Another maternal death: How the quest for the idealized birth experience continues to kill

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There’s denial and then there is something so desperate, so illogical and so ridiculous that labeling it denial seems grossly inadequate.

The story is simple and straightforward. A pregnant woman was facing a C-section because all the obstetricians she consulted advised her that vaginal delivery might result in the death of one of her twins or herself. She decided to ignore their warning and gave birth at home unassisted. She died of a massive postpartum hemorrhage. Whose fault is that?

According to a fellow homebirth advocate who was her friend, it’s the fault of obstetricians. Let me say that again to make it clear: She was warned she might die if she attempted a vaginal birth. She attempted a vaginal birth and died. But supposedly she bears no responsibility for the choice that killed her.

The story of this preventable maternal death, My Friend Died: A Story of How the War Over Women’s Bodies Continues to Kill, can be found in the appropriate named journal Squat. Everything in the journal isn’t worth squat. It was written by Nekole Shapiro who “focuses on oxytocin-infused states, birthing parts and healing birth trauma.”

Our friend died last year.

She was pregnant with twin girls that would be daughters number 3 and 4… When she was 36wks pregnant, I received a text message that the family had exhausted their search for a provider who would support her to birth her twins vaginally… [T]he couple had decided to do it on their own.

This did not sit well with me. This was not a family who said, We would like an unassisted vaginal home birth of twins. This was a family who felt they were left with no better option since no one would support them in what they saw as the best and safest option: a spontaneous vaginal delivery…

What happened?

Next thing I knew, I got a text that she had birthed her twins: spontaneous labor at 38 weeks. I was elated and couldn’t wait to hear more. But then the second text came: she had lost quite a bit of blood and was in a coma…

Initially, the mother’s prognosis was unclear. Unfortunately:

Then they reported that there was only brain stem activity…

The next update I got was via this Facebook post, “[My wife] has not, and will not, wake up again. She has been moved to a room where she will be kept comfortable until the end.” Some days later she passed away.

Nekole grappled with tremendous cognitive dissonance:

At first, I was quite shaken by these events and I knew others would be as well. I knew people would quickly say, “See, you can’t trust birth. Birth IS inherently dangerous. How dare you be one of those people who support anyone thinking otherwise! See what can happen?” But, I also knew that this is one story of many and I did not want my raw emotional state to start dictating my view of the world. I reminded myself that many people die in car accidents, but we have not outlawed cars.

We don’t go around pretending that driving cars is “as safe as life gets,” either.

But cognitive dissonance is hard. Denial is easy:

Ultimately, this story is a horrific reminder of our broken system. If we walk out of a birth with this type of unfathomable outcome when in fact all the support needed was present, that is one thing. But, to have this outcome with a complete lack of support, that is simply unacceptable. Our system should be designed and focused on supporting mothers to birth the way they feel is best for them!…

No, no, no. This is not a horrific reminder of a broken “system.” It is a horrific reminder of a broken philosophy, the philosophy of natural childbirth.

Natural childbirth advocates encourage women to value process over outcome. They encourage women to seek an idealized “birth experience.” They encourage women to reject medical advice in favor of “intuition.” They encourage women to risk the deaths of themselves and their babies and as a result, women and babies die preventable deaths.

Obstetricians do not exist to provide support. They exist to provide safety. Women ignore them at their own peril. They have every right to do so, but let’s at least be intellectually honest enough to acknowledge what actually happened. A woman ignored the lifesaving advice of obstetricians and died as a result.

The people who bear responsibility for the outcome are not the people who warned her; the people who bear responsibility for yet another preventable death are the mother who made the choice, and the natural childbirth community who encouraged her to pretend that women are “perfectly designed” for childbirth, that obstetricians should not be trusted, and that women should make complex medical decisions by relying on intuition instead of education and training.

A philosophy that encourages women to value process over outcome is a philosophy that inevitably kills women and babies. Unfortunately, Nekole’s friend died as a result of that philosophy and left 4 motherless daughters as the true victims. Too bad Nekole and the editors of Squat didn’t learn anything as a result.

  • The Friend

    And that is your opinion Dr Amy. One that is very narrow and bias. You clearly did not get the point of the article as well you do not know all the facts. I am a close friend of this family. They were totally willing to go to the hospital with an OB……However the 3 different OB”s were more concerned about the liablilty to themselves than looking at the facts of this woman’s history etc.
    You dear one are a perfect example of how the system is broken…..void of all empathy, compassion and respect for the mother and her knowledge of her body.

    • guest

      empathy and compassion for the mother yes. respect for the mother’s knowledge of her body, no

    • guest

      But even if the OBs were “more concerned about the liability,” then that means they were concerned about a bad outcome. Personally, I think most OBs I’ve met are actually far more compassionate and concerned about women as individuals than midwives, many of whom are very dogmatic and not concerned with the needs of an individual mother and baby. But even if you think they are totally heartless and unconcerned about women as human beings, if they are worried about “liability” and thus want to do a C-section, then they are worried about a bad outcome happening. People don’t sue over peachy-keen outcomes, so if the OB is worried they need to do a C-section to prevent a lawsuit, then they are in fact worried that things will go badly for mom and/or baby.

      • AndreaRealMPH

        I knew midwives before I knew OBGYNs andhad heard the whole spiel about how awful OBGYNs were. I went to a midwife and she was the pits. Terrified, I avoided routine GYN care for at least three more years. Then, surprise! I went to an OBGYN in another town and It. Was. Great.

    • Jocelyn

      Your sentence isn’t quite finished. You say: “They were totally willing to go to the hospital with an OB……” That should read: “They were totally willing to go to the hospital with an OB, provided that the OB ignored their educated and experienced reservations about the safety of a vaginal birth for this mother.”

    • Karen in SC

      Her knowledge of her body? It’s quite tragic she missed a chapter or two.

      • The Bofa on the Sofa

        Wait a minute, the whole reason we are talking about this case is because the mother had a serious complication and died, right? I gotta say, it is the utmost of idiocy to come back with how the doctors should have respected the mother’s “knowledge of her body.”

        I know this is going to sound harsh, but, um, her knowledge of her body was obviously WRONG.

        How can anyone defend it?

    • Yves

      She ignored medical advice! Maybe the reason she couldn’t find anyone is because they all knew how very unsafe it was! And wouldn’t you know… it was. Instead of pretending you have a medical degree, you should listen to those that actually have one. I am pregnant now, and would never attempt something 3 separate doctors said was unsafe. I am sorry for her family’s loss, sounds like if anything she was brainwashed by the “natural” birth community. That said, it was a choice she made, knowing the risks. There is no one to blame but herself.

  • Glad to visit your site. Thanks for this great post that you
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  • Fran

    It might interest regular readers of the blog to know that Miss Amy Tuteor, aka “amateur,” aka the made up persona for industry friendly homebirth fear-mongering… was kicked out of the science-based medicine group. “Her” peers are not into her absolutist statements that are never backed up by references or data. “Her” only attacks are to say that everyone who disagrees is ignorant and stupid and that “all the science says so.” She never bothers to elaborate on that are provide any supporting sources. She just assume that you are all too stupid to understand. (Or… she’s just full of bs, which is really more likely.)

    http://theskepticalmother.blogspot.com/2011/10/will-real-dr-amy-please-stand-up.html

    http://www.sciencebasedmedicine.org/index.php/dr-tuteur-has-decided-to-leave-science-based-medicine/

    • Amazed

      It might shock the newcomer who dropped by to enlighten us because she fancies herself so clever but we are well aware of Dr Amy’s relationship with SBM. We are also aware of who the Skeptical Mother is – Sammy who regularly drops by and presents ridiculous arguments hiding under several nicknames.

      But thanks, anyway.

    • PJ

      I know the ant-Amy brigade make it a point NEVER EVER to read what she writes, but she actually regularly discusses research papers. So if you really are interested in evidence, why not sit down and actually read some of those posts?

      • Bombshellrisa

        Don’t you wish you had a red correction pen to mark the post? I do. People who wish to make a logical argument ought to proofread what they have written. Punctuation and spelling still count for a great deal.

    • auntbea

      Wait, we’re putting “her” in quotes now, too? So she’s not only no longer a doctor, she’s secretly a man?

      • Bombshellrisa

        Even if Dr Amy was a he AND was removed from the Science Based Medicine Group, it doesn’t change the fact that homebirth is dangerous and the midwives who attend homebirths are injuring and killing mothers AND babies.

        • FormerPhysicist

          AMEN!!

    • Squillo

      Miss Amy Tuteor [sic], aka “amateur,” aka the made up [sic] persona for industry friendly [sic] homebirth fear-mongering . . . “Her” peers are not into her absolutist statements that are never backed up by references or data. . . . [s]he just assume [sic] that you are all too stupid to understand.

      Irony, thy name is Fran.

    • The Bofa on the Sofa

      Oh come on, can’t you do any better than that? Amy Tuteor (sic) = amateur and “her” in quotes? That’s pretty weak.

      I hereby decree a “make fun of Dr Amy better than Fran did” contest. I’ll start:

      “Dr” Tuteur is just an old washed up gas-bag. She should just change her name to “Tooter”

      • Eddie
        • Squillo

          That’s great! I especially liked: “Will everyone who advocated for evidence-based care please leave the room” and “Now, what were you going to say about vaccines?”

          • Eddie

            Too funny. Yeah, her video was much funnier than this one.

      • Squillo

        Ooh, can someone please do a Downfall video?

    • Karen in SC

      How can a made-up persona file a lawsuit in a Massachusetts court?

    • Captain Obvious

      What’s more embarrassing than coming to a blog to make fun of and try to warn blog followers about the blogger is to be totally wrong in nearly everything you posted and to have the blogger leave your comment there so everyone can see what an idiot you are.

  • yentavegan

    is it possible that this mother had a precipitous labor and that her babies were born before they could get to a hospital?

  • Lori

    Wow, hard to imagine how that family will begin to explain the loss of their mother to those girls. Really sad.

    I went to the link and read the friend’s article in its entirety and found the hints towards them not knowing enough to do more immediate skin to skin and how that may have changed the outcome really frustrating. Especially when the article was devoid of any real acknowledgement that this tragedy most likely would have been prevented in a hospital.

  • TheSadOB

    Impressive to me is the idea of “researching”. Ms Shapiro appears to believe that Hemorrhage occurred because the couple didn’t research hemorrhage thoroughly enough — despite having researched home birth, twin delivery, breech delivery, and shoulder dystocia. If only we had known more about hemorrhage than it wouldn’t have happened? And what is this about the head-in-the-sand idea that if no one had panicked, that oxytocin would’ve prevented the blood loss?? Ludicrous. Total fact-deficit.

    Why is it up to the family to research every complication? Ms Shapiro has been a home birth advocate for years and still didn’t appear to know the profound risks of twin delivery at home. Neither, unfortunately, did her “expert in normal birth”.

    Not all birth related complications are preventable. This one was. My sympathies to the children and surviving husband for the loss of their mother and wife due to the malpractice, maddening incompetence, and mind-numbing negligence of their well-intentioned but clearly moronic care providers (including the ill-informed advisor Ms Shapiro).

  • deafgimp

    Am I the only one who has this problem with the site? The theme has black at the bottom, and the comments continue into the black with dark grey text. It’s really difficult to read and I usually give up when I hit that spot, I only finish the comment that I’ve already started reading if it goes into the black.

    • TheSadOB

      same for me. using google chrome

      • deafgimp

        Yeah, I use Firefox as well. This is so frustrating!

    • Jocelyn

      Same for me! Also using google chrome, and it does the same thing on Mozilla Firefox.

    • Box of Salt

      Tips: when you scroll to the far right of a comment, little grey icons appear. The minus sign will shrink them along with their replies. This can help pull things back into white part of the page.

      • AvalonS

        I hit control-a to select everything and read it highlighted. =)

      • Lisa Cybergirl

        Thanks! This has been driving me crazy FOREVER! It never occurred to me to just collapse the threads – it’s always a tiny little simple thing like that, isn’t it? XD

      • Lisa Cybergirl

        In case anyone wants a picture of how it works:

  • I don’t have a creative name

    This didn’t have to happen. These 4 girls will never have their mother because of all the NCB tripe out there, tripe that this poor woman naively bought into. Hope you’re proud of yourselves, MDC’ers and all the rest of you.

  • Bomb

    Has there been a post on oligohydraminos? I googled “low amniotic fluid” today (the latest bumb in our pregnancy road)) and immediately a bunch of dubious stuff popped up from the usual sources (Gloria Lamay, an article about ‘overcoming’ it on a site addressed at ‘mindpowerworld’, science and sensibility, etc).

    If there hasn’t been a post it looks like fertile territory.

    • Lizzie Dee

      How far along are you, Bomb? I hit that bump too, and like you had no clue what it meant. A complicated pregnancy is one long journey of finding out things you had no clue about previously – which is why I find “I am informed” a bit hard to believe.

      All of these signs that might mean this, or might mean that, or might have no significance at all. Hard enough for doctors to figure it out and get it right, and it seems to me that it is experience of complications that makes the difference. If all you have ever dealt with is straightforward and uncomplicated then how can you judge? An expert in normal birth is of very little use once Mother Nature gets playful. I’ll take a nervous nellie who doesn’t take chances any day, thank you.

      • Durango

        I suppose that’s one of the appeals of NCB-land: since everything is a variation of normal, you’re much less likely to hit a bump in the road, because, well, bumps are normal.

    • Captain Obvious

      Low AF
      Amniotic fluid exchanges daily. Fetal urine, tears, saliva, sweat, and lung efflux as well as transudation across the cord and placenta add to the volume. Fetal swallowing and reverse transudation and ROM can subtract from its volume. AF allows room for growth, development, and movement. Aids in pulmonary development and has antibacterial properties. AF peaks at 34-36 at about 1000ml and then gradually declines as placenta function deteriorates.

      Oligohydramnios is associated with congenital abnormalities like renal agenesis and other renal abnormalities, fetal anuria, chromosomal abnormalities, IUGR, PROM, post maturity, HTN, and preeclampsia. Complications of this can lead to cord compression and fetal hypoxia, limb contractures, pulmonary hypoplasia, increased infection risk, and thicker meconium, poor fetal outcome.

      When some discuss low AF, the usual response is to drink more fluid and you’ll be fine?! Really? The study usually refered to suggest that women who are dehydrated may increase their AFI by 2 or maybe 3 at best. When your AFI is 4, this doesnt help much, does it. Well hydrated women did not show increase in AFI volumes. And most women are already well hydrated so I wouldn’t expect any improvement. It doesn’t matter how much fluid your drink if your placenta is no longer able to transfer it to the baby.
      I just cannot understand why so many don’t appreciate the risk for a failing placenta calcifying up, not being able to transfer fluids and nutrients to the baby, leading to shunting of blood and fluids to the fetal brain and core from the extremities leaving the baby to have restricted growth (asymmetric IUGR), contractures, and risk cord compression.

  • PollyPocket

    What a horrible tragedy.

    My first thought, after getting over the initial shock of the outcome is how similar that is to my experience with back pain patients. Many of them want narcotic analgesics, which have been shown in numerous studies to be a very poor option. They do not improve outcomes, and the risks are quite staggering when looking at a population-scale. But patients may go from doctor to doctor and be told the same thing, “no.” They may choose to take matters into their own hands and obtain narcotics some other way, after being informed of the risks. And often, the outcomes are tragic.

    I have never heard of the providers who refused to write prescriptions being blamed for the ultimate outcome.

    • fiftyfifty1

      “I have never heard of the providers who refused to write prescriptions being blamed for the ultimate outcome”
      No, not legally, but patients do it all the time informally. When I tell a chronic back pain patient that they are a poor candidate for narcotics and that I will not prescribe them in their case, they not infrequently say “Well then I’ll buy them on the street then!” and flounce. But you’re right in that if they do end up overdosing, their friends don’t claim that it is your fault in a blog post. They see the addiction for what it is.

  • Bomb

    Today we are celebrating my daughter’s third birthday. She is alive and well thanks to the care of doctors I’d never met before I dumped myself at the hospital following an attempted home birth. I am continually sickened to think what would have happened if I’d trusted my midwife, trusted birth, trusted ANYTHING the NCB people said. If I’d entrenched myself in message boards and developed a sense of ‘community’ with these people. Gone to the echo chambers and heard all about what was ‘normal’. What June 3rd would be like the rest of our lives? I am so grateful to the on call OB, to the nurses, to everyone that helped us. I do not have the words to express how thankful I am that we were eating donuts and playing in the sun this morning, instead of visiting a grave.

    I don’t care how magical home birth can be, it just isn’t worth it.

    • BeatlesFan

      Happy 3rd to your daughter! I don’t know if you have any older kids, but if you haven’t experienced “the threes” before, all I can say is: good luck to you! 😉

    • Susan

      Happy Birthday!!

    • Amazed

      Happy Birthday to your daughter!

    • Bombshellrisa

      But it sounds like you had a pretty magical morning and you will have many more magical moments with your little girl! Donuts (were they Top Pot donuts?) and sunshine-sounds like fun!

  • BeatlesFan

    Pardon me for not asking this question on the relevent thread further down, but I didn’t want it to get lost in the shuffle.

    A few posters here have mentioned the mother in this post could have gone to the hospital and refused a c-section in order to have a TOL. Bofa then brought up the sleaziness of such actions, as the parents could then sue to OB if something went wrong. My question is this: I know a consent form must be signed in order for a c-section to be done; if the OB in charge of a laboring woman strongly recommends a section and said woman refuses, is she then required to sign a waiver, or anything similiar which would protect the OB/hospital if things go pear-shaped?

    • Susan

      No. Though in classes it has been recommended that you do ask someone refusing lifesaving care to document the refusal. I saw a doctor do this once-write up the risks of her refusal and ask her to sign it. The patient changed her mind and consented! But you can’t refuse to care for patient who refuses something you recommend. She could sue you for abandonment. This is especially true of labor patients who are covered under EMTALA. What they tell you to do is document everything carefully in such a situation. But the patient still could sue if things didn’t go well and say she really didn’t understand the risks and that they were not explained in a way she could understand.

      • Haelmoon

        I have had this happen to me before. I approach it with lots of documentation, but I also dictate a note into the hospital record and do so in front of the patient, so they know exactly what I was saying. I comment in the dictation that the patient is right next to me. Most times, they have consented then. I have one patient who refused and does have a compromised baby. That was during my residency, I have yet to hear anything of it.

    • EB151
    • CanDoc

      I have had women refuse cesarean section twice. Both times I clearly explained risk of death/disability for baby/mom, documented in chart, and asked woman and partner, “Tell you that you understand that if we don’t get your baby delivered, I think that it may die or have brain damage.” One family consented and had a cesarean for a mildly acidotic but live baby who did fine. The other couple I still refused and I called in a second OB to provide a second opinion (same as mine), which was also extensively documented, and she in fact had a vaginal delivery of a mildly asphyxiated baby who required extensive resuscitation and a NICU stay but ultimately seems undamaged so far… and who of course thinks I’m an idiot because I didn’t trust birth and her baby is just fine.

      • fiftyfifty1

        Thanks for doing what you do.

      • Ali

        If years from now, the second couple’s kid can’t learn high school math or have the focus needed to pursue their dream career, I wonder if it would occur to the parents to feel any responsibility. Sadly, probably not. Why are people so much more cavalier about their children’s brain cells during their birth than at any other time?

        • Lisa from NY

          Or if the kid is “slower” in school than the rest of the class and gets made fun of. There is so much emphasis on mainstreaming but bullies will have their fun.

          • Amazed

            It’ll be the mainstream teachers’ fault, don’t you know? Or a vaxxed kid breathed over theirs once and infected him with a brain-destroying substance.

      • The Computer Ate My Nym

        An extensive resuscitation and NICU stay and she thinks everything was “just fine”?

        • fiftyfifty1

          Everything is more than “just fine”, silly! Don’t you know that this is how Indigo children get made?

          • The Bofa on the Sofa

            I’ve said it before, and I say it again. The reason that we have so much trouble communicating with these folks is that they live in an alternate reality.

            Who cares about a NICU stay, as long as it all turned out in the end, then it was all good? It’s a concept that I can’t grasp, because my objective is to AVOID emergencies, and not hope that we can make it through them.

          • Eddie

            Part of the alternate reality is this: That everything turned out fine means the NICU stay was unnecessary and was just a money grab by the hospital.

          • fiftyfifty1

            To embrace the Wisdom inherant in Freebirth you need to free your mind to make the quantum leap. You need to stop disparaging the Non-Rational as a way of Knowing. I have faith in you, Bofa! It may take you light years to open your mind to the truth, but the Godess has all the time in the universe and She is waiting.

          • The Computer Ate My Nym

            Ironically, these are the same people who will go on and on about how doctors never do anything to prevent disease…

    • ratiomom

      I have had this happen on occasion. This is a very crappy situation to find yourself in.
      If a patient in his/her sane mind refuses to have surgery, there is no way you can force them to have it. The important thing to do is document that you explained to the patient what the consequences of the refusal are, and that the patient understands. Writing up the risks in a very clear simple language and asking them to sign it is a good way to do that. In case of a laboring woman, I`d probably have her partner sign it as well.
      She`d probably have gotten het TOL if she had played it this way. I don`t see what else the hospital could have done. They can`t operate without her consent and they can`t abandon her care either.

    • The Computer Ate My Nym

      There is no absolute protection from a lawsuit. Patients who refused to consent to necessary procedures repeatedly have successfully sued for damages based on failure to perform the very procedures that they refused. But documenting the refusal decreases the risk that you’ll be sued successfully.

      • BeatlesFan

        I have read (on this site) of at least once instance where parents refused an emergency section, baby died, and they sued, claiming they “didn’t really understand the risks”. Which as well all know is BS, because if you sign something without understanding it- hey, that’s on you. I wonder if anyone has sued after a c-section, claiming they didn’t really understand the consent form? I imagine parents who tried to sue after signing consent for a successful c-section would be laughed out of court… I don’t see why a form spelling out the risks for refusing treatment should be any different. Then again, I live in a country where a burgler can sue a homeowner if their dog bites him while he’s breaking into their house, so…

        • The Bofa on the Sofa

          Which as well all know is BS, because if you sign something without understanding it- hey, that’s on you.

          You’d like to think so, but not really.

          Moreover, you need to protect against unscrupulous providers, who will, if not straight out lie, will very carefully stretch the truth.

          It’s really easy for those providing services to mislead clients. For that reason, the law makes it clear that no one ever waives their right to sue.

          And it is the right thing to do.

          • Lizzie Dee

            And, of course, you cannot waive the BABY’S right to sue.

            One does wonder how brave the midwives would be (or the mothers either) if they faced up to the reality of financing expensive lifelong care. Though dead is cheaper and more likely at home.

          • The Bofa on the Sofa

            Hey, we already know that midwives aren’t willing to put their money where their mouth is. Remember, “malpractice insurance is too expensive!!!!!”

          • Jennifer Clark

            They don’t know unless they get a quote. Remember, quotes are free.

        • The Computer Ate My Nym

          I think a person who had a c-section would only have a case if they could demonstrate that they were harmed by the c-section and that the situation was such that performing the c-section was not standard of care. This is harder to prove since there are few situations where a c-section at or near term is not an acceptable mode of delivery. (Though I may have this wrong…maybe the OBs can comment.)

  • An OB/Gyn Resident

    What bothers me the most about this is that she still could have given birth vaginally in the hospital. She chose to give birth at home because apparently being supported in your choices is more important than the outcome. She could have shown up to the hospital in labor and refused a c-section. We can’t do a surgery without consent. Sure, she would have have been spoken to ad nauseum regarding the fact that she was proceeding against medical advice, but we as physicians can’t refuse to care for her at that point. She would have gotten her vaginal delivery and perhaps her children would still have a mother. 🙁

    We had a patient refuse a c-section despite a strong indication for a cesarean section at 37 weeks. She delivered vaginally at 41+ weeks – thankfully for her without incident. She still chose to deliver in the hospital despite it being extremely clear that none of the medical staff supported her decision.

    • The Bofa on the Sofa

      I find it mind-boggling that you all are talking about this like it is really a viable option.

      Oh sure, you can do it, if you want to, but that is a really, really sleazebag act. No wonder doctors don’t trust NCB folks, if they are going to seriously contemplate playing this type of idiotic manipulation games.

      It really disgusts me.

      • Anj Fabian

        I loathe it mostly because the NCB folks not only acknowledge that the medical folk are required by law to care for them, but they celebrate it.

        In a way, I’m glad that it’s an NCB tenet that the medical establishment is a safety net because it means that even those deep in the woo know that they can always show up in the ER and be cared for. Making it clear that it’s ALWAYS an option means that people will use that option, even reluctantly.

        However, framing it as punking or pwning the medical establishment by showing up ready to push is needlessly antagonizing and doesn’t help the larger relationship between NCB and conventional medicine.

        • The Bofa on the Sofa

          Thank you for your concern, but that’s what it is.

          It is a manipulative game, and a punkass act. That doctors put up with it is a testament to their profession and dedication, but the people who deliberately pull this shit are slime. There is no other way around it.

          I’m not saying that the practice shouldn’t be done, and it is because doctors have ethics. The folks pulling this shit? Not so much…

          • Anj Fabian

            There’s an obvious ethical gap between people whose jobs depend on adhering to a professional code of ethics and those who don’t.

            Quacks, charlatans and snake oil sales reps are in their line of work specifically to avoid oversight. (Orac has been covering Burzynski again.)

          • The Bofa on the Sofa

            But these aren’t people doing a job. These are aholes who taking advantage of people who do their job.

            And for the folks here to talk about it like it is a viable option really disgusts me.

            Any discussion of it should consist of

            1) Yes you can do it

            2) Only a real sleaze to do it intentionally

          • Eddie

            Here is my (perhaps weak) analogy:

            You go to a steakhouse and ask for your meat uncooked because that is how you like it. The waiter politely points to a note on the menu explaining the risk. You say the waiter is being rude and demand another waiter.

            The next waiter comes and you demand your meat uncooked. The waiter carefully explains that there have been parasitic diseases caught, recently and in this area, from undercooked meats. (e.g., TOL is not indicated in your specific case) You get angry because you’re the customer and the customer is always right. The waiter says OK.

            The chef comes out and explains that he doesn’t want to give you uncooked meat because of the risk and because he’s seen instances in the last two weeks. You pitch a fit and demand it anyway. The chef gives in.

            You get a parasite and sue the restaurant, the chef, and both waiters. If only they had trusted natural foods, uncooked the way we are supposed to eat, you wouldn’t have gotten ill. OR. You get lucky (and those idiots clearly didn’t know what they were talking about).

          • Squillo

            Exactly. Docs are expected to take responsibility without exercising any authority. Homebirtth midwives expect to be treated as authorities without taking any responsibility.

      • fiftyfifty1

        Well it IS a viable option. Sure it’s immature and unethical. Duh. Yes it’s disgusting and maddening. Duh. But it’s a viable option in the end.
        What other option is there? Forcing docs to somehow be willing to do what they are not willing to do? Ridiculous. Forcing c-sections on women? No. Turning women away from the ER? No. Having a situation where a doc just gives the woman a “I understand the risks” waiver to sign and then is legally off the hook? You yourself previously have pointed out the very real problem with a plan like that –it could leave patients at the mercy of a poor or lazy doctor. So what other option is there? Reducing the demand for this crazy NCB by attacking the sources like B.O.B.B. and Gaskin etc. is a good place to start. But there will always be a few wingnuts.

        • The Bofa on the Sofa

          What other option is there?

          Follow the doctor’s advice.

          DUH

          • fiftyfifty1

            Nobody here disagrees with you about it being a manipulative, immature, sleazy, annoying, you-name-it move on the part of the mother. But what I can’t understand is that you can’t understand why we physicians are “talking about it like it is really a viable option”. It’s a viable option because it’s reality. Don’t you think we’ve already tried to get the woman to “Follow the doctor’s advice”? In these extreme cases we are far far beyond that, and telling us what women “should” do is nothing more than an annoying game of “If I Were King for a Day”. It comes down to this: A woman showing up in high-risk labor refusing a c-section is a nightmare. But it is far from the worst nightmare doctors have.

  • Eddie

    Here’s how I look at it. If EVERY doctor you ask gives you the same answer, maybe, just maybe, the problem isn’t the doctors, but it’s you. This seems like people who have bad relationship after bad relationship and blame the whole other gender as being bad.

    • The Bofa on the Sofa

      “The common denominator in all your failed relationships is you.”

  • Lisa from NY

    Look at the positive side of things. As more women choose to remove themselves from this earth by sheer stupidity, they make their husbands available.

    Isn’t there a shortage of good men?

    • Lisa from NY

      Profile on Match.com: My wife died attempting a home birth, and I want a rich woman who will do the same.

      • EB151

        That’s cruel. Four little girls are motherless because their parents made a terrible mistake. They are real people and deserving of our compassion, even if we think they are responsible for the situation. Especially because we think that.

        • Certified Hamster Midwife

          I have one of the darkest senses of humor you’ll ever see, and am approaching middle age single and childless, but this is cruel even by my standards.

        • Lori

          Thank you! Her comment just above grossed me out but this one literally made my jaw drop. Just not at all funny.

    • Guestll

      Assuming that all women who die attempting out of hospital birth are stupid, and that their husband’s aren’t in any way complicit, are we?
      We do a huge disservice to these women, stunt-birthers or not, if we automatically assume they’re stupid. Some of them are. Some of them aren’t. And there’s a difference between ignorance and stupidity.

      • Lisa from NY

        True.

        I spent months trying to convince my neighbor to have her baby in the hospital, and her response was, “God only expects me to do it the natural way.” I gave her articles to read and she said, “I only want to be around positive people.”

        At what point does ignorance border on stupidity?

        (P.S.: She nearly died of PPH, as mentioned elsewhere.)

        • Susan

          That must have been weird to have a neighbor having a homebirth. I bet you were scared they’d be asking you to come over if things hit the fan. We used to get “only positive comments” on birth plans all the time. I think it goes to the cult like nature of things. It’s a “thought stopping” technique found in any cult where the very thing one needs to do to escape the group is forbidden.

          • BeatlesFan

            “Only positive comments” = “I can’t handle criticism or the slightest implication that what I want might be wrong.”

            Granted, I never wrote any birth plans, so I never had my wittle speshul snowflake feelings on the line.

          • Lisa from NY

            The father notified us at 1 o’clock in the morning to babysit their other child so the mother could go to the hospital with no advanced notice and no way to know when he would return. Weird it was. And this child and newborn might have been left orphans. I am still angry at her.

            This story of the twins reminds me of what could have happened. These unfortunate orphans will never know their biological mother.

        • EugeneMom

          There are people in this town that won’t even be around you if you don’t like HB, even when you have everything else in common, even if you had been “friends” for years. Seriously- their thinking is that you make them feel “unsafe” just by your mere existence.

          They don’t want your “respect”, or just agreeing to disagree and not talking about it. Nope. You have to promote their beliefst is baffling and tell them it is wonderful, and support killer MWs. Having the attitude of “your body your choice” is not enough. I.

      • Susan

        I believe that many women who choose homebirth are smart, educated and perhaps just not sufficiently skeptical about “woo”. For instance, who on earth could read Magnus’s story, or the Dr. Biter homebirth loss, or in fact most of what’s on hurt by homebirth, and say it’s because the parents weren’t smart enough. It’s really like Dr. Amy said here, the home birth world needs to be challenged, just like the hospital birth world is, to have standards and ethics. Hospitals aren’t perfect, nor are doctors and nurses, but we have oversight, and tons of it. Why is Biter turning to midwifery, because the medical board did something about him. I’d like to see the standards that AAP set be strictly implemented. There would be lots of wailing if all midwives had to have a university level education and meet those standards, but they’d only be having to meet the same standards that the rest of us do. It wouldn’t get rid of all homebirth tragedy, but fewer women would fall through the cracks thinking that a license to practice midwifery means something it doesn’t.

  • Isilzha

    “My mind, just kept saying, “This is what is NOT supposed to happen!” But in fact, it had happened.”–yeah, reality often bites.

    • Stacey

      Um, it WAS SUPPOSE to happen! EVERY single professional called it. If I was a betting person, I would have gone with the docs advice.

      Only someone in serious denial would think this wasn’t “suppose” to happen. Of course it was. It was easily preventable, but certainly not surprising.

  • Isilzha

    Do these people also not realize all the safety improvements cars have had over the years? Can you imagine how dangerous cars would be if there had been no improvements on safety and designers only cared about the speed, style and comfort of the vehicles? How many people would be dying without safety glass, crumple zones, safety belts, and air bags? So, no, we haven’t outlawed cars, but we have made laws and changes to improve safety.

    Also, all states have laws about what types of vehicles can use the roads. If a vehicle doesn’t meet those requirements then it’s suppose to stay off the roads.

  • theadequatemother

    I’m pretty sure she could have had a TOL in hospital…all she had to do was SHOW up at the hospital in labour. The docs would have been obligated to care for her and she could have refused consent for any surgical intervention right up until the point where she passed out and became unconscious and decision making passed to a substitute.

    its not the medical systems fault. The fault rests with the primary decision makers in this case…and they made a very bad decision with horrendous consequences. Reading the source material for this post I was absolutely blown away by the ignorance…surely someone who likes to spend their time “birth dancing” should not be so stunningly ignorant about things like PPH? Because she is so ignorant, she has no place opining about “what went wrong” and should have limited herself to memorializing her friend.

    • GiddyUpGo123

      Yeah, that’s a really good point. I remember when I was scheduling my second c-section, a friend of mine advised me to forget the c-section and just labor at home until the very last possible second, and then go into the hospital because “the hospital isn’t going to turn you away and they can’t force you to have a c-section.” To which I just stared at her blankly, because having done it both ways I frankly preferred the idea of a c-section, certainly a lot more than the idea of being at home without pain medication for many hours before dragging my sorry butt into the hospital. But really, I’m pretty sure my friend was right … I don’t think they’re going to turn you away if you’re in active labor and you don’t *have* to consent to a c-section. So even though it would have still been a stupid choice, it wouldn’t be quite so stupid as doing it at home alone.

      • Guesteleh

        I discussed this above but to reiterate: my ob was on call when a woman showed up at the hospital in labor with a footling breech that she eventually delivered vaginally because she refused CS. Baby spent 6 weeks in the NICU but survived.

    • Box of Salt

      I absolutely agree.

      I will add:

      To the family discussed in the linked post, I would like to offer my condolences.

      To the author of the post: I would like to suggest you quit teaching anything until you have actually learned something about anatomy and physiology – and before you endanger more lives.

    • The Bofa on the Sofa

      I’m sure that would go a long way to address the problem of
      “how to increase trust between OBs and patients” discussed below.

      Of course, the beauty of this approach is that you can still sue the doctor if something goes wrong.

      Gotta say, it is about as low and sleazy as you can get.

      “My doctor doesn’t think it is safe to do a TOL, so I’ll manipulate him and get it anyway.”

      Yep, pretty much the picture of a real asshole.

      • Captain Obvious

        I am happy for the doctor on call that night at the hospital that she could have gone in to. He/she was able to avoid a nearly certain uncooperative patient and litigation opportunity of this grieving family.

        • Lisa from NY

          As the popularity of NCB spreads, it’s only a matter of time before this becomes a regular occurrence at hospitals.

          • Susan

            Isn’t that what Fishbein was forcing on the hospital in Thousand Oaks? They had a no VBAC policy and he would tell his patients to go in and refuse a cesarean. We sort of had this problem, we do vbacs, and women would come in from surrounding areas without an OB and insist on a VBAC with the doc on call. Not all the docs want to to VBACs so it really was dirty pool. On the other hand, we don’t tell Jehovah’s witnesses not to come in because they will refuse a blood transfusion. It’s a difficult question. I firmly believe in a patient’s right to refuse anything but I also know that it feels awful to be held hostage to someone demanding you give them substandard care.

        • fiftyfifty1

          Seriously? I mean I understand it being a relief in a sense, but actually Happy? Don’t you think the doc who was actually on call that night also feels very sad? Along the lines of “Holy buckets it would have been hell to have that woman come in in labor and refuse a section. I would have been sweating bullets and almost puking from the stress of it. But in this case what would have happened is that she would have birthed the twins alive and then started to hemorrhage. And I would have stopped the bleeding and saved her. And she might never even have been grateful, but I would know that I saved her life”.

      • theadequatemother

        Look, Bofa, I get where you are coming from, I think. But really, she ended up manipulating things to get a TOL anyway. When situations between docs and patients are less than ideal, I favour harm reduction. The job isn’t just to look after “ideal” patients. It’s to look after people, the flawed people, the ridiculous people, the people with kooky ideas, the violent people, the high people. If she’d showed up at the hospital in labour, even if she refused a c-section, I still think that is a better situation than a UC at home with twins.

        Harm reduction.

        • Captain Obvious

          And yes, it would be the job of that on call OB to take great care of her had she come in, but from a physician’s perspective from being on call, it is a relief to not have to engage with such a situation.

        • The Bofa on the Sofa

          But really, she ended up manipulating things to get a TOL anyway.

          She didn’t manipulate shit. The hospital/doctors wouldn’t give her what she want, so she refused their services.

          I do that all the time with service places. It’s a perfectly honest way of doing business. I don’t like what you have to sell, so I’m not going to use your services. That’s not manipulation, that’s being a customer.

          No, what she is doing is more like after being told by some place that they cannot ethically and professionally give me what I want, so I go in and pull off some trick to force them to do it anyway.

          Litigation aside, this is just slimeball. You are taking advantage of the doctor’s obligation, but treating them with no respect at all. As I said, it takes a royal asshole to do it.

          • fiftyfifty1

            But being a patient is not much like being a customer (even if some people try to make us believe it is by re-naming patients Healthcare Consumers). The life-and-death stakes move it out of the realm of the market. I get the sense that you feel in is more honorable or something to just take your lumps and potentially bleed out at home. And I suppose it is, just in the same way that it used to be honorable for losing soldiers to commit suicide, among other examples. But holy shit, there is human life involved here! And there is manipulation going on no matter what happens. When a woman pregnant with twins chooses a UC, *somebody* is getting emotionally screwed. Think of all the stake holders involved: the babies, the other kids, the husband, the grandparents, the ambulance driver, the concerned neighbors and friends. Somebody is going to have to suffer for this dumb ideology. In the end, I would rather have the doctor have to put up with the manipulator and everybody end up (I hope) safe.

          • theadequatemother

            That was exactly my reply…but probably more articulate, thx 50501

        • stacey

          If you were in the USA and could lose EVERYTHING because of a patient who has been repeatedly warned of sneaking and refusing a SS, you would agree with BOFA. In Canada, you can just treat the patient, and whatever happens happens. In the USA, you watch helplessly as your patient refuses herself to DEATH, then watch your life savings disappear as well.

          I am a strong believer in harm reduction, but that has nothing to do with the fact that people that do this are TOTAL ASSHOLES. Yes, I would rather a sneaky asshole that is alive, than a dead asshole that leaves 4 kids, but the fact remains- people that lie for a TOL ARE LYING ASSHOLES.

  • So is homebirth for healthy, low-risk pregnancies or isn’t it? Make up your mind, homebirthers! This was a stunt birth. Nothing about multiples is low-risk in delivery.

    • Guestll

      All you have to do is redefine the terms. The key word to manipulate is normal. Breech? Normal. Twins? Normal. Three day second stage? Normal.
      Everything is either normal or a variation of normal, until it isn’t, and then it’s the woman/couple’s fault for not taking charge of their birth/eating properly/being in the right frame of mind, etc.
      Here in Ontario, midwifery is incorporated into the hospital system. Big difference between American CPMs and Canadian RMs, education-wise. It’s routinely touted as being a wonderful option for low-risk mothers. My own ex-GP praised me for choosing a midwife, because I was healthy and RMs are great at low-risk pregnancies.
      Yet I was almost 40, 3 miscarriages, no live births, and carrying a child who was the result of ART. Thin? Sure. Healthy? Sure. Fit? Sure. And also old, with a bad ob/gyn hx, and an unproven pelvis. Hardly low-risk.
      Just move the goal posts. That’s all you need to do.

      • Lisa Miller

        That’s freaking scary as hell.

      • Certified Hamster Midwife

        Just to be clear, you were with a midwife, but was this for a home birth?

        • Guestll

          Homebirth. I changed my mind at 41+4 and gave birth the following day in a hospital. The senior RM at my clinic deserves a lot of the credit for getting me to realize that refusing induction in a hospital was a bad idea at that point.

  • Felicitasz

    Her poor husband, this is my first terrified thought, oh my, having to raise four girls alone – and, first of all, having to take care of newborn twins and two more little girls, without their mom.
    This is insane.

  • GiddyUpGo123

    OT: but this whole “dolphin assisted birth” thing just keeps getting wackier and wackier. I just found this quote in a news article on the subject:

    “According to the Sirius Institute, ‘Children born in the water with the
    dolphins develop six months faster over their first six months, have
    perhaps 150 grams more brain weight, and are ambidextrous.’ ”

    Really? Really? Really? I would SO love to see the science behind that claim. And better yet, I would love to understand the mechanism by which this happens. Magical dolphin powers that infuse the waters and are transferred to the baby during birth? Seriously?

    • The Computer Ate My Nym

      All babies are ambidextrous. Right/left preference develops later.

    • BeatlesFan

      I thought nobody had actually ever *had* a baby with dolphins yet? Evidently I was not correct in thinking that… how many women have had successful dolphin-assisted (that phrase makes my brain hurt) births so far?

    • Lisa Cybergirl

      Ugh, way to annoy dolphins!
      And dolphins aren’t exactly totally safe to hang out with, either – it’s not unusual for them to attempt to mate with humans.

  • GiddyUpGo123

    I don’t get why an OB should be morally required to “support” a woman he
    knows is making a dangerous choice. What they’re saying is that a woman should have a right to make a stupid choice under the care of a doctor, because he should be able to save her from her stupid choice. It’s like her saying: “OK I’m
    going to jump out in front of this car now. But you’re a doctor and
    you’re standing right there, so you should be able to save me.” And him
    saying: “Please don’t jump out in front of that car.” And her: “If you
    don’t let me do it while you’re standing there, I’ll just wait until you
    go away and do it anyway, and then it will be your fault if I die,
    because if you’d been standing there you could have saved me.”

    • Lisa from NY

      And then she can sue the doctor for not saving her in time. Meaning, if her heartbeat was checked before her pulse…

    • SadOB

      the ethics are maybe a bit different. I believe it is that the doctor cannot force a patient to accept interventions they do not want. Likewise, a patient cannot force a doctor to perform interventions they do want. IE: you can refuse a c-section and still expect the physician to care for you and provide alternatives. you cannot demand your doctor start pitocin for your breech baby.

  • LynnetteHafkenIBCLC

    “We are fairly sure however, they did not study up on hemorrhage. ”

    WTF is this supposed to mean? Would “studying up” have allowed the mother to get instant surgery or a blood transfusion?

    • Anj Fabian

      Maybe because midwives like to say

      “We can take care of almost anything, so you don’t need to worry about that. Plus, it’s very rare, so you don’t need to be concerned. If it does happen – hospital. Ten minutes. Relax, it’s all good!”.

    • Lisa Cybergirl

      Maybe if they’d studied PPH, and seen how nasty it can be, they would have given up the idea of having twins at home alone, and gone to the hospital like they should have in the first place.

    • PeggySue

      She could have chewed on the placenta, right?

  • Lisa Miller

    I don’t….I don’t understand. So, it’s the OBs fault for not helping her do something that ultimately killed her? No, it’s the Birth junkies faults for making women believe that a vaginal birth is worth the risk or your life or your baby’s life.

    • anonymous

      Because in the birth nutter’s mind a loss is a win. The baby dies, but the VBAC went fine. The evil doctor saves the mother and child but she didn’t want any interventions so she screams rape.

      The mother here dies and the system is “broken” but they fail to realize that it’s the woman herself that broke it.

      • Lisa Miller

        And that’s it, right there.

    • GiddyUpGo123

      That’s exactly what they’re saying … the OBs wouldn’t support her decision to have a vaginal birth, so she was forced to go off and do it on her own. So it’s their fault that she died. Whereas, if she’d had a vaginal birth in a hospital under the care of an OB, it still would have been his fault if she died, because you know, it happened under his watch. Either way, it seems to me like she was bent on dying.

      • Lisa Miller

        I’m sure those twins would have preferred their mother to being squished through a vagina. They aren’t even going to remember it.

      • Antigonos CNM

        Let’s just assume, for the moment, that an OB had gone to court, had her made a ward of the court, then ignored her screams of protest, wheeled her into the OR and delivered her by C/S. She survived.

        Any guesses on the immediate filing of lawsuits charging that the C/S was unnecessary, an assault, grievous bodily harm and who knows what else?

        • stacey

          Thats what should have happened- if outcome matters, any way.
          Those type of lawsuits go nowhere. If he had forced the CS AND she died anyway, well, then he would be in deep shit (maybe). But forcing a CS and having everyone alive and healthy? You don’t get to sue for that.
          Nope, instead you join birth boards and talk about your birth rape and how awful docs are, and how you just KNOW you could have had a successful VB at home alone….

      • Certified Hamster Midwife

        It’s not that she was bent on dying. It’s that she probably didn’t believe that the risk was real.

        • Box of Salt

          CHM, Absolutely! This is made clear in the opening of the linked article: “Since she had birthed her first two babies vaginally without trouble, she did not understand why this would be any different.”

        • BeatlesFan

          Of, even if she did, it’s fairly common for people to suffer from “it won’t happen to me” syndrome. I was a smoker for 15 years, and fed myself that line plenty of times, even after losing a grandparent to lung cancer in her 60’s.

  • This is a terribly tragic story – I can’t fathom the pain and loss her husband must feel, the huge whole left in his and his daughters’ lives by a mother who should have been there for them, but is not. I get annoyed and frustrated when so much of the focus is on things that do not matter (like the cesarean section rate). There must be a better way – surely they is a role that needs to be filled to help women like this mother navigate towards a healthy outcome. OB’s do not have the time to do the hand holding that is needed, but perhaps a prenatal social worker/therapist would….

    So sad and tragically preventable…

    • Karen in SC

      I agree that there needs to be a protocol to refer a mother in this situation. It seems to be “self harm”.

  • me

    Just a devil’s advocate question (and I realize no doctor is obligated to take the legal risk, but just for the sake of argument, I wonder): Would she have died had she delivered her twins vaginally in a hospital where they could have treated the PPH immediately?

    • BeatlesFan

      Hard telling, not knowing, but her odds of surviving would have been greatly improved in a hospital setting. Having a heplock in place, being typed and crossed, and having blood readily available wouldn’t have hurt and would almost certainly have helped.

      • me

        Thx for the replies. That’s kinda what I expected. I don’t blame the docs for not wanting the liability, nor do I blame the hospitals for not wanting the liability. I’m not so certain that twins don’t land you in the ‘automatic c-section’ territory… I think that depends on where you live and what your options are wrt hospitals and doctors. I mean, there are plenty of places that ban VBACs altogether (no matter how good a candidate the mother happens to be), so why is it such a stretch to think some places ban vaginal delivery of multiples?

        Now, I don’t know the specifics (nor do I care – HB of twins is about as stupid as it gets; well, that and HBAC, or HB of a breech… they’re in the same category AFAIC). But the reason she couldn’t find someone to attend a TOL may very well have been liability concerns rather than her being a “poor candidate” for whatever reason. To me this speaks to the need for tort reform more than anything. JMO.

        I still can’t imagine living with an ideology that makes c-sections so awful that you’d rather risk not only your life, but the lives of not one but TWO babies rather than get one. And it does occur to me that someone so deep in the woo as to try a UC of multiples would also have likely refused all the “evil” interventions that could have made vaginal delivery of her twins safer (IV access, CEFM, active management of third stage, epidural in place in case of crash section, etc, etc), so who knows how it would have gone. But at least in the hospital there are people who know how to handle complications…

        • The Bofa on the Sofa

          But the reason she couldn’t find someone to attend a TOL may very well have been liability concerns rather than her being a “poor candidate” for whatever reason.

          Why would there be concerns about liability if she were not a “poor candidate”? Apparently, the doctors were concerned that, if something were likely to go wrong, that their decision to do a TOL would not be defensible, and the chance of that happening (something going wrong) was too high to take the risk.

          • Lizzie Dee

            Funnily enough, I do agree slightly with the issue of discussing tragic stories here – because in one way they are stories – and it is very difficult to find a reliable narrator. If we take this one at face value, these babies were born easily – so it doesn’t seem as if it were an issue of positioning – and, perhaps, if she had been allowed a TOL, had consented to risk whatever it was she feared in hospital, this ghastly scenario might have been avoided.

            Now, if anyone is using an event like this to forward their own agenda, it is the narrator. The system is broken, she claims. And certainly rather a lot of people, including those with zero experience of hospital, seem to want to believe that. Maybe there is something about institutional thinking and general attitudes that does need to be put under close scrutiny, not because it is at fault for things like this, but because it allows the fantasies of NCB to seem plausible.

            Hospitals are never going to be cosy, cuddly places. Women may have bad experiences there that COULD – and should – be improved, but the idea that it is inevitable and built in needs to be dismantled. Reading between the lines, I suspect that this poor woman may have got caught up in the romance and excitement of a more transgressive choice, but the cry of “I felt so much more relaxed at home” unfortunately does make as much sense as insisting that bears are really cuddly creatures who mean us no harm, or that driving that Pinto with the brilliant air conditioning but lousy brakes is a good choice.

            People who are into the woo are never going to be convinced by logic. Maybe focusing on improving and demystifying hospitals, telling the GOOD stories, as sometimes people do here, and more thoroughly investigating the bad might be more effective.

          • Box of Salt

            Lizzie, ” If we take this one at face value, these babies were born easily”

            I don’t think that’s a good assumption. The narrator wasn’t at the birth – her information came via text messages, and she does not mention how much time elapsed between the the two messages. And the babies (reportedly 38-weekers) went into the NICU.

          • fiftyfifty1

            We can’t infer from the fact that they came out vaginally, even if they came out “easily” that there was no problem with positioning. Take as an example the footling breach position. It is extremely high risk, to such an extreme that a footling position should never, never have a trial of labor. And yet many, even most (as in over 50%) come out safely and easily.

        • fiftyfifty1

          ” I’m not so certain that twins don’t land you in the ‘automatic c-section’ territory… I think that depends on where you live and what your options are wrt hospitals and doctors”
          It is true that there are some hospitals where all twins, no matter what position, are delivered by scheduled c-section. But that is not because of physician philosophy or risk aversion. It’s due to *resources*. If your hospital cannot provide 24/7 anethesia coverage, and 24/7 in-house OB and at least basic NICU services, it is risky to provide twin TOL. Even if the twins start labor in perfect vertex/vertex position, everything can go to hell in an instant, especiallly once the first twin is born.
          One of the scariest births I ever saw was a young healthy mom with 2 previous births and a vertex/vertex twin presentation who came in in the middle of the night in precipitous labor. Twin A squirted out within minutes of arrival, twin B immediately fell out of position, had partial placental detachment and heartrate dropped to 50 and didn’t rebound. Mom got general anethesia and an emergent C-section. If OB and Anesthesia and NICU hadn’t all been in house at 3am, Twin B absolutely wouldn’t have survived.
          Not all hospitals provide VBAC, not all provide twin TOL, not all provide heart cath, not all provide brain surgery. If you have twins in good position and want a TOL, but your hospital doesn’t offer it, then go stay with your Great Aunt Mildred in the big city until you deliver. Too impractical for you? Well that’s

          • Therese

            I am skeptical that there are hospitals out there that have a carte blanche ban on twin births. They were allowed at my little community hospital that banned VBACs and I belong to “natural” twin groups and have never encountered anyone claiming there hospital forbid all twin births and I have encountered a lot of people complaining about the restrictions placed on them by their hospital. Since twin births have to take place in the operating room it is usually not a problem to get the OB and anaesthesiologist in the hospital in time. It would be a problem for a precipitous labor, but that is a problem in and of itself.

          • fiftyfifty1

            “Since twin births have to take place in the operating room it is usually not a problem to get the OB and anaesthesiologist in the hospital in time”
            Huh? How can delivering in an operating room make it possible for the OB or anaesthesiologist to arrive faster than they would otherwise be able to arrive?
            Either a hospital has the resources to offer these services in a timely fashion or it doesn’t. I have worked at a hospital that did not deliver twins. It was rural and babies were delivered by family doctors. Only one of them did C-sections. A twin birth can go wrong any minute. Twin births were all delivered at the nearest large town, 30 minutes away, which had 24/7 access to the needed services.
            Over-reaching your abilities/resources is a dumb move that doesn’t do anybody any favors in the long run.

          • Frequent Guest

            There was one hospital with three OBs in my small town where I grew up. The hospital and all three OBs refused vaginal delivery of twins. It was scheduled c-section or driving hours to the nearest bigger city.

      • PeggySue

        But… but a heplock is an INTERVENTION!!!!

    • Captain Obvious

      She would very likely be alive. IVF bolusing, Blood transfusing, uterotonics like methergin, hemabate, or cytotec, Bakri balloon placed in the uterus until uterine artery embolization, uterine artery suturing, b-lynch sutures, recombinant factor VII infusion, or hysterectomy could have been performed could have easily spared her life.

      • The Computer Ate My Nym

        One caveat: This is all assuming that there was nothing much wrong except that she bled out. If she had some other problem that led to her being a poor candidate for a vaginal delivery, this might affect her likelihood of survival in the hospital as well. For example, if she’d had a previous hemorrhage and now had multiple antibodies making it difficult to get blood for her.

        • Antigonos CNM

          Yes, I’ve been thinking about that. There is some information missing, this doesn’t seem to be a straightforward twins situation. Women do, after all, vaginally deliver twins and both the babies and the mother lives. The main reason given for advising C/S is that the BABIES are in some danger [malpresentation, prematurity, placental abruption, and so forth, which can compromise their chances]. Twins are NOT regarded as a definite risk factor for maternal mortality, although there is a higher percentage of PPH due to uterine atony, etc. My guess is that the placenta was also problematical — possibly low-lying and known to be so from early in pregnancy — or that the woman had some form of coagulopathy as well as twins. Possibly there were other maternal reasons to avoid vaginal birth as well.
          The incidence of twin birth is high; but twins are never low-risk. Back when doctors were more willing to deliver multip twins vaginally, the actual delivery was often done in the OR, with what we called a “double set up” which meant the doctor could go immediately to C/S if anything indicated the necessity. Since this woman was being warned not to attempt vaginal delivery well before the onset of labor, I suspect there were other factors at work as well as simply two babies.

          • Anj Fabian

            With two previous babies, that means a possibility increased risk from prior complications.

    • Ducky

      It seems this is the point on which her friend is focusing … the mother might have survived had she been able to trial birth in the hospital. (Though, as Dr. Amy points out, she’d almost certainly have lived had she just had the CS.) An OB makes a judgment (in this case, absolutely no trial of vaginal birth) and maybe there is some wiggle room or maybe not .. but the mother and certainly no one else is any position to judge without that same medical training and experience. So the big question seems to be… how to increase trust between OBs and patients?

      • Or some way to ensure that the patient is making a choice that meets the requirements of informed consent and has considered the options and has reasonable access to the options available. Harm reduction is perhaps the policy that needs to be deployed.

      • Amy Tuteur, MD

        “how to increase trust between OBs and patients?”

        Step1: Confront the people like Gaskin, Goer, and other NCB advocates who work full time at undermining it.

        • SadOB

          spot on. has anyone looked at average charges for the homebirth industry? all i know is that most doula’s charge more than the physician fee.
          There is definitely a strong financial incentive for maligning OBs and Hospital Birth.

          • Susan

            Absolutely. And they get what they charge and have very little overhead.

          • Bombshellrisa

            Seattle area doula (includes two meetings before birth, time during birth and a postpartum visit) $750-$1000. A postpartum doula charges between $16-$20 per hour to come and help do light housecleaning and help with the baby.
            Belly photography $500-$1000. I don’t know about birth photography but they usually charge a travel fee on top of their fee for the photos.

      • theadequatemother

        is “distrust” between OBs and patients this rampant epidemic or is it a much smaller problem confined to a few bad apple OBs and a subset of pregnant women that have either had bad experiences with docs in the past, super-crunchy tendencies or fallen for the NCB industry propaganda campaign without any contradictory personal experiences to draw on?

        If the vast majority of women in the listening to mothers surveys I and II report being happy with their care, is there really a problem or is this a problem manufactured by those that want you to hire them along with their birth tub, doula cousin and friend the birth photog?

      • Hannah

        My understanding was that a caesarean was a risk factor for PPH. Depending on the position of the twins it might be the only safe option for the babies, but it’s not prophylactic for bleeding, in fact, I had thought it would make it more likely.

        • stacey

          Thats not correct. CS causes less PPH than a VB does.

  • Captain Obvious

    ” I reminded myself that many people die in car accidents, but we have not outlawed cars” But we have made seat belt, air bag, and other car safety measures law. We have also speed limits and other rules of the road.
    But I want to drive fast. And reckless. Hell, I don’t even want to wear my seat belt. How dare those politicians ridicule my desires. I want that driving experience because it will allow me to get to work faster and the seat belt will wrinkle my tie. This reminds me of when I travelled to Maui and the car rental place told me not to drive along the southeast side of the island. I guess the roads there are not paved and the car insurance wouldn’t cover any of the damages that might occur. They even went as far as to refuse to come and pick me up if the car broke down out there. How dare they. I want my vacation experience to entail that I drive around the whole frigging island.
    Ultimately, this story is a horrific reminder of our broken system. If we walk out of our house and into our cars and an unfathomable outcome happens, when in fact all the support needed was present, that is one thing. But, to have this outcome with a complete lack of support, that is simply unacceptable. Our system should be designed and focused on supporting working and vacationing drivers to drive the way they feel is best for them!…

  • Bombshellrisa

    People blame ‘our broken healthcare system” when they don’t hear what they want.There are busloads of people who head into Tijuana every day for “cures” that the FDA won’t allow. Hoxsey, Latril, Apitherapy-you name it, there is a clinic that will administer it to you for a price. Up front. There is no evidence that any of these treatments are effective, but again, people want the “natural” remedies, they like the fact that the setting is beautiful (BioMedical Clinic in Tijuana is housed in the former home of a mob kingpin. It’s so beautiful, it’s unreal), the staff is warm and caring and they give you the answer you want to hear. It also seems that when this type of treatment fails, nobody is angry at the doctors, angry at the system, instead they talk about the US system being broken and not wanting to find a “cure for cancer” due to greed.

    • staceywm

      I use to live in Tijuana, and I have seen lots of medical tourism.

      Thankfully, most are just there for the same services or meds they get in the US, that just happen to be much less expensive, especially when the exchange rate is favorable.

      There are some scary clinics though, like the ones that promise to “cure” your heroin addiction with Ibogaine. It might happen, or you might die, which has also happened more often than people in the US think. Just because WE don’t hear about it, doesn’t mean it doesn’t happen.

      There is one lesson to learn here- people never blame those that feed them the lies. They kill the messenger of bad news everytime.

      • Bombshellrisa

        We have lost loved ones to the woo. My husband doesn’t have parents precisely because the lies were more palatable than the truth. Thank goodness he is alive today, despite being a UC to a mother battling Hodgkins lymphoma.
        Why is it that the woo doesn’t treat things, they “cure”?

    • Lisa Cybergirl

      If the treatment fails, it’s the patient’s fault for not believing hard enough, or having too many negative thoughts, or something like that. What can the “healer” do against such obstacles?

  • Dr Kitty

    I have a wonderful OB.

    He is pretty old school when it comes to certain things- he’ll still do vaginal twins and breeches if the (properly informed and clinically appropriate) woman wants to. So, I thought, if anyone will support me in a vaginal birth it’ll be him.

    He did, although at the end he couldn’t put my chances of a successful vaginal delivery at more than 10%. He told me it was entirely up to me what we did, and if I really wanted to “have a go” he’d be on side. When we opted for a planned pre-labour CS, his relief was visible.

    Some NCB person might have gone to that appointment and thought he was blowing smoke up her ass and trying to bully her into a CS.
    I can read an ultrasound scan for myself and knew that *if anything* he was being optimistic. A high, free foetal head at 38 weeks in a primip with known abnormal pelvic morphology, a long closed cervix and an estimated foetal weight already at the upper limit of what we thought would be safe for me to deliver…it suggests a failed induction or a long difficult labour, probable CPD and either an emergency CS or an instrumental delivery with a high risk of dystocia would have been in my future.

    I really resent the idea that anyone would try and force a highly skilled and experienced clinician into supporting something they feel is unsafe, and then be on the hook when predictable adverse outcomes occur. Especially when so many are already doing everything they can to support women within what IS safe and acceptable practice.

    I like knowing that if my Ob says “it’s ok, we can try it” they think it is safe enough to do it, and “no, really, this is not a good option” means just that.

    I don’t want every loopy idea to be greeted with “ok mama, if that is what you want- fine.” No other doctor you see has that outlook, for good reason.

    • Antigonos CNM

      What we have here is the complete opposite of the old “the doctor is always right” mystique; the doctor is held to be always wrong, always obstructive, always motivated by greed and/or ulterior motives like getting to the golf course. He LIKES hurting people.

      Now, doctors were never omniscient, but they behaved as if they were because the patient expected him to be, indeed, almost demanded it. People like you and I, Dr. Kitty, have the education to make informed choices, but most of the public don’t. And if they are already paranoid about the person or institution advising them, then they just don’t listen. THAT’S the tragedy here, not that a husband is left alone with 4 daughters, IMO.

      Short of getting a court order asserting that a woman is mentally incompetent to make a decision regarding whether to have a C/S or not — which no judge is going to ever give –the OB has no choice, nor any way to force her to have that C/S. He has to let her do what she wants to do, even if he knows she is effectively committing suicide [or manslaughter, if her daughters don’t survive]

      I was present at a very ugly situation where a Jehovah’s Witness woman, with a history of previous severe PPH and DIC, was told by her husband [a minister in the church], that he’d divorce her if she agreed to have any blood products should she hemorrhage again, or even if the doctor, with a tacit agreement from her, went to court to have her made a ward of the court for the duration of her labor [so she could then say she hadn’t given any consent of her own free will]. The husband, in his best black funeral suit, insisted on being with his wife constantly so the doctors could not “sneak” any transfusions. She did hemorrhage, and came close to death. Afterward, when the doctor advised them against future pregnancy, the husband said that her life was in God’s hands, and that contraception was against their beliefs. I really think he was disappointed his wife hadn’t died.

  • guest

    Or this mother was planning on having more babies and was concerned something like this would happen to her, so she wanted to avoid a cesarean.

    http://www.indiegogo.com/projects/inspiring-mother-of-6-dies-in-childbirth-help-family-let-s-blow-out-the-goal

    Wonder why the woman above hasn’t been posted here. If only she had had a vaginal birth, she might be alive today.

    • AL

      What you fail to miss is that had she not gotten a C-section first time around, she probably would’ve died then and not had the 6 kids.

    • Captain Obvious

      I am a doctor with a blended family of seven kids. I would love to go sky diving, take up roller bladeing, get interested in small town race car races. But I have a family to raise and I cannot afford to get hurt. I am the majority money maker for my family. Even after my gall bladder surgery I was back in the office after 5 days. If I was a women and had a CS, and have so many kids as she, I would seriously think of limiting my initial dreams of having a large family because of the new changes to my circumstances. I want to be around to raise the family that I have. This does get mentioned in the counseling, but so many women believe this cant happen to them. So sorry for that family.

      • LukesCook

        Indeed. With my history of cancer I had a hysterectomy on my doctor’s advice. Although I very much wanted a sibling for my son, I thought it more important for him to have a mother.

    • Ducky

      Wow, that story is heartbreaking. What strong little kids…

      We don’t know the circumstances of her prior c-sections- it is possible – probable, even, as AL suggests that one or more were medically necessary to save mom or baby.

      C-section is of course riskier than “normal” vaginal birth – but birth without the option of c-section is still far riskier.

  • stenvenywrites

    Someone’s irony meter is busted:

    “If we walk out of a birth with this type of unfathomable outcome when in fact all the support needed was present, that is one thing. But, to have this outcome with a complete lack of support, that is simply unacceptable.”

    Bingo, Honey.

    • Squillo

      Indeed. Thing is, the outcome was, apparently, not only fathomable, but predictable. Which is why she found no OBs and had difficulty even finding a midwife to “support” her.

  • suchende

    Her rationalization is is, “they just weren’t sufficiently faithful to NCB principles of course!” How fucking stupid. I seriously doubt and NCB-minded home birther would not have done immediate skin-to-skin and offered nursing. But oh, if only a midwife with her ancient wisdom had been there to channel the oxytocin-energy to this mother’s hemorrhaging uterus by blowing cinnamon breath!

  • Amy (T)

    Since she pulled out the car accident analogy: that’s like someone taking their car to multiple mechanics who say the car needs new brakes and the owner denies it’s the brakes (or wants them replaced naturally!), and won’t allow the mechanics to replace them. When they get into the inevitable accident, that is not any mechanic or systems fault. Absolute cognitive dissonance.

  • The Computer Ate My Nym

    From the article: “Two midwives contacted me saying they could help. These two amazing
    birth keepers were willing to drive across several states to this
    family’s home and stay with them so they could support the mother in a
    vaginal birth. But, there was a snag — there was no money to get them
    there.”

    But I thought that only greedy OBs demanded to be paid before they saw patients. Don’t tell me that the “amazing birth keepers” (WTF is a “birth keeper…never mind) demanded to be paid for their services? Incidentally, an OB will see any woman in labor who presents to their hospital-insurance, money, or no. But they won’t agree to a plan that is flat out unsafe. At least, the competent ones won’t.

    • Alenushka

      When I did not have insurance but doctor treated me for free and gave me samples from Big Pharma. Some of my relatives went to free clininc ran by volunteers. I have doctor friends who volunteer a lot from Burning Man to homeless outreach programs. The HB MW, however, nicked and dimed my relative. Would not let them by supplies at a cheaper price but insisted on ridiculous HB kit she was selling. It was never use because they went to the hospital. No refund, of course.

    • Bombshellrisa

      “WTF is a “birth keeper” They “hold the space” for a birthing woman. In my head, I see these midwives and their assistants forming a circle around a woman and not letting concerned family members call 911 or get to their cars to try and help the woman to the hospital.

      • LovleAnjel

        “hold the space” = “take up space”. It means they sit in the corner knitting or nap on the couch the whole time they are there.

        • Bombshellrisa

          So if they leave the woman to go shopping or check on another laboring client, are they still holding the space? And for all the talk from homebirthers about wanting to have things intimate with just a few people, ever notice in the birth videos and photography how there seem to be so many people all gathered around the bed/birthing pool/bathtub? Seriously, it seems like there is a crowd there, all sitting around watching the laboring woman. At least the hospital that I work at limits the number of support people (during the birth part) to 4.

      • auntbea

        Hold the space from what? Or for what?

        • AmyM

          The demon dimensions. They perform the Rite of Ashkente, didn’t you know?

    • Antigonos CNM

      “Birth keepers”? That’s a new one for me.

  • grenouille

    I am having serious trouble with posting today. So… sorry if I am spamming. I just cannot see any of my comments.

    From Shapiro’s piece:

    If all else failed, the most heroic move mentioned was a manual clearing
    of the placenta from the uterus. Since my friend was able to keep her
    womb as they stabilized her at the hospital, the midwives were fairly
    certain her source of blood loss was the placenta and thus completely
    manageable. This is a perception still haunting the many people who
    wished they could have been there to help my friend.

    So let me get this straight… A bunch of CPM birth junkies could have done better than the ICU? Maybe she’s right. I cannot remember the last time I heard of an ICU performing “luscious nipple stimulation.” But I live in Canada. Maybe such advanced techniques haven’t made it up here yet.

    This whole thing fills me with rage. So much of natural “medicine” is old-fashioned victim blaming. If you don’t fear the hemorrhage, it won’t happen. If you don’t worry about high blood pressure, you won’t get pre-eclampsia. Disgusting.

    • sleuther

      Judging from what actually happened, I think the most heroic move should have been “Gee, maybe you should listen to the doctor who thinks that you actually need a c-section.”

      But you know, I’m not an expert in these matters. I don’t contextualize stuff so good.

    • Dr Kitty

      No hysterectomy doesn’t necessarily meant that the cause of bleeding has to be placental, nor that it was “thus completely manageable”.

      DIC, sepsis, lacerations, uterine involution – all possible causes of PPH.

      If the cause WAS uterine atony or a retained placenta- well, I’m sure ALL the drugs, including Oxytoxin, were used, and in much higher doses than nipple stimulation would generate from a pituitary gland that was presumably being seriously underperfused due to hypovolaemic shock.

      For the All Natural Oxytocin Loop to work you need to have a functioning pituitary, and that means enough blood getting to it, and from it to the uterus. You don’t have that if someone is bleeding out, which is why you don’t rely on the pituitary, and instead give drugs to do its job.

  • EB151

    ” I reminded myself that many people die in car accidents, but we have not outlawed cars.”

    No, but you know what we have outlawed? Babies riding in cars without properly-installed carseats.

    “Perhaps. I’ll go back to my earlier assertion: we are powerless over birth.”

    My obstetrician is badass over birth. Just ask the daughter he had out in seven minutes when my perfectly normal, healthy labor failed.

    • The Bofa on the Sofa

      No, but you know what we have outlawed? Babies riding in cars without properly-installed carseats.

      Yep, infringing on our autonomy and freedom of choice.

      They don’t even let us drive drunk.

    • suchende

      Well I for one have always thought driving with babies is pretty nuts. It’s why we pay more rent to live on the regional rail line.

  • moto_librarian

    The cognitive disconnect is stunning. The author continues to assert that vaginal birth was the “safest” option, despite having been proven false by the death of her friend due to giving birth that way. Twin pregnancies are complicated. Some can (and are) delivered vaginally with no problems, but they are done in the operating room with an epi catheter placed for good reason.

  • Guestll

    “I remind myself that many people die in car accidents, but we have not outlawed cars.”

    This is one of my favourite pro-unsafe birth arguments. Certain things can be unsafe, so let’s just use that as justification for doing whatever we want. I could die giving birth unassisted at home to twins? Well, I could die in a car accident, too. It’s a weird brand of fatalism blended with more than a spoonful of self-centeredness.

    I had a friend, years ago, who died giving birth. She had two previous sections close together and was strongly advised against having a third child. She got pregnant with her third child in four years, and her OB scheduled a section right at term. My friend didn’t want a section, she wanted to deliver vaginally, so she didn’t show up for her section, and planned to go to the hospital once labour commenced.
    My friend and I had known each other since childhood. We grew up on the same street. I was away at grad school at the time. My friend was the first amongst all of us to marry and have children. What she was telling me over the phone, her plan — I didn’t understand it, but I knew that it sounded dangerous. She asked me not to say anything to anyone.
    I broke that confidence and called my mother, an L&D nurse. My friend and her husband had purchased her parents house, on the same street where my own parents still lived, and my mother tromped over there through a foot of snow at 10 pm, in her housecoat and winter boots. She pleaded with my friend to reconsider her plan.
    My friend never spoke to me again. She passed away three weeks later, at 41 weeks, having gone into labour at home. She never made it to the hospital. She died in front of one of her children, while her husband was putting the other in a car seat. Her baby didn’t make it, either. Perfectly formed baby, >10 lbs.
    My friend and her baby died not because a few OBs refused to honour her wishes. They died because my friend prioritized her wishes — ephemeral and in the grand scheme of things, inconsequential — over something tangible and meaningful. They died not because she had the courage of her convictions, but because she lacked the self-awareness to understand when she was in the wrong.
    Two children, now in their teens, who’ve grown up without their mother. Ask them if it was worth it, Nekole Shapiro.

    • Karen in SC

      Can I say that I love your mother? I am so sorry that she was unsuccessful in changing your friend’s mind. What a tragedy!

      • Guestll

        My mother used to look after the two little ones sometimes when my friend (a SAHM) wanted a break. My mother was one of the first people in the house when the first responders showed up and had no idea (not their fault) what was going on. My friend was already dead.
        This is the thing that people don’t understand — the tears, the screaming, the begging, the desperation, the denial, the chaos. This is what they don’t talk about and this is what people like my mother, who was not new shit happening in childbirth, will never ever forget. She knew that girl from the time she was little, watched her grow up with me. That didn’t have to happen, it shouldn’t have happened, but it did, and I challenge people like Shapiro to witness it, try to help pick up the pieces, and still blather on with their lunacy.

        • KarenJJ

          This is one of the key things about midwives with bad outcomes that I just don’t understand. They’ve witnessed the shock and the horror of a mother delivering a longed-for baby that she thought was alive and is now dead. They’ve witnessed first-hand someone that they’ve cared for during a pregnancy and all the hopes that it entails, and then delivered a dead baby. They then go on with their merry lives and blame the mother for it. They should know better – they hold obgyns to such high standards – but hold no such standards of themselves.

          I remember Doula Dani on here describing a bad outcome and following the mother in her car, crying because she thought the baby was dead and how shaken it had made her. This seems like a very normal response to me. A desire to learn more, become better at it, search for answers. Not keep practising and go on to deliver more dead babies, keep lying to future women about their record, their names, their licensure. There is something very flawed in that mindset. I don’t know what it is, I suspect it’s pathological – a compulsion, a lack of empathy, sociopathy?

          • Susan

            I don’t get that either. I guess they are so entrenched in their beliefs they think it would have happened anyway or that avoiding the risks of the terrible hospital are worth it. I bet some do stop practicing when faced with the reality of a likely preventable death. But Sisters in Chains et all, Dr. Biter… I think you are right about it being pathological. Some, who seem to specialize in high risk stunt birth, I think it’s something akin to Munchausen by Proxy…
            I was thinking earlier about when I was a Bradley teacher way way way back in the early eighties. I had a mom call me considering classes. She shared with me that her previous baby had died after a shoulder dystocia at a homebirth. I had a homebirth myself…and when she heard that she didn’t want anything to do with me. I felt like it wouldn’t have happened to my baby because I had CNMs who had very careful risk criteria ( EFW had to be less than 9lbs despite my previous baby being more than that) and she had been to lay midwives. Funny thing was those same lay midwives had a video screening of Ina Mays Gaskin Manuever. In fact it had a clock on the video showing how many minutes had elapsed. I know those midwives continued to practice and didn’t appear to feel that what happened could have been prevented. But that sure wasn’t how that mother felt… it was chilling.

    • moto_librarian

      That is heartbreaking.

    • Dr Kitty

      I’m so sorry about your friend and her baby.
      It must have been very hard for you and your mother, but I guess you did what you could to dissuade her.

    • LukesCook

      “I remind myself that many people die in car accidents, but we have not outlawed cars.”

      What a stupid argument.

      Firstly, while we have not outlawed cars, the driving of cars is one of the most regulated possible activities, starting with the strict requirements that must be met before one is licensed to drive one.

      Secondly, nobody has “outlawed” the unassisted birth of twins at home. It speaks volumes about the natural pathways of a person’s thoughts that “outlawing” is seen as a logical consequence of an activity being identified as risky. It also makes it very clear why such a person would be invested in refusing to countenance the evidence of risk.

      • The Bofa on the Sofa

        Secondly, nobody has “outlawed” the unassisted birth of twins at home.

        As evidenced by the fact that her friend had one!

        “Don’t require doctors to do it if they don’t think it is safe enough” =/= “outlaw it”

        It’s the whole “persecution” thing. Ooooo, I’m persecuted because the government won’t force someone to do something for me that they aren’t willing to do….

        • Amazed

          … and take the responsibility too. Don’t forget that part.

          In short, they want their service provided and if they get their wish, they take it to mean that it was safe. Then, when the you know what hits the fan, can you guess whod be right on the hook? Yeah, me too.

          Had an OB agreed to honour this woman’s irresponsible wish, they might have found themselves in Karen Carr’s shoes. By the way, what happened to her? I think she got away lightly but I can’t remember any details.

          • suchende

            Well. I will say that I agree on some level that society “failed” this woman, based on the information provided. IMO twin moms should be offered a TOL in hospital. And I do think it’s insurance standing in the way of that. If there were strong legislation indemnifying doctors and hospitals from liability in cases like these, maybe the mom really would not have died.

          • LukesCook

            If there were such legislation then the risk does arise that twin mothers who are happy to have a c-section might be pushed towards a TOL for financial reasons. Which do you think is the lesser evil?

          • suchende

            It wouldn’t HAVE to end up that way.

          • Amy Tuteur, MD

            There may have been additional risk factors beyond a twin pregnancy. There are many obstetricians who will deliver twins vaginally. The fact that the mother couldn’t find anyone to do so (including any local midwives) suggests that there were additional issues.

          • suchende

            “There may have been additional risk factors beyond a twin pregnancy.”

            True, and guessing at the circumstances is idle speculation.

            “There are many obstetricians who will deliver twins vaginally. The fact that the mother couldn’t find anyone to do so (including any local midwives) suggests that there were additional issues.”

            Or, possibly just living in a rural part of the country.

            Of course I think MDs should not be forced to assist labors they don’t want to. But I do wonder if MDs would consent to more TOLs if it weren’t for the liability risk.

            That said, I have read some of the legal research on the impact of tort reform on medical practice, and based on the data I have seen, it doesn’t appear to make a big difference.

          • The Bofa on the Sofa

            True, and guessing at the circumstances is idle speculation.

            Didn’t stop you, though, did it?

          • suchende

            “Yes. But where is there such a great liability risk? Because it is very risky!”

            A high risk… of getting sued and losing.

            Here is a story of a woman who made a terribly wrong decision because she wanted to avoid a c-section. Now, I don’t know the specifics of her situation exactly. But I don’t think it’s outlandish to suppose that her odds of living would have been higher in hospital. It does open the door to the question of if “the system” (whatever we mean by that) would be improved by letting patients assume more of the risk but also make more of the risk decisions.

          • The Bofa on the Sofa

            A high risk… of getting sued and losing.

            But why would she lose?

            The only way she would lose is if the plaintiff could convince the jury that the procedure was so risky that the dr should have known better than to do it, and made a mistake when they did the procedure.

            Why shouldn’t doctors do things to avoid malpractice suits? What’s the alternative? Commit malpractice?

          • LukesCook

            Doctors only get sued when people get hurt. What a coincidence!

          • Amazed

            But also find the provider who would accommodate them.

            No one likes to catch dead babies or have a mother bleed to death. There’d be always doctors who wouldn’t accept some level of risk in their own practice. No one should force them into acting against their judgment just to accommodate someone’s wishes.

            By all means, let’s let patients make more of the risk decisions. But don’t let them force the OBs in the only rural, unequipped for emergencies rural hospital attend what they see as a disaster waiting to happen.

          • theNormalDistribution

            Uuhhhhh… How can there be a high risk of ‘getting sued and losing’ without there also being a high risk of something awful happening?

            It sounds to me like you’re saying that doctors should be held less responsible for the decisions they make, so they have more flexibility to let patients choose their course of treatment. Why even bother having doctors at all, then? What is the point in spending years training someone to provide care, so you can go on to ignore their advice? The only thing I can see coming out of that is a few happy people who get their way and are lucky to survive it, and a whole lot of preventable deaths.

            I think most doctors shy away from risky procedures because they don’t want people to get hurt. But if there are doctors who are just afraid of being sued, well golly. That’s A-OK with me. Who cares what their motivations are, as long as they keep me safe from harm.

          • staceywm

            You LOSE a lawsuit because of a BAD OUTCOME! Losing a lawsuit and bad shit happening go TOGETHER.
            YOu can do tons of CS and even be a total dick, but if everyone is safe, you are FINE. YOu do something known to be risky, and people die, well YOU are on the hook! Rightfully so.

            Lawsuits help this by keeping docs to the standard of care. Maybe some moms would have been fine with a TOL, but if the risk is high, docs learn to avoid it. For good reason.

          • Guestll

            Except we don’t know why she wasn’t offered a TOL. We don’t know if there was a pre-existing issue, if one of the twins (or both) were malpositioned, we don’t know. Shapiro makes it sound as though the only reason this woman wasn’t offer TOL was because she was carrying twins. Even if that were the case, delivering unassisted at home is not the answer.
            Here was my friend, on wanting a vaginal birth. Plausible explanation: I have two young children, my c-section recoveries were brutal — and her own mother had passed and she didn’t have a great relationship with her MIL, and her husband had to go back to work pretty soon after the birth — little support, this is valid — except: My mother: I will stay with you and look after you and the kids, for however long you need. I will be as active or as passive as you like. I will respect how you raise your kids and won’t intervene but when you need me. I will cook and clean and take care of you in whatever way you need. Bear in mind, she had looked after them on previous occasions, she was a trained L&D nurse and had raised 4 of her own kids. My friend: That won’t work for me.
            My friend: I’ve seen 3 OBs and I don’t get the feeling that any of them are really listening to what I want. My mother: I know many OBs and you can speak to as many as you like, but I’m pretty sure given your history that they will all tell you the same thing. But I will set up appointments for you and come with you and do my best to act as an intermediary, if I feel anyone is being unfair. My friend: That won’t work for me.
            All these years later, and my primary RM said, it’s a shame that nobody listened to your friend.
            Society didn’t fail the woman in this post and it didn’t fail my friend.

          • Amazed

            Well, since all OBs the woman was seeing seemed to say that it was too dangerous, maybe it was too dangerous for HER? I know a woman who years ago had a C-section for a transverse twin and a breech twin. She didn’t even think of a vaginal birth. Not that she was offered that option.

            We want each woman to be treated on her own but then we generalize – twin moms should be offered a TOL. Some twin moms, yes. Offering it to all twin moms gives a false sense of security. I, for one, as a lay person cannot imagine an OB who would suggest a TOL for a woman like the one I know.

          • The Bofa on the Sofa

            MO twin moms should be offered a TOL in hospital.

            You have NO basis for that assertion.

            You don’t know her medical condition. Did you think that maybe there was a reason that no doctor nor even a MW would take her on? MWs do twins all the friggin time, yet they are denying her?

            It tells ME that there was a LOT more going on than just “twins.”

            This comment is bloody irresponsible, and beneath you.

          • AmyM

            I have twins, and had them vaginally. The reason I was offered TOL was because they were both head down. If either or both had been breech, my OB wanted them to come via Csection. I was fine with that. While I wasn’t keen to have surgery and feared a painful recovery, I was less keen to risk my children’s lives.

            As it was, they were born in the OR, with an epidural in place (I wanted the pain relief anyway), with a gajillion staff around ready to jump into action should a Csection be needed stat.

          • Guesteleh

            The reality is no one can force you into a CS. You can show up at the hospital and then refuse it. How do I know this? My ob was on call when a woman showed up at the hospital in labor with a footling breech. She refused CS and her husband backed her up. She continued to refuse even after the ob in desperation had her sign a form saying she understood her baby could die. Baby survived but spent 6 weeks in the NICU. So yes, if you’re willing to be a complete asshole, endanger your baby’s life and emotionally scar everyone involved in your labor, you can get a TOL in the hospital no matter what your condition.

          • staceywm

            Well, there have been cases where they got a court order to do a CS.

    • Guestll

      For the record, she died of multiple organ failure. It went: placental abruption>DIC>multiple organ failure. All of which would have been prevented by a timely delivery via section three weeks earlier.

    • Ducky

      I am so sorry to hear about your friend’s passing. Thank you for bringing her story to the discussion. It really puts our birth desires in perspective…

    • auntbea

      In front of her child? Good God.

  • Squillo

    I wonder what these geniuses would say if it were, say, a woman who tried to find a plastic surgeon who would place ginormous breast implants? If, having been denied by the physicians, she found an unlicensed cosmetologist to do it and subsequently died, would it be the fault of “the system” that denied her her wish?

    • suchende

      Doctors are supposed to give you whatever sort of care your magical mama intuition guides you to. And then settle with you for $$$ if it goes badly.

    • The Bofa on the Sofa

      I wonder what these geniuses would say if it were, say, a woman who tried to find a plastic surgeon who would place ginormous breast implants? If, having been denied by the physicians, she found an unlicensed cosmetologist to do it and subsequently died, would it be the fault of “the system” that denied her her wish?

      Absolutely, because the system owes it to society to implant ginormous breasts whenever possible. That almost goes without saying…

      • auntbea

        I’m sure your ginormous breast implants will look lovely, Bofa.

    • Eddie

      Sarcasm follows: No, you don’t understand. Birth is different. Breast implants are not natural but birth is. (end sarcsam)

      But anyway, isn’t there government funding for breast implants as long as they are over DD? (Not my personal preference, but it’s funnier that way.)

  • Squillo

    Shapiro’s post should be titled, “I Helped My Friend Kill Herself.”

    But God forbid she should ever question her beliefs.

    Once I found my emotional ground again, my intellect could get to work contextualizing all that had occurred. Your intellect needs to work a little harder. Before helping someone else kill herself or her baby, one hopes.

  • Dr Kitty

    I do not think people like Ms Shapiro understand the concept of medical ethics.
    This woman’s doctors thought that FOR HER vaginal birth of twins was so risky as to make it impossible for them to condone it or participate in it.

    This isn’t about doctors saying “I’d love to help you, but my hands are tied by hospital policy” or “I think your birth plan sounds great, but I have a golf holiday booked for the whole month” or “your birth plan sounds great, but my insurer has nixed it”, which would indeed suggest a broken system.

    This was about OB after OB saying “this sounds like a disaster waiting to happen, I’m out”.

    She had a choice- she could have agreed to a CS. She didn’t HAVE to have a UC. She decided to UC rather than have a CS. After she had been advised that a vaginal birth IN HOSPITAL WITH A FULL STAFF was felt to be too risky, she opted to UC AT HOME, which she must have known was riskier.

    Her belief that a spontaneous vaginal delivery was safer than a CS was demonstrable false. She was told it was false by OB after OB. She didn’t believe the OBs were telling her the truth.

    Her false belief in the safety of vaginal birth killed her.

    This isn’t about a broken system abandoning women. This is about women accepting that not all choices are safe and OBs DON’T have to support obviously unsafe choices.

    Childbirth is not a restaurant where you get to order off menu if you don’t see anything you like. It is more the kind of restaurant where there is no menu, you get whatever the chef feels like cooking and you just have to roll with it.

    • Squillo

      Evidently, they had difficulty finding midwives too.

      • staceywm

        You know something is dangerous when LDEMs won’t touch it!

    • Squillo

      I don’t think Ms. Shapiro understands that being responsible for the lives of others isn’t a game. It couldn’t be clearer that to her, birth is a game.

      Did she even once stop and think, “These are my friend’s and her babies’ lives we’re talking about?” That maybe, just maybe, all those OBs knew something she didn’t? No, Nekole Shapiro knew better.

      She’s like Michael Jackson’s erstwhile doctor, but without the education. And like him, she should be prosecuted for manslaughter alongside the brain-trust midwife.

    • The Bofa on the Sofa

      The odd thing to me is that they don’t really want “personal choice,” what they want is _service_. They had all the choice in the world. They had the option of securing the help of a doctor, and they were able to shop around and seek out a doctor that they felt gave them what they wanted. Not finding that, they had the option to seek out midwives, or do the birth at home, so they could have exactly the birth they wanted.

      What the complaint is, though, is not that they didn’t have choice, it’s that they couldn’t force others to do it the way they insisted. That’s what this about.

      Our current experience is useful here. My wife and I are currently in the process of building a house. Now, building a house comes with it a lot of thought and effort, with countless decisions to be made. However, there are restrictions on what we can do. For example, we wanted to remove the door from the basement stairs. No can do, no matter how much we want to. Arrgghhhh!!!!!! Damn builders, infringing on our autonomy and restricting choice!

      • Dr Kitty

        I’m guessing this is a safety ordinance, designed to prevent a headlong fall in the dark down basement stairs?

        Trust getting a glass of water in the dark- you’ll only fall down the stairs if you don’t trust in your innate ability to see in the dark.

      • sleuther

        True. I wonder how the NCB lunatic fringe would feel about living in a house where the electric was wired by an unlicensed Direct-Entry Electrician who trusted his intuition and never took the required coursework of an actual professional. I bet they’d sleep really well at night….

        • suchende

          Wiring isn’t natural. Your body doesn’t know how to survive and electrical fire.

          • sleuther

            Wiring is much simpler than the physiology, endocrinology, etc of human pregnancy and childbirth… Hey, if the NCB crowd hates technological advancement so much and wishes to return to the 1890s, why do they all have blogs????

          • suchende

            Not to return to the 1890s. They want a hunter-gatherer society. Paleo-pure.

          • Amazed

            … but with that dirty internet also, please.

      • Squillo

        The odd thing to me is that they don’t really want “personal choice,” what they want is _service_. They had all the choice in the world.

        Yes.

        • Antigonos CNM

          I think what I would have said is “subservience”. It’s more than mere ‘service”.

    • Captain Obvious

      I hate when crunchy mommas say “doctors wont do something that the momma desires because of the liability, even though the doctors know its safe.” So not true. What the doctors know to be dangerous and the liability usually goes hand in hand. Life insurance asks you if you smoke, weigh you to see if your obese, get labs to see if you have medical disorders, check your BP to make sure it’s not high, ask you if you participate in high risk behaviors like sky diving, or race cars because they know this increases your risk for extra health care dollars and will charge you a higher premium or not insure you at all. Medical malpractice liability is the same. They know what makes a higher risk patient and what is likely to lead to litigation. Doctors usually agree with not wanting to jeopardize the patients or child’s life for those risks and the insurance doesn’t want to pay for the higher cost risk or litigation.

    • Something From Nothing

      If she had previous vaginal births, I’d venture an issue with the placenta might be why she was advised against TOL? Maybe partial previa or possible accreta?

    • auntbea

      Happens every time I eat at a restaurant in Uganda!

  • suchende

    “[W]hat they saw as the best and safest option: a spontaneous vaginal delivery.”

    Why oh why won’t anyone support me in my belief that driving a motorcycle with my baby in a carrier is the best and safest way for me to transport my baby? Who are you to tell me that facts don’t support my wise mama intuition?

  • Expat in Germany

    4 motherless daughters. that is very sad. At the worst, there is a death and at the very least, a woman gets all psyched up to have a natural birth along with her prenatal yoga class, only to feel like a failure or get overly dissapointed when the fairy tale doesn’t go down like they led her to expect.

  • sleuther

    Is this woman for real…?

    In the dialogs I had with these very experienced and astute midwives, I continually heard their skills as focusing in on keeping what I call the Oxytocin Loop going. I would go as far as to say that for them, this Loop is the primary medicine. Some of the conversations went to questioning who was present at the birth. Was anyone panicking? Was anyone interrupting the Oxytocin Loop? They mentioned keeping the cord attached and placing the babies skin to skin on Mama. Some suggested working towards a latch or providing luscious nipple stimulation.

    • Durango

      Ah, you beat me to it. This woman’s post is so incredibly ignorant (and she is so sure she is asking the right questions that no one thought to ask, eyeroll) and applying her made-up theories to this mom’s death. That was painfully dumb, and so self-centered to boot.

      • sleuther

        Yes – PAINFULLY dumb. As in, I bet my 8-year-old daughter would shake her head at hearing the “theory” (not that I’d willingly expose her to any of it at this age….)

        I’ve never bled out, thank goodness, but once (in the hospital) my BP crashed and it was SCARY. The doctor ordered push epinephrine via my already-present heplock (oh noes!) I was very grateful at that time to be in competent care, as opposed to having a bunch of idiots with patchouli and herb tea and cinnamon candy and “good vibes.” Things can go downhill very quickly. You don’t want to futz around with nonsense while someone’s life slips away.

        • EB151

          I’m trying to imagine how the father must feel at having his wife’s gruesome death described — on the Internet — as his fault because he panicked and put her in the car for the hospital instead of providing luscious nipple stimulation.

          • Anj Fabian

            Panicked, put his bleeding wife, two smallish newborns (and the two other children?) into the car and driving like a demon…

            Can I have any volunteers from the audience to re-enact this?

          • LukesCook

            I doubt it even registers in comparison to the culpability one assumes he feels for his part in the reckless choice that caused his wife’s gruesome death.

    • Squillo

      It’s all they can do. It’s like a firefighter who goes to a 3-alarm blaze without a hose and blames the bystanders for not using a fire extinguisher.

    • Karen in SC

      What kind of baloney is the Oxytocin Loop? Utter lunacy! As if those measures would release enough in an emergency.

      • sleuther

        It sounds suitably pseudo-scientific, I suppose, to reassure homebirthers. I believe Dr. Amy has pointed out in other posts that homebirth midwives are over-fond of favoring “treatments” that they (hb midwives) can legally administer. Coincidental, no?

  • Claire

    “I received a text message that the family had exhausted their search for a provider who would support her to birth her twins vaginally”

    This is like a toddler trying to find a new set of parents that will let them eat the all candy diet they are so insistent upon.

    • sleuther

      Our tendency to minimize cognitive dissonance is strong. Once you’ve decided that doctors are “teh debbil,” nothing they say is to be trusted and you end up in the feedback loop of woo.

      • Are you nuts

        Yes. And as long as there are idiots with a lot of [meaningless] initials after their name who write blogs encouraging women to give birth to quintuplets at home after a dozen c-sections, these home birthers can continue to confirm their closely held beliefs and make really dangerous decisions for themselves and their babies.

    • Amazed

      Hey, don’t insult toddlers, they are smarter than that. My baby brother once wailed that he’d find a new mommy because the one he had didn’t let him decorate the wall with the content of his potty. Her reaction? “Okay, there’s a whole line of mommies waiting for you outside.”

      His reaction? He went to the window, looked out, saw no line there and resigned to his fate.

      I don’t get it. Grown ups being more reckless than a toddler?