No limit to the stupidity at Midwifery Today

wise and stupid in letterpress wood type

Over on that festival of stupidity known as the Midwifery Today Facebook page, I found this:

Midwifery Today

From Stephanie-jean *****

My best friend is currently attempting a hbac and is a at road block. Her membranes ruptured 56 hours ago. She was group b strep positive in her last pregnancy, but was not tested this time. All over our research would suggest that 95% of women will go into labor on their own within 72 hours of prom. She is looking to hear other women’s experiences with hbac with prom. She really wants to avoid a repeat c-section as she had a really traumatic c-section the first time. All advice, support, and baby waves is highly appreciate!

My comment (soon to be deleted no doubt):

Go to the hospital before you kill this baby! Your question is the equivalent of asking if it’s okay to keep drinking while you’ve already been driving drunk. The best you can hope for is that no one gets hurt from this idiocy.

Midwifery Today 4-18-13

  • Disgusted

    I like the part where Crystal Nieland admits she lies to hospital staff. Nothing like expecting people to do the best job taking care of you and your child after you give them deliberately false information.

    • Susan

      That seems to be a pretty common thing– that it’s ok to lie to the hospital staff. I have actually seen that happen when I was in a group of friends that included some home birth lay midwives LONG ago. As a nurse I have had patients tell me the midwives told them not to tell the truth about how long she was ruptured (ROM-ruptured of membranes) for those who might misunderstand what was ruptured .

      • Disgusted

        Mmm hmm. What kills me about it though, is that if things go wrong after they’ve lied to the doctor, they will blame the doctor for incompetence.

      • MaineJen

        This is true. I have heard a CNM (relative of mine) say to people “Oh, NEVER tell them when your water really broke. Say that it’s only been a couple of hours, even if it’s been a couple of days.” Forever glad that I didn’t take her advice… –ROM/no labor mom

  • Renee Martin

    She had her baby via CS!

    You know, had she just gone in when she had PROM, she probably would have gotten a little pitocin, and may have had her VBAC after all. There would have been plenty of time for a TOL with augmentation, and to let labor progress from there. I had pPROM, got pitocin 72 hours in, and had a VBAC 6 hours later. It happens.

    Instead, she wasted this window of opportunity by sitting home, waiting and drinking castor oil instead. Putting herself and her baby at risk, in order to get a HBAC.

    At the very least, she could have skipped the whole ordeal by having an ECRS when labor didn’t start. I don’t know why she had a first CS, so maybe a TOL wouldn’t have been successful. But you guarantee yourself the worst case scenarios by staying home for three days after PROM- emergent CS, stat CS, sickness for baby, or death. I don’t think any HBAC should labor at home for days, but if you’re not even laboring? come on.

    • Allie P

      I’m so glad she and the baby are okay.

      I agree that the NCB people seem to forget that the purpose of these eeeevil interventions is to avoid surgery. A little pitocin to help the contractions in a stalled labor, a little epidural so the mom can rest up for the pushing… were it not for my interventions, I would not have been able to have a vaginal birth.

      • Eddie

        I’m so glad she and the baby are okay.

        Here’s the difference between us and the NCB extremists. (There’s only one?!) Even if she took the risk and got lucky and had the baby and all were OK, we’d say that. But some in the NCB crowd, when someone “gives in” and has a CS, vilify them. “You didn’t have a normal birth. Too bad you failed.”

    • Captain Obvious

      I would be curious to see the placenta pathology, wether any chorioamnionits or funisitis was present. Infection has definitely been known to cause neonatal encephalopathy and subsequent CP as hypoxia-ischemia can.

      Neonatal Encephalopathy

      These guidelines must be met to assign acute intrapartum asphyxia as a cause of neonatal depression:

      Evidence of metabolic acidosis in intrapartum fetal, umbilical arterial cord, or very early neonatal blood samples (pH < 7.00 and base deficit ≥ 12 mmol/L)

      Early onset of severe or moderate neonatal encephalopathy in infants of ≥ 34 weeks' gestation

      Cerebral palsy of the spastic quadriplegic or dyskinetic type

      Exclusion of other identifiable etiologies such as trauma, coagulation disorders, infectious conditions, or genetic disorders, PKU, prematurity, medications, drugs, congenital brain disorders.

      • Lisa from NY

        If so, she can sue the doctor who delivered the baby. (She’ll never blame herself or her midwife.)

    • CSM

      Somehow I’m not surprized. Hopefully, she avoided chorio and baby is ok. Our MW guidelines suggests that it’s ok to wait up to 96 with PROM given all VS are normal etc so many women decide to really push it. Somehow they think that if no one messes with the vagina (no exams etc), risks of infection are very small.

    • Crystal Nieland

      Just saw this. Lol No, my baby was born vaginally, as was the one in after . Get your facts straight if you’re going to talk about me. 😉

  • KarenJJ

    OK so CPMs are illegal in NC (if that’s where this mum is, the original poster is asking for a ‘friend’ and looks to be based in NC). So what’s the bet that the original question was being asked on the behalf of an illegal midwife.

    When ‘all are comfortable’ with the situation, I imagine the facebook information being posted by those being more cautious and advising mum to go to hospital and not take castor oil was being filtered to the mum via this ‘midwife’… Because I was surprised that the mum started drinking castor oil after all the info that was posted on that thread. Every mum I know, even the very few homebirth mums, want what is best for their baby and would be much more cautious than a renegade ‘midwife’ who has no regard for the baby’s health.

    NC really shouldn’t let CPMs become legal practitioners. I believed that previously, but far out that particular homebirth was never going to be low risk. These sorts of risky practitioners are not helping their own cause.

    • Allie P

      I think this “friend” was probably the illegal midwife, too. This is apparently quite common in NC. The woman is officially having a UC homebirth with a “doula” — but not really.

  • When a csection is considered the worst that can happen, it is a sure sign that people have lost touch with what really is the worst that can happen and why it is a good thing to minimize that risk.

  • Dr Kitty

    OT: jury has returned a verdict of death due to medical misadventure at Savita Halappanavar’s inquest. Today would have been her 5th wedding anniversary.

    • So sad.

    • Renee Martin

      Medical misadventure?
      That was MURDER, directly by religious dogma.

      • Dr Kitty

        Personally, I’m not going to argue with you, although I think the current legal situation put her doctors in a horrible position.

        They had to wait until her life was in danger, and by the time her life was in danger it was too late.

        I trained in Ireland, and believe me there are doctors who feel the current situation is untenable. Unfortunately their hands are tied.

        I won’t go into the situation here, over the border, except to say that the letter of the law might not be adhered to, and such a case would not arise.

        • Hannah

          “I won’t go into the situation here, over the border, except to say that the letter of the law might not be adhered to, and such a case would not arise.”

          I thought that in NI it wasn’t so much a case of the “letter of the law” (as in statute), but how you applied the case law particularly R v Bourne which allows abortion to prevent “physical or mental wreck.” Nevertheless, this may well be a semantic point but the relevant statute is the Offences Against The Person Act (1861), which prohibits the use of drugs or instruments to “procure a miscarriage.”

          http://www.legislation.gov.uk/ukpga/Vict/24-25/100/crossheading/attempts-to-procure-abortion

          I’m not sure you can be said to “procure” a miscarriage that is already in progress, particularly not if you’re essentially talking about medical augmentation where cervical dilation has already occurred, to an extent, which was my understanding of what was at stake, in this case.

          Incidentally, do you know if the full inquiry report is available online?

          • Dr Kitty

            R v Bourne is case law that provides a possible defence to charges under the 1861 Act, there actually isn’t anything legislated that “allows” abortion.

            It is more an agreement that R v Bourne applies and that no one will try to investigate abortions performed here too closely to find out whether medical staff are applying it correctly.

            For example, abortions for foetal abnormality are illegal in NI, even under R v Bourne. Doesn’t mean they don’t happen.

            “Procuring a miscarriage” is any medication or surgery used to empty the uterus, so yes, even in Savita’s case where there was ROM and dilation it would be considered an abortion.

            Currently we in a DADT situation, which isn’t good enough.

            I don’t know if the full text of the inquest has been made public, but I imagine it will be.

        • LukesCook

          “Personally, I’m not going to argue with you, although I think the current legal situation put her doctors in a horrible position.”

          I remember reports at the time making much of her having been in terrible pain for days and days. Something I would have hoped would have stiffened her doctors’ spines. And if the legal situation really puts doctors in the position of being obliged to act unconscionably, then it isn’t as though medical doctors aren’t in demand in more civilised countries.

          • Dr Kitty

            The legal position is that the woman’s life must be in danger before you can act. In Savita’s case it meant that she actually had to be septic.
            The medical mistake which caused her death was that no one picked up when potential sepsis turned into actual sepsis and failed to act until it was too late.

            You make excellent points otherwise.

          • I suppose one lesson from this is that skill and training don’t matter if an ideology gets in the way.

            And maybe it takes an obscene,horrible, wasteful nightmare like this to challenge the ideology.

            Have the doctors involved made any comment?

  • Dr Kitty

    Today has been a not so good day (work related, I worry about my patients).

    I read this site (believe it or not) to relax and reassure myself that I’m not the only one who thinks the NCB stuff is not always helpful.

    That FB thread is just awful.

    It just makes me sad that there is so much wilful ignorance about.

    I’m going to be worrying about that woman and her baby, and my own patients tonight.

    • KarenJJ

      Someone updated on the Fed Up facebook page:

      “She got a CS, and healthy baby, which is great news. I wish she would read this so I could tell her: staying home so long actually ruined your chance to VBAC, and made the birth worse than it needed to be. Had you gone right in w PROM, you may have gotten a little pitocin, which could very well have allowed you to VBAC. You would have had time to try to get labor to start, at least. You could have skipped the hassle w an ECRS, which would have been easier to recover from than an HBAC attempt, tuned Cs. I am so glad you went to the hospital.”

      Happy to hear good news. Hope the mum is enjoying her baby and that she didn’t find her second cs as traumatising.

      • Dr Kitty

        Ok, just worrying about my patients now 🙂

      • Renee Martin

        I’m sure even if it was not actually traumatic, it will be made into a trauma.

        • KarenJJ

          *sigh* you’re right. Even if she does, at least it will be regret for an unecesarean and not anything worse.

  • Is it any wonder why doulas have a bad rep?? Oh Meaghan Bird, please change your name to birth “donta” not birth doula.

  • Are you nuts

    Wow! This is truly BSC (bat s… crazy). Thank you, Dr. Amy, for lowering my productivity this afternoon as I read the thread on FB.

    Stray observations… I like how the stay-at-home camp acts like GBS is some bacteria that exists only at the ends of evil OB’s gloved fingers, rather than existing in the woman’s own body. If they only leave everything alone, SURELY GBS can’t hurt me or my baby at home.

    I like Jessica Boadi’s suggestion in the excerpt above that suggests cuddling. Cuddling solves everything.
    I like that how even the home birth advocates can’t agree on what the woman should do. Try hibiclens! Whatever you do, don’t use hibiclens! Take castor oil! Whatever you do, don’t take castor oil! But I guess when you make medical decisions based on touchy feely garbage rather than science, these are the types of opinions you get.

  • Yammy

    Just astounding that someone in an urgent situation would stop to consult mother-effin’ Facebook. Sometimes I wish humans just laid eggs. Though I imagine there would still be foolishness made up for how to properly lay and incubate them.

  • Jocelyn

    Ugh, I was just reading post after post on the Facebook page, and it was just depressing me… All those women wanting and planning home births, and encouraging each other to do things like HBACs. I just wish we could shake some sense into them!

  • Certified Hamster Midwife

    OT: If anyone wants to help out here, this is a mainstream enough page as far as I know but people are saying “homebirth” and I want to say NO NO NO NO oh hell no.

    https://www.facebook.com/plussizemommymemoirs/posts/488029867918899

    • Captain Obvious

      VBAC: she sounds like a greater risk of failure, but hell, what’s the worst that can happen?

      Increased success
      Prior vaginal deliveries
      Go into spontaneous labor

      Decreased success
      Recurring indication for 1st CD
      Increased maternal age
      Non white ethnicity
      Gest age greater 40 weeks
      Maternal obesity
      Pre eclampsia present
      Short inter pregnancy interval
      Increased neonatal birth weight

      Other tangible factors
      Type of scar
      Thickness of scar by sono at 36-38 weeks
      Doctor experience
      Hospital accommodations
      Need for induction
      Need for fetal monitoring ( usual first sign is fetal HR abnormality, not pain)
      Breech/Twins/version
      Previous fibroid/uterine surgery
      Previous rupture
      Calculator risk percentage

      So if you have a non previous failure to progress cesarean and a small baby and thin build and go into labor on your own prior to 40 weeks great!
      And HIE is associated just with TOLAC and not with ERCD. An if uterine rupture occurs, one study showed 1/3 of those babies end up with HIE.

      • Sue

        Capt O – stop muddying the waters (pun intended) with all that sciency stuff. We all know it;s about her attitude and trust.

    • Captain Obvious

      I hate when homebirthers quote ACOG wrong! “Mandy Patterson: …but my advice would be to not schedule a csection or refuse to have one and labor at home for as long as you can. I believe every woman should be able to birth the way she wants without judgment from her doctor or other women. The goal here is to be supportive, not make her feel like she is making a bad decision because she wants to at least be able to try to birth a certain way. The ACOG guidelines say TOLAC for a VBAC and a VBA2C are perfectly safe.” ACOG guidelines recommend VBACs to be on continuous monitoring when in labor and in a hospital where emergency access to an OR is present. I know the Practice Bulletin doesn’t say it is “perfectly safe”. ACOG clearly states your success is lower when having a TOLAC with a large baby, or because your first CS was because of dystocia. Your risk for UR is higher with with TOLAC if baby is large. One study showed UR was greater with TOLAC after 40 weeks. ACOG states that gestational age greater than 40 weeks alone should not preclude TOLAC, but coupled with other risk factors, success is lower. I can go on but ACOG does not say it is perfectly safe. ACOG states patients should be clearly informed of such potential increase in risk and management alternatives.

      • Dr Kitty

        Correct me if I’m wrong here, but this women isn’t yet in labour.

        We’re not talking about TOLAC, we’re talking about prolonged PROM, at term, in a GBS positive woman with previous CS.

        Pretty sure ACOG would NOT support staying home and drinking castor oil.

        • Captain Obvious

          The above link takes you to a different FB link where a 34 week plus size previous CD due to FTP is whining about her doctor telling her that her risk of success is less because of above reasons. So she is going to refuse and stay home unmonitored as long as she can when she does go into labor. Then Mandy Patterson tells her you go girl because ACOG says VBAC and VBA2C are perfectly safe?!

          • Dr Kitty

            Ah.
            I don’t Facebook.
            As they say, The stupid, it burns.

  • I don’t have a creative name

    That was painful to read. There are so many stupid people in the world. And people are free to be stupid, but what makes it painful is that so many innocent, lovely babies pay the price for it.

  • Amy Tuteur, MD

    Update 10 hours ago:

    Stephanie-jean *****: Ps- we were not not looking for “validation”. All involved are comfortable with the situation. We were looking for other moms who may
    have experienced prom with labor being delayed more than 48 hrs. Not
    looking to be attacked for making any decision that mother makes.

    My comment:

    Why? What would [finding another woman with labor delayed more than 48 hours after PROM] tell you about the risk to this mother in this
    situation? Nothing. You could only be asking for validation of what you
    already know is a dangerous situation.

    It’s the equivalent of asking anyone if they ever drove drunk and got home
    safely. I’m sure that many people have, but does that make drunk driving
    safe? No, it doesn’t.

  • Although I have no way of confirming that they are indeed the same person, a woman of the same name as the original poster is tweeting about a friend with a stalled labor hoping to avoid interventions. https://twitter.com/lifesemicrunchy

    • EmbraceYourInnerCrone

      I honestly do not get the “avoid interventions at all costs” mentality. Maybe its coming from the fact that my family and my husbands both have a history of pregnancy related complications (all different and not genetic, just bad luck). How about avoiding a dead or brain damaged baby?

      Neither my OB nor the L&D nurses did anything (IV, Heplock, EFM, internal monitoring) without my Ok, and when things went south they explained what they needed to do (while they were doing it) so my husband and I didn’t panic.

      I had a textbook pregnancy and no problems with the first stage of labor and most of the second stage…until the meconium and late decels. You are low risk, right up until you aren’t.

      • So glad your labor went safely and that you were in the care of compassionate and competent professionals. I suppose when a mother has read so much nonsense about interventions that she has been brainwashed into believing that labor is safe but interventions are dangerous, then she’ll honestly think interventions are what is going to harm herself and her baby. I just hope this woman’s labor won’t turn into another tragic homebirth loss story.

    • Captain Obvious

      Would head cooling after birth to minimize neonatal encephalopathy be an intervention this mom should be trying to avoid?

      • auntbea

        That’s actually what non-hatting is for. Keep the head nice and chilly.

        • The Bofa on the Sofa

          Ah, the lack of intervention approach to intervention prevention.

          Hatting is just the beginning of the cascade of interventions…

          • auntbea

            Once you’re down that road, it can only end with a baby who rides in the cart at the supermarket.

          • Dr Kitty

            Shhhh, you might bring Alan back…

        • Klain

          Slightly OT but having just seen an episode of the US version of One Born Every Minute I was quite surprised to see the mothers didn’t really get to hold their newborn till the babies had a hat and a nappy. I guess that’s what all the talk of hatting is about.

          • suchende

            It’s an interesting question. I specifically asked not to be handed my infant until she was cleaned off because I didn’t want to be introduced to her all covered in blood. I wonder how many moms agree with me.

          • Klain

            Mine were given a rub with a towel so I guess they were cleaned up a bit before I got them, plus I held them with a towel draped over them. With my last one it was well over an hour before he was dressed in anything else.

          • AmyP

            Me! Freshly-born babies are much more human-looking and lovable when not covered in birth crud.

            Anyway, a little rest is good.

          • Yes! I agree with you. Thank you for making me feel like less of a freak. I figured if I admitted this to other women or even the doctor they would think I was some kind of monster for not wanting to hold my baby the very second they were born. I have been worried the hospital would just thrust the child at me for the required immediate skin to skin contact. It makes me feel so relieved that I can request that they do not.

          • Eddie

            Our rough birth plan involved our youngest being cleaned first.

            While I remember every step after the birth clearly, it seems in retrospect just as it seemed at the time, that in less than 30 seconds there was a whirlwind of activity where our baby was weighed, assessed, cleaned, eye ointment applied, and swaddled (not exactly in that order). Before we knew it, my wife was holding our swaddled newly-born baby. I watched the whole process in awe of the skill level of the nurses involved, the obvious mastery they had of this set of tasks (as well as the other tasks that came before that point in time).

            We had enough opportunity for skin-to-skin and didn’t need to or care to experience someone else’s idea of how things were supposed to be.

          • moto_librarian

            My first son was placed on my chest immediately with his cord still intact. Honestly, feeling his cord pulsating kind of squicked me out. He wasn’t crying, so they took him over to observe him (and ultimately admitted him to the NICU for TTTN). My second needed some help with his breathing immediately after delivery, so he spent the first 15 minutes of his life with the NICU team and was handed to me hatted and swaddled. I can say that I actually preferred this. Glad to know I’m not the only one who would rather have a cleaned up baby handed to me.

          • Susan

            I’ve had a few ask for that. It’s hard to remember to NOT put the baby on the tummy and remind the doctor not to when it’s the norm to give them to mom.

    • Yet another reason CPM’s do not need licensed in NC!!

      • libbycone

        It’s been 14 hours now. I’m so worried!

  • Squillo

    Whenever I see something like this, I think about the “Storm Bride” tragedy on MDC. All those “experts” were so free with their advice, and then so free with their little sad face and candle icons when her baby died.

    Here’s hoping this baby is born healthy and happy.

    • I don’t have a creative name

      Yep. And like that lady on babycenter who was strongly urged by those idiots there to avoid the c-section her midwife recommended for 39 weeks, whose baby died in utero 2 or 3 days later.

      I hope this baby ends up okay.

    • Dr Kitty

      What makes it worse is that Storm Bride is all over MDC telling people how damaged she was BY HER CS, not by the death of her baby, and she advises other women to avoid interventions.

      She is NOT the kind of person you want to take advice from.

  • The Computer Ate My Nym

    Any follow up? This sounds like a set up for bad outcomes in a number of ways, but hoping she comes to her senses or, if not, at least is one of the lucky women who gets away with it. (Not all drunk drivers crash either.)

    • KarenJJ

      Aren’t these posts awful. There’s been a few white knuckle rides posted about on Skeptical Ob in my time as a reader. A lot of them seem to come through OK by all accounts, so I have hope it’s going to be all right. That said I still remember the shock I felt when Shazad passed after following Margarita’s story.

      And I’m a complete stranger from very far away. Their families must be besides themselves.

      • libbycone

        It’s still going, and I had to put my two cents’ worth in. They didn’t erase your post, Amy.

        • Amy Tuteur, MD

          The OP is a supporter of NC Friends of Midwives. I wonder if this is yet another homebirth disaster taking place in North Carolina.

  • Guestll

    This thread depresses me. I have nothing to add that hasn’t already been said, other than “festival of stupidity” is some of your best, Dr. Amy.

  • jen

    Wow. Posts like this make me infinitely grateful for my wonderful OB and super, super, super, super awesome repeat c-section.

  • LynnetteHafkenIBCLC

    Unbelievable how some commenters who had cautionary tales or concerns for the mom to consider were denounced as “fear mongering.”

    • BeatlesFan

      And yet, tales of demonic, mysoginistic, slice-happy OBs and horrible interventions at uncaring hospitals are NOT considered fear-mongering. Ignorance and hypocrisy all rolled into one.

      • Science deniers work the same line of patter everywhere. In climate change studies, for example, you’re a fearmonger if you point out global warming threatens human welfare, and you should be ashamed, because any effort to wean ourselves from fossil fuels will cause economic and social collapse, mass starvation, and the totalitarian rule of the survivors by Agenda 21 thugs.

        Self-awareness is not their wheelhouse.

  • Guest

    http://www.cracked.com/article_20398_5-ways-your-brain-tricking-you-into-being-miserable.html OT: this is not an academic article, but it gave me some insight into why women get so obsessed with -birth trauma- c section or otherwise. Some people get addicted to grief: “they just keep reliving it, refreshing that feeling over and over. Because of the jacked up way your brain is wired, even the most horrible thing that’s ever happened to you gave you a rush… They get trapped in a feedback loop because they are subconsciously fraid to let go of the one strong emotion that makes them feel alive”

    • or perhaps it’s just PTSD.

      • Guest

        Maybe sometimes, when it is debilitating and intrusive and physically and mentally shakes you to the core at the slightest provocation, but the addiction to grief described in the article is more of a habit with varying degrees of severity. It is the tendency to obsess over unpleasant experiences because other stuff is more boring – doesn’t release dopamine. It is the same mechanism involved when we like watching a sad movie or getting on a roller coaster. Birth blogs of all sorts may be so popular because of this sort of entertainment feature. They remind us all of that crappy/dramatic/painful/great day when a baby was born. The disagreements over what/how is best play into our fears about what might’ve happened had we gotten different information and made a different choice. Homebirthers may be paranoid about hospitals, hospitalbirthers are afraid of quacks. Both sides hate feeling judged, but it is impossible to out the truth without stepping on someone’s deeply held beliefs.

      • LukesCook

        Or attention seeking.

      • Can be a little of both. CBT, the only evidence-based form of therapy, discourages reliving and reflecting on experiences, because it tends to strengthen the emotions and dysfunctional behaviors involved.

        CBT suggests that rather than changing our feelings -> thoughts -> actions, successful change comes by modifying actions -> thoughts (self-talk) -> feelings.

        Interestingly AA got there almost a hundred years ago: “Fake it until you make it.”

        • Eddie

          CBT, the only evidence-based form of therapy

          OK, I’ll bite. The only evidence-based form? Seems unlikely. My guess is that folks doing other forms would disagree with you pretty strongly. However, it does seem to be pretty self-evident that just saying, “Don’t think about pink elephants” and stopping there is unlikely to be successful no matter what “pink elephants” is replaced with.

  • KarenJJ

    Hope Bostonian’s are staying safe. Just caught the current events on the news.

  • Box of Salt

    Clarification needed:

    Why is the poster calling this “prom”?

    Are we talking about a term baby, or an early one?

    Please correct me if I’m wrong. I thought the ROM part referred to Rupture of Membranes.

    Then we add adjectives, such as “S” for Spontaneous (what first child and I experienced), you know, after 37 weeks, or “P” for Premature, before 37 weeks.

    Please, someone clarify this for me.

    Waiting around for labor at term while at higher risk for infection seems like a bad enough idea as is.

    • Dr Kitty

      PROM- pre-labour rupture of membranes.

      PPROM- pre-term pre-labour rupture of membranes.

      PPPROM- prolonged pre-term pre-labour rupture of membranes.

      You don’t have prolonged pre-labour ROM at term, because you deliver the baby before it gets to that point, whereas you might try and keep someone pregnant as long as possible if they had a slow leak at 25 weeks.

      Confusing, isn’t it!

      • AmyM

        How long must the rupture go on before labor (regular contractions that dilate the cervix?) starts to be considered pre-labor?

        • Dr Kitty

          From what I was taught, if it is before regular contractions start it is PROM. Doesn’t matter if labour starts 5minutes or 5hours later.
          Things may have changed.

          • AmyM

            Thanks! Guess I had PROM then (pPROM really, at 36wk). Was about 12hrs + pit before things became regular contractions. Baby A was malpositioned, probably contributed to the delay.

      • Box of Salt

        Thanks Dr Kitty! Sounds like we had prom, too, then. I no longer remember exactly how long the delay was, but the rupture was definitely first.

      • Eddie

        I had the most Ps then. I was born almost four weeks early, and the water broke about a week before I was born. My mom leaked for a week before labor started. Yay, I’m a winner! 🙂

        And incredibly lucky.

  • Renee Martin

    FYI- Her friend posted an updated pic of the mom drinking a huge glass of…Castor Oil!

    I simply cannot wrap my head around anyone reading that whole thread, and taking “drink castor oil” from it. You really want diarrhea along with your PROM? Seriously? There was some good advice on there, and she listens to someone saying drink castor oil?

    I hope that she did not have PROM. These people are so ill informed, I can see this being possible.

    • KarenJJ

      So the advice that taking castor oil when you have a previous c-section scar and those that recommended getting checked out because the baby could get a GBS infection even though mum shows no symptoms went completely over their heads?

      I saw those comments in there. Even Dr Amy’s was still there. I hope the baby is doing OK. Can’t blame the original poster for being uniformed anymore. She knows now, she’s just choosing to ignore it and go with the quack advice. I don’t understand it myself. I hope this ‘friend’ also passed on the advice to see a doctor and to not take castor oil as well as the relax, take castor oil and walk up the stairs two at a time so that the mother herself could make up her own mind. It’s a different scenario when it’s the mum making a decision as opposed to a ‘friend’..

      By ‘friend’ in this scenario, we don’t mean ‘midwife’ do we?

      • Dr Kitty

        Well, one thing castor oil is likely to do is produce meconium and with PROM that should be easily evident. One would hope that meconium in the absence of contractions, at term, in a HBAC with probable GBS would prompt transfer…right…RIGHT?

        • Guestll

          Wrong-o.

      • BCMom

        And of course by now she’s probably s******g her brains out due to the castor oil, further increasing her chances of introducing fecal bacteria to the equation.

    • Box of Salt

      Castor oil!?

      Do they know where the poison ricin (see the news, please) comes from?

      Yes, the dose makes the poison and all, but, oh, the irony!

      • The castor bean is indeed a source of ricin, but the oil is not.

        Ricin is a protein that is a metabolic toxin. Nasty, and difficult to counteract.

        • Box of Salt

          According to wikipedia (not a real source, I know) they both do come from the castor bean. However, the extraction of the oil apparently involves heating, which since since ricin is a protein deactivates it (presumably denaturing it).

          Wikipedia also gives the LD50 for ricin at 22 mg/kg. At that dose I’m not willing to risk accidental contamination.

          • Sue

            That’s true – the oil doesn’t contain ricin, which is very toxic.

            What I don’t get is the cognitive dissonance: either castor oil works to enhance uterine contractions or it doesn’t. If it DOES, why is it better/safer than oxytocin? If it doesn’t, why use it?

          • BeatlesFan

            One of the birth boards I frequented when pregnant with my daughter had a post with a mom inquring about castor oil; there were three pages of women telling her not to use it, and all the reasons why; there was also one very outspoken lady who graced us all with multiple posts about how pitocin is terribly dangerous. (Others did point out that the OP wasn’t asking for a comparision of pitocin vs. castor oil, but Ms. Outspoken didn’t seem to care). As I’m sure most people here could guess, the difference she brought up the most was that pitocin is eeeevil because DOCTORS administer it at the HOSPITAL and it’s an INTERVENTION! Castor oil, on the other hand, is NATURAL!

            It seems most crunchies aren’t adverse to the idea of stimulating contractions; it’s whether the method is considered an “intervention” (IE, done at the hospital) or not.

          • Eddie

            I’ve shared here before my example of crunchy folks saying anti-depressants are bad because they are chemicals, but lithium is OK because it’s an element. Absolute ignorance of the effects of exposure to elemental lithium!

          • The Bofa on the Sofa

            I sure hope they aren’t giving elemental lithium! 🙂

            I haven’t got around to commenting on this topic, but I just want to say that, for some reason, I rest assured that the picture shows her drinking castor oil and not Castrol Oil.

            Then again, that speaks a lot to the low level of expectation that I have for those folks. Ever since I heard about the warning to be sure it was CASTOR oil, and not Castrol Oil (motor oil, that is), I haven’t had much hope.

          • CSM

            I have seen it work – anecdotally speaking, of course. I recall glimpsing at a pre-clinical study where it was proposed to stimulate some uterine activity. But what a crappy way to go into labour!

    • I’m sure dehydration will really help the mom….

  • LibrarianSarah

    I noticed that when people commented to tell her to the hospital a bunch of “white knights” road in to say that you were only supposed to tell your own experiences but when other people came in giving bullshit advice (caster oil, nip stim, orgasm, etc.) that would let her stay at home mum was the word. Double standard much?

  • Dr Kitty

    It makes you wonder.
    What are the HBAC contingencies?
    Like…if there is PROM, are you going to wait 48hrs or 72 hrs or a week?
    If go into labour at 72 hrs, are you still going to labour for “as long as it takes” or would you put a clock on it then?
    Is a maternal fever prompting transfer 37.5C, or 38C or 38.5c?
    Is maternal tachy prompting transfer 120, or 130, or 140?
    Is foetal tachycardia prompting transfer 170 or 180 or 200?

    You’ve had months to prepare for this. The transfer criteria should be set IN STONE well before labour starts.

    Otherwise you end up with the “oh it took 3 days to go into labour, so OF COURSE you can labour for another 24 hrs, because your body will need the extra time, and OF COURSE you’ll be tired and anxious, so your heart rate will be up and OF COURSE the anxiety will feed back to baby, so OF COURSE the foetal HR is 200…let’s just stay at home and try to re-centre your aura.”

    Rather than…”evidence of maternal and foetal compromise and ineffective contractions…let’s go”

  • Sue

    The answer to PROM in a prev GBS +ve stuck in a traffic jam is homeopathy and “encourage her to relax”?! The stupid burns.

  • COdoula

    I was hoping that there would be a post on this. I don’t even known why I still “like” that page. You should read the post before it about the best way to avoid PPH (red raspberry leaf tea). Midwifery Today is an embarrassment to midwifery and the women’s health profession in general. The entire staff and publication involved should be ashamed. It is a forum that is not only idiotic, but dangerous and deadly in some of the advice offered.

    • KarenJJ

      Women and children deserve better than quacks passing themselves off as professionals. It goes right to the heart of this blog and the anger people have towards the dangerous advice given. And yet it’s fear-mongering, being ‘meen’ or being a bitch to point this out. I’m over the excuses for the women giving advice at Midwifery Today.

      A woman has a traumatic c-section, so the solution is to run off and give birth with know-nothing numpties. It makes no sense to me. Like improving law and order by bringing in vigilantes.

      • Karen in SC

        Know-nothing numpties – great expression! I bet they are also “lying liars that lie.” (another great one from a commenter here)

      • Certified Hamster Midwife

        “Vagilantes.”

      • Sue

        A question for the boys out there….are there equivalent lay providers for “men’s problems”? I’m thinking of areas that are essentially physiological – I guess like erectile dysfunction or prostatism. I suppose there are “herbal remedies” but do guys seek out non-mainstream “providers” for these conditions? If not, why not?

        • The Bofa on the Sofa

          Check your spam box for all the “natural enhancement” crap.

          Oh sure, you think its a joke, but remember, if someone didn’t fall for it, they wouldn’t keep sending them.

          There are also the baldness fixes.

          • Eddie

            My favorite question for people who believe in those enhancement creams is — can you identify the users because they have huge or hairy hands? (Depending on the problem they are trying to solve.) Or do you have to use a glove when you apply it?

          • AmyM

            I don’t know about huge, but Rogaine works by stimulating hair follicles. There aren’t any hair follicles on the palms of the hand or fingertips. So applying it with bare hands (which is how most people would do it) will not cause hair to grow where it has never grown before, even though the hands were exposed to the chemical.

        • AmyP

          I’m guessing that in the body-builder or fitness world there’s probably a lot going on (nutritional supplements, etc.). I’m female, but I remember being in high school and how the wrestlers would do all sorts of crazy stuff to keep their weights down for competitions.

        • Eddie

          One of my sons got fooled into thinking consuming extra protein would make him stronger. I tried to explain that protein is protein and the body doesn’t care if you get it from meat or milk or powder or beans. And that the body can only process so much protein and the rest exits the body within 24 hours. I’m willing to believe that a few percent of professional strong men need more protein than a normal diet can give them. But a non-vegetarian high school boy in America? No chance.

          There is a huge industry around body building, tons of supplements of questionable value (but mostly no harm except to your wallet). The gym we go to pushes a lot of supplements, although not to an offensive degree. It’s trivial to ignore.

          In areas where men are embarrassed to talk to a medical provider, yes, many men will seek out alternative cures if it means they don’t have to talk to anyone about it. I’ve talked to more than one man who “would rather die” than experience a prostate exam or colonoscopy. Most of these men just ignore the issue rather than seek out alternative cures though.

          I’d say the most common “men’s problem” where people seek out alternative cures are low testosterone and prostate problems. Of course, diagnosing low testosterone is not as trivial as “this is your value and it is low” as low for one man is normal for another.

      • BeatlesFan

        Well, it worked in The Boondock Saints…

  • nice. Do you use with PTS ?

  • CDN Guest

    Obscenely Stupid.

  • Natalie

    I just read some of the responses on their page for a question about placental abruption. “oh I know some one who abrupted early, gushing blood for days. She stayed home and stayed calm and it was all fine.”
    As a woman who had an abruption at 25 weeks this makes me want to tear my hair out.
    The stupid. It’s infuriating!

    • Sue

      Perhaps she stayed calm ‘cos she was unconscious’…

    • slandy09

      I have a friend whose baby was stillborn because of a placental abruption. All I know is that she went in for a normal prenatal exam and they found out the baby had died. They delivered and discovered that the cause of death was an abruption. That’s all I know.

      What’s really sad was the morning right before she went in for her exam, she felt the baby move for one last time 🙁

      But bleeding for days?! Being calm?! Dude, I spotted at five weeks (a week after finding out) and I was FREAKING OUT! It turned out to be nothing and I have my 13-month-old, but still.

      • The Bofa on the Sofa

        Dude, I spotted at five weeks (a week after finding out) and I was FREAKING OUT!

        It is because of stuff like this that I simply cannot comprehend the whole “trust birth” stuff. When my wife was pregnant, and when everyone I know is pregnant, the common perspective is one of constant worry that something is going to go wrong. Any little thing creates a panic. My wife called the nurse to ask whether it was ok to wear bug spray when she went outside. Avoid deli meats and cat litter, because there is a teeny, tiny chance that you could get infected.

        When my wife got up in the middle of the night to go to the bathroom, I would lie in a state of panic until she got back, because I worried she was going to tell me something bad.

        And as I said, this was the common attitude for everyone I talked to. I never met anyone who said, “Don’t worry.” Everyone said, “I know what you mean, I feel the same way.”

        So when I hear the claim, “trust birth,” I can’t comprehend it. I was a nervous wreck every step of the way.

        And now that the kids are born? Even worse…

        • Dr Kitty

          True that.
          The only time I clung to stats was when we though I had an ectopic pregnancy or a miscarriage, and I kept saying “80% chance this is viable” over and over again. It was, and my kid is three, but I was a nervous wreck.

          To give you an idea, I took 2 days off work because I didn’t think I’d be able to concentrate properly because of the worry. That is a big deal for me, I went back to work 5 days after laparoscopic surgery and the day after I got out of hospital when I was admitted with acute kidney injury from hyperemesis. Taking time off when I don’t have surgical wounds or organ failure is a big deal to me, but yes, I was THAT worried.

      • Natalie

        Oh so sad 🙁 I’m so sorry for your friend’s loss.

        I got so lucky. They think I abrupted at 21 weeks (car accident), but they couldn’t see it on ultrasound after the accident so they assumed I was fine. I kept having contractions and eventually went into preterm labor at 25 weeks they couldn’t stop.

        I think these women don’t realize that a partial abruption clotting off and maintaining sufficiency for more than 24 hours is incredibly rare and almost unheard of.

        Thank goodness I went into preterm labor or I’m sure she would have been stillborn due to placental insufficiency (50% abrupted).

        I was told over and over again after they examined my placenta post partum how lucky I was. If my daughter was born within the normal 24 hours of abruption she wouldn’t be viable. I thank God every day.

        So when these women take things like vaginal bleeding in pregnancy and possible abruption so lightly it infuriates me. I would be rushing to the hospital in a heartbeat.

        It really shows how little they care about being mothers, they just want to give birth.

  • Melodie

    I particularly like the thread/comment on that page from the woman wanting to be a midwife via a correspondence course. Nice. I want HER to deliver my baby!

    • Guest

      I have a friend doing that course right now. Sigh.

  • Captain Obvious

    Neonatal encephalopathy has many risk factors like maternal fever, chorioamnionits, persistent OP, emergency CS, operative vaginal delivery, acute intrapartum events like uterine rupture or abruption, category III tracing (absent variability, repetitive decelerations, or bradycardia), fetomaternal hemorrhage, among other factors. TOLAC appears to be associated with a higher risk of HIE than ERCD. One study of 33,000 shows incidence of HIE was 46/100,000 for TOLAC and zero cases for ERCD. Anybody remember Emily Dickey’s coadministrator from her ICAN chapter whose baby ended up with HIE after HBAC.

    • Antigonos CNM

      I harbor a suspicion that a considerable number of the commenters on Facebook would have trouble pronouncing, let alone understanding what all those fancy words mean.

  • auntbea

    Acupuncture!

    • suchende

      But c/s is more dangerous for mother & baby.

      • ‘Nother Lawyer

        Huh? Not sure if you are being sarcastic, but I’m absolutely positive 1/30 moms and babies don’t die from c-sections.

        • suchende

          Someone in the Facebook thread had said c/s are still more dangerous. I guess to the extent that your risk of having a scar is nearly 100%.

          • Amy Tuteur, MD

            They’re totally wrong, as usual.

            The demonization of C-sections is at the heart of homebirth midwifery? Why? Because midwives can’t perform them.

            There is simply no question that a planned C-section is much safer than an emergency C-section when a VBAC goes wrong. There’s absolutely no controversy on this point. The only people who appear to be unaware of it are homebirth advocates.

            It’s also a red herring. Women don’t attempt an HBAC because they think it is safer. They do it for the bragging rights and the experience.

            They aren’t remotely interested in safety because they don’t understand the concept. If they did, they’d risk women out depending on the reason for the first C-section, the position of the baby, the GBS and ruptured membranes status and a variety of other factors, but they never risk anyone out since they don’t understand risk.

          • The Bofa on the Sofa

            It’s actually weird. The claim is not that a c/s is “more dangerous”, but that more women and babies dies from c-sections than from GBS.

            Is GBS ever fatal for women? I can imagine that it isn’t.

            And if it is true that more babies die from c/s than from GBS (don’t know that it is, but it doesn’t matter), it is because we are proactive in treating it!

          • Amy Tuteur, MD

            Very few women, and almost no babies die “from” C-sections. They die in spite of them. But of course these women have no idea of the concept of confounding:

            http://www.skepticalob.com/2011/04/death-by-confounding.html

          • auntbea

            My sister’s neighbor’s veterinarian’s daughter died because the OB bullied her into a c-section and then stabbed her in the heart with the scalpel so the morgue would take over and he could get to his golf game.

          • The Bofa on the Sofa

            If I had a nickel for every time I heard that same story…

          • CSM

            I think some do, yet they choose to ignore it just to go against community standards. Many MWs (the ‘real’ midwives) in Ontario are very much into HBAC and it is within out scope.

      • I’m not sure if you are serious here either.

        You can argue that surgery should be avoided whenever possible, but the idea that CS is “dangerous” is ridiculous. Like most other things, including a natural vaginal birth, complications can occur, but under optimum conditions it must be one of the safest forms of surgery going.

        Since antiquity a method of saving women and babies from the hazards of natural has been sought, and now that it is possible people get hysterical about it. As far as I know, doctors are still trying to reduce the few remaining hazards, and those NICU admissions may be part of the process of doing just that. Science learns from errors and problems – more than you can say for NCB. An uncomplicated vaginal birth may be better for the mother – though I am not convinced that 100% uncomplicated is all that common if you take into account longer term/minor, consequences, but the idea that it is always better for the baby might turn out to be less certain. A baby might prefer optimum neurological condition to skin to skin.

        • Renee Martin

          There is one safer surgery- abortion.
          You won’t hear anyone bragging about this fact either.

        • Sue

          (I suspect suchende was quoting from the FB stream – in exasperation)

    • Studying CNM

      Risk of EOGBSD if culture unknown + risk factors = 1:120
      Risk of EOGBSD if culture positive + risk factors = 1:25

      Quite frankly I think this is a sure fire way of ending up with a STAT C/S (let alone the potential for a very compromised baby). A little blow of oxytocin could preserve her wish for a vaginal delivery and decrease the risk of infection. Yes, it will mean it cannot be at home. Yes, it will mean that cEFM will be recommended. And yes, it means that she will need to come to terms with the fact that her situation is not really favorable for a successful VBAC.

  • Holy shit.

  • fiftyfifty1

    Crystal Nieland is especially stylish in her ignorance. I love the way she dismisses GBS as a 3rd world problem. Well sure it’s more of a problem in Africa…because when women rupture there and don’t go into labor for days and don’t have access to antibiotics and pitocin, then the GBS has time to invade their babies and kill them. If you intentionally create a 3rd world birthing environment for yourself, then you can no longer wave away 3rd world outcomes.

    • suchende

      It’s really astonishing, isn’t it? What do you think happens in Africa, the sub-Saharan dust combines with the GBS to form a super-virus?

      • auntbea

        People on this board make me LOL.

        • suchende

          And then they say, oh, it’s diet. You mean all-organic, local, paleo foods? Hmm…

      • Certified Hamster Midwife

        Maybe it only affects people of African descent, like sickle cell.

        • It’s just further proof of their racism and cultural elitism.

          • suchende

            After africanbabiesdontcry.com I don’t know that further proof was necessary.

          • I wish you were kidding….wow.

          • CSM

            WTF does she mean by ‘African babies don’t cry?’

          • Sue

            Isn’t a significant percentage of the US population of African origin?

          • CSM

            Indeed! But I couldnt figure out her connection with African babies – the picture doesn’t look particularly African…maybe she lives in South Africa?

          • Pam Forma

            She is South African. Unfortunately we (also a South African…) also have those immersed in all sorts of woo. Luckily most are not.

          • LukesCook

            There are white people in Africa, just like there are black people in Europe…

            This blogger is particularly embarrassing. She makes the statement that African babies don’t cry (at least not the “traditional” kind) then goes on to say “Obviously I don’t have first hand experience with this… in fact the only thing that relates me to these Africans that practice attachment parenting so naturally is that I live in Africa.”

            Because, obviously, living in Africa is no reason to come into contact with Africans. Unless they’ve been safely Westernised first. I wonder if there’s an African woman who leaves her children at home to come and wash this woman’s cloth diapers?

          • CSM

            Reminds me of a fellow MW student, the typical white, Canadian-born, lawyer-married neoliberal girl who asked me what country I was from. After I replied, she cheerfully announced, “Oh really? Our cleaning lady is from the same country! She’s great!” I had no idea what to say to that but felt like shit for a while.

          • An Actual Attorney

            Carolyn Hax has the best response: a stone-cold flat “Wow”

          • Spiderpigmom

            I spent 5 minutes on this blog before I realized it was actually not a satire… Or is it? I’m still a bit unsure.

        • Eddie

          I know you’re speaking tongue-in-cheek, but FYI, there are groups of Italians and Greek with no African blood who also get sickle cell. It is predominantly a disease of sub-Sarahan Africans, but not entirely. I knew someone of 100% Italian descent in college who had both sickle cell and beta thalassemia major. She actually had people tell her it was impossible for her to have sickle cell since she wasn’t black.

    • Antigonos CNM

      I cannot be absolutely sure, never having read any data on this, but I don’t believe that GBS is the usual causative organism in amnionitis. Once the membranes are ruptured, it’s paradise for any and every organism in the vagina, once it ascends into the uterus, and, bacterially speaking, the vagina is a very dirty place indeed. We are dealing with two separate types of infection here: maternal sepsis resulting from the uterine infection due to the ruptured membranes, and GBS infection of the infant from passing through the birth canal.

    • Sullivan ThePoop

      That’s what they always say. Measles, only a problem if you are a malnourished child in the third world, but at the same time have this weird idealization of the third world.

      • Squillo

        Yeah. Aside from being racist, elitist (who cares about people in the developing world, anyway?) bullshit, it also assumes that no one in the “first world” ever has compromised health that could make measles more dangerous or that babies here can be born with other problems that would make any infection problematic.

    • anon

      The baby I took care of this year to a mother in similar circumstances (born at home, no GBS screen but positive in prior pregnancies) who went on to develop GBS meningitis didn’t die. He has seizures and shunted hydrocephalus, and will probably never walk or talk. Probably in sub-Saharan Africa he would, in fact, be dead, so, um, points for Crystal?

      • Renee Martin

        That sounds horrible. why do people think GBS is no big deal?

        • suchende

          Like every other risk factor, because modern medicine has too successfully insulated us from the scary realities of certain diseases.

      • :headdesk:

        I explained my son’s meningitis vaccine to him by describing what meningitis is, how fast it moves and how difficult it is to treat effectively in a very short time frame. It’s seriously scary shit.

        • EmbraceYourInnerCrone

          OT but speaking of vaccines, and people who are into woo: 800 people have come down with measles in Wales SO FAR this year mostly due to non-vaccination. For comparison last year there were 112 cases for the whole year:

          http://www.rawstory.com/rs/2013/04/19/anti-vaccination-campaign-blamed-for-massive-measles-outbreak-in-wales/

          They are running vaccination clinics now and there are many people rushing to get their kids immunized. i hope they realize that it takes ones immune system a little while to produce antibodies…

          • Dr Kitty

            A 25 year old man, described as a “devoted father” was found dead in Swansea this morning. Preliminary testing is positive, the post mortem next will confirm if measles caused or contributed to his death.

            Those people who decided not to immunise their children “just in case” Wakefield was right should be ashamed.

          • EmbraceYourInnerCrone

            Maybe it’s because I am in my fifties but I never thought twice about getting my daughter immunized. I am old enough to remember having chicken pox, mumps, measles (my older sister I was lucky in that the vaccine came out by the time I came along) I remember my cousin being hospitalized for meningitis which developed when she got chicken pox. My mother remembers her whole family coming down with scarlet fever and her 2 month old sister almost dying…

          • Certified Hamster Midwife

            I was part of the last generation where chicken pox was a rite of passage at some point in elementary school, and I’m in my thirties. So many women becoming mothers now don’t even have a memory of that. The worst childhood diseases they probably remember are colds, flus, and ear infections.

          • Allie P

            I had chicken pox. When my 1.5 year old brother got it from me, he ended up in the hospital. When my mother’s sister had measles as a child, she ended up deaf in one ear.

            Pass me the needle. My kid’s getting every shot there is to get.

          • An Actual Attorney

            I got chicken pox at 16. It was awful! I had pox down my throat; all over my vulva; and up inside my vagina. The only good side was I scratched the hell out of those: I figured whoever got close enough to see the scars shouldn’t care. I wouldn’t wish that on my worst enemy. Get a freaking shot.

          • Box of Salt

            I’m old enough to have a smallpox vaccination scar. My husband isn’t, nor are most grownups my kids (who are in elementary school) know well enough to get a good look at their shoulders.

            When my kids ask about it, I use it as a teaching point.

          • Dr Kitty

            I recently met one of the last people in the UK to get smallpox. She did not recommend the experience .

          • Wishful

            Your timeline for the chickenpox vaccine seems a little funny I am in my early 20’s and I know that shot didn’t come out until I was 12-13. I remember having it, and I have a positive titer. I think most the women becoming mothers now had chickenpox, but like for most people it is a mild illness (I mostly remember the baths…), I never even knew it could be a serious illness until I went to medical school and I think that is the problem.

          • The Bofa on the Sofa

            In what way is 10 days of incessant scratching with some fever, “mild”? Compared to the measles, maybe, but there is no way that we should characterize chicken pox as “mild.” It is very often a very miserable disease, regardless of how dangerous it is.

            You remember all those baths, but do you remember why you had them? Because you were feeling miserable! And you had so many of them because it lasted so long.

            For the most part, chicken pox sucks. THAT is the problem.

            Add in the fact the cost of chicken pox, and that just compounds it (someone has to spend 10 days at home with the sick person)

            You know what’s mild? Vaccine reactions. Predominantly redness and soreness at the injection site for maybe 24 hours. The likelyhood of anything serious is less than the chance of having something serious from the disease.

          • Eddie

            Chicken pox, as you say, is miserable. Except for when adults catch it, in which case it is miserable and also dangerous. Despite the lack of any immunization available when I was a kid, I never caught chicken pox. Both of my brothers came down with it within a day of each other when we were all adults. I was with them when they were exposed but I didn’t come down with it. No idea if I had a very mild case as a baby that wasn’t recognized as chicken pox (although such cases don’t usually confer strong immunity) or if I just got lucky. So last December I got the vaccine. 🙂

          • Wren

            My son, now 7, had chicken pox last year, after having been exposed many, many times. It was over the long 4 day weekend here last June and he was totally miserable. He wasn’t just itchy. He was in pain. His back was so covered in blisters you couldn’t tell where one ended and the next began. He also had a terribly high temperature for 4 days due to the accompanying ear infection, and the only way to get a doctor over the long weekend would have been to go to the emergency room for hours of waiting. Poor timing on his part, I guess. Another boy in his school was hospitalised with it the same weekend after he had a seizure. I thought the case I had as a child was terrible right up until I saw my son’s. I still feel incredibly guilty that we never went ahead and paid privately for a chicken pox vaccine, since it’s not on the schedule here.
            Why would any loving parent want to subject their child to this, let alone risk the worse complications that can occur?

          • Disgusted

            My son had the vaccine in 1999.

          • AmyM

            Yep, me too. I had chicken pox along with most of my brownie troop and 1st grade class. And I infected my sister. We got through it without complications, but what a nasty bug that one is. My boys have been vaccinated, and I hope they never end up with chicken pox anyway (i know it hasn’t been one of the most effective vaccines). Meanwhile, both my grandmother and mother had shingles, which was awful, and I am afraid for the day that happens to me. I am 36, so I’ve probably got a few years, but I think that just makes it worse—harder for older folks to tolerate infections sometimes.

          • The Bofa on the Sofa

            (i know it hasn’t been one of the most effective vaccines

            I wouldn’t say that. It is pretty much just as effective as the so-called “natural” immunity. Yes, it is possible to get the chicken pox after being vaccinated, but the chances are basically the same as getting the disease twice. Moreover, if you do get it, it is generally much milder than if you had not been vaccinated.

            Given that in the past, pretty much everyone got chicken pox somewhere in their lives, and now maybe 10% of those vaccinated will get a mild form, this is clearly a very effective vaccine.

            And the shingles vaccine works, too.

          • Squillo

            I’m in my 40s and never had chicken pox, despite multiple exposures. Before my first pregnancy, I had my titer checked (in case I had had a mild case and didn’t know it) and it indicated I wasn’t immune, so I got the vaccine. Bloodwork when I was trying to conceive my second also indicated I wasn’t immune, despite the vaccine. I’m technically one of those folks for whom the varicella vax doesn’t work. So I’m pretty happy when folks get their vaccines.

          • Eddie

            I’ve seen (over time) a lot of anti-vax people complaining about the chicken pox vaccine, because *most* (there’s that word again) people who got it had no serious consequence. Although in the US alone there used to be over 10,000 annual hospitalizations and more than 100 deaths (mostly in adults) due to this disease. Thanks to the vaccine, hospital admission due to chicken pox is down over 70% and fewer than 10 people die per year. But I guess “natural” is better, huh? I guess out of 300 million people, we don’t care about a few hundred preventable deaths a year.

            I had also heard the chicken pox vaccine was not as effective as many other vaccines (although still worth using, of course). But doing some research, it looks more complicated than that. It looks like natural immunity as well as vaccine-given immunity are both imperfect, and exposure to kids with the disease would help “revaccinate” adults who had already experienced the disease. Now that this pool of re-exposure is mostly gone in the US due to the successful vaccination campaign, booster shots *may* be necessary. (Like with tetanus.) However, as you say, even in cases where the vaccine “fails,” people get a much less severe illness than they would without the vaccine.

          • The Bofa on the Sofa

            I’ve seen (over time) a lot of anti-vax people complaining about the chicken pox vaccine, because *most* (there’s that word again) people who got it had no serious consequence

            You know what has even less serious consequences? The chicken pox vaccine!

            This is the really dumb part about the anti-vax argument. The chicken pox vaccine is one of the mildest vaccines out there, and has very, very little in terms of any sort of reaction. Serious reactions are really, really rare, and death is basically nil.

            You can’t say that about the supposedly “mild” disease.

            As I have said, compare the vaccine to the pox, and it isn’t even close. Only a monster could choose to inflict the disease on their kids given the availability of the vaccine.

          • Guest

            I had terrible chicken pox as a kid – it was the worst case my ped had ever seen – inside my nose, my vagina, my ears, my eyelids. I then got a mild case of it in highschool, about 8 years later. I always tell my anti-vax friends about this. Currently, many of my friends are looking for a chicken pox party to bring their young children to, and are excited that one of our friend’s baby may have the pox. Ugh.

          • Spamamander

            My middle kidlet got chickenpox despite the vaccine, but it was EXTREMELY mild. Just a couple of spots. She didn’t even really itch, and had a slightly elevated temp. That’s it. She has Down syndrome, and with it a mild cyclic neutropenia which might make it so she doesn’t develop antibodies as strongly (I’m not a doctor…) so that may have contributed to her catching it despite the vaccine. Or she could take after her dad, who already had the chickenpox as a kid, but caught it again from her. My other two kids didn’t show a single sign.

          • Disgusted

            Except for idiots like a certain friend of mine who actually bragged to me recently, when I made a blog post about “things that are a part of the past” and included chickenpox, that it is NOT a thing of the past, and all of her kids got it because she refused to vaccinate them. What do you even say to such idiocy?

          • The Bofa on the Sofa

            that it is NOT a thing of the past, and all of her kids got it because she refused to vaccinate them. What do you even say to such idiocy?

            Quote Tom Hanks from A League of Their Own: “What are you, stupid?”

          • Bombshellrisa

            I actually heard the “hospital is only 10 minutes away” anecdote applied correctly by someone talking to an antivaxer. The girl who does my hair has two children. the first had an allergic reaction to some vaccines. Some suggested she skip the vaccines for the second child because “who knows how badly he will react”. She countered with “hospital is ten minutes away”, She also pointed out that we are only a generation or two down from the ones where only a few children out of many born to a family survived to adulthood, and a lot of those children would have lived had they had access to vaccines. My husband’s favorite aunt has a whole host of health problems related to having polio as a child and she wasn’t the only child in the family of 9 to get it.

          • Eddie

            My youngest had a very strange allergic-style reaction to the 4 month vaccines. Hard, hot, raised red areas, a few inches in diameter, at the injection sites. (both legs) So we did the rational thing. We had her allergy tested against all of the components of all of those vaccines. No allergy found. We proceeded with all remaining vaccines on schedule. No undue reaction to any of them.

      • Allie P

        That poor child.

    • “f you intentionally create a 3rd world birthing environment for yourself, then you can no longer wave away 3rd world outcomes.”

      This. You can’t simultaneously count on modern high-tech medical interventionist safety standards whilst refusing to participate in those self-same modern high-tech medical interventions.

      • Modern high tech – and more CS – have reduced the casualties to the point where people have very little real knowledge of the risks. Statistics, especially if you don’t really understand them, look very reassuring. I spent some time trying to comfort my GBS+ daughter by quoting the risks, which do seem quite low statistically.. Sensibly, she would have none of it and made sure she got the antibiotics, despite the casual attitude of the midwives.

        Really, the idea that we should all support each other has to go. The pleas that we get here that if only we would explain nicely and stop being sarcastic everything would be so much better is …crap. Fairy stories are for children, and grown women should be “supported” to deal with reality, consider responsibilities as well as rights and stop demanding a right to blissful births regardless of the baby. Women should, of course, be listened to – but not necessarily deferred to if they are wedded to nonsenses. Cries of admiration and the Yah Boo look how natural approach should be attacked and derided by every sane woman, loud and often. If there are problems in hospitals, deal with them, don’t run away from them. If the comfort of your own home is more important, fine. Fancy your chances and accept that it is risky and stop trying to pretend it isn’t.

        • Disgusted

          “Really, the idea that we should all support each other has to go.”

          This. Totally. Not just on this issue but on many I am getting tired of this idea that I should be “tolerant” and “accepting” of other people’s idiotic choices, like not vaccinating their kids.

    • Squillo

      There are your garden-variety idiots, and then there are those who take idiocy to entirely new levels. Nieland may be the current title-holder.

  • Bombshellrisa

    “GBS scare tactics”? Facts are facts. If she was traumatized by a C-section, losing a baby that could have lived will surely make her wish she was dead.

    • Mona

      OBs just want to scare women into getting treated because they get kickbacks from the antibiotic manufacturers. OPEN YOUR EYES.

      • Petanque

        Really? What a convoluted way to make a living, Mona. Honestly, do you think that’s really true?

        • Dr Kitty

          Pretty sure that is sarcasm!
          The most valuable things I got from drug reps were pens, post it notes and a pen drive, and they’re not really even supposed to give those out any more.
          No junkets to high class hotels or fancy free laptops here.

          I’ve since made a decision not to see drug reps, so I get exactly nothing from them. Not all of us make money from drug companies, and as I’m paid a flat rate no matter what I prescribe, I have no financial incentive to prescribe anything at all.

        • Mona

          🙂 It was sarcasm. I’m a med student with a lot of “hippie friends”…they love to “inform” me that I’m a vaccine pusher and that doctors get kickbacks from them.

          • Petanque

            Oops, sorry Mona! Scary that it’s so close to the bone I missed the sarcasm, isn’t it?

      • Aussiedoc

        Really? Why did nobody TELL me. All this money I’ve been missing,

  • Mona

    It continues to astound me that people will listen to strangers on the internet with zero credentials, but refuse to believe their doctors. Eight years of post graduate training? There’s no way they no what their talking about. Skimmed an Ina May book once? Must be an expert!

    I’m a third year med student on my peds rotation right now…spend a day in the peds ER or NICU, and you will stop taking these things so lightly.

    • Antigonos CNM

      Couldn’t agree more, but risk denial springs eternal, and everyone knows someone who lucked out, so why shouldn’t I? I think I was very lucky in that, early in my career, I managed to see or be involved with a LOT of obstetrical catastrophes, and developed a very strong respect for the danger potential in birth. But hey, as I once heard someone say, “Birthin’s normal, man!” “Sho’ nuff!” [The two “midwives” who said this were stoned out of their minds at the time]

      • ol

        I found a good explanation of such interpretation of statistics – from http://debunkingdenialism.com/2012/07/06/the-role-of-motives-in-arguments/

        “It may be useful to look at the concept of substitution in cognitive
        psychology. It occurs when one is replacing the actual question with a
        question that requires fewer cognitive resources to answer. The classic
        example is when the question being evaluated concerns how common or how
        statistically likely something is. This is, for many, usually replaced
        by the simpler question of “how easy can I imagine examples” of this
        something. The answer most people give to the question “How common is
        crimes by a certain ethnic minority?” will depend on how easy it is to
        imagine examples that you know of it, usually corresponding to how
        frequent it has been portrayed in the media. This is called availability
        heuristics. Other examples of substitution is replacing “how likely is
        this product to succeed in the market place?” with “how much do I like
        it?”

    • Melodie

      I once asked for washing machine recommendations via FB post. Got a lot of useful info! Hmmm….maybe I’ll go that route next time my asthmatic daughter has ragged breathing and I want advice on whether or not I should take her to see a medical professional. My 11th grade locker buddy who is now a car salesmen may be able to help!

    • suchende

      But have you ever seen a normal birth?

      • Antigonos CNM

        Thousands. And more than “see”. I have worked in all branches of maternity care since 1968 to my retirement a year ago. And that includes about 50 homebirths, which I did as part of my midwfery training in the UK.

        • suchende

          Trick question. The only truly normal, intervention-free birth is a UC, and if a midwife saw it, it wasn’t a real UC.

          • T.

            I support it, as long as you will not request any kind of medical help if, say, you or your child need intervection*. Including life-saving intervection.
            I support your freedom to have your “normal” birth. And nod freedom is true without the freedom to take the conseguence.
            *(Including things like “I need money because my brain-damaged child need therapy”. You had an UC? You made your bed, you lie in it)
            How does this sound?

          • Poogles

            “*(Including things like “I need money because my brain-damaged child need therapy”. You had an UC? You made your bed, you lie in it)”

            Well, the mother made the choice for birth, not the child, and the child would be the one to suffer from denial of care. I could never support that.

          • Renee Martin

            Cruel and unnecessary.
            People do stupid things all the time. we don’t punish their kids because of it (well we shouldn’t anyway…)

  • Antigonos CNM

    Going to Facebook — not a site I normally use — what impresses me is not so much the stupidity of some of the commenters, as the fact that very few are really professionals in any sense of the term. Apart from myself and Dr. Amy, it does not seem that more than one or two are even nurses, let alone midwives [by that I mean, real midwives — CNMs] It is really a case of the blind leading the blind. I cannot imagine asking my next door neighbor for advice about which form of chemotherapy I should opt for if I were diagnosed [or diagnosed myself] with cancer, yet the original poster is asking for totally uninformed advice. What good is that?

    • BeatlesFan

      In this case, no idea since the original poster is asking about a friend. I find that typically, the person is asking about their own situation and they aren’t seeking advice so much as validation. They know, deep down, what they are doing (or not doing) is incomprehensible and stupid, so they post on a website where they have a very good chance of being told “You go, girl!” and then they can feel good about their shitty decisions.

      • Becky05

        Often they specifically ask for ‘support only,’ because they simply want their opinion confirmed.

        • What they have is not an opinion – it is a set of delusions. If you think you are Napoleon, I am not sure support in that particular delusion is terrible helpful. Nor in this.

          I went to a talk on the Mental Capacity Act the other day. A piece of legislation here that deals with the thorny issue of helping people to make decisions when they “lack capacity.” Do they understand the consequences? Do they have proper sources of information, etc? It is issue specific. No matter how “informed” or supported , this woman lacks capacity right now.

          The idea of drinking castor oil then sitting in a pool of tepid water is just too bizarre, and treating it with respect irresponsible bordering on criminal.

    • Becky05

      I wondered if that comment was you!

      • Antigonos CNM

        I’m currently visiting my son, and I guess, since he uses Facebook incessantly, and I never do, that when I clicked on Dr. Amy’s link, Facebook thought I was him. I am nowhere as good looking as my son. 🙂

    • Sue

      This (Amy’s) blog seems to have an unusually high rate of both health professionals and just smart, savvy people commenting. This is unusual in the open blog world, where having actual training in an area seems to brand you as arrogant and rigid. This certainly happens on the many anti-science sites like anti-vax and pro-CAM, where having both specific knowledge and experience in the area they are discussing makes you persona non grata because you are biased by your orthodox training, think you know everything, don’t respect other points of view and are just plain MEEEEEEN!!!!

      I’m being accused on another site of being a trouble-maker and “troll” by an architect who is opinionated about diet and obesity but, of course, sees no reason to back up his comments. I keep calling him out. (OK, so maybe I AM a trouble-maker – but definitely not a troll…)

      • auntbea

        Have you considered having opinions about load-bearing walls and building codes?

  • Antigonos CNM

    Actually, there are a surprising number of comments that are critical of the mother remaining at home.

    This woman has so many high risk factors that it will be a miracle if she and the baby come out of this at all without at least serious morbidity. Again, a situation where a previous birth, a “traumatic” C/S [whatever that was] is made to be the excuse for birth Russian Roulette.

    • Alenushka

      As far as roulette goes. Interestingly enough Russian Internets can;t find any credible source of that actually being a Russian invention. First description appears in American literate.

    • Renee Martin

      Most of those comments that said “go in” were from us….