Apparently Melissa Cheyney, CPM, head of the Oregon Board of Direct Entry Midwifery and and Wendy Gordon, CPM (and placenta encapsulation specialist!) are feeling pressured by my “attacks.”
Hallelujah!
I didn’t think that either my exposure of Gordon’s lies, or my exposure of MANA’s attempt to hide their own death rate could exert any pressure on them since they don’t seem to be the least bit pressured by dead babies. From my perspective (naive, I know), there could be no greater pressure than the fact that babies are dying preventable deaths for no better reason than preserving the ability of lay people to get paid for pretending to be midwives. Every REAL health care provider that I know (physician, house officer, medical student, CNM, student CNM) would be utterly devastated by even a single preventable death, let alone dozens of them.
I find it truly mind boggling that both Cheyney and Gordon could engage in such utterly reprehensible, totally unethical efforts to keep critical information from American women. Don’t they care at all about the dead babies?
Evidently not. They have progressed from lying by omission, refusing to release the MANA death rate while simultaneously boasting about the low C-section rate that resulted in those babies’ deaths, to straightforward bald faced lies like Wendy’s whopper appearing in her MANA blog post:
This research, which claims to be the largest study of its kind, relies on data from birth certificates (known as “vital records”). What we know about using information drawn from birth certificates is that they are pretty good for capturing information about things like mother’s age and whether she is carrying twins. They are not very accurate when it comes to rare outcomes like very low Apgar scores, seizures, or deaths (Northam & Knapp, 2006).
What does the Northam & Knapp article actually say? The exact OPPOSITE.
Birthweight, Apgar score, and delivery method agreed 91.9% to 100%. The high-percent agreement supports the reliability of those variables …
Before MANA started blocking comments, I managed to ask:
So the heart of Gordon’s argument is completely untrue. And Gordon referenced the mistruth with a citation that showed the opposite of what she claimed it showed.
Do you plan to correct that misinformation?
No one denied that Gordon deliberately misrepresented the data on the reliability of Apgars and deliberately misrepresented the North & Knapp paper. How could they? Anyone who can read can see the lie for themselves. But they didn’t correct it, either, because the truth is the last thing MANA wants women to know.
Cheyney and Gordon are downright pathetic. They are far feeling far more “pressure” about being exposed as liars than they feel about behaving grossly unethical and letting the deaths of innocent babies count for naught.
I’d like to address Cheyney and Gordon directly, since they obviously read this blog:
Stop lying! Stop hiding! Stop trying to bury dead babies twice, once in the ground and the second time in our collective memories.
How dare you two lie to American women by omission or commission? I never had any doubt that you aren’t healthcare providers; I’ve always known you are lay people trying to get paid while you get your birth junkie fix, but really??!! Have you no decency at all?
Release the MANA death rates. Stop lying about existing research. Start acting like the healthcare providers you claim to be and not a bunch of selfish, self-absorbed women who casually step over the tiny bodies of babies who didn’t have to die on your way to picking up a check.
And, one more thing: If you think this is pressure, you ain’t seen nothing yet!
If the behavior of Cheyney and Gordon makes you angry, please sign the petition to force MANA to release its own death rate.
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Completely OT (Sorry!) – I was wondering what people here think about Montessori. I’m considering sending my 2 young kids there for daycare (ages infant and 2) but I’m afraid of finding myself in a weird cult.
It’s very difficult to find information that shows it in a bad light and I found articles about it that read like advertisements. There is a study from 2006 that purports to show that it works but it was conducted by someone that also wrote a book called “Montessori – the Science Behind the Genius”.
It’s a very popular type of daycare where I live and people I’ve spoken to all seem happy with it, but something seems fishy to me.
My experience with daycare is to go and see what they do and see how happy the kids are and how responsive the carers are. The actual ‘brand’ doesn’t mean as much, in my experience, because good, qualified early childhood carers pick and choose the best options available. Even in public schools where I live the teachers have chosen some stuff from Montessori that has stood the test of time. Steiner is weirder then Montessori, from what I’ve read.
For little ones though, a friendly, responsive carer that provides fun activities is the most important thing. My eldest had two standout carers at her daycare, they were friendly, open and honest (I wasn’t just told that she’d had a ‘good’ day every day), they played music and sang songs and did stories. They did sandpit play with them (one of them would actually get hands on with the kids too making things for them to knock down), provided play dough. Did fun activities like ‘warm paint, cool paint’ and different textures etc for them to experience. This was just my local non-profit daycare. They were great. Daycare in my country can be a bit of a mixed bag so I was happy to have found a spot with this particular one. Unfortunately we moved and the new daycare cantre has not been as good (they now go to a family daycare instead).
Marguerita, if the vaccination rates at your daycare/school are important to you, I’d check them out. In my local area, the Montessori school has the lowest ones.
Yes, that’s certainly on my mind. A lot of the online discussions I found about this method were in places like mothering.com
Both in our Montessori preschool and school (different ones), a vax record is a required admission material.
The comment about the affluent moms sounds quite correct, I guess it depends on the area as well, and the prices.
(I hang my head in shame and admit that I decorated 23 mandarines with a black permanent sharpie to make them look like Halloween pumpkins. For snack. Will I deserve to be forgiven if I promise that I do that again?)
My kids go to a Montessori, and it’s not wacky at all. We vaccinate our kids. They eat all sorts of foods, including the occasional refined sugar and hydrogenated oils (gasp). Their school is a nice daycare, alternative to public kindergarten, where they get to visualize math with cubes, write short stories, do yoga, and flower arranging. There’s a big “work at your own pace” sort of philosophy, mixed-age classes. Seriously, I want to regress and go to Montessori.
Your best bet is to tour several schools and see what you think is the best fit for your child– no one approach is best. But don’t rule out Montessori (or Waldorf, or Whole-Child, or Reggio), just because you don’t recognize it.
It sounds fun for sure but I’m just worried there’s not enough structure and too much underlying ideology that I may not agree with.
How is it with the mixed age classes? That idea makes me a little nervous (yep, overprotective mom here).
A friend of mine sends her daughter to Montessori. She’s very happy with it, and it sounds really nice. This is in the greater Boston area, so vax rates are pretty high (and I suspect probably a requirement to get in?, I hope?), but so is the price tag. The little girl is doing very well, but this girl happens to be quite bright, and flourishes in this atmosphere. You know your child, so think about that—would your children benefit from more structure, or from setting their own pace? They are not left to their own devices all day…the teachers guide them at their own pace, but I think children have to have be self-motivated to thrive in that environment.
My child had a speech delay and it was recommended that at age 4 he attend a special pre k. The hours of this special school were not compatible with employment and finding a sitter willing to drive your children around is impossible. I crossed my fingers and enrolled him in two day a week montessori program which also offered speech therapy. Turns out, he didn’t need ANY speech therapy, by October of that year, he caught right up and THEN some. In his two years there, he learned to read, and add and subtract. When I transferred him to a mainstream grade one, he was bored out of his mind. Other than that, he is a genius :). My husband gives montessori all of the credit, I credit his mother’s genes, but nonetheless I wish I’d had the opportunity to put our oldest son (also pretty darn smart) in montessori because of the boost that they get. It was pricey, most of the parents were affluent, and if anything, what bothered me was the obnoxious show of wealth, mom’s dripping with diamonds and starbucks in the boot room, all heading to hot yoga together after dropping junior off. I was the mom who got off of a night shift, sometimes still in a uniform, bags under my eyes, waiting around in the bootroom for the door to open so that I could go home to bed. I was the mom who never volunteered, and when I did, there was always some jerk who would one up me with better snacks or something. Like the mom who carved 50 oranges like pumpkins for halloween one year. I think you find those sorts everywhere, but in this case, there were an inordinate amount of people with too much time and money on their hands. Aside from that, a great experience!
Would have been funny to see the 50 oranges carved as pumpkins.. Hilarious 🙂 I think some people take pintrest very seriously. Personally, there’s no way I could carve 50 oranges and feel happy with my achievement for the day.
My kid’s psychologist recommended Montessori school to us for our daughter who is mildly autistic. I’m not sure exactly what the psychologist liked about it, but I think that they may do individually paced work, which is a good thing for children who may be out of sync in a normal classroom.
Generally speaking, I believe it is true that psychologists tend to like Montessori.
OTOH, I have spoken to several mothers of special needs kids who were very unhappy with Montessori. Schools were not willing to change anything to accommodate their kids. Some children, special needs or not, do better with more structure and clear expectations, which isn’t a Montessori thing.
Giving it some thought, my feelings about Montessori are similar to my feelings about Attachment Parenting. Great to get some additional ideas from, great to use the methods if they are working for the teachers and students, but not to get too bogged down forcing a “method” because it is Montessori. I imagine a good teacher/early childhood educator would be incorporating best practise no matter where it originated from.
My son did three years of a montessori program starting shortly before two years old. Each program is different but we found that the mixed ages was great for him – he felt competent by helping younger children but he also had the example of older children to learn from.
When he transitioned to a private school program at 4 he was reading basic words and working on the concept of multiplication.
I have friends who feel that for older children (1st grade and up) being in a Montessori program hid their child’s learning disabilities because the kids were focusing on what they were good at rather than what they struggled with. At the preschool level we found that our son was eager to be directed towards any sort of learning so that his teachers were able to balance what he worked on easily.
You might ask how they communicate with you about your child’s day, what they are learning, what they are struggling with. One of the things I loved about my son’s preschool is we got a ton of photos and videos each week showing his various activities and that his teachers were always available to tell us what was going on.
We had the same concerns about the local Montessori, which came highly recommended. On the plus side, it was a much calmer atmosphere and seemed to have more emphasis on individual learning, but it just didn’t seem to have enough structure for our mildly autistic son, who desperately needs structure AND accommodation for his individual needs.
Our local public elementary school was fantastic (definitely not always the case)–they had a terrific, supportive special ed team, and my son ended up in the mainstream classroom with a 1:1 aide, which has worked beautifully for him. (And the teachers liked having the aide in class because she could help other kids when my son didn’t need her directly.)
Good luck!
There IS structure (prepared environment, choreographed daily routines through which children learn an awful lot of communication, problem solving, emotional intelligence and all sorts of skills), it is just not a teacher-dictated structure.
My son thrives in the mixed age environment. Started at age 3 with no spoken English but complex Hungarian sentences and basic reading, no aptitude towards music whatsoever but very advanced in math, fine coordination and drawing, strong-willed and impulsive with good manners.
The ” no English” went unnoticed as he was “the small one” in the group, older children patiently taught him and felt proud of themselves. The highly advanced math also went unnoticed, he was fairly level with the average 5-6-year-old in the group and could progress as he wanted, no one ever restricted his ambitions telling him that he is “too small” for something. He did not end up being shy and ridiculed for the obvious lack of English, he was never made to feel “special” and entitled because of how smart he is.
This is why I love his mixed age gr1- gr 3 school class, too. In his kindergarten year, he was the one translating for the newcomer little boy who spoke no English. Now, once again he is the “small one”, and whenever he acts like he governs the universe, there is a 9-year-old nearby who corrects him about it. Given that Montessori is an absolutely nonviolent, no-bullying environment, correction from peers is just wonderful.
We had a “parents in classroom” day today, I am so full of the great experience, sorry about the length 🙂
Montessori is very conventional these days, but the name “Montessori” refers to a wide spectrum of different practices. Nothing weird either way.
Waldorf is a totally different story. Run, run, from Waldorf!
http://blogs.reuters.com/felix-salmon/2011/11/01/the-most-dangerous-school-in-los-altos/
You absolutely have to go and see each Montessori school in action to get a feel for how it interprets the founder’s ideas. Montessori schools are all over the map in what they offer and how they teach. There’s far more variety than you’d expect.
Yeah, from what I understand, these days Waldorf pretty much means no-vax. Most Montessori schools aren’t that bad.
I had the same concerns when my little guy’s father wanted to put him in Montessori for pre-k and k. Turned out they’re awesome! And not hippie-dippie at all.
It depends on the specific school. Look at any school carefully before sending your children there, especially infants who can’t say “I don’t like that school”. But as far as I know Montessori per se isn’t particularly bad. My small one went to a school that used the “Bank Street School” philosophy and seemed to like it, if that helps any. (Not that I’d trust any school based on that key word alone either…)
I wouldn’t trust Montessori after he left Fortunato bricked up in the wine cellar. Even if he did sort of deserve it.
Oh my god, thank you so much- you have no idea how much I needed a hearty laugh today
I didn’t really trust the free form style they use here until age 6 because I kept hearing about the kindergarten curriculum in the US. Here – No reading, no math, just crafts based on numbers and some games with singing and coordination exercises. I don’t know a single mom here who brags that her four year old is multiplying and reading a few words. The only place I get that is from folks from the states. They start here with the reading and math curriculum in 1st grade where the kids are all 6 and 7 years old. The idea is to wait until they are all ready and then march them through the programming. In the US it is all about being an early reader, in the best reading group, etc. Here, they try to keep the kids at the same level until 4th grade and then split them up. The curriculum starts out slow and accelerates, with after school help for those who need to catch up, so that when the challenges of 4th grade hit, it is easier for parents and teachers to channel the fast learners into different schools. It seems more egalitarian than a system which fast tracks the kids who had the best preschool.
Here in the states it’s a very big thing to have your kid read and do math extremely early. I don’t get it really. I mean, everyone learns to read and do math eventually, is it really an advantage to start super early? I’m more concerned that my kid won’t get stressed out at age 3 if he fails to recite the alphabet.
We are in your 4th year of Montessori (daycare, Pre-K, K, and now Gr1) and VERY satisfied. All sorts of parents in the community (Research Triangle in NC).
“I’m more concerned that my kid won’t get stressed out at age 3 if he fails to recite the alphabet.”
This is the thing you absolutely do not need to worry about in a Montessori school.
Here’s what I’ve done so far:
I sent an email to a computer professor about revamping the computer curriculum in the local college to include information literacy and the abundance of false health claims on the Internet.
Then I will find out if there is any meetings with other colleges so we can disseminate the enhanced curriculum to them.
I teach Information literacy for a living or at least I try to. It is hard to teach student how to evaluate information and think critically when the students, faculty and administration seem to be more interested in the”just show them how to use the databases so they can write papers aspect of it. It also doesn’t help that a lot of professors don’t like to listen to librarians, who are the expert in the area. I know this has little to nothing to do with what you wrote but you used the magic words that gave me an opening to vent.
I know that there are a few websites that are deliberate hoax websites that I’ve heard have been used by teachers to get students to think about claims on the internet.
The rare tree octopus site.
DHMO website
You could also look at Drop Bears.
And of course there’s always Snopes (I started my Dad on that one – he was sending me every internet hoax on email – I would reply with the link from snopes and he’s stopped sending them to me now).
I remember a primary school teacher giving us an elaborate story which ended with the discussion of “is what I’m saying true or not?”
A research exercise on the compute might work better then a presentation (not a teacher, but found things had a more lasting impression if I ‘did them’ as opposed to ‘hearing about them’? But that would depend on resources and time.
Fake websites have been used in the past but are considered kind of out dated now. We try to steer students away from using the general internet and towards the libary databases because those databases have more reliable information and cost us a lot of money.
Frankly, I was not looking for tips on doing my job but was pointing out a more systemic problem in information literacy instruction. The goals are often very short term. “Help me find information so I can write this paper” is usually the goal for the students.”Make sure that the students use library resources so the library’s budget doesn’t get shredded again is the goal for library administrators. The goal for the professors is also often related to finding resources for a specific project.
If I am lucky, I see each student at least four times during their college career. Out of those four classes, 15 minutes of instruction is geared towards evaluating information. The rest is finding items in databases, avoiding plagiarism, and requesting items via inter library loan. Each time I see a student, classes get progressively more subject-specific and more skills are introduced but the focus is on schoolwork not society.
Apologies, my reply was more for Lisa. I didn’t read her comment very well either because now that I read it again I see she is talking about college students. My current thoughts are along the lines of helping upper primary school students and high school students be wary of crap they read on the net. From memory I thought she originally started talking about schools, but my memory is generally not to be trusted these days.
“No MANA Bashing. This is the Midwives Alliance of North America (MANA) online community for Midwives Alliance supporters and those who wish to gather evidence-based information about midwifery. We wish to offer a safe space for all who want to discuss midwifery. It will naturally have a pro-MANA bias. It’s simple. If you don’t like the Midwives Alliance, then don’t participate in our community. We will not tolerate disruptive activities that alienate or threaten our community members, be they in the form of attacks against MANA or members of the MANA community or off-topic and inflammatory comments.” <—–This was posted in their new community "guidelines".
What is the point of having any kind of discussion forum? This is disgusting.
Translation: We like our echo chamber nice and… echoey.
Love this!
It basically says that you cannot be both Pro midwifery and pro data transparency.
That by raising the issue of the hidden death rates you are automatically anti-midwifery.
Not anti preventable deaths, or anti important information about risk being withheld from patients, or anti birth junkies acting beyond safe guidelines, or anti woo.
No, to be anti MANA is to be anti midwifery.
I’m pro midwifery. I work with great NHS midwives who are very, very good at what they do.
I’m totally anti the idea of CPMs (because I think that when you are responsible for two lives the LEAST you need is proper training, professional standards of practice and malpractice insurance).
It seems like such a daft idea that there is such opposition. I work a lot with electricians and engineers. They have different roles. The hands on stuff like wiring and terminations, is done by electricians. The design and sign off and other stuff (commissioning, running tests etc) done by engineers. Sometimes people pretend that one or the other is useless (and in individual cases sometimes they are right), but really most of us respect the knowledge and experience of the other and work together.
Now if there was a group of engineers or electricians that were into ‘natural electricity’ and trying to check for live voltages by blowing cinnamon breath onto some terminals then I think that there may be some more animosity. Or maybe not. It wouldn’t take long to work out that this method doesn’t work too well.
Well, this all goes back to the hijacking of the term “midwifery”. And, it is very American. No one in Europe, the UK, or here in Israel has to be told that a midwife is a highly trained professional, but I can’t tell you how many times I’ve been asked by Americans if “I’m also a nurse?” or “Do you have to study to be a midwife?” “It takes THAT long? Really?”
When I was in nursing school, we were shown a film, made around WWII, called “All My Children” about one of the black women licensed by the state of Mississippi to deliver rural black women in their homes. She had been taught to keep her instruments, basically a couple of clamps and a pair of scissors, clean [not sterile] and worked in cabins without electricity or running water, carried newspapers with her as newsprint, which is heated when printed on, could be used as a cover for any surface she needed to be clean. The state of the rooms in which she worked was appalling [often the entire family was in one room] Apart from this, she had no other formal training, and was thought to be “good enough” for the population she tended. Film had considerable “folksy” and gospel music on the background. THIS is the image of “midwife” into the 60s in the US. Then it became pot-smoking hippies who were in tune with the Earth. NBC ran a news segment on a couple of this variety in California that I remember: “Birthin’s normal, man” giggled the “midwife” who looked all of about 19. The concept of the true professional midwife is VERY recent in the US, and generally still is struggling. [OB opposition has a lot to do with that, btw]
I am curious how midwifery came to be part of higher education in Europe and how that didn’t happen in the US. Why are “real” midwives CNMs here? What is different about nursing there? If there are not L and D nurses are nurses otherwise the same? Are NICU nurses nurses in Europe or midwives. Such a different system.
It has to do with history. About the time the US was getting underway [late 18th-early 19th century], it became very fashionable for the upper classes in Europe to retain the services of an “accoucheur”, that is a physician who specialized in delivering babies. This came about largely because they had a monopoly on the use of forceps [initially, the first medical families like the Simpsons, who developed them, kept them strictly a trade secret, smuggling them into the birth and using them under the bedclothes or getting rid of any witnesses, in order to keep the secret]. For aristocrats, a simple midwife was regarded as “not good enough”.
American women wanted only “the best”: after all, wasn’t an American the equal of any European aristocrat? So it became fashionable to have a doctor in the States, too, although midwives did continue to practice, especially on the frontier, where doctors were thin on the ground. But by the time Florence Nightingale began her creation of professional nursing, in Europe obstetrics was firmly in the hands of doctors, and the midwives got passed over as being passe. [Ms. Nightingale wasn’t interested in midwifery anyway] This was reinforced when women began getting analgesia in labor in the form of chloroform and later “twilight sleep”, and of course, once C/S became feasible. However, in Europe midwifery soon was professionalized as nursing became so, whereas in the US, doctors were glad to maintain their monopoly, and to keep nurses “in their place”. Frankly, before antibiotics, nurses spent huge amounts of time scrubbing things, which did not seem to require much intelligence, and they had pretty low status as a result.
In Europe there are no registered nurses as such in L&D, only midwives. However, registered nurses do work in NICU.
In the UK [when I was there, and AFAIK there is the same system], nursing education which leads to the State Registered Nurse qualification [RN means Royal Navy in the UK] is basically entirely medical-surgical. Beginning with her second year in school, a student enters the NHS pay scale and gets a salary. There is, therefore, motivation to do postgraduate courses such as Midwifery, Sick Children’s Nursing, Theatre [OR], etc. because you are paid while learning. Many of the young women who were in the midwifery course with me had actually done at least 4 or 5 years of nursing education. This was before academic degree programs began in the UK, btw. So a registered nurse in an NICU would have done a postgraduate specialist course for it. I don’t know if this system still applies now that one does not go for a diploma but for an academic degree.
American nursing education tends to be all-inclusive but does not go into the depth or take as much time for specialities that European programs do. For example, I had 3 months “OB” in my general nursing courses, whereas my British counterpart had none, but the midwifery course was an extra year.
So it’s an “online community for Midwives Alliance supporters” and a “safe space for all who want to discuss midwifery” and if you don’t like MANA, you shouldn’t participate in their community.
That’s a great way to encourage and “meet head on” those “tough conversations” they claim to want on the other page.
It is a perfectly “safe space” for “all who want to discuss” what we call “midwifery” according to the way we see it.
What a shame they don’t have the guts to call a spade a spade. Then it would be obvious that they are merely a group of cheerleaders, not a professional organization.
Have you looked at their guide for researchers who want to apply to use the data? It’s…something. AND it includes a non-disclosure agreement. In the spirit of openness.
I wonder what a meeting would be like at MANA? How do they bring fresh ideas on board? How do they evolve and change as an organisation? How do they encourage and nurture talent?
Of is it mostly just sucking up (sorry, “supporting”) those at the top of the chain?
I don’t know, but there was a kerfuffle last year when several members of MANA’s Midwives of Color Inner Council resigned from the council and some from MANA itself, basically accusing the organization of paying lip-service to the idea of diversity to further their own agenda. Stating the reasons for the resignation, they wrote:
Given that one of MANA’s rationales for the existence of CPMs and other lay midwives is to increase the ability of minorities and marginalized communities to access both midwifery as a profession and midwifery care, that’s pretty damning.
Yes, and the KKK is just trying to create a “safe space” to discuss racial stereotypes and epithets.
Like I was saying to my husband, there are places that support a particular point of view, and there are echo chambers. Here, if you post a coherent, relevant comment opposing Dr. Amy’s point of view, you might get criticized. If you say something really dumb, we’ll probably make fun of you. But the comment won’t get deleted unless it’s spam or something. It’s the same on most of the other skeptical blogs I read, opposing viewpoints are debated, not deleted.
Deleting on-topic posts in decent language just because they disagree with the group’s consensus, now THAT’s the mark of an echo chamber.
MANA is a religion. It is faith based.
That kind of ”safe space” is fine for a tweenie Justin Bieber fan club, but not for an organisation holding data that reflects life and death.
Professionals in health care practice outcome reporting, audit and open disclosure. Time to move on or move over, MANA.
OT: For Tim Minchin fans.
http://www.timminchin.com/2013/09/25/occasional-address/
OT: I’m so saddened by all the recent tragic cases in the news due to post partum psychosis. Off the top of my head, there was Cynthia Wachenheim, Felicia Boots and now Miriam Carey in DC. I know there are others I’m forgetting. They were all otherwise successful women who were functioning well before having a baby. There must be something that can be done to prevent these sorts of situation? It’s just heartbreaking.
I think we can spread more information about hormonal changes following pregnancy and not laugh off women or shame sufferers of mental illness. I think better healthcare is key.
Is a six week post-partum visit, followed by a yearly visit adequate for postpartum women?
I think so, for the vast majority of women. I don’t think it makes sense to have extra OB-GYN visits solely to screen for postpartum depression. That really isn’t there area of expertise anyway, right? Maybe pediatricians should ask a few screening questions for post partum depression at the baby’s well baby visits?
When I did general peds, I asked a few basic questions at the one month and two month visits.
I have seen that as a recommendation these days at well baby visits too. Though it definitely sounds like an area where the NHS model is better.
I’ve had a couple of nurses have me do the Edinburgh scale (? or some depression test I recognised at the time).
This is where the NHS model of primary care is good.
I see every woman 6 weeks postpartum, her midwives will have seen her several times at home in the first 2 weeks postpartum, and the Health Visitor (who is a specially trained early childhood community nurse) will see the baby at home at week four for a basic visit and in the GP surgery at week 8, 12 and 16 for vaccinations.
As a GP I’ll also be seeing the kids for the usual childhood ailments, mum for contraception, smears, iron tablets etc and dad if he has any health issues. Especially, I’ll be the one mum will come to see if her PND expresses itself as health anxiety for the baby, or as physical symptoms (panic attacks, exhaustion, aches and pains, sleep disturbance etc). Mum will also come to see me for sick lines if she doesn’t feel able to go back to work at the end of her planned maternity leave.
Post natal depression is easier for a family physician to diagnose and manage.
Although the NHS system doesn’t always work – the community midwifes in the area I had my first son were too busy to make some appointments so I got a phone call instead and one midwife came to the house, found me in tears and said “sorry but i’m running late for my next appointment, heres a brochure, someone will call you…”
However antenatal care was excellent and the Health Visitors were great too.
Not good…
But the midwifery services are horribly understaffed and overstretched.
Hopefully your HV and GP were better.
I do ask questions about mood/anxiety/stress and sleep at the postnatal visit and will happily offer everything from a review appointment in a week to CBT to medication to a support group, or any combination of the above.
Quite often I’ve picked up PND at an appointment which was ostensibly about the baby or an older child, or about contraception or “do you think I need my thyroid checked?”. Six weeks is just one appointment, GPs are there for pretty much everything, all the time.
As a maternity patient at 22 weeks I tried to transfer from Oxfordshire to London, only to be told it would take 5 weeks to do the paper work before I could be seen in London. Still trying to work out what the “N” is in NHS.
Again, weird.
I don’t work in the English NHS.
I had a lady move here at 23 weeks, saw her the next week and got her booked at the local maternity hospital and seen before 25 weeks.
You are in Ireland, I believe? Republic or the North?
North.
Did my medical degree in Dublin.
Reasonable experience of both systems.
In terms of the NHS, Northern Ireland is a parochial little backwater with some peculiarities due to history and logistics- which boil down to longer waits for some things (orthopaedic surgery, paediatrics) and much, much shorter waits for others (CBT, obstetrics). Our services are integrated more, simply because it’s a smaller place and everyone knows everyone.
My sister’s boyfriend in London works as a psychotherapist for the NHS- he has a six month waiting list for CBT. I can get someone an appointment for CBT within 2 weeks.
There used to be a blog by a community midwife in the NHS [Midwife’s Musings, or something like that] and, over the years I read it, she constantly reported cutbacks in staff and other reductions. Eventually, I believe she retired, after she could no longer do the work of 2 full time midwives [one was let go, and she had to assume the workload in addition to her own], and ended the blog. By the time she quit, she was quite bitter about the deterioration of NHS services where she lived. The blog of another NHS nurse, in a geriatric unit, ended when she emigrated to Canada, feeling she just could not cope with the immense workload at her English hospital [apparently, toward the end, there were only two registered nurses per shift for over 40 very sick elderly. The morning meds round took almost 2 hours, and yes, patients went unfed since they were incapable of feeding themselves and not enough staff, trained or untrained, to get to them all]
It seems to be a postcode lottery, however. I have a number of cybercorrespondents who tell me that, whatever one hears or reads or sees on TV, the services in their areas are still very satisfactory in general. So, YMMV.
Yes, and the NHS and other “socialized medicine” programs, such as we have in Israel, provide a safety net which is completely lacking in the US. Nearly all the women I took care of in the US went home without even the name of a pediatrician [who is thought of as a doctor for SICK children, anyway]. When I was teaching, out of my home, a preparation for childbirth course, I offered, for an additional payment [not large] to do a home visit during the first two postpartum weeks to check the mother and baby. It was amazingly successful, with a great many mothers telling me “I just didn’t know where to turn” because they couldn’t bring themselves to go to a DOCTOR because of what they considered problems “too minor to waste a doctor’s time” [and didn’t want to pay a large dr’s bill]
Between the six week postpartum visit, yearly visit, and all the well-baby visits, most new moms are probably in a doctor’s office at least 3-4 times within the first 3-4 months after birth and another 2-3 times before the end of the first year postpartum. I think the main thing is to figure out the right questions to ask new moms at those visits so that the medical providers they see are able to accurately determine whether there are signs of postpartum depression and/or anxiety.
no, because it is not done by a mental health professional. I think the issue is so important that this should be included in the assessment. Mothers who have never experienced depression before are NOT going to come out and say it. They need to interviewed by someone who can spot it.
More evidence that MANA is feeling the heat. They’ve had to change their comment policy so that they can keep out comments that they don’t like.
http://www.mana.org/blog/25/updated-mana-community-policy
Is there a single homebirth website or blog that believes they are telling the truth, or do they all have comment policies that squelch dissent because they know what they are writing is not true?
I have no problem with the cited changes; requiring a name and e-mail is pretty standard. I would have been happy to leave my name and e-mail in my initial comments, but “anon” was the only option in the first few days.
What they don’t say is that they will no longer let through germane, polite comments they don’t like. This too, sadly, is pretty standard.
Wait. How do we know they are feeling the pressure? Did they send a grumpy email or something?
Yes, this article seems kind of incomplete.
http://research.nd.edu/news/36692-modern-parenting-may-hinder-brain-development-research-shows/
Help in responding to this? Has Dr Amy commented on this yet? This is making it’s rounds among expectant moms groups right now. I’d appreciate thoughts. Everyone is commenting it proves Attachment Parenting is right… Oh my.
She’s just touting her own research; I don’t see any publications referenced. I’ve written about her in the past:
http://www.skepticalob.com/2012/01/sanctimommy-manifesto.html
I’ve mentioned this before, but unfortunately her ‘research’ has impressed the US Lactation Consultant Association (the US branch of ILCA), to the point where she, along with fellow sanctimommies Tracy Cassels and Wendy Middlemiss, have been allowed to dominate an entire recent issue of their journal: http://www.clinicallactation.org/Volume/4/Issue/2 . That lactation consultants feel they should have a say in infants’ sleeping habits at 6 months is worrying, and the one-sidedness shows a clear bias on the part of the USLCA which makes me wonder just how accurate their breastfeeding-related advice is, as well.
The fact that lactation consultants feel like they have the right to say anything about anything that isn’t the connection between my baby’s mouth and my boob is a problem for me. The one I saw gave me a hard time about taking advil for my episiotomy.
In which case the line to use is that pain increases adrenaline and cortisol levels and decreases oxytocin.
So taking safe analgesics will be beneficial to the nursing relationship.
Or you can tell them to take a long walk off a short pier, if you prefer to play it that way.
Either way, if your physician has recommended a medication, a LC telling you not to take it is sailing awfully close to the line of practising medicine without a licence, IMO.
Yes, at 6 months nursing is either established or not established.
I followed your link…ugh. What trash. They seem to equate sleep training of any sort with leaving your child in a closet for hours screaming. It is almost like they want new mothers (and not fathers, because of course they want the women breastfeeding exclusively) to be sleep deprived zombies. Why? Why do they want to punish those poor women? What do Tracy Cassels, Wendy Middlemiss and Darcia Narvaez have against mothers? Is it “Omg, you had the gall to reproduce/have sex/be a woman/wear pants/eat a salad, so you must pay the price! Hope you hate every minute of it, and become so sleep deprived that you hallucinate and get depressed and decide you are a horrible mother and realize that WE were right and you can’t hack it, you trollop!”
Maybe they are smarting from that whole “women can work AND have families” thing…I don’t know how old they are. Something like “You wanted a family? Here’s your family! Now you will never leave the house! HAHAHAHAHA! You thought you could have it all, you arrogant ambitious feminist!’ Is that it?
I’d take issue right at the beginning of Paragraph 2: “Life outcomes for American youth are worsening, especially in comparison to 50 years ago”
Says who? What “outcomes?” Crime is at an all-time low. Crimes committed by youth are especially low. Death rates for youth from all major causes have dropped through the past couple decades. The teen pregnancy rate has plummeted 40% since 1990. More youth are graduating high school and starting college, and fewer are using drugs. IQ scores continue to creep up with each generation. The only thing that’s wrong with kids today is that they can’t get good jobs, and that’s only because the global economy is in a semipermanent slump.
Further, the author does not present any evidence of a connection between the parenting practices she urges (which were actually much more common a generation or two ago) and any sort of long-term outcome.
I couldn’t make heads or tails of the slides. But the photos of happy, well-adjusted African mommies and babies were pretty.
Wow. I never looked at the slides before. What a jumbled mess. If someone presented slides like that in my field, I think we might all start throwing pieces of conference-donut at her,
I’m sure the talk made it all much more comprehensible. (Note: This may or may not be snark.)
It’s Darcia Narvaez…she’s ALWAYS banging on about this crap. I don’t think she even has children. Take anything she says with a grain of salt, she has a very clear agenda and no interest in reality.
http://skepticalmothering.com/2011/12/13/the-dangers-of-being-insulting-and-misleading/
Here, this is hilarious and gives a good idea of what Ms. Narvaez is all about.
I read the comments from that article and one person was trying to say that if you followed sleep trained children for 20 years you would find that they have anxiety, depression, obesity, and diabetes. Really? How common is it for people in their 20s to have diabetes? Not to mention, how does everyone’s pet parenting style seem to prevent all these same things?
And what about all the criminals? I thought they were all sleep trained?
Darcia Narvaez can just *expletive deleted* right off.
I have a four year old who has slept through the night from 5 months and whose bed time consists of putting on PJs (currently rocking a dinosaur outfit with tail), a cuddle, turning on night light and sleepy music and saying “sleep tight, see you in the morning”.
Like most sane people we did what worked. For us is was a planned, pre-labour CS, exclusive BF for 14 months, baby food from jars or homemade depending on what was convenient, using a push chair not a sling, giving the kid her own room from 3 months and sleep training her from the point where I thought it was appropriate.
She’s perfectly awesome as is.
I don’t want to jinx myself with the current baby, but my kids have had a very similar sleep patterns. Currently, I nurse my 11-month-old to sleep at night, brush her teeth, and plunk her down in her crib by herself for the night at 9:30. I see her again sometime after 8 AM. She really honestly doesn’t need us at night–she’s asleep.
Oddly, our 11-year-old has gotten much needier at bedtime over the past several years. She’s the most prone to popping out from her room and disturbing grownup TV time and needing reassurance. I partly blame that on several memorable episodes with huge cockroaches in our last apartment last year (it’s Texas–the big outdoor cockroaches are wildlife).
Yeah, also I have two sleep trained children in their 20s and neither of them have any of those problems.
Let’s not forget what the Center for Children and Families is all about, either:
In other words, the research done there is expected to reflect a particular world-view.
Contact: Darcia Narvaez.
Hmm that name sound familiar.
It proves nothing at all. Darcia Narvaez is a thinking mom’s worst friend. No one could possibly comply with her parenting standards, but the good news is, you don’t have to. Those standards are made up, guilt-inducing bullshit developed on the basis of nothing at all.
I don’t know what Narvaez’s damage is, but the evidence suggests that if you don’t do what she suggests, nothing determinable will happen. Darcia will weep inside for your baby, but, as a parent, you have no responsibility to keep that from happening. Of the two – Darcia and your baby – Darcia will probably suffer more.
Do you suppose she has no children because she’s selflessly realized she could never live up to her own standards of parenting and has decided not to inflict the inevitable harsh upbringing on a child? I mean, she wouldn’t want any more children to suffer, right? Or do you think it is because she’s such a self-righteous jerk that no one wants to reproduce with her?
She’d be someone pretty scary to reproduce with, since she has such strong opinions on raising children already. Unlike the rest of us who partnered up with people where we enjoy their company, respect their opinions and believe them to be kind hearted, she also has to find someone that is also wants to support her in her particular brand of parenting. Much easier on the rest of us who have just been muddling through together, altering preconceived ideas and trying to get to know our little ones. She’s already fixated on a certain course regardless of partner, circumstances and her children’s individuality.
True dat!
I just…
I mean can you imagine that conversation, where you get to the point in a relationship where you talk about whether or not you want kids* and Darcia brings out AP as a deal-breaker.
*DH and I have been together since I was 19- that conversation went “Do you want kids one day?” “Uh…eventually” “Me too! Let’s worry about the details later and try not to have one in the meantime”.
She seems to believe that her problems with social anxiety were caused by her parents leaving her to cry it out as a child.
“Ill-advised practices and beliefs have become commonplace in our culture, such as the use of infant formula, the isolation of infants in their own rooms or the belief that responding too quickly to a fussing baby will ‘spoil’ it,” Narvaez says.
She’s obviously inhabiting a timewarp stuck in 1965.
The only reference I’ve EVER heard to “spoiling” a baby has been in educational literature advising that babies can’t be spoiled.
Obviously you do not spend enough time reading parenting manuals from the Victorian era.
That must be it!
“The only reference I’ve EVER heard to “spoiling” a baby has been in educational literature advising that babies can’t be spoiled.”
I think it is a holdover from decades ago when parents were warned not to hold their children too often, or “coddle” them too much because it would hinder their independence and make them “weak”. This hasn’t been “official” advice for quite a long time (since the 1950’s or so?), but it is still the common belief in certain regions/among certain socio-economic groups.
For instance, most of my family still subscribes to this belief – that if you pick up your baby to comfort them when they cry (and all of their physical needs have been taken care of) then you are “spoiling” them and teaching the baby how to “manipulate” you.
In another gaffe, on Gordon’s original blog post Jeanette McCulloch (who was responding to comments and who is now listed as “MANA Community”) tried to defend MANA’s not releasing their stats by citing two other orgs with databases, including the British Columbia Perinatal Registry. Thing is, the BC Perinatal Registry releases quarterly reports to the public including–guess what?–perinatal deaths.
Sense and Sensibility never let my question through regarding which journals the “in-press” articles were going to be published in.
They will do and say anything to avoid letting the public in on the death rates.
I posted the petition on my FB page and got some of my friends signing up 😉
I hope this will lead to something soon.
You are very brave.