did benefit from that. It’s an area that is often neglected during five minute OB appointments – there just isn’t time, and an OB is over-qualified to give that type of care anyway. I wish we could see a marriage of sorts of midwifery-esque prenatal lifestyle/nutrition counseling combined with OB oversight and care for the delivery. Is there anyplace in the world that does this type of care routinely?

          • The important bit is what would’ve happened if blood pressure/urine etc. deviated. Would you have been risked out, or given some more helpful advice on nutrition and assured it was a variation of normal?

          • KAD

            I am pregnant in NYC and go to Weill-Cornell, a very busy Manhattan hospital. My OB spends as much time with me as I need and never ever rushes me. He never makes me feel like I am taking up too much time and answers all my questions. The “5 minute OB appointments” are BS as far as my own experience is concerned.

          • The Bofa on the Sofa

            My OB spends as much time with me as I need

            But they don’t want the care they need, they want to feel loved.

            I wouldn’t say the 5 minute OB appts were necessarily BS for us. We met with the doctor exactly as long as was needed. She would provide us with some critical information relevant to that stage of the pregnancy, and then gladly and effectively answered any questions we had.

            And if that took 5 minutes, then she was out in 5 minutes. But what else should she have done? Sit there and talk about the weather?

            If you want you OB to talk about nutrition and “healthy lifestyle” issues, ask about it. They’ll do it, and they won’t give you a bunch of nonsense. More importantly, they are also likely to put it in perspective for you.

          • Eddie

            My wife’s OB sent her to a dietician due to GD, which was luckily very successfully controlled with diet only. I think he would have referred to a dietician for any of those kinds of questions anyway. As you say, many of her OB visits were short, but that was because there was nothing else for the doc to check and we had no more questions. We weren’t there for feel-good, “please spend time with me.” We were there to be sure that there were no surprises and that we’d be ready when the day came.

            The funniest visit was one of the short ones when the OB saw I had the annual car issue of Consumer Reports magazine. He spent five minutes raving about the Honda Odyssey, having just returned from a trip to visit a friend of his who had one. He spent more time talking about the Odyssey than anything medical related to the reason for our visit! We left shaking our heads and laughing about it. But it wasn’t as if we had a single unanswered question and we never felt rushed out.

          • Eddie

            My wife’s experience in a Chicago suburb is similiar to yours. (Because only one of her OBs spoke her language, I went with her to every appointment.) What I found funny was that the office staff was irritating and difficult, but every single doctor and nurse in the practice was fantastic, with only the exception of the doctor that speaks my wife’s language, who was still mostly adequate. (He clearly brought some of the patronizing attitude of his home country’s medical practices with him when he came to America. His favorite thing to say was “Don’t worry about it”)

            None of the doctors in her practice rushed us out the door, and I never had a problem getting answers to any question that my wife or I had.

            I’m sure the “5 minute OB appt” exists in some places. But it is definitely not universal in the US and it would be a big mistake to think it is.

          • AmyM

            Yes, my OB was always willing to stick around and address any questions or concerns we had. The first visit, we asked questions for 45minutes (twins) and she was willing to answer more if we’d had any.

            Some time after the children were born, I went back with a sexual dysfunction problem. She listened, and said it was depression, highly unlikely to be anything else, and she gave me the name of a therapist. I probably spent a good 40min at that appt, and I wasn’t even pregnant.

            Then, this year, I went for my routine gyn exam, which do tend to be fast, but again,she’ll answer any questions I have. She said “I miss seeing you now that you aren’t pregnant!” That was a nice thing to say, even if

          • AmyM

            woops, that’s “even if she says it to everyone.”

          • moto_librarian

            CNMs provided my prenatal care and delivered both of my sons. My appointments were as long as I needed them to be, but by the time I was in my second pregnancy, they probably averaged 5-10 minutes. As a working mom, I appreciated this. I will also be forever grateful that after 10 days of prodromal labor when I went in for a dilation check, the midwife asked if I wanted my membranes stripped to see if we could finally get me into active labor so I wouldn’t have to keep suffering. It worked, and my second son was born early the next morning at 38 weeks and 5 days.

  • The Bofa on the Sofa

    I really don’t know what “right for our family” means.

    It worked out. We took a risk for our own selfish reasons, and fortunately nothing bad happened. How does that make it “right”?

    It’s like the drunk driver saying he chose to drive because the last time he took a cab home, it was such a hassle on everyone to have to go get the car, which inconvenienced his wife and others. This time, his wife had an early doctor appt the next day, and they couldn’t afford the hassle of not having a car, so driving home drunk was right for his family.

    • An Actual Attorney

      There was a case in my city where a cab driver allegedly raped a young woman who got a car home when she was blotto. (The facts are muddy and I want to be clear — see my name — that this man may not be guilty at all of anything). If it happened it is tragic. But it’s not an excuse to drive home when blotto. No one would argue that it is. It might point to the need to better screen drivers or other safety measures. But I think that’s what NCB-ers do with birth.

      • The Bofa on the Sofa

        Cab drivers get in accidents, too

    • Something From Nothing

      Bofa,
      I always love your comments!

      • Sue

        Me too, but you’re a bit thin with the pop culture references, lately. Smarten up, Bofa! 😉 (I miss them!)

        • The Bofa on the Sofa

          I have noticed that. You are correct, Sue, I have been slipping. I’m kind of waiting until I can drop the hammer by using an example from a Bionic Woman episode, now that I have been watching that (Cozy TV on Tuesdays). Did you know that while Steve Austin is the $6 million man, the cost of Jaime Sommers’s bionic replacements was classified? Given that the only difference between her and Steve Austin is the bionic ear instead of an eye (they both have a bionic arm and two bionic legs), I wouldn’t think the price would be that much more, but then again, it could depend on how extensive the damage was. Sadly, Jaime is too kind and gentle (can I just say that I am in love with Lindsey Wagner?) to really take advantage of her bionic features, except her hearing, which she uses a lot, although I did get a kick out of the time she used her bionic arm to get her a gig dealing blackjack. Bionic dealing, classic!

          • Sue

            Bofa – you should write an essay on the cultural significance of that observation. Why won’t they declare the cost of Sommers’ replacements? Is there a conspiracy involved?