Henci Goer: Sure, homebirth is dangerous in reality, but what about in theory?

What if analysis

I almost feel sorry for Henci Goer. She has styled herself an advocate of evidence based obstetric practice, but the evidence continues to mount that homebirth, which she supports, increases the risk of perinatal death.

What evidence?

  1. Well, there’s the CDC data on planned homebirth, collected since 2003, that consistently shows homebirth to have a death rate 3-7X higher than comparable risk hospital birth.
  2. There’s the data from Colorado that shows that homebirth has a death rate more than 15X higher than expected.
  3. There’s the data from Oregon, probably the most definitive American dataset, that shows homebirth has a death rate 9X higher than comparable risk hospital birth.
  4. There’s the Birthplace Study from the UK, rigorously controlled for all possible risk factors, which still showed that homebirth increases the risk of adverse outcomes.
  5. There’s the Grunebaum study that shows that homebirth increases the risk of 5 minute Apgar score of 0 by nearly 1000%.
  6. There’s not a single study of homebirth with a CPM (certified professional midwife) that shows it to be safe; the Johnson and Daviss study is a bait and switch.
  7. The Midwives Alliance of North America (MANA), the organization that represents homebirth midwives, has been hiding its own death rates for nearly 5 years, while simultaneously boasting about the low rate of C-sections and interventions in the same group.

But Goer is still out there gamely trying to put on a brave front. This is especially impressive since she tries to have some integrity. Unlike MANA and its executives, who simply issue bald faced lies, and refuse to correct them even when it is pointed out they are lies, Goer tries to stick to the truth.

And now she’s been reduced to this: acknowledging that in practice homebirth increases the risk of death, but wondering what might happen theoretically.

Her latest piece of the Lamaze International blog Science and Sensibility is Safe at Home? New Home Vs. Hospital Birth Study Reviewed by Henci Goer.

The paper Goer reviews is yet another that shows that homebirth increases the risk of death. The paper is Selected perinatal outcomes associated with planned home births in the United States by Cheng, Snowden, King and Caughey. I had the pleasure of participating in a panel with Dr. Caughey at the ACOG conference in Maui and reviewing the dangers of homebirth.

The study looked at 2,081,753 births term singleton live births in 2008 in the United States. Of these, 12,039 births (0.58%) were planned home births. The authors found:

Women who were multiparous,35 years old, of non-Hispanic white ethnicity/ background, married, and college-level education or higher were more likely to have planned home births. Women who had planned home births had lower rates of obstetric intervention than those who gave birth in hospitals.However, neonates of planned home births were more likely to have critically low 5-minute Apgar scores (<4) and seizure activity, both of which are known prognosticators of neonatal death and poor neurologic outcomes such as cerebral palsy and longterm developmental impairment.

Goer doesn’t really quibble with the fact that the study shows that in practice, homebirth increases the risk of adverse outcomes. Instead, she tries to divert attention away from reality by musing about theory.

Goer claims:

To begin with, the relevant question isn’t the tradeoffs between planned home birth per se and hospital birth. It is: “What are the excess risks for healthy women at low risk of urgent complications who plan home birth with qualified home birth attendants compared with similar women planning hospital birth?”

That’s nothing more than wishful thinking. Goer’s target audience is women considering homebirth. They want to know whether choosing homebirth puts their babies at risk. In other words, they want to know what actually happens. It makes no difference to them whether homebirth might be safe in a theoretical world that doesn’t exist.

Goer is shocked, shocked that women with high risk conditions are giving birth at home:

Not all women planning home birth were low-risk. For one thing, women with prior cesareans were included. For another, the methods section states that the analysis adjusted for medical risk, and the discussion notes that women with prior children in the home birth group were more likely to have babies with low Apgar scores even after removing women with medical risk, which implies that some of them had medical problems.

Yet, I’ve never seen Goer criticize MANA or the many state groups of CPMs who consistently lobby for increasing scope of practice to embrace high risk conditions.

And Goer is shocked, shocked that not all homebirth midwives are actually qualified to represent themselves as midwives:

Not all women in the home birth group had qualified home birth attendants. Outcome data on the overall population came from women recorded as being attended by MDs, DOs, “other midwife,” “others,” and “unknown/not stated” as well as by professional midwives.

But that’s hardly the problem. “Professional” midwives, such as CPMs have hideous homebirth death rates.

Then, as homebirth advocates typically do, she cites studies from foreign countries that have higher standards for midwives, dedicated transport systems, and greater integration into the hospital system. Look, look, see the Netherlands and Canada!!! Well, in the first place, we are not talking about those countries, and in the second place, the Netherlands has nothing to boast about. Low risk births attended by midwives (home or hospital) have HIGHER death rates than high risk births attended by obstetricians.

Goer’s conclusions are rather bizarre, since they aren’t supported by anything she presented:

Women desiring home birth should have access to professional midwifery care, which argues for making CPMs legal in all 50 states.

But legal, licensed CPMs in Colorado and Oregon have extraordinarily high death rates, so that’s obviously not the answer.

Second, less than optimal candidates are birthing at home, and some women may be continuing labor at home who shouldn’t… [H]ospital-based practitioners need to address the behaviors, practices, and policies that drive women away from hospital birth.

No, Henci, that conclusion is unfair to the women choosing homebirth in high risk situations. They are not deliberately choosing unsafe birth. They’ve “educated themselves” to believe that homebirth in high risk situations IS safe, in part by reading pieces such as the one you have just written, and by listening to the counsel of CPMs.

The correct conclusion is precisely the opposite: Homebirth proponents like Goer need to address their own rhetoric to determine why women are reaching the erroneous conclusion that homebirth is a responsible choice even in high risk situations.

Personally, I would have written a shorter, crisper analysis of this study:

  1. It is yet another study that shows that planned homebirth in the US increases the risk of death.
  2. It is very valuable because it represents the real world risk that women should contemplate when choosing homebirth.
  3. It doesn’t matter whether homebirth is safe in some other country or in some theoretical world that doesn’t exist.
  4. We need to have much higher standards for midwives; the CPM is grossly inadequate.
  5. Homebirth midwives and advocates need to do a great deal of soul searching to determine where women are getting the idea that homebirth is safe in high risk conditions.

I feel for Goer. She’s staked out a position that homebirth in the US is safe, and it clearly is not. Unlike MANA and other homebirth advocates, she appears to have some integrity. Therefore, she should start telling women the truth. Homebirth in the US increases the risk of death compared to hospital birth. Unless and until she does that, Goer is part of the problem, not part of the solution.

  • JaneT

    Anyone who cares to widen their thoughts beyond themselves: Michel Odent “Childbirth and the Future of Homo Sapiens”
    Discussions and arguments can exist beyond our own reality. I’m disappointed that my views in the wider sense have been reduced to me being seen as refusing c sections to save lives, preferring that disabled people’s weren’t in existence, infertile couples should remain just that, and decreeing that all people should come out a vagina irrespective of individual circumstance.
    Stop individualising and start thinking of the bigger picture.
    And btw the main person of privilege here waxing lyrical about things that don’t concern her and mean little to the people it really matters to, is Amy Tuteur. A woman of her intelligence could be making a real difference instead of writing a blog that single mindedly expresses views based on only her own world view.

    • Dr Kitty

      “Stop individualising and start thinking of the bigger picture”.

      Ok, why don’t YOU?
      Most women in the world give birth without the benefit of proper sanitation, without analgesia, no skilled attendant and without drugs to prevent haemorrhage.

      Millions of women don’t have access to wanted contraception.
      Thousands are dying from unsafe abortion.

      Instead of feeling sad and handwringing about “unnecessary” interventions in a very small minority of women (the majority of whom have excellent outcomes and are happy with the decisions made during their pregnancies) why not worry about ensuring the majority of women worldwide have safe deliveries of children they want to have?

      Or is that TOO macro for you?

      • JaneT

        No Dr Kittycat it is not. But this blog entry was not about that. I was responding to the topic: based on 1st world studies of 1st world women.
        This is like banging my Neanderthal head against a big ol brick wall.
        Bring on the day that Dr Amy does write a blog that induces thought and discussion to what really matters as you have eluded to above. I’m picking we’ll be waiting awhile.
        FFS this is bizarre.
        PS my name is clearly Jane – I clearly own what ever the trick it is I am saying. I don’t use my MD to show how relevant I am, I don’t use my PhD to elude to how clever I might be.
        Just Jane, plain and you’ll all love this… Simple.

        • DaisyGrrl

          It’s allude, Jane, not elude. Allude means to indirectly refer to, while elude means to evade. If you’re using your PhD to evade or escape your cleverness, you’re certainly succeeding. I generally try to avoid correcting usage on blog comments, but if you’re trying to convince us you’re an MD or PhD, please please please watch your usage or we’ll never believe you.

    • Amy Tuteur, MD

      The only people who pay attention to Odent are gullible NCB advocates such as yourself. He just makes stuff up:

      http://www.skepticalob.com/2013/06/just-what-we-need-another-old-white-male-mansplaining-birth-to-us-women.html

      • JaneT

        You are seriously going to quote your own blog as evidence?
        And none of the people you read, quote or epitomise make stuff up? They’re all solid I take it?
        Just the man that’s spent 50 yrs researching birth that makes stuff up. Oh and every other ‘NCB’ as you put it.
        Shame on them for spending a lifetime dedicated to harm. Makes no sense either coz there’s no money in NCB. Private Obs though, a bit of money to be made in that so I’m told.
        I’m glad you’ve pitched in though – your readers are raising extremely pertinent points about the state of childbirth across the world, so would clearly love your insights into how to better achieve better outcomes across the globe.
        If you really care Amy you would blog on the ins and outs of the lot, not just hate on the natural childbirth movement.
        I imagine there is inherently some sense in what each other are saying. Go figure, more than one way to skin the cat.

        • Amy Tuteur, MD

          Yes, I am quoting my own blog because what I wrote is true. If you want to rebut it, please present some actual facts.

          There’s no money in NCB? Are you living under a rock? Midwives, doulas and childbirth educators make money from NCB, not to mention authors who write for laypeople like Michel Odent.

          Odent hasn’t spent 50 “researching” birth. What research supports his claims?

          • JaneT

            No one here bar you, as you say, has presented actual facts, they have all eluded to stuff the same as I have. So Amy, in order to better get my head around this whole hood winking that I have unwittingly been a party to, please tell me, who and what do I read, because I will read it.
            And this is a really honest question, not glib, or antagonistic – what is it about natural childbirth – the process, not the ‘movement’ – that you find untenable?

          • Amy Tuteur, MD

            In other words, you have no actual facts to present. You can’t even defend your claims about Odent. I’m not surprised. NCB is about belief, not facts. Most of what NCB advocates think they “know” is false.

          • JaneT

            Like I say, head me in the right direction, somewhere other than this blog.
            So none of the research or literature gathered together in Odents book are relevant? None of it?
            Or are you saying it is relevant but in this case chosen to back his point only? Coz that happens right?
            And I can defend my claims when I am home and can access literature. Surely I’m not expected to quote pg numbers from the park?
            Boy you set a hard yardstick for blog rebuttal rights I must say.

          • JaneT

            You wrote a book for lay people. Ooh but let me guess that was different – what you wrote was ‘true’.

      • JaneT

        So you find absolutely nothing of interest in epigenetics and the possible relationship between what happens at birth and the plethora of modern day physical and mental epidemics we face in the 1st world? That field of science is nonsense you are saying?

        • Trixie

          Actually, virtually every type of epidemic is on decline in the modern world, despite the fact that there are now more people alive than ever before. Thanks to science! What epidemics are you talking about that could possibly be explained by mode of birth?

          • JaneT

            Obesity on the decline? Autism in the decline? Primary school shootings on the decline? Rape, murder and child abuse on the decline? MRSA on the decline? In the developed world?
            Think again Trixie. Polio is the least if our worries.

          • Trixie

            You’re right, Jane. C-section babies grow up and become fat, autistic homicidal rapists. They should have died in utero rather than be allowed to be born. I’m sure you’ve got stats to back that up?

          • Young CC Prof

            And yet infant mortality goes down every year, down 50% over the past 30 years in the USA, and life expectancy goes up every year.

            Murder is also on the decline. The murder rate hasn’t been this low in 100 years. (Unfortunately, we can’t get accurate statistics on rape or child abuse due to rampant non-reporting, which was probably worse in earlier eras.)

            MRSA is not a new plague, it’s an old and familiar enemy which is not responding well to antibiotics. I can tell you, I’d rather have MRSA today than regular Staph 100 years ago.

            School shootings aren’t a new problem either, and autism is an old, old problem with a shiny new name. Do some actual research.

            The only genuinely new problem you’ve cited is the obesity epidemic. Guess what, that’s what happens when we all have plenty to eat and most of us have sedentary jobs.

    • KarenJJ

      ” I’m disappointed that my views in the wider sense have been reduced to me being seen as refusing c sections to save lives, preferring that disabled people’s weren’t in existence, infertile couples should remain just that, and decreeing that all people should come out a vagina irrespective of individual circumstance.”

      But this is what you’re left with once you remove medical technology. I do not understand your point. You don’t want many women to be having c-sections, disabled people or chronically ill people to receive medical treatment and infertile couples to receive medical assistance because YOU don’t like it for the reason that the human race will start relying too much on medical technology?

      Too bad. The people that are relying too much on medical technology may have their own reasons for wanting access to medical treatment. I’m sure you wouldn’t want your access to medical treatment restricted ‘for the betterment of the human race’, why should anyone else’s?

    • DaisyGrrl

      If your views in the wider sense have been reduced to an absurdity, it’s because you have failed to put forward an otherwise coherent argument. You’ve insulted people for not giving birth in a manner that is acceptable to you without bothering to understand why these women make the choices they made. What is this bigger picture you speak of that is harmed by medical intervention in childbirth? I only see decreased maternal and neonatal mortality and morbidity. Do you want women or their babies to die for lack of intervention? Is permanent disability preferable to an induction or c-section? I’m really struggling to see your perspective without coming to the conclusion that this is indeed what you want.

      • JaneT

        Who did I insult when? Really? I have never made any statement other than let’s use technology wisely.
        You people are acting small minded. To think an entire nation of you lot are “The leaders if the free world”.
        And thanks so much for helping with my spelling. My bad.
        And the epidemics that might, just might be related… there are a few.

        • Box of Salt

          JaneT, take a step back and re-read your own words.

          Do you really think “advances in medicine that mean we can get labours sped up, women anaesthetised, and deliver our genetically engineered off spring by surgergical incision” suggests “let’s use technology wisely.”?

          Do you?

    • Box of Salt

      JaneT who complains “I’m disappointed that my views in the wider sense have been reduced to…”

      I am posting this many hours after initially reading your new comment, and without reading the other replies.

      If you are disappointed in how your views were received–well, you need to either reconsider your views, or their delivery.

  • JaneT

    I agree – why all the fuss about giving birth! Why push the point any further. What we need to do is go to hospital, get augmented, and have c sections, for as long as it takes – which won’t be long thank goodness – for humans to become completely incapable of giving birth without the aid of medicine and surgery. Then at least we can get down to focusing our attentions on things like ADHD, allergies, cancers, autism, childhood obesity and the like: the real issues of our time. Because let’s face it, thanks god for advances in medicine that mean we can get labours sped up, women anaesthetised, and deliver our genetically engineered off spring by surgergical incision.

    • KarenJJ

      Humans already are incapable of surviving without other humans and without using technology such as fire and clothing. Do you also argue against cooking and clothing?

      • JaneT

        Like I say – cut them out. No sweat. But when your children’s children are reaping the rewards of these wisely sown seeds of advancing technology – you’d better be ready. Without birth, we are not here; to my mind there is a likelihood that how we are born actually matters.
        And to compare using fire and clothing to enhance survival, with literally choosing, when it is without cause, to cut babies from our bodies, is moronic.
        To continually only find trust in intervention and advancing technology is at our peril I believe. A modicum of respect for nature wouldn’t be misplaced in this ridiculously crazy world we live in.
        And, I’m pretty sure that getting clothed never saw women being cut open to their very core in the process.

        • moto_librarian

          Sigh. Do you really believe that Dr. Amy and the people who comment here regularly are actually advocating for ALL women to be induced/sectioned? Would you really prefer that we went back to the way things used to be (and still are in the developing world) where childbirth was the number one killer of women? As it is, the primary rate for c-sections is only 15-20% in the states. That 40% that is routinely trotted out by NCB ideologues is for ALL sections, including repeats. Not every women wants to have (nor is a good candidate for) a VBAC.

          • JaneT

            Sigh no.
            Do you seriously believe the reverse of NCB advocates.
            Clearly you do.
            Double sigh

          • Wren

            In many cases, yes, I do. The NCBers who advise against prenatal testing that could inform the decision to have a C-section do so in large part because it might lead to a C-section. The NCBers who chastised me for having a C-section when my son was in a footling breech position, which carries a significantly higher risk of death or brain damage in a vaginal delivery than other positions were advocating for me to risk my child for no reason other than avoiding a C-section.

          • Young CC Prof

            Side note: Even without a c-section, how do you not know if your baby is breech? I haven’t been kicked in the ribs ONCE, only along the bikini line. Even without any testing, if you know anything about pregnancy, if your baby is persisting in a bad position, you’d have to realize it.

            Of course, you wouldn’t know about various placenta or cord issues that could be just as dangerous in a natural birth. No one would know until the bleeding started…

          • Wren

            Mine turned at term, when big kicks were difficult. A GP, a midwife and an OB all missed it, though a med student caught it but was told he was wrong (the GP later apologised to him). He was head down through most of the pregnancy. We know when he turned (that sure was hard to miss!) in retrospect, but at the time I was a first time mother who thought I was going into labour, then didn’t.

          • Young CC Prof

            Yes, I can see where babies who turn at the last possible minute could confuse people. That happens occasionally.

        • Meerkat

          Without evil C-sections there wouldn’t be children’s children to reap the technological rewards of the future. Because these children would have died during labor or received brain damage.

          • KarenJJ

            I’ll just quietly remove myself and my children from the gene pool then and let this style of “natural” advocate get on with her eugenicist utopia then.

          • Jennifer2

            Without evil c-sections, I wouldn’t have been born, and therefore my 3 year old wouldn’t have been born (vaginally) and been able to use an iPad or to sassily tell me “no mommy, that’s the mouse!” when I reached for the mouse and told him to move from the desk chair because I needed to use the computer. Or is that not the “children reaping technological rewards of the future” that JaneT was talking about?

        • Trixie

          So, if I am too nearsighted to have survived as a hunter-gatherer, would you also argue that I shouldn’t breed so as not to pass this condition on to my children? Even though science has invented corrective lenses?

          Also, you do realize that most c-sections are performed for reasons that are not necessarily inherited, right? Just because your mom had placenta previa doesn’t mean you won’t be able to give birth vaginally.

        • Meerkat

          I wasn’t cut to my very core. I had a tiny incision and now, a year and a half later, it is practically invisible.

          • KarenJJ

            That’s because your ‘core’ would be your brain, heart, soul etc. I, personally, believe my ‘core’ is the 10cm wide, and maybe 2mm high, piece of skin and uterus lining that sits in line with my hips. Damaged forever by the evil scalpel. Oddly enough the other surgery I’ve had never damaged my core, it was only the c-section..

          • Meerkat

            I think my core my vigina. I am so happy my vigina is the same nice shape it used to be. (Joke)
            Seriously though, what would have happened if you didn’t have the C-section? Would the risk of something awful happening be worth it?
            Maybe I am too overprotective, but I wasn’t ok with any degree of risk to my son. It is and will be my job—always—to protect him.
            I prefer to think that my “core” is love. I don’t want to think that aging, sickness, or surgery will destroy my core. I would rather believe that nothing will.

          • JaneT

            Meerkat are you serious??? Holy shit balls you are indeed speaking like a moron.
            Ladies, a plate.
            I am never going to have a reasonable conversation with you.
            I am not and never would be advocating leaving women and babies to die. I am not and never would be advocating we take leave of every discovery and advance that has been made across time. I NEVER suggested that for those in need scientific advances should not be theirs to make use of.
            For you people to really think so basically about my comments is quite insightful of how your minds think.
            Before I take leave of this weird little website dedicated to those who’d hate to believe in the power of themselves, I will reiteterate: how we are born matters. WHERE there is the choice we should make it carefully.
            Honest to goodness I am astounded at how personally and single mindedly you people are approaching the process of EVOLUTION.
            Jane

          • JaneT

            PS
            Saved at birth by modern forceps
            Saved in infancy by modern medicine
            Mother of 2 born via c section when completely stuck in labour
            Owner of silicone bags to enhance chest
            Wearer of hair extensions and acrylic nails.

          • Guestll

            You really are a privileged tool, and you don’t even know it. All fine and well for YOU to be saved, but please, keep dictating what should be other women’s choices.
            Speaking of choices, why don’t you come with me on my next trip to SSA? Would love to hear you humble yourself in front of women who lack the choices you so cavalierly dismiss.

          • JaneT

            So you advocate for elective c section for no medical reason in low risk women in first world countries? You advocate for limiting labour to 12 hours in spite of progress in low risk women in low risk settings in first world countries? You advocate using antibiotics ROUTINELY in low risk situations, in low risk women in first world countries?
            How in the hell is that going to help the women you speak of?
            For the love of god people! Listen to what I am saying. I am not advocating not using anything. I am simply saying use it where and when it is needed!
            BTW if so many first world women weren’t taking advantage of technology in cases where it is not needed, maybe the women you deal with would stand a better chance.
            How can you not get that I simply advocate the judicious and wise use of these things in the care and respectful treatment of women and babies.

          • Guestll

            You know what I advocate for, Jane? Choice. Even choices I wouldn’t make for myself. A section by choice is by choice. The Friedman curve/partogram exists for a reason, and nice straw man on the “limiting labour to 12 hours” — please demonstrate where this is routine and cite your sources. Antibiotics used in low risk situations — I have no idea what you’re talking about, but if it’s GBS+ status then yes, absolutely. Know why the rate of neonatal sepsis has declined so precipitiously in the US and Canada? Three guesses, first two don’t count.

            “BTW if so many first world women weren’t taking advantage of technology in cases where it is not needed, maybe the women you deal with would stand a better chance” — WRONG. You clearly have no clue as to the challenges of MNCH in developing countries — political, cultural, economic — zero to do with the L+D choices women make in developed countries.

          • JaneT

            Agree. I was being defensive. I do have an appreciation of the challenges all sorts of places in the world face. I have an idea of the disenfranchisement of people in their indigenous state, I have an appreciation of travesties committed all over the world on a regular basis. I have an appreciation don’t worry about that. The humble women that are thankful for some health, a healthy child, and a place to be, should make those of us more fortunate in that regard more contemplative about the very real choice we do have, and to that end we should choose wisely and with respect.
            My opinion.

          • Guestll

            And Jane, I am going to repeat something I wrote to someone earlier tonight, and maybe this will help you understand:

            There is stratification even in extreme poverty. Women
            talk about birth wherever they go. They ask about your experiences.
            In the less poor areas, they ask, were you in pain, were you in a hospital, did you get an epidural/peridurale? In the poorer areas, they simply say, Oh,you are safe, and baby too?
            They don’t have choices, Jane. You do. I do. The choices I make are none of your business.

          • JaneT

            So when a woman has an IUCD and asks for an elective c section and is refused as it is too risky? Where is our beloved choice in that?
            You are completely correct – your choices are none of my business, and vice versa. BUT the choice each and everyone of us make each and every day has an impact further down the line. And in regards to childbirth – some of it is being over medicalised and we will simply lose the ability – even if we wanted to – to labour and birth effectively without intervention.
            Re the Friedman curve – I never said it was routine to limit birth to 12 hours, I referred to the increasing trend to decrease the time we allow women to give birth before we are intervening.
            I think as women we deserve better than to be hoodwinked into believing that without technology we cannot safely and happily birth our children. I think at we will look back in time and see treatment of women in the name of ‘choice’ as being one of the great travesties. Twilight sleep was a choice – looked freakin awful to me. Who’s to say that our children’s children will not look back and mourn birth, be horrified at the fact that over 50% of them (in some places and no I do not have my refs ready to cite) were cut out of semi paralysed women.
            Others of course will feel blessed that they are in existence thanks to the above… My guess is that those numbers will be smaller.
            We employ these advances on women ADHOC without trial or research. We collect retrospective data and realise it was not such a good ‘choice’ and then we mourn that it happened.
            Again, as I also said earlier – ease use wisely and with keen regard to women and humanity.

          • Trixie

            Are you arguing against the use of antibiotics for GBS in labor? Because that would be a stupid argument. Babies die from that.

          • Meerkat

            Silicone breasts, and hair extensions, and acrylic nails, oh my! What would Darwin say???

          • Meerkat

            Ok, I will bite. If how we are born matters, what does it mean for my son who was born by an emergency C-section? Wait, I see that in the comment below you say that your children were born by C-sections??? What does it mean for your children? And how does evolution factor into your argument? Evolution made it harder for women to give birth because modern humans’ brains (and heads) increased in size over millions of years. I hate to break it to you, but majority of C-sections (even scheduled ones) are not elective. Women and doctors choose this option because in certain circumstances it is safer than vaginal birth. Also, majority of women in the US have health insurance. Health insurance is not keen on covering elective procedures, especially surgeries. Yes, wealthy can afford such extravagances, but I think the number of women getting elective C-sections without any reason to do so is very very small.

          • JaneT

            That’s my point – what does it mean for our children? Anything? Nothing? We have no idea yet.
            Drs do some c sections because it suits them. They’ve told me. Time factors and fear of not being able to control the outcome large consideration in the 5 I interviewed.
            And Darwin, if he discovered my remains would not comment as it would be a regular occurrence of the time. Nil of note here.

          • Meerkat

            Ok, the silicone boobs and Darwin was a joke, I was actually referring to your “EVOLUTION” rant. Never mind.
            So I am confused, please elaborate on what doctors told you. What did they mean by time factors? Were they late for their golf game? What did they mean by “not being able to control the outcome”?

          • JaneT

            Yes I got the joke – it was hilarious.
            As much as I love this debate you’re never gonna win so I’m out
            😀

          • Meerkat

            What? What? I thought I won! Oh no! Whatever shall I do with my evening?

          • Mindylou

            Meerkat is correct, we have been evolving larger fetal head sizes for thousands of years. Even the Neanderthal pelvic remains dating to the late Pleistocene show a modern human pattern of fetal rotation to move through the female pelvis . The problems we run into during childbirth involve rotational movements required to fit through the female pelvis and a larger brain/head size, a problem our primate cousins do not have. I fail to see the link between modern c-sections and the fact that for thousands of years our head/brain have evolved at a rate faster than the female pelvis width. Blame that on sex selection and better nutrition. C-sections are not a new thing either, having been performed as far back as the time of ancient Rome as a means to save the baby…not to save or convenience the mother since death was imminent once it was performed. Only since the 19th century have women been able to have a c-section and live to procreate another day. If the fetal head has become too large for vaginal delivery, it is the result of thousands of years of human evolution, not modern c-sections which are only a blip on the evolutionary timeline.

        • Mindylou

          I suppose you can tell by looking at random people on the street whether they were born vaginally or by c-section, since those who are born “naturally” and not cut out are obviously superior beings. I am 34 weeks pregnant with a partial previa and may very well need a c-section to deliver my son in the next few weeks, but I guess JaneT would rather the both of us die of blood loss, as a sacrifice on the altar of vaginal birth. By her “logic”, my son shouldn’t even be here because I had to use modern technology in the form of clomid to conceive him. Never mind the fact that my husband and I tried for over a year to start a family, or the absolute joy I felt when the stick finally turned blue. I guess since it wasn’t natural that wasn’t real happiness. I could care less about the birth experience. It’s not about me, its about getting my son here safely by whatever means necessary. The only part of the birthing process I am looking forward to is seeing his sweet little face, which from the evil modern ultrasounds I know will have his mommy’s nose and his daddy’s smile. When I look into his eyes for the first time, after waiting for him for so long, the last thing I will care about is what part of my body he came out of. That, JaneT, is what really matters.

        • theNormalDistribution

          Hey doctors in the comments – I never really learned anatomy; where is the “very core” located, exactly?

    • araikwao

      GMOs = genetically modified offspring. Tee hee

    • Trixie

      Do you realize how stupid you sound? Virtually everyone in modern developed countries should have already died at least once or twice by now.

    • The Computer Ate My Nym

      Give it up. Humanity has been dependent on technology since our great ape ancestors discovered that they could get more to eat by poking a stick into a tree and eating the insects that crawled out on it. In short, before there was any such critter as H sapiens.

    • Meerkat

      Oh, JaneT! How right you are! I agree. Let’s allow the nature to take its course in childbirth. Want paid meds? Too bad, they might be harmful! Cutting out babies is barbaric. We should let them die, just like nature intended. There are plenty more where they came from. Women, too. As long as we are at it, let’s forget those scary advances in medicine, and deny treatment to people with cancer, heart disease and diabetes. Nature clearly meant for them to die, so what are they doing, still hanging around here??? Same for preemies. People who are missing limbs don’t need modern prosthetics. Wooden pegs will do. We will hear them coming from far away! All right, you blindies, take off those glasses and contacts, cheaters! Your bodies are not lemons! Squint harder! Let’s also stop fluoriding our water, brushing our teeth, and visiting the dentist. Nature meant for us to loose our teeth by the time we were 30. It’s ok though, what do you think those naturally born children are for? That’s right, they will chew your food for you.
      Ok, what didn’t we cover? No antibiotics, of course, the fittest will survive all infections. Let’s just hope it is us, wink wink! No vaccines, because those are just pure poisons. Polio, flu, and tetanus will make Christmas shopping so much more relaxing, no crowds, am I right!?!
      As long as we are at it, let’s take care of other scary technological advances like plumbing (ever used an outhouse? I have, the aroma is so so natural!) electricity, washers, dryers, TVs, modern cosmetics, tampons and disposable diapers (washing your own rags and poopy diapers will be so liberating. Don’t forget to boil and iron them to kill bacteria). Your car. What about your clothes? Made in China, I suppose? With some synthetic fibers? With zippers? Take ’em off, cause they were manufactured using modern technology! No hair dryers, hair elastics or clips. Did you know women used thread to literally stitch their hair into the hairstyles? No birthing pools, no IVs, no disposable needles. No cell phones or tablets. Finally, no internet or computers. Why are you on the internet? It’s definitely modern technology. Very scary. Do you ever wonder what those electromagnetic waves are doing to your brain?
      This is a satire.

    • why do you care if women use technology or not?

      • JaneT

        Again you miss my point.
        I care that we open slather hand over humanity to science, medicine, and advancing technology. I care that we whole heartedly embrace being cut to pieces yet find digust and distaste in giving birth.
        I do not find anything so abominable in the use of technology. I find it sad that you guys find the thoguht of birth as beautiful in it’s own right, and a process of humanity worth protecting as so afronting that it is attacked as would be an enemy of the state.
        All I’m ever trying to say is use it wisely.
        We are on different pages.

        • LibrarianSarah

          Only the abled bodied and heathly can worry about shit like “handing over humanity to science, medicine and advancing technology.” I hate to break it to you but millions of people depend on them to live and function. All of your comments reek of the same eugenics bullshit I had hoped we got over in the 30s. I guess all us disable and sick people should just die off then like nature intended. Your privlege is showing Jane and it doesn’t look pretty.

  • ThunderMama

    Erm, I know someone personally who consulted Henci Goer on her HBAC. She should not be surprised. Goer told this acquaintance she was an excellent candidate. Luckily, baby was born without complications.

  • An Actual Attorney

    OT – UGH, now WHO is in on the game: http://www.who.int/mediacentre/news/releases/2013/philippines-breastfeeding-20131128/en/

    Feeding babies with formula in emergencies must only be considered as a last resort, when other safer options – such as helping non-breastfeeding mothers to reinitiate breastfeeding, finding a wet nurse or pasteurized breast milk from a breast milk bank – have first been fully explored.

    UNICEF and WHO strongly urge all who are involved in funding, planning and implementing the emergency response in the Philippines to avoid unnecessary illness and death by protecting, promoting, and supporting breastfeeding. Community leaders are called upon to monitor and report any donations that may undermine breastfeeding.

    • Kate B

      Oh, no, this is awful!

    • Young CC Prof

      And how about mothers who lose their supply due to the stresses of disaster, like not having enough food or water? Get to the emergency help station, be told, “Oh, of course we have food for you, but nothing for your desperately hungry baby who stopped even crying hours ago. I really hope your supply comes back after we feed you!” How about mothers who are killed or separated from their babies during disasters, how do you propose to keep those children alive?

      Of course, mothers who are currently breastfeeding successfully should be encouraged to continue, with extra food rations if necessary. But sealed ready-to-feed formula should be as basic as sealed antibiotic vials.

      • Trixie

        I think the WHO’s concern is that once the initial disaster relief efforts dissipate, the baby will have been weaned and then the mother will not be able to afford formula for the remainder of the time that the baby would need it. Or that the mother won’t have ongoing access to clean water. In other words, there are probably enough shipments of RTF formula for the first couple months, but then what?

        • Young CC Prof

          Oh, definitely. You want to make sure you support and strengthen existing breastfeeding relationships. But at the same time, aid stations have to be set up with the assumption that there will be some hungry babies for which no teat is available.

          Yesterday, we were talking about my aunt who became a wet nurse under emergency conditions: Hong Kong, 1947. Wall-to-wall refugees, another mother lost her supply from stress and hunger, and there was literally no other food available for either baby, other than rice flour paste. She couldn’t just watch the child die.

          Her biggest obstacle, of course, was food rationing, although at that point she had two families scraping the edges off their rations for her. But somehow or other, it worked. The other woman’s baby survived, though the families were eventually separated when my aunt and uncle got out to Australia. Their baby thrived and has two grown children of her own, both redheaded like their grandfather.

          In that situation, I’d like to think I’d do the same. But what if I can’t produce enough milk for two babies? What if the other baby has a disease that could be spread to mine? Not keeping formula just isn’t practical, and it doesn’t sound like the kind of decision someone on the ground could make.

        • rh1985

          In a situation where the mother cannot breastfeed in a disaster area, individual RTF bottles would be easier to store safely than milk from a milk bank. That is why I do not get prioritizing milk from a bank over sealed individual RTF.

          • Young CC Prof

            Exactly, that’s what bothers me. It’s promoting milk banks and milk sharing over RTF formula. Mother’s milk should be the first choice, but sterile formula should be second choice, and should be made readily available in a rescue effort.

          • rh1985

            Then again I haven’t had respect for the WHO’s breastfeeding position for a looooong time thanks to their aggressive pushing of things like the BFHI in developed countries where FF is perfectly safe. So this is really just another strike against them. I simply don’t get it. RTF is easier to store, doesn’t have the issue of contamination, and a lot of the frequently mentioned “benefits” of breastmilk would be absent in donor milk from a bank anyway. It won’t be uniquely made for that particular baby/age (as BF promoters often claim a mother’s milk is) and do we even know if most of the things like antibodies survive the process milk banks use?

          • Trixie

            Yes, most of the antibodies do survive. Not all of them, but most. It’s one reason why preemies do better on donor milk.

          • rh1985

            Thanks for answering. so I suppose the main issue would be refrigeration? Hopefully the little ready to feed formula bottles will be offered for areas where safe shipping/storage is not possible.

          • Young CC Prof

            Shipping under refrigeration, and coming up with enough banked milk in the first place. Here in the USA, we never have enough even for the preemies in hospitals.

          • Trixie

            Yeah, shipping is a huge issue, but availability of properly screened and pasteurized donor milk is an even bigger one. There just simply isn’t enough to go around even here in the US where we have a safe and established formal milk banking system. And it’s not cheap, even though the donor mothers donate for free, and the banks operate as non-profits.

          • Trixie

            While I agree that milk banks in the middle of a natural disaster are logistically challenging and possibly implausible, in a third world country, after a natural disaster, diarrheal illness is often rampant and, and in that situation, breast milk protects infants significantly better than formula. I’m thinking of Haiti after the earthquake, for example. Of course RTF formula is part of the answer and no baby should be denied food. But when you’ve got a high risk of people in horrible close conditions without basic sanitation, you’ve really got to think hard about how to keep getting breast milk into babies if at all possible.

          • deafgimp

            Well, Haiti didn’t have any natural reservoirs of cholera, which was what caused the diarrhea. The UN brought it over from Nepal and that is why the Haitians were dying of cholera.

          • Young CC Prof

            Cholera can kill a healthy adult in a few hours unless you get aggressive rehydration going. Generally when you talk about breastfeeding protecting babies against diarrhea, you’re talking about rotavirus or similar illnesses, the kind that don’t usually kill adults. Cholera in a baby is… *shudder.* Can’t imagine breast milk helps much, though it might reduce exposure to bad water in the first place.

          • Trixie

            I’m not in any way arguing that breastfeeding is enough to protect against cholera, but cholera wasn’t the only diarrheal illness happening, either.

    • araikwao

      Wait, how long does it take to re-lactate??! What is the baby meant to do in the meantime??

      • anh

        it’s my understanding that it takes a while and basically requires pumping or feeding around the clock. I honestly cannot understand how anyone could think it was a reasonable solution for a baby starving after a disaster.

  • Sandra C

    Interesting how experience and research results differ with the UK experience.

    • Cynthia Ray

      Thankyou. This isnt just theory. In other countries it is a theory that was tested into fact

  • Lisa from NY
    • Lisa the Raptor

      Aw, poor little pitiful things.

      • deafgimp

        Pitiful? That’s a sad way of looking at someone with a disability. These girls have a world of freedom available to them now that they are separated. The girl who uses a chair, that chair actually represents freedom to her, just as much as being able to walk is freedom for the other girl.

        • Lisa the Raptor

          Does not mean that I don’t want to give them a big old hug. Being born stuck to someone else is a terrible thing to have happen and I feel bad for anyone in that condition.

    • T.

      I am so terribly sorry for the baby… Still, better for both anyway. The children seem strong and brave young girls 🙂

    • MaineJen

      I have always wondered (but was kind of afraid to ask): how in the world did any set of conjoined twins, OR their mother, survive birth 100+ years ago??

      • deafgimp

        Well, Chang and Eng (the original Siamese Twins) were connected by just a bit of cartilage. Their livers were fused, but each one functioned separately. If they had lived in modern times, their separation would have been easy peasy. Because they were just connected by a little flexible bit of tissue, they were a fairly easy birth (I can’t imagine giving birth vaginally to babies that were conjoined with hard bones). When they died, One had gotten pneumonia then had a stroke. The living one tried to get himself separated but he waited too long and he died not soon after. My guess is he went septic.

  • Her explanation looks like cognitive dissonance to me. I anticipate Goer changing sides as the evidence mounts and she is given time to process the more shocking aspects of DEM attended homebirths.

  • Meanwhile in BC, this first time mom who wanted a hospital birth could not get access to a bed when she was in labour. We need to give our heads a collective shake. http://www.vernonmorningstar.com/news/180253651.html

    • Lisa the Raptor

      I remember this story. If I recall she was not dilated enough or some such, but was in active labor? This could have been me. I had been having contractions 9 minutes apart for 24 hours and my second birth once it was going was only 6 hours. I was scared that if I waited until they were 3 minutes apart it would be too late. Finally I just told all that to the midwife, and pretty much said, I have all the criteria for labor and these contractions hurt and have been 9 minutes apart for a day. She said, “Let’s induce and have a baby!” The idea that a woman is in labor but should be sent home is stupid. In the hospitals here if a woman comes in at a two and is at a 3 in and hour she stays. They don’t send her home and tell her to come back when she is at a 7.

  • Allie P

    “Women who were multiparous,35 years old, of non-Hispanic white ethnicity/ background, married, and college-level education or higher were more likely to have planned home births.”

    That says it all, IMO. Homebirth is privileged. It’s shocking that these college educated parents are more likely to deprive their own kids of brain function.

    • “were more likely”=/= monolithic group

      Here in Utah there is a lot of homebirthing mormons that fit the profile but they definitely aren’t what I would called privileged. They are pushed from day one to have as many children as god will give them, even if they can’t afford it. There is a high rate of college education here, but you’re still poor if you are college educated and have 7 kids. A lot of these women have midwives so that they don’t end up homeless from having to pay so much more at a hospital.

      • Awesomemom

        Um not so much. I happen to be LDS and the church leaders are very clear that the number of kids in a family is between the husband, wife and Heavenly Father. There is no pushing at all. Also we are very much encouraged to make full use of modern medicine along with prayer instead of prayer instead of medicine.

        • Lisa the Raptor

          I’m sure as with many religions there are small, extremists sects that should not be looked at and considered the norm nor a good example for an entire religion. I think that is whats happened here. I know some LDS members who use birth control to limit family size and modern medicine.

          Edited to add* There are sects of all religions that people end up having tons of kids, and LDS is not alone in this, but I would not say that there are “tons” of Mormons who are like this, just like there are not tons of Christians who are quiver full., but she might live in a neighborhood with literalness on all sides?

  • Susan

    Is this sort of like “if you don’t count Portland”?

  • Captain Obvious

    Homebirth in America with a CPM IS as Homebirth in America with a CPM does.

  • Amy M

    Totally OT: anyone here allergic to nuts, or have children who are? IF so, can you tell me some good resources? Friend of mine, her daughter just got diagnosed with nut allergies, she’s freaking out, so I’m trying to help by pointing her in the direction of websites, forums, support groups, books or whatever else could make her life easier. I found the FARE site, which seemed good.

    • KarenJJ

      Not a peanut allergy, but my ‘go to’ website for allergy information is the ASCIA website (Australian Society for Clinical Immunology and Allergy). They have some great resources, including general infant feeding advice. My immunologists have all been ASCIA members and have all been fantastic.

      There may also be similar for immunologists/allergists in the US. The reason I like it is that the information is directly from the Immunologists/Allergists themselves, and also they update their recommendations when they need to.

    • Mariana Baca
    • Teleute

      My son has a tree nut allergy. I keep up with allergic child on Facebook:

      https://www.facebook.com/AllergicChild

  • AL

    A little off topic, but in regards to the disaster in the Philippines, I donated to Doctors without Borders. I got this update yesterday as to what the money is being used for so far:

    “RESPONSE DETAIL
    On Samar Island:
    Doctors Without Borders has opened a 25-bed tent hospital in Guiuan. The
    facility includes an inpatient department, a delivery room, a maternity
    unit, an isolationroom, and a unit for sterilizing equipment. The team is doing 5-6 deliveries per day and around 40 minor surgeries.”

    Notice that they built delivery rooms and maternity units for the victims. No one is building birthing pools for these victims and shipping out useless midwives. I don’t think they care about the birth experience, these are people who want to live and want their babies to live. I wish people would see how fortunate they are to avail of modern medicine and how giving birth in a hospital with all the help you need should something go wrong is such a wonderful thing.

    • Captain Obvious

      And the stress these pregnant women are experiencing is not preventing them from going into labor.

    • araikwao

      Yes, but that’s because they’re eeeeevil doctors who just want to foist interventions upon these women so they can get paid more, right?

      Geez I hope giving birth in a natural disaster zone won’t be the next NCB stuntbirth to emulate.

      • AL

        If there was a Doctors without Borders set up and a woohoo midwife set up, midwife set up would be empty. I am originally from the Philippines (lived in the Philippines until I was 9), and know that the poor there (In Manila) go to the free or very minimal fee maternity hospitals which are run by DOCTORS to give birth. There is medical care available to the pregnant poor in the bigger cities.
        But…of course I found this BS. Looks like they are NCB’ers are invading the Philippines too and taking advantage of the poor anyway…but of course only with our tax deductible donations. http://www.mercyinaction.com/about-mercy-in-action/
        This makes me want to scream. Who knows how many babies have died because of these incompetent folks, and probably doesn’t get counted or reported because these women are poor.

        • Young CC Prof

          I looked at their education program: “Module 15 Newborn Complications.

          “Remember that when evaluating newborns, breastfeeding is your number one vital sign, meaning that if a baby can and will breastfeed it is probably telling you it is ok, and if it won’t, you should worry.”

          Funny, I thought the key thing to check is how well a newborn is managing to breathe. Of course, I’m not a doctor, what do I know?

          • fiftyfifty1

            “”Remember that when evaluating newborns, breastfeeding is your number one vital sign, meaning that if a baby can and will breastfeed it is probably telling you it is ok, and if it won’t, you should worry.””

            Newborns with developing sepsis can go from breastfeeding well to being dead within a few hours. But just as long as a baby feeds well at the beginning the homebirth midwife thinks her job is done. If a parent reports that the baby will no longer feed they will dismiss it as “oh babies go through a sleepy stage that starts a couple of hours after birth, this must be normal because he started off feeding fine”. If I remember right, something like this is what happened to both baby Wren and Mary Beth. That’s why it’s important to have trained medical professionals around during at least the baby’s first 24 hours. Signs of newborn distress are subtle unless you know what you are looking for. You need to take frequent vitals. *Especially* if Mom’s GBS status was positive or unknown.

          • Sue

            Airway
            Breathing
            Circulation
            Disability
            Exposure
            .
            .
            Feeding??

          • Dr Kitty

            DEFG- Don’t Ever Forget Glucose!
            Hypoglycaemia in a neonate is not good.

            Some CHD babies will feed- but turn blue doing it.
            Is that on the CPM list of things to worry about?

    • Zornorph

      Unfortunatly, some lacto-nazi in the Philippine Ministry of Health is refusing pre-mixed formula, insisting that mothers should just re-lactate or find a wet nurse to feed their babies.

      http://gulfnews.com/news/world/philippines/phlippines-nursing-mothers-urged-to-breastfeed-babies-in-typhoon-hit-areas-1.1255115

      • Young CC Prof

        That is pretty darned stupid. I was particularly fond of this line:

        “We are also not sure if the water used to prepare formula milk is clean.”

        Right, because internationally transporting breast milk into a disrupted infrastructure while maintaining an uninterrupted sterile cold chain is SO much easier than sterilizing water, or just delivering sealed packages of ready-to-feed.

        How about we go back to disaster basics, eh? Provide shelter, clean water and sanitation, deal with the wounded, guard against epidemics, and make sure everyone has SOMETHING suitable to eat. If you don’t provide formula, mothers are going to start improvising out of whatever they have, which will be far less nutritious.

        • Allie P

          True. After the Haitian disaster, I remember hearing reports of babies who died after their mothers fed them what they had, which was Seven Up.

          • KarenJJ

            What an awful, desperate situation to be in 🙁 How government officials can deny these babies milk is beyond my understanding.

      • rh1985

        even WHO said premixed is fine if needed….. fail

      • An Actual Attorney

        That’s infuriating!

      • AL

        Absolutely ridiculous. Similar to the way it is in the US, that is another elitist point of view of course by that idiot government official who is probably corrupt and part of course part of the “haves.” In the Philippines, it pretty much works this way: You either have help, or you are the help. There really isn’t much in between. This is another horrific way that the poor will get exploited by being paid to be a wet nurse, and then most likely graduate to be the childs nanny as well. This is not a solution for those who ARE poor and cannot afford a wet nurse. Their kids will be the ones who will be severely malnourished, and be stuck in poverty. Don’t even get me started on the reproductive health bill that would allow the poor access to contraception, and how the Catholic Church rallied against it….
        FYI, I was a formula fed child in the Philippines, and so was my brother (our mom is epileptic and was and still is on anti seizure meds) and we turned out just fine (Although my husband would probably argue otherwise 😉 )

        • araikwao

          Elsewhere in the Pacific, babies get fed pawpaw juice.

          • The Bofa on the Sofa

            I’ve always wondered why Pretty Little Susie was way down yonder in the pawpaw patch. She was getting juice to feed her baby!

        • Lisa the Raptor

          It’s true. An ex-friend lived there and they had a driver, a nanny, a cook…on and on. You are considered selfish if you don’t provide jobs. She didn’t want to leave because they’d never be able to afford that help in another country. She had a home-birth with a CPM, from the states. This sounds like a ex-pats doing.

          • KarenJJ

            I have some friends from Bangladesh and it can be a tough situation when the children move to a country like Australia, where it is quite expensive to have live-in help. The adult kids (that have often studied at university here) are used to doing the dishes, cleaning and cooking for themselves, but elderly parents find it a much harder transition if they choose to relocate to be in the same country as their adult kids.

      • Lisa the Raptor

        …Um, does that not take time? I have heard of adoptive mothers lactating and they have to start way in advance. Why not get the men a’ pumpin’ too. Men can lactate!

    • Antigonos CNM

      There weren’t any birthing pools in the field hospital the Israelis sent to the Philippines, either.

    • areawomanpdx

      actually, I was distressed this week to learn that Doctors Without Borders actually takes CPMs as volunteers. ICK.

  • lilin

    Is she serious? Even the fact that high-risk women are having babies at home is somehow the doctors’ fault?

    Can’t midwives take responsibility for anything?

    • Sarah M

      I didn’t read it like that – it’s pretty obvious that there *are* things about hospitals that are part of some women’s decision making about where to give birth. Is that the fault of hospitals and doctors? Hell no. If hospitals can change those things without increasing risk, then should they do it? Hell yes. I don’t care whose fault it is, I care about getting those women back into a hospital.

      It’s not like hospital policies are perfect or indeed all about risk – look back not that long, and it was unusual for a father to be allowed to be there for the birth of his child, something that didn’t increase risk but which most women would agree should be allowed. These things change, and looking at would could change to improve the experience without increasing risks is a good thing, not an apportioning of blame.

      • lilin

        Actually, an apportioning of blame to midwives who say that “variations on normal” are safe, that home birth is as safe as hospital birth, and that hospital procedures that carry no risk are likely to cause autism or “failure to bond” or some such nonsense is important. It lets potential mothers know about the actual risks, and it makes people who try to scare women away from hospitals with pseudoscience responsible for the death and destruction they cause.

        Until then, you can’t discuss what hospital procedures do and don’t increase risk, because some self-certified quack says that vaccination increases risk to a baby and giving birth in a pool of water that you’ve shit in is safe.

      • A confounding issue is that a lot of the things NCB rails against that are “hospital policy” are simply wrong. How do OB/GYNs “improve” on things that are flat out lies?

        • Young CC Prof

          Clearly, hospitals should return to the discredited practices of earlier generations so they can stop doing those things.

          • Sarah M

            Kumquatwriter, yes agree – and of course not every hospital has identical policies, either, so the thing someone is afraid of may be something no hospitals do anymore, or may be something the hospital closest to them doesn’t do anyway. But it’s still something worth exploring.

  • Jenny Star

    She sounds like the kind of midwife the crazies would call a “medwife”. The sooner she wises up and realizes she is sticking up for people who aren’t actually working with her, the better.

  • Anonymous

    Henci knows exactly what she’s doing by loading her writing with weasel words. Starting with the question “What are the excess risks for healthy women at low risk of urgent complications who plan home birth with qualified home birth attendants compared with similar women planning hospital birth?”

    qualified being the key word. Calling a CPM “qualified” is like calling me a pilot because I took a plane flight. She’s intentionally leaving herself a literary “out” so she can step back later and claim that when she said “qualified” that she meant CNM, OB, etc and not someone who read a book or two.

    • MaineJen

      Not to mention that she doesn’t seem to care about the excess risk to BABIES at home birth, just the risk for healthy women. If you’re at home, you aren’t at risk for a C section or vacuum/forceps delivery, that’s certain. You yourself will be fine (probably). But your baby might not be as happy with his/her experience.

      • Amazed

        But Jen! Think rationally! If you care about the excess risk to healthy women, then you care about something that isn’t too likely to cause any significant trouble. Therefore, you can pat yourself on the back and proclaim your abilities are unsurpassed. What happens when you care about the excess risk to someone who’s already vulnerable to start with? I wanna my self-pat on the back, dammit.

        Silly, silly MaineJen.

      • Young CC Prof

        Maybe I’m an over-involved mother, but I can’t help but think a dead or damaged baby is harm to ME.

        Of course, some of the most extreme NCB midwives may not see it that way.

  • attitude devant

    This. This. This! I just can’t get over how much of the NCB chatter comes down to beliefs, and poorly considered beliefs at that. Birth is inherently safe? You can’t grow a baby to big to birth? Stalled labor is due to personal conflict? These people are immune to rational argument because they are not talking about reality. They are talking about faith.

    • Captain Obvious

      Love how they say doctors are fear mongering and playing the dead baby card to upset and worry you, because, you know, you can’t go into labor when your stressed, and then the doctor wins and gets to cut the baby out of you.

      • Love how people here pretend doctors are saints and never abuse people. I can tell none of you have ever worked with med students!

        A lot of the people who got into NCB are there because they had one child and were traumatized by the hospital experience. There aren’t any practical consequences for abusing patients unless you happen to do it to someone who is rich and motivated enough to do something about it. Dealing with a legal fight like that and a baby is nearly impossible even for women with lots of resources and privilege. The statute of limitations on battery is usually a year or so and most lawyers are unwilling to take on the fight.

        NCB is a scam to prey on women who are afraid of the medical system. Their fears aren’t ridiculous or stupid. This is especially true if you are fat, not heterosexual, a person of color, etc. There is a lot of evidence that people who are otherwise disadvantaged are treated poorly in hospitals in every speciality.

        The NCB scam goes on because most of the time NCB works out okay so its easy to lie about it. You can drown out the deaths with success stories.
        It also goes on because hospitals don’t do anything to solve the problems I mentioned. They won’t until there are real consequences for it.

        The truth is that there are horrifying birth experiences all around (either because of a bad outcome or a terrible provider). Labor is a vulnerable time for a woman. There needs to be better laws in place to protect women no matter what setting they choose for birth.

        • fiftyfifty1

          My own OB is a lesbian. The CNM who delivered my first was obese. The head of the department was a black gay man. Another senior faculty was a morbidly obese lesbian. Of the 8 students who went into OB from my med school class, 3 were obese women, one was an obese man, 2 were non-straight. None were non-white, but one was married to a black man. The hospital I trained at provided free ethnic-matched doulas to foreign born women. And yet there is demand for homebirth in my community….from priviledged white women.

          The hospitals are not driving women away. Surveys show women are overwhelmingly pleased with their maternity care. The modern homebirth movement is driven by NCB luring priviledged white women away with its lies.

          • Lisa the Raptor

            My pediatrician is gay. Does that count? lol

          • Susan

            This is a great post. I am not the youngest poster here. My oldest child was born in 1979 and even with him, I interviewed a home birth midwife ( I had a lot of very granola type friends– spiritual midwifery and Immaculate Deception were gifts before the first prenatal visit ) but decided to go with the Bradley friendly OB. Back then, it was the labor room, delivery room, recovery room then nursery and postpartum routine. Only the husband, nobody else, could be your “coach”. Rooming in was allowed, but not routine or normal. Breastfeeding was encouraged, but not super common. Even so, I was happy with the hospital afterward. Fast forward to now where I live… LDRs and LDRPs are norm, all the local hospitals have tubs if mom wants them for labor, none limit visitors in labor, breastfeeding is not just encouraged it’s difficult for moms to just say they want to formula feed, I have had moms squatting on the floor to deliver and have worked with CNMs tons. We pretty much bend over backwards to give parents what they want. Still, homebirth is MORE common, ,than back in the 1970s-1980s. It’s hard for me to believe that it’s really anything hospitals are doing wrong that drives most women who choose homebirth. That’s not to say that there aren’t things that should change, and that some women who have homebirths don’t do so after terrible hospital experiences. But I don’t think it’s really the driving force. I had a homebirth back in 1982 and I still know women who do. Most just believe, really believe, in the as safe or safer stuff, and like the idea of being at home, and in control. For myself, I believed that. And yes, homebirth is great when all goes well, there’s just very little about a strange bed and being in someone else’s territory that relieves pain and makes labor easier to cope with ( besides epidurals). Of course, once I stopped believing in the “as safe or safer” I chose to have my third in the hospital. That was even before I had really delved into why those studies are BS. I was a nurse, and I saw that there was just, no imaginable way, that resuscitating a baby, or an emergency cesarean, were going to go as well at home. I figured that for me, a very low risk mom, that was unlikely to need pain meds or intervention, ( I never have ) that there was just nothing the hospital would do but possibly save my baby’s life. All the dreaded unnecessary interventions were not likely to happen to me. So I could only envision, once I understood how a crash C/S or a resuscitation works in the real world, that we both would be best off in a hospital. Even if it wasn’t as comfortable as my own bed. That’s why Dr. Amy’s message is critical, because the “as safe or safer” deal appeals to otherwise sane individuals.

          • Antigonos CNM

            I am a fat heterosexual. Does that mean that I am, ipso facto, a good or a bad midwife?

            Oh, and I’m Jewish, too. That must have some significance.

        • Antigonos CNM

          I agree that failure of communication is a major problem which leads patients to feel neglected and/or abused. But while doctors often behave insensitively, patients often feel to intimidated to voice their questions and concerns. Far too much of my career has been spent in being the liaison between hospital staff and patients. But I don’t think the answer is to increase the level of risk becuse having a warm, fuzzy feeling takes priority over safety. A woman shouldn’t take a doctor because he’s a loveable guy but because he’s a good doctor.

          That being said, hospitals have a long way to go before patients will WANT to be admitted. Th birth center was supposed to redress this issue, but far too many have compromised on medcal excellence.

          • Kate B

            This is absolutely true; I think the key thing to keep in mind here is that when a doctor acts in a neglectful or unprofessional way; you can put in a complaint and take it as far as necessary; you can sue.
            Complaints DO make a difference; if you can prove your doctor has been neglectful; it could even result in your doctor losing his license and having to pay damages.
            There is accountability for doctors.
            Wheras with homebirth midwives; having unresolved or even proven complaints does not count as a strike against their name. If anything, it seems to enhance their careers. You can honestly imagine the medical community rallying around the OB equivalents of Ina May Gaskin or Lisa Barrett? Can you imagine ANY ob who had been found responsible for multiple infant deaths still being able to practice; with wide support from the medical community and the public?

        • Lisa the Raptor

          I’ve never seen anyone here say that doctors are perfect and always act like saints. When a doctor screws up we go after them, however, there is a process by which the victim of such maltreatment can get her story told to the proper authorities who will investigate. There is no similar thing for lay midwifery, which is why we are pushing so hard to correct that. I recall a few months ago someone posted a picture of a baby with cuts all over it’s face. It had supposedly been done by an OB doing a c-section (thought it was most likely done by a hook trying to tear the bag open). Either way, the readers of this blog tore into that photo with anger and calling for his license. Dr. Amy herself said it was pure malpractice. We got very mad when the baby was circumcised without the mothers permission, we got mad when the mother had her tubes tied without her permission. We call bad doctors out all.the.time.

        • The Bofa on the Sofa

          Love how people here pretend doctors are saints and never abuse people.

          Nice strawman.

          In fact, look up the words on this blog about Dr. Biter. Or Dr. Fischbein. They get a ton of criticism here. In fact, it is the NCB world that loves them.

          Get that? The NCB world LOVES a doctor who has sex with his patients. Why? Makes no sense to me, but the answer is, it seems, he makes them feel loved.

          Look at the stories you hear about midwives, and how friendly they get with their patients.

        • The Bofa on the Sofa

          This is especially true if you are fat, not heterosexual, a person of color, etc

          BTW, this is a really funny comment considering that women of color are NOT the ones running from hospitals! They lack proper care, but because the system lets them down.

          If these are the women who are afraid of the medical system, why are the NCBers and particularly homebirthers all white women?

        • Captain Obvious

          Your comment is taking on the NCB format. Probably a small percent are what you say, but you post “a lot” to make it a big deal. And yes I have worked with med students. And yes anyone can refuse medical students or residents for that matter.

        • Kate B

          Nobody here disputes that there are poor doctors. But those doctors are infinitely better educated and are held to infinitely higher standards than CPMs.
          The answer to the problems with hospital birth is not to throw out the baby with the bath water; to just totally discard the expertise of ALL obstetricians and instead birth at home with an uneducated non-professional pretending to be a midwife.
          The stats show that outcomes are better in hospital than at home; and ultimately, whether your baby lives or dies or suffers serious brain damage – that’s what matters; not your ‘experience’.
          Women may have reasons for turning away from hospital birth; but it’s totally irrational to take the position ‘I had a bad experience at hospital; therefore; screw all the facilities and expertise that a planned hospital birth with an OB can offer me; instead I’ll just hire some random woman to help me give birth at home’
          There also seems to a persistent myth that you can’t be traumatized from a ‘natural’ birth. Childbirth is a very intense, very painful experience and involves strangers dealing with intimate parts of your body. I personally felt traumatized by my second, entirely natural, birth because the whole experience was so intensely painful and unsettling. I imagine it’s much more likely to lead to trauma, if you birth at home, with no real access to pain relief when it gets too much. And if anything does go wrong, or threaten to go wrong- I can’t imagine how intensely stressful it would be having to deal with that at home. Imagine having to transfer to hospital when you are transitioning; imagine hemoragging or having your baby born with sholder distoycia at home…
          I also feel that the ridiculous expectations fostered by the NCB movement contribute to this trauma. Women read about how they should ‘trust birth’; they read about how awful obs are; how almost all interventions are unnecessary; how your doctor wants to ‘birth rape’ them. They’re encouraged to make lengthy and detailed birth plans and they seem to expect that they can control everything. They’re told that birth doesn’t hurt; that contractions are ‘tightenings’ and pushing involves ‘effort but not pain’.
          It’s hardly surprising that so many women feel disappointed and traumatized by their birth; when this is the image they’ve been given of the ‘birth they deserve’. Repeatedly we hear women saying they feel that they’ve been ‘shortchanged’.
          There are multiple things we could do to address all of these problems; but women giving birth at home with an unqualified non-professional is not the answer to any of them.

          • Antigonos CNM

            There is a major difference between malpractice and rudeness, bad manners and/or not taking the time (or having the inclination) to behave in a cosiderate manner. The lay person often confuses the latter for the former. That doesn’t mean it is right to be brusque, but it is no indicator of lack of professional excellence, which is the whole point of retaining a specialist.

          • Kate B

            Oh, absolutely.
            It’s important to make that distinction too.
            But we do hear people claiming that actual malpractice and neglect are widespread amongst Ob-gyns too.

  • Wow planned cesarean must be amazingly safe compared to planned homebirth and yet one is lauded and one is denigrated by these “evidence based” birth fetishists!
    I do think hospitals need to look at policies and practices as there is a group of women who are choosing homebirth often after traumatic first births because they feel that they will have more control and respect in that environment. Birth trauma survivors have unique care needs – and a lot can be done to better meet those needs (and prevent birth trauma in the first place).

    • Antigonos CNM

      Particularly with primips, many women have totally unrealistic ideas about labor. It’s not an experience remotely like any a woman has had before and I think every woman is changed by it. IMO, too many women blame their surroundings or attendants for a “trauma” which probably would have bben just as bad if they hadn’t gone to a hospital, because that is the nature of a first labor. So when the second birth is”easier” at home, the assumption is made, wrongly that is the home which made the difference, when in fact preknowledge of what labor is like, and certain physiologic differences in the progress of labor itself make the difference in perception.

      I had many primips who “failed Lamaze” and then would not try it again, in spite of my telling them that they were much more likely to succeed the 2nd time, since there tends to be a shorter prodromal period and less pushing, etc.

  • prolifefeminist

    Dr. Amy – typo in seventh paragraph down, just before the first quote (“The study looked at There were 2,081,753 births…”)

    • Amy Tuteur, MD

      Thanks! Fixed it.

  • Lisa the Raptor

    Not all women who were included were low risk? Sorry Henci but if we took all those women away then the midwives would have like, three clients. A huge part of the problem with lay midwives is that they have no idea from their undereducation how to tell if a woman is high risk or not. Explain that one, Henci? How can so many midwives who are perfectly trained to deliver at home, miss the fact that HBAC was dangerous?

    • Lisa the Raptor

      Me personal idea for a woman who just has to have a homebirth? Two CNMs, on Pediatric nurse practitioner, and an EMS squad in the drive way. That is as safe as you could get and STILL it’s too dangerous for me. But that should be the homebirth norm….and that’s going to be expensive as hell.

      • Karen in SC

        You’d probably like my entrepreneurial idea for an RV birthing center – parked in the hospital lot with a high (90%+) transfer rate. Some babies will no doubt be born too fast for a timely transfer. 🙂

        • Lisa the Raptor

          Could you empty it out and parents could bring in their own furniture? lol

          I am constantly lost as to how it’s ever acceptable to have one midwife and two or more patients? With my second I had asked for as few people as possible and still there was a CNM and a baby nurse. Unless you can give CPR on both ends there has to be someone else there.

    • Amy M

      I can’t believe they let Henci still play in their club, since she’s admitted there IS such a thing as high risk, and even worse that VBAC should be included in that category.

    • Trixie

      Yeah, just like this babykiller. http://lancasteronline.com/article/local/907006_No-charges-will-be-filed-against-county-midwife–but-grand-jury-urges-strict-regulation-of-midwifery.html
      And she lives in an area of PA where there are many actual CNMs who do home birth, legally, with actual regulation and oversight (including the one who testified against her).

  • sunny san diego

    a little of topic but here is the news from San diego….can he still be a home birth midwife NOW?

    http://www.nbcsandiego.com/news/local/Doctor-Accused-of-Botching-Home-Birth-Surrenders-License-233560431.html

    • prolifefeminist

      Of course he can! And I’ll bet he will be. Either that or he’ll reinvent himself into some kind of alternative woo “healer.” Or both. Probably both.

      I feel so sorry for the patients he hurt, especially the family who lost their precious baby boy last year. I cannot even imagine the anger that must have piled on top of their sorrow when they learned he had no liability insurance. Horrible.

      • An Actual Attorney

        Does he own a house? What’s that worth?

      • Anonymous

        What really sickens me about people like him is that they outright LIE to patients. Most doctors will actively tell you why they lost a patient. If they start glazing over it there’s a reason. More telling about Mr. Biter is that he was acting as his own attorney.

        • Antigonos CNM

          Biter is still able to put “Dr.” in front of his name, just not “MD” after it. He still has his academic degrees.

          • And yet we see so much “Dr” Amy, because SHE isn’t a REAL doctor anymore.

      • Squillo

        I don’t know about being a homebirth midwife. The MBOC oversees the licensing of non-nurse midwives in California. I have a hard time imagining they’d grand him a midwifery license. But who knows? I wonder what has happened to all the money donated for the as-yet non-existent birth center?

        • Lisa Cybergirl

          Perhaps he could be a doula?

          • Young CC Prof

            Perhaps he should call himself an “Accoucher.” It’s not a legally protected term, and it is accurate. (Somewhat antiquated term for a male midwife who isn’t a physician.)

    • Captain Obvious

      Business of Being Born. The Sequal.

    • Squillo

      Interesting, given that his license expired September 1.

    • Squillo

      Of course, it’s all someone else’s fault. Scripps Encinitas, the MBOC, the patients who sued him–they’re all just out to get him.

    • Squillo

      Also, it appears that the case he filed against Scripps and a bunch of its docs has been dismissed without prejudice, apparently at Biter’s request.