Homebirth midwives, exploitation, and irony

Fraud steal

When it comes to having zero insight, it’s really hard to beat homebirth midwives. They are so totally clueless about how their own behavior comes across that homebirth midwives like Wendy Gordon, CPM, MANA (Midwives Alliance of North America) executive, can actually write an inadvertently hilarious blog post like this: Why ALL Midwives Should Care About What’s Going On With Midwifery International.

I wrote recently about the charge leveled at Midwifery International, an organization that promotes medical tourism of homebirth midwives. To her credit, Gordon acknowledges that she exploited women of color in the developing world in order to get “catches.” But, of course, she excuses herself because “she didn’t know” how truly exploitative it was. Sorry, but that’s not an excuse.

And why didn’t she know she was exploiting poor women of color in the third world? Because of her “white privilege” that blinded her to the reality of what she was doing. The irony is that her desire to turn her birth junkie hobby into a money making exercise (“birth junkie privilege”) blinds her to the fact that homebirth midwives are exploiting white women in the first world, and in exactly the same ways.

I’ve taken Gordon’s excuses and just changed a few words to illustrate how homebirth midwives exploit privileged Western white women.

Consider:

It is Wendy’s birth junkie privilege that says a homebirth advocate’s story — even when it remains untold — is always more believable than the obstetrician …

It is Wendy’s birth junkie privilege that helps her to believe that women need homebirth midwives more than homebirth midwives need clients …

It is Wendy’s birth junkie privilege that says that the tone used by obstetricians is offensive (“My OB Said What??!!”), so she can dismiss what they’ve said …

It is Wendy’s birth junkie privilege that says that her beliefs about what is unethical trump those of doctors and medical ethicists .., while the ethical concerns of the babies and mothers being harmed by homebirth midwives are not addressed at all.

It is Wendy’s birth junkie privilege that says that homebirth midwives get to decide what and who is to be believed. Hence the deleting and banning of dissenting opinions or even actual facts from every homebirth website, blog or message board.

It is Wendy’s birth junkie privilege that makes her believe that her truth is The REAL Truth … and that anyone who disagrees should “educate” herself

It is Wendy’s birth junkie privilege that permits her to think that she gets to determine when REAL harm is done … Hence the rallies to support homebirth midwives who have presided over deaths instead of investigations into their conduct.

It is Wendy’s birth junkie privilege that tells her that there will be no consequences to sweeping aside the voices of homebirth loss mothers who express that harm is being done to them …

It is Wendy’s birth junkie privilege that allows her to decide who, if anyone, she will be accountable to, which generally means no one … Hence the refusal of MANA, her organization, to release their own death rates.

And my personal favorites:

It is birth junkie privilege that permits homebirth organizations like Wendy’s organization, MANA, to silence dissent by deleting curious questions from their Facebook page; … to keep recruiting and pretend as if there is “nothing to see here” while sending out a newsletters that makes no mention of the issue at hand.

It is birth junkie privilege that refuses to examine the possibility of another version of the truth other than her own; that will actually lash out at those who dare to speak up about scientific evidence and turn the tables back on them, making herself and her colleagues out to be the real victims. It is birth junkie privilege that says that the real damage done here is to the good reputations of the homebirth midwives, and that this concern for the reputation of homebirth midwives supersedes the harms being done in communities where homebirth midwives practice.

Birth junkie privilege assures Wendy that there will be no adverse impact to homebirth midwives if they just walk away from deaths and injuries at their hands. The folks at MANA (Melissa Cheyney, Geradine Simkins and Wendy Gordon among others) just continue to wave their hands, avoid the conversation with the community, and hope that this blows over quickly so that they can all just get back to making their money. It is certainly uncomfortable to have to think about the complexity of this and the deeper training issues that need to be addressed within homebirth midwifery …

And when Wendy and her colleagues exercise that ability to turn their backs and walk away without consequence, to go back to their daily struggles that are already hard enough, and leave this mess for someone else to sort out, then we have opted to once again leave their patients to bear the brunt of their profession’s problems. When MANA is not only allowed to be completely unaccountable to the communities that they purport to serve, but are openly bullying them in front of the professional leadership for speaking about being harmed (or holding “human rights” conferences to whine that homebirth midwives are persecuted), they highlight a major, major problem for the entire homebirth midwifery community.

Wendy Gordon willingly exploited women poor women of color in the third world to benefit herself. She says she’s sorry and she didn’t understand, but I don’t see her making any effort to provide restitution to the women she used and may have harmed.

In fact, what I see is a woman willing to say “sorry” when she’s wrung what she needed from poor women of color in the third world, then pivot on a dime to exploit well-off white women in first world countries to wring the money and the prestige that she wants out of them. No doubt she’ll say she’s sorry when MANA is forced to acknowledge that they’ve hidden their death rates all along, and the CPM is abolished. In the meantime she’ll take what she wants and ignore those she harms. I wonder if she’ll eventually blame it on her birth junkie privilege.

  • CNM
  • J

    This is quite off-topic, but I hope someone can help me. A friend is considering having a homebirth specifically so she can give birth in a pool (the midwife would bring one). I’m looking for reliable information about the potential dangers of giving birth in a pool.

    She says there is no danger of the baby drowning because they don’t start breathing until they come in contact with air. Is that true? How about fecal matter in water (that’s very likely to happen, isn’t it — lots of women have bowel movements during labor)? How about midwives not cleaning the pool properly after previous births?

    Thanks!

    • The Bofa on the Sofa

      they don’t start breathing until they come in contact with air

      That’s technically true, but how does that mean they won’t drown?

      Of course they don’t breathe underwater. The question is, do they need to? And the answer is, how else are they going to get their oxygen? Is the placenta still providing oxygen after the baby is born?

      • J

        That’s a good point. Doesn’t the umbilical cord “close itself off” to restrict blood flow after a while, when the temperature change?

        Does anyone have links that show potential dangers of water birth?

    • Poogles

      “She says there is no danger of the baby drowning because they don’t start breathing until they come in contact with air.”

      The “dive reflex” is what they are referring to here, and it only applies to COLD water (which a woman is very unlikely to be giving birth in), and isn’t always reliable. For instance, if the baby has been partially oxygen deprived during labor/birth, they are much more likely to gasp for air immediately (sometimes even before the shoulders are born).

      For more info, see these posts by Dr. Amy:

      http://www.skepticalob.com/2010/10/waterbirth-barbara-harper-spreads.html
      http://www.skepticalob.com/2012/12/waterbirth-do-the-benefits-outweigh-the-harms.html
      http://www.skepticalob.com/2013/02/homebirth-baby-dies-of-virus-contracted-during-waterbirth.html

      • J

        Thank you!

    • Ainsley Nicholson

      Babies “practice” breathing in the womb, using their amniotic fluid instead of air. These breathing movements are one of the things that are looked for when a biophysical profile is done via ultrasound.

    • PJ

      My baby started crying before his body was born. I am sure glad he wasn’t born in water!

    • An Actual Attorney

      I can’t figure this out. Imagine that I, straight out of the shower, sloshed my ass and cooter around in a bowl of warm water. Would you drink it? Why would you want to risk your newborn do it?

    • koffeewitch

      Waterbirths were popularized by OBs, not midwives. The expert on water birth is Dr. M. Odent the famous french OB and overwhelming supporter of the safety of home birth.

      • Amy Tuteur, MD

        Michel Odent is a general surgeon, not an obstetrician.

  • Dr Kitty

    I saw someone recently who has a ERCS date for next month and, after doing some research, and after some recent changes in her situation is adamant she doesn’t want to try for VBAC if labour starts before her date.

    Unfortunately, her NHS MW wrote that she was “happy to attempt SVD if SOL prior to CS ” in her notes, based on a conversation some weeks ago.

    I’ve now written underneath, in capitals, signed and dated and highlighted in neon ink “PATIENT NO LONGER WISHES TOL if SOL prior to CS- fully informed risks/benefits VBAC vs ERCS- ATTEMPTED VBAC NOT DESIRED. IN EVENT SOL, CS ASAP”.

    We can only hope.

    • FormerPhysicist

      Thank you for fighting the good fight.

    • Guest

      She’s extremely lucky to have you! I am adamant that I do not want to have any more biological children unless they are born by MRCS.. I’m terrified that the MWs at the hospital won’t respect my wishes and may deliberately delay contacting my OB in the event of SOL. I’ve heard of similar things happening and women essentially being forced into having vaginal births they didn’t want and it terrifies me… enough so that the possibility of it happening makes me question whether I will ever have more children.

      • Karen in SC

        You might be interested in the blog “Awaiting Juno.” It’s on the blog roll.

      • I want to avoid vaginal exams. thats why I’m going to MRCS if I ever have any more kids. its a weird reason, but its mine. I don’t think anyone could blame me, considering.

        • yarnbarf

          I used to wonder why people said this, but (1) it’s your body and you get to decide who touches it unless it’s a true life-or-death emergency and (2) a friend mentioned having people he had never seen before wandering in his laboring wife’s room and “treat her like a hand puppet.” I find that very off-putting.

          • The Bofa on the Sofa

            Well, it’s better than having people you know well treating you “like a hand puppet,” isn’t it?

            I LIKE my doctors to be impersonal. They should view me from a professional, medical standpoint, not as their friend. I don’t want a friend to give me an intimate medical exam, like a prostate exam. I want that to be from a complete stranger.

          • its not my body and I don’t get to decide who touches it and when. I learned that the hard way. There is basically nothing you can do if they decide to force you to have an exam or a procedure, but I figure since c-sections are so much easier for providers to deal with I cut down my chances of being abused again. I learned the hard way that no one cares if doctors or midwives do this to patients. that is why it happens so much. the department of professional licensing refuses to do anything, and I am having a difficult time finding an attorney to help me. The hospital didn’t care either. Its just so frustrating to deal with the helplessness of it all.

          • Dr Kitty

            Your birth story was horrendous, i totally get why you’d prefer to avoid examinations again.

            A Pre labour MRCS is, indeed your best chance of avoiding vaginal examinations.

            Yes, they’ll have to put in a catheter, but by that point you’ll be numb from the chest down, and the screen will probably by up.

            They may offer you rectal suppositories for post op analgesia at the end of the surgery (I accepted…again, numb and absorbed with the baby, I didn’t even notice, but I gave verbal consent at the time, and written consent beforehand- you could decline).

        • Lizz

          It’s actually one of the reasons I continued to have c-sections. I don;t know about anybody else but cervical checks hurt like nothing else.

  • I don’t think you understand white privilege if you are using the term ‘birth junkie privilege’ with a straight face. People choose to be ‘birth junkies’, people don’t choose their race. Midwives have an organized political/media campaign to further their goals, they could stop at any time. A white person cannot decide to just stop having privilege.

    • yarnbarf

      What about “Christian privilege”?

      • its an interesting comparison. religious belief can change, but I don’t think I would call it a choice either. Then there are people who convert for marriage or convenience, but aren’t very invested in the religion. I am not sure how to compare it to racial privilege.

  • Melissa

    Somewhat off topic, but a popular free standing birth center has made local (Charlotte, NC area) news today. It was shut down by the health department. Of course the only “news” that can be found on this is overwhelming support for the midwives, and martyr like cries that this won’t be tolerated.So odd. Suppose your favorite restaurant was closed by the health department. A logical response would be concern. You’ve eaten there after all. I don’t understand all this unwavering allegiance. Anyway
    My question is, what reason(s) could such a business be made to close their doors for the foreseeable future?

    • The Bofa on the Sofa

      Standards? We don’t need no stinking standards!

    • R T

      You would think so, but I developed salmonella poisoning, along with around 40 other people, from a popular upscale brunch place in Beverly Hills in August of 2007. I was hospitalized and the owners lawyers were shoving settlement paperwork in my face while I was still in a hospital bed. We were all infected by eating their dishes made with the same hollandaise sauce base. Now mind you over 40 people were hospitalized and we were all violently ill and somehow the owners were able to keep from having their doors closed for one day. I was so disgusted by how quietly it was swept under the rug, I contacted the local news media and took to the social network. You would not believe how many people attacked me and defended the resturaunt! They said it was just an isolated incident and shouldn’t stop anyone from eating at the resturaunt. They said it wasn’t that big of a deal because no one died and these things happen. They weren’t concerned at all how little investigation the health department did or how easily the owners were able to but their way out of everything. The owners had several other expensive resturaunt and other businesses in town and were politically connected. It took me two years to years to feel completely healed!

      • R T

        Ugh! For some reason I can’t edit my post! Please excuse the typos!

        • auntbea

          Whoa, really? Where? How did I miss that?

      • prolifefeminist

        I had something similar happen a few years ago. The local swimming pool in my town (privately owned club on leased public land) was shut down for a day because a random inspection showed that they had ZERO chlorine in any of the pools, and hadn’t been sending out water samples for weekly testing like they were supposed to. I only found out the reason for the closure because I called the health department after receiving an email sent out by the owners that sounded like bullshit to me (and I was right – it was complete bullshit). I have an immunocompromised child who had been in that pool, and I was livid that the owners refused to notify their members of the hazard, so I made it public myself. I wasn’t prepared for the vigorous backlash from people – other pool members who said it wasn’t a big deal, all that could happen is a little tummy virus (!!!), it’s all fine now, you just want to see the pool close, blah blah blah. Thankfully about half the people were as disgusted as I was, but I was SHOCKED at the number of people who defended the negligent actions of the pool operators. It just boggles my mind.

    • thepragmatist

      I think it’s a few things that make women defend negligent midwives. Firstly, pregnancy and birth is an intimate, vulnerable time for many women, so I understand why women will support their caregivers, even in the case of negligence– there’s a special bond there. Midwifery often exploits that relationship and pushes the boundaries of appropriate client/provider relationships far past what most would find acceptable, like the midwives who bring their own children to deliveries! And then, add to it that the women also have made a choice that is counter-culture, so egotism demands they stand by their choices, especially if they live in an area that condemns their choices outright. I should know about that, because I had a complication from a c-section that I had requested, so I got lots of “So, are you still happy with your choice now?” afterwards. (PS. Answer was yes)

      I’m watching the local community rally to a popular midwife’s defense right now. Nobody even cares what she may or may not have done, she’s already innocent. I’ve not actually seen any debate about her behaviour. It’s a political foot ball and a class identifier, but it’s also personal, and it’s also about protecting one’s own choice from criticism. JMO.

      • Melissa

        So true. I was a healthy 22 year old experiencing a run of the mill pregnancy when I delivered my first son via emergency c section at 28 weeks. The hidden blessing behind having mother nature show you her claws are bigger than your plans is learning upfront that so much of motherhood is out of your control. The experience left little if any room for ego.
        I can only imagine that the families behind the cause for birth center closures/cover-up are paying a hefty price for that ego.

      • Would love to know more details as you are in my neck of the woods I believe….

    • Karen in SC

      Here’s a link: http://www.nbcnews.com/id/52965157/#.Ui5hdT8pjzM

      and a quote from the story: “First responders confirm to NBC Charlotte that they’ve responded to the center seven times this year. It was not clear if those calls were related to the ongoing investigation.”

      • Lisa from NY

        Another link: http://www.charlotteobserver.com/2013/09/09/4300503/fort-mill-birth-centers-license.html#.Ui6JM8asj0s

        “Monday evening, the center released a statement saying it is appealing the suspension, which stemmed from “a birth with a bad outcome.” The center referenced a “grieving family,” but did not provide specifics.

        It did say its midwives “took appropriate emergency measures in transporting the laboring mother to the hospital.”

        • Lisa from NY

          Statement from birth center:

          “Calling a physician to come to the birth center would have delayed transport. A physician would not have been able to provide appropriate care at the birth center as operating room facilities were needed.”

          Translation: Emergency C-Section was needed and not provided in time due to location.

          • Bombshellrisa

            Alternate translation: births centers and CPMs are NOT equipped to handle any kind of emergency that may arise with a laboring woman or her baby.

        • Melissa

          “I know of several who are planning at this point to do unassisted births in their homes because they have no other option because they don’t consider hospitals an option,” she said. “It’s not an ideal situation to have to transfer your care at 41 weeks.”

          Read more here: http://www.charlotteobserver.com/2013/09/09/4300503/fort-mill-birth-centers-license.html#.Ui759zDD8a9#storylink=cpy

          Even when confronted with a dead baby (presumably) there really is no limit to the willful ignorance and selfishness of some of these women. Heartbreaking.

    • amazonmom

      It had to be pretty damn bad. I wish a particular local birth center would be shut down! Apparently they have decided to actually follow the formal transfer agreement with the local hospital, for now.

      • Bombshellrisa

        Cause, ya know, the MAWS president works there-she has to set an example

        • amazonmom

          Or enough OBs complained about the dump and run “transfers” coming through the ER….BWAHAHA

          • Bombshellrisa

            Haha I hope so-since the selling point of certain birth centers is “we are only down the street from X hospital with an amazing NICU”. Never mind that they aren’t going to see their patients through the transfer process unless they get their palms greased with more moolah.

          • Melissa

            I always thought the location of this place was scary. It is a good 15 minutes from the hospital.

          • Bombshellrisa

            That is 45 minutes in transfer language! At least! The birth center amazon mom and I wish would no longer be in business is close to a hospital, but they don’t always use this hospital that is only a few
            minutes away. The midwives have been known to transfer to a hospital that is two freeways and a toll bridge away (and never wide open, both are always backed up in the area being traveled).

    • Bombshellrisa

      http://carolinasbirthcenter.com/
      Is this the same place? Read the intro-they won’t “make you lay in a bed” or “hook you up to moniters”. Sounds like trouble right there

      • Melissa

        Yes. That’s the one. An area with a demographic of mostly college educated white people (myself included.) This area is chock full of ultra crunchy moms at the ready to educate and offer their suspicious condolences for my c section births.
        This is just over the border in South Carolina due to higher regulations in North Carolina.

        • Bombshellrisa

          Since the website for birth center is all rahrah for your choice of birth (you can move around! You can birth in water!), you would think that your choice (having a live healthy baby) would be respected.

      • Antigonos CNM

        If they don’t know the difference between “lie”* and “lay” I don’t think I’d trust them to know how to deliver a baby, frankly.

        *As both a verb or a noun.

        • fiftyfifty1

          Perhaps they are using lay in the sense of giving birth, as in “lay an egg”. I like it better than using plain “birth” as the verb.

    • Sue

      A call to arms for the rational majority of the (trained health care provider) midwifery profession:

      CALL THESE ROGUES OUT!

    • in utah the birth centers with only one birthing room are exempt from a bunch of the laws about birth centers soooo I don’t actually know who oversees them. I’ve looked into how to get the place shut down but it gets exhausting.

      • Lizz

        That’s how some of them work. I always kind of wondered that since quite a few of the birth centers I’m aware of are basically just a house with a nice tub and only one birthing room technically.

  • Captain Obvious
    • Lisa from NY

      Are you implying Wendy knows how to read? Since when is being literate a requirement for midwives???

      “In 2012 six Oregon mothers lost their babies in births attended by

      DEMs. They may feel guilty about having chosen a home birth with a

      DEM and are unlikely to lobby their legislators.”

    • Amy Tuteur, MD

      As far as I know, no one from MANA has responded to the Judith Rooks report.

    • Karen in SC

      something ignored doesn’t exist…

  • T.

    OT:

    Well, at least she admits it!

    Childbirth is my extreme sport:
    http://www.salon.com/2013/09/08/childbirth_is_my_extreme_sport/

  • Carolina

    This is totally off-topic, but could you do a post about the research/science behind common pregnancy restrictions? I’m curious about things like alcohol (avoid entirely, or 1 drink/week in third tri okay?).

    • Captain Obvious

      FAS. Would you ever give alcohol to a newborn?

      • Isramommy

        I think throwing fetal alcohol syndrome at a woman who asks about a very moderate amount of drinking is very sanctimommyish. Plenty of women are told by their obstetricians that an occasional drink is perfectly fine. Hell, at one point in my first (high risk) pregnancy, my perinatologist even **suggested** that I go out to a nice dinner with my husband and have a glass of wine. And for what it’s worth, pretty much every. single. woman. I know has at least a sip or two of wine once a week , and give their newborn boys wine on their eighth day, all without an epidemic of FAS.

        I find the holier-than-thou attitude that good mothers would never let even a drop of alcohol touch their lips very distasteful.

        • The Bofa on the Sofa

          Captain Obvious is an OB, btw…

          • R T

            But CO doesn’t speak for all OBs. My Perinatalogist said an occasional glass of wine was fine. I wanted to puke at the smell of wine, but I did ask him out of curiosity because it was a heated debate on my Internet birth board.

          • The Bofa on the Sofa

            Yes, but to call CO a “sanctimommy” is completely baseless. She is speaking not from the perspective of a mother, but from that of an OB.

            Sure, other OBs won’t agree, but that doesn’t make CO a sanctimommy.

          • R T

            Oh yeah completely agree on that, lol!

          • thepragmatist

            The issue with alcohol is that it is disinhibiting and a drug of abuse. A relatively large proportion of the population is alcoholic which means that a drink or two is not possible. A parallel would be saying, well, a line of cocaine once or twice during pregnancy won’t hurt… I know this is going to sound very heavy-handed, but as a recovered alcoholic, I find current advice to just stay away from a highly addictive and dangerous substance (which alcohol CAN be and which, statistically it IS) to be prudent. It’s fine for YOU to choose to drink moderately and make that assessment for yourself, but for public health authorities or physicians to openly condone it goes too far. The job of public health authorities is to protect the public as a whole, not speak to individual circumstance, and to mitigate harm. IMO, it mitigates far more harm to go with a zero tolerance policy on alcohol, given the reasons I’ve cited above. Individuals can discuss their personal desires with their physician and may come to a different conclusion, and that is just fine, privately.

            The public bias and fear of FAS was a great motivator for me during pregnancy and later, while breastfeeding, to stay sober. By the time I’d got through pregnancy and nursing, I was well on my way to being *easily* sober, without a second thought. My sweet boy doesn’t know it, but I’ll always quietly credit him with that one, since it’s a choice I made that I never regret, and his timing was impeccable.

          • Karen in SC

            what an inspiring story!

          • Isramommy

            I do know Captain Obvious is an ob, although when I wrote that comment, Discus had the FAS comment under the name of another poster for some inscrutable reason.

            That said, I stand by my statement that it is very distasteful to imply that women who consume a very moderate amount of alcohol are endangering their children or equivalent to binge drinking women who cause their children to have FAS. So, if you like I will withdraw the “sanctimommy” charge, but OB or not I still think the original response to Carolina’s comment was very sanctimonious.

          • The Bofa on the Sofa

            She is an OB. She has the authority to be sanctimonious. Seriously, the question was asked, an OB answered. You don’t like the answer, so you pull an ad hominem.

          • Isramommy

            I’m not sure that I agree. Being an ob certainly gives CO a position of authority and knowledge far beyond a layperson. But he was making a comparison between the impact of an occasional drink and FAS. I have never seen evidence showing that very moderate drinkers are at heightened risk for FAS (feel free to correct me you do have studies to that effect). So if the comment isn’t based on strict medical evidence then it seems like a moralistic judgement that good mothers don’t have an occasional drink and bad mothers do. If there was more consensus among all obs that even a single drink is dangerous, then I wouldn’t take issue with the comment. But since many obs do allow very moderate alcohol consumption during pregnancy, it seems judgemental and extreme to imply such behavior risks FAS.

          • Captain Obvious

            CAGE
            1. Have you ever felt you should cut down on your drinking?
            ***2. Have people annoyed you by criticising your drinking?
            ***3. Have you ever felt bad or guilty about your drinking?
            4. Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover (eye-opener)?
            Drinking while driving or pregnant is unnecessary. If you feel you cannot withhold from drinking while pregnant, then I am sure you don’t withhold from drinking during other situations where drinking is inappropriate. I don’t feel one or two drinks while pregnant is really going to affect your baby just like I don’t think if you gave your baby a bottle with Kahlua in it will affect your baby long term. But why do you feel you should?

          • Laural

            Because… I freaking love beer.
            There are a lot of pleasures that are unnecessary. I am an adult and even us adults of average intelligence can understand the definition of one 12 ounce beer. I resent my doctor assuming I am lying or have a drinking problem or can’t understand the definition of one unit of alcohol.
            So, while I wish I had an OB that would tell me that I could have one real 12 ounce beer every Friday night I am typically faced with one who takes CO’s stance. I have enough guilt as a parent that in the end it is not worth it for me to have a beer, though common sense tell me that I am probably would not be hurting my baby.
            I do have an ODouls (NA beer) once or twice a week in the summer. It is delicious, thank goodness for that. It brings me great pleasure. Happiness, even.

          • Courtney84

            I have had a few sips this summer. I will admit that I am sad to see a whole summer go by and not have enjoyed 12 ounces of Leinenkugel Summer Shandy all to myself. I don’t think it’s because I can’t abstain from alcohol for a year or two – I totally can. But I wish I could enjoy one cold beer before summer is over.

          • Wren

            I’m more than capable of abstaining from alcohol, but unless there is actual evidence that the occasional drink can actually cause harm, then why make pregnant women who choose to have a drink feel like bad mothers for it? I will freely admit to having a sip of champagne at the toast at my sister’s wedding when I was 20 weeks along with my first.
            No one is suggesting drinking to excess is a good plan, but there is a huge difference between that and a glass here or there. The idea that all women must be advised to abstain totally, and made to feel like bad mothers if they do have a drink, because some women are not capable of exercising good judgement about their alcohol consumption is frankly pretty offensive to most women. Why not extend that argument to say nobody should ever drink, in order to prevent those who do not possess good judgement from drinking to excess and causing damage to themselves or others? Oh yes, because we generally expect adults to be able to make judgements for themselves, as long as they aren’t pregnant women deciding whether a glass of wine or similar is ok.

          • Carolina

            I don’t think any profession has the “authority” to be sanctimonious. I have a fair amount of expertise in my field, but if I responded rudely and flippantly to my business units, I’d be out of a job pretty quickly. It’s my job to explain the law and the risk of a particular strategy or course of action based on that law, even if I find it tedious or think the answer is blatantly apparent.
            And I wouldn’t say the question was answered. My question was serious — I’m curious what the latest and greatest research is about drinking during pregancy (as well as the research supporting other dietary restrictions). Given the number of OBs who do permit occasional alcohol consumption, there’s clearly a split of opinion with the “don’t drink if you are even thinking of conceiving because FAS camp.” What drives the differing opinions?

          • The Bofa on the Sofa

            It’s not sanctimony when you are an authority.

          • Carolina

            Disagree. But perhaps we’re quibbling on the definition. Having an expert opinion is fine, even having an absolutist, extreme expert opinion. Delivering said opinion in a pious manner gets you end to sanctimony-territory. Put another way, authority doesn’t give you a pass on rudeness.

          • The Bofa on the Sofa

            It’s ok to know more about it than us, but you can’t act like it?

          • Carolina

            I think you’re deliberately misrepresenting my argument. Like I said, I know quite a bit about my little niche of law. I absolutely do not act like a jerk about it, even when presented with questions that are so far outside the realm of what is legal/appropriate that I’d love to laugh. But laughing at one’s clients is rude. I enjoy being employed, so I don’t do it. I simply explain my reasoning. I don’t say “I’m a lawyer so I can say what I want, how I want.” I also think if your goal is to convince/persuade, tone matters.

          • Amazed

            You are not CO’s patient, so I don’t see why you insist on comparing yourself with your own clients, not your fellow commenters. You asked a question, CO gave you a professional opinion without the dimplomacy she (by the way, I thought CO was a man? ) has to show towards the patients in her office and your response is to compare this blog to your workplace? I don’t understand it, truly.

          • Isramommy

            I also (obviously) disagree.

            But while this is an important and serious conversation, and one worthy of genuine science based discussion rather than debates about tone (or pop culture references), at this point I have to confess that all I can think about now is the Simpsons episode where Bart’s delinquency is traced back to Marge’s “unforgivable” accidental ingestion of a single drop of champagne during pregnancy. I think it pretty much says all that needs to be said on the “only bad mommies would do that” position.

            http://www.hulu.com/watch/40212

          • Amy M

            Well there this:

            http://www.nofas.org/

            and

            http://www.mayoclinic.com/health/fetal-alcohol-syndrome/DS00184/DSECTION=prevention

            I don’t know what drives the differing opinions, but the official stances seem to be: we don’t know if there is a safe level, so don’t do it. If individual doctors are willing to bend a little, maybe they haven’t had much experience with FAS? I am just guessing here…..

            I am pretty sure my OB was in the “no alcohol at all” camp, back in 2008/09 when I was pregnant, but she was down with moderate amounts of caffeine.

          • Isramommy

            “what drives the differing opinions”

            I think that’s the key. What do studies say about actual specific amounts of alcohol during pregnancy? I’ve heard that advice not to drink at all was based on the fact that women tend to underestimate their own drinking. So for a woman with an alcohol problem an ob’s permission to drink “moderately” could lead to heavy drinking that the woman only perceived as moderate. I think the original question in this thread though was in reference to a specific amount of alcohol though, rather than a qualitative interpretation of “moderate”.

          • batmom

            “No known safe amount of alcohol” just means “for obvious reasons there’s been no study done finding out how much alcohol is bad.” Unethical to propose a study, and people lie about how much they drink.

            A good friend of mine is a pediatric cardiologist who likes to point out continually that pediatric recommendations are particularly conservative because doctors have to deal with a wide range of patients, who come in a wide range of common sense levels. “Moderate” to some of my friends means “measure out exactly 4oz of red wine, only on special occasions.” To others “moderate” might mean “lol i’m only partying like every other weekend now luv mah babee!”

            The best we have are observational studies (i.e., look at France) which suggest that having a glass of wine with dinner probably won’t hurt things. I abstained completely while pregnant largely because I was having a hard time staying hydrated as it was, but I wouldn’t think much of having an occasional glass of wine.

          • Sue

            That’s spot on, batmom. “No known safe level” is a consequence of the reluctance to test anything on pregnant women these days.

            But the risk of half a glass of wine once a week or two causing FAS? Probably less than a car crash.

          • Captain Obvious

            Yes, the risk is small, but present, and people do under report how much they drink. So if you are comfortable with this small absolute risk, then go ahead and drink low to moderate amount of alcohol as you have a Homebirth with a CPM. Both have small increases in absolute risk. 🙂
            FAS
            Causes brain damage and growth problems. FAS tend to weigh less, have smaller heads, and be very fussy. As the grow up, they tend to have problems in how they think and behave.
            The safe level of prenatal alcohol consumption has not been determined. Alcohol freely crosses the placenta. Fetal BAL match maternal BAL within 2 hours. There is no dose-response relationship between the amount of alcohol consumed and the extent of FAS manifested. There is a continuum of outcomes of fetal alcohol spectrum disorder (FASD) from fetal alcohol effects (FAE), to alcohol-related birth defects (ARBD), to FAS. National guidelines as well as Canada, UK, Australia, and France all recommend complete abstinence. Binge drinking and drinking more than 9 drinks/week have shown to increase risk of FASD. A study in Washington state show some effects of FASD (language, memory, and activity) don’t become apparent until up to 18 years old. Many studies reassuring that low to moderate alcohol consumption is safe stop assessing children at age 5. Older maternal age, high parity, African American and Native American factors among others appear to increase the risk of FASD. First trimester use showed dysmorphology & IUGR. Second trimester use showed decreased weight and length as well as deficits in spelling, reading, and math. Third trimester use showed decrease length of baby. An increase in stillborn incidence was shown with more than 5 drinks per week.

          • Sue

            There was a good discussion on the source of the abstinence message in the BMJ 2005: “Low level alcohol consumption and the fetus
            Abstinence from alcohol is the only safe message in pregnancy”

            The authors stated that ” The likelihood is that individual differences in alcohol metabolism may protect most women when drinking small quantities.”

            Then they went on to explain that, because self-estimation of drink dose-size is unreliable, it was not felt safe to say ”one drink” or ”two drinks” because of the range of interpretations of what that means.

            That is quite different from saying that even a very small amount occasionally has been shown to cause harm.

          • araikwao

            They are recruiting for a study here in Aus, I was given a leaflet on it at an antenatal visit last year. There was a bit of outrage over the ethics of fetuses knowingly being “administered” alcohol

          • Lindsay Beyerstein

            Captain Obvious has an informed opinion, which she offered when asked. That’s great, but I was a little taken aback by her tone.

            The poster was asking a perfectly reasonable about very moderate drinking, and the Cap’n went and played the FAS card. She wrote as if it were a stupid question. But the decision is nowhere near as clear cut as she’s making it out to be. There’s a spectrum of opinion among OBs, from advocating complete abstinence to endorsing very moderate, occasional drinking.

            Nobody believes that one drink a week can cause full-blown FAS, not even the OBs who advocate total abstinence. So, whipping out the FAS card in response to a question about very light drinking is hyperbole.

            One might argue that since we can’t prove it’s completely safe to consume alcohol in small doses, and we know that very large doses can cause huge problems, pregnant women are better off abstaining all together. On the other hand, we’ve looked and haven’t been able to prove that children whose moms drank very moderately are worse off than kids whose moms were totally abstinent. Maybe they’re all slightly worse off, but so mildly affected that we can’t measure the difference. Or maybe very light drinking causes rare adverse effects that get lost in statistical analyses. Or, maybe, alcohol in pregnancy is like other potentially toxic substances in that the dose makes the poison.

          • Antigonos CNM

            But Captain Obvious is obviously not old enough to remember the days when a woman in premature labor would be given a bottle of her favorite hooch as well as an IV drip containing alcohol to try to stop the contractions. I remember it well. At the height of the Age of Aquarius we had a hippie whose EGA was 35 weeks who was so drunk that when the anesthesiologist put the nurses’ station radio next to her ear she crooned along with Janis Joplin and never felt the pain of delivery at all. [the medications now used to stop premature contractions act on the same nerve receptors alcohol does]

          • Amy M

            They did that on Quantum Leap once….

          • Captain Obvious

            I am aware of IV ethanol use for preterm labor management. And it is not used anymore(, just like thalidomide.) Studies showed ethanol was no more effective than placebo. Women still delivered, but were drunk. So which nerve receptor does alcohol work on?
            Indocin works through prostaglandins. Nifedipine works through calcium channels, terb and ritadrine works via beta adrenergic receptors, and mag is only theorized to compete with calcium inhibiting muscle contraction. Atosiban competes with oxytocin receptors. All quite different ways of attempting to decrease uterine contractions.

          • Antigonos CNM

            We were taught that ritodrine acts on the same beta receptors as alcohol, but of course, that might not be true.
            I remember having some success using ethanol, but the patient was really, really miserable and we were glad when it went out of fashion.

        • Carolina

          Thanks. I can’t stand that attitude. There are many things that I wouldn’t give a newborn that I consumed while pregnant: coffee; kale; ribeyes; apple juice; and gasp, a few glasses of wine during the last 10 weeks. etc. etc. My baby only ingested breastmilk until she was six months old. She seems pretty smart and articulate now (and definitely doesn’t have FAS).
          I’m just curious about the research.

        • Tim

          When my wife asked our newborn daughter’s cardiologist if it was ok for her to drink coffee while she she was breastfeeding, her reply was that she thought we should go out and have some tequila shots because we deserved it with everything that was going on. I think she did more to endear herself to us in that first 15 minutes than she could possibly ever realize.

        • wow really? I was nauseated my entire pregnancy. My balance was awful because of the high center of gravity and I had to pee all the time. Alcohol would have made all those things wayyy worse, the thought didn’t cross my mind.

          • Isramommy

            Let me be clear, I am not encouraging alcohol consumption during pregnancy. When I was pregnant I personally never drank more than a sip or two of kiddush wine on Fridays. I’m not much of a drinker anytime, actually, let alone during pregnancy. But I also don’t think women should be shamed for having an occasional drink if the scientific evidence says that occasional, moderate drinking is likely to be relatively safe. My original comment was speaking to the fact that occasional drinking is allowed by many obstetricians and it is unfair to imply that those women are all causing their kids fetal alcohol syndrome or giving their babies bottles spiked with vodka.

  • anonymous

    This ls the same exact new age bs that you see in all these communities. They have all this “knowledge” because they’re “educated” but at the core of it these people really don’t know jack about the subject and when pressed they scream persecution.

  • I’m tired of the provider centric attitude – we need a woman centric attitude regardless of who the provider ultimately is. We need informed consent and respect for medical decisions. We need care that is compassionate and respectful provided by people who are actually qualified to provide care. I really do not care if a woman wants to squat out a baby in the comfort of her home – I care that she is doing so as an act of informed free will and that she has been apprised of the risks of doing so (including the risks of 3 times or more the mortality rate for her baby compared to hospital birth and the risks of planned vaginal delivery in general). I want women to know what their full scope of choice is, and to actually be able to exercise it – that might mean telling more women that planned cesarean is also a choice that is available. I’m fed up with the birth mommy wars (and the feeding mommy wars) – I applaud the work Dr. Amy does, because I believe absent that work many women who choose homebirth may have been deprived informed consent about their choice.

  • Staceyjw

    She didn’t know? C’Mon. She did what many white people (which I am) do- took advantage of a situation that benefited her, while pretending that it’s for the good of the people she was exploiting. This is classic, really, American politics depend on it.

    I also realize that white privilege can be so pernicious that even well meaning people miss recognizing some of the benefits, but I am pretty sure that paying to practice your non existent skills on poor women of color is not in this category. This is 101 stuff, basic racism, people!

    I also know white feminists can often be blind to intersectionality. But no matter how blind we are, even we know that when you go to places that are entirely unregulated, full of poverty, and practice on women of color, it’s NOT “heroic”, but disgusting.

    People that squawk about the rights in birth and “feminism” sure are wholly ignorant to even the very basics of both……

  • Squillo

    CPMs: Bringing developing-world care to the developed world.