I told you so!

i-told-you-so-400x600

I’ve been at this for quite sometime. I started the predecessor of this blog, Homebirth Debate in 2006. Over the years, I’ve approached the issue from many different angles, but my central contention has never changed: homebirth increases the risk of perinatal death.

And now, yet another player in the homebirth debate has acknowledged the truth of that claim. In an article in today’s Wall Street Journal (in which I’m mentioned), Marian MacDorman of the CDC admits it:

Marian F. MacDorman, a statistician who studies birth trends, said that more families are choosing home birth to avoid what they perceive as unnecessary hospital interventions…

Ms. MacDorman said that planned home births might be somewhat riskier than hospital births, but that “the absolute risks of home birth are very low, no matter how you slice it.”

Apparently those hospital interventions aren’t so “unnecessary” after all.

In other words, homebirth advocates are giving up the lie at the center of homebirth advocacy: the lie that homebirth is as safe as hospital birth, and replacing it with another tactic. Yes, babies die completely preventable deaths at homebirth, but who cares, since the absolute risk of dying is still low.

As far back as November 2011, Hannah Dahlen, spokesperson for the Australian College of Midwives uttered this gem:

When health professionals, and in particular obstetricians, talk about safety in relation to homebirth, they usually are referring to perinatal mortality. While the birth of a live baby is of course a priority, perinatal mortality is in fact a very limited view of safety.

Really? On what planet would that be?

Even the Midwives Alliance of North America, the organization that represents homebirth midwives, and the organization that has hidden the death rates of its members for years is throwing in the towel. MANA executive Wendy Gordon CPM, LM, MPH, MANA Division of Research, Assistant Professor, Bastyr University Dept of Midwifery (and placenta encapsulation specialist!) wrote back in March of this year:

Let’s say that a person’s odds of getting struck by lightning in a heavily populated city are one in a million, and those same odds in a rural area are five in a million. These odds are called your “absolute risk” of being struck by lightning. Another way to look at this is to say that a person’s odds of being struck by lightning are five times higher in a rural area than in a densely-populated area; this is the “relative risk” of a lightning strike in one area over another.

A common approach of anti-homebirth activists is to use the “relative risk” approach and ignore the absolute risk, because it’s much more dramatic and sensationalistic to suggest that the risk of something is “double!” or “triple!” that of something else …

How amusing that Gordon and other homebirth advocates have suddenly discovered the difference between absolute and relative risk. The same people who have been howling about the “dangers” of epidurals (the risk of death from an epidural is less than the risk of being killed by a lightening strike), are suddenly insisting that the risk of death at homebirth, which is anywhere from 100 to 1000 times higher, is actually so small that you should ignore it.

As I wrote back in March, there are two important messages to take away from this:

Homebirth (particularly homebirth at the hands of grossly undereducated and undertrained CPMs) dramatically increases the risk of perinatal death.

More importantly, professional homebirth advocates have steadily and repeatedly lied about the increased risk of perinatal death. They should never have been trusted before, and cannot be trusted now.

Women contemplating homebirth need to ask themselves an important question: why should you trust anything that homebirth advocates have to say when they have been lying to you for years, claiming that homebirth is as safe as hospital birth, while simultaneously hiding data that shows that it leads to preventable perinatal deaths?

And let me point out: I told you so!

  • Anonymous

    I just read that quote a second time in the article and is scares me:

    “When health professionals, and in particular obstetricians, talk about safety in relation to homebirth, they usually are referring to perinatal mortality. While the birth of a live baby is of course a priority, perinatal mortality is in fact a very limited view of safety.”

    Think about how ghastly that really sounds. Substitute something else:

    “When health professionals, and in particular neurosurgeons, talk about safety in relation to surgery, they usually are referring to surgical mortality. While the survival of a live patient is of course a priority, surgical mortality is in fact a very limited view of safety.”

    Anyone else think this is really, really scary?

    • ol

      I understand these strange words in this way: “I don’t understand preventive medicine. I don’t understand interventions when I’m not deadly ill. I don’t understand why I broke the rules (homebirth) and nothing bad happened to me and my baby. My own experience is much more important than the system I don’t understand, and when came out the system no one punished me in any way (nothing bad happened).”

    • Jennifer2

      To me it makes sense that mortality, especially when the absolute risk is very low, should not be the only consideration. Serious injuries, surgical complications, etc. should also be considerations. Of course, the medical profession does this. Otherwise, probably every baby would be delivered by c-section between 39 and 40 weeks if they didn’t show up on their own. But instead, there have been advances in fetal monitoring, pain relief options, assisted delivery, etc. to try to ensure a good result of live, healthy baby and live, healthy mom. But this quote doesn’t seem to be talking about that. They aren’t saying “hey guys, we are really glad you’ve gotten death rates almost down to zero with the mandatory c-sections, but now everyone has these long, brutal recoveries from the vertical incisions and general anesthesia, so any chance we can find a less complicated way of keeping the death rate down?” They phrased it in a way that says “we are willing to risk a few lives if it means a more comfortable, birth experience.”

    • Squillo

      “When aviation professionals, particularly pilots, talk about airline safety, they usually mean not crashing. While getting passengers and crew to their destination without plummeting from the sky is a priority, it is a limited view of safety.”

      True: we also don’t want passengers injured by turbulence or having scalding tea spilled on them.

    • fiftyfifty1

      Actually your quote with the neurosurgeon part seems pretty reasonable to me. Neurosurgery in particular is one where mortality alone is not the be all and end all. Because a bad neurosurgical outcome can result in a living person with brain function or personality so changed that they might have a very poor quality of life and/or be an unrecognizable person afterwards. For myself, I can imagine neurosurgical outcomes that I would consider “worse than death”.
      But of course that is not what those clowns are talking about, or they would be carefully measuring and publishing their rates of homebirth babies with permanent brain damage. What they consider a “bad outcome” are things like getting an epidural or getting a C-section. I’ve had a C-section, and if that is your idea of a bad birth outcome, you are a fool.

  • ol

    I wonder what an effective system is homebirth (or alternative medecine) movement is. Despite worse statistics, despite confrontation to all other world, to family members and friends. Perhaps it gives socially more to people – close communication, support, and selfconfidence.

  • EB151

    In 21 years of driving approximately 450,000 miles I have never had an accident. Despite this, every single time I take the wheel I insist that all passengers are properly seated and belted.

    The quickest hospital transfer in the world can have the baby out about forty-five minutes after the first sign of trouble. A baby born in a hospital can be delivered within seven minutes of trouble. Those 37 minutes can mean the difference between brain damage and death, or healthy, thriving, normal kid.

    I know because my firstborn was out in seven minutes, delivered into the hands of a waiting NICU team with an ambu-bag and incubator. She spent her first hours with strangers. She has spent eleven years with me because of their care.

    I wear seat belts in the car, and I deliver in hospitals.

  • Older Mom

    Dr. Amy…are those numbers right? Is the risk of death at homebirth really “anywhere from 100 to 1000 times higher” than at a hospital? I thought it was about 3 times as risky from reading your blog. That’s still awfully high and not a risk most sane moms would want to take if they understood the risk.

    But am curious where the 100–1000 times higher comes from…

    • KarenJJ

      It is comparing the risk of dying at homebirth with the risk of dying due to receiving an epidural.

      • Older Mom

        Thanks KarenJJ! Yes, that makes sense, and sounds about right.

    • realityycheque

      Does anyone know what the 3x greater risk is comparing? Is it low risk HB compared to low risk hospital birth? Low risk homebirth compared to ALL hospital births? Does anyone know what the difference is in risk between high risk HB and high risk hospital birth?

  • ngozi

    To be honest, I get “skeptical” everytime anyone starts spouting statistics. You can make statistics look anyway you want. You can present the ones you like, and ignore the ones you don’t like. I also get “skeptical” when people start presenting studies and say things like, for example, “Studies show 45% of American women have had unsatisfying hospital births…” Really? Studies are usually very expensive to conduct and take a long time. If you find out the truth of how these studies are conducted, you might find they only interviewed about 500 women. Who knows if the demographics of the women studied actually represent the whole population of American women having hospital births?
    I am a person who would like to have my births as natural as possible, no epidurals or c-sections (haven’t had one yet). But that isn’t what everyone wants, or can have medically. While I can respect a lot of what birth advocates have to say, I can respect that Dr. Amy is presenting an opposing (and even necessary) viewpoint.
    BTW, if it hadn’t been for an induction it would be possible that my mother nor I would be here today. Both of her previous labors had been almost 3 days.

    • Sarah

      That’s why I’ve gone back to Uni and am studying biostats- so I can understand and interpret studies for myself

  • Isramommy

    Going back to the question of homebirth and ivf downthread, looks like midwives are expanding into assisted reproductive technology now:

    http://www.slate.com/articles/double_x/doublex/2013/08/intrauterine_insemination_at_home_midwives_are_performing_iuis_without_formal.2.html

    I do think steps need to be taken to ensure that lesbian couples have equal access to ART, but at home intrauterine insemination with a cpm cannot be the best way to address that need.

  • moto_librarian

    My oldest child is turning four this Friday. If it had not been for a team of excellent healthcare providers working within a hospital setting, I might not be here to celebrate this milestone with him. No one wants to spend a lot of time dwelling on what can go wrong, but that’s why the majority of women give birth to their children in hospitals. Childbirth is risky for both mother and child, and we ignore this fact at our peril. To willfully downplay these risks to pregnant women is negligent, and IMO, criminal.

  • Mel

    Not all absolute risks are created equal. People need to weigh the severity of the outcome along with the absolute risk.

    When I wear sandals and carry a heavy box out to my car, I have a small absolute risk of dropping the box on my toe. Since the severity of the injury is small (broken toe; bruise under the nail or a torn nail; nothing that will disrupt my life immensely), I’m willing to risk it.

    When I drive to work, I have a small absolute risk of being in a car accident. By HB logic, wearing a seat-belt is silly since I have such a small risk of being in the car accident. The potential outcome, however, could be catastrophic – death, disability etc. While a car accident is unlikely, the damage to my body could be horrific without a seat-belt so I take the half-a-second to buckle up every time I’m in a car.

    Just to be clear, giving birth at home is much more like choosing to not wear a seat-belt. You’d probably be ok…..but the bad outcomes are so dire that it’s not worth the risk.

    • Karen in SC

      This!! Low probability but the high consequence makes all the difference.

    • auntbea

      Watch out! One of my mother’s colleagues ended up deciding to have her foot amputated after six years of unsuccessful surgeries to repair all the damage done to her foot by dropping…a computer. Seriously.

  • Stuart

    Erm. How’s about some evidence-based medicine?

    de Jonge A, van der Goes BY, Ravelli AC, Amelink-Verburg MP, Mol BW, Nijhuis JG, Bennebroek Gravenhorst J, Buitendijk SE.Perinatal mortality and morbidity in a nationwide cohort of 529,688 low-risk planned home and hospital births.BJOG. 2009 Aug;116(9):1177-84. doi: 10.1111/j.1471-0528.2009.02175.x

    “No significant differences were found between planned home and planned hospital birth (adjusted relative risks and 95% confidence intervals:
    intrapartum death 0.97 (0.69 to 1.37), intrapartum death and neonatal
    death during the first 24 hours 1.02 (0.77 to 1.36), intrapartum death
    and neonatal death up to 7 days 1.00 (0.78 to 1.27), admission to
    neonatal intensive care unit 1.00 (0.86 to 1.16).”

    And this meta-analysis of studies:

    Olsen, O. (1997), Meta-analysis of the Safety of Home Birth. Birth, 24: 4–13. doi: 10.1111/j.1523-536X.1997.00004.pp.x

    “Results: Perinatal mortality was not significantly different in
    the two groups (OR = 0.87, 95% CI 0.54–1.41). The principal difference
    in the outcome was a lower frequency of low Apgar scores (OR = 0.55;
    0.41–0.74) and severe lacerations (OR = 0.61; 0.54–0.83) in the home
    birth group. Fewer medical interventions occurred in the home birth
    group: induction (statistically significant ORs in the range 0.06–0.39),
    augmentation (0.26–0.69), episiotomy (0.02–0.39), operative vaginal
    birth (0.03–0.42), and cesarean section (0.05–0.31).”

    And a more recent meta-analysis:

    Joseph R. Wax, MD; F. Lee Lucas, PhD; Maryanne Lamont, MLS; Michael G. Pinette, MD; Angelina Cartin; Jacquelyn Blackstone, DO. Maternal and newborn outcomes in planned home birth vs planned hospital births: a metaanalysis. American Journal of Obstetrics and Gynecology, Volume 203, Issue 3, September 2010, Pages 243.e1–243.e8

    • Bombshellrisa

      The first study is based in birth in the Netherlands, a place where the providers who attend home births are better trained than American home birth midwives and are not independent of the healthcare system. Every home birth advocate quotes this study as evidence that home birth in the US is “as safe or safer” than hospital birth.

      • Dutch midwives are pretty independent (they work in independent practices, and if there is a GP in the same region that delivers babies, the midwives will get more money. However, they seem to be well educated and their criteria for homebirth are rather strict. This being said, Dutch midwives lose money with every transfer, so they may be not so “happy” to do it… and I have heard stories where the midwives neglected a condition such as Pregnancy Diabetes…also, the Dutch healthcare system is very into natural things (my friend was pregnant and had a high fever and called her doctor where they told her that they didn’t have time for her and told her to wait- she had the fever for a few days). So even though the midwives work together with the healthcare system, that system is pretty “laid-back” as well and only reacting to problems rather than trying to prevent them.

        • Bombshellrisa

          But they are still licensed within the system right? American homebirth midwives are independent because they can’t do anything else. They can’t admit a patient to a hospital, they can’t prescribe meds, they can’t do ANYTHING but attend a birth at home and give herbs.

          • THat much is true, they are licensed with the system, and of course I know it is very different from the American CPM. However, I am not entirely sure that the Dutch system is so great…so each time someone tells me how we should have a healthcare system like in the Netherlands, I cringe… I must say that I was happy with my midwives, they were very strickt, took no risks, gave me pain relief, and we always got antibiotics from our GP if they were needed. BUt I sometimes feel we are the exception rather than the norm…

          • Bombshellrisa

            I agree it’s not wonderful (considering the article Dr Amy wrote about Durch midwives with low risk patients vs Dutch OBs with high risk patients), just interesting that while its more organized and with more educated practitioners than the US and the outcomes still don’t equate to “safe as or safer than hospital birth”.

          • R T

            It is MUCH safer than the system in the US though!

          • Antigonos CNM

            Anybody comparing the Netherlands with the US ignores several basic differences: the size of the respective countries, and their populations. While it’s completely true that better midwifery education, stricter controls on standards of practice, etc. are pertinent too, Holland is a SMALL country, and urbanized. Transfers are not a matter of long distances, for example.

          • I agree! However, while Holland is highly urbanized (and especially where I live), and hospitals are not far away, midwives often delay getting to the hospital (because they come to the house first to check on mom and baby). But of course this is something totally different when your next hospital is an hour or more away rather than let’s say 15 mins it took us to get to the hospital. And, a Dutch midwife is way better than an American CPM (from what I am reading here).. it seems that the midwives will even get more competences, for example now they can administer gas and air for pain relief), and I hope this will go hand in hand with even more training…this is a topic very dear to my heart, and I’ve been blogging about this for a while

    • Amy Tuteur, MD

      Too bad Dutch midwives caring for low risk women (home or hospital) have higher death rates than Dutch obstetricians caring for HIGH risk women.

      http://www.skepticalob.com/2010/11/stunning-indictment-of-midwives-in.html

    • Dr Kitty

      Sorry, do you not understand what a perinatal mortality 95% CI (0.54-1.41) or (0.69-1.37)means?
      It means that the data set makes it difficult to decide if HB halves the perinatal mortality, or increases it by 50%.

      The large scale data we have suggests it is the latter, and if it is HB as practised in the USA, rather than the tightly controlled, low risk groups in the British and Dutch studies forget a 50% increase, it is now 100-200% increase.

      • Stuart

        Dear Dr Kitty, I do understand, and it is principally the point I made – the data cannot say one way or the other as such, we can’t say HB are worse (or hospital births are better). And it isn’t the data set that makes it difficult to decide, it means that there is no clear definitive answer (statistically).

        You also point to an important issue: it is not home vs hospital – but appropriate care (See also comments below). The safety of home birth is dependent on the system it is related to, but also the prior risk. Without a description of context then one cannot discuss i.e. a blanket statement that one or the other is worse isn’t true for EITHER case. What I wanted to do was provide an evidence base (As opposed to anecdote), to say this.

        • auntbea

          If only you and Bayes were friends.

        • Dr Kitty

          No, it’s the data set.
          Perinatal mortality is so rare that you need huge numbers to narrow the CI.
          Huge numbers like the death statistics for the USA…like the CDC stats…

  • hurricanewarningdc

    Too bad that the story doesn’t actually explore the safety issues. Or the cause of the trend. They just throw in your quote as if that makes for a balanced article. Another disappointing, half-assed effort by the media…

    • Amy M

      I also like how the journalist keeps saying “perceived risk” as though people just think babies and mothers could die.

    • JC

      This is one crappy article. That does not mean all media is making “half-assed” efforts. I know many ethical, hard-working journalists. And I know lazy journalists. Just as all doctors are not greedy and only concerned with leaving early to get to their golf game, not all journalists are “half-assed.” I really don’t like generalizations of this kind and how the media has become society’s scapegoat lately. Living in a country without a free press would undoubtedly be much worse. And what if a woman read that article and did a search for Dr. Amy and decided not to have a home birth? At least her name was in there.

      • hurricanewarningdc

        Neither the time nor the place for a lengthy discussion on that subject, but I respectfully disagree. I am in a field where the media plays a big role, and I see the same sort of bias or negligence day in and out. (I know many good journalists, as well, but balance and effort are too often replaced by preference and convenience.) One can simply look to the shameful (even fictitous) reporting on events like the CT shootings or the Boston bombings for widespread, lazy, bandwagon journalism. Or for that matter, the pages of this blog where time and again, journalists parrot the latest quack “study” without the application of critical thought or research into the subject matter or the source… The profession has, imo, lost its way.

        • auntbea

          Are you a political scientist by any chance?

          • hurricanewarningdc

            No, but I work around the Beltway. In that world…

        • JC

          With all the layoffs, cutbacks, buyouts, etc. that the profession has gone through the last 10 to 15 years, it is no wonder there is more laziness. I know many journalists who would love to do in-depth, investigative stories but simply are not given the time to do so. And in the rush to be the first to report on a story or update a story on the Internet, it also is no wonder there are inaccuracies.

          Again, we can agree to disagree, but I don’t believe in stereotyping an entire profession. I wouldn’t do that with any profession, by the way. It’s interesting to me that the majority of commenters on this blog are against labeling all OBs or midwives as X, Y or Z, but I consistently see broad, negative statements against journalism and the media. This is the one thing I find tiresome about this blog. Many people in my family have dedicated their lives to this profession for little pay and little respect from society.

          My husband is a photojournalist and we have talked many times about homebirth and attachment parenting and what a good in-depth story it would be. Guess what? He is constantly swamped by work already. But he goes out of his way to be ethical and accurate all the time.

  • Isilzha

    So, what’s my risk of getting struck by lightening if I stand outside during a thunderstorm, in the middle of an open field, and holding a 20 ft metal rod?

    • Isramommy

      I think that would be the HBA3C waterbirth of weather.

      Don’t let Big Meteorology stand in your way and play the electrocution card! Go get your thunderstorm experience, mama!

      • sleuther

        This comment wins at the internet.

    • Mel

      I don’t know. You should get a video camera, climb up on a hill and film yourself getting hit by lightning! That would be totally crunchy!

    • The Bofa on the Sofa

      This is funny, because I can just imagine it possible that there would be a group of lightening-storm golfers.

      In fact, it is known that far more people get struck by lightening while fishing than golfing. However, you don’t hear people using that as an excuse to golf in a lightening storm (the reason, of course, is because there has been a very good awareness campaign for golfing in lightening, but not near enough about the dangers of lightening and water activities)

      • Karen in SC

        How dare anyone tell golfers and fishers how to do anything! Trust Golf! Trust the fish!!

  • Jessica

    Somewhat OT: I posted before about a blog I read written by a woman who had three miscarriages. She finally got pregnant thanks to IVF. In the week before her due date, her blood pressure was quite elevated, and her doctor wanted to induce. She wrote this ranty post about her desire for natural, intervention-free birth and complained that the doctor wanted to administer pitocin post-delivery because of the risk of bleeding to death. I posted a comment explaining the risk of PPH and uterine atony. ANYWAY…her blood pressure returned to normal and she opted for regular BPPs rather than an induction. She decided to be induced at 41w6d b/c baby did not respond well to a BPP. What was really scary reading her birth story was when they broke her water and found thick, thick meconium. Baby was suctioned immediately upon birth (so no skin-to-skin or daddy cutting the cord) and was just fine, thank God (if not big – 8lbs 12 oz).

    This woman bought into a mentality that babies “know” when to be born and it’s better to let them “bake” as long as possible. And what did she get for that? A baby who was probably in trouble at the time of that BPP and whose story might not have had such a happy ending. All because the belief that natural is better and the risks of problems are so low but the risk of a *gasp* C-section is so high. It is maddening.

    • The Bofa on the Sofa

      Babies don’t “know” how to get conceived, but “know when to be born”?

      What was her response to the (inevitable) comment that her “natural, intervention-free birth” went out the window with the IVF?

      • Jessica

        Oh, of course no one comments on that. It was all “go momma!” and “your doc is so mean!”

        I just have such a hard time making sense of stories like hers. It took her more than three years to carry a pregnancy beyond the first trimester, and only then after expensive IVF. She was on BED REST for the last three weeks of her pregnancy due to her hypertension. She had a medical justification for an induction and STILL said no. And while she finally did consent to one, and other interventions like an epidural, it was clear she and her doctor were at loggerheads the whole time. I don’t understand WHY someone who has suffered so much loss and wanted a baby so desperately would push it so much right near the finish line.

      • Bombshellrisa

        No no Bofa! There is a CPM here who believes “babies know how to get in and know how to get out”. In fact, she calls it her “birth philosophy”. She doesn’t understand how much this makes her sound like someone who only deals with a very narrow margin of women, hardly an expert in anything. If my OB said something so stupid I would not seek her care anymore.

        • The Bofa on the Sofa

          But this baby has demonstrated that it DOESN’T know “how to get in” so why should anyone think it knows how to get out?

          • Bombshellrisa

            Trust birth?

          • The Bofa on the Sofa

            True. No one ever says, “Trust conception,” do they?

          • Amy M

            Well sort of…they say “just relax, and it’ll happen!”

          • Josephine

            Not in so many words, but you’d be surprised…ugh.

    • Mel

      I had a cousin with a similar set of pregnancy complications. She had pre-eclampsia leading to an early medical leave from work. Her BP never dropped and the baby started showing signs of distress so she had a C/S a few weeks before her EDD. The only difference is that my cousin worked in PICU followed by NICU and was educated enough to be grateful for her wonderfully healthy baby girl and for getting the baby out without my cousin stroking out. Mom and baby are doing wonderfully – not even a whiny blog post!

    • Mel

      Also, my twin sister and I were born at 29 weeks thirty-odd years ago. One of my aunts was born around the same gestation fifty-odd years ago. If babies are supposed to “know” when to be born, how the heck the three of us get our due dates so messed up?

      • Bombshellrisa

        We must be part of the population of babies Ina may Gaskin termed “not meant to live”. I most certainly “didn’t know when to be born”. If I had, I would have opted to be a couple days late, so the baby who would grow up to be my husband would be born on the due date shared by our mothers and I wouldn’t be older than him by a month and a half!

        • Ceridwen

          I think my daughter should get some awards for “knowing when to be born”. I went into labor with her on my due date, 2 hours after finishing my last final for the semester. She was also early enough that we were able to get her her first round of vaccines before taking her to a large conference with us and she arrived right at the beginning of the month, maximizing the “free” time we got for her being covered on our health insurance plan. Of course she also apparently felt like dragging things out quite a bit and after >30 hours in labor I welcomed the pitocin augmentation. I guess she “knew” when to be born but didn’t know how to get my cervix to cooperate?

          • Bombshellrisa

            Can you imagine that as part of a toast when you all are celebrating one of her achievements? “My darling daughter, I want to congratulate you on earning your Masters degree and knowing how to be born and when to be born!”

          • KarenJJ

            Co-operative kiddo! My eldest baby was overdue by a week. I had a c-section scheduled (due to her not moving down into the pelvis) but went into labour two days before when my SIL was getting induced. She waited for the day when her little cousin was also born. we do combined birthdays for them. They’ll probably hate it when they get older but it’s cute now.

      • Amy M

        Oh yah, my babies were really indecisive. First they thought maybe to come at 30wks, then changed their minds, thought about 32wk, decided against that, and finally settled on 36wks, still too early by most textbooks. 🙂 They must not have wanted to be Christmas babies and have that whole combined birthday/Christmas present thing, I bet that was why they waited until late January instead. They really DID know what they were doing.

      • The Bofa on the Sofa

        At least by being born early, you have a chance. My sister’s first apparently got his due date messed up and ended up dying before he could be born.

        I guess he was just not smart enough to be born alive, eh?

        I’d really like to hear what the babies-know-when-to-be-born would say to my sister? Other than to tell her that her baby was not meant to live, that is.

        • Dr Kitty

          That must have been hard, Bofa, my condolences.

          • The Bofa on the Sofa

            It was devastating to everyone. My oldest sister, her first was the oldest grandchild. Stillborn at 41 weeks. Everything was going fine until the day before.

          • R T

            How sad! I’m so sorry. Did she have more children? Did she choose to have them early?

          • The Bofa on the Sofa

            She subsequently had three little girls. With the first, they tried inducing her early. I clearly remember the night they were doing it, things were going great, and then just stopped. So they did a c-section. Her other girls were also c-sections, a little early. No way they were going to let her go long again.

            All three girls are grown (the oldest is now 32, I think) with kids of their own. Two of them just had baby girls of their own this summer. Both by c-section.

            But one has forgotten her first.

        • Jessica

          Exactly. If babies knew when to be born, one of my cousins and my sister would be alive. Stillborn at 43 weeks, both of them. Thirty-four years after my sister’s death my mother STILL gets viscerally angry when she hears about women opting for homebirths or going past their due dates.

        • FormerPhysicist

          Condolences.

      • amazonmom

        My Dad likes to be early for everything so I guess coming at 34 weeks was just in his personality. My daughter had my cervix 100 percent effaced and dilated to 3-4 at 36 weeks. Then she said OH NO NOT NOW and flipped breech. She got cut out at almost 41 weeks.

    • Gene

      It is hard for me to wrap my head around the idea that (by definition) intervention intensive IVF is OK, yet any intervention during the birth itself is horrid and must be avoided at all costs. Is it that you couldn’t get pregnant without help and must, therefore, prove that you are still biologically sound by giving birth without it?

      • The Bofa on the Sofa

        Is it that you couldn’t get pregnant without help and must, therefore, prove that you are still biologically sound by giving birth without it?

        Got it in one. In fact, there are those among us here who have admitted falling into that trap.

        I agree that I can’t wrap my head around it, but then it’s more the concept of trying to “prove” something through pregnancy in the first place.

      • Karen in SC

        I conceived with the assistance of fertility drugs and IUI (a step down from IVF). My sons are now 20 and 16. I did treasure my pregnancies and would do nothing to harm the babies. At the time, I was sucked into a few NCB tropes – I thought getting an epidural would harm them so I planned on natural childbirth and breastfeeding.

        However, when my water broke at 39 wks with the first one, I had no qualms about consenting to a c-section if that was in the cards.

        I never was about proving anything about my body, it was all about the baby. Of course, this was before blogging and facebook and twitter.

      • Kerlyssa

        Diet coke with your supersize fries= healthy. People do it all the time.

    • ngozi

      I just want to share that part of the reason some women are so against having a c-section is that they have no one to help them recover at home. It is pretty daunting to have to come home after having a c-section and have no one to help you out, or worse, have people there that help you for one day and then want you to hurry back to serving them. And some of these mothers have other children to take care of as well. Of course, none of this is the doctor’s fault, and of course a c-section is better than dead babies or mothers (or even very sick ones).

      • Jessica

        I did not want a C-section. But I wanted a healthy baby more. So I consented to interventions, notably an induction, to get the latter result even if it risked the former. I literally cannot comprehend why so many in the NCB community do not weigh these priorities in the same manner.

      • GiddyUpGo123

        That is actually a good point, which is why I’m always telling people to stay as many days in the hospital as policy (or your insurance company) will allow. But for me anyway, recovery was easy enough that I could have (and did, really) manage most things without a lot of help. That’s not saying that everyone should ask for a c-section because I realize some people have more difficult recoveries than others. But having a c-section is not a slam-dunk guarantee that you’ll be flat on your back for six weeks unable to manage. I’d guess most people probably do OK. The main thing is, when it comes to an emergency c-section that saves your life or your baby’s life vs. an easier recovery at home when you don’t have anyone around to help you out, you should take the c-section because a few weeks of pain and difficulty moving around is nothing compared to grieving over a dead baby.

        • sleuther

          Two c-sections here, and recovery was not that bad. A friend of mine who had unmedicated vaginal birth (not by choice; she was a fast finisher & already in transition when she got to the hospital) got a 3rd degree tear and it took a year to heal. A YEAR! I was pretty much up & around after a week and a half, thanks to drugs.

          • Young CC Prof

            Actually, I seem to remember that the extra-fast labors are more likely to cause tears than the average-speed ones, because there’s just not enough time for the tissue to stretch easily.

        • ngozi

          My point exactly, probably better worded!

      • Dr Kitty

        I saw someone who ended up with a temporary colostomy after baby number one (pelvic floor damage from a traumatic delivery).

        Planned CS with baby number two, and quite happy about it in comparison.

        It isn’t always VB= easy recovery/ CS= difficult one

        • ngozi

          I have known plenty of people that have experienced vaginal births and c-sections and they say their c-section was by far the easiest to recover from. I know more people who had c-sections and have horrible stories to tell. I also know people who probably would have had a difficult c-section recovery had it not been for friends and family who did almost everything for them in the first couple of weeks.
          I am just saying that when you don’t have anyone at home to help you adequately (not saying you have to become a total invalid) a c-section could possibly be a very scary and daunting thing.
          I am currently pregnant now. During my past deliveries I have not had much help after coming home from the hosptial. I’ve told my husband this time around that if I am not up to it, I’m not cutting my recovery short to do things around the house he could do for short while. The servants have quit! The maids are on strike! The slaves have revolted! Do it yourself!

      • ratiomom

        I didn’t have any difficulty with the c-section recovery, mainly because I had a cleaner and a laundry service for the first couple of weeks. I am aware that I am in a privileged position here, but I don’t believe that the answer to your problem is less c-sections. If one is needed, it should get done, period. The answer is more help and support for new mothers. Families who lack both the support network and the financial means to organize some form of postpartum help should have a good long think before getting pregnant in the first place.

  • The Bofa on the Sofa

    The struck by lightening analogy is so friggin dishonest to be scary.

    Chance of getting struck by lightening: 1 in a million. Bad chance to get struck by lightening: 5 in a million
    Chance you die if you drink and drive: 2 in a million
    Chance of MATERNAL mortality: 110 in a million
    Chance of baby mortality: 300 in a million
    Chance of baby mortality in homebirth: 1000 in a million

    To lump this altogether as “low absolute risk” is a complete sham.

    • fiftyfifty1

      Wow-that is eye opening. But I don’t get this first part “:Chance of getting struck by lightening: 1 in a million. Bad chance to get struck by lightening: 5 in a million”.

      • fiftyfifty1

        Oh, I get it now. You mean what that woman said about it being 5x more common in a rural setting.
        But what is the real risk of getting struck by lightening?

        • The Bofa on the Sofa

          It’s hard to define. Apparently, the overall chance of being struck by lightening is 2 in a million, but that is in a year. Unlike the other things listed above, it’s not like being in lightening is a single event (so when I talk about the chances of dying while drinking and driving, I am talking about the chance of dying on a single drunken drive, not “for the year” or other such measures that are typically mentioned; similarly, childbirth mortality is per event).

          I don’t know what to use for a lightening “event.” Thunderstorms containing lightening? That depends on where you live, but might be 50 days a year on average (making that up). If so, the absolute risk, per lightening storm, is even lower.

          If you avoid being outdoors and “high risk” lightening activities, such as boating, then your risk of being hit by lightening is basically nothing. If you golf in a lightening storm, then your risk is much, much, much higher. I have no idea of the absolute risk (since most people avoid doing that)

    • Bambi C

      I guess I no longer need a DD! Woot! I’ll just drive home when plastered!

      • The Bofa on the Sofa

        The problem with drunk driving is not the absolute risk, it is the prevalence. You driving home when plastered have little chance of a problem. However, when 5 000 000 people choose to do that each day,* the 2 in a million risk starts adding up very quickly. That’s why it has to be illegal, or even MORE people would be doing it.

        *That’s about the number, assuming the average length of a drunken drive is 8 miles. The USDOT estimates that there are 27 000 drunk driving miles for every DUI, and there are about 600 000 DUIs in the US each year.

        • The Bofa on the Sofa

          BTW, before anyone says it, the risk of getting in any accident while drunk driving (so creating collateral damage with innocent victims) is about 90 in a million. I’ve added that on the absolute risk list in my original comment.

  • Amy M

    There are only a few comments on the article, but they are all along the lines of “better safe than sorry.” And the old “40% Csections in the hospital!!11!eleventy!” without stopping to think–how many of those are repeats? How many are maternal request? How many are planned because of some complication that is known about before the birth like breech or placenta previa? When talking about the average woman with a normal, full term, singleton pregnancy, even a first time mother, isn’t she only likely to end up with a C section 10-20% of the time? And if it is a woman who has already had an uncomplicated vaginal delivery, aren’t her chances of repeating that much greater?

    It is not like setting foot in a hospital suddenly creates complications. There is no doctor standing at the door sending 4 out of every 10 preggos to the left, where the OR is—guess what!? You just won the Csection lottery! Oh, you didn’t want one? Guess you shouldn’t have come in here then, or you should have been counting, and waited until you were number 5. Sucks to be you. Is that really what they think goes on in there?

    I’ve said it before–if anyone was going to be chosen for an arbitrary, doctor-convenient Csection, it would have been me, with my complicated identical twin pregnancy, with the 36wk delivery. Yet, I didn’t end up with one, because conditions were favorable for a vaginal birth. OMG, those meeeeen doctors and hospitals forcing me to…wait, what?

    • Isilzha

      Given their repeatedly dismal understanding of risk, statistics, individuals vs population and just general science, I think many of them DO believe that statistics works exactly like that!

      • Amy M

        Yeah, I suck at math (not proud of it), but even I can figure out that a 40% Csection rate at a given hospital doesn’t mean that each woman who walks in the door of said hospital in labor has a 40% chance of having a Csection. I think the people at hospitals like that need to post signs on the doors that say:

        “40% of the women who gave birth here gave birth via C section. This doesn’t mean YOU have a 40% chance of a Csection birth if you come here. It means WE have a Level 3 NICU, and are located next door to a top rated IVF clinic and also have some excellent MFM specialists here. You morons. That is all. Good day.”

        • Bombshellrisa

          Love it! Seriously too, it depends how many births take place at the hospital too. For example, Swedish Medical Center First Hill had 7,000 babies born there last year, they have a to notch NICU and its where the high risk docs are. So a C-section rate of 32% shouldn’t be considered extreme. They also serve a diverse population, so they have seen it all.

    • hurricanewarningdc

      Agreed. I wish people would think before quoting the statistic. The hospital where i gave birth (Georgetown U) has a very high rate by comparison to others in our region. But if someone stops to think about it: 1) DC has many older, over-35s/40s mothers (many of whom are first-timers), 2) the hospital has a well-known high-risk practice, 3) the hospital has the city’s advanced NICU in house, etc… I would EXPECT this hospital to have a high percentage of births that end in c/s. Good: It means that they’re doing their job for the community that they serve. And as someone who ended up with one there – b/c of caring, attentive, well-trained drs and nurses who saw that it was vital after my very, very long labor and for the safety of my son – I am thankful that i was able to do it in a place that was so prepared and skilled to assist me.

      • ngozi

        Hooray! Someone who is looking carefully at the statistics presented rather than just swallowing them, or criticizing them off the bat!

    • batmom

      Agreed. I was very worried about winding up with a C-section, but looking into the reasons they’re done helped me feel more confident that my risk as a first-time mom at age 33 with a textbook pregnancy wasn’t going to be the same as the hospital’s 22% rate (they have a level 3 NICU in-house.) It’s a major surgery, but it’s not like they deal them out like cards.

      As it was, I nearly did have an emergency C-section. My son’s heart disappeared, then came back before they wheeled me down the hall, and I wound up pushing for two hours, laboring down for an hour, and then pushing another two before out came the forceps and out came the baby. In retrospect: C-section? Not the scariest thing about that day. Never been so glad to be in a hospital.

    • moto_librarian

      I would much rather deliver at a tertiary care facility with a level III NICU and a high c-section rate than a rural hospital. I would still favor the rural hospital over a homebirth, though.

      • I would have chosen an elective C section over a 38hour birth, an episiotomy (I’d much rather had a scar elswhere) and taking ages to recover. Luckily, my two other births were much easier