For natural childbirth advocates, every day is Opposite Day

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At the heart of every alternative health movement are two critical attributes, defiance and denial.

The denial is easy to recognize and can be summed up in one sentence: Bad things aren’t going to happen to me.

I’m not going to get cancer/die of cancer/have children who contract vaccine preventable illnesses/have childbirth complications because I eat right/waste money on useless supplements/waste money lining the pockets of alternative quacks/have a strong immune system/chant affirmations.

In other words, it’s nothing more than wishful thinking, because it is too scary to contemplate anything else.

The defiance is also pretty easy to recognize, particularly in natural childbirth, and I don’t just mean the immature defiance of authority.

As is obvious to anyone with basic critical thinking skills, in the world of NCB, every day is Opposite Day. If the doctor says one thing, the NCB advocate says the opposite, without any research, or indeed, any attempt at research to back up the increasingly absurd claims.

Since every day is Opposite Day, there are never any complications, only “variations of normal.”

Since every day is Opposite Day, labor isn’t agonizing, it’s orgasmic.

Since every day is Opposite Day, birth in water, although unheard of in any other primates, is “natural.”

Since every day is Opposite Day, the umbilical cord shouldn’t be cut immediately, it should simply be allowed to rot off.

Since every day is Opposite Day, newborn baths and hats are evil.

I’m hardly the only one to note this. According to Ellen Annandale and Judith Clark, authors of the widely quoted paper, What is gender? Feminist theory and the sociology of human reproduction published in Sociology of Health & Illness, going so far as to accuse proponents of the “new midwifery” of unreflective defiance:

… the lived experience of midwifery … is revealed only as the largely unresearched antithesis of obstetrics… [I]ts central precepts (such as ‘women controlled’, ‘natural birth’) are vaguely drawn and in practical terms carry little meaning.

Simply put, contemporary natural childbirth advocacy (particularly homebirth midwifery) is nothing more than an extended childish temper tantrum.

And like most childish temper tantrums it is a defiance of authority for its own sake, involves deliberately disregarding harms, has no basis in objective reality and is all about how the individual having the tantrum wishes to view herself as opposed to the ostensible subject of the tantrum.

Natural childbirth and contemporary midwifery theory discounts the value of education, since scientific evidence does not support objectives of the tantrums. It valorizes “intuition” which is just a fancy way saying “we make it up as we go along,” and it gives primacy of place to magical thinking.

Childish temper tantrums are amusing and irritating when they occur in children. However, they can be downright deadly when they occur in adults.

Natural childbirth and homebirth advocacy get goofier and goofier as the years go by, but that is entirely predictable. If all they are is unreflective defiance, it stands to reason that every aspect of modern obstetrics, from serious issues like pre-eclampsia all the way down to trivialities like hats will represent an opportunity to have a tantrum.

In the world of natural childbirth and homebirth, every day is Opposite Day, not because the opposite is true, but because oppositional behavior for its own sake is the hallmark of the immature behavior at the heart of temper tantrums. And natural childbirth and homebirth advocacy are nothing more than childish temper tantrums writ large.

  • This has been a good blog post! I’ll go ahead and actually share it….continue the truly
    amazing work!

  • nice article……….

  • Guest

    OT: does anyone know how bad 2 hrs of postnatal hypoxia in a meth exposed baby are? She had pulmonary hypertension which resulted in dic, but 48 hrs later she is doing well and coming off of the respirator. No bleeding in the brain. My quick googling put her odds of disability at 25% but I don’t know how accurate that is. All the docs say is that it could go either way, long term. Thinking of adopting, but don’t want to invite disaster. Do you know of any good discussion boards for this?

  • Liz Earle

    Well if this is the state of the US care system thank GOD im in the UK. Where we have correctly trained and educated doctors and midwives. Over here we have decades and decades of research to support natural and home birth. We have endless amounts of evidence to support delayed cord clamping. We have evidence that women during the cave man era birthed in water. We have evidence to support that minimal intervention reduces trauma and stress to both mother and baby and increases breastfeeeding and bonding. We have endless research to support midwifery led care. Im really sorry that women in the US are obviously different to those in the UK. It must be real shame to be at risk during during your pregnancy and labour all the time. But dont worry as you have doctors AKA god, with a white steed AKA the knife, to save you. God forbid that as a women that grew a complex human you can birth it -that would never do. Pre-eclamsia and emergencies exist, I would never suggest that these dont and that they are dangerous and need medical intervention, but fortunately for women in the UK our doctors are trained to know the difference between high risk and not high risk – this person does n not, or perhaps every women in the US is high risk?. Women who have had a normal pregnancy with no complications should be able to birth their baby at home, in water or however they choose, without knife hungry doctors around. Our research very very very very clearly shows that doctors and hospitals cause complications with their desire to control nature. As a midwife I’ve had 5 years intensive training in midwifery – over here doctors get about 6 months and its all high risk. Women who think this person knows what they are talking about just take a look at “rotational death figures” in the areas of obstetrics. Around June – August women and babies have a higher death rate – why? because we have new doctors who have no experience. The best thing i can say right now is find a midwife who is trained in both normal and high risk care and get a balanced view of childbirth. It doesnt have to be scary and you do have choices. Also ponder this – if you got pregnant you obviously have hormones and an uterus and a vagina – this means you have the ability to birth your child.
    Dont throw this away based on a narcissistic unbalanced unresearched untrue post of someone who obviously has a personal axe to grind.

    • Kalacirya

      “Also ponder this – if you got pregnant you obviously have hormones and an uterus and a vagina – this means you have the ability to birth your child.”

      Oh come on.

      1) If you got pregnant, you can have a miscarriage, and not wind up birthing your child at all
      2) If you got pregnant, you can have a fetal death, and wind up birthing your stillborn child
      3) If you got pregnant, you have have a complication during labor such that you birth your brain damaged child

      You pretend like you’re speaking from a place of evidence and logic, meanwhile you’re saying “Well if you’ve got the hooters and the hoohaa and your babydaddy put one in you, then that’s all you need in order to have a successful birth”. And I’m somehow doubting you see a c-section as a successful birth.

      • Liz Earle

        If you drive a car you could die… that doesn’t mean you should discard your car, does it? If you have got pregnant you do process the equipment to birth with support guidekce and TRUTHFUL education. Birth is a very highly driven hormonal activity – screw with it and it will screw things up. Going into hospital can slow and stop some womens labour as the hormones prefer a dark, quite safe place. If your brain registers any fear it will stop labour and for some this means birthing in hospital for some it means home and for some it means C-sec. Birth shouldn’t be planned around fear, and this doctor that trained far to many year ago to be relevant to today’s practice comes form the point of medicalisation and fear which is not helpful to anyone and just embeds fear into women.
        Yes as a midwifery trained professional I do come from an highly experienced evidence based point. And yes i do think that C-secs are life saving and sometimes needed and therefore successful. I have already said there are time when interventions save lives and complication occur.
        In the UK the average current rate of C-secs are 24%, only about 3-6% of these are “live saving” the rest are planned due to some reason. This does mean that 95% odd of women having a normal pregnancy can give birth without the need for intervention. C-secs are dangerous, all interventions carry extreme risk. For the majority of women childbirth can be a natural process and without fear.
        Why would you opt to be chopped open and risk death? why would you not breastfeed and protect your child against cancer if you could? why would you pump drugs into yourself and your baby when there are ways of doing it pain and drug free? These options are not suitable for every women but women should make the choice that is right for them based on evidence, choice and NOT fear!

        • FormerPhysicist

          Pfft, fanatic.
          I got 3 c/s before they were “life-saving” because my doctors and I didn’t want to wait until my life was in imminent danger, thank you very much.

        • Kalacirya

          “Why would you opt to be chopped open and risk death? why would you not breastfeed and protect your child against cancer if you could? why would you pump drugs into yourself and your baby when there are ways of doing it pain and drug free?”

          Hahahahaha, there’s nothing evidence or experience based about any of this. You’re just a quack.

        • Amy Tuteur, MD

          You don’t come frrom an evidence based point of view. You just repeated a whole bunch of crap that was made. There is NO scientific evidence that “screwing” with birth messes things up; indeed since modern obstetrics has been “screwing” with it, the neonatal death rate has dropped 90% and the maternal death rate has dropped 99%.

          There is NO evidence that fear has ANY impact on childbirth. Grantly Dick-Read (who was a racist and sexist) simply made that up to convince white women to have more children.

          As I have said elsewhere many times, the only people who claim homebirth is safe are those that make money from it … like you.

        • Anj Fabian

          “Why would you opt to be chopped open and risk death?”

          Live baby versus dead baby. I didn’t conceive, carry and endure labor so I could give birth to a stillborn child. When things went south, I valued my child’s life enough to “risk death”. Then again, I “risked death” for nine months because being pregnant endangers any woman’s health and life.

          Them’s the facts, sunshine.

        • Lizzie Dee

          Lord, this refrain gets boring doesn’t it? EVERY SINGLE ONE of these “advocates” tells us the same things as if they were the first to do so

          .”interventions carry extreme risk” but no risk to childbirth so long as you sing tra la la and are a PROPER woman, who uncritically swallows this stuff.

          Yes, yes, birth is safe for 95% or so. Seldom blissful and entirely unproblemmatic, but more or less safe. The trick is being certain you are one of the 95%. The reason for seeking decent health care is that you cannot be certain you will not be one of the 5% – no matter how healthy and informed.

          • Karen in SC

            “And I wish someone would explain to me why these brave, fearless, warrior women are so easily “traumatised” by the trivial?”

            Truth!! Fearless warrior until asked if pain relief is wanted, received a free formula sample, experienced something not on the “birth plan”.

        • auntbea

          Do OB carry axes these days? I didn’t realize that.

        • Sullivan ThePoop

          I really thought that England had better midwives than the US until I read your post.

  • Kelly

    Dr. Teutor,

    I stumbled upon your website after watching a huffington post interview about the dangers of homebirth. I’ve done some poking around and I have some questions that perhaps yourself or your follows might answer or at least point me in the right direction.

    1. You make a distinction between the CNM and other types of less educated, less regulated midwives in the US, often calling the other types of midwives “homebirth” midwives. However, many CNM’s will attend homebirths. What is your assessment of homebirths attended by CNM’s in this country?

    2. What do you believe that the evidence suggests about epidurals during labor? (Or other pain relief options, for that matter). We all know the home birth argument but my common sense actually does tell me that *something* is amiss here. How can it be that I cannot have so much as an advil during pregnancy but a cocktail of narcotics has no impact on my baby?

    3. I am absolutely a believer in the time and place for both induction and c-section. Are there any reliable studies showing at what time these interventions are NOT called for? This is a big sticking point for the natural childbirth movement. Inductions before 37 weeks are associated with higher complication rates and elective c-sections/inductions are associated with higher complication rates than waiting for labor to begin on its own. True?

    4. What are your thoughts on the book by Marsden Wagner, Born in the USA : How a Broken Maternity System Must Be Fixed to Put Women and Children First ?

    5. And just for fun: Obviously certain areas of the country have better access to care than others. If your only options were a hospital with poor neonatal and maternal outcomes or a homebirth midwife (we’ll say even that she is a CNM) with better health outcomes than their hospital counterpart, which would you choose? (I have a feeling that we may argue about whether or not this is a possibility but I can assure you that there are parts of this country with atrocious standards of care, so for my sake, let’s pretend this situation might happen, however rare)

    I’ll fully admit that my bias is against the hospital establishment but I’m not here to argue any of those points, so I request that the vitriol be reserved for some of the more ridiculous comments I’m sure you receive. I’m here to more fully understand the reasons why my bias might be wrong or misguided.

    • I don’t have a creative name

      I like the way you phrased your questions and I will be here with popcorn waiting for answers. I imagine you’ll get some from a variety of people and the discourse might be quite interesting.

    • suchende

      “I have a feeling that we may argue about whether or not this is a possibility but I can assure you that there are parts of this country with atrocious standards of care[.]”

      Well, this is probably impossible. For one thing, a gold standard homebirth setup also has a gold standard transfer hospital, who already has an anesthesiologist and surgeon at the ready to do an emergency c-section. Besides that, I question that top-notch CNMs are practicing where top-notch OBs aren’t.

      • Kelly

        So, basically you are saying it comes back to the fact that hospitals absorb the impact of midwife transfers, so care can really only be as good as the worst case scenario (the event of an emergency c-section, other surgery, and/or NICU for baby)?

        There is some real truth in this but I have trouble disregarding the quality of care I received up until the point an emergency happens.

        Thanks for your response.

        • Bombshellrisa

          ” I have trouble disregarding the quality of care I received up until the point an emergency happens.”
          How so? The low intervention, watch and wait attitude of the midwifery model of care as practiced by CPMs is often what makes those emergencies turn into bad outcomes.

          • Kelly

            But we were pretending that the midwife is a CNM and had better birth outcomes than their hospital counterpart, remember? Presumably, a good CNM would include his/her transfer statistics as well.

          • Bombshellrisa

            Midwives pride themselves on a low intervention/transfer rate. Saying that they have a 40% transfer rate (I believe that is the stat for UK midwives, where homebirth is an option as part of their healthcare system) would not win over the people who want to give birth with a midwife specifically because they wish to avoid interventions. A midwife can say that she has a less than 1% C-section rate, but that means very little. A midwife can’t do a C-section, so saying that is more to pander to a certain attitude than provide accurate statistics to a potential client. A strictly home birth CNM can’t provide ECFM or IV pitocin to a patient, so they are still watching and waiting and leaving a lot of room for there to be a bigger emergency.

          • Kelly

            What I meant by including transfer statistics is that the outcomes of those births which transferred would also be a part of her record (not just whether they transferred).

          • Bombshellrisa

            I think that would be a good idea!

          • Kelly

            The 2 CNM’s that I interviewed did this. They included total births, total transfers, total c-sections, total NICU, and total mortality (though the mortalities were all zero). Granted, the transfers all had caveats, right?

          • Bombshellrisa

            Not necessarily-transfer for pain control is pretty common.

          • Kelly

            No no, lol. I mean that there were excuses for transfers. Disclaimers. By the midwife.

          • Bombshellrisa

            They sound like good midwives. So did they mention what their transfer policy is? There is one midwife who has a high transfer of care rate to OBs and a high hospital transfer rate here. She refers patients out at the slightest “variation of normal” and is very strict about things like how long she lets a woman labor or how long she lets them push.

          • Kelly

            Yes. One midwife I interviewed from a birthing center across the street from the hospital was very strict.

            However, several friends have shocked me with what their CPM’s considered acceptable risks and chided me for stating that I would not be comfortable with that level of risk or a midwife who was. Others have stated that they are against certification and regulation of CPM’s completely.

            So yeah, I am aware that there are plenty of delusional quacks but I am a bit surprised to hear such an impassioned argument against home birth altogether. The CNM’s I have known and worked with seemed capable, experienced in recognizing issues, prepared in the event of emergency, and had relationships with ob’s and hospitals. I am most curious about whether Dr. Amy believes that research shows that home birth with these midwives is also dangerous. A midwife was actually the one that told me about the anesthesiologist not being 24 hours and to make sure I understood the NICU
            Levels. Another encouraged me to have a birth plan that included the hospital, even if I chose her care, stating that it was important to understand the risks of all options and possible outcomes.

          • Bombshellrisa
          • Kelly

            Includes but not separates…that I saw. Am I missing something?

        • suchende

          That’s exactly what I am saying. Even if it were the world’s best birth attendant were attending your home birth, if your backup hospital is a rural hospital that could take 20-30+ minutes to get an anesthesiologist scrubbed in, you’re in a grim situation.

          I am sorry you had a bad experience. It’s unfortunately true that care quality varies widely. It’s also true that for some women, no hospital could provide a birth experience to her satisfaction. I don’t know where you fall on that spectrum. I selected the hospital in which I birthed very carefully. While I didn’t love everything about my prenatal care or birth (“paternalistic” sums it up tidily) I know that the quality was irreproachable.

          • Kelly

            Just so you know, in a rural hospital, the anesthesiologist is not 24 hours. They are “on-call” during off-hours (nights and weekends), which means that the same situation would occur even if you were already in the hospital.

            I am currently expecting and have toured 3 hospitals so far for this pregnancy and 2 for my first pregnancy. 3 of those 5 had an “on-call” v. an “in-house” anesthesiologist. I made sure to ask after finding out that there wasn’t one always around. The 2 with “in-house” ones are located close to a very large city metroplex.

            I also had to do some due diligence on the NICU levels. Apparently many rural hospitals barely meet level II standards and getting to a level III can be a challenge.

          • suchende

            “Just so you know, in a rural hospital, the anesthesiologist is not 24 hours. They are “on-call” during off-hours (nights and weekends), which means that the same situation would occur even if you were already in the hospital.”

            My father is a rural hospital surgeon who does c-sections. It’s absolutely untrue that “the same situation” would happen. If you show up at the hospital in an emergency situation, they have to 1) call my father 2) call the anesthesiologist 3) prep the OR. If things are starting to look questionable during a hospital birth, the hospital calls those people in advance of the shitshow. I think you must intuitively know that the two situations aren’t even comparable in terms of risk to baby.

          • Kelly

            And a trained CNM midwife wouldn’t call the hospital if things started to look sketchy? They *should* anyway, completely averting the situation you are talking about.

            Anyway, my point was only that you don’t always have fast access to the anesthesiologist in a hospital either and I have made a criteria when I shop because if one of the benefits of hospital birth is fast access to emergency care, damnit, I want it FAST. 😛

          • suchende

            IF the CNM had privileges at that hospital, I think it’s possible that the hospital could get an OB/anesthesiologist there as quickly.* That’s a big IF. If the CNM has no privilege relationship with the MD, they’re going to give her judgment as much heed as your Aunt Bea.

            But yes, I also would never intentionally deliver at a hospital without 24/7 anesthesiology staff.

            *Then again, without hospital grade monitoring equipment, would she realize the OB needed to be called as quickly as she would if this were a hospital birth?

          • Kelly

            You’re telling me that an anesthesiologist would take his/her sweet time getting to the hospital if the case was a home birth transfer v. a hospital birth to start? That seems…unethical.

            “But yes, I also would never intentionally deliver at a hospital without 24/7 anesthesiology staff.”

            -Unfortunately, that is not a choice a lot of women have to make. (I did not have that choice at my first birth, for example, and I *think* that this is also the case in my hometown)

          • Bombshellrisa

            No, what I think is meant here is that unless a midwife had privileges at a hospital, she is going to have to call around to see who had a bed and enough staff for a transfer. The patient had to be assessed upon arrival to see what needs to be done and what staff needs to be called in.

          • Kelly

            Which begs the question, what if I was a hospital birth to start? How would this change whether they had a bed or enough staff for my care? I guess maybe then I get first preference but when the next mama shows up in labor (home birth or not), where does that leave her?

            Also, if you live in a small enough area, you don’t get to call around. There is one hospital. That’s it. You get what you get.

          • Elizabeth A

            Hospitals that accept federal funds are not permitted to turn away women in active labor, period. If you show up and there’s not a bed on the unit, they either make a bed somewhere else, or put you in an ambulance at their expense and send you someplace that has room to take care of you. If you show up in labor and they aren’t capable of taking care of you (if you’re too premature for their NICU, for example) they do the same. Or deliver you, stabilize and life-flight the baby.

          • Kelly

            This is my understanding as well. So it shouldn’t matter at what stage you show up…they respond. True if I came with the intent to deliver there or not.

          • suchende

            They respond faster the more information they have about how things are progressing. If all you show up with is a CNM without privileges, they’re going to evaluate you before anyone is called. If you’ve been there the whole time, the surgery staff is being updated in live time about the chances of them being called in.

            I can’t even tell you how many times I came downstairs to my father, fully dressed, eating ice cream at the dining table, because the nursing staff wanted him to know he may be needed. Or how many times he ran down to the hospital to find out he wasn’t needed after all. If you really think a home birth mom isn’t costing her child precious minutes by having to transfer, you’re kidding yourself.

          • Bombshellrisa

            I don’t know how it works though if its the midwife calling first. My former preceptors had to call around to hospitals to see who could take a transfer. They wouldn’t just have the woman transfer.

          • Bombshellrisa

            The midwives I was precepting with would deliver in rural settings. The nearest hospital was one like the ones you are describing. Even when attending births at their birth center (3 minutes away from a hospital with a NICU), they transfer to hospitals that are farther away.

          • Elizabeth A

            You’re telling me that an anesthesiologist would take his/her sweet time
            getting to the hospital if the case was a home birth transfer v. a
            hospital birth to start?

            That’s not how I would interpret it. If a birth starts out as a hospital birth, the anesthesiologist on call is likely to have more advance warning of the need to come in then s/he would if the birth was a home birth transfer.

            If you’re in the hospital, the time to anesthesia is time for the phone call + time for travel and scrub in. If you’re not in the hospital, and your care provider doesn’t have privileges, the time to anesthesia is time to travel to ER + time for evaluation in ER + time for phone call + time for ana to travel and scrub in.

          • Elizabeth A

            Kelly, I think it’s easy for women who live in areas with a lot of hospitals to overlook this factor. If you’re from Boston, where you can barely park the car without hitting a teaching hospital, it’s easy to say that you’d never deliver at a hospital without dedicated, 24/7, OB anesthesia.

            And, indeed, if you were in Boston, why would you.

            If you live in West Virginia, your situation is quite different. Doctors and hospitals are not evenly distributed on either a geographic or a population basis. That means that patients sometimes travel for care, and in some cases, they wind up coping with fewer resources.

            Midwives tend to sell themselves as a good solution for those scarce resource situations, where there are limited OB beds, or care centers that could handle certain complications (like vaginal breech or VBAC) are too far away. However, midwives actually function best when resources are near at hand – if you’re only bringing your laboring patients to the hospital in an emergency, you’re best off having dedicated OB anesthesia on the floor 24/7. And midwives aren’t evenly distributed any more then doctors are – women with scant hospital options tend to have correspondingly few midwife options.

          • suchende

            It’s not unethical to not call the anesthesiologist until a qualified health care provider with privileges at that facility has made an assessment. Do you really think it works any other way? Otherwise it’s just someone claiming to be a CNM on the line insisting that it’s an emergency.

          • Amy Tuteur, MD

            The Malloy study showed that homebirth with a CNM has double the mortality rate of hospital birth with a CNM. Truly, the only people who believe homebirth is safe are homebirth advocates. Everyone else knows better.

          • Kelly

            Malloy. Thanks.

            What do you mean by home birth advocate? If you mean ‘supporter’ or ‘believer’ then yeah, of course. Why would anyone else really even think about it at all since so few births are at home anyway? I don’t know what you’re trying to say there.

          • Amy Tuteur, MD

            What do I mean? I mean that the only people who think homebirth is safe are those that make money from it (homebirth midwives, doulas, placenta encapsulation specialists, etc.) and those who brag about it.

          • Kelly

            Point taken. Granted, Obstetricians don’t really have any incentive to believe any evidence it is safe (we won’t argue whether there is any or not), since they don’t make money there. Money makes ALL the birth world go round, not just the homebirth industry.

            I also believe that “risk” and “safety” are two different things. Homebirth certainly does have some higher risks, but what will be the benchmark for safe and unsafe? If it is the raw statistic, then there are a lot of really unsafe hospitals and OB’s out there too.

            Thank you for your time and allowing me the freedom to comment on your board uncensored. I have learned one or two things I will take forward with me and other things that will direct my reading until the birth of my second child.

          • Amazed

            Kelly, the OB/gyns are ob/GYNS. I don’t have children yet, so homebirth midwives cannot make money off me. My gyn, though, can and does.

            I have yet to hear about homebirth midwife/gyn.

          • suchende

            I don’t follow you on how risk and safety are different things. Unsafe practices lead to bad outcomes which inform our understanding of risk.

            You seem to be substituting the term “raw data” to mean “anecdotes.” No system is perfect; that is why we turn to risk analysis: to be able to sensibly compare things. Raw data will show us what we knew: nothing’s perfect. Risk analysis will show us what is ACTUALLY safer. Not what feels safer, or smells safer, but what has actually been shown to be safer, which in turn lets us avoid risk.

            It’s like saying, the raw data shows us babies have bad outcomes strapped into carseats. If the benchmark for safety is raw statistics, car seats aren’t preventing every death, cars are really dangerous! And then concluding its okay to skip the carseat. Um, no.

          • Liz Earle

            That is so untrue i cant even begin to form a reply im shocked! Home birth is safe for a women having a normal pregnancy assisted by a trained and trusted midwife – decades of research supports this. I will however add that as the US doesn’t seem it be set up for homebirth, this perhaps has an impact but only as the service lets women down not because it “unsafe” Please a take a look at research before you write untruths. To give you a working UK example: I work for a UK midwifery company over 40% of our women homebirth – our transfers rate is 3%. No deaths either maternal or neonatal. This figure is also made up of women having “high risk” home birth ie VBAC, previous PPH etc so if they can birth safely any women in the US can as well. Just make sure you chose your midwife well.

          • Amazed

            Claire Teague?Joshua Titcombe? These are the first two I can think about. Or maybe they don’t count because they didn’t happen in YOUR midwifery company?

            Seeing you writing ‘high risk’ in quotation marks tells me all I need to know about your morals. You are a greedy moneymaker who feeds on the sufferings of mothers and babies – literally. You are a babykiller in waiting. You and your despicable co-wrokers have lied to lots of women and sooner or later, one of them will draw the short stick and you’ll just shrug your shoulders and move on to the next source of money – maybe placenta previa at home!

            We already had one like you here. Kim Mosny, her name was. Finally, she ended up with a dead baby under her belt.

          • Amy Tuteur, MD

            No, there was NO high quality research comparing homebirth to hospital in the UK; none, zip, zero, nada. As the authors of the Birthplace Study (which showed an increased risk of adverse outcomes at homebirth) acknowledge, theirs was the FIRST such study.

          • Dr Kitty

            No neonatal deaths or maternal deaths….yet.

            Which UK midwifery company? If 60% of clients don’t homebirth, are they delivering in private hospitals or private birth centres? NHS midwives don’t work for companies, and independent midwives don’t work in NHS hospitals.

            Transfer rate of 3% is suggestive of inappropriate risk management- incidence of meconium, foetal tachys, bradys and decels and maternal intrapartum fever is higher than 3%, and none of those should continue to be monitored at home.

            You should know that giving birth at home in rural Montana with a CPN is a very different prospect to giving birth at home in Primrose Hill with two independent Midwives.

            From RCOG Greentop guideline, “Birth After Previous Caesarean Birth”, available from RCOG website.
            “Women should be advised that planned VBAC should be conducted in a suitably staffed and equipped delivery suite, with continuous intrapartum care and monitoring and available resources for immediate caesarean section and advanced neonatal resuscitation.”

            What part of that say “homebirth” to you?

            Either you’re making stuff up, or the midwives in your company are knowingly working outside RCOG guidance- which is it?

          • Lizzie Dee

            What is a UK Midwifery company? A group of independent midwives? Presumably all trained by the NHS before they dropped out?

            Your figures sound very impressive – except that 40% of not very many (those who opt for private services) is still not very many. A quick Google tells me that there are in the region of 700,000 births a year in the UK. One to two percent birth at home on the NHS, around 1,000 pay privately. What is the actual number of customers you have? 100, 15, 200? And 3% of them transfer?

          • Elizabeth A

            That’s why many, many premature babies wind up transferred to NICUs in urban areas, far from home.

            My daughter spent 32 days in NICU, alongside a lot of babies whose parents had superlong commutes. A high-level NICU is a large technological undertaking, and resources are not evenly distributed. The care model we have in the U.S. now does result in cases with certain needs being referred from community hospitals to tertiary care centers in cities. (This is not unique to OB or NICUs. I’ve observed a lot of commuting for oncology patients as well.) Within this system, the absence of level 3 NICU in a rural hospital is not a deficiency, it’s a means of addressing cost while maintaining availability of care in a wide variety of areas.

          • Kelly

            I understand financial limitations but it is a limitation nonetheless. If you had a choice between a level 1, 2, or 3 NICU hospital, which would you pick?

          • Elizabeth A

            It depends. Isn’t that always the answer?

            For my first, I chose a hospital convenient to my commute. They happened to have a level 3 NICU, but I never checked on that. For my second, I chose a hospital with a well regarded practice of CNMs and an excellent rep for natural birth, but only a level 2 nicu. When I presented at 29 weeks with bleeding from placenta previa, they put me in an ambulance to a hospital with a level 3, where I spent a week on bed rest. When I bled more heavily at 32 weeks, the ambulance crew offered me a choice of two appropriate facilities, based on level 3 nicu availability, and I went back to the one where I had rested. However, if I had delivered at my original hospital for that pregnancy, the baby would have been transferred to the nicu at a famous children’s hospital, where my pediatricisn had privileges. I eould have pregerred that nicu, but children’s hss no OB facilities, and my insurance wouldn’t pay for the transfer across the street to the same level NICU,when the baby didn’t need anything that couldn’t be done whete she was.

            There are a lot of factors I’m hospital choice

          • Kelly

            All other things equal, would choose the higher level. Birth does definitely have a lot of factors though.

          • Elizabeth A

            All else is seldom equal, but I see your point.

          • Elizabeth A

            …and a lot of typos up there. Sorry.

            When asked to give advice on hospital choice, I tell people to consider the whole picture. Distance from home, overall convenience, hospital stats, in house resources, transfer arrangements. If my favorite odb worked down the street from home and delivered at s hospital with good l&d stats, and transfer sgreements with the best Nicu inthe country, I’d go there instead of the hospital around the corner with lesser stats and level 3 nicu, but I’d be aware that if I hit an emergency preterm, ambilance crews would override me.

    • FormerPhysicist

      I’ll bite on number 2. Your common sense is probably reasonable in some ways, but you’re questioning the wrong thing. OBs, US-based OBs at least, tell you to avoid certain things completely, instead of very carefully limiting exposure and comparing risk vs benefit. One advil, at most parts of your pregnancy, isn’t going to do much if any harm. But other analgesics are safer – if used correctly. One drink, at most parts of your pregnancy, isn’t going to do much if any harm.

      Also, the effect on a fully-formed fetus within hours of being born is different than the effect on a few cells that are actively differentiating.

      • Kelly

        But the official stance on alcohol, for example, is that no amount is known to be safe during pregnancy. This is the same or best case for other recreational drug use.

        So why is the epidural viewed as completely safe and offered with little regard for its possible impact? I have heard nurses and Dr.’s say that there is “no impact” and I cannot believe that this is the case if we cannot know that there is no impact to a single glass of wine in the 3rd trimester (for example).

        Again, I view it as appropriate in many cases but having attended several births, drugs are basically no big deal in the hospital. People seem like they have one or another hooked up at any given time, oftentimes multiples and it seemed like a strange dual standard.

        Anyway, it was a little off-topic anyway, as you can refuse an epidural during labor in a hospital, I just know how incredibly common they are and yet never hear about anyone informing us of possible side effects.

        Thanks for your response. Your points about the dosage and development stage are good ones.

        • Kelly

          When I say “attended” a birth, I mean as an observer, not as any kind of care provider.

        • Karen in SC

          Also on question #2. I’d refer you to a blog written by an anesthesiologist for more information. The epidurals of today do not cross into the baby’s circulation. The needle is placed in the dura of the spine iirc. There are other possible side effect (note the word possible) that should be disclosed before consent. Note that vaginal birth has its own set of side effects. Here is one post from The Adequate Mother that has information on epidurals and length of labor.

          http://theadequatemother.wordpress.com/2013/02/04/2-cm-810/

          • Kelly

            I’m a lay(wo)man, so bear with me. What difference does it make where the drugs are administered? None of it ends up in my blood stream (because if it does, then some gets to the baby)?

            The blog you shared discusses the impact of the epidural on the c-section rate, which is pretty interesting (since I’ve heard that it slows labor) but doesn’t cover the impact of the epidural on the baby (or other possible side effects).

            Good link though, thanks!

          • Elizabeth A

            What difference does it make where the drugs are administered?

            Epidural anesthesia goes into the spinal fluid, which doesn’t circulate. Spinal fluid does not get filtered through the placenta to the baby in any way. If anesthesia went into your bloodstream it could effect the baby (and you might decide to have it, regardless). Epidural anesthesia doesn’t end up in your bloodstream.

          • Kelly

            Thanks! I think my concern is put to rest. I may do some more reading but this makes perfect sense.

          • Karen in SC

            You’re welcome! Since you seem to be in an evaluation phase, I’d also recommend a few other blogs to the right: Safer Midwifery for Michigan (info applies to other states), Mama Doc, and of course, Happy with Hospital Birth and it’s tragic counterpart, Hurt by Homebirth.

            My inference could be wrong, but these are very good blogs concerning these issues.

          • Kelly

            Thank you

        • Ainsley Nicholson

          The official stance on alcohol during pregnancy is a matter of public health policy, which means that they have to take into account the fact that some people in the general public will misunderstand anything more nuanced than a simple “no alcohol” policy. Thus, despite mounting evidence that minimal use of alcohol during pregnacy poses little danger to the developing fetus, the “no alcohol” policy makes sense as a public health policy. Use of epidurals in a hospital setting by highly trained medical staff is not subject to the same concerns.

    • Elizabeth A

      I’ll bite on 2, 3, and 4.

      2 – Your common sense is just plain leading you wrong. Epidural anesthesia is not necessarily narcotic (indeed, one of it’s advantages is that you can avoid narcotics). Because it’s administered directly to the spinal column, it doesn’t circulate through the bloodstream or get filtered through the placenta and should not effect the baby.

      Elsewhere, you mention the official stances on alcohol in pregnancy:

      But the official stance on alcohol, for example, is that no amount is known to be safe during pregnancy. This is the same or best case for other recreational drug use.

      This statement here drives me nuts because, at bottom, it’s not how science works. We can never be absolutely sure that ANYTHING is 100% safe. Here’s what we know about having a single glass of wine while pregnant – we have never been able to observe an adverse effect to pregnancy that we can confirm was caused or exacerbated by the consumption of such a small amount of alcohol. On that basis, plenty of OBs tell their patients that the occasional drink is fine.

      3 – Of *course* inductions before 37 weeks are associated with higher rates of complications! 37 weeks is term, the only reason you would induce earlier is because there already *are* complications. (Unless you meant 39 weeks? That’s the current limit on most elective induction in the U.S. The 39 week issue has been covered extensively on this blog – the stillbirth rate begins rising at 38 weeks, so complications resulting from induction before 39 weeks may be preferable to making everyone wait until 39 weeks.)

      4 – Marsden Wagner is not an obstetrician. He’s a perinatalogist. He is the guy who provided the 10-15% target c/s rate to the UN, but they’ve withdrawn that recommendation, because Wagner basically made it up. It is not backed by research.

      I am not moved by his recommendations. Aside from the fact that he doesn’t provide maternity care, that piece of history makes me prefer other sources.

      • Kelly

        Thanks for your response.

        2. I realize how science works. 🙂 Dr.’s aren’t scientists, I know that, so I take A LOT of their recommendations with that in mind (because recommendations are not the same as 100% absolutely certain, right?). But the way I phrased my statement is exactly how the statement is issued to the public, so if I am to take it at face value, I must also take the idea that the epidural is without risk at face value. As a scientist myself, that is EXACTLY why I am skeptical. Everything has risks. Thanks for the clarification on how the epidural works though. I am ignorant on that subject.

        3. I typo-ed. I meant 38/39 weeks. I lived in WV when they had the 2nd worst neonatal outcome statistics in the country. They issued a policy change to encourage hospitals to end elective induction before 38 weeks and their outcomes drastically improved in just 8 months (Read this in the newspaper).

        4. I did not know that the UN had withdrawn the recommendation. Thanks.

        • Elizabeth A

          I’m not going to argue that you should take ANY statement issued to the public at face value, and I’m certainly not going to argue that you should treat all statements made to the public exactly the same.

          I prefer critical engagement. It’s why I read this blog.

          On item 3 – I wonder what the published stats were, I wonder what the raw data was, and I wonder if the 8-month improvement continued over the next few years. There are a lot of possible confounding factors, and the press isn’t a good source for numbers you can crunch into.

          • Kelly

            Elizabeth, can you provide a link to where the WHO (I think we were both misquoting them as the UN) has revoked the c-section rate targets? I couldn’t find it.

          • Kelly

            Never mind, found it!

          • Elizabeth A

            Try here:

            http://www.cesareanrates.com/blog/2013/1/8/world-health-organizations-15-percent-cesarean-rate-recommen.html

            There’s a link on that page where you can download the WHO’s full handbook “Monitoring Emergency Obstetric Care”, and large quotations regarding the c-section rate recommendations. The key point is “Ultimately, what matters most is that all women who need cesearean sections actually receive them.”

    • theadequatemother

      I’m an ane…re epidurals.

      A combo of very dilute local anesthetic (about 1/5th what the dentist uses when doing fillings) and a small amount of short acting narcotic, mixed together, is infused into the epidural space via a catheter. The spinal nerves go through the epidural space on their way out and these are frozen by the solution.

      The presence of the narcotic allows a very dilute solution of local anesthetic to be used (the two are synergistic)…this means that walking epidurals are possible and removes the problem of poor pushing and need for forceps and vacuum. With modern low dose epidurals there is no association with a need for an assisted pushing stage anymore.

      The medication that goes into the epidural space is removed by absorption into the mom’s bloodstream, metabolism in the liver and excretion via the liver and kidneys. Because it goes into the blood stream, it can be transferred to the fetus via the placenta. Both narcotics and local anesthetics cross the placental barrier. However, the dose is so low, and is further diluted by the maternal blood stream that even with very sophisticated neurobehavioral testing we have been unable to demonstrate an effect on the fetus.

      Babies whose moms had epidurals are bright eyed and alert just like babies whose moms had no meds.

      recent large randomized trials have shown no impact of epidurals on length of labor, need for c/s or need for forceps/ vacuum.

      There are risks associated with epis: 5% chance of it not working right first go, 1-2% chance of failure to make it work even with re-siting, potential decrease in BP that needs to be treated wth IV fluids and possible medications, 1% chance of post dural puncture headache, 1/20 000 risk of meningitis, 1/220 000 chance of bleeding or pus that could compress the spinal cord and require urgent surgical evacuation, 1/500 000 risk of paralysis and 1/ 1 000 000 risk of death. These risks are generally disclosed as part of informed consent prior to the ane doing the procedure.

      • Kelly

        Thanks, this was extremely informative.

  • Childish temper tantrums are amusing and irritating when they occur in
    children. However, they can be downright deadly when they occur in
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  • VanGo

    Amy, you are inviting so much negativity into your life through your writing. This whole site is full of anger, controversy, judgment and cruelty – the last emotions one would associate with the birth of a child. I’ve had hospital-based natural child birth three times. Each experience was beautiful and empowering. There is nothing alternative about it, as human beings have been giving birth naturally since the beginning. But I don’t judge women who choose otherwise. We all do what works best. I sincerely wish peace for you – I won’t be visiting this blog again but hope you can find a way to create more acceptance and happiness amongst your readership.

    • The Bofa on the Sofa

      Wow, the dictionary definition of a concern troll.

    • Amy Tuteur, MD

      And you felt the need to comment on this because ….?

      You don’t judge women? You just judged me. Hypocrite.

    • Cellist

      If you don’t plan on visiting this blog again then…don’t.
      Self righteous much?

    • Bombshellrisa

      And if you actually took the time to read before you commented, you would understand that Dr Amy ALSO gave birth naturally in a hospital a couple times. What exactly are you finding so negative?

      • The Bofa on the Sofa

        What exactly are you finding so negative?

        Failure to recognize that the NCB approach is far superior to those medicated sheeple. It’s baaaaaaaaad.

        • The Bofa on the Sofa

          (ok, I deserve to be slapped for that one)

          • Bombshellrisa

            Slapped? No way, anyone who makes me laugh so hard at 9am deserves to be voted up

    • The Computer Ate My Nym

      Your concern is noted.

    • wookie130

      I don’t think the purpose of Dr. Amy’s blog posts are to create harmony, acceptance, and happiness “amongst her readership”. Someone correct me if I’m amiss, but I believe the point is to shed light on those practices that harm women and babies, and to debunk a lot of the woo brought forth by the NCB and homebirth community. What of the anger, controversy, and judgement laid on those who choose hospital birth, and OB care, rather than a doula, midwife, or my personal fav, no one at all? How many blogs/discussion forums/message boards are dedicated solely to making women feel like crap on a stick if they chose something OTHER than an unmedicated/natural/home/unassisted birth? I would say a great number. You’re right. Humans HAVE been giving birth naturally since the beginning…now call me crazy…but that’s PROBABLY because there wasn’t the science or medical know-how to do much else at certain times in our history…and not surprisingly, a lot of women and babies died. So, perhaps you were coming on here to read something a bit more warm and fuzzy, or more delicately presented…but let’s be honest, and admit that since it IS a life and death issue, that there’s really no need to namby-pamby around things, is there?

    • violinwidow

      I don’ think a blog called the Skeptical Ob is going to be replete with feel good affirmations and bible verses. I wouldn’t expect quotes from Buddha or Gandhi or lovely pictures of green landscapes. I wouldn’t expect the purpose of a blog called the Skeptical Ob to create happiness and harmony for its readers. I would expect a blog called the Skeptical Ob to contain scepticism about things relating to childbirth and maternal health. When I want fluffy, happy things to read, I type something else into my search bar. Did you accidentally show up here while looking for something inspiring to post on Facebook?

    • Impeding Lies

      Telling women who write or speak out about science or other sterotypically ‘manly’ things to ‘be respectful’ is just another way of putting them in their place and telling them to shut up. There is nothing empowering about that.

    • Sue

      Yet another fly-by who doesn’t get that our use of ”NCB” is short-hand for radical-OB-hating-intervention-rejecting-homebirthers-who-kill-babies.

      (But we knew you would come back to read responses…waves!)

  • Petanque

    It is not, you big meanie!!!

  • Sue

    The Monty Python reference for this post is ”Is this the two-minute argument or the five-minute argument?”

    ”i’m not arguing”
    ”Yes you are”
    ”No I’m not”
    ”That’s not arguing, it’s just contradicting”
    ”No it isn’t”.

  • Lisa from NY

    And many NCB people are going vegan. Vegan diets have no B12, and vegans who breast exclusively (and don’t supplement) can have brain-damaged babies.

    http://evolutionaryparenting.com/being-vegan-breastfeeding-and-infant-safety/

    • guest

      I’m afraid that was before Sally Fallon hit the scene with the Weston A. Price Foundation. If you are a health hipster, vegetarian and vegan are soooooo yesterday. Today it’s all paleo, traditional foods, anti grain and pro raw milk. Anyone who questions any of this is part of the vast CDC medical-industrial conspiracy.

      Seriously, all the people that I know who are vegan are vegan out of their concern for animals or because they are trying to deal with or prevent heart disease. They also tend to powder nutritional yeast (a good source of B12) on anything that doesn’t move. People who have those things in mind have stuck with it. The trendy-somethings have all moved on.

      P.S. If you find the WAPF pov tempting, you might want to double-check their work. For example, their popular “Soy Alert” raised eyebrows among these vegans, who also happen to be R.D.s http://www.theveganrd.com/2011/03/soyfoods-in-asia-how-much-do-people-really-eat.html
      and
      http://www.veganhealth.org/articles/soy_wth

      • yentavegan

        I became a vegan the same week/month I went into menopause. My family are all omnivores. I do not recommend veganism for anyone still growing or planning on becoming pregnant. I also have the time and financial resources to purchase and prepare special foods,

      • Sue

        Isn’t yeast a living organism?

        • LibrarianSarah

          If “living organism” was the cuttoff point for vegans they would starve to death. Animals and animal products are what vegans avoid.

          • Impeding Lies

            There’s always breathatarianism. 😉

          • guest

            Oh please. How on earth would you follow the Brewer diet that way?

          • LibrarianSarah

            Breathatarianism is proof that natural selection is still applicable to humans.

  • MichelleJo

    OT, but as an ex-Brit, they are thrilled to announce that Kate has given birth to a baby boy, 8lbs 6oz. She gave birth naturally!

    • Certified Hamster Midwife

      Naturally in a hospital. Imagine that!

      • Isramommy

        Couldn’t “naturally” just be taken to mean not by c-section? Relevant in that they announced that mother and baby should be released tomorrow. I really do hope the palace won’t be making announcements on whether or not Kate had pain relief.

        • Certified Hamster Midwife

          Yeah, just that no one wants to say “vaginally” on TV and regarding a princess.

          Ultimately, it’s not any of our business. I mean, we had a whole war to ensure we don’t have to care one bit about the new prince except to coo over how cute he is. Like every baby.

        • Allie P

          Usually when they say “naturally” in the media, they mean “vaginally” — since as is proved in Texas, grown men faint dead away at the word “vagina”.

        • Squillo

          I really wish they hadn’t told the world which hole the baby came out of.

          I mean, why not tell us which position the baby was conceived in?

    • MichelleJo

      Priceless, from a comment on CNN Disqus “Is it true that William bit through the umbilical cord as a time-honored tradition going back to the 1300’s?”

  • Impeding Lies

    Both my parents are not even that well educated. When community college first came to our province they did take a course my mom took secretarial and my dad took meat cutting my mom never ended up using her trade and it was before computers like we have today my dad did use meat cutting for a long time and eventually went into labour like land scaping and bridge restoration. My mom has worked at a grocery store for more than 20 years. They are very hard workers. Even though we have always been working poor my father would be pissed if we got sunburned bc skin cancer runs in the family and its taken very seriously to protect our skin from the sun in my family and even though that idiot Jenny McCarthy was going anti vax all over the media my parents got us all vaccinated and had faith people who went to med school would know better than some twit on a talk show. I have known people with parents that were much more educated than my own who let them get sunburnt to a crisp, binge drink and question vaccines. This is a public school teacher btw.

    • Tim

      People who are sheltered from true suffering, forget what it looks like, and take it for granted.
      Nobody who had a sibling die of polio would turn down vaccination.

      • Impeding Lies

        You’re right Tim my parents both had alcoholic parents and barely drink and if they do, they dont binge. They have seen that suffering first hand and lived with real suffering and modern medical has treated them well I feel lucky Canada is more socialist than the US if we lived there a family like mine would not be able to go to the doctor much. It makes a huge difference if we could not afford medical one or both of my parents would probably be disabled.

      • Allie P

        every time I run into the anti-vax contingent in my neighborhood, all I can think is, “they must not have an aunt who is deaf because of measles. They must not have a brother who went to the hospital with chicken pox in his lungs at 2 years old.”

        • Bombshellrisa

          I commented on a lower thread but EXACTLY. They have also never seen first hand Post Polio Syndrome, or spent the weekend in the hospital with a loved one who had polio as a child, who has yet again broken one of her fragile bones while trying to do something as simple as take a shower (last year she broke her leg and wrist walking down her hallway, over the years she has also broken a hip, arm and the other wrist).

          • Impeding Lies

            That is so sad and horrible. I am sorry she is suffering like that.

          • Bombshellrisa

            Thank you-she is the sweetest, kindest woman I know. There was no way to avoid what happened to her, but seeing mothers who insist it would never happen to their special snowflake and putting them in harms way IS avoidable.

        • MichelleJo

          “they must not have an aunt who is deaf because of measles. ”

          Snap. Measles at 11 months and deaf for life.

    • LibrarianSarah

      To be fair, a lot of the upper middle class does these kind of things BECAUSE they are so educated. People who only have high school diplomas know that their are people who smarter and know more than they are and are not afraid to go to them for advice. People who graduated at the to 5% or 10% of their class and attended top tier schools have trouble believing that they are not the smartest person in the room at all times. They spent their entire lives being told how smart they are and have invested a lot in this idea. Their pride gets the best of them and they begin to think that they know best about things that they have not been trained for. These people usually study humanities or social sciences because the hard sciences tend to beat intellectual humility into you but people with scientific background also fall into this trap as well. Look at the chick who played Blossom.

      NCB and alternative medicine further feeds the ego of these women and confirms what they were told all their lives. That they know better than everyone else, including those elitist medical professionals. This is one of the reasons I am glad I took the short bus to school. Nothing like being called “SPED” and “retard” on a daily basis to teach you that, no you don’t know everything.

      TLDR: Dunning-Kruger effect.

      • The Bofa on the Sofa

        Nothing like being called “SPED” and “retard” on a daily basis to teach you that, no you don’t know everything.

        But the part that I don’t understand is that, in my personal experience, getting the PhD showed me more than anything that I don’t know everything (it is kind of the whole premise behind the PhD degree). And when I got done with my PhD, I knew that I knew a lot about what I did, but I also knew that I did not know as much about my labmates’ work as they did. IOW, the PhD taught me what I am an expert in, and that others were more expert in their areas than I was.

        Even as a grad student, I would go to seminars and conferences to learn new stuff. But where did I learn that? From others that already knew it. IOW, they knew more about it than I did. And I wasn’t stupid enough to think that just because I heard their talk that I knew as much as they did about it.

        What makes it so baffling is that this is absolutely inescapable if you get a PhD. Knowing what it took for me to become an expert in my field, it makes no sense that I should be equally expert in another area. Yeah, a lot of PhD study is preparation, so you don’t have to go through it all again if you are doing a related topic, but anything far afield? No way. I pretty much have to start from the beginning.

        I just don’t get it.

      • Yeah :/. I mean, I fit your description pretty perfectly- graduated #3 in my class in high school, cum laude from college (summa cum laude if I’d remembered to write just one more essay), political science degrees.

        I don’t see me falling for NCB/woo anytime soon though. The reason for that? I require evidence; not anecdotes, but hard data. I have enough statistical background to pick out the most common errors people make and I require things to have an action-mechanism that makes sense (it still might be wrong, but if you tell me your technique to do whatever works through “transferring positive energy”, then say no more. I’m out). Most importantly, I understand what science is and what it is not.

        I’m one of the smartest people I know, in terms of ability to intake, process, and synthesize information. I do not know anywhere close to everything, and I well understand the difference between general book-smarts (what I have) and the specialized and practical knowledge to oversee labor and delivery or any number of other specialized fields (what I don’t have). There are also lots of people who are objectively less smart than I am who know lots of things I don’t know, because we’ve studied different fields, and if we’re talking about their field of expertise my general capabilities don’t matter. What matters is that it’s their field of expertise. That’s why I don’t fix my own cars, after all, but take them to mechanics who know what they’re doing. When it comes to cars, I’m dumb as a brick.

        • Impeding Lies

          I agree there are lots of different kinds of intelligence. I am more naturally inclinded to the abstract thinking of philosophy and humanities so I try to push myself to read about stuff I am not good at aka hard science. Helps a ton when its relevent to all women’s lives (childbith) even if they choose not to give birth it will be a more informed one. I also like blogs like the beauty brains and future derm on the science of skin care.

        • Expat in Germany

          There are so many types of intelligence: Musical, mathematical, linguistic, strategic, diagnostic, etc.. I know people with quick processors but terrible ROM and average RAM, or lots of RAM, but a seemingly slow processor. I know an excellent physicist who can’t carry a simple tune or write a decent sentence. I know some top managers who’s careers are made or broken based on the ability to read how smart a person is based on a brief interaction. One of the smartest smart things I’ve seen a smart person do is to not let others see where they stand in a mental heirarchy, all the while, categorizing and judging and finding a way to get a point across without wounding any egos. It takes a lot of practice, I’m sure. People’s defence mechanisms are so strong and they make them deaf. People’s arrogance antennas are oversized and the privilege of an education or an astute mind will not win friends if a disagreement arises.
          The people who go for NCB may be stupid or smart, but what they have in common is curiosity, credulousness, and too much time to kill. A healthy dose of skepticism does everyone good as long as it doesn’t go in the conspiracy theory direction that is the basis of the NCB line of thinking.

    • MichelleJo

      I think that the way we look at things could be part of the problem here. We tend to think that those who don’t have degrees or a high school diploma are stupid. But in many many cases it is because of circumstances and not their intelligence. In other words our thinking is PhD = Brilliant, high school dropout = stupid. But if we went according to IQs, the clever and stupid groups wouldn’t match at all. There can be plenty of uneducated people who are brainy enough to see through the woo, and college educated people who simply can’t.

      • Impeding Lies

        Defintely!

      • The Bofa on the Sofa

        But if we went according to IQs, the clever and stupid groups wouldn’t match at all.

        Oh, I’m sure there is a correlation, although how strong is a good question.

        • Expat in Germany

          My mom has a JD and is amazingly stupid in many respects. She might have been able to do alright on the LSAT once upon a time, but she has taken a million vitamins and medications that have really damaged her health (crumbling cartilage due to a steroid she didn’t need, muscle problems due to a bad statin, stomach and bruising problems due to daily aspirin). She has held a grudge against her ex husband for decades and still tries to paint herself as the victim when it is clear to everyone else that it was she who wronged him. She cheated on him and spent the money he earned (turned the house into a rococo McMansion nightmare) when he wanted to save for the kids and for retirement. She calls him a narcissist without any awareness that the description fits her perfectly as well.

  • Dr Kitty

    OT, Dr T, you need to read Jen Gunter’s piece on BMJ.com if you haven’t already.

    • Amy Tuteur, MD

      Frankly, I’m disappointed. It is inevitable that restricting deliveries before 39 weeks will increase the stillbirth rate. I don’t understand why obstetricians are falling all over themselves in a politically correct effort to ignore reality.

      • rh1985

        Do you mean deliveries before 39 weeks when there is indication of a less severe problem but it’s not considered “bad enough” to go ahead and deliver under the 39 week rule?

        • stacey

          No. This includes elective deliveries. The stillbirth rate goes UP at 38 weeks, so reducing births that week has to increase deaths.
          So far, it looks to be the case in one hospital, but not another. I say err on the side of caution, and let the OB do their job!

          • rh1985

            hmm I thought it mostly went up at the due date? do you have a link? I’ve read different things. I have an IVF pregnancy currently and really don’t want to go overdue since date of conception certain…but I was hoping to induce between 39-40 weeks (which is far off since I’m 8 and a half weeks)

  • Isramommy

    Very OT, but there is polio here in Israel. POLIO!!!. That disease that supposedly doesn’t exist in first world countries and people shouldn’t worry about vaxxing for. The health authorities have been going on about it for weeks now and encouraging the un-vaxed to get vaxed as it has been found in the sewage system in several southern cities (but only one symptomatic human case reported, as far as I know).

    Honestly the whole thing really hadn’t even registered with me until I just took my son in for his six month shots, which of course includes his second dose of polio vaccine (it’s part of a combined 5 vaccine shot, I think). Only then did it enter into my head that I’ve had my not-yet-fully-vaxed infant son in a public swimming pool at least three times a week for the past month when there are active warnings about polio in the country. I have to say it freaked me out a little bit.

    • Bombshellrisa

      My husband’s aunt was the only child out of 10 in her family to contract polio. She was 13 months old at the time, and it was before the vaccine. Her poor bones are so brittle, her legs were affected so she has trouble balancing and walking and as a result, she broke yet another bone this last weekend. We sat with her in the hospital. She said that its most likely she got polio from a family outing to the Des Moines river. Until her death, auntie’s mother blamed herself for taking the children to the river that day, even though it was the only place to take her five restless children on a hot day. We told her that antivaxing is huge in the area. She said “what are these mothers thinking? If there had been a vaccine then, my mother would have made sure all the kids had it. My children got every vaccine available when they were growing up. It they only KNEW what they are potentially volunteering their children for”.

      • Impeding Lies

        That is terrible I am sorry she had to go through that. I wonder what will happen when the children of these crunchy mamas end up getting one of the preventable diseases they could have been vaccinated against? Take gardisil I think it is such a great idea even if it can’t protect us from all the strains but there is so much misinformation and low vax rates I hope in the future they can create more to prevent STIs despite all the hysterial backlash against a perfectly good vaccine.

        • Proskomen

          I completely agree. Parents and doctors need to think twice before making decisions that will affect their children forever.

          • fiftyfifty1

            You don’t think that they aren’t already thinking twice? Come on.
            “Mom, I’m really a girl not a boy”.
            “Well sounds great, let’s go out right today and sign you up for hormones!!”

        • Ainsley Nicholson

          From what I’ve read, the puberty blockers simply give the child a few more years to think about their decision- no irreversible changes are made, and there would be nothing to “de-transition” from. Hormones or surgery are a differant story, of course…and the decision to use them can be postponed by using puberty blockers.

          • Certified Hamster Midwife

            The blockers hit the snooze button on puberty so the child has a few more years to mature and decide what to do.

            It raises the question: would the natural sex hormones that the person has take over and make them more comfortable as the sex they were born into. This hasn’t been the lived experience for trans people I know. They say puberty felt more like turning into a werewolf, with unwanted lumps or hair and changes to their facial features that feel wrong.

          • Impeding Lies

            I have a friend whos trans she describes her penis as ‘a birth defect’ to be honest I think that is an insult to people with real birth defects because she is perfectly physically healthy and now eventually going to risk her life and health with a dangerous surgery. So many horrible side effects can come of it. Surely someone should not have to mutilate/dramtaically change their body to conform to a ‘gender identity’??

          • Alenushka

            Until you are actually in her shoes, you have no idea what you are talking about. If a person feels they are of the wrong gender, they do not have perfectly physically healthy body. Some people choose a different path of deciding tha their body does not need to be exactly as their gender identity. Google Buck Angel.

          • Impeding Lies

            Gender is a social construct while sex is biological. I can damn well speak on the subject of gender actually because I am a victim of it a female in a woman hating world gender is a hierarchy where men always come out on top. It is child abuse to force gender roles on a child so heavily they feel the need to alter their bodies forever. Also I am not ignorant on trans issues so I don’t need to google anything I just disagree with advocating of child abuse.
            http://liberationcollective.wordpress.com/2013/05/20/socialization-matters-why-identity-libertarianism-is-failed-politics/

          • stacey

            I don’t think that ALL hormone therapy for trans kids is child abuse. I think it very hard to know whats the right course of action in these situations. MOST parents just want whats best for their kids. I know that there are parents that want to force a particular gender role, and thats abusive, but that is not always the case.

            The trans people I have known are changing their SEX. They want their biological sex to match the gender they feel is correct. Gender may be fluid and socially constructed, but it still exists. The need to have the right sex organs is more than just pressure from a social gender role.

          • T.

            You are mixing up gender and sex, not the people who thinks that are born in the wrong body.

            There ARE people who are phisically female (or male) but who choose gender role not typically masculine or feminine. I am one of them. I am a woman and I work in a male fiend, all the people I talk with are men. So what? And there are men who are the primary caregiver of their children, thus fulfulling a gender-female role.

            Yet I am indeed biologically female and I don’t feel any need to change my sex.

            Please, don’t mix up things.

          • stacey

            Flip that around and look at it this way-
            how severe does the misery of having the wrong body parts have to be, for someone to be willing to go through ALL the painful and risky treatments and surgeries to get it corrected?

            Trans people are DESPERATE to be in the right body, doesn’t this tell you something is seriously wrong with their gender identity? That pain is serious. Feeling you are in the wrong body has to be horrible if you are willing to go to such lengths to fix it.

            Also- It IS a birth defect if you have a penis and are a woman- It means you got the wrong body parts! I have no idea why this would offend anyone with other defects.

          • Impeding Lies

            There are serious consquences to all medication including puberty blockers they are not harmless and are not studied for long term use same as cross sex hormones and yes de transition I meant someone who has taken hormones and done surgery. There are kids with their parents pushing them into it because they don’t ‘gender conform’ whatever that means.

          • Alenushka

            Yes, it is what it is used for. And you can not just run to Walgreens and get some. A lot of psychological assessment and counseling is involved.

        • Bombshellrisa

          It reminds me of the movie “The Village”-people trying to live in their own Utopia, even if it means children are going to die from diseases that we have vaccines for and women die in pregnancy and childbirth from things that could have been controlled with modern medicine and interventions.

          • The Bofa on the Sofa

            “That which doesn’t kill me makes me stronger. That which does kill me, well, I’ll be dead so won’t have to worry about it.”

          • The Bofa on the Sofa

            Actually, check that.

            “That which doesn’t kill YOU makes you stronger. That which does kill you, well, if you weren’t strong enough to survive, then we didn’t want you here anyway.”

            THAT’S “Utopia”

          • BeatlesFan

            Unfortunately, when it comes to anti-vaxx, it’s an issue of “That which doesn’t kill me could still potentially kill an infant or that 90-year-old or that mother of four who has Lupus.”

          • Tim

            Or the second grader with a transplant that is stuck in class with my kid

          • The Bofa on the Sofa

            Yeah, see my revised statement below.

        • stacey

          When their kids get VPDs, they tell the world that it is SO great because now the kid has “natural” immunity.

          /headdesk.
          (Whats the point of immunity if you have to get SICK to get it? Seriously stupid.)

          If its something like whooping cough, they will claim it “wasn’t so bad, just 3 months of coughing and 2 weeks in the hospital!” Not bad for whom, is what I wonder, as they don’t have to be sick.
          This Sure beats the vaxx, amirite?

          They will also try to infect other AV kids at “pox parties” and even measles parties, because the other parents want their snowflakes to get “natural” immunity too.

          WISH I was kidding. I am not.

          • The Bofa on the Sofa

            I’ve laid it out before. The standard reaction to chicken pox is 10 days of incessant itching, typically with a couple days of fever, with quarintine (which means that if parents are working, someone can’t go). If you get chicken pox, you have a slight possibility of getting it again, although it is not likely, and you are now prone to shingles when you are older. The mortality rate is something like 1 in 20 000.

            If you get the chicken pox vaccine, the most common side effects, which happen in maybe a little more than half of the cases, is soreness and redness at the injection site for maybe a few hours or a day, although a small number develop mild fever. The death rate is too small to measure. Sure, you do run a small risk of getting it still, albeit more mildly, and you do run the risk of shingles later in life.

            So the main differences between “natural immunity” and vaccination is that natural immunity involves 10 days of nasty rash, more time with fever, and mom or dad having to take two weeks off of work. Vaccination is an ouchy that last a few hours (my kids were unphased after 15 minutes, but I won’t claim that is typical). And, although absolute rates are low, mortality is greater with the disease. How is this even close?

          • Sue

            Right, Bofa – and there’s also this: the immunity you develop from reacting to the antigens in the vaccine is just the same ”natural immunity” that you develop from surviving the disease – it;s the antigen that;s not natural (ie safer) – the immune reaction is natural.

          • MichelleJo

            Oh boy, imagine it was the other way around. 10 days of suffering to avoid a 1/20,000 and no chance of shingles. The woo crowd would have propaganda for months.

    • Amy H

      Surely the chlorine would protect against it in a public pool? I hope!

      • Isramommy

        I think it does. I am not really worried about my baby getting polio, just disconcerted to see a disease like polio show up in the sewage system in several cities and towns in a country where there is universal access to free vaccination. This shouldn’t be happening. Bombshellrisa’s aunt’s story is a reminder of how horrible polio is, but at the same time it is so easy to slip into complacency and forget about the existence of vaccine preventable diseases. The problem is that we have to depend on everyone else in our societies to work together (ie vax) to keep those diseases at bay. The non-vaxers are throwing the whole system off and removing everyone else’s safety net.

    • Ainsley Nicholson

      The scary thing is that only a small percentage of people who are infected with the polio virus will actually show symptoms, so the virus can get quite well established in a population before anyone notices.

      • Isramommy

        I think that’s the problem here.There’s been one case which triggered testing and then the virus has shown up in wastewater from several municipalities.

        • Esther

          No, there haven’t been any cases so far THANKS TO HIGH VACCINATION COVERAGE. They found wild polio virus in the sewers of a southern town – since the outbreak of actual cases in 1988, they routinely test the sewage. The virus was probably from the bowels of someone who came from Egypt (as the strain is identical, or nearly so, to the viral strain prevalent there).

          • Isramommy

            According to Ha’aretz, it’s been found in several cities and the assumption is that it has infected people but there just haven’t been any symptomatic cases:

            http://www.haaretz.com/news/national/.premium-1.535338

            I didnt know that they did routine sewage tests here. Very interesting. And yes, vax rates are generally very high, but lower than they should be in some Bedouin and ultra-Orthodox communities, hence the big vaccine push (try dialing Maccabi’s appt/info line, for example. They’ve added a recording about Polio vaccines to the main menu. I’m guessing the other Kuppot have as well).

          • Esther

            The best info is straight from the horse’s mouth i.e the Ministry of Health – http://www.health.gov.il/newsandevents/spokemanmesseges/pages/17062013_2.aspx (Sorry, Hebrew link). Right now there is no evidence of asymptomatic cases (other than someone,or someones, coming from another country and introducing the virus into the sewage) – they’re taking stool samples to test that.

          • Isramommy

            Thank you for the link! I’ve only been following the story in the media and from what my tipat halav nurse mentioned. I’m interested to read what misrad habriut has to say on the subject.

  • mydoppleganger

    Quick question I want thoughts on, please.:)
    Attempting a doctor led V-BAC. Do I get a doula or skip it?
    -VBAC-vaginal birth after cesarean

    -The wild card is: must enter labor naturally by such date with no big issues to attempt VBAC.
    -In the hospital I am open to use of epidural. *I have never experienced labor before*
    Would a doula be helpful or just a gamble with money? I’m on the fence about it knowing there is a chance a repeat C-section could happen before the trial of labor occurs. My other pal is getting a doula for her VBAC attempt, pretty sure she is going to try to do the all natural route.
    Thanks for input on how essential you think a doula is in this situation.

    • The Bofa on the Sofa

      What would you expect/look for the doula to do?

      One thing that we talk about at Dad’s Boot Camp (I’m not supposed to say it, but I’ll be vague) is how you need to establish the role for each person you want in delivery with you. What are they there to do?

      • mydoppleganger

        I would hire a doula for moral support, (extra company LOL?), comfort techniques. I am leaning more towards not hiring one. Being that I was so caught up in NCB, the message of a doula being essential has gotten stuck in my head. My hubby and I talked about it and he assured me he can do all the doula can do without the doula.:)

        • The Bofa on the Sofa

          This would be my question. Are there others that can bring moral support? Baby’s dad? Your mom? Sister? BFF?

          As long as you think about what you are wanting from the situation, and how to get that, then I am sure you will make the right decision.

        • Zornorph

          Well, I would let your husband do it, then. He knows you better than some stranger would and presumably could give much better support.

          • mydoppleganger

            I agree as well. He told me he is more than willing to do everything a doula would already. Plus, being that this will be such an up in the air situation, I think we will keep it simple. Thanks for you input!

    • moto_librarian

      I think it depends on whether or not you can find a doula who actually adheres to the defined scope of practice. I know that there are some out there (Doula Dani springs to mind), but regrettably, many doulas are incredibly brain-washed adherents of NCB. A doula should NEVER give you medical advice or attempt to argue with your healthcare provider. She should be there to support you throughout your labor and delivery, regardless of how you give birth. I think that the best way to screen for an appropriate doula would be to ask if she will support you if you ask for an epidural. If she says anything other than “Of course!” I would stay away.

      FWIW, when I was pregnant with my first, I asked my primary CNM about getting a doula since we were planning to go for an unmedicated delivery. She had a very dim view of most of the doulas in our area. There were only two that she liked working with – the others were prone to interfering with care.

      • mydoppleganger

        I can see that. Most doulas I know are pretty deep into NCB. However for this birth I am more flexible and open as a patient. With my first birth, the Business of Being Born freaked me out so badly that when I got to the hospital I felt terrified of all the “interventions.” I think I may have had a better experience had I not been so on guard for avoiding interventions and was a tad more go with the flow. The checklist of everything a hospital would try to do, happened. Of course, that was a lot of emotional stress to put myself in, The only relief I felt was when I agreed to a c-section. Somehow, that was the most peaceful part of the experience, not having to keep my guard up to the point of exhaustion,

        • mydoppleganger

          If I could go back in time, I would just admit to my OB that I had been looking at natural childbirth stuff and was now too terrified of Pitocin to try it If he could have said “Oh, well, don’t let it scare you too bad. We are not going to turn on the Pit and ignore you down in L and D. It’s not the end of the world.” I was under the impression Pitocin was going to be nonstop brutal hell for me and the baby, and no one would save me from the torture. I had a c-section because I was terrified of pit and the induction for medical reasons was going nowhere after 3 days. Everyone was exhausted from the waiting.

          • Sue

            You experienced the cascade of non-intervention.

    • Karen in SC

      I hired a doula twenty years ago since my husband was not keen to be a support person for natural childbirth (he really wanted to stay in the waiting room haha). I found a retired L&D nurse who also assisted the the homebirth OB we had in the St. Louis area (who was famous in NCB circles back then and has since passed away). Can’t really remember if she gave medical advice, but she wasn’t against epidurals if a mother ended up not being able to cope with labor.

      • mydoppleganger

        That’s great! My hubby is all for supporting me. He feels off put by me hiring a doula because he feels it takes away from his role in support. I can see why he feels this way.

        • Sue

          There’s your answer, mydoppleganger.

    • Frequent Guest

      I didn’t attempt a VBAC, but I did have an unmedicated birth and I think a doula would be a waste of money, honestly. Especially if your husband is supportive and wants to be there for you. The nurses at my hospital were also wonderfully supportive (even rubbing my back during back labor when my husband’s hands got tired!), I can’t imagine there would have been any additional need for a doula.

      Good luck on your upcoming delivery!

      • Amy M

        I have to agree with Frequent guest. If your husband/partner is supportive, or if you have a mom/sister/friend to be there, maybe go with that person instead? You can always call the doula group or whatever it is near you and talk to them. I expected to have a Csection, so I called DONA and asked them what they thought about hiring a doula for that. They thought it was a good idea, but they wanted my money. I didn’t hire a doula, and I didn’t end up with a Csection either. Turned out my husband, a resident and the nurse who was there during the delivery were excellent support/coaches.

    • SarahSD

      I think, like others have said, that it depends on what you want a doula for, and whether you can find an a doula to meet your needs. I’ve only give birth once, but having a doula was great for the physical support, to show my husband ways to help me, and to give him a break from being the main support person. It was also nice to have someone present the whole time who was a little more distanced but also more experienced with birth, a level head if you will. Not to give medical advice (she didn’t) but to help me stay calm and accept BOTH what was happening in my body AND the procedures that the Drs and nurses wanted to do (to which I had built up an unhealthy resistance).

      In my case, the hospital where I gave birth has a volunteer doula program, and I was lucky to have a doula available when I requested one (there are a limited number of doulas ‘on call’ at a time). I would not have paid for a doula if this program hadn’t been available. If I have another baby, I might consider hiring a doula if I could find the right one for us.

      If you are thinking that a doula can ensure a vaginal delivery in any direct way other than by supporting you through labor (and therefore only indirectly), I’d rethink it. My experience was that a doula helped to make the overall experience less scary, but would not (and should not) have changed the outcome.

    • Allie P

      I’d save your money for a postpartum doula or “night nurse” (I’ve heard both terms used) — she’s the one who comes to your house, does laundry, provides support when you get home — you’ve got nurses and a husband at the hospital.

      • Durango

        I’d never heard the term “night nurse” for a postpartum doula before. Is that very common? I think it’s very misleading because a postpartum doula has zero medical training and should not be giving anything that resembles even a whiff of medical advice.

    • stacey

      Save your money and get help post partum instead.

      To me, the reasons to have a doula are because you want an NCB and need the labor support a doula can provide, you don’t have a partner or family to help you and keep you company.

      I will say this- if you want to be awake for the birth, regardless of how it happens, get the epidural. Even if you are unsure if you will need the pain relief, having it placed can help a LOT if you need an emergency CS. They will be able to easily get you ready for surgery without using general, which would knock you out entirely. You can get an epidural on a pump, so you don’t have to have it working unless you want it.

      (I had a hospital vbac last year)

    • Wren

      I had a vbac with my second. I had experienced very little labour with my first. I did not have a doula but I did have my husband and a friend there. My vbac was in a hospital and supported by the ob who did my c-section. I’m in the UK, so the vbac was with a midwife (2 actually) but with doctors who all flooded in just before she was born (some concerns about the cord) then melted away when she was obviously fine.

      What do you want a doula to do?

    • yentavegan

      Your chances of giving birth vaginally are not dependent on who is present during labor. Please do not take to heart the information gathered from pro-vbac sources. The reason your doctor delivered your baby via c/sec the first time was to protect your health and your infants life.

    • A doula who practices within her scope, yes! Obviously I’m biased but a doula – if you get a good one – can be wonderful support to you AND your husband.

  • non rebal

    I think your wrong about “immature defiance of authority.” What else could it be that drives this whole natural childbirth, alternative medicine lifestyle. Take nonvacers for instance. Why would anyone not vaccinate a child when all of the science and even incidental evidence shows vaccines prevent horrible diseases like polio and measles – Because being a rebel is cool and since hardly anyone dies from polio and measles anymore its easy to be “safe” rebel. See what what happens when an outbreak of measles starts killing children at the local playgroup and how quickly all of these rebels will flock to real doctors. Homebirth is cool too, until your baby dies and then your tune changes (sometimes at least for safe rebles).

  • And of course in NCB world feminism=biological essentialism….

  • XLhz

    We could all use a little magic in our lives. Unfortunately, some seek to gain it through ‘magical thinking.’ Which often ends up producing entirely predictable and occasionally tragic outcomes.

    • The Bofa on the Sofa

      My old college buddy used to quote Doug Henning (I don’t know if it’s a real quote):

      Life is magic, and magic is an illusion. So life is an illusion. Thank you.

      It’s more endearing if you say it in Doug Henning’s voice. Especially the “thank you” part.