Increasing trust in obstetricians: Step 1, confront homebirth advocates working tirelessly to undermine it

Evil obstetrician

Periodically a homebirth advocate will parachute in to the blog to school the rest of us on the appeal of homebirth. In the case of homebirth deaths and injuries, the claim is often made that the best way to avoid such tragedies would be to “increase trust in obstetricians.”

Rather ironic, don’t you think? That’s because the cornerstone of homebirth advocacy is the tireless effort to undermine trust in obstetricians. It is the centerpiece of homebirth (and natural childbirth) advocacy, and its most potent marketing tool.

Craig Thompson, professor of marketing at University of Wisconsin wrote about this tactic in Consumer Risk Perceptions in a Community of Reflexive Doubt in the September 2005 Journal of Consumer Research. Thompson marveled at the ability of homebirth advocates to market a “product” by directly defying common sense:

Advocates of natural childbirth seek to inculcate reflexive doubt by countering two commonsense objections to their unorthodox construction of risk: (1) medicalized births would have never gained a cultural foothold if they were so risk laden and (2) the medical profession would not support obstetric practices that place laboring women at risk.

In other words, it is absolutely critical to the natural childbirth project to convince women that doctors don’t know what they are doing, and willfully and cheerfully risk the lives of women and babies to promote a secret agenda.

I can’t think of a single prominent homebirth or natural childbirth advocate who does not work assiduously to undermine trust in obstetricians.

The approach may differ among individuals and organizations:

Ina May Gaskin resorts to new-agey nonsense, and animal birth, which she believes, in her absolute cluelessness, to be perfect. Whereas Henci Goer favors cherry picking data, selective interpretation of scientific papers and pandering to homebirth advocates’ desire to see themselves as “educated.”

Feminist anti-rationalists like Robbie Davis-Floyd deride rationality and insist that women have “other ways of knowing.”Clowns like Jennifer Margulis point to diseases they don’t understand and pretend they are caused by “technology.”

Every homebirth and NCB book, blog and website is predicated on the belief that obstetricians are “surgeons” “untrained in normal birth” who make millions performing unnecessary C-sections in the few moments they have each day between endless rounds of golf.

The tremendous successes of modern obstetrics and the fact that 99+% of women give birth in hospitals is dismissed as the result of an economic war perpetrated by obstetricians on midwives.

Childbirth lobbying organizations like the Childbirth Connection are front and center in the effort to destroy trust between women and obstetricians. How else to explain the endless iterations of the “Listening to Mothers Survey,” a giant push polling project that desperately seeks evidence that obstetricians are not “listening to mothers” and repeatedly finds that the vast majority of American mothers are very pleased with obstetric care?

Homebirth and natural childbirth advocates fiercely grab on to new methods for demonizing obstetric care, such as the unproven claims that modern obstetrics causes “traumatic birth,”  and the hope that C-section cause long term health problems which have heretofore escaped detection despite the fact that there are tens of millions of adults walking around who were born by C-section and appear no different than those born by vaginal delivery.

NCB and homebirth bloggers pile on with inane accusations like “every day 12 babies are given to the wrong mother.” That makes it sound like there’s an epidemic of women leaving the hospital with the wrong baby, when what it really means (if it is true at all), is that an attendant (and that includes midwives) may bring a baby into the room of the wrong mother and discover her mistake when she checks the ID tags on mother and baby.

What about the spectacular advances in modern obstetrics, dropping the neonatal mortality rate by 90% and the maternal mortality rate by 99% in just 100 years?

That is simply dismissed out of hand, with claims that hospitals actually kill babies, or at instigate the medical disasters from which obstetricians thereby appear to be “saving” babies.

Homebirth and natural childbirth advocates have an “answer” for just about every objection you can name to homebirth and those “answers” often involve misinformation, and always involve undermining women’s trust in obstetricians.

Of course, the irony of homebirth and natural childbirth advocates bewailing the very loss of truth between women and obstetricians that they themselves promoted is exceeded by another irony. That irony is the reflexive and unstated reliance of homebirth and natural childbirth advocates on obstetricians to save their lives when they’ve taken terrible chances and made hideous decisions.

The backup plan is always to head for the hospital with the expectation of immediate access to the care of …. you guessed it … obstetricians. Apparently those evil doctors, who can never be trusted, can always be trusted in an emergency.

  • How good this article is! I like it. I will share with my friends. I hope that many people also have hobby the same as me.

  • lol

    Careful that you don’t sound like this here bunny…

    http://www.xtranormal.com/watch/12471398/sammy-vs-a-dr-amy-follower

    • Eddie

      Are you Sammy?

  • realityycheque

    “(obstetricians) make
    millions performing unnecessary C-sections in the few moments they have
    each day between endless rounds of golf.”

    Laughed out loud at this line. It’s hilarious if not incredibly depressing that these women actually believe this crap.

  • amazonmom

    The woo pitching idiots in the Seattle area are always trying to tell me my OB is full of crap. Apparently she has been quite vocal about how their home VBAC plans kill babies and mothers. She is tired of cleaning up their messes. Funny, because I think she’s the best thing since sliced bread. She saved me and my daughter from almost certain disaster in my first pregnancy. She has dropped everything to help me out more than once. She spent an entire week calling specialists from all over the USA when my second child was conceived while I was on meds she was unfamiliar with. (oops Im her first patient with a Mirena failure)
    All the woo pitchers have ever done for me is say that my stargazing frank breech baby with a cord presentation should have been a vaginal birth instead of a primary C section. And they wonder why I think their Bastyr “education” is worthless….

    • Bombshellrisa

      No matter how safe the midwives at Puget Sound Birth Center claim to be, they do HBACs. They let women push for hours and hours. Their transfer plan sucks. No amount of hand holding can make up for an injured or dead baby (or woman). Your OB sounds fabulous AND no nonsense!

      • amazonmom

        I agree with ALL of your statements. I’m tired of having to witness the horrible deaths of babies after transfers that happened way too late. My OB is completely no nonsense, I told her I hired her exactly because of that. She actually still says it’s a shame my daughter presented breech because she jokes that my lovely gynecoid pelvis has enough room to birth a 12 pound baby! She is offering a TOLAC if this baby presents cephalic. Of course the hospital requires two anesthesia providers to be in house with no main OR duties, for the L and D nurse to be staffed 1 to 1 for the TOLAC, for NICU to be notified a TOLAC is in progress, and for the attending OB to be present at all times on the unit (not in the office attached to the building, sleep room on unit is ok). The hospitalist OB is also present to be the second surgeon if needed.

        • Bombshellrisa

          And they say that OBs just want to “cut you”. I think that most women fail to understand what goes into a VBAC in terms of staffing. All for the safety of the woman and her baby.

  • itry2brational

    The point about feminism/feminists cannot be stressed enough. It is the vehicle by which this irrational thinking is transported. It offers a very seductive message of power and control to women but its hollow.

    • staceywm

      Are you trying to say that feminism is the main way that NCB gets transmuted to others? I do not see this as even close to the truth. Sure, there are a few feminists that promote biological essentialism, which is baffling to the rest of us feminists, but they do exist in the rad fem minority. Most NCB is spread through “all natural” groups, from CAM, anti vaxx, “paleo” and GAAPS diets, to certain parenting types.

      Most modern feminist thinkers are not pro NCB at all, and correctly see it as one more way to keep women in the home, tied to traditional gender roles.

      • itry2brational

        Transmuted? No. Transported, yes.

        “Most NCB is spread through “all natural” groups, from CAM, anti vaxx, “paleo” and GAAPS diets, to certain parenting types.”

        I would say, sorta. Its the empowering message that women have “other ways of knowing” which enable them to come to their conclusions about all of those things.

        “Most modern feminist thinkers are not pro NCB at all, and correctly see it as one more way to keep women in the home, tied to traditional gender roles.”

        Can you define some of the core concepts and theories surrounding feminism as you understand it? Who are some of the modern feminist thinkers you speak of? Because I’m getting the opposite impression…I would say most modern feminist thinkers would lean to NCB, vaccines, CAM etc being a woman’s/mother’s -choice- and women have a “special way of knowing” the right choice.

        • Eddie

          I respectfully disagree that modern feminism has much to do with NCB woo. There is indeed that anti-rationalist feminism, a loud but very small minority that champions women’s “special ways of knowing.” Don’t let their loudness fool you. They are a tiny minority. But these feminists happen to overlap in belief with a right-wing anti-feminist set of beliefs that put men and women in different realms and a woman’s place in the home with the man as the breadwinner. Again, this is a minority today as well. Most conservatives I’ve met and spoken to do not support this kind of anti-feminism.

          Woo crosses political lines and causes some very strange allies.

          • itry2brational

            Is this person a radical or modern feminist thinker?

            https://www.facebook.com/thefeministbreeder

          • Eddie

            You’re seriously using TFB as a representative of “feminism”? You just made her day, I’m sure. TFB is well known here. She is not an academic feminist, nor is she leading a (serious) movement. I don’t know how I would categorize her thinking.

            If you take her to be representative of current feminist thought, then I believe you’re quite mistaken. Don’t assume that the loud, inane, small minority is representative of the majority.

          • LibrarianSarah

            I would categorize her as a blowhard that co-opted a political movement that she doesn’t really understand but she tries really hard to make it appear as if she does. She is as the kids say… “a poser.”

          • Eddie

            Blowhard-poseur is a good summary. 🙂 I find it somewhat astonishing that itry2brational is seriously suggesting she represents anything mainstream. And feminism is definitely mainstream.

            Part of what makes Michele Bachmann stand out in her own party, for example, is how anti-feminist many of her ideas are. If feminism were not mainstream, then Bachmann would not stand out so much. She would seem like a normal Republican voice. Even among conservatives I talk to, she is not seen that way.

          • itry2brational

            “I would categorize her as a blowhard that co-opted a political movement…”

            This is exactly what I am saying too.

          • She appears to be a gender essentialist who doesn’t understand modern feminist thought at all.

            You know the bumper sticker that says “Feminism is the radical notion that women are people”? Strip it down to its core and that’s what feminism is. TFB argues that women are special and know things in some sort of intuitive, anti-rational way. That’s … well, it’s BS is what it is.

          • Lizzie Dee

            What pisses me off about the “special” version of feminism is that their intuition works best (or only) around things like how to clean a floor or push a baby out. These things are of not much importance in the great big world run by men, so denigrate women and keep them in their place while allowing them the illusion of being empowered.

            As I can mix irrational thoughts with rational as well as most people. I do actually believe that intuition or instincts can be real things sometimes – I just don’t believe it is gender marked, or always to be relied on. Men have benefitted from advances in feminism and one of the things I like about the generations after mine is that many now feel free to nurture their children and hone their instincts. Don’t think NCB has much to offer them, except for those who are comfortable admiring the “womanly” qualities of Birth Goddesses as a way of maintaining an oppressive status quo. Me, I am not that impressed by men who think the hazards or pain of childbirth are no big deal.

          • itry2brational

            “About TFB
            Q: Okay, so then what IS a feminist?

            A: “Feminism is the radical notion that women are people” ~ Cheris Kramerae author of, A Feminist Dictionary, 1996.”
            “Feminism is the advocacy of political, economic and social equality between women and men.” ~ Feminist Majority Foundation
            “A feminist is anyone who recognizes the equality and full humanity of women and men.” – Gloria Stienem, founder of Ms Magazine, leader of the Women’s Movement.

            Does any of that sound like you? Then I hate to break it to ya – but you’re a feminist too!” -TFB, Gina Crosley-Corcoran

            http://thefeministbreeder.com/about/

            See why I asked? TFB says the same thing about feminism as you say.

          • Eddie

            Err, please, let’s be accurate. TFB says some of the same things about feminism. That word “some” is critical here. Below, you agree with LibrarianSarah that TFB is “a blowhard that co-opted a political movement…” so I am very puzzled about what your point is. You started out this conversation saying that feminism is how NCB is transmitted. You use TFB as an example, but then admit she is not representative of feminism. Didn’t you contradict yourself?

            Your argument appears to be equivalent to saying, “Racism is transmitted by white people.” This statement is wrong on two counts: 1) Racism is transmitted by a loud minority of white people, so saying “white people” in general is not accurate, and 2) There are plenty of non-white people who are racist.

            The same objections apply to your statement that feminism is the primary vehicle by which NCB is transmitted.

          • Aye, she has said that. But in other posts, as others have mentioned, she champions gender essentialism by arguing that women know things in special ways that aren’t scientific and that “women’s intuition” trumps medical knowledge in the mystery of childbirth. She argues for a very intensive form of mothering as better than other forms, even though it effectively ties women to hearth and home. In other words, she’s talking the talk, but she’s not walking the walk. Women are people- their bodies are not “designed” for anything and things will go horribly awry sometimes. Not all women can or want to do unmedicated childbirth, breastfeeding, baby wearing, co-sleeping, and the other AP things; when you try to shame anyone for being different, you’re not being a feminist.

          • itry2brational

            “I respectfully disagree that modern feminism has much to do with NCB woo.” -Eddie

            “As a result, feminist scholars and activists have taken an active interest in childbirth over the years.”
            -So the connection isn’t new.

            “As was discussed previously, second wave -feminist birth activists and scholars- place a great deal of emphasis on the role of the (male) medical profession in the relocation and transformation of childbirth.”
            -Feminist activists AND scholars.

            “Birth activists’ tendency to treat midwifery as synonymous with feminism and to overlook possible conflicts between midwives and birthing women is also a source of concern.”
            -Precisely my point. They are clearly using feminism for their movement.

            “Although third wave critics are prescient to point out that midwifery is not synonymous with feminism or birthing women’s interests, it would be a mistake to therefore assume that there is no association between the two”
            -You’re making a mistake if you assume there is -no- association.

            Conclusion
            “Although offering quite disparate analyses, each of the three waves of feminist reflection on childbirth in the United States is aimed at empowering birthing women and destabilizing dominant understandings of childbirth.”
            -So all three waves “aimed at empowering” women. That’s what a feminist scholar says. “[feminism] offers a very seductive message of power and control to women…” is what I said.

            Alll quotations are from feminist scholar Katherine Beckett, in Choosing Cesarean: Feminism and the politics of childbirth in the United States in the publication Feminist Theory
            http://faculty.washington.edu/kbeckett/articles/Feminist_Theory.pdf

            What I am arguing is practically in the title of Beckett’s paper: Feminism and the politics of [“natural”/alternative] childbirth in the United States.

            The connection between birth and feminism is a long and storied one. Beckett describes it in waves with the third wave being the most recent. “Third wave critics” are the critics of the third wave of feminism which the NCB movement piggy-backs. They (and I think Beckett is one) are a -minority- of feminist activists and scholars who are critical of the NCB movement’s ties to/association with feminism. She wrote the paper to break the connection, to argue that the association is “problematic” and “inadequate”. Its in the abstract.

            Eddie, “vehicle”, transported, co-opted, piggy-backed, association all convey the same or similar message: Feminism IS being used in the NCB movement and a feminist scholar wrote an entire paper about it.

          • Eddie

            Do you see any difference between these two statements?

            1. Feminism is the vehicle by which NCB is transported. It (feminism) offers a very seductive message of power and control to women but it (feminism) is hollow.

            2. Feminism has been co-opted by a loud minority as a (not the) transport for NCB. The feminism of this minority offers a very seductive message of power and control to women but it (the feminism of this minority) is hollow.

            The reason I am arguing with you is because of the difference between those two statements, which you appear to be ignoring even as several people have called you out on it. You do understand, right, that just because someone self-identifies with a group, that doesn’t mean that they speak for or represent the group?

            If all you said was, “A group of women who self-identify as feminists use that to justify and spread their woo,” I don’t think anyone would have disagreed with you. Is that all that you were trying to say? Because the words you used painted all feminists with one brush.

        • Lizzie Dee

          I am not up to date on what modern feminism is saying – most of the “pop” stuff I see makes me groan, as mine is of the simple old fashioned equality type. I assume (hope) there are some good ones about, and my definition of good would be “No time for NCB”.

          The convergence I imagine is around the idea that Mothers Matter Too and should not just be regarded as incubators. I can’t get round the fact that a mother’s rights, and choices to some extent, do have to take precedence but I have a problem with the rights of an about to be human baby being non-existent. The whole designed to give birth and Birth Goddess stuff as far as I am concerned sets the clock back generations and infuriates me. It makes fifties sexism look benign.

        • auntbea

          I am a feminist. I am pretty good at thinking. And I do NOT lean toward anti-science.

  • Elle

    Feminist anti-rationalists? Because calling themselves “irrational feminists” would just be way too funny.

    • staceywm

      No, they ARE actually feminist, anti-rationalists. I know it sounds funny, but it is a subset of radical feminism which has nothing to do with mainstream feminism.

      • auntbea

        What is radical feminism? (I should probably already know this.)

        • BeatlesFan

          *lights bra on fire*

          • auntbea

            Hope you took it off first.

          • KarenJJ

            Well now you tell us..

            *ouch*

          • The Bofa on the Sofa

            In honor of Jean Stapleton:

            (in a discussion about feminism)
            Archie (to Edith, after she made quiche for Sunday breakfast instead of his usual): What next, you going to start running around in hot pants and burning your bra?
            Edith: Oh, Archie, you know I don’t like fire.

  • Laura

    Okay, so honestly, I would never go to an ob/gyn who looked like that! I’m happily married and want to stay that way. Just sayin’….

    • Susan

      I wondered why Dr. Amy didn’t choose this photo

      http://www.nytimes.com/imagepages/2013/05/12/books/review/0512-bks-PAUL.html

    • auntbea

      I also wonder about a particularly attractive female friend of mine who seriously considered urology as her specialty. She ultimately went with internal medicine, so I never to got to find out if her patients were happy or uncomfortable to have her as their penis doctor.

      • Laura

        This may sound shallow, but a very beautiful female urologist discussing and examining a nervous patient’s penis MIGHT be very distracting to the patient. God forbid the wife or girlfriend saw the doctor! I don’t know, MAYBE….

      • Eddie

        It’s funny, but I doubt I’d care much. My current GP is, in fact, extremely pretty and maybe in her young 30s. I had to ask her about what turned out to be a skin tag in that awkward area close to — do men have a perineum? Anyway, that area. She had to look from a few inches away to really identify what it was. I apologized for the awkward location. If she were a male doctor, I know it wouldn’t have occurred to me to apologize, so I’m not saying gender is totally irrelevant. But mostly it just doesn’t make a difference to me, and where it does the difference is small like this one. Even if I were discussing ED or something like that, female doc, male doc, wouldn’t matter to me.

        I do imagine that some male patients might have … embarrassing reactions, depending on what exactly she had to do in an investigation. 🙂

        • Laura

          You sound like a dream patient! I really appreciate your intelligent contributions to this blog, too.

          • Eddie

            Thank you!

        • The Bofa on the Sofa

          When it comes to doctors, I have no shame. It’s the body, it’s medical. They’ve seen plenty of naked people of all sorts. It’s their job, and I expect them to be professionals, and, for the most part, they are (I’ve never met one who wasn’t).

      • Frequent Guest

        We have a very, very attractive male family practice doctor. Me, my husband, and my daughter all see him. I did have to see him for an embarrassing issue once, but I think I would have been embarrassed regardless of his attractiveness. 😉

      • Ashley Wilson

        In high school, a friend of mine got diagnosed with testicular cancer. His primary doctor was a 30-something female who he described as EXTREMELY attractive. A bunch of his guy friends used to tease him about how lucky he was that his doctor was so hot. They shut up when he put it in perspective: he was a 16 year old guy sitting naked in front of a beautiful woman who was going in detail about how she was going to cut off one of his balls. Worst nightmare.

        But side note: he’s fine last I heard. No recurrence or anything. So that’s definitely something.

  • HolyWowBatman

    I wonder at times how many physicians, specifically ob/gyns, any specific homebirth Nazi actually knows personally or professionally. It’s easy enough to demonize an idea or concept, but it’s another thing to demonize a person…especially once you really know the price they have paid and sacrifices they have made for the purpose of helping others.
    By the way, this is an excellent post.

    • OBPI Mama

      Most homebirthers I know have never been to or met an OBGYN. I hadn’t either until I got pregnant with my second kiddo (family doctor stitched me up when midwife couldn’t with my first). It was shocking to actually see “these” people had families and smiles on their faces and asked questions… certainly not what I had read about in homebirth books!

      • Eddie

        Do you really mean never been to an OBGYN? Never had a pap smear? Never had birth control? Never had any of that routine care?

        • Karen in SC

          Some family practices do all that…so I’m guessing that was the case here.

          • auntbea

            Until I ended up in various university systems, with easily accessible specialists, my family practice did everything. I can still remember being horrified when they asked me if I wanted my doctor — a 60-year old guy who had seen me since I was toddler — to do my first gyn exam.

          • Sullivan ThePoop

            My great aunt who had been my doctor my whole life did give me my first gyn exam and diagnosed my first pregnancy. It didn’t bother me, I liked her.

          • theNormalDistribution

            Wait… I’m confused. Were you horrified to have him do it, or horrified at the thought of having someone else do it?

          • auntbea

            Having him do it. Like being inspected by my uncle. I believe I said, “Ick. That’s gross.”

        • RiceVermicelli

          Until I got pregnant, I got those things from my GP. Insurance wouldn’t authorize me to have both a GP and a GYN, one had to be primary, and the GYN wasn’t going to see me when I had the flu, so….

          • An Actual Attorney

            FYI — the ACA (Obamacare) rules require that plans have to let you access an OB/GYN without a referral: http://www.healthcare.gov/law/features/rights/doctor-choice/index.html

          • Sullivan ThePoop

            Most HMOs let you choose an OB for your primary if you are a woman. I had an HMO once that let you have both a primary and an OB, either could refer you and they both cost the primary care fee. Now I have a PPO so you do not need all the referrals, but they charge the primary fee instead of the specialist fee for an OB or even just a GYN, which could not be your primary on my HMO and cost a specialist fee. Pregnancy is different because it costs a set amount instead of a bunch of fees.

        • theNormalDistribution

          I’m in Canada, but I think it’s relatively common to never see an OBGYN unless you were referred for a specific problem (or pregancy, of course). My sister has endometriosis, but our GP still does her pelvic exams and prescribes birth control. I think she saw a gynecologist once in total. If you are into homebirthing, I can totally see never meeting an OBGYN.

        • Bombshellrisa

          They seriously don’t see the need for things like pap smears. Heck, CPMs don’t even do internal exams until a woman is far along in labor. It’s a reason that a lot of the women like seeing the midwives, they don’t have any of the routine things like pap smears and pelvic exams. Just lots of talking and reassurance. There are women who have had 4 children with midwives at home and NEVER had a yearly exam. It’s one of the reasons they hate OBs so much, all the “clinical stuff” that isn’t fun and isn’t about having BAYBEES

          • Eddie

            I spaced and forgot that so many with that mind set don’t believe in preventative medicine, period. Because “right living” renders them immune to disaster.

        • OBPI Mama

          Never. I got married at 21 and had my first son at 22 (are pap smears/routine care a “supposed to” at 21?). We’ve never used hormonal birth control. The male family doctor (I had never even met him before this) who stitched me up was the first doctor since I was a newborn that had seen my parts… and I was shocked that I could have cared less. And it turns out that when I had to find an OB to deliver my 2nd baby, my amazing obgyn is a male too. It still surprises my friends… The thought of going to an OBGYN freaks them out, let alone it being a man!

          • Eyerollin

            That’s really scary. yes, pap smears are a “supposed to” at 21 – I know someone who had cervical cancer at that age. It can develop very quickly.

          • OBPI Mama

            I just read that’s the recommended starting age for them if one is not sexually active or have history of cervical cancer, so I wasn’t too far off. I have no idea what my friends will do as they age….

          • Dr Kitty

            Atually- depends on region again. The UK doesn’t start smears until age 25, doesn’t recommend them for women who have never been sexually active (although does recommend them for Gay women) and does them every 3 years until 50 and then every 5 years until 64.

            Smears are a screening test of symptomatic women- there will be false negatives and false positives. The USA prefers to over diagnose and over treat, the UK prefers not to.

            Both approaches have their critics.

          • Dr Kitty

            Darn, that should say “asymptomatic women”.

          • Eddie

            When my oldest daughter approached 18, we asked her pediatrician when she should first see a Gyn and have a pelvic exam, pap smear, etc. She (pediatrician) said 18 was fine to begin those for someone not yet sexually active. Otherwise earlier.

            FWIW, the insurance I have is hard to explain, even to my own family, but it’s like a PPO not an HMO. Thus, we don’t need pre-authorization to see a “specialist.” I wouldn’t have previously thought of a Gyn as a specialist though. Last time I was on an HMO I was single with no kids, so I have no idea how HMOs handle this.

            Aside: Do people outside the US have an idea what the difference is between PPO/HMO?

            My wife doesn’t care about the gender of her Ob/Gyn. My oldest daughter demanded a female Gyn, which of course was no problem at all. I’ve had prostate exams from both male and female doctors, and it’s equally weird either way. Gender for my medical provider is irrelevant. Some people do care. (shrug) Vive la différence!

          • auntbea

            Hey! Answer my question upthread about my female urologist friend. Pretend you speak for all men,

          • araikwao

            PPO/HMO??? No idea in the slightest!

          • OK, I’m no expert, but this is my understanding of it from doing the paperwork to pick plans for myself and my husband.

            HMOs are cheaper, but they require pre-authorization to see anyone but your “primary physician”, who is normally your GP. That is, the insurance won’t pay for it unless you ask them first and get permission from someone at the company. Needless to say, while these plans are cheaper, they don’t actually give great coverage and people often wait months to get approved for specialist visits, which can be dangerous.

            PPOs are what everyone else in the world would see as more normal. You can see the doctors you think you need to see (though they still have to be in-network) when you need to see them. The plans cost more, but are also generally more comprehensive.

          • Eddie

            PPO = Preferred Provider Organization. You get to see almost any medical provider or specialist without pre-authorization. If you see someone in-network, they’ll pay typically 80-90% of the cost. If you see someone out of network, they’ll typically pay 60-70% of the cost. A PPO may or may not assign you a primary physician, but if they do there isn’t any meaning to it in terms of insurance coverage.

            HMO = Health Maintenance Organization. You have to see your primary physician — who MUST be in network — before you can see just about any specialist. Exceptions exist for emergency situations. Most office visits you pay a co-pay of $25 – $35. Typically, you cannot see anyone out-of-network unless there is no in-network doctor of that type in your area. If you see someone out-of-network at all, or even in in-network specialist without authorization, you pay the entire cost yourself. Before you can see any specialist, the HMO needs to approve the treatment or it may not get covered.

            When my company offered two choices, a PPO and an HMO, the HMO had higher insurance premiums, maybe 5-10% higher, but since most routine medicine had co-pays (a fixed fee) rather than co-insurance (a percentage of the billed cost), the HMO was a better deal for most families.

            FYI: An average family insurance policy obtained through an employer currently costs around $18,000 per year. Employers typically cover most of that cost (say, 3/4) with the employees having the rest deducted from pay every paycheck or every other paycheck. Insurance obtained on the open market can be even more expensive, as most people looking for it are people with a pre-existing medical condition.

          • Sullivan ThePoop

            Now they say 21-22 unless they are on birth control or have an issue.

          • PoopDoc

            Most people inside the US don’t have a clue what the difference is between an HMO and PPO.

          • Anj Fabian

            One diff is that when I turned my ankle and was still in pain two weeks later – I made an appointment with an orthopedic specialist directly, without going through a GP first or calling the insurance to get authorization.

            It saves time and money too. I got the care I needed without having a GP look at my injury and say “Yes, I think you should see a specialist for this.”.

        • Dr Kitty

          Depends on the system. I work as a GP in the NHS.
          I do smears, breast exams, birth control, HRT, antenatal and post natal checks.
          I don’t deliver babies.

        • Clarissa Darling

          You don’t need to go to an OBGYN for that. I’d always gone to my general practitioner for those things and never met an OB till I was pregnant. No one at my GP’s office ever directed me to an OB for routine exams although I’m sure I could have gotten a referral to one if I’d wanted.

      • Eddie

        Reminds me of the prejudice against Muslims I occasionally run into among friends (mostly among WW-II veteran age friends). I am not Muslim, but have worked with many over the years. Maybe if some of my bigoted friends actually *knew* some of the people I knew, they would see things differently.

    • Bomb

      I actually know a few home birthers that work in hospitals. They have no education and their jobs are completely devoid of the kind of high stakes decision making doctors deal with all day everyday. So they see doctors make mistakes and assume they are just as smart, can make themselves more educated, etc. when in reality if they were under the same pressures they would crash and burn. But since they don’t make mistakes sitting at a computer all day, clearly the OBs making mistakes are just idiots and proof med school is a joke.

      • realityycheque

        It’s truly arrogant the people I see who act as though anyone with an ACTUAL education in a field is no more capable than they are because they can jump onto Wikipedia and read an article.

  • Studentmidwife

    OT: is anyone else worried about stunt birth rayanne? If she is still pregnant she is 43+3 today, which is insane. I am hoping she went to the hospital, got induced, and has a healthy baby and a perfectly happy birth story that she can’t share on the mothering site. The alternatives – that she is still pregnant or that she had a bad outcome – are what worry me. I think if she has had her successful UC she would have been crowing from the rooftops about it by now.

    • Eddie

      I have wondered/worried about this as well.

    • Karen in SC

      Me, too. If she was a fake, why didn’t she come back with a fake victory?

    • Bombshellrisa

      She had mentioned her daughter was born at 42w5d. Since this is a UP, maybe she seriously got her dates wrong.
      I also want this to be a happy, albeit unsharable on MDC kind of story, not the sad kind.

  • Which is why the work you do Dr. Amy is so important, if the assertions of the NCB proponents go unanswered, then women (wrongfully) conclude that they are true. Thanka-you for your tireless work to bring rationality and facts back to the conversation on birth.

    • Amy Tuteur, MD

      Thank you.

  • Gretta

    Meeerow… who is that OB/GYN?

  • guest

    And then if your hospital C-section still leaves you with an oxygen deprived baby, you can sue, claiming that it was the evil hospital’s fault – not the hours at homebirth with a negligent midwife – that hurt the child. I’d still like to see the documents from that lawsuit.

    • amazonmom

      Yup, gotten sued along with all the docs after homebirth that resulted in dead baby. Hospital risk management made that go away pretty fast, love those lawyers!

  • Maria Miller

    Dr. Amy your logical and essay writing brilliance is astounding!

  • Bombshellrisa

    “the “Listening to Mothers Survey,” a giant push polling project that desperately seeks evidence that obstetricians are not “listening to mothers”

    There is a midwife in the Seattle area who brags in her bio that “listening is my best skill as a midwife”.

    • AmyM

      At least they published the results of the Listening to Mothers Survey, instead of throwing it away since it didn’t say what they wanted it to. I took that survey and raved about my OB and the care I received at the hospital with the highly medicated birth of my children.

      • Bombshellrisa

        Gotta hand it to them for not taking a page from Melissa Cheyney. Still, I don’t want a medical professional whose best skill is listening. My doctor has a whole bunch of things listed on her bio that she is skilled in, listening is not one of those things (although I have never felt like she didn’t listen)

        • AmyM

          My OB is actually an excellent listener, though that is not why I chose to see her for obstetric care. I count it as a bonus, which I am actually getting more benefit from now, years after my children have been born. (Of course, I am asking her to listen/talk to me issues that pertain to gynelogical health, not chatting about how other women suck at life because they do things differently than I do.)

  • KumquatWriter

    Fantastic closing line!

  • anonymous

    Another fun tactic: suing doctors for “raping” women in the ER. I have a certain friend that was the resident at a hospital here in GA. A woman came in after attempting VBAC, and even admitted her doctor had told her not to. My friend managed to save the baby and mom, so much so that the senior OB on staff essentially told her that her handling was exemplary. The whole time mom was insisting she didn’t want “useless interventions” all the while she’s losing blood. When the dust settled, they’d but, according to my resident friend, 14 units of blood into her. Mom’s ok. Baby’s ok. Midwife shows up, and ten minutes later the police are there for a “rape” investigation.

    • auntbea

      Did the mom report it? Or the midwife?

      • Anj Fabian

        Better:
        “Did the mom report the midwife?”.

        What? You think only OBs can commit “birth rape”?

        • Bombshellrisa

          Some of Lydia Owen’s patients feel raped after their experience with Power Birth

        • auntbea

          True enough. But I still want to know whether it was the mom or the midwife who felt violated by the OB.

    • Anon

      That is special. This is one of those times when it is good I’m not the dictator. I’d blacklist whichever one of them called the police for rape from ever getting medical care again.

    • Anj Fabian

      14 units means they completely replaced her blood volume plus a few units. It probably put a serious dent in the available units in Blood Bank. It likely tied up OR as well.

      Mom and baby alive and healthy – major bonus points.

      Midwife? I want a name. I have SO many questions for her.

  • Claire

    I starting thinking reading this how NCB always say, “The OB came in at the last moment to catch the baby.” Perhaps they are just Holding The Space in their own way not being in the room the entire time?

    • Captain Obvious

      Again, the OB works as a team with the L&D nurse. Does the NCB think the L&D nurse with all her education and experience is invisible? The OB, the L&D nurse, the ancillary staff drawing blood, the nurse anesthetist all work together to provide a safe birth. The doctor doesn’t need to be in the room the whole labor. Many families prefer to labor with there husband or family only in the room so they can act silly, talk about what they want without feeling judged by a doctor or nurse ever so watching them. The Homebirth midwife is the nurse, doctor, and natural anesthetist. All to often not knowledgable enough in any of those job descriptions and if too busy, then too tired to have a busy practice. And if not busy, then not experienced enough to handle complications. And if not experienced enough then shouldn’t be handling all of the responsibilities to deliver a baby. I would rather have specialists like nursing, and doctors, and anesthesiologists all helping me than one person. Have each show up when they are needed.

    • Rabbit

      The only one of my deliveries that the doctor came in just in time to catch was because I never really pushed. I went from telling the nurse that I thought I was maybe feeling pressure, to baby’s head out in the three steps and 30 seconds it took to get from the bathroom counter to the bed. My OB was in the next room delivering another baby – but she got to my room 30 seconds after baby’s head was out, and got my daughter’s shoulders unstuck and her out safely. And that wasn’t the first time I’d seen her that day either. She was there at the start of the induction, checked in again after having me walk around for an hour, stuck around for 30 mins or so after my daughter appeared to experience some temporary difficulties after my water broke, until the doctor was sure that the cord hadn’t prolapsed, and that baby’s heart rate and variability had returned to normal.
      With my other babies, the OB was there for all of the pushing part, and at least 2 other times to check in. My longest labor was around 4 1/2 hours, so the doctors were there a fairly significant portion of the time. Also, with at least my most recent doctor, she could see the strips from her office upstairs.

      • Captain Obvious

        The OB has been there for the whole pregnancy providing good prenatal care. If any issues arise, provide information and treatment. The doctor stops by at the start of labor, and a couple of times throughout labor, and to “catch” the baby. If the baby comes out so fast before the doctor can get there, the L&D nurses are usually well trained enough to deliver the baby. The doctor IS needed for the difficult deliveries, not so much for the ones that slide right out. It is nice not to miss any deliveries, but are you really going to judge a doctor for missing a delivery after providing such good care of you for nine months that allowed you to have such an easy delivery that the doctor wasn’t even needed to be there for?

        • The Bofa on the Sofa

          Are L&D nurses “experts in normal birth”? Ha ha ha!

          Actually, it’s even better. They are “experts in easy deliveries”

          • Captain Obvious

            No offense to L&D nurses, but some crunchy L&D nurses do catch several easy deliveries, then go on to become midwives believing they can handle anything.

          • Ducky

            Yeah, actually a midwife in The Business of Being Born was a former L&D nurse. Though she seemed to exercise good judgment to the extent one can as a homebirth midwife…

          • Amazed

            In the movie, you mean. Not so much in real births.

          • Sullivan ThePoop

            An L&D nurse told my SIL that her C-section was unnecessary.

        • anon

          Exactly! Why are these women all so dang emotionally needy that they want someone who is not a member of their family to be there holding their hand the whole time? My doctor broke my water (cascade of interventions!!!ONE!!!!) and then came back to deliver each of my three babies. And when the third took a bad turn, CFM alerted my highly-trained nurse that she needed help, and help was there in seconds.
          THAT’S why I had hospital births. Not to forge a lifelong friendship.

    • Jessica

      I don’t know if my experience was unusual. My OB is in a group practice, but each doctor delivers his or her own patients (95% of the time, he said). I saw only him during the entire pregnancy, and I was worried I would go into labor one weekend when was on vacation – I wanted him to deliver my baby.

      He was not there when I checked into the hospital at 10p to start the induction, but he came by the next morning after his one outpatient surgery of the day, and then a few more times as labor progressed to see how I was doing and eventually to break my water. When I was complete they called him, and he was there the entire 40 to 50 minutes I pushed. He had me grab his arms and pulled me toward him as I pushed. He of course tried some perineal massage to prevent tearing. He made jokes about naming the baby after him. He did catch the baby. But he was actively there during the second stage, and my memories of that time period are of him and how he helped me, the annoying labor nurse only secondarily. I don’t really remember my husband’s presence (he was there and comforting, but I wasn’t paying attention to him) until the baby was actually born. And the doctor came by the next morning to see how I was doing and congratulate us on our new son.

      I adore my OB. Not just because he’s kind and personable, but because he’s a damn good doctor. It is possible for OBs to be both, and I hate that NCB advocates try to deny this reality, which MOST women I know have actually experienced!

    • suchende

      The OB who was there throughout my labor was not the OB who caught my baby, which of course would never have happened with a CPM. Because who would want a refreshed, well-rested birth attendant? Much better to have someone on the scene who is as exhausted as me.

    • BeatlesFan

      I only had an OB at my daughter’s birth, not my son’s (because a CNM-in-training delivered my daughter, so they had another CNM and the OB there as “backup”). Both CNMs and the OB were present the entire time- most likely because I arrived at the hospital at around 8AM at 8.5cm, and my daughter was born at 10:30AM.

      With my son, we arrived at the hospital at 9PM Sunday night, and he wasn’t born until 7PM on Monday. If a CNM or OB had tried hanging out in my room that entire time, I would have gotten annoyed and told them to GTFO.

    • Bombshellrisa

      I would love to ask those NCB types how a midwife holds the space when she is napping, leaving the laboring woman to attend another laboring woman or going out shopping!

      • auntbea

        If you are a truly mystical midwife, you do not need to be conscious to hold the space.

    • Victoria

      So the OB who walks in at the last minute to catch the baby and isn’t present for the whole birth is ALSO the one that is pushing unnecessary interventions on mothers? Holy crap. What was that thing Hermione had in the Harry Potter series that allowed her to be in two places at once? OBs got mad magic.

  • Eddie

    And make no mistake. This anti-OB campaign is actually a cleverly-designed pro-NCB marketing campaign, designed to increase revenue of midwives, book authors, and others in the NCB marketplace. It’s tragic that so many people repeating this nonsense don’t get that.

    Part of why Apple is so successful is that they are great at getting their customers to become free marketers and strong advocates of their products, including in some cases attacking their competition. (Ah, the fanbois.) The NCB industrial complex aims to do the same. As a marketing plan, it’s brilliant.

    • The Bofa on the Sofa

      I always get a kick out of the accusation that OBs are against HB because it cuts into their business. Let’s compare…

      HB advocates like to crow that HB has increased by 30% in the last period. What does that mean?

      From a HB MW perspective, it is growth in market share by…about 30%. A 30% growth in business is pretty big, for sure. If every MW has 30% more business, that is a pretty good haul. Call it one extra delivery a month (from 3 to 4, right?).

      Meanwhile, for the OBs, however, it constitutes a drop of about, what, 0.2%? The market share drops from 99.5% to 99.3%? That means that they lose 2 patients for every 1000 they have.

      So who’s more concerned about money? The MW who can increase her caseload from 3 clients/mo? Or the OB, who has 2 for every 1000 drop out? Especially considering that most OBs are already complately swamped, and it can actually be hard to find OBs who are willing to take on new patients since they are so overwhelmed already?

      Yeah, the OBs are all concerned about losing money….NOT

    • auntbea

      Why is “fanboi” spelled like that?

  • Eskimo

    OT but… http://www.huffingtonpost.com/2013/06/04/kim-kardashian-eat-placenta_n_3383038.html

    Kim Kardashian is going to eat her placenta. NOT surprised though, getting attention for being an idiot is kinda her thing.

    • OttawaAlison

      Will that make consuming the placenta ‘Jump the Shark’?

      • Zornorph

        Well, she mated with a gay fish, so quite possibly.

    • Rochester mama

      At least when her sister Kourtney investigated home birth when she was pregnant she decided it was ultimately safer to do it in a hospital, proving the Kardashians are smarter then homebirth advocates. Ouch.

      • Bombshellrisa

        And from what I hear, Kourtney got to “catch” her own baby and cuddle him immediately-something homebirth advocates claim doesn’t happen in hospitals.

        • Captain Obvious

          On my easy deliveries, I offer the woman to reach down and grasp the baby to pull up onto her abdomen. Many women decline this. They want the baby in blankets and not skin to skin. Or they want the baby skin to skin after the first bath.

          • auntbea

            I was offered this opportunity. And was pretty sure I would drop her on the tile floor if I tried.

          • Marguerita

            I was shaking terribly at the end of my delivery and I was surprised that the lactation consultant wanted to have me hold the baby in that condition to breastfeed… I didn’t know anything about “baby friendly” at the time. I told her I’m too shaky and the OB agreed.

          • auntbea

            I have no excuse. I am just clumsy.

          • The Bofa on the Sofa

            Tsk tsk!!!! That’s not baby friendly!

            You know that unless you immediately put the goopy baby on mom’s bare skin, they will suffer with life long emotional problems and never breastfeed.’

            Baby haters!

          • Susan

            And baby hatters!

        • BeatlesFan

          I “caught” my son- I had never heard of anyone catching their own baby before, so I was somewhat surprised. My husband caught our daughter, although I’m sure if I had said I wanted to do it, I would have been allowed. With both, the baby was on my chest, skin-to-skin, immediately. The babies were toweled off, hatted (gasp!), given eye ointment (the horror!) and then we were left alone. And all that was without a 3-page, condecending, overly specific birth plan! /snark

    • Zornorph

      So Kim joins the cannibal crew.

      • nohika

        Don’t you know it’s actually the kannibal krew. Get with the k-party.

    • Captain Obvious

      The only way to eat a placenta fresh and clean is after a cesarean. Without denaturing the proteins by encapsulating it. I would shudder about eating a placenta after a long labor with inflammation and infection and thrombosis affecting the placenta. Would you eat a steak after dropping it on the patio and flies land on it? :-/

      • Bombshellrisa

        I wish someone could tell Wendy Gordon this!

      • Ducky

        Gross! I would not.