Let’s review: Do obstetricians ignore scientific evidence?

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Natural childbirth advocates love mantras. They spread through the community, are quoted over and over, and become received wisdom as though by saying something enough times it might make it true. Classic NCB mantras include “pain is caused by fear” and “animals need privacy to birth successfully; so do humans.” And let us not forget the infinitely inane “trust birth.”

Mantras change with time and in response to cultural values. In an age in which science is greatly respected, the most popular mantra is “obstetricians ignore the scientific evidence.” All the celebrity natural childbirth advocates insists that this is so, and some of them might even believe it. Many midwives consider it among the most important of their marketing techniques.

Professor Barry Beyerstein wrote about the technique of applying a veneer of scientific respectability as a way to improve the status of pseudoscientific beliefs. As Beyerstein explained:

The prestige and influence of science in this century is so great that very few fields outside of religion and the arts wish to be seen as overtly unscientific. As a result, many endeavors that lack the essential characteristics of a science have begun to masquerade as one in order to enhance their economic, social and political status. While these pseudosciences are at pains to resemble genuine sciences on the surface, closer examination of the contents, methods and attitudes reveals them to be mere parodies. The roots of most pseudosciences are traceable to ancient magical beliefs, but their devotees typically play this down as they adopt the outward appearance of scientific rigor. Analysis of the perspectives and practices of these scientific poseurs is likely to expose a mystical worldview that has merely been restated in scientific-sounding jargon.

And that almost perfectly captures the public relations ploy of choice among NCB advocates. What could sound more impressive that shouting from every rooftop that obstetricians ignore the scientific evidence, while NCB advocates are slaves to scientific rigor? The fact that the claim is a lie is beside the point. Many NCB advocates neither know the truth, nor care.

If you say “obstetricians ignore the scientific evidence” fast enough, people won’t stop to consider if it makes sense. But if we do stop to consider it, we might amplify it as follows:

We are supposed to believe that obstetricians (with 8 years of higher education, extensive study of science and statistics, and four additional years of hands on experience caring for pregnant women), the people who actually DO the research that represents the corpus of scientific evidence, are ignoring their own findings while NCB advocates and many midwives, the people who rarely, if ever, do quantitative scientific research, are assiduously scouring the scientific literature, reading the main obstetric journals each month, and changing their recommendations and practice based on the latest scientific evidence.

See what I mean? That makes no sense at all.

And what does the scientific evidence on childbirth really show? There is virtually no support for ANY of the central tenets of homebirth advocacy. Let’s start with a favorite NCB claim that “lots of scientific papers show that homebirth is safe.” When it comes to homebirth in the US, ZERO scientific papers show that homebirth is safe. Indeed EVERY paper written on the subject shows that homebirth increases the risk of neonatal or perinatal death, even the Johnson and Daviss BMJ paper that claims to show otherwise. National statistics on homebirth collected by the CDC from 2003-2008 show that homebirth with a non-CNM midwife triples the rate of neonatal death, and homebirth with a CNM doubles the rate of neonatal death.

Consider other, easily verifiable claims:

Proper position speeds labor? No, no evidence for that.

Eating in labor gives women “strength” and improves outcomes? No, no evidence for that.

Babies won’t breathe if delivered under water because of the diving reflex? The diving reflex works in cold water, not warm water.

Epidurals are dangerous? No, no evidence for that, either.

Indeed, I am hard pressed to come up with even a single NCB tenet that is based on scientific evidence. Oh, wait. I can think of one: breastfeeding is beneficial for your baby. But even that scientific evidence is misrepresented by NCB advocates, since the benefits are actually quite small.

The bottom line is that the NCB claim that “obstetricians ignore the scientific evidence” is a big lie. NCB advocates seems to think that if they say it loud enough and long enough everyone will believe. Unfortunately for them, even a cursory investigation demonstrate that obstetricians follow the scientific evidence and NCB advocates don’t even know what the evidence shows.

Adapted from a piece that first appeared in January 2011.

  • Martin Smith

    What you are saying here about obstetricians seems to be contradicted by this:
    http://www.ncbi.nlm.nih.gov/pubmed/21826038

  • Ducky

    While so much of the NBC is based on subjective feelings, for the discussion to get anywhere I think it’s important to acknowledge that it is rooted in some valid observation. For example, isn’t it true that c-sections do increase the risk of certain complications in subsequent pregnancies? It’s that legitimate and complex trade-off between short-term and long-term risks that I think natural birth advocates exploit.

    • The Bofa on the Sofa

      While so much of the NBC is based on subjective feelings, for the
      discussion to get anywhere I think it’s important to acknowledge that it
      is rooted in some valid observation. For example, isn’t it true that
      c-sections do increase the risk of certain complications in subsequent
      pregnancies?

      Maybe, but there is absolutely no indication that any of the NCB attitude originates in the potential long term risks of multiple c-sections.

      Yes, there is room for rational discussion, but the NCB crowd isn’t providing any of it. It is carried out among the OBs and other healthcare providers.

      • rh1985

        Yeah, they don’t seem to like c-sections any better if it’s a 45 year old mom who will probably never get pregnant again.

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  • Captain Obvious

    This goes for PhD, MD, or midwife…

    http://www.ncbi.nlm.nih.gov/m/pubmed/22996110/

    • Captain Obvious

      “Clinical researchers should be trained to perform research. Learning medicine by apprenticeship was abandoned more than a century ago and replaced by formal instruction and credentialing. Why lesser standards prevail in medical research remains unclear. Badly performed research (eg, “stupid epidemiology”) harms patients and wastes resources.”

      Grimes an Schulz must be unaware of Homebirth midwife credentialing.

  • Kelly

    I am responding to a variety of posts below:
    – How would I feel about midwives endangering women and their babies? The same as I would a doctor or any other person who did the same. They ought to be charged with a crime.
    – In terms of my problem with the post, but really the blog at large, is much more serious than the “tone.” The blog is damaging to the cause it wishes to remedy. It is hypocritical, accusatory, even cruel at times.

    Lets look at the same issue the blog addresses in another context. Let’s look at another culture (you might be tempted to assume third world, but just leave it at another culture). This hypothetical group of people have a grave misunderstanding of Western medicine and as such, innocent people are endangering themselves and dying. What would you do? Do you waltz in and point fingers, call them a bunch of dumb f*$ks and say if you don’t change you are going to die? I certainly hope not.

    Now I know what you are going to say next: This is America. We have a well educated populace that knows better, and even worse, they are claiming to be more educated than the doctors. But the catch is this, even with the most educated people in the world, with all the facts and science they can muster, there will always, always, be differences. And the way to work with differences? Cooperation, coming together, caring.

    If you want to save women and babies, even it is from themselves, you still have to stop being jerks!

    So the specific thing? Stop being polemic, not because it is a nasty tone, but because it is making it worse.

    • PJ

      Kelly, you keep making all kinds of inflammatory claims about the nature of this blog, but you aren’t actually giving any concrete examples of what you mean. It would be easier to take you seriously if you would back up what you’re saying with something more concrete and precise.

      • Lisa Miller

        Yes, I’d love to see some examples. Please quote.

        • Lisa Miller

          Otherwise we are forced to believe that you think the blog is mean because it disagrees with you.

    • Karen in SC

      Maybe she tried being nice and cooperative years ago. I know she has offered to publicly debate several NCB leaders, in person or via this blog. No one has taken her up on that. She is who she is. She backs up her “tone” with data and links. I understand that she gets impatient when asked about or accused of things repeatedly. (which happens to me a lot in chem lab “i forgot how to change mL to L…”)

      Regardless, her blog works! Read the comments on this post from the beginning of the year. So many mothers grateful for the information she shares.

      http://www.skepticalob.com/2013/01/thanks-to-my-readers-for-the-best-year-ever.html

    • Jocelyn

      Kelly, I understand where you’re coming from. I remember that when I first started reading this blog I was surprised by the harshness of the tone and noticed it a great deal in every post I read. Now having read so many posts, however, I think I’m used to it, and I think I understand it more. Watching so many people suffer (those who have lost children or mothers or wives) because of the natural birth community’s propaganda can be extremely sad and frustrating. And to see it continue to happen, month after month and year after year, you become quite angry at the whole thing. So I think that’s where it’s coming from.

      • Kelly

        Thank you for saying so. This is something I can understand. Ultimately, I just disagree with how Skeptical OB is going about this. If she wants make positive change, I feel that she needs to be more positive, more cooperative, but most importantly less judgmental and vitriolic.

        • KarenJJ

          Thank you for your concern.

        • Box of Salt

          Kelly, read this:

          http://www.skepticalob.com/2013/01/an-ode-to-c-section-mothers.html

          Read all the comments, too (COI declation: I commented).

          Then please think about where the vitriol is actually coming from.

        • suchende

          Why is it Dr A’s job to make nice? She’s rallying the troops. Preaching to the converted (because that is who shows up to her congregation). How many of her converted readers take her message and spread the word more diplomatically? How many fewer readers would she have if she wrote in a neutral tone, avoiding offending people? I don’t understand why you think you know better than Dr A what her goals are and how to accomplish them.

        • The Bofa on the Sofa

          Huh. Earlier, you claimed it wasn’t just about the tone. However, after being called out about it, and asked to provide specifics of things that are said that are wrong, you now backpedal to make it just about the tone.

          Thanks for your concern.

        • Guestll

          You’re right. Amy needs to be a nicer person. She needs to lighten her tone, smile more, be less blunt, less factual…maybe put on a little mascara, bat those lashes…

    • Meercat

      Kelly, I am one of the mothers who benefitted greatly from reading this blog. You can even say it saved my son’s life. I too wanted a natural birth in a hospital. I was very worried about the “cascade of interventions” after watching “Business of being born.” I was preparing for a fight with doctors and nurses when the time came. Then something clicked. I was reading a lot of birth stories when I was pregnant, and a lot of them involved natural birth- blissful, easy, and safe. I am a sceptic. I know that every coin has 2 sides and even the safest drug has side effects. Why wasn’t I seeing stories of adverse outcomes when I googled “natural childbirth?” I felt that something was off. I googled “natural birth dangerous,” found this blog and loved it. I read all the posts like a book.
      My son’s birth proved that birth is dangerous. His heartbeat was falling dangerously low during some contractions. Not all-some. It would have been easy to miss with intermittent monitoring so favored by the NCB crowd. Thankfully the monitor was placed on my belly as soon as I got to labor and delivery floor of my hospital. My doctor became worried after several contractions, and wanted to do (the horror) internal monitoring. Internal monitoring showed the same falling heartbeat pattern. My doctor became even more worried and told me that he didn’t like what was happening. My son needed to come out, NOW. I could see in his face that my doctor was preparing to fight, cajole, and convince me to go ahead with the C- section. Thankfully I read this blog, so I screamed: “Go ahead, hurry, hurry!” It took just a couple of minutes to get to the OR and prep me. My son came out blue, but was doing great within a couple of minutes. He is healthy, and so am I. I am so thankful to Dr. Amy for removing any trace of doubt from my mind. I am glad that I didn’t worry about interventions, my doctor’s “ulterior motives,” or any other crap NCB movement spews. I am not offended by the tone- it makes this blog interesting. I keep coming back. Dr. Amy treats women like adults who are responsible for their actions, and adults can take the vitriol. I much prefer the truth and vitriol to the patronizing placations NCB crowd offers.

      • Meerkat

        I should have said “benefited!” How embarrassing!

        • Erin Shetler

          Meerkat, I am so, so glad your baby is well and that you and your doctor made the best decisions together. I think the problem is that a lot of doctors, including the one who was on call when my daughter was born, are dismissive or disrespectful of the women in their care. I think Dr. Amy’s tone perpetuates this. What makes a good birth is a doctor and mama working together and making decisions together, just like what makes the best care in other medical situations. When that happens, everyone benefits. When instead women are ignored, bullied or overridden by healthcare providers, bad things can happen to moms and babies. I never wanted a natural childbirth, but I did expect the medical professionals I trusted with my care to communicate with and respect me. That’s what the birth movement is about. and that’s what makes better moms and babies.

          • PJ

            I’ve read a lot of terrible stories about how midwives treat their patients too. Why do you assume poor bedside manner is a doctor thing and not an individual thing? I don’t see anyone in the “birth movement” doing anything meaningful to advocate for better care in hospitals, by the way (most of them seem to have precious little idea of what even goes on there), so I’m very sceptical about your last claim.

          • Erin Shetler

            I don’t assume poor bedside manner is a doctor thing. You’ll notice I said “healthcare professionals,” which is all inclusive. The doulas I’ve worked with have been all about communication and respect. The medical professionals who “cared for” me during my delivery ignored me, lied to me and violated my consent rights. A little more respect and communication and I’d be writing them thank-you notes instead of complaint letters.

          • Karen in SC

            Note that with a licensed professional, you have a way to make an official complaint, also with an accredited hospital. Did you contact a patient advocate at your hospital? I hope you can find closure.

          • Erin Shetler

            Yes, thanks Karen. I complained to the hospital, the state board and the Joint Commission. The hospital was receptive and met with me and was very understanding. However, I have to caution people about patient advocates. My hospital’s “patient advocate” was actually a “risk management specialist.” That means she was responsible for minimizing liability, not necessarily helping patients. Just a watchout.

  • Kelly

    I’ve been wanting to bring this up for awhile, and this post seems close to the topic:

    There is a pretty stark divide here between doctors/science and natural birth advocates, but I am finding that the starkness is creating the inaccuracies. I gave birth at an HMO (Kaiser). I was exclusively seen by a midwife because my pregnancy was healthy. It was not a choice, it was cheaper for them to do it that way. They told me that I should not induce before 42 weeks because I was healthy, though I did go in for non-stress tests after 40 weeks. They told me to labor at home as long as possible, and wouldn’t even admit me if I wasn’t dilated to 4 cm (first baby). They recommended I take a shower before trying drugs. Delayed cord clamping so I could bond with my baby. Lots of breastfeeding support. I did all these things because I was told it was the most current medical advice. Sure, they wouldn’t want me to have a home-birth, but most of the other “natural” things were assumed to be better. It’s funny because I saw that the clear motivation for the HMO was cost and efficiency, but also positive outcomes (They sure as hell don’t want dead babies or lawsuits). Admittedly, I am not a medical expert, but Skeptical OB makes the real point that the doctors are the experts, and I took that seriously. So what about this discrepancy?

    This blog is not trying to give women the truth, or correct a wrong, seek positive change, and sadly does ultimately want to save babies as it so often refers to. The Skeptical OB is not representative of all obs and that the polemic, snarky, defensive, outlash is really just imitating the crazy activists it seeks to criticize. For someone who seems so passionate about saving babies, it seems like a wildly ineffective and damaging way to go about it.

    • Kelly

      *does not ultimately want to save babies

    • Amy Tuteur, MD

      Too bad you don’t recognize marketing when you see it.

      http://www.skepticalob.com/2011/02/midwives-and-commodification-of-birth.html

      • Kelly

        This response is deeply amusing:

        Firstly, this article does not speak to my experience in any way. For one, there was no marketing of midwifery, it wasn’t even a choice. In fact, most women I know who use this HMO do not like that they primarily see midwives for their pregnancies. The marketing has gone too far the other direction and people think that midwife automatically equates to witchcraft. The CNMs are (obviously) overseen by an Ob/Gyn. The reason the system was set up this way is purely a cost issue.

        But more importantly, the point of my post was that this blog is decisive, biased, vitriolic, and worst of all doesn’t do anything to benefit women and babies other than to terrify them and create an angry mob to attack them. To cite this article, you Dr. Amy are “not about the baby, and [not] really about birth.”

        I am deeply passionate about women and children’s health, and it saddens and scares me to hear of the homebirth horror stories, but if you want them to stop, why don’t you use that good ol’ science brain of yours and look up best practices, harm reduction and simple facts of how best to present people information, educate them, and enact real positive change? You have the resources and the brains to do it, you just don’t seem to care!

        • suchende

          You’re a good baker, but why don’t you learn how to be a butcher?

        • fiftyfifty1

          I still don’t get your point. Can you give a concrete example of something you think this blog should change other than its tone?

          • Lisa Miller

            Still nothing . Quotes dang it! We want quotes!

          • The Bofa on the Sofa

            And she’s been around since this, even, and still no examples, just a boring old tone complaint.

        • MaineJen

          “it wasn’t even a choice. In fact, most women I know who use this HMO do not like that they primarily see midwives for their pregnancies”
          So how is this a good thing? Making women settle for a lower standard of care than they’d prefer just to save some money is a good thing? Those of us who want NO part of the woo, who don’t want to use acupuncture of chiropractic or herbal supplements or positive imaging…what if you JUST want to see a doctor? What if you don’t *want* to try the shower first, you just want effective pain relief? Those who don’t want medical interventions aren’t forced into them unless they are necessary; the same courtesy should be extended to those who really would prefer a few interventions, just to be on the safe side.

    • PJ

      Do you seriously think delayed cord clamping helps with bonding?!

      • Kelly

        They delayed cord clamping because there was no need to. There wasn’t a push for the delay, but there was a push for the skin to skin the first couple hours.

        • S

          This confuses me. I’ve never seen it done, but why couldn’t the cord be clamped while the baby is being held by mom?

          • Lisa Miller

            That’s how they did all three of mine. Laid the baby on my belly and daddy cut the cord. It seems like a few minutes passed but my memory of that time might be off because I was too busy adoring my slimy, beautiful, crying new housemates.

      • Captain Obvious

        I delay cord clamping by 3-4 minutes. Most of the time the cord is short enough the baby has to stay over the moms pubic area until I can clamp it and allow the husband to cut it. Then she can finally bring the baby up to her chest skin to skin and to her breast. In many instances, delayed cord clamping delays bonding this way. I can only imagine these 1-2 hour delayed clamping or lotus birth extremists trying to get their baby up to their breasts with the typical average length cord or shorter. Long cords are nice, but their are not that common.

    • Lizzie Dee

      You had a natural birth in hospital, because there was no reason or pressure for you to have anything else. What do you think that proves exactly? NCB heavily pushes the idea that interventions are done for fun and profit, and you can testify that they are not. No-one here is surprised that that is current medical advice.

      • Kelly

        I never said I had a natural birth. Aspects of it were natural. May labor lasted three days, I had pitocin, I had an epidural, I had narcotics. The only thing I am trying to point out is the vitriolic nature of this blog, which makes me wonder what the point of this blog is.

        • Karen in SC

          How would you respond to midwives who continue to endanger mothers and their babies?

        • KarenJJ

          You can read some of the stories of women and babies that have been treated negligently by US homebirth midwives. You can read stories of deaths and disability and brain damage from the lack of care provided by these midwives. There is a hurt by homebirth blog that describes some of this. Most of these midwives have been able to continue to practice due to a lack of regulation.

          So why are you angry at this blog? Why are you trying to vilify us? What are your thoughts on the topic at hand? You seem more then happy to talk in generalisations and judge the people here – why?

    • S

      What is the discrepancy? Sounds like you had fairly standard care to me. Can you explain further?

      • S

        To elaborate — I’m pretty sure most doctors would prefer their patients not take pain medication if they’re able to cope well without it. And they certainly would agree that breastfeeding is a healthy choice for most mothers. Induction varies by provider, but yours sounds within the range of normal. Most hospitals won’t admit you if you’re doing well and not yet in active labor. (The delayed cord clamping and bonding sounds like someone’s opinion; i sincerely doubt there’s any solid evidence for that.)

        In short, i don’t understand what point you are making with your anecdote.

        • fiftyfifty1

          “Induction varies by provider”
          Although there is probably less variation than there used to be as it becomes increasingly clear that waiting past 41 weeks has no benefits and many downsides.

          • rh1985

            I’m 6 weeks with an IVF pregnancy and if it turns out to be viable I really want an induction at 40 weeks – when the dates are that certain I really feel more can go wrong for baby inside than outside – especially when it took so much to get this baby. I’m fine with risking a c-section if induction fails but I want this baby out at the earliest safe time and I think that when the conception date is 100% certain 40 weeks is safe.

          • Lisa Miller

            Congrats rh1985!! I work in the Arts business. Sticky sticky baby!!

          • rh1985

            I have an ultrasound tomorrow and really hoping to see heartbeat at that point since I’ll be 6w4d.

          • Lisa Miller

            Once you see the heartbeat the chances of a loss are waaaaaay smaller 🙂 Please keep us updated .

          • rh1985

            I will. My clinic does early ultrasounds too, so I had a 5w1d scan that showed a correctly sized gestational sac. So I know it implanted and it’s uterine. Hoping for the best!

          • rh1985

            saw and heard 1 perfect heartbeat!

          • anh

            HOOOOORAY!!!!!! so happy to read this

          • Lisa Miller

            Woohoo!!!!!! Yay!!!!!!!!

      • Kelly

        This implies that doing the “high intervention” style medicine is the best, and that asking for anything different would be insane. I’m wondering if my experience something that Skeptical OB would have a problem with, even though it had “natrual-ish” moments.

        • suchende

          Sounds like a straw man argument.

          • The Bofa on the Sofa

            Actually, it’s pretty much a non-sensical argument, as in, it doesn’t make any sense. What is a “high intervention style of medicine”? A) What constitutes an intervention? and B) what makes it high?

            I mean, there are different types of interventions. The one thing that they all have in common is that they are there to prevent emergencies and bad outcomes. However, the level of intervention that is used is going to depend on the level of risk faced. If the risk is high enough, then the intervention will be more extreme, like a c-section. At the other end, the intervention might be something extremely minor, like CFM. Just saying there are a lot of interventions really means nothing without addressing the details. There could be a lot of interventions but they aren’t adequate to prevent problems. There could be too involved interventions for minor problems. Just saying that there is a “high intervention style” could just as easily mean the interventions aren’t adequate as that they are too invasive.

            Of course, there is also the tendency to define interventions as things doctors do that midwives can’t, and if the midwives do it, they aren’t considered interventions, so that adds another layer of nonsense onto her statement.

            I see nothing wrong with a “high intervention style of medicine,” for the right types of intervention. And Kelly hasn’t shown how any interventions are improper.

        • S

          This particular post does? In what way?

          Quickly rereading, she says that epidurals are not dangerous, and that’s the only intervention i see mentioned. Where do you see that asking for anything different would be _insane_? I am trying to figure out exactly what you’re responding to.

    • Karen in SC

      Were you ever given any factual information about why “most of the natural things were assumed to be better?”

      As far as cost and efficiency, it could very well be that it was calculated that the savings in discouraging epidurals (take a shower????) and aiming for some nature ideal for the thousands of babies in the HMO Kaiser system would result in more profit than a payout for a baby death. Corporations are often like that.

      You can read more about the safety of epidurals, the risks of going past 40 weeks and other fact based information on this blog and others on the blog roll (Adequate Mother (an anesthetist), What ifs …(a doula), Quality Care for BC Mothers (a health economist, I think).

      • Karen in SC

        Safer Midwifery for Michigan is another excellent blog. And the author’s style is quite non-vitriolic, in fact the opposite. Yet, most of her great posts have zero comments, others one or two. Does that mean being “nice” and “cooperative” doesn’t work? Or that there is a place on the internet for both styles?

    • Captain Obvious

      You were offered a higher surveillance monitoring after 40 weeks, trying to prevent a first cesarean by waiting for you to go into labor on your own without induction, trying to labor without an epidural until you think you need one. Sounds like good quality hospital care. Some studies currently suggest to strongly consider induction after 41 weeks but different doctors still have their own opinions on that. Delayed cord clamping for 2-4 minutes is fine, but a lotus birth or delaying resuscitation until the cord stops pulsing is malpractice. Most posters here including dr Amy agrees with this. What you are describing at kaiser is not a Homebirth with an undertrained unlicensed midwife not monitoring a high risk momma. I believe this is the bulk of what is trying to be prevented here. What is your point? Babies are dying and women are being lied to about the safety of Homebirth with Homebirth midwives. MANA won’t even reveal their mortality figures of their multithousand Homebirth data. Being seen by a CNM with an OB backup in the hospital is fine. A DEM/CPM at home is malpractice, but then again they usually don’t carry malpractice insurance to protect the families they tack care of in case of a catastrophe. Doctors and hospital CNMs carry this coverage. I believe you agree with this blog but your ignorance of the difference between Homebirth midwife and hospital CNM is getting in the way of your understanding.

    • Lisa Miller

      “They recommended I take a shower before trying drugs”

      Nowhere is that best practice. Best practice is treat pain immediately, sometimes even before examination. Every time I have gone in to the ER for pain (Migraines, Gall stones, appendicitis) I was treated for my pain within 10 minutes of being admitted. Sometimes before the doctor had done a full exam. Just because you hospital tried to cut corners to save money does not mean that the hospital is representing best practice.
      I was healthy as a horse with my second pregnancy but my midwife would not let me go to 42 weeks. We were talking induction at 40w 2d.
      Cord clamping delay for bonding-Not best practice anywhere I’ve ever heard in fact, I’m willing to bet it’s nonsense.

    • Karan

      I agree, I don’t think she actually cares about babies, I think it’s a personal battle….she’s the expert how dare these un-educated mothers and midwives question her…that’s the feeling I get. I have yet to see anything that would help babies…and for the record, there are a great deal of ob who want midwives to have the job of delivering so that they can focus on other women’s health…

  • Mac Sherbert

    “animals need privacy to birth successfully; so do humans.” — Actually, I was watching a show about elephants and they don’t birth in private. The other elephants stand by and when the baby is born they rush in and grab it, so the mother doesn’t crush it. Nature is interesting.

  • Allie P

    Oh for Pete’s sake. A pamphlet at Whole Foods as a sub for actual science? You can’t make that shit up.

    Oh wait, you can, and you make money doing it.

  • yentavegan

    After taking a brief time-out from this blogsite and licking my wounds and swallowing humble-pie I have a few choice things to say.
    I have been duped and I will no longer support the duping of others.
    The rhetoric from the NCB fannatics is so pervasive in La leche League that one of the principals of LLL is encouraging women to birth while active and alert. Active and alert soon morphs into supporting drug-free intervention-free home-birth encouragement
    This madness will stop with me as far as my LLL group is concerned. So mothers to be, do not buy the myth that only birthing like a cavewoman will enhance your ability to breastfeed. Biology is a crap shoot. .

    • The Bofa on the Sofa

      What is the purpose behind the “active” goal? Does anyone know?

      I tend to suspect it is just a backdoor attempt at a “drug-free” movement, as you suggest.

      I realize that activity can help with pain, but an epidural does that, too. So if you have an epidural that helps with the pain, you don’t need to be active for that.

      • yentavegan

        I think the emphasis on “active and alert” was the belief that lactation failure was due to mom/baby being too groggy to initiate early and often breastfeeding feeding pattern.
        This is indeed a false belief and it blames a mother for giving into interventions which then precipitates the cascade of interventions leading to lactation failure.
        So only true warrior women can be the champions of breastfeeding, lesser mothers who give in to fear set themselves up for poor breastfeeding outcomes.

        • suchende

          You have to be able to blame the failure to successfully EBF on technology. Otherwise you’re admitting it sometimes just fails “naturally,” which is an unacceptable conclusion.

          • yentavegan

            Yes! this is exactly what I have recently learned. The mindset, religiously held dogma is that if we were only given the opportunity to birth and breastfeed without interventions from disbelievers,(doctors) then every mother could breastfeed without supplementing. And if mothers supplement it is called lactation failure, rather than being judgement free and letting mothers choose for themselves what works best for their families.
            It is the know-it-all attitude and the judging of other women for not wanting to breastfeed that makes me angry and ashamed of buying into the rhetoric.

          • suchende

            It’s very disillusioning to struggle with breastfeeding. I am (now) pretty sure I have IGT. Through all my struggles, no LLL member, no LC, no nurse, no OB brought that up as a possible issue. I didn’t even know that diagnosis existed. The only “help” or “support” I got was suggestions that I pump more (not that anything came out when I pumped; just sorta moistened my pump parts), nurse more, wake up more often, spend less time away from baby. Because it’s sacrilege to blame failure to BF on anything but the amount of effort mom exerted.

          • yentavegan

            on behalf of myself a, a LLLLeader for more than a quarter century I apologise for not knowing enough about anatomy and physiology to give you accurate information. Telling a mother struggling with supply issues to pump more is a terrible disservice.

          • fiftyfifty1

            Sometimes the words “I don’t know” is just what a struggling mom needs to hear! I remember what a relief it was to hear those words during the quest to diagnose what was going wrong with my first. I was in tremendous pain and my baby was very restless on the breast. The first 2 lactation consultants I saw were very certain and very sanctimonious about what I had done to bring the problems on myself. So it was SUCH a relief to find a LLL leader and have her say “I have no idea what the problem could be, but I know this is not your fault”. She referred me onto a third lactation consultant who was able to make the diagnosis (crush injury reynaud’s). It didn’t matter to me that the LLL leader wasn’t able to help me directly. She helped me just by listening to me and believing me and that was what I needed most of all.

          • KarenJJ

            Me too. We had enormous issues. Hearing ‘you are doing everything right’ gave me an enormous boost of confidence, peace and resolve to keep at it and also do what we needed to keep her fed and thriving. There comes a time when effort in breastfeeding becomes a zero sum game and nobody benefits from the extra efforts. Keeping mum and baby happy, fed, rested and confident in what they are doing (including giving a bottle) would be a lot more helpful.

          • Ainsley Nicholson

            I had huge struggles getting started with breastfeeding too. In my case, supply was not the problem, which made it even more strange when the hospital lactation consultant suggested that I supplement. My babies were all slightly early (38 weeks, 36 weeks) and right around the time they would have been 40 weeks, they just kinda “got it” and started latching on well and sucking efficiently.

          • The Bofa on the Sofa

            It’s interesting, with our first, that he was doing great nursing on the first day. I actually have a “letter” I wrote to him in the middle of his first night praising him for how good he was doing with his nursing.

            And then, on the second day, it all stopped, after my wife’s milk came in. We think it was just a reaction to the fact that he had already got the hang of sucking hard, but when he did that when her milk came, the gush basically knocked him off. After that, he was not good about going back. So the first night, all was great. He pretty much didn’t eat anything the second day, and by that night, we were giving him expressed milk from a syringe. After a couple of days of that, he seemed to get the taste for it and was fine.

        • The Bofa on the Sofa

          I think the emphasis on “active and alert” was the belief that lactation failure was due to mom/baby being too groggy to initiate early and often breastfeeding feeding pattern.

          That accounts for alert, sure, but it doesn’t seem to have anything to do with active, I don’t think.

          Then again, if you really want mom to be alert, have a c-section scheduled noon, so she can get a good night’s sleep the night before. Drugs or no drugs, if you’ve been awake and in labor all night, you are going to be exhausted when the baby is born. I would suggest it is going to be even worse for those who are trying to battle excruciating pain through natural coping techniques.

          • Lisa Miller

            I don’t know. I was induced at midnight (got the epidural before the pit because after two natural labor attempts I was over.it.period.) I slept like a champ. Barely woke up to break my water. Woke up at 9 am to push. Twas nice!

      • Amy M

        Well, I had an epidural, and though I could not have run around the block, I was certainly alert and could have actively participated in a rousing game of poker, or something like that.

        • The Bofa on the Sofa

          LOL! I guess yeah, it does depend on the definition of “active.” But I think yentavegan is right in her implication that their version of active means “no epidural.” To which, I ask, why?

          • suchende

            Because all the moms I know who had NUCBs didn’t struggle with BFing and all the epidural moms did (or at least, the ones I conveniently remember right now). And nothing anyone says can convince me otherwise.

          • Ainsley Nicholson

            I had no pain meds for my births, and I struggled plenty with breastfeeding.

          • The Bofa on the Sofa

            Yeah, and saying “be alert and active” sounds a lot more appealing than “don’t you dare get an epidural.”

          • Amy M

            Really? And you think it had to do with the epidural? How did the epidural affect breastfeeding? (not trying to be obnoxious, I want to know)

          • suchende

            No no no… being satirical. Bofa asked, essentially, what is the evidence that it’s better? And I am speculating that there isn’t any real evidence.

          • Amy M

            Oh! Sorry, this thread is hard to follow, esp on feedly!

          • The Bofa on the Sofa

            I thought the part about “nothing anyone says can convince me otherwise” tipped it off, even if you didn’t recognize her as a regular

          • Amy M

            Yeah, I thought it was odd…now I am schooled. 🙂

          • Amy M

            I also ask why, because I think it is total BS. For whatever reason (some cite the Bible, others seem just to be mean) a bunch of people think women should be in pain during labor/birth and those who get pain meds are cheating. Using formula is also cheating, by the same bizarre logic. I totally cheated my way through labor, delivery and early parenthood. I guess I still cheat, since if I can find a convenient, efficient way to do something, you bet I’m all over it. Not sure where that leaves me now, when do we find out who wins?

    • suchende

      I didn’t realize you were on a break, but welcome back.

      I have a video of my less-than-an-hour old epidural baby sucking on my boob like a vacuum and staring at the camera like a deer in headlights. If that’s the face of being drugged, I’m a little worried what alert would look like.

      • Jessica

        Yeah, my baby looks alert in all the pictures from the first two hours of his life, despite the Stadol I got a few hours before my epidural. Baby was pretty sleepy thereafter until about two weeks old, but I was told that is NORMAL of all infants, epidural or not. The sleepiness did make nursing hard for the first month, but here we are nearly 13 months later, so it all worked out in the end w/r/t breastfeeding.

        • Amy M

          Mine were sleepy for the first 2-3wks but they were 4wk early, and I was told that was typical for early babies. Around “term” they woke up and had more alert periods, so that makes sense.

    • Ainsley Nicholson

      Glad to see you back, yentavegan. I was a little worried about you.

    • Dr Kitty

      I’m glad you’re back too. I enjoy your comments.
      My kid was latched on and feeding within 30minutes of birth…and since I had a spinal block for the CS I couldn’t feel my nipples, so it was actually much more pleasant and lasted longer than the subsequent feeds in the next few days!

      • FormerPhysicist

        I had a c/s, and then a few minor side effects of the anesthesia, so I didn’t hold my oldest for over 2 hours. But she was a barracuda from the moment she first tried to latch and I had huge supply and no problems.

    • Lisa Miller

      My daughter latched on so fast it made the midwife jump. She stayed on there for 9 months too. Both my son’s were more hesitant. My first was really really freaking hard because he had jaundice and I had to wake him up with wet cloths and he fell asleep about every two minutes. I imagine that my second son (third child) would have been the same way had he been my first. Lucky for us both I was a seasoned nursing mom and I had him on there in no time flat. nursing can be really hard….Oh yeah and I had the epidural with all of them and narcotics too. Yum yum yum.

    • me

      My “epidural baby” was my hardest to nurse. She was also my first baby. I tend to think that had more to do with it than the epidural 😉

  • MomAnd Midwife

    YES! A Dr. Amy blog post directed at ME! Wooh-hoo!

    • S

      Ooh! Can you share some examples of evidence that you feel is ignored by the medical community?

      (Not sarcastic. Interested. I don’t agree with all your comments, but i really appreciate your perspective.)

      • MomAnd Midwife

        Thanks, but no, I shall not feed the beasts here.

        • Amazed

          I’ll repost my reply from the previous post, I just left it there. A reply all for you! Aren’t you happy?

          For the other posters: I posted it right now, under a reply of hers in which she is awed by the fact that a friend of theadequate mother’s is an evidence-based OB.

          Slow clapping.

          Good act, MomAnd Midwife. Good act. You must be thinking you’re so
          clever, acting as if you are an evidence-based professional instead of
          homeopathic loving woo-infected pretender. How clever you are, to pose
          as if you respect doctors and scientific evidence, You’re even awed by
          the mere existence of a good doctor because they are so RARE, thus
          subtly demeaning the whole profession.

          You know what? You’re not so clever. I saw right through your envy and subtle badmouthing.

          I wouldn’t let you come within 10 feet radius of me with your woo.

        • The Computer Ate My Nym

          In that case, why did you comment at all? What’s the point of saying “it’s all about me!” then refusing to explain yourself? Even if you don’t think you’ll reach any of the people who comment regularly here, aren’t you interested in explaining to the lurkers why you feel wronged by this post?

        • Captain Obvious

          And you can predict the AFV within 1 cm. I call BS. On plus size and tall women women it is hard enough to predict EFW let alone AFV. Different examiners on the same day can have their independent AFV vary by as much as 3-5 cm. so for you to be within 1 cm is fudged data.
          And you only had one breech not turn? In 21 years I have seen breeches because of Mullerian defects, double or more nuchal cords, low AFV, anterior low placentas, fibroids obstructing the lower uterine segment, congenital anomalies, as well as idiopathic. Many breeches are not good candidates for version that may put baby at risk. But you have turned all breeches that you have encountered but one? Again, I call BS on this troll. You are trumping up your imaginary stats like The Farm does, but worse.
          Being a midwife patient is by far the greatest risk to have a breech baby in labor without anyone knowing. Midwives tend to restrict vaginal exams and don’t have access to ultrasound to confirm presentation or position. Hospitals and doctors perform vaginal exams and confirm with sono. The only laboring breeches I have seen were midwife clients.

          • Karen in SC

            is AFV amniotic fluid volume? if so, shouldn’t the measurement be in cubic centimeters, or mL?

          • Dr Kitty

            AFV is measured with ultrasound, which gives a 2D picture, so it is measured in cm, being the size on the US monitor of the pools of fluid.
            Does that make sense?

        • KarenJJ

          That was a great question. A shame you choose not to answer. You can learn a lot from the commenters here. Opening up your knowledge to critiques and new information is a fantastic way to improve. It is this lack of self-reflection and accountability that will keep midwifery side-lined and backwards.

          • suchende

            I didn’t realize I could dismiss my critics as “beasts.” We’ll see how the partner likes my next response to an objection by opposing counsel.

            In fact I bet that was GCC’s first recommendation to her lawyer to respond to Dr. A’s suit. “Thanks, but no judge, I shall not feed the trolls in your forum!”

        • Charlotte

          That’s pretty passive aggressive and juvenile, making a sarcastic complaint then immediately backing out when asked to explain and defend it. I think the real reason you won’t is that you can’t.

          This sort of thing is definitely one my biggest pet peeves.

          • KarenJJ

            This type of defence is a lot less convincing then they must imagine it is. MomAndMidwife has sure shown us how midwifery actually is evidence-based and that Dr Amy is wrong.

          • The Bofa on the Sofa

            For some reason, this reminds me of my favorite exchange…

            Me (to some other person on the internet): “Wow, you’re really an asshole”
            Him: “Come say that to my face and I’ll kick your ass!”
            Me: “Probably true, but that wouldn’t do much to convince me you’re not an asshole”

            It was just what I thought of in terms of “Defenses that are not all that convincing”

        • Sullivan ThePoop

          Well, at least you are providing more proof that home birth midwives are childish.

        • MaineJen

          No, you know what? I’m not a beast. I’m an actual interested person, and I have friends and relatives who are both midwives and OBs. Please tell us what actual pieces of scientific evidence are being ignored by the doctors, but that the midwives are aware of. I’m not being sarcastic, I’m actually curious, because I’m a layperson who got OB care and I felt it was very good care. You are in a position to ‘educate’ people like me, so actually SAY what you’re trying to say. Please.

        • stacey

          So, why are you here? I would like to think you are here to learn., but thats a dubious assumption.

        • Anonymous

          More like you can’t and you won’t. Any of us that are legitimate medical professionals, and by legitimate I mean MD, PhD, or CNM know you can’t.

          This reminds me of what happened over xmas at a party before my wife and I had our first. My pop and I attended and unbeknownst to us one of the ladies in attendance was a “midwife” but lacked even the pathetic CPM. She spent a good 15 minutes attacking dad and I because “you don’t know and never can know birth” even though we’ve got probably 50 years experience, between us not to mention the proper medical training. All the typical banter came out about doctors wanting to make money, play golf, bebies die, etc. She decided to end with this rant about all these amazing studies that had been done. Finally dad took a long slug on his drink and asked:
          “And do you have peer reviewed studies to back up what you’re saying to us?”

          The next thing she said was gold. Keep in mind this is a room where the only two people that aren’t MDs or PhDs are this lady, my sister and her husband(sis and hubby both have MBAs).

          “No but if you go to this website there is lots of useful information.”

          “So, no real studies?” one of the other guests asked.

          “Well in my experience….”

          At that point she started to realize that this was going to end really, really badly and sort of trailed off.

        • S

          Disqus ate my comment eight hours or so ago. Apologies for the double post if it pops back up close to the bottom of this thread.

          I can understand not wanting to invest a lot of time in what is likely to be a heated discussion. However, it bothers me that you, a health care provider, may just be unwilling or unable to stand behind your recommendations to your clients.

    • Susan

      Why is it aimed at you?

      • Captain Obvious

        Haha, the trolls have that guilty understanding that the conspiracy is out to get them and any rational post must be for them. Guilty is as guilty does, and she knows it.

        • S

          I’m not sure this is a fair characterization. I was one of those trolls a couple years ago, and that post seemed to follow naturally from one of Dr. Amy’s responses in a conversation we were having. It could have been just a coincidence, though, a topic that was on her mind anyway.

          • The Bofa on the Sofa

            Well, I’m sure the conversation yesterday might have prompted the re-post, but note that it IS a re-post of an article written in 2011. OK, MomAnd Midwife might be the posterchild for the type of person it applies to, but it is safe to say it was not written about her specifically.

          • S

            Yes, i was talking about the timing of the re-posting rather than the writing of the post.

      • Lisa Miller

        The previous post had Momand Midwife claiming that OBs are not evidence based and that midwives are.

    • Margie

      Erm, I guess you missed the bit at the bottom that says this post first appeared in 2011?

  • realityycheque

    Dr. Amy, I’ve seen this paper touted as proof that OBs don’t submit to evidence-based ideals. I would love to know your thoughts?

    http://motherscircle.net/wp-content/uploads/2012/08/Wright-et-al-2011-evidence-based-practice-bulletins-in-ACOG.pdf

    • Sue

      The same exercise in any area of health care would reveal something similar – in many areas of practice, evidence either hasn’t been, or cannot be, obtained by high-quality randomised trials. A lot of information that guides practice is physiologically-based or based on population studies – not everything is amenable to RCT.

      This extract from the paper is relevant:
      “Some organizations, such as the U.S. Preventive Services
      Task Force, do not issue guidelines when evidence is
      insufficient. The corollary to this is that care must be rendered in clinical scenarios where high-quality data are lacking. One could argue that these are the situations when clinicians may benefit most from guidelines, even when these recommendations are based on observational studies or consensus. Many professional societies are now re-evaluating how evidence is graded and how guidelines are issued.”

      Interestingly, the paper did find that 30% of obstetric guidelines were based on Level A evidence – that seems quite high to me. What would the equivalent figure be for radical-NCB and lactivist dogma. (Oh, I forgot – they have no ”guidelines” – just dogma).

      • stacey

        Considering MW have ZERO evidence of any sort, its pretty ironic that they complain about this.

    • Amy Tuteur, MD

      Here’s the response I wrote to the midwifery “interpretation” of the paper:

      http://www.skepticalob.com/2011/08/hypocrisy-and-mendacity-of-big-push-for.html

      • suchende

        It amazes me that you still find new things to write, after having covered pretty much everything already!

    • EllenL

      I found the study interesting. It illuminates a process I didn’t know anything about. It didn’t shake my confidence in my doctors and their ability to evaluate and use appropriate evidence.

      If anyone reads that study and concludes ” I’m not going to believe a thing my (highly qualified, well-educated and experienced) OB says” – that response would be idiotic IMO.

    • The Computer Ate My Nym

      The usual reason that recommendations are based on class B or C evidence is that there is no class A evidence. You can’t make a recommendation based on data that doesn’t exist. Want more OBs to follow strict evidence based guidelines? Call your congresspeople and ask them to fund the NIH at a higher level, particularly with respect to OB/GYN research.

  • Lisa Miller

    Bet I know where this blog post idea came from 😉

  • In which I counteract with this.

    Latest issue of WDDTY (What Doctors Don’t Tell You, July/August, 2013)

    Heres some of the highlights from this particular issue that I found to worthwhile and I’m not even done reading it myself. They are as follows.

    Asthma Exclusive:

    End Your Child’s Wheezing without Drugs

    Cervical Cancer: What all Parents (and Their Children) Should Know about the HPV Vaccine

    ‘How I avoided a Hysterectomy through Diet’

    Natural Botox: Safer Ways to beat Winkles

    Sorry, I don’t have a specific link to it because I somehow deleted the email
    that I got pertaining to it. But still heres some of the links to it.
    http://wddty-us.com http://wddty-us.com/subscribe http://wddty.com

    Basically, found WDDTY while was at one of the local Whole Foods. Looked and read through it to make sure that I wanted to subscribed to it. In which I did because to me I found this magazine is really truly important in this day and age. Going into the future as well. Not just UK, Europe,
    US, but all over the place for sure.

    I’m going to be copying, pasting, emailing, blogging, posting about in other parts of the web that I belong to, and etc.

    Please feel free to forward, copy, paste this email about it in other parts of the web that you belong to, and etc.

    Think thats it for now.

    Thank you, again, in advance.

    Jessica

    • GuestB

      Oh my God I can’t stop laughing. Please, everyone, click on that link. Totally worth the amusement.

    • PJ

      Blink, blink.

    • Lisa Miller

      Ha ha ha. Winkles

    • Bombshellrisa

      Whole Foods-at least they know their audience

      • rh1985

        Aww, I am not into all that and I love Whole Foods – they have really good baked goods and prepared food and cheese.

        • Bombshellrisa

          Agreed-it’s hard to beat their Mac and cheese.

        • mamaellie

          Whole Foods Candy Island in Austin has chocolate covered smores. They are pretty much the most amazing thing I’ve ever eaten.

    • PoopDoc

      Wow. Medical advice from a grocery store flyer. Excellent.

    • KumquatWriter

      I…don’t…understand…

      Flyer. Whole Foods.

      Peer reviewed journals.

      I…What…Don’t…

      *head explodes*

      • In which again, I counteract your response to my comment here.

        You got to be kidding me on this. I for one found these alternative magazines, journals, or whatever they called to be better. Then those mainstream magazines, journals, or whatever. In which I do take everything with a gain of salt.

        • Renee

          HAHAHAHA. But you probably like Natural News too, eh?

          • KarenJJ

            I suspect so. You can google her username and find other information like above posted on blogs.

        • Ainsley Nicholson

          There is a big differance between anything written for public consumption (mainstream magazines or alternative magazines) and the peer-reviewed journals (aka scientific literature). Peer-reviewed journals contain articles that are written by scientists and doctors, and go thru a review process to make sure they accurately describe high-quality work.

        • Cellist

          Have you ever studied university level stats? Until you have this knowledge it is difficult to fully understand why the information in these alternative publications is not actually evidence based. Why trust your health to something which is unproven?

          • Huh and need further explanation as to what meant here.

          • Cellist

            Many of the claims made in alternative publications or by alternative practitioners are based off tradition, or hunches or a misunderstanding or misinterpretation of the scientific literature.

            In order to judge the validity of a claim, it is vitally important to understand HOW the claimant reached their conclusion about this claim.

            Did they conduct a controlled study?

            Or did they hear that this is what people traditionally claimed?

            Did they just trust their instincts?

            Did it merely work for them?

            Did some random on the internet claim it?

            The beauty of an understanding of scientific method and statistics is that you can verify the basis of claims.

            I strongly, strongly urge you to study statistics so that you can verify whether the claims that you are spreading on the internet are actually based on evidence.

          • cellist,

            Oh okay, but oh please. Because to me its just not a logical argument and etc.

          • Cellist

            I really don’t understand what you mean by this?

          • Cellist,

            What the heck do you don’t understand by my latest response here.

          • Cellist

            “Oh okay, but oh please”
            I think that this is sarcastic but I’m not entirely sure.

            “Because to me its just not a logical argument and etc.”

            What is not a logical argument? What is ‘etc’ referring to?

          • Oh okay. Basically, logical argument is common ground sense. Well, at least my eyes of course.

          • Cellist

            The difficulty with relying on common sense is that it is often contradictory.
            Which is true ‘Out of sight, out of mind’ or ‘Absence makes makes the heart grow fonder’? What about ‘Opposites attract’ or ‘birds of a feather flock together’?
            It was common sense in the 16th century that Queen Elizabeth I came down with small pox because she had a bath! (Not joking, kind of wish I was!!)
            It was common sense just to let your children get chicken pox, because it was safer to get it as a child than to have it as an adult. This always made complete sense to me! I had absolutely no idea until recently that children die from chicken pox every year in Australia.
            Common sense is great, it is just also important to figure out what it is actually based upon. Is it merely cultural tradition?

          • Hmm interesting, but at the same time oh please. Because to me your arguments are the same old ones. Well, as far as I can tell.

          • Bombshellrisa

            Do you think you are the first person to come here and try to “enlighten” us? I have listened to patients refuse conventional treatment for colon cancer in favor of coffee enemas and herbal cancer treatment. Women who don’t want hysterectomies try to take evening primrose oil, chasteberry capsules and black cohosh for things like endometriosis or fibroids. Patients whose joints are worn away refuse joint replacement and try and take glucosamine and cinnamon capsules. They “did their research” and somewhere heard someone who had “cured” their condition in those ways. And they believed. Hoxsey, the Greek Cancer Cure, chlorella for heart disease, green tea capsules for diabetes: I have heard it all. I have been called unsupportive for not getting on the bandwagon of cheerleaders when family and friends chose these methods of self treatment. I wish I could scream that back at them, but they aren’t alive for me to fight with.

          • Cellist

            Everything you said and more. Don’t waste your time trying to convince this person – I’ve already tried being resonable with her.

          • Bombshellrisa

            I guess I don’t understand the responses. Maybe she is voice to text for replies (which almost makes me wish for he whom we shall not speak of).
            I used to get all those magazines, although the ones I got at the health store were always free. The “cures” have not changed much, surprisingly. I would put them in my student midwife bag and then tote them to my accupressure classes all the way at Bastyr (this is before the midwifery school moved there). I read all about blue green algae for weight loss, apple cider vinegar being a panacea and about aromatherapy.

          • In which I say, oh please.

          • Bombshellrisa

            Oh please what?

          • suchende

            A logical argument is one that isn’t logically fallacious. A convincing health claim is one that’s based on high-quality scientific evidence. Common sense plays no role.

          • Ainsley Nicholson

            Jessica,

            The way some of your sentances are structured raises the possibility that English is not your native language. Is this the case?

          • Ainsley,

            What to this because english is indeed my native language. But at the same time I have a speech impairment.

          • Playing Possum

            Don’t forget a plausible mechanism of action! And something concrete: biochemical, physiological, pathological processes. Not imagined, unmeasurable quantities that can’t be proven to exist let alone have any effect.

            Sorry for the thread jack. Science is just so freaking amazing and awe inspiring and terrifying and beautiful and improbable. There is so much to be fascinated by without making stuff up.

          • Cellist

            “Science is just so freaking amazing and awe inspiring and terrifying and beautiful and improbable. There is so much to be fascinated by without making stuff up.”

            I know! That’s what I love too!!!

          • KumquatWriter

            And the point is made!

      • Bomb

        Has to be a troll. Hope it is a troll…

    • Sue

      Jessica – Dr Amy’s blog discussed misinformation about pregnancy and childbirth, particularly by people who unrealistically emphasis ”natural” birth over safety.

      Are you sure you intended to post this here? Do you have the wrong blog for your topic, maybe?

      • Sue-Thanx, but no thanx. I found this to still be relvant to here as well.

        • Bombshellrisa

          Actually it is relevant, as it proves that “natural” remedies are a combination of taking less than effective herbs or homeopathic remedies and finding support for that, even if your validation has to come from the free pamphlet section at Whole Foods.

          • Tell you, truth WDDTY isn’t a free pamphlet section at Whole Foods. But its exactly a magazine, in which you have to pay for. Maybe subscribe to it afterwards.

          • Wishful

            Good to know its not vaguely a magazine…but just because people pay for it doesn’t mean much. I mean after all people pay for all sorts of things, some of them are nonsense.

          • Bombshellrisa

            True, how else can you explain phone reiki and amber necklaces for teething?

          • suchende

            Believe it or not, no one is regulating magazines to make sure they’re not printing junk science. Pick up any women’s fitness magazine to see what I am talking about. I mean, if you have a sufficient science background to recognize junk science.

    • Cellist

      Follow the links to Jessica’s blog (in her profile
      I draw everyones attention to her ‘open letter to Dr Amy’ post.
      Logical argument is a waste of time

  • Ainsley Nicholson

    I’m planning to delve into the primary literature to look into the eating-during-labor question; I’m quite concerned about this issue for my upcoming delivery. I’m one of those people who just does not do well when I go without food for any length of time. My current understanding is that eating is discouraged due to a small risk of vomitting followed by aspiration during general anesthetic, when can lead to death. I may chose to take that risk, but I want to know everything that is in the scientific literature before making that decision. Does anyone know of any must-read papers or really excellant reviews on the subject?

    • Captain Obvious

      Many woman think they are going to be starving when in labor, surprising to them the pain of labor, excitement of the baby coming, the shakes of labor, and the delayed gastric emptying during labor leaves them with little appetite. When you do eat, the delayed gastric emptying usually causes you to retch and vomit anyway. My last patient are while in labor, threw up her food, and when she needed a cesarean, the epidural had such a patchy block that her anesthesia had to be converted to general endotracheal intubation. Luckily her stomach was quite empty by then. FTM should be the least likely to allow to eat because of the CS unknown. Low risk multiparous women nearly guaranteed to deliver vaginal have better argument to allow meals while in labor.

      • Ainsley Nicholson

        Thanks for your thougthful response. Since I’m not a FTM, I fully expect to be not interested in food once serious labor starts. I’m more concerned about early labor, or even pre-induction…my last delivery I was sent to the hospital to be induced a full twelve hours before they started the induction.

      • AmyP

        I don’t think I remember being hungry during my labors (despite the no food rule), but for my first baby, I somehow missed the hospital’s dinner service after delivery after having been there since the wee hours of the morning. I forget what we did, but I was SO hungry and so annoyed. I was very happy to be fed right after delivery in the L and D room with my third child–I suspect that wasn’t even an option with the first hospital.

        Now I realize that I should have just sent my husband out for food that first time but 1) it would have taken a long time 2) we were totally unfamiliar with the geography of the area or the hospital itself, as my OB (who I subsequently fired) had pulled a last minute switcheroo as to choice of hospital 3) my problem solving skills were not at peak performance. 4) It was a 37.5 week delivery, so I was totally unprepared (no bag or anything).

        They were also remiss with pain killers and responding to buzzes at that first hospital (and I had what must have been a nasty tear or episiotomy). Knowing what I know now, I would have packed Tylenol, nuts and granola bars and taken care of myself, but I was a total newbie at the time.

    • theadequatemother

      My hospital had no restrictions on eating during labor, well not for low risk women anyway. I remember when I asked my OB about this he raised an eyebrow at me like I was crazy to even think there would be a restriction. Then he told me I’d probably vomit up anything I ate.

      During my anesthesia training I learned that evidence favors light meals and fluids in early labor. What to do later seems to be a more a matter of opinion. Many places say clear fluids only after an epi but I think that is consensus. If you look at Mendelsons original studies of aspiration during OB anesthesia (100 yrs ago) it was all either with an unprotected airway and the only women who died did so because they aspirated chunks (like one was steak that completely occluded the trachea).

      All pregnant women are treated as if they have a full stomach by us anyway. Maybe I am overly progressive but I never ask when the last meal was when treating pregnant women for urgent emergent cs or for epi placement. I will delay elective or no urgent cs for 6-8 hours after eating, two hours after clear fluids tho.

      • S

        I read somewhere that inhaling straight stomach acid would be as bad as, or
        worse than, stomach acid plus food/drink. Do you have any thoughts on that? (This was awhile ago,
        and i’m guessing it was not a reputable source, but rather some NCBer’s
        personal opinion.)

        • S

          Bah! Sorry about that formatting.

        • theadequatemother

          it comes from the idea that aspiration pneumonitis (chemical pneumonia) is less common if the acid is diluted to a higher pH. This comes from a theory in the medical literature that you needed a critical volume at a critical pH to get a symptomatic aspiration. That work, of course, comes from studies in animals and studies looking at stomach contents in different scenarios and retrospective series looking at aspirations that did and did not have consequences. To my knowledge, there isn’t strong evidence that this is the case with actual people in actual clinical practice.

          There is evidence that a glass of water an hour or two before surgery results in stomach emptying and less gastric contents than fasting tho this isn’t routinely recommended to patients…because we suspect they will push it and have coffee instead of water…or juice..and maybe a donut. We routinely give patients a small amount of water with premeds prior to elective surgery and no one worries about that.

          • Sue

            More-than-adequate-mother is right. At the risk of incurring the ire of the anesthetically-trained, I’ll add that the entire concept of fasting prior to general anaesthesia has a poor evidence base.

            There is evidence that prolonged fasting increases gastric acidity, thereby worsening the theoretical risk of pneumonitis from aspirated gastric contents.

            In labor, however, you are dealing with a woman with inherent airway risks – anatomically (hug uterus, enlarged breasts) and physiologically (reduced tone of sphincter at the stomach opening). So, it;s natural to be more cautious.

            I do wonder, however, that we over-emphasise fasting before anesthesia. It would seem that food and drink intake in a Labor and Delivery environment would be relatively easy to control – but I’m really only speculating ‘cos I don’t work there. (Hypocritical, I know. Sigh).

          • S

            …except when the patient has her mom smuggle bananas in. =) Terrible patient, sorry. Thanks, adequate mom and Sue!

            Ainsley, you sound like me; i eat a lot and am still always hungry, so here’s my anecdote. I was starving as soon as the epidural went in (a whole five hours my last snack!) and so thankful for those bananas! Except the half banana i ate right before pushing, thinking i’d need the strength — I spent the whole time trying not to barf, and it was distracting (I was trying to push with zero sensation, which was confusing to begin with). Then after it was all over, i did barf and thought, “Why didn’t i just do that sooner?”

            I’m curious as to whether you had difficulty with being hungry in your other labors.

          • S

            Oh dammit. I need to think up a login and quit hogging space. My last question was of course partially answered in your post below. Twelve hours is a long time! (I’m likely to start dry heaving at that point.) And no IV during that time, i take it, since you were just waiting? =(

          • Ainsley Nicholson

            LOL S…I smuggled food in also. I can’t remember if I ate it before or after the induction was finally started (correct, no IV, just waiting), but it was definitely before I was having significant contractions. I was not hungry during that labor. For my first birth, I had a big lunch during early labor, after being sent back home from the hospital because I was not dilated enough, but skipped dinner because I started having “I’ve got to get to the hospital NOW” contractions just before dinner, and I was not hungry during that labor either. I guess for me, it is not so much that I want to eat during labor as that I want to have the option to. The idea of being denied access to food when I’m really hungry makes me kinda panicky.

      • Ainsley Nicholson

        Thank you very much.

    • Bomb

      I threw up during all three of my labors. Even the one where I ate nothing but ice chips. The risk of vomiting isn’t high, but the risk of nausea, which is really lame, is pretty high.

      • Ainsley Nicholson

        Yeah, nausea is a rather horrible feeling. I wonder if this is something that differs from person to person, or from labor to labor? I didn’t have any nausea with my two previous labors, which I hope bodes well for the next one.

        • Sue

          Definitely varies between individuals, and probably also between labors. Nausea can be induced in both chemical ways (infections, medications) and physical ways (stomach emptying/gastric motility).

        • melindasue22

          I will say that with my son I maybe vomited once while I was pregnant but during the onset of labor I basically emptied my whole stomach in a matter of minutes when labor came on quickly.

        • me

          Absolutely varies person to person. I felt somewhat nauseous towards the end of my first labor (pretty hard core induction), but didn’t throw up. Never had any nausea with the second two labors, nor did I throw up. I had been “cut off” food for about 10 hours with my first, had eaten (lightly) until I was no longer interested (about 2-4 hours before delivery) with the other two. I do tend to get nauseous when my stomach is totally empty, so it could have been the stronger ctx, or the fact that my stomach was totally empty, that caused the nausea with my first. It wasn’t terrible, and fortunately it didn’t last long (it was during what we found out to be transition).

          So, I would think (JMO) that since you didn’t have nausea with your first two, you likely won’t this time. Just don’t eat anything too heavy, or let your stomach get too empty (if you happen to be someone who gets nausea when your stomach is empty, that is).

        • MaineJen

          Both. With my son, I had no urge to eat whatsoever once the pain started for real, and I never had nausea/vomiting at all. With my daughter I was nauseous all through transition (until I got the epidural, which strangely took away the nausea as well as the pain) but I never actually vomited. My mother tells me she vomited during transition with all 4 of us. You don’t know what’s going to happen until you go thru it; it’s just part of the “fun” of labor…

    • Jessica

      I was induced and before starting the pitocin the nurses encouraged me to eat something light. I had a few bites of toast and really couldn’t stomach much more, and that was before the pitocin was started. I threw up four or five hours later, while waiting for the epidural. At no point was I ever hungry – thirsty, yes, but definitely not hungry.

  • Bombshellrisa

    I can remember being neck deep in the woo. What I believed was evidence or proof was purely anecdotal. I would see women give birth at home and then they would get up and take a shower and that would be “proof” that “childbirth isn’t an illness” and that somehow they wouldn’t be doing the same thing had they given birth in a hospital. At post partum visits, seeing a woman doing laundry, cooking dinner and caring for their older children was “proof” that women who gave birth at home faired better. Midwives who brag about having lower C-section rates as “proof” that natural birth is better and midwifery care superior have totally missed the point and should NOT call that “evidence based care” (I could brag that I haven’t had one patient I have performed a AAA repair on and it would be true, only it’s because I can’t perform one, not that I haven’t cared for a patient who needs one). The fact that my friend’s baby turned one week before she was due may be because she had acupuncture done OR maybe he just turned because he was going to anyway. The client who drank raspberry lead tea every day and followed a strict diet may have had an easy fast labor because of those things or (more likely) it was simply how things happened to unfold. Most of what passes for the art of midwifery is dressed up old wives tales and I am sick of it.

  • Captain Obvious

    I believe what a lot of NCB supporters mean that OB/GYNs do not follow scientific evidence is that many protocols (VBAC, breech vaginal delivery, no antibiotics for GBS, twin vaginal birth, twins going to 40 weeks, shoulder dystocia risk for large babies, labor risks for IUGR or oligohydramnios, GDM past 40 weeks, i can go on) show small risks to the baby or mother and the OB/GYN are trying to avoid these small increased risks. The NCB are trying to say the overall risk is small (and they all have a friend whose baby turned out safe), so why are the doctors not allowing them to try these things. Well, if you have ever been there to counsel a grieving husband or grieving parents that their baby or wife just died, they would understand better why the doctors are siding on the side of safety and not on the side of it only happens a small percent of the time.

    • Captain Obvious

      Good example of this….

      http://community.babycenter.com/post/a43026853/i_had_a_uterine_rupture._my_story

      Most doctors feel this rupture could have been prevented. She is a plus sized “fluffy” woman, who had GDM last pregnancy, a baby with an unstable lie (likely polyhydramnios), whose labor was induced with pitocin. She has an increased risk for rupture. So if a doctor declines he isn’t following scientic evidence about the increased small risk of disaster. If a rupture does occur and the family sues, then he wasn’t following the scientific evidence about the increased small risk of disaster. This baby had APGARS of 1,6,9. I hope there was no long term neurological injury.

      • Anj Fabian

        “My sweet little baby girl was completely
        outside of my uterus and in my abdominal cavity along with the
        placenta. She was also once again breech. My uterus had ruptured. ”

        If this had happened at a home birth, the baby would have died.

        • Lisa Miller

          Man, I am pretty sure that is what happened to Brody 🙁

          • I don’t have a creative name

            Wait, who’s Brody?

          • Lisa Miller

            A baby from NC that was delivered by one of the 5 CNMs that deliver babies in NC. Turns out their supervising OB only checked their records once a year :/ . I don’t know how much I can say because I know the Mama personally and I don’t know if his story is public or if her name is public. Suffice it to say that the placenta was delivered before he was and he got suck in her body cavity where he passed away.

          • I don’t have a creative name

            Oh Gawd. 🙁 My heart just breaks. So unnecessary. My thoughts and prayers to his family. Thanks for answering.

      • Sue

        What she really means is ”VBAC is safe so long as you displace the risk onto the OB, resuscitation team and NICU staff.”

        (Interesting that both her OB and anesthesiologist were female – so much for the patriarchy).

      • Kerlyssa

        Fluffy??

        • stacey

          Fluffy is a kind word used to describe overweight, first used by a very obese comedian. He said “I am not fat, I am fluffy! and it took off.
          (AFAIK, maybe the origins re different, but he popularized it)

          • The Bofa on the Sofa

            Gabriel Iglesius. His “5 stages of fat”

            1. Big
            2. Healthy
            3. Husky
            4. Fluffy
            And the 5th one is DAMN!!!

  • “Safe” is a relative term and when you start by defining an intervention, such as an epidural or a cesarean, as a harm – you get to a place where Homebirth is “safe” while ignoring the real risk and danger of long term disability or death to either mother or child. Further, women can make risky choices (there is not obligation to always make the safest choice, if you find the risk that is being taken acceptable) – however, I would argue that they are entitled to informed consent, and that by telling women that Homebirth is “safe” and implying that it is as safe as hospital birth, and not telling women of the credentials of their care providers, a large group of women are being denied their right to make an informed choice about the location of birth.

  • Mel

    “Animals need privacy to birth successfully… so do humans?”

    I see that NCB folks are as clueless about zoology and animal behavior as they are about human childbirth. Animals hide when giving birth to avoid predators. When an animal is birthing, it is very vulnerable to being attacked and killed. Evolution has selected animals that hide well over ones that don’t hide and are eaten by the next carnivore coming by.

    There’s two other ways to avoid predation when birthing:

    1. Get in a big group. Form a colony or herd. The odds are better that you won’t be eaten if the carnivore gets to pick from 500 of your species than just you alone.

    2. Be protected by a mate.

    I’m willing to bet lots of money that predation is not a large factor in mother or infant mortality during birth anywhere on Earth. If you are worried about being eaten, go to the hospital. Carnivores don’t have opposible thumbs; the doorknobs will stop them. Even if they get through, you will have lots of people around who will try to stop the carnivore from eating you.

    • PrecipMom

      Animals need privacy. Therefore, ban doulas! That’s the logical conclusion, right?

  • Karen in SC

    I once posed a question on Doula Dani’s blog – what are examples of evidence-based care that midwives do and OBs ignore? She said something to the effect that she didn’t know either. (Doula Dani is a frequent commenter here and no longer attends homebirths.)

    • PrecipMom

      If you want to go back to the era of shaving pubic and routine episiotomy, those would count, but I can’t think of anything remotely recent that would fit the bill.

    • Jessica

      One I see on TheBump is induction for suspected macrosomia.

      • expat in germany

        The evidence based birth site is probably responsible for that. It is totally slanted nonsense which minimizes the risks of ignoring aevidence of a big baby. In her “research” on the topic, she repeats over and over an inaccurate estimation from a 1995 paper that for every 3 babies saved from permanent nerve damage by a cesarean, 1 mom will die of cesarean complications. It is nonsense because it uses a ridiculously pessimistic estimate of the risk of death from planned cesarean compared to vaginal birth. Newer and better research has a hard time to find big difference in the mortality risk. I sent a link to a study from the birth trauma assocciation and this one http://www.cmaj.ca/content/176/4/455.full as a counterpoint to the estimate and she sent me away with an admonishment and the “punishment” that the back and forth conversation we had had would be deleted (it made her look bad). Don’t waste your time.

        • Jessica

          The comment I see is that ACOG recommends against induction solely for suspected macrosomia, and this is brought up every time someone posts that a growth U/S showed an 8, 9, 10lb baby and doctor wants to induce.

          • The Bofa on the Sofa

            Wouldn’t the objective to be to induce BEFORE macrosomia occurs? I can imagine that inducing a 10 lb baby might not be a great plan.

          • Jessica

            You would think, but these Google U Grads point out the relative inaccuracy of U/S to determine fetal weight, the increased risk of C-section when labor is induced, and the risks to baby of being born early (if the induction is before 39w especially).

          • expat in germany

            Like I wrote, oversimplifying. There are risk trade offs. I think what some people also miss is that relative inacccuracy is not the same as no accuracy. A 10 lb measurement is for a minimum 9 lbs and maximum 11 lbs baby. That is a big baby, and waiting an extra week means it gains a half of a pound. If it is 11 lbs, you will probably end up with a c/s but if it is 9 lbs, the induction might work. Why wait until it is 9.5 lbs? The available research suggests trends in certain groups, but it definitely doesn’t cover all permutations. That is why it requires an expert judgement call.

          • fiftyfifty1

            The objective is to try to prevent the risks associated with macrosomia (e.g. shoulder dystocia, tears etc) while at the same time not CAUSE any problems (e.g. the problems of prematurity) taking into account the uncertainty of fetal weight estimates. Not an easy task.

          • Ainsley Nicholson

            The 2001 recommendation (http://www.aafp.org/afp/2001/0701/p169.html)

            was based on the best available evidence at the time, which they knew was incomplete. More recent evidence suggests that induction for suspected macrosomia results in less birth trama and fewer C-sections:

            http://www.medpagetoday.com/OBGYN/Pregnancy/31102

          • expat in germany

            I think that the problem is that it is a complex issue, but the web info oversimplifies, takes acog recommendations out of context and slants it and encourages women to reject their doctor’s advice. You end up with people who take recommendations and mix thwm and think it is okay to go post dates with a big baby, when individually each condition might be okay, but together it is bad. Like if ultrasound errors were smaller than 1 lb, it might be a good idea to induce a bit early if you measure an 8 lb baby at 37 weeks, but because they aren’t, first time moms can end up with failed inductions and cesareans for a baby that wasn’t as big as expected. If a 9 + lb baby is measured and you’ve had an easy vaginal birth before, I bet you’d be a good candidate for induction. Since it is a complicated judgement call, taking advice off of some ideological non-doctor’s website or trying to interpret acog recommendations without understanding all of the caveats involved is just stupid. Docs have studied this and dealt with it every day and they shouldn’t have to fight their patients. (I am not a doctor so don’t use my numbers as references)

  • KarenJJ

    Here’s a hint. If you say that obgyns do not practice evidence based medicine, and then in your next comment you mention recommending pregnant women take homeopathic remedies to get a breech baby to turn, you have just shown that you have no idea what you are talking about when it comes to what evidence is.

    • Guesteleh

      Don’t forget she also brought up chiropractic and acupuncture. It was a trifecta of bullshit.

    • Karen in SC

      What herbal remedy works to turn a baby’s position? haha That is the more charitable view of that midwife’s “potion.” The other type of homeopathy – like cures like – what is the “like” of a breech baby? Beech nut? That’s got five of the six letters!!! In reality, successive dilutions render doses that may not even contain ONE molecule of the like substance. NOT EVEN ONE!

      • Sue

        Homeopathy is the poster child for non-evidence-based – there isn’t even evidence of a ”remedy”!

    • theadequatemother

      a cochrane review of ECV showed that there was no point prior to 36 weeks cos those suckers can flip around..so what is the point to visualization, accupuncture and homeopathy at 32-35 wks, I ask? If epidemiologic studies show that something like 25% of babies are breech at 32 weeks and only 2-4% are at term, then it really doesn’t matter if you think pretty thoughts, stand on your head, dance a jig, eat papaya, shine a flashlight up your lady bits or seek out the whiskers of a virgin kitty cat to tickle your lower abdomen with…odds are it will “work” because that is the natural history of the process.

    • realityycheque

      Don’t go forgetting moxibustion 😉