Homebirth and conspiracy theories

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Just last month an independent investigator released data on Oregon homebirth deaths. The death rate for planned homebirth with a direct-entry midwife in 2012 was more than 800% higher than term hospital birth.

This is cold, hard, in your face data; what are Oregon homebirth midwives and advocates doing about it? They are NOT attempting to improve standards for Oregon’s self-proclaimed “midwives.” Rather they are spinning conspiracy theories about the data and, worst of all, about Judith Rooks, the certified nurse midwife epidemiologist who presented them.

Coincidentally, I read an interview in Salon yesterday about conspiracy theories and it has a great deal of relevance for Oregon homebirth midwives and homebirth advocates. The article, aptly titled Why People Believe in Conspiracy Theories is an interview with Professor Stephan Lewandowsky, a cognitive scientist at the University of Western Australia, known for her work on climate denial. Just about everything he says in regards to climate denialists applies to Oregon homebirth midwives and their supporters.

First of all, why do people believe conspiracy theories?

There are number of factors, but probably one of the most important ones in this instance is that, paradoxically, it gives people a sense of control. People hate randomness, they dread the sort of random occurrences that can destroy their lives, so as a mechanism against that dread, it turns out that it’s much easier to believe in a conspiracy…

Homebirth advocacy give women a sense of control over pregnancy and childbirth. By pretending that “trusting” birth, eating right and having long prenatal appointments can prevent devastating complications, women feel a false sense of control over pregnancy outcomes.

Homebirth midwives and their supporters invoke a wide variety of conspiracy theories, including the purported conspiracy of obstetricians to ruin your birth experience, the purported conspiracy of doctors who fear a financial threat from homebirth midwives, and the conspiracy of organized medicine to ignore the safety of homebirth.

One aspect of conspiracy belief seemed particularly relevant to Oregon homebirth midwives and their supporters:

Another common trait is the need to constantly expand the conspiracy as new evidence comes to light. For instance, with the so-called Climategate scandal, there were something like nine different investigations, all of which have exonerated the scientists involved. But the response from the people who held this notion was to say that all of those investigations were a whitewash. So it started with the scientists being corrupt and now not only is it them, but it’s also all the major scientific organizations of the world that investigated them and the governments of the U.S. and the U.K., etc., etc…

Hence the need to add Judith Rooks to the conspiracy. Do the hideous death rates show that homebirth with an Oregon homebirth midwife is dangerous. Of course they do, unless you are a conspiracy theorist. Homebirth conspiracy theorists can ignore the data right in front of them by insisting that Judith Rooks is part of the conspiracy, too.

Everyone is prone to some degree of bias and motivated reasoning — where do you draw the line, if there is one?

The crucial difference between having a preconceived notion — we all do that, of course — and conspiratorial thinking is when you get into that self-sealing reasoning and ignore every piece of evidence that is pointing the other way, when you’re starting to broaden the circle of conspirators …

The evidence doesn’t matter to homebirth midwives and their supporters, because they can blithely ignore any evidence that they don’t like. From mind bogglingly stupid pronouncements like that of author and advocate Jennifer Margulis: “Oregon has some of the safest best homebirth stats in the country IF YOU DON’T COUNT PORTLAND…” to the ugly insinuations that Judith Rooks is part of the conspiracy, homebirth advocates reach for their conspiracy theories to justify their refusal to look at the evidence.

There’s nothing we can do about the conspiracy theorists, but we can educate the public to the fact that homebirth advocates are deliberately ignoring the scientific evidence.

And we can point to something else: We can point out that Oregon homebirth midwives KNOW that the data is hideous. That’s why they refused to release the MANA statistics for Oregon, and that’s why they are not publicly announcing a major investigation into the data. The leadership of Oregon homebirth midwives, including Melissa Cheyney and Silke Anderson, are engaged in an ongoing effort to hide the truth about Oregon homebirth. Dead babies are just collateral damage in their effort to support lay birth junkies in pretending they are “midwives.” People who are unafraid of the truth launch investigations; people who are afraid of the truth launch conspiracy theories, instead.

  • Bombshellrisa

    OT (but only a little) Speaking of Oregon midwives, my husband and I spent the last few days in Oregon. We had been joking that we could make money on the house there by turning it into a birth center. I could just see the intro on our webpage: “Bring your angel earthside at the Ponderosa Center for Birth. Nestled in the shadow of Mount Emily, our birthing suites have views of the surrounding pastures and the sound of a babbling brook to soothe you. Waterbirth available, RN run and supervised”. Sounds awesome right? And the hospital is only 10 minutes away, but that is AFTER you drive down the dirt road that leads to the gravel road (10 miles an hour max speed limit) and you get on the main road. And all prenatal visits can be in the birthing suites (like Puget sound birth center)! All for $3800! My husband asked what I would have to do to be called a midwife and I told him put up a sign on the house. And we could charge people for that? But what about licensing? Nope, I told him. That stuff isn’t important to the people who push for CPMs in Oregon. I showed him the Oregon homebirth death rates and then I showed him the two midwives we could offer “privileges” to at our “birth center” These are the two CPMs in town http://oregonmidwifeinfo.com/brenda-holcombe/ This one still calls herself a midwife and CPM in La Grande (she has a ND practice there)

    http://oregonmidwifeinfo.com/sherry-dress/ This is the other one, she delivered a footing breech at home (according to one of her fans, overheard while I was at Starbucks)

    My husband now thinks it would be safer to go with Karen’s idea of offering a service where we park an RV in the hospital parking lot and offer a cushy pre-admission lounge type of thing for woman before they can be admitted to the hospital.

    • Karen in SC

      Yeah, that idea is golden. You can cover the NW and I’ll take the SE.

      • Bombshellrisa

        Just make sure you offer hair braiding-I guess it’s a traditional way of soothing mothers before birth (I heard that, but I have never been to Indonesia where that is supposed to be the tradition so I couldn’t speak to the truthfulness of it).

  • R T

    Another reason people are drawn to conspiracy theories is because conspiracies and coverups do occur! They occur in all different types of businesses and institutions!

  • CanDoc

    Thank you. Keep the heat on. People need to know about this.
    And again, as always, thank you for shining a bright light on an issue of such critical importance.

  • Dr Kitty

    OT, College of Psychiatry in Ireland has quite properly come out against the idea of having mandatory 12 person panels(!!) to judge whether a suicidal pregnant woman would merit a legal abortion in Ireland.

    Anthony McCarthy, the president of the CPI is a perinatal psychiatrist, and he has some very sensible things to say.

    http://www.irishtimes.com/news/health/suicidal-women-will-still-go-abroad-for-abortions-says-leading-psychiatrist-1.1369112

    http://www.bbc.co.uk/news/world-europe-22285303

    http://castroller.com/podcasts/RtNews/3525484

    • Dr Kitty

      Speaking of conspiracy theories…it is almost as if the Powers That Be want to make the process so onerous that no woman would actually put herself through it…

      But that is, of course, just crazy talk.
      No one could possibly want to be seen to fulfill their legal obligations under European Law, while insuring that the status quo doesn’t actually change and that women are harmed in the process.

  • theadequatemother

    I was on a plane flight with my toddler recently and we watch the life of pi (no audio). He enjoyed the animals, I enjoyed distracting him for 10 minutes even through the “no tv before two” recommendation means I am rotting his brain. Anyway, I was reminded at the end of the book when Pi says something to the effect of te truth first matter. What matters is what is a better story.

    There is a certain type of person that thinks why the natural birth movement comes out with is a nicer story. Me? I honestly think that what obstetrics andabesthesia have been able to do to improve both the experience and outcomes of pregnancy to be the better story complete with drama pathos and miracles and great characters.

    • fiftyfifty1

      “complete with drama pathos and miracles and great characters.”

      The characters in particular! Sweet Oil of Vitriol but there are good characters!

      • Eddie

        Are you sure it’s not Castrol oil? Bofa, where are you?

        • The Bofa on the Sofa

          Changing the oil in my car. 30W Vitriol

  • But don’t you know birth is not about science, it’s political and as such a conspiracy theory is far more appropriate than facts. Facts mean there’s a right and a wrong and leave so little to faith – is it not better to believe that you are right than to know, for certain, that you are wrong? What’s a few dead babies in the interest of maintaining a belief system?

  • mollyb

    I’ve always felt that the true allure of conspiracy theories is that they give marginalized people (or believe who believe they have been marginalized) a chance to feel smarter, more educated, more savvy than the rest of the ‘sheeple’ out there. The rest of us just swallow whatever BS the voice of authority instructs us to, but not the conspiracy theorist. They alone have the courage and intelligence to look deeper. To me, that’s also why these beliefs are so hard to let go of. It’s hard enough for anyone to admit “I was wrong” but for a conspiracy theorist, it goes beyond that. It’s not just “I was wrong” but also “I’m not as smart/special/savvy as I thought I was.”

    • Sue

      I agree, mollyb. Similar influences seem to operate for the anti-vaxers and other anti-science people. And you need an huge number of people to be in on the vaccination conspiracy…

  • Elle

    We would all trust birth like our ancestors did if it weren’t for the chemtrails, dontcha know. Or maybe the fluoride…

  • NursingStudent

    Just that regardless of the side they are on, people who are at opposing extremes of an issue hold tight to their position because they believe they are right. I don’t disagree that it is unacceptable to Oregon midwifery organizations to stay quiet when this kind of data comes out–they absolutely owe birthing mothers a response. I just find a lot of your posts to be about tearing down midwifery instead of giving constructive solutions to the maternity care system as a whole. Clearly you have a sharp intellect, in my honest opinion, you could contribute a lot by using it to address some of the larger maternity care issues. Some of the big stats (ie. 33% C-section rate, US maternal mortality rate, high percentage having feelings about lack of control in hospital setting) lead mothers to make alternative choices, some of which are dangerous. How can we give them more options, improve maternity as a whole, etc.?

    • Amy Tuteur, MD

      Conspiracy theories have nothing to do with holding tight to your position. You can hold tight to a position with facts; there’s no need to resort to conspiracies. You are trying to create a false equivalency that simply doesn’t exist.

      Homebirth midwifery is based in large part on conspiracy theories. Modern obstetrics is based on scientific evidence. If you believe otherwise, please present evidence of conspiracy theories in modern obstetrics.

      • Sue

        Amy is right – a conspiracy theory is not just about believing you are right – it’s about theorising that other people are colluding against you, intentionally and dishonestly.

        For this to work for anti-vaxxers, the conspiracy would have to involve just about every immunologist, vaccine researcher, GP, pediatrician, early childhood nurse, NICU nurse and NICU physician – all deceiving you and pretending that they want to help children when they really want to harm them.

        • Eddie

          Isn’t it funny when you see people who cling to an orthodoxy because they simply know they are right (e.g., NCB) assume that that is how their opposition operates as well? Anti-science folks routinely accuse science of being something you have to have “faith” to believe in, for example, in evolution.

        • KarenJJ

          That’s why I wonder how many immunologists anti-vaxxers have met. I’ve now encountered a good half a dozen or more as a patient and they have been very knowledgable, interested in the immune system issue we have and in particular our response to vaccines and adverse reactions. Some of them have worked in vaccine research too. They’re been hard working, intelligent and very caring people who have gone above and beyond for my family. The chance that they are all so naive someone is pulling wool over their eyes or so duplicitous is just so miniscule it is laughable.

          • The Bofa on the Sofa

            That’s why I wonder how many immunologists anti-vaxxers have met.

            Not to come off as dismissive or anything Karen, but…come on! You can’t be serious. That has to be a rhetorical question.

    • Eddie

      The important distinction here is — are those on opposite sides of the issue all willing to pay attention to scientific evidence. If multiple strong, well-done studies came out and showed that home birth under a specific set of circumstances was exactly as safe as a hospital birth, you would see people here change their minds and support that. Even with the stats showing a general 3x higher risk of fetal death at home birth, quite a few people here support home birth as an option as long as the attendants are properly educated (e.g., CNM) and insured and as long as the parents have actual informed consent rather than being fed misinformation.

      The specific stats you mention have been debunked and/or discussed in this forum before. The reasons for the US C-Section rate are many and that is not a short conversation. The reasons for the high US maternal mortality rate are also many and complicated. Part of the problem is less access to medical insurance for large parts of the population. If you assert that the entire difference is due to failures of the medical system, then you are wrong. Of course, there are ways in which the US medical system can improve, and there are plenty of people looking at that. Not every blog has to address every possible issue.

      • Accepting scientific evidence as fact does not make one dogmatic.

        • Eddie

          That was my point. I was just more long-winded about it.

    • Renee Martin

      Tearing down MWery? Come on now.
      Dr Amy supports MWs, CNM, not fake ones that made their credential up.

      I Love how NCBers and HB MW supporters always try to put the responsibility elsewhere, or change the subject, instead of trying to do something about the deaths. It is NOT the OB/CNM/hospitals job to fix these issues, even if they were caused by fewer “alternative” options- which is in NO WAY true in Oregon, as the most progressive hospitals are here (free doulas! Jacuzzis in every room, OHP even covers acupuncture and BCs!)

      Nope, this is squarely on HB MWs.

      Modern maternity care IS improving all the time, and the Cs rate is irrelevant to this conversation, unless you want to point out that the HB MWs have low Cs rates but a HIGH death rate…..

    • Alenushka

      Have you thought of population facts that have nothing to do with OBs that make our numbers different? We have older, more overweight , sicker mothers to begin with and we have access to life saving technology C-section rats are very low in Afghanistan but is it a good thing?

      • Lori

        I totally realize it was a typo, but when I read “C-section rats” it totally reminded me of that one day where somehow in the comments people started talking about rodent C sections and then someone linked to a YouTube video of one and I watched, and then, when it was all said and done was like, “and THIS is why I love the internet.” Okay, end of nostalgia, carry on!

        • The Bofa on the Sofa

          For more fun with animals, look up fish surgery. It’s a really amazing concept.

          • Lori

            Wow, I like how they pretty much intubate them with a garden hose!

        • fiftyfifty1

          I used to do rat c-sections.

        • Susan

          And after the C/S you can milk them! ( more nostalgia) though it was mouse milk, rat milk sounds even more revolting.

          • Lori

            Hey now, keep your judgments to yourself. My family drinks only local-source, raw, unpasteurized rat milk!

    • Clearly, then, you don’t read many of her posts. Dr. Amy gives pretty clear and concise “what they could have done better” advice on everything from interpreting statistical data correctly to why pitocin prevents PPH.

    • T.

      Can somebody please tell me why a high CS rate should be a bad thing?

      Pregnancy and childbirth wreak havoc on your body. Some people are lucky. Some ends up with horrendous problems. If somebody has learnt the pro and cons of a vaginal birth VS a CS birth, and decided that she would prefer a CS, so what?

      I do not plan to have children at all, but would I be a different person, I would completely choose a CS. So? Even if the CS rate is 90%, but it is because women want it, where is the problem?

      People are weird.

      • The Bofa on the Sofa

        Can somebody please tell me why a high CS rate should be a bad thing?

        Well, CSs are bad, see, because if you have a CS, it means you have failed, because women’s bodies were meant to give birth vaginally. Therefore, if you have a high CS rate, it means that you think that lots of women are failures, and strong women will not accept being labelled a failure, and our society should not accept a practice that treats a large fraction of women as failures. OTOH, if women can avoid a CS, that means they have not failed, which means they are better than all those sad, poor women who can’t even fulfill the purpose that they were designed for.

        (for non-regulars, this is satire)

      • theNormalDistribution

        We don’t have kids yet, but my spouse and I have already agreed to go the planned c-section route when we do. When you actually compare the risks and potential complications of each, to me, it seems like an easy choice. I’m really surprised that there are not more women requesting a section.

        • I hope your choice is supported when the time comes, as finding a doctor and hospital willing to accomodate can sometimes be challenging. This may be particularly true when there are incentives to try and lower the rate of cesareans.

          • theNormalDistribution

            For sure! My spouse’s cousin is an OB/Gyn and we’re hoping she will be an asset, but we’ll burn that bridge when we get to it.

        • Had a c-section

          Just bear in mind that a c-section recovery can be very hard (which does not feel good when you have a newborn to take care of) and that if you are planning more than 2 children, the risks of repeat c-sections is higher than repeat vaginal births

          • Awesomemom

            It can be very hard but then it can also be pretty easy. Recovery from a vaginal birth can be very hard or it can also be easier.

          • araikwao

            Ohhhh yes. Every MW I have ever met says how much quicker it is to recover from a vaginal delivery, and that was not my experience at all. I’ve had one of each, and I think the duration of severe pain was longer after the vaginal delivery. For me, both took 4 weeks to feel somewhat recovered. Either way, you have restrictions on lifting and activity for 6 weeks afterwards.

          • AmyM

            I didn’t find that I had a lot of pain during my recovery from vaginal delivery, but since I had PPH, I was exhausted all the time, and got winded from walking around Target. Also, the 2mos of bedrest made it so I was really out of shape. It was very unpleasant,compounding the typical exhaustion that new parents get. Looking back, if I had to do it again, I’d probably have a Csection on arrival at the hospital (OB offered)—had prom anyway, so I wasn’t uncomfortable and tired out from contractions yet.

          • theNormalDistribution

            No kidding?! Gee, I had no idea. We actually didn’t do any research before we made our decision, so your comment is really helpful.

          • had a c-section

            I didn’t mean that! It just that when you read up about c-sections you run across something like “recovery after c-sections may take longer but after 6 weeks you should be feeling better. ”

            My reality was quite a bit harsher- waking up in middle of the night for my son and being in too much pain (since the painkillers wore off) to roll over, sit up and never mind lift him. I felt terrible not to be able to take care of him! Two months later, I was driving on cruise control whenever possible to avoid stepping on the petal for too long. My c-section was supposedly uncomplicated, not like someone I know who had her bladder cut open. It was after a trial of labor, so I guess that was some of it, but I don’t believe that was all of it.

            With my VB with my daughter, yes I couldn’t sit for two weeks, yes the stiches itched like crazy, my insides felt a bit funny, but laughing didn’t hurt!

            Many (most) people who I speak to who who had c’s have had similar experiences,

            Birth is unpredictable and the stakes are high, but with modern medicine your chances of a safe VB with positive outcome are high. (pleasant can’t be guaranteed on either side of the coin)

          • VeritasLiberat

            Sounds like you had a really bad experience. My own c-section experiences were not nearly that bad (worst part of the entire experience was hearing the NCB woman down the hall screaming at 4 am .. I was actually kind of expecting her to die after a while, the screaming was so agonized). After the second c-section, I was carrying the two-year-old upstairs after two weeks (you’re not supposed to, but she was unwilling to transport herself up). I took percocet for four days in the hospital, then stopped.
            One of my relatives had such a bad experience with vaginal birth that she refuses to have more kids. I think she had a 3rd degree tear.

          • FormerPhysicist

            My experience was totally different.

            “Birth is unpredictable and the stakes are high, but with modern medicine your chances of a safe VB with positive outcome are high. (pleasant can’t be guaranteed on either side of the coin)”

            Can just as easily say:

            Birth is unpredictable and the stakes are high, but with modern medicine your chances of a safe C/S with positive outcome are high. (pleasant can’t be guaranteed on either side of the coin)

          • LukesCook

            Your experience was atypical and I don’t believe that “most” women who’ve had c-sections report similar experiences. Certainly not those that I know. I was able to nurse pretty much immediately, roll over and sit within an hour or two (beats your vag experience), walk soon after, lift my son and walk to the nursery carrying him or pushing him in his crib within 24 hours, and go home and do pretty much everything within 3 days. After my first I went home the following day and pretty much did the same things as usual, barring the gym routine. I was able to drive without discomfort after a week, both times. Most of the women _I_ know behave similarly after their c-sections. Clearly there’s some self-selection going on (and it isn’t me who’s seeking out friends who like c-sections).

          • fiftyfifty1

            LukesCook, my c-section experience was like yours. Sore yes, but never in actual pain (like I was after my vaginal birth). Rolling and walking and carrying baby by the next day without problem.
            Having both a number of friends and a number of patients who have had c-sections, I would say that my experience was a bit easier than average, but not by a lot. However I do have one friend who had 2 very different c-section experiences. The first was after a long labor, but despite that she had an easy recovery and was back to running within 2 weeks (she is an avid runner). But then she went on to have a much more painful recovery for her second section, even though it was scheduled so no labor. She was on the percocet and ibuprofen for a full week and did not run a step until week 4. So results do vary. I wish I could clone easy deliveries and give them to every woman and baby!

          • Durango

            My recoveries from Csection and VBAC were pretty similar. I had a largish PPH with the vbac that left me incredibly drained and bed bound for a couple of days. And it hurt to sit! Nursing was difficult with both children.

          • Box of Salt

            Also bear in mind that recovery from a c-section after a trial of labor is far different from a scheduled pre-labor c-section. I’ve done both, and in my opinion recovering from the first one was more about recovering from the 24 hrs of nonproductive labor than recovering from the surgery (which, the second and scheduled time around, was easier to deal with than any other surgeries I’ve had).

          • Captain obvious

            Is recovering from a third or fourth degree laceration much better. Risks for anal fissures and fistulas? Poor sphincter control with flatus or stool? Cystoceles and rectoceles with or without stress urinary incontinence?

        • auntbea

          Because if you request one, people will take it upon themselves to censure you for that choice?

        • jenel

          Recovery from a c-section is difficult. Why any woman would choose that over a vaginal delivery is beyond me (have experienced both). And scarring, and numbness at scar site, and holy cow I could go on and on. Also, vaginal delivery is best for baby’s immune system. Have you come across that in your research?

          • Eddie

            I know that others will reply, but don’t you understand that your experience is not universal? If it was, women would make different choices.

            Also, despite speculation, I haven’t seen any reference to any serious research that suggests that baby’s immune system is improved — or even affected in any meaningful way — by vaginal delivery. Do you have any references? I strongly doubt that any such research exists in peer-reviewed journals.

          • Becky05

            ” I strongly doubt that any such research exists in peer-reviewed journals.”

            You’d be very wrong. There is in fact a great deal of ongoing research into the association between cesarean deliveries and immune system abnormalities.
            http://www.ajog.org/article/S0002-9378(12)00857-5/abstract

          • theNormalDistribution

            “However, it is still unknown whether CS causes a long-term effect on the immune system of the offspring that contributes to compromised immune health.”

            Indeed.

          • Eddie

            OK, I accept that I was uninformed. I’ll be curious to see if this correlation holds up to further research, and I’m curious how significant the effect is.

          • theNormalDistribution

            Please read the paper. The author’s conclusions aren’t particularly well supported by the data they used in their meta-analysis. I’ve been looking through the papers they cited, and I just don’t understand how they figure their conclusions are warranted. At least half of the work they cited found no evidence of the correlations they were looking for, and the assumptions we could make from those that do seem to be stretched as far as they could possibly manage.

            I would need to do hours of review before I would feel comfortable accepting the conclusions of this analysis. Notwithstanding the fact that the whole mess of papers is confounded as hell and even if the their conclusions were completely warranted, it would not show what Becky would like to think it shows.

            On a slightly unrelated note, I find it interesting that in their introduction, the authors note that “The World Health Organization recommends that in up to 15% of deliveries, CS may be indicated” and resolve that the national c-section rates exceeding 15% indicate that there are a high number of c-sections being performed without medical indication. hmmmmmmmmmmmmm….

          • Eddie

            Doing some Googling, I found this Scientific American blog entry:

            http://blogs.scientificamerican.com/guest-blog/2012/03/28/cesarean-sections-in-the-u-s-the-trouble-with-assembling-evidence-from-data/

            While I saw a few obvious errors of fact in there (such as the assertion that past average life expectancy of approx 30 meant that women didn’t often live past 30, which due to infant mortality is just wrong), it seems like a reasonably accurate review of the facts. And it explains the many confounding factors that make interpretation of the facts difficult. Note that the SciAm article references the same WHO 15%, which is addressed in comments to the blog entry. It appears that WHO still says 15% is the ceiling above which no country should go, but now admits they have no basis for that recommendation.

            One link from the Scientific American blog was a 2008 study: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2475575/ Toward the end, that paper references the hygiene hypothesis. They give three references that support it and three references that do not support it.

          • Box of Salt

            jenel, did you read any of the other replies to this comment?

            “vaginal delivery is best for baby’s immune system. Have you come across that in your research?” Could you specify what exactly research you came across that led you to make that statement? I mean actual research papers you’ve read.

            Finally, how would vaginal delivery help a baby’s immune system if the baby does not survive the delivery?

          • Box of Salt

            ^argh. please read “exactly what research” for what’s typed above. Why can’t we have a preview function?

          • Becky05

            There’s actually a decent amount of research suggesting that mode of delivery does have an impact on the immune system. Cesarean delivery is associated with an increase in the risk of allergies, asthma, type 1 diabetes, celiac, Crohn’s disease, etc. It is speculated that this is due to differences in gut microbiota. But yes, there is an association that has repeatedly be confirmed.

            http://www.ajog.org/article/S0002-9378(12)00857-5/abstract

          • Amy Tuteur, MD

            Actually, there isn’t. There is some research suggesting a correlation and other research which reaches the opposite conclusion. There is NO research that shows causation.

          • Becky05

            I didn’t say there was proved causation, I said that there was a repeatedly confirmed association. There’s a lot of research being done in this area.

          • Amy Tuteur, MD

            And it has failed to be confirmed in an equal amount of studies.

            Not to mention that many studies that purport to demonstrate an association don’t control for confounders.

          • theNormalDistribution

            I like how some of them conclude that there is an association between c-sections and asthma while brushing off the fact that it also correlated with low birth weight.

          • You mean it is one of the many conditions associated with preterm and low birth weight babies?

            I swear at times, NCBers appear to believe that all babies are born full term and healthy, and that any ailment can be attributed to either surgical birth or formula feeding.

          • Eddie

            Are there known correlations (whether cause/effect or not) between premature birth and immune issues of any type?

          • Becky05

            Most of the recent research I’m finding does take into account confounders, but I actually haven’t found a lot contradicting the general idea. Do you have links?

            Yes, this is still speculative, I never said it wasn’t. It isn’t a good reason to avoid an indicated cesarean. It probably isn’t strong enough to influence the choice of an elective delivery. However, too many here are dismissing and mocking the notion that mode of delivery might influence immune system function, without even looking to see if there is or is not evidence, and what kind of evidence there is. It is assumed to be woo and absurd from the beginning, when it is actually an active area of research.

          • theNormalDistribution

            Most of the recent research I’m finding does take into account confounders.

            Then it should be pretty easy to cite some them for us so we can evaluate them ourselves.

          • Becky05

            I posted a review because I assumed that people would read it and follow up by reading the cited studies.

          • theNormalDistribution

            I have been reading them. If you could point out which of the cited studies you think have adequately addressed confounders, that would be helpful. You must be familiar with them, having read enough to say that most of them do.

          • Eddie

            I was clearly wrong when I said that I doubted peer-reviewed studies existed. But you have to admit that this sounds woo-y. I’ve read (in Scientific American I believe) recent research suggesting that H Pylori helps regulate the human immune system (for its own gain, of course, but ours too by suppressing auto-immune diseases). Speculative. But *if* it in fact turns out that vaginal flora help baby do the same, that this is real, then the cure for this C-Section problem is simple.

            One thing about science. I trust the truth will come out in the end, and whatever the truth is — no matter how silly or funny it seems to us — will become mainstream as soon as it is reasonably proven.

          • Eddie

            About H. Pylori, I found the Scientific American article: http://www.scientificamerican.com/article.cfm?id=human-microbiome-change&sc=WR_20091229

            Googling also found me one serious reference, where I can only moderately understand beyond the abstract:

            http://www.biosignaling.com/content/9/1/25

            Am I correct to guess that the proposed mechanism by which vaginal delivery or lack thereof can affect later immune function is similar to what is being discussed about H. Pylori? Or is it even more speculative with no proposed mechanism, just an observed association in some studies?

          • DiomedesV

            I am aware of the connection, but am aware of no evidence that it makes any short-term or long-term clinically significant difference. Moreover, the studies are almost always very small.

            Much of this is based on sequencing flora, which in itself comes with major methodological issues. In practice, you get only a few species. In terms of the significance, babies do not acquire their flora from their mother only. They acquire it from their environment, which includes parents, siblings, caretakers, friends, and the broader environment of acquaintances, etc. It is difficult to model “transmission” in this context, since all the people that a child comes with also come into contact with each other. However, attempts to model this in the simplest scenarios indicate that within a threshold range of vertical and horizontal “transmission” the endpoint over time is likely to be very similar, and that threshold is very broad. (In this latter case, I am referring to results that I heard at a talk, and which have not been published yet).

            Again, the evidence that it is meaningful is largely based on association studies, which in themselves are dogged by confounders which include the usual genetic and environment confounders, but also the interaction between them, where the interaction term itself is 1) dependent upon adequately quantifying the environment, 2) very, very important. You can’t adequately measure it and you can’t ignore it. Call me cynical, but given what seems to be the typical level of statistical insight regularly seen in medical/association studies, I have no confidence in the current level of “understanding” on this complex issue.

            That is not to say that flora is not important. What I am specifically questioning here is the importance of flora acquired at birth.

            Finally, as I stated in another thread, the remedy to this is probably simple.

          • Box of Salt

            Becky, is any of the animal research free to read on line? If so, could you post some links as I’d like to take a look (although I might not have time to do it in detail for a few days).

          • Becky05

            I’ll see if I can find any free full texts online.

          • Becky05

            I had a hard time finding free full texts. Here’s a couple things, though:

            http://naldc.nal.usda.gov/download/17256/PDF
            Not immune function, but interesting: http://212.250.180.69/cs/118/0047/cs1180047.htm

          • The Bofa on the Sofa

            I didn’t say there was proved causation, I said that there was a repeatedly confirmed association.

            Goodness, Becky, we can read. That is not all you said. You said

            There’s actually a decent amount of research suggesting that mode of delivery does have an impact on the immune system.

            “…does have an impact on the immune section” is NOT saying it is merely associated with.

            You asserted causation. You can admit your wrong if you want, but insult us by denying that’s what you said.

          • Becky05

            Because “suggesting” is such a strong word.

          • LukesCook

            If you weren’t asserting causation why would you even have posted? Or gone on to mention the animal research also “suggesting” causation?

          • The Bofa on the Sofa

            Moreover, she was responding to the question of “is there any reason to think VB is best for the baby’s immune system.”

            Oh, but she wasn’t claiming there was any causation….

          • Becky05

            There’s a difference between asserting that causation has been proved and saying that there there’s information suggesting that there’s a causal link.

          • Box of Salt

            Thanks, Becky, although it is behind a paywall. I’d really like to read the full text, and see what the actual numbers are for each condition, and how all the confounders are handled.

            I will note this line from the abstract:
            “However, it is still unknown whether CS causes a long-term effect on the immune system of the offspring that contributes to compromised immune health.”

            Even if c-section truly do compromise immune health, there’s no point in saving the immune system if you lose the baby.

          • Becky05

            “Even if c-section truly do compromise immune health, there’s no point in saving the immune system if you lose the baby.”

            I agree, absolutely!

          • LukesCook

            Besides which, isn’t this the “maternal flora” thing that we’ve discussed previously, that could on the face of it be solved by administering a small dose of maternal vag juice/poo/hygienic pharmaceutical substitute?

          • Becky05

            Probably. There’s some speculation some of the differences in cesarean born babies is related to stress hormones during labor, too.

          • theNormalDistribution

            Have you actually read this paper?

          • jenel

            Box of Salt. The issue was not at all whether a vaginal delivery would serve a dead baby’s immune system. Of course a baby in distress should be delivered as quickly a posssible-immune system health taking a distant second place.The original comment which I replied to was how the author had conducted research and decided that a C- section was for her. As I experienced both types of deliveries, I am surprised (yup) that someone would reach that decision ( to have a c-section over a possible and likely uncomplicted vaginal delivery). I believe I am not alone. However, I really am not concerned with the decisions that other women come to when having babies, but women should have all the information, and if child’s immune system might be compromised by a c-section delivery, then that might be a legit concern as it was for me. I believe the research has been done already as another poster has pointed out but I understand that this doesn’t gel with elective c-sections

          • It is obviously possible to have an uncomplicated vaginal delivery, but how likely is it that it will be 100% uncomplicated? That is a genuine question because I don’t know the answer.

            I am more than a bit muddled on this. Babies are delightful, but neither method of getting them seems that appealing to me, and I don’t think I am alone in that. The possible complications both to infant and mother of vaginal birth seem to me to be played down, while those of CS are constantly highlighted. What is this about exactly? It somehow seems to have more to do with ideology and attitudes to women than science. After generations of trying to combat the depredations of natural in the interests of the humane, why do we now arrive at the conclusion that pain is good, interventions are bad?

          • I’d have to dredge through studies, but while the odds are on your side to have an uncomplicated pregnancy and/or delivery – there’s quite a good chance you won’t have either. The incidence of the most common problems is quite high – GD, pre-e, PIH, HE will affect a good chunk of women. Miscarriage will affect another percentage. Delivery – SD, GBS, breech and other unfavorable presentations, prolonged labors and/or failure to progress, CPD, fetal distress. Third stage – retained placenta, placenta accreta (and worse), PPH.

            And those are for healthy women with no pre-existing conditions.

          • I was thinking also of those other complications that nobody much wants to talk about that can affect women post birth and pregnancy. Someone mentioned piles, sexual function, continence issues, the psychological effects of major and minor traumas. An elective CS may be disappointing, but in my book it beats a traumatic labour followed by a panicked CS where you run the risk of both sets of complications.

          • Eddie

            if child’s immune system might be compromised by a c-section delivery

            “Compromised” is a strong word. As has been described by others, this is a speculative area of research. Medicine has had many of these over the years, including, for example, the idea that vaccines cause autism (no proven link after how many studies now?), the idea that cell phones cause brain cancer (the same), the idea that high tension power lines cause cancer (the same), the idea that stomach ulcers are caused by bacteria (proven), the hygiene hypothesis of auto-immune disease (that Western culture’s reduced exposure to disease and parasites is indirectly responsible for the increased incidence of auto-immune disease — still an unproven theory so far as I know), and more. It’s good to be aware of these speculative theories if you are capable of putting them into the appropriate context, but it would be unfortunate to heed each such theory as if it were true.

            Again, don’t assume that your C-Section experience is representative of what everyone or even most will experience.

          • moto_librarian

            ” to have a c-section over a possible and likely uncomplicted vaginal delivery”

            But that’s the rub, right? You can’t predict with certainty that you are going to have an uncomplicated vaginal delivery. There was no reason to believe that mine was going to cause so many problems, but it did. I will never judge a woman for wanting to have a MRCS. I had plenty of problems related to vaginal delivery, and when I consider what has happened to other women, I realize that I got off relatively lucky.

          • LukesCook

            If it were a matter of being able to choose between a c-section and an uncomplicated vaginal birth, then the choice would be clearer. Choosing vaginal birth requires you to accept a bundle of risks and outcomes, including an uncomplicated birth but also including having to recover from a difficult labour AND an emergency c-section. Not to mention the issues mentioned by Captain Obvious. These risks aren’t remote or rare, they’re considerable. And the of course there’s the possibility of death or brain damage for the baby, which, while rare in the proper setting, may be totally unacceptable for some parents.

          • Dr Kitty

            C’mon, it isn’t that bad for everyone.

            No labour pains and an intact pelvic floor was totally worth the small scar (seen but nobody but me, my husband and my gynaecologist) and the 3 days of painkillers I needed.

            So a tiny patch of skin on my lower abdomen is a little numb. So what? It isn’t like I need to be able to feel it for any reason, and I’d rather be numb THERE than my vulva, thanks.

            Jenel- your preference for VB does not mean that my preference for CS is wrong. Likewise, just because you had a tougher recover after your CS, doesn’t mean that everyone will- ask women who opt for planned CS after experiencing 3rd and 4th degree tears which recovery they prefer.

          • LukesCook

            “So a tiny patch of skin on my lower abdomen is a little numb.”

            That actually came in handy when we did IVF for my second and I had to inject myself in that area daily for several weeks.

          • KarenJJ

            Same! It’s been a very useful side effect from the c-section.

          • Squillo

            The rectrospectoscope suggests that a pre-labor c/s would have resulted in an easier recovery for me (bad pain for two weeks or so, plus about a year when I couldn’t sit properly thanks to a bruised or broken tailbone) and (more importantly ) a few more functioning brain cells for my son. Plus, I probably wouldn’t have half my vaginal vault hanging out like some kind of genital remora.

          • fiftyfifty1

            Probably a broken tailbone based on how long it hurt. The rule of thumb for tailbones is: If it hurts 12 weeks, it was bruised. If it hurts 12 months it was broken.

          • Squillo

            Could be, since it took so long. Fortunately, it doesn’t bother me now; I’ve heard of others that have lifelong problems. Yet another risk of VB no one ever mentions.

          • Eddie

            This is also a risk of flying a kite. (Technically, of bouncing off a decorative boulder of exactly the wrong height.) My tailbone hurt unbearably for a week after my injury, badly for a few weeks (sweet, sweet Vicodin and Flexeril), and I still felt it a year later although I wouldn’t call it pain. Just awareness, twinges. What can I say? I was young and dumb.

            I cannot imagine how delivery can bruise, let alone break, a tailbone. Do I want to know?

          • Squillo

            If you had had a kite doula, it doubtless wouldn’t have happened.

            And no, you really don’t want to know. (Something about force and resistance…)

          • Eddie

            I’m still laughing at the concept of a kite doula.

          • The Bofa on the Sofa

            No labour pains and an intact pelvic floor was totally worth the small scar (seen but nobody but me, my husband and my gynaecologist

            I have NEVER seen my wife’s c-section scar. I saw the stitched up incision in the hospital when the doctor pulled the bandage back, but her pubic hair grew back over it and it isn’t noticeable. At all. And make no mistake, it’s not because I haven’t looked down there, even close up.

          • LukesCook

            Not everyone cultivates pubic hair, as you’d know if you’d done your research on YouTube.

          • The Bofa on the Sofa

            YouTube, huh? I need to check that out…

          • Eddie

            As Homer said, “They have the Internet on computers, now?”

            The comment from yesterday (or day before?) on rat C-Sections on YouTube had me there. Found one. A couple clicks away you see a NCB frank breech delivered at home, complete with complaint that the midwife couldn’t be present for fear of losing her license. Yow.

            Maybe not what LukesCook was referring to though.

          • The Bofa on the Sofa

            OK, can we get this discussion back to looking for pubic hair on youtube? That was a lot more appealing…

          • Eddie

            In the interest of “research” that will be difficult to explain to my wife (not that she would care), I went to youtube and searched for pubic hair. To my surprise, the first two links were to videos by Target (a US big box store). I think they need to rethink their ad campaign. The third video was by DrProdigious and was frankly frightening. The birth videos were actually more appealing. Like so many other things, it seems to be easier to find when you don’t look for it directly. I hand the research baton over to you.

          • The Bofa on the Sofa

            The key to an effective search is to use the proper search parameters.

          • Eddie

            I learned that lesson in the mid 90s when searching for “SCSI termination master slave” and most of the search results were VERY clearly unrelated to computer hard disks. I can see that Google today is much, much better at figuring out context than Yahoo was back then.

            But now this discussion is even farther from the direction LukesCook sent it.

          • LukesCook

            Amazing how many “natural mamas” get a full Brazilian before filming their home birth.

          • auntbea

            Totally natural as long as the wax comes from an organic hive.

          • fiftyfifty1

            And typically the numbness goes away. The nerves heal slowly, but they do heal. For me, the numbness was sort of annoying for the first 6 weeks. I had to wear “granny undies” that came up almost to my belly button because bikini undies rubbed on the numb skin and gave a creepy feeling. After that it was no longer a problem, but still sensation wasn’t totally normal again until year 4.

          • moto_librarian

            Yeah, my recovery from my “natural” vaginal birth was such a picnic, unless you count the 6+ weeks of exhaustion from anemia due to blood loss from a pph, the pain of a healing cervical laceration (which required oxycodone for a week to keep me functional), plus the time in physiotherapy for continence issues.

          • Bombshellrisa

            If she was saying “My goal is a vaginal delivery!!!”, would you ask her if she had done her research about the possible risks or the recovery time? Your recovery experience sounds like one that you tolerated poorly. This doesn’t mean that she will have any of those symptoms or will react the same way.

      • Captain Obvious

        Found this legal tidbit in a CME program….

        The issue of offering elective primary cesareans is fueling some new types of malpractice cases against obstetricians. In the case shown here, one of the first of this type reported, the mother sued after delivery of a baby with Erb’s palsy. The issue brought to the court was whether the patient was informed that she could have an elective primary cesarean which would reduce the risk of her infant having an Erb’s palsy. The patient said, of course in retrospect, that if she had been informed that vaginal delivery had a risk of shoulder dystocia which increased the risk of Erb’s palsy, she would have chosen the elective cesarean. The court believed that this was a piece of information that a reasonable person would need to know to make a decision for vaginal versus cesarean delivery.
        The potential for FHR monitoring issues to come up in a similar complaint exists. If, for example, a laboring patient has a Category II or Category III FHR tracing then delivers a child with a bad outcome, she could sue and attempt to claim that if she had been informed that labor carries the risk of intrapartum hypoxia, which could increase the risk of a child having some deficit, she would have chosen to have an elective primary cesarean. Central to the decision in the case described was the assumption that informed consent is obtained for vaginal delivery that includes the option for an elective cesarean. While it is not considered the standard of care to offer every pregnant patient a cesarean without a medical indication at this time, there may be experts who can convince a jury that it is, or should have been in retrospect in a given case.

        • Lisa from NY

          Did the doctor note weight gain in patient?

        • theNormalDistribution

          That is really interesting.

      • Becky05

        “Can somebody please tell me why a high CS rate should be a bad thing?”

        Increased maternal mortality and severe morbidity, for starters?

        • Eddie

          Is the increased maternal mortality caused by the high C-Section rate, or just associated with it and caused by the same factors, such as obesity, GD, high blood pressure, multiples, maternal age, and so on?

          I’ve read that if you adjust the US C-Section rate for these kinds of factors when compared to other industrialized countries, our section rate is far closer to other countries than it appears. So how much of the increased mortality and morbidity is actually caused by the sections themselves, and how much is caused by the US having higher obesity, higher multiples, older mothers, and so on?

          • Becky05

            It is probably a mixture of both. As a surgery cesarean has some inherent risks, and also increases risks in any subsequent pregnancy (especially after several cesareans), but of course women who are sick are more likely to be delivered by cesarean. The increased risk is a consistent finding, though the difference in risk of mortality has declined significantly in recent years.

            Here’s one study: http://www.ecmaj.ca/content/176/4/455.full

            I’m trying to find a more recent review.

          • Eddie

            Thanks for the link. This study shows no significant increased mortality, but only looked at first C-Sections. The study showed a 3x increase in morbidity, from 9/1000 to 27/1000. As far as the mother’s health is concerned, it is a reasonable assumption that breech presentation is a good proxy for elective C-Section?

          • LukesCook

            Going by the example Dr Kitty gives of the cost differences between c-section and vaginal birth, the fact that the costs of vaginal birth so dramatically approach those of c-sections (difference of £500 closes to £73) after factoring in the cost of future complications (but not those relating to the baby), I think that the case for c-sections being the cause of the higher maternal morbidity looks weaker. Or there are complications of vaginal birth not being counted (or treated) at the time, maybe because they’re considered “normal”.

          • fiftyfifty1

            Absolutely! If I had been part of a study, my first vaginal birth would have been counted as a “no complication” birth. I had nothing more than a “skid-mark” for an official tear. What was NOT counted however (because nobody is looking) is the levator ani avulsion and nerve damage I sustained. I have already made up, a few times over, the difference in price between vag birth and c-section with my visits to the fecal incontinence specialist and the pelvic floor therapist. And I still will need surgery for my prolapse.

          • Eddie

            My guess is that to a lot of people, the morbidities from C-Section are more obvious since they were “artificially” introduced and in that sense are more preventable by not doing the thing that caused them. It is certainly not appropriate to say C-Section is “bad” without first balancing it against the morbidities it prevents, as Dr Kitty did.

            Measuring the cost of repair is a proxy for measuring the degree of impairment, the discomfort of an injury. But how many of the injuries of vaginal birth (such as nerve damage) have no effective treatment, and will therefore not be counted in such an accounting? I know women whose hemorrhoids were markedly worse after vaginal birth. While those won’t (normally) kill you, I’ve spoken to some who almost wished it would when a flare-up was at its worst.

        • jenel

          Not to mention the cost.

          • Dr Kitty

            A CS costs the NHS £500 more than a normal birth.
            It costs £73 more if you take into account future surgery for prolapse and incontinence.
            It costs less if you take into account damages from birth injuries.

            Next.

          • jenel

            Dr Kitty. CS is VERY expensive here in the US-several thousand dollars more than a VB. The health care system is a royal mess and getting messier.

          • Eddie

            @jenel, you completely missed Dr Kitty’s point. Yes, the way the US health care system prices things is broken, and it screws the uninsured. That is absolutely true, but irrelevant to the point Dr Kitty is making. To an individual person who has an uncomplicated vaginal delivery with no interventions, yes, it is a lot cheaper than a C-Section.

            However.

            Dr Kitty’s point is that if you look at the costs of handling the complications of vaginal birth, the cost “to the system” of vaginal birth becomes a lot more expensive than it is to that one person who had the uncomplicated birth. As part of the cost of vaginal birth, you have to count the costs of extra care for the babies that are harmed. You have to count the costs of the injuries the mothers receive. It is, of course, fair to also count the costs of the complications of the C-Sections as well.

            An individual who only sees their bill may not care about this analysis if they are one of the lucky ones with no complications. But when looking at the bigger picture, it is absolutely necessary to look at the costs of the complications.

          • The Bofa on the Sofa

            CS is VERY expensive here in the US-several thousand dollars more than a VB.

            If that were true, it would indicate that a VB done here is like, almost free.

            jenel, once again, you are improperly extrapolating from your experience.

          • Eddie

            I’m sure if you compare an uncomplicated vaginal delivery in the US with no epidural to a C-Section, that the price difference can easily be a few thousand dollars. The cost of my wife’s epidural was about $1500. Now, her Ob/Gyn was paid the same regardless, but the hospital charges would be higher for a C-Section and you have to pay not only for the anesthesia, but for the anesthesiologist, plus charges for the operating room usage.

            That said, the price difference out-of-pocket to someone with insurance will be minimal.

            My wife’s last delivery, including prenatal care and the epidural and the hospital stay, cost approximately $30,000 before insurance adjustments. It was about $14,000 after insurance adjustments. Insurance paid about 90% of that, so our out-of-pocket was a little over $1000. I kept track of all of the precise costs in a spreadsheet, which is helpfully on a different computer.

          • VeritasLiberat

            Our out-of pocket was only around 200$, and that was for collecting the umbilcal cord blood / placenta and packaging them fo storage / donation. This is for a c section n with weeklong NICU stay.

    • LukesCook

      In what way does any of that drivel support your contention that “this conspiracy article applies to anti-midwifery zealots?”

      And what’s the big issue with “tearing down midwifery anyway”? Nobody has ever managed to explain the point of it. And your argument suggests that the raison d’être of midwifery is the perceived inadequacies of obstetric care. If this is so, then by your own argument all the little bunnies busily promoting midwifery at the expense of children’s lives should rather be devoting their attention to improving obstetrics. Except they can’t, because they don’t understand it and the so-called problems with it are largely imaginary.

      • The Bofa on the Sofa

        And what’s the big issue with “tearing down midwifery anyway”?

        If anything, isn’t Dr Amy trying to RAISE UP midwifery, by holding them to higher standards?

        • Guestll

          Yes, this!!

          Save your ire for the likes of Cheney and Co.

        • Eddie

          That’s how I see it as well. Are we going to treat midwives like special widdle people who cannot handle criticism, who need us to walk on eggshells before saying anything negative? Are they shamans who cannot be criticized lest the heavens collapse?

          Or are we going to treat them like adults and actually have reasonable expectations of them, just as we already do with doctors and nurses and pilots and lawyers and architects and other professionals? Hell, it seems like even bus drivers hold themselves to a higher standard than some midwives hold themselves to, than many people hold midwives to, and that’s a position that requires far less special training than any other professional I’ve mentioned above. If a bus driver gets into an accident and injures people, there is an investigation. Every time, so far as I can tell. Why is it reasonable to hold midwives to a lower standard?

          I know, many midwives want the authority of a doctor without the responsibility of one. My teens are the same, wanting the freedom of an adult without the responsibility of one. So I give them the respect of actually treating them like adults and expecting responsibility, and ensuring consequences for when that responsibility is lacking. Do they like it? No. But that’s what it means to be an adult. Should I hide that from them? How would that help them in any way?

          • LynnetteHafkenIBCLC

            Like like like!

          • The Bofa on the Sofa

            Or are we going to treat them like adults and actually have reasonable expectations of them, just as we already do with doctors and nurses and pilots and lawyers and architects and other professionals?

            There was a comment in another threading directing to midwives whining about how they are being persecuted, because they are treated like criminals, but doctors are never arrested. Whhhhhhaaaaaaaa! It’s not fair!!!!!!!

            As I responded, ok, let’s treat them like doctors. For example, doctors require a license to practice, so that means that all non-licensed midwives are practicing illegally. They must be stopped.

            Let’s see how long they want to keep being treated like doctors.

            I know, many midwives want the authority of a doctor without the responsibility of one.

            Bingo. Actually, it is not just “many” but “way too many”

          • The Bofa on the Sofa

            So my reply got too long above and was cumbersome, but there is an interesting thought I had. I was about to write that when it comes to practicing medicine, we don’t lower the standards so that unqualified wanna-be doctors can now have the same privilege as legimate MDs, but I realized I was wrong. We do, in fact, do that. We now have cranks like “naturopaths” and chiropractors given actual medical authority.

            And I realize, that is what it is. CPMs are basically be the midwife equivalent of naturopaths and chiropractors.

            In fact, wait for the “not all chiropractors are quacks” response to this comment, which is exactly the same defense of midwives.

          • Eddie

            One of the external threads linked to in recent weeks had British midwives complaining that the cost of medi-mal was beyond their means, and that they needed “cheaper malpractice insurance.” I just cannot get past that. Insurance companies don’t have high rates just because the market allows it. It’s because the costs are genuinely that high. (To think otherwise would be to believe there’s a conspiracy amongst all insurance companies to refuse to compete on price.) Part of being a professional means you don’t ask society to bear your costs. You bear them yourself. If you cannot afford the trust cost of your practice, then maybe it’s not appropriate for the market.

            Yes, “way too many” is the right way to put it.

          • The Bofa on the Sofa

            Then again, there are US Supreme Court Justices who apparently don’t understand what insurance is, either, and had to be schooled by a colleague (“That’s what insurance IS”). If you remember that insurance is, first and foremost, shared costs (+ administrative overhead), then the fact that premiums are high means that costs are high.

          • LukesCook

            The independent midwives claimed that the higher premiums weren’t attributable to their outcomes, but to the insurance companies’ inability to distinguish between different modes of birth. Because actuaries totally need freelance baby-catchers to teach them about numbers.

      • auntbea

        This is an excellent point. What is the NCB community doing to promote the compromise they claim to seek between obstetrics and NCB?

    • fiftyfifty1

      “Just that regardless of the side they are on, people who are at opposing extremes of an issue hold tight to their position because they believe they are right.”
      Some say the Earth is flat but scientists say it is round and keep holding tight to their position because they believe they are right!! Clearly the scientists have a sharp intellect, in my honest opinion they could contribute a lot by using it to help us all reach a compromise on the issue.

      • Precisely. The compromise that dreamers want is that we should “support” homebirth. One thing that WOULD make it safer is being more realistic about the dangers, not head in the sand denial on the “It was right for my family” basis.

        I don’t really see that the denial of the arbitrary risks of childbirth lie in conspiracy theories. The key fact is stated above: people dread random, uncontrollable, disastrous events. For the first time in history, women can deny the realities, because, thanks to science, they are less common.and visible. The conspiracy theories come later as rationalisations for a very weak thesis – that birth can be trusted. The conspiracy theories are a problem, because they can sound plausible, but what I think is more of a problem is the way that women who do not attain perfection get scapegoated and demonised, made to feel guilty and failures. It is in the nature of things that It is in the nature of things that ther

    • Guestll

      I’ve been reading here a long time, and Amy has never once glorified the hospital system. I don’t think she’d dispute that there are issues. But the answer does not lie in a lesser standard of care.

      As for tearing down midwifery, again, holding the profession of midwifery (and CPMs are not professionals) to a higher standard — well, if that’s tearing it down, then so be it.

      Do you have any citations to support your assertion about “high percentage having feelings about lack of control?” Because the evidence I’ve read indicates that most American women are satisfied with their birth experience. Also, you need to look into why the MMR appears (key word) to be increasing in the US. Do you know why that is? Do you understand the changes that have taken place with respect to reporting?

    • LibrarianSarah

      Please look up “false equivalence fallacy” and “the golden means fallacy.”

    • araikwao

      “..people who are at opposing extremes of an issue hold tight to their position because they believe they are right.”

      Yes, yes and yes. Am reading Daniel Kahneman’s “Thinking, Fast and Slow” at the moment, and he described the “affect heuristic” – people let their likes and dislikes determine their beliefs about the world; when you believe the benefits are large, there is a corresponding belief that risks are small.

      NCB’ers like the concept they espouse, and so believe the benefits are great and the risks negligible. (It also makes changing their minds difficult, even with robust data to the contrary.) Conversely, they dislike hospitals/medicine, therefore perceive great risk to be associated with them, and benefits to be small.

      I can see the same tendency in the writings of people who are anti-vax/ CAM users/MDC posters – they really like this stuff for various reasons, which makes a paradigm shift incredibly difficult. (Not to say that medicine is immune to the phenomenon, of course.)

  • Eddie

    That’s exactly it. People want a simple narrative that they can understand, that has a clear and unambiguous causitive agent. And this explains quite a bit of quackery as well as a lot of conspiracy theories.

    Real life is complicated. Conspiracies make it seem far simpler.

    • The Bofa on the Sofa

      IMO, it’s not about simpler, it’s about control:

      There are number of factors, but probably one of the most important ones in this instance is that, paradoxically, it gives people a sense of control.

      I have always thought that one of the main features of people who fall for conspiracy theories is that they tend to believe that it is possible to be far more in control of things than it actually is. Everyone’s actions are extremely well choreographed, evidenced is easily manipulated in undetectable ways, and witnesses are completely dealt with.

      It’s just not that easy to control the outcome.

      • Eddie

        We’re largely saying the same thing with different approaches. Complex processes by definition are harder to control. If something is simple, it can far more easily be controlled.

        • The Bofa on the Sofa

          We’re largely saying the same thing

          Not really, though. I am saying that it’s not that they think it’s simple, it’s that they think that very complicated things are still controllable. IOW they don’t accept your premise that “complex processes by definition are harder to control”

  • NursingStudent

    ironically, this conspiracy article applies to anti-midwifery zealots as well.

    • Amy Tuteur, MD

      In what way?

      • Renee Martin

        Don’t expect an answer. We have data, but if they don’t find that compelling, theres no starting point for any discussion.

    • Susan

      I call BS on that nursing student. I was fully enmeshed in the homebirth/NCB world before I went to nursing school and became a labor and delivery nurse. The conspiracy type thinking is far more prevalent among homebirth/NCB types. I read the article and it just doesn’t apply to mainstream obstetrics. Go to any OB conference and you will see far more self criticicism and willingness to look at how practice can change based on current research than you will see at a Lamaze conference, a Bradley workshop…or any of the many events I have attended that are popular among natural childbirth adherents. They are almost uniformly based on having a unique special insight of “the truth” that only they know but can’t get the general public to buy into. Isn’t that the essence of a conspiracy theory?

    • Karen in SC

      Claiming that MANA and other homebirth advocates are hiding the data on homebirth deaths is NOT a conspiracy theory when in fact, MANA has not released the data they have gathered on thousands of births.

      • auntbea

        Yes, they have. You just don’t remember because Dr Amy found out your real name and where you live, flew down there to knock on the door, and when you opened, she got you with one of those men-in-black memory wipe wands.

        • Eddie

          I wasn’t supposed to say anything about it, but I haven’t returned the memory wipe wand yet. I’m sorry! I’ll get it back to you, Dr Amy!

          • auntbea

            So, in this example, you are an elf?

          • Eddie

            MIB clearly. Oh wait, I shouldn’t have admitted that. I’m in real trouble now.

    • Nope. We don’t see that there is a vast network of hidden secrets…we see a vast network of ego maniac baby slaughterers.