But the baby’s heartrate was fine right before it dropped nearly dead into the homebirth midwife’s hands

Hand of a  doctor with oximeter sensor

I am angry.

Why? Yet another baby has been placed at risk of significant brain damage and possible death because the clueless homebirth midwives didn’t understand how to diagnose fetal distress.

The story of baby Thaddeus-James is depressingly familiar:

… Our son was born floppy and unresponsive just after noon today. Throughout the birth his heart tones were good for the most part, although there were certain positions he didn’t seem to cope well with. It appears that there was a trauma in the last few moments–perhaps cord related. Full CPR was initiated practically immediately by my two wonderful midwives. He didn’t respond until about 20+ minutes into resuscitation…

And, as we’ve come to expect, the mother believes the midwives, the ones who actually bear responsibility for failing to anticipate this disaster, are just awesome:

His heart rate was checked very frequently, and the last check was 2-3 minutes before birth and still strong and in the normal range. It was with Doppler, so we could all hear it. After that, we lost it for those last few minutes, so that was when the abruption likely occurred. I am now praising God that our placenta stayed attached as long as it did. That He gave me wonderful health care providers who immediately jumped into action and saved my son’s life. For the tray I bought at a bargain store that ended up being used as a firm surface to put him on for the chest compressions. For the emergency responders who didn’t give up on my son and rushed him to safety. For living in a time and place with amazing medical care…

That’s right. We live in a time of amazing medical care, yet homebirth advocates continue to deprive their babies of this care until AFTER they are nearly dead and their brains have been permanently injured.

Why would a baby fall nearly dead into a clueless homebirth midwife’s hands?

The mother insists:

… [T]he most likely cause of the acute trauma that occurred in the last moments of his birth was a placental abruption (premature separation of the placenta).

That, not to put to fine a point on it, is bullshit.

Let’s leave aside for the moment the fact that the mother had NO signs of placental abruption. Babies do not go from fine one moment and nearly dead the next. It takes a long time, sometimes hours, for a baby to die of an abruption.

But you know what does cause a baby to have an excellent heartrate and then drop dead or nearly so into the midwife’s hands? A clueless homebirth midwife who thinks that fetal distress inevitably produces a bradycardia (low heart rate).

As I’ve explained in the past, the fetal heartrate monitor provides much more information than listening to the heartrate.

For example, this tracing shows a baby in serious trouble:

late decellerations

Surprised? You might be if you thought that a fetal heart rate tracing supplied the same information as intermittent auscultation (listening) with a doppler. But electronic fetal monitoring provides a wealth of information that cannot be obtained by listening, and that allows for a more comprehensive view of fetal well being.

This is a tracing with limited beat to beat variability and subtle late decelerations.

Notice what you don’t see:

You don’t see a bradycardia, a sustained period of abnormally low heart rate. That’s because bradycardia is often a terminal event. Most babies can tolerate long periods of significant oxygen deprivation before they die, and they may not have any bradycardias until immediately before death. On this tracing, there is never a single moment when the heart rate is outside of the normal range, but the baby is nonetheless suffering from serious oxygen deprivation.

This is almost certainly what is happening in hours before a dead or nearly dead baby drops into a homebirth midwife’s hands. The midwife may be intermittently listening to the baby’s heart rate, but unless she is listening for long enough AND frequently enough AND exactly at the right times AND can distinguish subtle changes in heart rate, she will be blissfully unaware that a baby is dying right in front of her.

Homebirth advocates and their midwives who insist that the baby’s heart rate was “fine” until just before delivery are completely wrong. The baby’s heart rate was not fine; they just couldn’t tell what was happening because they only listened intermittently.

And because they couldn’t tell, the baby pays a hideous price.

Baby Thaddeus-James received state of the art medical care, including cooling his brain to reduce brain damage. He was recently warmed up.

Despite the blessing of getting to hold him 3 times today, there appears to be a significant set-back tonight, as it looks now like Thaddeus-James may be having seizures. We are all very concerned about him. Please pray for him…

Seizures indicate the likelihood of significant brain damage, brain damage that didn’t have to happen and almost certainly would not have happened in a hospital, because:

  1. The signs of oxygen deprivation would likely have been diagnosed with electronic fetal monitoring.
  2. A C-section or vacuum might have been recommended to prevent further oxygen deprivation.
  3. A team of resuscitations experts would have been standing by to perform immediate advanced resuscitation with intubation.
  4. An additional therapy could have been initiated sooner, instead of waiting for transfer to the hospital and hospital evaluation, all of which takes precious minutes. During those minutes the baby’s injured brain continues to swell, and brain damage may actually increase over that present at birth.

Thaddeus-James’ mother is right about one thing though. We live in do live in a time and place with amazing medical care. Too bad Thaddeus-James didn’t have immediate access to it because his parents chose homebirth.

  • Midwest Guest
    • Amy Tuteur, MD

      And there’s nothing in the story that indicates a placental abruption.

      • Midwest Guest

        But plenty of indications to transfer to a hospital. That was not a “everything was just fine, then the baby came out limp and white” birth – there were multiple signs of complications, none that were acted on.

  • manabanana

    The mother in this story appears to have been running a birth center out of her home. And I’m sure she thinks this public yahoo group is private. But have a read:
    http://health.dir.groups.yahoo.com/neo/groups/stcroixbirthing/conversations/topics/101

  • Sally Hathaway

    Dr. Amy, I’ve been following this blog for about two years now, and as a NICU nurse at a level 4 NICU, I greatly appreciate your advocacy. It’s possible that nothing angers me more than stories like this. I care for babies for a living, and am devestated when they come to my NICU from birthing centers and homes. The lost time due to tranfer is usually what gets to me the most….

    My hospital is also the largest birth center in my city, delivering approximately 4000 babies annually. So, I’ve seen my share of births – the good, the bad, and the very sad. I run to code NRPs and high-risk situations in both labor rooms as well as C-section areas on a daily basis. Because no matter how well things are going, it ain’t over until the fat baby sings, er, cries. No singing please, we don’t like grunters!



    What strikes me as the strangest part of this story is the claim that the baby’s
    condition was likely due to an abruption. I know you address this above, how
    abruptions take time to actually terminate the life of a baby, which is so
    true…we have abrupting moms walk in who have been bleeding for hours and
    their babies are usually fine as soon as we get them out….sure, they usually
    need a little volume, but usually not cooling. Not that it doesn’t happen, but
    generally we can get those nuggets out fast enough to divert a major crisis.

But
    what I am puzzled by is the abruption claim and the condition of the mom. If
    she had abrupted, she herself would have been in a very dangerous situation,
    right? Again, I’ve been present during the delivery of numerous abruptions, but once the kiddo is out, we’re off to the NICU. But, even a slight abruption
    would need immediate medical attention, right? I mean, bleeding to death is
    sort of last season.

    This is the first time in two years I’ve decided to join a conversation. And I try so very hard to not judge women who put their perfect experience above the potential harm to their babies. So, I do not want to criticize or attack this mama, but….per her Facebook profile, which is indeed still public and live,I just learned that she actually owns the St. Croix Birth and Parenting
    Center, where according to her profile, she aims to:

    “…provide growing families with education, resources, and support from conception through parenthood. Since 2006, I have expanded my offerings from natural childbirth classes to a full spectrum of family education and support, including breastfeeding classes and counseling, fertility education, natural family planning classes, doula care, perinatal loss care, and prenatal care and midwifery services.”

    We’re a birth educator?
    And we’re stickin’ with abruption? Alrighty then.

    Dr. Amy, keep on the good fight. Your blog is so important to raising awareness regarding the dangers of home-birthing. I believe it is a complete injustice to the sweet babies of the world, and it’s needs to be regulated.

    • Gene

      I can’t imagine meds were given by the homebirth midwives during resuscitation as most are not legally able to carry or administer them.

      • Sally RNC-NIC

        Yeah, I was reaching. I know I’ve read some stories where certain emergency medications were allowed to be carried, depending on the level of training of the midwife. Pitocin, epi, vitamin K, etc. Total reach. And reach on the CPAP because, well, that would require an oxygen blender and high pressure. So, stimulation and perhaps some compressions? For 20 minutes. Great.

    • hurricanewarningdc

      1. Thank you for what you do. It was the great L&D nurses who saw that my 41-weeker was in trouble and the NICU staff who saved his life. We’re forever grateful to people like you who not only took care of our son but they also ushered us (with kindness and support) through the hardest, most surprising days of our lives. Heck, it was over 4 years ago and I’m tearing up as I type. Really – you and your colleagues do Good Work.
      2. I hadn’t noticed that the mom/family owns a “natural” birth center. That makes me even angrier about this child’s unnecesary suffering. So their embrace (celebration?) of the horror in this birth story may not be the denial sort of self-preservation but rather the dollar-figure type? Not that I’d want one to suffer from the former, but I hope to God that the latter is not true. Disgraceful.

      • Sally RNC-NIC

        I’m so glad you’re little dude is ok, and that you felt supported and loved by your care team. It really is so scary having your baby admitted to the NICU, but luckily, as I mentioned, babies are so darn resilient! It’s quite amazing.

        Yeah, it made my stomach hurt a little when the possible connection between the “reality” of the situation and the mom’s business popped into my brain. However, it’s obsurd to think this tragedy wouldn’t hurt business…without a little PR twist. Bleh.

        • moto_librarian

          Allow me to also add my thanks to you and all other NICU personnel! Both of my babies had issues at birth. My eldest spent 2 days in the NICU because he was a bit grunty (vaginal delivery at 38 + 3 following SROM), and his baby brother passed light mec during labor, prompting the presence of the NICU team at his birth. This was indeed fortunate, as he went into sudden distress when crowning, and basically rolled out of his umbilical cord. He had deep suction, O2 via CPAP, and was stable and in my arms in 20 minutes, no NICU time required. Since I was also in serious trouble after my first delivery (cervical laceration and pph), I am so grateful that there was an entire team available just to take care of my baby. Honestly, I cannot imagine why anyone would feel comfortable with homebirth for this reason alone.

          • Sally RNC-NIC

            I am so glad both your boys are a-ok! The story you tell about little brother happens so often….yes, we are always present anytime there is meconium, and there is a reason, as you can testify to! Sometimes it’s nothing, but it does let us know something is stressing the little nugget out. I think meconium is one of the scariest things about home-births, especially since so many of these women go past 40 weeks, which always increases the likelihood mec will be there. I keep going back to this tragic story Dr. Amy shared, and the part of the story where the mom says, “Full CPR was initiated practically immediately by my two wonderful midwives. He didn’t respond until about 20+ minutes into resuscitation…” I shutter to think how these efforts were played out. I wonder if these midwives were even NRP certified…

            Thanks for sharing – this is an excellent example of how when the unexpected happens with the proper care team in place, the outcomes are typically fabulous. Babies ARE resilient, especially when given the gift of proper intervention! The same situation at home? No way.

    • The Bofa on the Sofa

      Thanks, Sally. I have said it before, but it is worth repeating. As much as I enjoy the regulars here, the best comments always come from the professionals – our resident OBs, doctors, and nurses.

      PLEASE continue to post. Your experience and expertise are very important, and it is important to have a real, live (ok, internet) person who can say, no, here is what it is really like. Here is what you need to do when you are doing NRP. Here is what we are doing when we do those things in the NICU. I loved your comment

      Did the midwives forecast for a potential cooling situation and begin that process by removing all sources of heat?

      because it shows the level of detail that real professionals apply in their work. Did the midwives think of that? I’d be shocked. But for professionals like you, it’s second nature.

      Stick around. Comment when you can. You are one who makes this blog great.

      • Sally RNC-NIC

        Wow. Talk about warm-fuzzies. Thank you SO much. I was nervous to post, but you guys have made me feel welcome. I’ve been an avid follower for years, but for whatever reason have never joined in. I will for sure stick around and try my best to contribute educated tid-bits, and maybe even a little humor. : )

        • The Bofa on the Sofa

          Throw in some pop-culture references, and you’d be perfect!

          • Sally RNC-NIC

            Mindless pop-culture factoids…and sarcasm…are two of my favorite things! I’m full of both!

  • Allie P

    My heart breaks for this family.

    Was stuck in traffic yesterday behind a car with a license plate reading “What Would Ina May Do? (Support Washington Midwives.)” I wanted to rear end her.

    • araikwao

      That reminds me, I was looking on the Hesperian Foundation website (publishers of “Where There is No Doctor” and other such titles for developing countries, and which illustrious author should they be selling in the store but Ina May, “America’s leading midwife” (or something similarly gushy). I only know about her from what I’ve read here – is it useful to be inflicting her stuff on women in developing countries? (Aside from the grossly inappropriate content that has been outlined before, of course).

      • Trixie

        Dear lord, no, that woman shouldn’t be inflicted on anyone. Surely the WHO/Unicef have created appropriate resources for this type of situation?

        • Sally RNC-NIC

          Indeed. This amazing organization is providing hands-on training and education throughout impoverished and underdeveloped areas of the world. Their curriculum is simple. based on current NRP guidleines, focusing mostly on those first precious moments of a neonate’s life. Check it out! http://www.helpingbabiesbreathe.org

    • LibrarianSarah

      That would mess up your car too and cause your insurance rates to skyrocket. Next time see if you can figure out where she is going and key her car.

    • Captain Obvious

      Let’s see, While Ina May was on her caravan to Tennessee she had a preterm birth at 32 weeks and decided not to be in a hospital and the baby died. Ina May then decides to profess that our bodies are not lemons? Ina May trained with midwives in Peru and learns that being on all fours may help alleviate a shoulder dystocia, so when Ina May comes back to USA she does not give them credit but decides to name that maneuver after herself. That is what Ina May would do.

  • The Computer Ate My Nym

    It just occurred to me: How are we to reconcile this claim that the baby was absolutely fine until the last few minutes with the claim that if anything goes wrong you’re just “five minutes from the hospital” and so there’s no need to worry?

    • Gene

      With the truth that even if the hospital knew everything about the pregnant woman and her medical history, the OR was fully staffed AND NOT IN USE, and the woman went to an L&D ED (as opposed to a regular ED), the time from her arrival to baby out at best is thirty minutes.

      • EmbraceYourInnerCrone

        That was the situation when my brother was born, my mom had placenta previa and a transverse lie and went into labor before her scheduled C-section(this was in 1966)

        My gradmother did the Mario Andretti-like drive to the hospital while my greatgrandfater called the hospital (where she was I believe already registered) and the OB to let them know she was coming. I think it was still about 40 minutes before my brother was delivered

        They had to do a hysterectomy as soon as my brother was out as the bleeding would not stop and the uterus “split” according to my mother. She did not care as she got a live, healthy baby. She didn’t appreciate the big scar or the long recovery tho..

    • fiftyfifty1

      The missing link is the dollar store tray of course! You can use this tray as a surface for CPR for 20 minutes or longer to keep the baby (barely) alive until real professional medical care can be obtained at the hospital. See? No need to worry!

      • fiftyfifty1

        ETA: Sorry for my anger/snark on that one. Just remembering my own personal homebirth midwife near miss story (witnessed sibling) that involved The Boiled Shoelace as a piece of medical equipment and how spectacularly terribly that went.

        These homebirth midwives are goddamn clowns.

        • theNormalDistribution

          My sister-in-law (the one who’s not a doctor) was really into the woo and attempted a homebirth with her first child – complete with birthing tub and a 15 minute drive to the nearest hospital. She ended up being rushed to the hospital for a c-section. They’re working on their second baby now, and I recently heard her sighing that unfortunately she won’t be able to attempt another homebirth. (shudder)

    • Bombshellrisa

      I am sick of hearing “everything was FINE until the last minute”. Don’t you know it’s the oldest line in the homebirth midwifery book? Seriously, how many home birth horror stories include that line?

      • DaisyGrrl

        The thing that annoys me about that is that homebirth midwives can “spot problems long before they become emergencies and transfer you to the hospital that’s 5 minutes away.” So which is it? Emergencies can arise spontaneously and minutes count when shit hits the fan or emergencies are easily prevented by a competent midwife who sees them coming?
        Of course, the real answer is complications can arise with variable timelines for resolution without long-term injury to the mother and baby, but that requires an actual professional using actual judgement and skills and stuff.

        • araikwao

          I remember the midwives in antenatal classes a few years back assuring us that if things go wrong, they go wrong “slowly”, and that an emergency C-section isn’t ever really needed in a real hurry…something *else* they were dishonest about, I guess.

          • Young CC Prof

            Sometimes things go wrong slowly, and you’ve got a couple hours to get yourself to the hospital and get into surgery, sometimes you don’t.

            Of course, when the provider isn’t looking for problems and/or actively denies evidence of a problem when it appears, that’ll seriously cut into the time you have to deal with a nice slow-pitch emergency.

  • Ann

    Dr. Tuteur- Education is wonderful. Using someone’s story without their consent is hurtful and unethical. Speaking rudely about others is ineffective and makes you look like a bully. It takes away from your educational mission. In the US we get to choose whether to give birth at home or in a hospital. That is awesome. I know this family personally- they are wonderful, well-educated, caring and devoted parents. They make their birth choices with all the facts. In fact, the mom was present at my daughter’s traumatic birth (where her life was saved by being in a hospital). They know the risks and the rewards of childbirth at home and choose to give birth at home. For them, the rewards outweigh the risks. That is a good thing. Bad things can happen at home and bad things can happen in a hospital, child-bearing has always been risky. You can’t control how the rest of the world lives, you can educate people if you remain polite and fact-based. Please don’t use other people’s stories without their consent. I’m sure you can find plenty of people who will willingly tell you that they don’t like home birth for one reason or another, to further your agenda. Taking someone else’s story without permission is unconscionable.

    • Gene

      You cannot “steal” something that is posted publicly and properly cited. If you do not want strangers on the internet to know something, for heaven’s sake, DO NOT POST IT ON THE INTERNET.

      http://www.skepticalob.com/2012/10/response-to-loss-mothers.html

    • Amy Tuteur, MD

      Personally what I think is unconscionable is letting ignorant, uneducated laypeople call themselves midwives (CPMs).

      What I think is unconscionable is letting homebirth midwives avoid responsibility for the death and destruction they leave in their wake.

      What I think is unconscionable is that the Midwives Alliance of North America (the organization that represents homebirth midwives) refuses to release their own death rates.

      What I think is unconscionable is parents who think they are “educated” because they read a bunch of crap posted by laypeople on the internet.

      What I think is unconscionable is parents who think their homebirth midwives are responsible for saving their babies when they are actually responsible for killing and injuring them.

      What I think is unconscionable is friends of the parents who are more worried about the parents’ feelings then whether the baby lives or dies.

      Looks like we have a difference of opinion, don’t we?

      • Chrystina

        What I find unconscionable is that you say parents find their education posted by laypeople on the internet yet here you are!
        What I find unconscionable is why you would be giving her a hard time for worrying about her friend’sfeelings whether than the baby’s life when you are using those feelings to further your agenda!
        I say let he or she that be without sin cast thy first stone. Clearly than No One especially some pompous bully blogger on the internet who prays on a poor woman going through a bad situation should be casting stones!

        • Amy Tuteur, MD

          I am not a layperson.

          You don’t appear to care about the babies who die at homebirth, either. Why is that?

          • Dan

            Ok, but I find it very hard to respect your “professional” medical opinion when you base your whole assessment on someone’s Facebook profile. I don’t know many practicing MDs who would do that. The fact remains, you werent there, and you dont know all the facts, so apart from the hypothetical I’m not sure posting a real life story of someone you dont know really helps your efforts here. As caring as you may be about the baby’s life, throwing words around like ignorant, uneducated, and clueless make you just that.

          • Bombshellrisa

            She isn’t practicing-but of course you knew that, since you aren’t ignorant, uneducated or clueless and you have read the short bio in the upper right hand corner (wouldn’t want to be throwing words around without thinking and knowing the facts)

          • Dan

            Sheesh…I can really feel the love on this blog.

            Yep i read that amazing bio. You just misunderstood me: the MDs I know are practicing and I can’t imagine them offering such a complete assessment of someone’s medical situation from their Facebook profile….

          • Amy Tuteur, MD

            You can keep trying to rationalize this disaster, but that’s all you are doing. Read today’s post and find out about many other homebirth disasters.

          • Amy Tuteur, MD

            You can keep trying to rationalize this disaster, but that’s all you are doing. Read today’s post and find out about many other homebirth disasters.

          • anion

            She didn’t offer a “complete assessment” of anyone’s medical situation based on a Facebook profile. She took the information provided in several posts, and offered some likely scenarios and possibilities based on her extensive education and experience, and on research- and science-based facts which are not opinions.

          • Captain Obvious

            There are only so many reasons for bad outcomes with deliveries. Reading this scenario really does suggest poor interpretation of the fetal HR. babies just don’t go bad minutes before delivery.

          • Medwife

            When they go bad minutes before delivery, they go good a few minutes after delivery (with proper resuscitation), not 20.

          • anion

            BTW, you do know that offering potential diagnoses/analyzing “what might have happened” based on limited information is a large part of an MD’s education, right? It’s a standard and much-repeated exercise for every medical professional; my RN mom had to do it in school, too.

            If a doctor can’t look at limited information or a short list of symptoms/short case history and offer some opinions and suggestions, and rule some things out, then s/he’s not a very good doctor.

            It’s not a full diagnosis, and it’s not “a full assessment.” It’s “Well, X and Y symptoms aren’t present, so let’s rule out Z diagnosis for the moment and look at A or B.”

          • Dan

            Sheesh…I can really feel the love on this blog.

            Yep i read that amazing bio. You just misunderstood me: the MDs I know are practicing and I can’t imagine them offering such a complete assessment of someone’s medical situation from their Facebook profile….

          • thankfulmom

            From their website for their birthing services, there is a link to info. about their midwife. It says she has attended around 150 deliveries. That is not a lot of experience. Dr. Amy’s concerns are about the lack of education cpm’s have. 150 deliveries is not enough to encounter the many unexpected complications that can arise during a delivery.

          • Dr Kitty

            I’ve easily been at 150 births and seen nuchal cords, PPHs, abruptions and shoulder dystocia…because they only called me when it was going pear shaped.

            No way would I consider myself skilled enough to be the primary attendant at a birth.

            CPMs are hubris personified.

          • Gene

            I’ve personally delivered maybe 40 babies (including two “parking lot” babies in the back of someone’s car in the past year). I’ve attended probably 250-300 at the responding Ped (and we’re called where then is a PROBLEM). And I would still NEVER attend a homebirth. And my job is “pear shaped” (though not L&D). Someone who has seen a few dozen deliveries is deluding themselves if they think they know what they are doing.

          • guest

            I’m an ob/gyn in private group practice. I attend 200-250 deliveries per year. I’ve lost count of the total but it has to be over 2,000 now. My heart rate still rises during pushing, I still stay up all night watching less than perfect fetal strips, and I know enough to still fear the unpredictability of cord prolapse, shoulder dystocia, uterine rupture, postpartum hemorrhage, and abruption. I expect that even after 5,000 deliveries (like some of my partners) that fear and respect for pregnancy and childbirth will remain and be part of what makes me a competent and compassionate provider.

          • fiftyfifty1

            150 births is nothing.

          • thankfulmom

            From their website for their birthing services, there is a link to info. about their midwife. It says she has attended around 150 deliveries. That is not a lot of experience. Dr. Amy’s concerns are about the lack of education cpm’s have. 150 deliveries is not enough to encounter the many unexpected complications that can arise during a delivery.

          • Captain Obvious

            Stick around and read some more Dan. Especially 12/30 thread, there is an unfortunate recurring theme.

          • Gene

            Dan, you might be surprised at what some of us practicing MDs are able to glean from what was posted on this woman’s (completely public) Facebook page. “Areas of concern” on an MRI in a depressed neonate are signs of hypoxic injury. We don’t cool babies for FUN! We don’t start powerful anti seizure medications for kicks. Would I be able to understand more if I had access to her son’s medical records? Sure. But most of us are pretty good at translating a lay person’s version of medical history into what really happened.

          • caring

            Gene, by your post you are stating that you are a practicing MD? Please, please enlighten us laypeople (since Dr. Tutor clearly is not answering my question) on the postpartum process. Please let us know what is going on with a postpartum woman’s body and emotions in the first few days and weeks. Please also explain what can happen in the postpartum period when a trauma to mother or baby has happened during birth. Could a post like this harm this mother while she is still very newly postpartum and is still in the midst of dealing with trauma? I understand what the OB stance on homebirth is and I have no arguments with it. However I see that the stance recommends all OBs to treat those who have decided to homebirth and then must be transported with compassion. Where is the compassion for this woman in this blog and in these writings? Everyone seems to think that this post is A-OK because the information was on a facebook page that was public. Nevermind that the page was clearly not INTENDED to be public. Yes, I am sure that this is a lesson to us all to be careful in what we post. But, in your professional opinion, COULD this blog harm this postpartum woman when it has been done without tact?

          • attitude devant

            Not Gene, but I can guarantee you that any annoyance that our discussion gives to this family is NOTHING compared to their dawning realization that their wilfull ignorance has irrevocably harmed their son. If they have any integrity they will want other parents to be spared what they have experienced. Why are you focused on Dr. Tuteur and not on the midwifery industry that peddles death and injury to loving parents?

          • attitude devant

            caring, do you know anyone who’s lost a baby or had their baby’s health destroyed by home birth? Well I know at least a dozen. These mothers all feel they were misled, duped, taken in by incompetents. Can you imagine how devastated they are? And that the grief is always raw, never-ending? No one is making these parents read here. This, they can escape. What they will never escape is what all the untruths of the midwifery world (that birth is safe, that the experience iw worth risking your child’s health, that midwives actually know what they are doing) have led them straight to the NICU and the MRI changes. That they will always have, right in front of them.

          • Bombshellrisa

            Define “harm”-do you believe that facing the reality her son suffered an injury that may have permanent effects because of her ideology will upset her?

          • DaisyGrrl

            I really question the motives of whoever alerted her to the existence of this post. I’ve seen this happen several times here. Tragedy written about, someone notifies the family, grieving family comes in crying “how could you?” I know that these posts can be controversial for this reason, but I suspect that the families are notified by NCB types who hate-read this blog for the sole purpose of stirring the pot.

            You’ll notice that when Thaddeus-James’ father posted, the replies were universally polite and respectful, even though most people here think he and his family took an unjustified risk with the baby’s life.

            These stories need to be told. You can quibble with the timing, the mother’s intentions when she posted to her public facebook account (and how we’re supposed to read her mind and *know* that she intended the post to be private), but at the end of the day, her post was put out there and I think the discussion that ensued here was a good thing. People also noticed that the family has a direct financial interest in promoting that birth is safe and the midwife is competent. This was also relevant to our discussion. The mother can choose to read the post and comments and reflect, or ignore it and move on with her life.

          • The Bofa on the Sofa

            I really question the motives of whoever alerted her to the existence of this post.

            THANK YOU!

            I have mentioned this many times.

            Unless the mother was a regular reader of this blog, the only way she would be aware of it is if someone somewhere else talked about it and she saw it. Either someone sent it to her directly, or she is hanging out in a place (usual suspects) where someone is railing on Dr Amy. Regardless, someone has had to tip her off about what is being said here.

            What kind of person would do that? “Hey, grieving mom, you should go over and see all the nasty stuff people are saying about you behind your back”

            Why?

          • Susan

            I agree with this but not entirely. Dr. Amy is a fairly big force in the blogosphere and I think a true friend would be in quite a dilemma deciding whether it was in her friend’s best interest to know this or not. I actually am not sure I wouldn’t feel some obligation to let my friend know; I think I would want to know… hard one really.

          • Gene

            Caring, I am going to attempt to answer your questions in a respectful manner. However, Dr. Tuteur is more qualified than I on postpartum physiology (she being an OB, myself as a Ped). Could a PUBLICLY posted website becoming more public than the poster intended create stress on the author? Sure. The same way that a sext being widely distributed could cause stress to the sender. Keep in mind that the author has, at this moment, over 200 “friends” on FB and her page remains publicly available to everyone. I choose to keep my FB page set to maximum privacy, have only the friends I know well and want (under two dozen), and still NEVER post anything I wouldn’t want broadcast over the evening news. This is basic internet behaviour. Never post ANYTHING you do not wish EVERYONE to see.

            The stress on the mother (both real or perceived) has little to do with the damage her son already received. His eventual outcome (be it, hopefully, as a completely neurologically intact adult without any lasting medical problems) will not be affected by his mother’s public posts. His damage occurred well before his family chose to broadcast their story to the world. Dr. Tuteur’s goal (and most of the regulars who follow her blog) is to PREVENT the initial injury. If an internet stranger hears the story of Thaddeus-James and decides to give birth with the care of an educated and competent provider instead of a woo-slinging quack, then her goal is being met.

            Regarding compassion: do I feel compassion for the patient and their loved ones who have been injured or died? Of course. The baby who overdosed on the “candy” found in Grandma’s purse? The baby thrown from the back of a pickup? The baby who suffocated while co-sleeping? Yes, we offer our compassion. But we also tell others about these events to PREVENT other families from suffer the same outcome. Keep your meds in a safe place. Use a carseat. Give your baby a safe sleep environment. Don’t believe me, read the story of someone it happened to!

            Statistics show that homebirth is safe. But a personal story resonates with us more than toast-dry mathematics.

          • VeritasLiberat

            Gene, you’ve got a typo in that last paragraph.

          • Gene

            Fixed. Thanks!

        • http://kumquatwriter.wordpress.com/ Kumquatwriter

          *preys, not prays

        • Bombshellrisa

          Dr Amy did not earn her MD on the internet.
          This is not a discussion about sin, rather it’s an example (such as those used in medical school) of how the ideals of natural childbirth do not translate well into the realities of pregnancy, labor and birth.

        • Captain Obvious

          Amy is not alone in this plight.

          1)Judith Rooks, CNM Oregon,
          2012

          https://olis.leg.state.or.us/liz/2013R1/Downloads/CommitteeMeetingDocument/8585

          http://public.health.oregon.gov/DiseasesConditions/CommunicableDisease/CDSummaryNewsletter/Documents/2013/ohd6220.pdf

          2)AJOG, 9/2013

          http://www.ajog.org/article/S0002-9378(13)00641-8/abstract

          3)The Netherlands. BMJ, 2005

          http://www.bmj.com/content/341/bmj.c5639

          4)The CDC data on Homebirth from 2003-2008

          5) even the Johnson & Daviss study in 2000 which is quoted so much by midwives shows an increased risk when you compare the year 2000 Homebirth stats with the year 2000 hospital low risk deliveries. The authors compared 2000 Homebirth stats with 1969 hospital stats!

          6) MANA has released every intervention statistic about their 27,000 Homebirth deliveries except the perinatal death statistics. Lower risk of interventions but at what risk? We don’t know because they won’t say!

          7) Colorado Homebirth statistics were posted only after getting Colorado Open Records request

          http://www.skepticalob.com/2012/06/no-wonder-colorado-homebirth-midwives.html

      • Ann

        We do have a difference of opinion. I definitely appreciate your drive to educate people. I still don’t appreciate how you do it. There are plenty of people who would love to give you their “why I will never have a home birth” or “how my home birth went wrong” stories without you pulling stories off FB to use as examples without permission. The mom was looking for support from her FB community. You diminish your message with the name-calling and judgmental statements. You do not know these people personally, you do not know the midwives who were in attendance, you were not there and you did not talk to the family or the midwives about the case. You are using someone else’s experience to push your agenda. Your agenda is not theirs. I actually would never have a home birth (prolapsed cord- 10 lb baby) – BUT I don’t judge others for doing so. If I am asked I tell my story and say I don’t recommend it – but it’s really up to the parents to choose. You would do far more good in just educating people instead of trying to use these emotional, traumatic stories for which you do not have permission and creating visceral response. Publish facts, publish statistics, use stories from people who are eager to share them. Leave the rest alone. Get your message out assertively, not aggressively.

        • Amy Tuteur, MD

          ” You would do far more good in just educating people instead of trying to use these emotional, traumatic stories for which you do not have permission and creating visceral response. ”

          Where’s your evidence for that statement? Can you point to someone who has been successful educating women about the dangers of homebirth who is successfully doing what you recommend?

          • Ann

            I’m talking about education technique in general. You have a really good message. Maybe your audience is different than what I think. You sound like a reality tv show in this article. These parents went to one of the top liberal arts colleges in the country, not the typical person who is moved by reality tv techniques. If they are indicative of the type of person who chooses home birth and whom you are trying to reach, taking the visceral “OMG these idiots” approach diminishes your argument to the point of being just noise. Using stories without permission and denigrating the participants is not the behavior one expects from a knowledgeable, well-educated professional. Yes- I am defending my friends because I think using their story as you did was inappropriate and unethical. If you want to troll the internet for stories at least take out the names, remove the identifying information and paraphrase the story. There is no need to blindside people with your opinion. But also, you do have an important message. A large portion of the discussion on this article is about pointing fingers and feeling sorry for the baby. How does that help your mission? It’s much more difficult to transfer information when the class is emotionally involved in the issue (yes, I have an MEd- and an MBA). If your goal is to encourage people to choose hospital birth over home birth- stick to the facts on the dangers of home birth and the benefits of hospital birth. For personal stories to add flavor- use them with permission. This is my totally unsolicited opinion- but since we are having this conversation, I’m offering it up. Keep up the good things you do.

          • Daleth

            The fact that this couple “went to one of the top liberal arts schools” is completely irrelevant to any discussion of how well informed their decision to do a home birth was. I have a master’s degree in a foreign language from a top university–does that qualify me to determine whether a home birth is reasonably low-risk or not? Of course not.

            I also have years of experience as a teacher with several teachers and professors in my immediate family, and if I’m understanding correctly what you’re saying–it sounds like you’re saying people remember facts better and are more effectively convinced by them if they are given only a list of facts, not an emotionally charged story–then I’m sorry, but either you’re misremembering what they taught on that point during your MEd, or you had a wacky teacher for that class. Nothing sticks in the human memory like an emotionally charged story.

        • Guestll

          “Be nice, Amy, be nice!” Same sexist tone-trolly scolding we read quite frequently in these parts. Thanks for parachuting in and telling a successful blogger whose work has changed lives (including mine) for the better how to manage her communications.

    • Guest

      “Bad things can happen at home and bad things can happen in a hospital, child-bearing has always been risky.” In one breathe you say they understood the risks, in the next you imply the risk is the same. I highly doubt that any parent would chose homebirth if you

    • almostfearless

      They know the risks? This is their website: http://www.stcroixbirth.com/childbirth-education.html Are they telling women of the risk of home birth? No. Is there a single reference on their site anywhere that mentions the risks of home birth? No. Do they sell products, advice and services to pregnant women that encourage home birth? Yes. So I guess what I wonder is if they really understand the risks so well, then why aren’t they disclosing this information before they take people’s money? They offer home births for VBACs and twins… not a single mention that these are not actually low-risk. They write: “83.3% of all couples who followed all of the steps in the Birth Matters Method had a normal, natural childbirth–vaginal births with no inductions; no need to speed up labor; and no pain medications used!” Great, but what percentage of babies needed 20 minutes to start breathing and brain cooling at the hospital? WHO IS UNETHICAL HERE? Dr. Amy who is writing about this for free to protect mothers and babies, or the parents who are selling services to women and hiding their own bad outcomes?

    • hurricanewarningdc

      What a horrible post. I had started a reply with statistics and a soft “out” for your friend, who couldn’t possibly be as educated as you claim “with all the facts.” But then, I get stuck your sentence about her witnessing the rescue of your own daughter’s life. She personally saw what training, experience, equipment, and medication can mean for an infant in distress and SHE STILL CHOSE TO REJECT ALL OF THAT TO DO A HOMEBIRTH WITH A FAKE MEDICAL PROFESSIONAL. You defend this choice as an evaluation of risks? Seriously? Especially with that information, there’s no way to minimize the fact that the parents knowingly put their son’s life in danger. (In that light, it’s even more sickening that mom’s describing her child’s descent into brain injury and possibly death with tidbits like the “bargain” tray that doubled as life-saving surface.) Fingers crossed that her post is just self-preservation and denial – and that she’ll soon condemn her own choice, file complaints with the state, talk to the police, go to her newspapers, thank the hell outta the real doctors and nurses who may salvage her baby’s brain (god willing)… And as others have said, if mom doesn’t want her horrific, sad tale used as a warning to other women (women who didn’t get the chance to see firsthand the difference that a hospital can make), then perhaps her look-at-me birth story shouldn’t be posted. For certain, the midwives and the ncb community hope that stories like hers are kept quiet – and that’s not out of concern for the family’s struggles with guilt and grief.

      • hurricanewarningdc

        Oh, and if I sound mad, it’s because I am. How many of these stories does one have to read (or ignore) before this dangerous, self-indulgent insanity stops?

    • toni

      Hm real sinister agenda trying to stop babies dying needlessly. I wonder if this is the tune hb midwives will be singing when word spreads and they can no longer claim with a straight face the same or better outcomes as obstetricians.. instead of ‘childbirth is safe, just trust your body, designed to birth etc’ it’ll be ‘childbirth has always been risky but so are lots of things..’

    • The Computer Ate My Nym

      If taking publicly posted information from the internet and commenting on it in a way the original poster might not like is wrong, what should we think of your comment? I doubt Dr. Tuteur likes it much and it is posted on the internet. Have you unethically used her post without her consent?
      There is an argument to be made for taking the post down now that the family has commented and made the post private, but an attack on Dr. Tuteur for using what was, at the time, public information strikes me as unwarranted and unfair.

      • The Computer Ate My Nym

        Though I suppose, in fairness, there’s an argument to be made for saying that facebook posts should simply be off limits given that facebook does sometimes change privacy settings without the users’ permission. But then there is bad advice like the “elder midwives” group out there causing damage and that needs to be countered…not sure I have a good answer.

        • Trixie

          Has FB ever turned someone’s private posts public though? I don’t think that really happens.

          • http://kumquatwriter.wordpress.com/ Kumquatwriter

            No, but they have repeatedly reset the “default” privacy setting. It won’t make private posts that already exist public but it does mean you should check that privacy icon EVERY time you post if you care about who sees it. It’s very easy to accidentally go public on Facebook.

            I think it was entirely reasonable for Dr. Amy to make this post. And I say that after having had a “bully blogger” (a real bully, too!) viciously document my life for several years. (She even self published a book).

          • anion

            You, too? Mine haven’t self-pubbed a book about me, but I’ve been gone after myself. Yeah, it sucks, but you CAN just ignore it. Personally, if I had a baby in the NICU, that would be my focus, and the internet can go jump in a lake.

            I don’t say that to judge the mother in question if it’s upsetting to her; my point is that yeah, whoever sent her the link is really creating drama for this woman. I had one person send me a link/quotes of what my little trolls had to say on a particularly vicious day, and guess what? That one person was just trying to insert herself into the situation for attention herself.

          • Trixie

            Really? Because I’ve never had my defaults change at all. I think some people (not you) just don’t understand FB. I know someone who is looking for a professional job but who has his FB set to public, including all his homophobic rants. I don’t think FB tricked him, I think he just genuinely thinks that’s okay.

    • JennG

      I personally am really glad the baby in this case seems to be recovering fine (I have to admit, given my experience, I am a bit skeptical). But as someone who would have raised every alarm in what turned out to be a disastrous labour had I had any idea how serious things could get, I wish there were more coverage of these kinds of events, not less.

      Yes, it is hard to be a family with a poor or dangerous outcome and have that discussed online, I’m sure. (Although in my case I don’t think anything was worse than the actual facts.) At the same time, we, the community of women making choices around labour and delivery, desperately need this information. Not just statistically, but in a human way that tells the story. Because there is a serious culture of silence around perinatal loss as well as malpractice within the natural birthing community and that harms women and their babies.

    • Sue

      I would gauge this family’s sensitivity about privacy by the fact that they posted their story publicly on the internet – where perfect strangers can access it.

      Dr Amy has accessed the story and used the example in an attempt to help others understand the reality of home birth risks.

      You say that the parents here are ”well-educated, caring and devoted”. SO they may be, but, from what has been written, they remain sadly unaware of the potential harm caused by their birth attendants’ potential negligence.

      If this discourse prevents even one repeat of the incident, its benefit will far outweigh any discomfort caused to a family who chose to broadcast their story to the world.

  • http://shameonbetterbirth.wordpress.com/ Shameon Betterbirth

    Heres the post about the most powerful woman in utah midwifery spinning the same “baby was fine then suddenly the heart stopped” bs to a class of aspiring doulas.

    http://safermidwiferyutah.wordpress.com/2013/12/30/kristi-ridd-young-spins-a-tale-about-a-homebirth-death/

    • FormerPhysicist

      Wow.

    • attitude devant

      Nice little indoctrination there. Thanks for the post.

    • KarenJJ

      It all sounds so plausible until you learn more.. An off-shoot though – what’s with the doula hugging the father and then the mother when the bad news is told to them? Terrible news like that I could imagine hugging my husband or maybe a nurse or doctor providing some comfort like holding a hand, but I really can’t imagine a hug from a doula in this situation? Is that odd or normal for doulas to do?

      • Dr Kitty

        I am very occasionally hugged by patients.
        I never hug them.
        I might squeeze a forearm briefly if someone is upset.

        Most recently I was hugged by the mother of a palliative patient I had been visiting weekly during his final illness, on what we both knew would probably be my last visit.
        That is pretty much the only situation when I’ll accept a hug.

        Hugging patients, IMO, is weird and unprofessional.

        • http://shameonbetterbirth.wordpress.com/ Shameon Betterbirth

          I don’t think its weird if you ask first. Some people like hugs and some don’t. I’ve hugged some patients who poured their hearts out to me after I asked them if they would like a hug. I couldn’t just do nothing, you know? I do know that some hospitals encourage RNs to put their hands on patients shoulders and get eye level with them to have every discussion. That is weirder to me than a hug when someone is upset.

      • http://shameonbetterbirth.wordpress.com/ Shameon Betterbirth

        Doulas do a lot of physical contact with their clients (massages and counter pressure etc). I would say that is about 1/2 the job, the other 1/2 is saying reassuring things. They are 100% emotional support so the hugging part wasn’t weird to me. Throughout my course everyone was on the same page about doulas not being medical professionals. What was weird was all the nonsense about the pathologist meeting with other nurses to stop them from being so mean to the mom and how it could never be prevented etc etc. I don’t see how that could possibly have happened.

  • Chris

    Dear Dr. Tuteur,

    Thank you for the work you do disseminating information about the risks of birthing at home. Everybody should have the best information available about birthing at home AND in hospitals so that each family can make their own decision about where to give birth.

    I take responsibility for accepting the risks associated with giving birth at home.

    I am the father of Thaddeus-James.

    However I don’t think you used the information from my wife’s Facebook page in a responsible or effective manner. In order to make your point you assumed quite a bit about the entire situation of my wife’s pregnancy, her labor, and the birth of my son. You based your assessment of our situation from my wife’s Facebook profile on which she recently posted private calls for prayer to friends and family. Because she wrote these posts under great emotional stress she didn’t set the privacy settings as she intended. They reflect her own non-medical opinion and perception of what happened. You do not have all the information about my son’s birth from our family doctor, our midwives, or the assessment of the doctors at the hospital. I am not saying that information from these other sources will alter your opinion about what happened during the birth of my son, but that you claimed to know enough about the birth, with information from a non-medical, personal, and incomplete source, to write as if you do know that my son’s heart wouldn’t have stopped if my wife labored in a hospital. Also, it is slander to call our midwives “clueless” without knowing them personally, their medical backgrounds, their birth experiences, and getting a firsthand report from them about what happened. I am saddened that you used my wife’s personal prayerful account of our family’s ongoing situation to bash homebirth midwives. You could have better made your point about the risks of homebirth by getting complete medical information about what happened during my son’s birth and leaving aside the condescending tone.

    Lastly, an update on my son: after undergoing various tests, he has no permanent brain damage. The “seizures” were temporarily misdiagnosed and the doctors now don’t consider his crying episodes seizures. Everything is looking normal for him at this point.

    I am humbled and awed at the prayers, concerns, and well wishes from the readers who have already commented on your post. I am also grateful for
    your concern and the hopes for my son’s full recovery which you expressed in your reply to my email asking for you to remove my son’s name and my wife’s Facebook postings from your post above.

    Again, God bless the work you do providing information about the risks of homebirth. The debate needs your voice, but perhaps not your tone or tactics.

    • Mac Sherbert

      Thank you for the update on your son. Prayers for your family and his continued improvement. I’m sure others will comment, but know that there are those who truly do wish your son to be 100% o.k.

    • jenny

      Yes, thank you for sharing the update about your son. I am also glad to hear he is doing well and hope for his continued recovery.

    • toni

      My husband and I are praying he makes a full recovery.

    • thankfulmom

      I am so glad to read that he is doing well and got a good report from the doctors! Was it the meds. for seizures that made him unable to nurse or bottle feed? Will you be able to take him home soon? Thank you letting us know he is doing okay now!

    • anion

      SO glad to hear your son is doing well! That’s great news!

    • Leah Timberlake

      Thank you for the wonderful response you have written. Bless you and yours!

    • Trixie

      Thank you for taking the time to post, and I’m glad your son is doing well!

    • Gene

      I am glad that it appears that your son is improving. Have there been any changes from the initial MRI with the “areas of concern”? Neonatal seizures after an anoxic brain injury can sometimes be difficult to distinguish from a purely physical observation. Were the results of the EEG normal? And was that an EEG done with or without antiseizure meds? I assume he was initially started on Phenobarbital as that is one of the most commonly used medications (with a half life up to 3 days – so in the system potentially for weeks).

      Most of my Pediatric Neurologist friends (I hope that your son is in a facility large enough to have Peds Neuro on staff) are fairly conservative about long term outcomes after a hypoxic injury at birth. Some will have no long term effects, some will have injuries so severe they will never speak/walk/talk, and everything in between. While cooling has been shown to improve outcomes, some of those outcomes cannot be measured for months or even years. I sincerely hope that your son is one of the lucky ones who has no lasting effects of his HIE.

    • batmom

      I’m very glad your son is doing well.

    • Former NCB True Believer

      I will continue to pray for you, your son, your wife and everyone touched by this situation.

      The statistics on home birth are really sobering, it’s scary when you become one and you don’t expect to. There is a lot to process, it will take time.

    • almostfearless

      I am so happy to hear that your son is doing better, that’s really excellent news. I also feel for you and your wife, being written about like this is painful. Maybe it was a mistake that your wife made to make those postings public, but something good has come out from it because these stories, even though it’s painful to be written about, these stories need to be told, because the midwives and home birth community are not talking about these risks. I was an attempted homebirth in 2010. I had no idea how much risk I was taking on. I thought it was “as safe as the hospital if not safer”. I read Ina May. I went through the entire pregnancy thinking I was doing what was best for my child. I was a lucky one and had a c-section after complications arose post dates. I now know that not everyone is so lucky. I wish a speedy recovery for your wife and son.

    • Frequent Guest

      Thank you for taking time to post. I am so happy your son is doing better. Wishing nothing but the best for your family.

    • wookie130

      I continue to pray that Thaddeus continues to make a full recovery…what excellent news that it’s looking like all will be well for him! Please take care.

    • RH

      I hope Dr. Tuteur responds to chris’s post. Whether or not she has contacted the family privately, her criticism (along with the negativity of many commenters) has been public, and chris raises valid concerns about her approach to their personal crisis as it has unfolded.

      • Amy Tuteur, MD
        • The Bofa on the Sofa

          Worth quoting:

          To homebirth loss mothers I say this:

          I am very, very sorry that your baby was injured or died. So sorry, in fact, that I want to make sure that it doesn’t happen to anyone else. It is deeply unfortunate that your stories serve as object lessons of the dangers of homebirth, but, in my judgment, the loss is compounded if we refuse to learn from these deaths, if we refuse to acknowledge just how common they are, if we let substandard self-proclaimed “midwives” continue practicing, and if we allow organizations like MANA (the Midwives Alliance of North America) to get away with hiding serial “babyslaugher,” the newborn equivalent of unintentional manslaughter deaths.

        • RH

          It is true that web postings are not private, but I question the decision to criticize the family and publicize their tragedy to a wider audience while the situation is still unfolding. This has put considerable stress on a family who is already in crisis. Would it really have hurt your case to simply wait until the immediate crisis was over?

          • Amy Tuteur, MD

            How did they find out?

          • RH

            I don’t know who informed them, or if they came upon the blog themselves. Does it matter?

          • toni

            I doubt they would have had the time or inclination to find this themselves with a baby in the NICU. They probably have other children to look after as well. Someone known to them would have found it and thought oh no it would really upset them if they were made aware of this at such a difficult time and then made them aware at this difficult time.

          • Caring

            Again, I doubt that they came upon it themselves, or that someone they know happened to come upon it. More likely someone read the blog and decided to find out how to contact this family and make their views known. I really think that Dr. Amy needs to “educate” in a more responsible manner. If this family has found out through threats this “education” has gotten completely out of hand.

          • thankfulmom

            I sincerely doubt the regular posters here would ever make a threat. IP addresses are not hard to obtain. People are not as anonymous as one might think. I think you are taking a wildly illogical leap to suggest this family was threatened in any manner.

          • LynnetteHafkenIBCLC

            Dr. Amy has the choice to prioritize one of the following: preventing future infant injuries/deaths, or protecting the feelings of a mother who has chosen homebirth. I think the more unethical choice would be to keep quiet and potentially let more babies be injured. For a blogger focused on the risks of homebirth, it makes no sense to do anything but shout tragic outcomes from the rooftops. Most people don’t have the gumption to do this, precisely because of people like you who would shame them for speaking uncomfortable truths at uncomfortable times. I often cringe at Dr. Amy’s tone on this blog, but in the words of Tina Fey, “bitches get things done.” (“Things” in this case being saving babies’ lives.)

          • RH

            I don’t know who informed them, or if they came upon the blog themselves. Does it matter?

          • caring

            Maybe you should ask them. It seems to me that while you have not threatened this family directly, you have put their info out publicly and there people out there who are not afraid to contact and make threats to others that they think have done something wrong. Use a little discretion please!

          • thankfulmom

            THEY put the information out publically. To suggest that she has indirectly threatened them is ridiculous. Does the media indirectly threaten people when they comment on a tragedy?

            You asked in another post if it would have hurt to wait on commenting. Possibly, they co-own a birthing service. Perhaps something they have read here will make them change how their client’s babies are monitored. Maybe another tragedy can be averted. I surely hope they will have the fortitude to ask hard questions to understand what went wrong. They could talk to the doctors who are caring for their son and ask what they can do to prevent this happening during another delivery or how to best minimize any complications if they do occur. Their midwife, who must feel terrible about all this, could further her education to become a certified nurse midwife. Having delivered about 150 babies is not a lot of experience. Knowing how to handle things differently could be the difference between life and death for the next baby she delivers.

          • Caring

            Dr. Amy, I find this repulsive- your quest to educate the general public has crossed the line- let me wave your credentials right back at you as you so clearly like to do and ask you to think back to what you know about the postpartum period…the time to criticize this family is NOT while this mother is only in her first week or two postpartum- and certainly not when their child is still in crisis. Regardless of your stance on homebirth, that poor mother does not need to be dealing with being attacked right now. Shame on you!

          • Amy Tuteur, MD

            I find it repulsive that a child has sustained brain damage because his parents chose to give birth far from expert medical help. I’m surprised that you don’t find that repulsive, too. Why not?

          • Abe

            Amy, this is nothing more than a straw man response. No where in the response by “Caring” did they say they were not repulsed by a child with brain damage (which by the father’s comment is not the case). Caring was simply pointing out what is obvious, mainly that you are more interested in making your case by kicking a woman who is already down than you are making a reasoned argument. You could have made all the same points without being specific but you seem to want to punish women who make decisions you don’t agree with.

            I’d be more willing to listen to your arguments if you didn’t beat up hurting mothers, ignore constructive criticism and make bad arguments based on false premises.

          • Amy Tuteur, MD

            Really? I haven’t noticed a single one of you expressing any concern for the baby, any interest in preventing such disasters in the future or any interest in holding these midwives accountable. Why don’t you care about those things?

          • Guest

            Straw man, once again…. Definition below.

          • Amy Tuteur, MD

            You appear to be confused about what a “strawman” is. Why don’t you tell us what you think it is?

          • Amy Tuteur, MD

            You appear to be confused about what a “strawman” is. Why don’t you tell us what you think it is?

          • Guest

            Straw man, once again…. Definition below.

          • Abe

            And once again, another straw man. How can you possibly imply that I don’t care about those things? Because I don’t directly state them on your blog? It seems to me you like to paint with a broad brush Amy.

            With all due respect, I am sure you are a very competent doctor, but you are not being careful with your reasoning or arguments. When you troll Facebook looking for families to take advantage of, it doesn’t make your arguments more effective. It actually hurts them.

          • Captain Obvious

            I would have a good medical malpractice lawyer review the care given.

          • Abe

            And once again, another straw man. How can you possibly imply that I don’t care about those things? Because I don’t directly state them on your blog? It seems to me you like to paint with a broad brush Amy.

            With all due respect, I am sure you are a very competent doctor, but you are not being careful with your reasoning or arguments. When you troll Facebook looking for families to take advantage of, it doesn’t make your arguments more effective. It actually hurts them.

          • caring

            Agreeing with Abe. No where in my response did I say anything about the baby and whether or not I am saddened by the fact that he could possibly have received better care by not being born at home. You completely missed my point. I think we are all concerned about these babies and the majority of us probably agree with you. However, YOU need to take some responsibility with your actions and how and when you use cases of homebirth to do your “education.” If anything, you turn away the very people that you claim to want to help. What would have been wrong with waiting for a few weeks to bring this one to light?

          • Amy Tuteur, MD

            Really? I haven’t noticed a single one of you expressing any concern for the baby, any interest in preventing such disasters in the future or any interest in holding these midwives accountable. Why don’t you care about those things?

          • Captain Obvious

            I don’t even see this as kicking parents while they are down. I see this as educating them that they were deceived by this Homebirth fiasco. Even MANA have not released the Homebirth death rates to help you decide if Homebirth is really even safe. I think dr Amy is trying to get you to consider if the Homebirth midwife is responsible for the outcome and if she can be held accountable.

          • Caring

            Have you ever been a postpartum mother? Do you know the complete exhaustion and the emotions that ensue? Furthermore, do you recognize how much these things are amplified by having a child in the hospital? I cannot even imagine how difficult this is for this mother. To add to this difficulty really is “kicking her when she is down.” I really think the “education” can wait a few weeks at least until this family has had time to process and to get out of the hospital. Nowhere did I say Dr. Amy should ignore this case of homebirth gone wrong. I am simply asking her to please use some discretion on when to reveal a case. She seriously could be doing some detrimental damage to a family that has already received and is in the middle of damage.

          • Captain Obvious

            From a medical malpractice aspect, the more the parents continue to see that provider and receive care and advice from that provider, the harder it would be to come back and litigate. Defense lawyers and jury will question why you continued to trust your provider and receive care from them only to sue them later. If you stop seeing them, have a lawyer review the case, then third parties will be more likely to realize that everyone suspected something from the get go. In the mean time, what family will that Homebirth midwife prey on next week? If another bad outcome happens, you could have prevented it.

          • LynnetteHafkenIBCLC

            I have never seen Dr. Amy go to a mother’s blog or facebook page and attack them. She takes stories that people publicly share on the internet back to her blog to discuss, in hopes of preventing future tragedies. How is this any different than what newspapers do?

          • caring

            Let’s not pretend that journalism has any high morals or standards that we should attain to

          • LynnetteHafkenIBCLC

            I’m not. I’m just saying that newspapers report on stories as they happen. Do you think they should delay covering wars, accidents, violent crimes, etc to protect victims’ feelings? And if so, how long of a delay would be appropriate in your opinion?

          • Abe

            Amy, this is nothing more than a straw man response. No where in the response by “Caring” did they say they were not repulsed by a child with brain damage (which by the father’s comment is not the case). Caring was simply pointing out what is obvious, mainly that you are more interested in making your case by kicking a woman who is already down than you are making a reasoned argument. You could have made all the same points without being specific but you seem to want to punish women who make decisions you don’t agree with.

            I’d be more willing to listen to your arguments if you didn’t beat up hurting mothers, ignore constructive criticism and make bad arguments based on false premises.

          • guest

            Maybe because billions of babies throughout history have been born at home just fine.

          • guest

            Maybe because billions of babies throughout history have been born at home just fine.

          • Amy Tuteur, MD

            And hundreds of millions have died. What’s your point?

          • Amy Tuteur, MD

            And hundreds of millions have died. What’s your point?

          • toni

            oh good grief. millions have survived falling down flights of stairs but we still install safety gates and try to resist pushing them down deliberately

          • toni

            oh good grief. millions have survived falling down flights of stairs but we still install safety gates and try to resist pushing them down deliberately

          • The Bofa on the Sofa

            You sound like a drunk driver justifying their actions.

            See our stats from yesterday. BILLIONS of drunk drivers arrive safely at their destination each each.

            If you found out a friend drove drunk, would accept the excuse that “Well, I made it home safely, therefore it is ok.”?

          • AlisonCummins

            Most home births go just fine. Not all. Which is why, in the days before modern medicine, women were terrified of the “pains and perils” of childbed. It will always be painful and perilous, but it is less so in hospital … which is why women who had seen and experinced home birth chose hospital birth as soon as they had that alternative available to them.

          • thankfulmom

            ? The father posted earlier there is no brain damage and everything is looking normal at this point. I would be relieved and rejoicing!

            Now you are saying the crisis is still unfolding? I hope the baby is still doing well.

            Since the family co-owns their birthing service and promotes their midwife, they do have a responsibility to their clients. If similar circumstances happen to one of their clients, the client will need a lot of financial help for the nicu bills, therapy, and possibly life long care. Homes, cars, and businesses are insured. Doctors and hospitals carry insurance. Babies are more precious than homes or cars. Does the family carry insurance to protect themselves and to assist the families in the event that something tragic happens to another baby? Even if they are willing to accept the risks for their own child, it would be uncaring not to plan for the unthinkable for their clients.

          • RH

            I hope the baby is doing well, too — chris’s post was encouraging. (I’m not sure how insurance came into the conversation, though. Medical providers of all sorts carry insurance, and I assume this would be required by law.) If their son is still in the NICU, I think it’s fair to say that the family is still in crisis. Now is not the time to hold them up to a critical audience as a bad example and then provide a link to the mother’s Facebook page. (Personally, I don’t think this is good at any time, regardless of the mother’s profession or whether she has made Facebook posts without restrictive privacy settings. It goes without saying that the health and safety of infants is of great importance, but effective education and debate does not need to involve specific names; it only invites personal attacks on suffering people.)

          • DaisyGrrl

            Homebirth midwifes almost never carry malpractice insurance.

          • RH

            Do you have a link or other reference for that? I heard there was a problem about their insurance rates going up — this wouldn’t be a problem if they weren’t actually buying insurance.

          • Bombshellrisa

            Malpractice Insurance: The midwife does not currently carry malpractice insurance due to the prohibitive costs which would have to be passed on to the clients.
            As a woman _______ _______
            _______
            _______
            _______
            _______
            freely choosing midwifery care and out-of-hospital birth, I understand that (please initial):
            I am ultimately responsible for the outcome of this pregnancy and birth.
            My midwife is responsible for providing adequate clinical management of healthy, normal childbearing, as outlined in her training, credentials, and licensing.
            The development of certain conditions during pregnancy, birth and/or the postpartum period may require the transfer of care to the medical system.
            There are benefits and risks associated with labor and birth in both non-hospital and hospital settings.
            The midwife carries certain emergency medication and equipment but cannot duplicate such services as are available at some hospital facilities, including continuous electronic fetal monitoring, Cesarean sections, or blood transfusions.
            My midwife may not be able to accompany me into the hospital and/or birthing room in the event of a transport.
            I have had the opportunity to ask questions of my midwifery care providers, and I am satisfied with the completeness of the responses. I have been encouraged to do my own research, and have had the opportunity to do so. I have made an informed choice regarding the place of birth of my child. I am choosing homebirth with my midwife.”

          • DaisyGrrl

            Minnesota does not require midwives to carry insurance. The required informed consent is supposed to disclose the midwife’s insurance coverage:

            https://www.revisor.leg.state.mn.us/statutes/?id=147D&view=chapter

            For a more general answer, the Midwifery Education Accreditation Council says no, they don’t.

            http://meacschools.org/prospective_students.php#Answer24

            I suspect that no insurer in their right mind would insure the services of midwife who is high school educated, correspondence course certified, and unable or unwilling to risk out high-risk mothers.

          • thankfulmom

            Do all the replies about insurance answer your question? Having gone through the trauma themselves, will they now continue promoting their birth services business if they do not have insurance? How is a massive nicu bill, therapy, or life long assisted care going to be paid if a provider injures a baby and doesn’t have insurance? Do you think providers who take on the responsibility of delivering babies should carry insurance? Do you think insurers should be forced to cover people who do not meet a standardized level of education (like in other first world countries)?

    • DaisyGrrl

      Thank you for taking the time to post here. I am glad to hear that Thaddeus-James is improving and hope that he makes a complete recovery. I’m sorry that your wife had to learn the hard way about Facebook privacy settings (she may want to consider changing her default privacy settings to friends only and make a conscious choice about what to make public).

      That said, when something is posted on the internet it becomes public and thus fair game for criticism. I don’t always agree with Dr. Amy’s tone or tactics, but by linking to original posts she gives her readers the opportunity to go to the source. We can read the story in the author’s words, and see the mother’s perspective on what happened. This also protects her from accusations of fear-mongering and making up stories to further her agenda.
      In reading many of the stories linked on this website, I have noticed some common themes. The parents of a birth-injured child will generally defend the medical care provided by the midwife and say that the outcome would have happened in hospital too. They often say that they have medical proof that the midwife is not at fault but do not disclose the proof. That is your right, but it is also the right of Dr. Amy and the commenters on this forum to draw inferences from the information available and for the medical professionals who comment here to speculate about what likely happened. Sadly, regular readers of this blog are all too familiar with the trope of “the midwife said the heartrate was fine until the baby was born without a heartbeat.” OBs, CNMs, and L&D nurses have all opined on various posts that this is wildly improbable based on their professional experience. As a lay person, I bow to their experience in the absence of other information.

      It is the combination of these blog posts and the associated comments that have lead me to rethink my position on the natural childbirth movement and the midwifery model of care. I used to think they were harmless or even superior to medical management of childbirth but I now believe that they are harmful and deprive women of true autonomy.

      I wish you and your family all the best. You have a long road ahead of you and I hope you have all the support you need from your family, friends, and community in the weeks, months, and years ahead. Thaddeus-James is in my thoughts and I hope he continues to exceed expectations and makes a full recovery from his difficult entry into the world.

    • Susan

      Chris I am so happy to hear your son is improving! I respect your dignified and thoughtful letter and my best heartfelt wishes and prayers to you and your family.

  • Leah

    Has a hospital birth ever made you angry? Do tell! I dare you.

    • anion

      What difference does that make, exactly?

  • Leah

    I must ask, has a hosbital birth ever made you angry? Do tell! I dare you.

  • http://shameonbetterbirth.wordpress.com/ Shameon Betterbirth

    https://petitions.whitehouse.gov/petition/review-direct-entry-midwife-credential-safety-and-accountability/hF2dcL6g

    lets petition the federal government to tackle this issue. Lord knows midwives won’t regulate themselves.

  • http://shameonbetterbirth.wordpress.com/ Shameon Betterbirth

    When I took a doula class from the midwives college of utah the instructor had a story very similar to this one. I’m going to blog it on safer midwifery utah soon (hopefully tomorrow!). I’ll update w a link.

  • theNormalDistribution

    This is totally off topic, but can somebody give me the scoop on breastfeeding and allergies? My sister-in-law (who is in her residency at the moment) rather emphatically stated that breastfeeding prevents allergies, and acted as if we have conclusive evidence for it. I Can’t find anything compelling, and the Internet tells me that the medical/scientific community is far from agreement on the matter.

    • Young CC Prof

      The word “prevents” (an absolute term) is definitely wrong as plenty of EBF kids still have allergies! Some studies show that it reduces the risk, some show no difference. No decent show that breastfeeding has a huge effect on the probability or severity of allergies, and the best studies show no difference.

    • Box of Salt

      I will offer anecdata refuting your SIL. I personally know at least one EBF’ed infant (now child) with several severe allergies.

      My understanding from discussions with the child’s parents is that genetics played a major role in these allergies. The one thing that getting EBF’ed did protect the infant from was dying from anaphylactic shock on her second dose of formula based on cow’s milk.

    • fiftyfifty1

      The best breastfeeding study that exists is the Belarus PROBIT study. It’s a great study because it is 1) large 2) randomized and 3) took place in a developed country, not a 3rd world country where risks are different. This study actually found an *increase* in allergies in the breastfeeding group as measured at age 6*. Here is the summary from the abstract:

      “The experimental group had no reduction in risks of allergic symptoms and diagnoses or positive skin prick tests. In fact, after exclusion of six sites (three experimental and three control) with suspiciously high rates of positive skin prick tests, risks were significantly increased in the experimental group for four of the five antigens.
      Conclusions: These results do not support a protective effect of prolonged and exclusive breast feeding on asthma or allergy.”

      * Of note, this study also found an increase in overweight and obesity in the breastfeeding group.

      • Meerkat

        I am curious, does this study mention mothers’ diet? I am from Ukraine, and I know that moms from former USSR republics have a very different view on breastfeeding. I know that BF women from that region tend to go on very restrictive diets. They are (or at least used to be, the ideas might be changing now) urged to eat a lot of kashas, only steamed or baked fish and meat, no raw fruit or veggies, avoid dairy, strawberries, citrus fruits, and a whole bunch of other things. My cousin’s wife gave birth at the same time as I did (they live in Ukraine). She was shocked that I ate normally. I think the only thing I avoided was cabbage because I thought it gave my son gas.
        I wonder if mother’s restrictive diet might cause more allergies?

        • fiftyfifty1

          The intervention they used was to promote breastfeeding heavily in the randomly chosen hospitals by doing lots of breastfeeding promotion and education and myth-dispelling. The rate of exclusive breastfeeding went way way up. I assume as part of that that they would have addressed the diet issue, but I don’t know that for sure.

          • Meerkat

            Interesting. I bet that majority of the women were on some kind of diet. I would be curious to see what such diets do to allergies… If anything.

          • Box of Salt

            Meerkat, even if many of the Belarus mothers followed some special diets, that study isn’t the only one showing an increased risk of allergies, rather than a protective effect. One of the references cited in the Polish study on breastmilk was on children in New Zealand – different hemispheres, different culture, different diets – same problem.

          • Meerkat

            So the lactivists are wrong, huh… Breastmilk doesn’t seem to protect against food allergies? I didn’t think so, but I think it does matter when the baby is introduced to certain foods. There are so many conflicting reports on when to start babies on highly allergic foods, I never know if I am doing the right thing. My son is 15 months old, and I have no idea if I should give him nuts and seafood or wait…I am afraid of a severe reaction.
            He had hives when I made him pancakes with rice brain oil and vanilla sugar, but I am not sure which one he is allergic to…

        • Lisa from NY

          I have a friend whose son has severe allergies, even while he was breastfed exclusively. She started cutting things out of her diet one by one, eliminating all nuts, eggs and fish from her diet. Eventually, she had no choice but to put her son on a special formula for kids who are allergic to every food in the world.

          He is now about 11 years old and on a rotation diet, drinking the formula and eating one food per day. There is one exception to this rule. He eats every day a few chocolate chips that are kosher for passover. Pure chocolate without lecithin.

          He drinks EleCare, which is extremely costly.

        • AlisonCummins

          I remember a study from way way back (when I was studying this stuff, in the early eighties) that looked at season of weaning and respiratory allergies. It turned out that children were *less* allergic to whatever was in the air while they were being weaned. Children weaned in the spring were *less* allergic to birch pollen. Children weaned in the fall were *less* allergic to ragweed.
          This isn’t what they were expecting and I don’t know if it’s been replicated. I’d just say it’s complicated.

    • sleuther

      Anecdata here, but my sister in law exclusively BF’d both her kids and both have allergies (as do their parents)and one also has asthma.

      • Former NCB True Believer

        Yes and babies die in the hospital, too. It’s the rates that matter. Although I have no idea what the studies say. But you and Box of Salt knowing breastfed kids with allergies is no more evidence than my vaccinated nephew having autism while the anti-vax one does not.

        Just trying to be consistent here. :)

        • Box of Salt

          Former NCB True Believer, if the claim in question is “breastfeeding lowers the rate of allergies,” then the data points sleuther and I presentd aren’t particularly relevant. But when the claim is presented absolutely – and in this case it’s quoted as “rather emphatically stated that breastfeeding prevents allergies” – then they do actually demonstrate the claim is wrong.

          • theNormalDistribution

            I think my original post may have been poorly worded. By ‘prevents’, I meant ‘greatly reduces the risk of’. (To be pedantic, it’s really hard to say that any protective measure actually ‘prevents’ a what it protects against. Staying indoors may vastly diminish the odds of getting hit by a car, but it doesn’t prevent it. Someone in my own town got hit by a car that barrelled through the grocery store window just the other day!)

            Anyway, my SIL was emphatic about the FACT that breastfeeding reduces the risk of allergy. It came up at christmas dinner; at one point, the topic of breastfeeding came up, and my spouse’s uncle started to say “I know breastfeeding reduces the risk of allergies later” and, expecting him to move on to obesity and IQ and whatever else he was about to say, I just said “No, that’s not true”, and started trying to explain the difference between correlation and causation, and the difficulties with prospective studies and confounding factors, etc. My SIL just interrupted to say that yes, breastfeeding DOES reduce the risk of allergies. The conversation pretty much ended there with me demanding evidence and her saying she would find it for me.

            I was thinking of reminding her about it because I am genuinely interested, but I’m afraid that instead of having read the research and then decided her opinion on the matter, she has unskeptically accepted the popular opinion and will just go out looking for abstracts that support it. I’d rather be wrong than find out that that’s what happened. :(

          • Young CC Prof

            Actually, my house was the victim of a hit-and-run car crash a couple years back. The damage was mostly just siding, and my husband fixed it himself, but it did look pretty impressive, impacted in more than one spot. (Clearly, the house jumped out in front of the driver. He didn’t see it coming.)

            Who knows, she might have gone looking for evidence and changed her mind! If she did, she might be reluctant to admit it to you, however. I’ve had that happen any number of times, I made a claim about something I “knew,” someone challenged me, I looked for a source to back up my point and discovered I was actually wrong, or at least much less right than I thought.

          • Former NCB True Believer

            I see your point! Unfortunately I think many lactivists do believe absolutes. I was shocked the first time my daughter was sick because, you know, I was told the antibodies in breast milk prevent that.

    • KarenJJ

      This is my ‘go to’ website for allergy and immunology questions. ASCIA is the Australian Society for Clinical Immunologists and Allergists and they have a website with info sheets on it as well as sources and the pdf info sheets have a ‘last updated’ date so you can tell how recent the info is. There is some breastfeeding info on here with some further studies listed below.

      That said, my experience with Australian immunologists is that they are not overly pushy of breastfeeding. The paediatric immunologist my daughter was seeing looked into breastfeeding for me on a biologics and recommended against breastfeeding even though they were initially OK with the idea.

      http://www.allergy.org.au/patients/allergy-prevention/allergy-prevention-in-children

    • Eater of Worlds

      If breastfeeding prevented allergies, then my nephew wouldn’t have anaphylaxis in response to nuts.

  • batmom

    OT but all this discussion has brought back memories of my baby’s birth…. he was nearly a C-section after his heart tones were lost (they bounced back to normal as I was being prepped, and he was a forceps delivery several hours later.

    The room was full of people. OB, CNM, at least three nurses on me, and another team for the baby.

    I was beyond out of it. I was so tired that when they put him on my chest I couldn’t manage to hold him. Was this a normal amount of people — or were they being prepared for a floppy baby?

    • Guest

      With my daughter, born in a hospital with a midwife, we used the vacuum to get her out and by that time, there was the OB, the resident, my midwife and 2-3 nurses. There was nothing to show that baby was in trouble, but that was still 5 or 6 people in the room for a relatively uncomplicated birth. So I think it’s pretty normal unless you have a completely uncomplicated birth and request that you only have your OB/midwife and another nurse there for help. I think the least amount of people in the room would be 2 or 3.

      • EmbraceYourInnerCrone

        Sounds similar to my daughters delivery(19 years ago). They grew concerned with what they were seeing on the EFM so they said they would like to rupture the amniotic sac(my water didn’t break on its own) and do internal monitering( attach the lead to her scalp). Meconium staining in the waters combined with late decels on the monitor meant they wanted to get her out quick so they used the vacuum. Sometime in all that they called in the NICU team who whisked her away to suction her lungs and make sure she was breathing ok. A bit scary but she was fine and they handed her to my husband first at my request. I was getting stitched up and was afraid I would drop her I was so tired. Between the OB, anesthesiologist, 4 NICU/peds people and 2 nurses (plus my husband and my friend) it was pretty busy.

      • Medwife

        At totally uncomplicated births there is me (CNM), a nurse for mom, and a nurse for baby. I don’t work at a teaching hospital though.

        • Trixie

          This is what I had at my totally uncomplicated birth.

    • Medwife

      They were prepped for a floppy baby and for you to hemorrhage- not an uncommon thing to happen after a forceps delivery. I’m glad you were both ok! Isn’t team work beautiful?

    • Elizabeth A

      My son was an instrumental (ventouse) delivery at a teaching hospital. The policy there, as I recall it, was that for instrumental deliveries, there would be a team of doctors and a team of nurses for the mother, and a team of doctors and a team of nurses for the baby. Depending on your definitions, that’s eight extra people at least, present because of the use of instruments. Instrumental deliveries present additional risk, and additional potential emergencies. It’s only responsible to be prepared.

    • batmom

      Thanks! To be clear, I have no complaints with the team or the number of people in the room. It just occurred to me that they must have been prepared (and since he was in great shape, most of them were out of the room by the time I was stitched up.)

      • Amy M

        There were quite a few people when my sons were born, but that was expected, since they were slightly premature twins. There was an OB, a resident, an anesthesiologist, a nurse for me, a nurse for each of them,and I think a pediatrician (or at least he was nearby). My husband was there too. I couldn’t actually see most of them and wouldn’t have cared if there was an entire orchestra in there at that point—in our case, it was protocol, there was no real emergency, and the boys were born with no problems. Still, I am glad everyone was there in case they were needed, I know my sons would have had excellent care should it have been necessary.

    • Gene

      Normal number of people in the room for an uncomplicated delivery is 2-3 (doc/CNM, 2 nurses). For anything complicated, you’ll get 2-3 (or more) people from the Peds/NICU team. And if you are in a teaching hospital, residents and fellows. Anesthesia may be there. Trust me, having been in deliveries where things are going bad, having MORE hands is a good thing.

  • caring

    The fetal heart rate monitors are only as good as the people using them…midway through my pushing with my first child the baby’s heart rate really slowed compared to where it should be. It continued for quite some time and my doc was concerned so they gave ME oxygen. After a reposition it was discovered that the monitor was tracking my heart rate instead of the baby’s and all was fine. I am thankful that they didn’t suggest a C-section because of that one! Yes, being close to medical care is great…but it is also important to recognize that doctors and medical care have limitations too and they cannot help everything. Also, the therapy that you state could have been initiated sooner (the cooling blankets) has been shown to be effective within 6 hours of oxygen deprivation. Thankfully, even with a hospital transport, they were able to receive this treatment well within it’s time of effectiveness. I think if you want to promote hospital births as the best scenario you need to focus on changing some of the ways hospitals treat births. My best birth experience was a waterbirth in the hospital. God bless this baby and family with full and quick recovery!

    • Young CC Prof

      But they didn’t do a c-section on you. They tried repositioning you first, and then figured out that the monitor had shifted and was no longer working right. Fixed the monitor, went on with labor. No one was harmed.

      “I think if you want to promote hospital births as the best scenario you
      need to focus on changing some of the ways hospitals treat births.”

      Hospitals have changed. There’s a lot of focus on providing a comfortable experience, keeping mom and baby together, etc. Interventions that were found not to help were discontinued, and the interventions that are still done have a great deal of evidence behind them. Some mothers avoid the hospital because they are afraid of an experience out of 1973 (or 1953), not because of anything that might actually happen there today.

      And yeah, he got his brain cooling within 6 hours, and I pray that it works and he makes a full recovery. But had he been born in a hospital, his distress would have almost certainly been identified and dealt with much earlier. Even if he did unexpectedly pop out not breathing, the hospital staff likely could have revived him much faster, simply because they have better equipment and more experience at newborn resuscitation.

      • Antigonos CNM

        As I understand it, not withstanding cooling, he has had seizures. That does not indicate a good prognosis.

        • Susan

          Yes, and cooling is far from a guarantee of a good outcome.

        • RH

          Actually, as of the last post he has not had any seizures.

    • amazonmom

      Sooner is better, and not needing cooling is best. The hospital is not perfection but it’s better than delayed treatment. Homebirth at its best results in a delay compared to the same situation in hospital. Cool cap or blankets will never restore baby to what they could have been without the initial insult .

    • jenny

      Yes, I really hope this baby recovers.

      It’s not the brain cooling that they are in such a hurry to do when a child is born hypoxic. There’s plenty of time for that. Unresponsive baby means distress before birth. If the distress goes on too long before delivery, then every second matters when it comes to the resuscitation, which can be more complicated than just needing some PPV.

      I had a baby who was born unresponsive. Paramedics were there to start resuscitation attempts. She arrived at the hospital within ten minutes of life. She had lost a lot of blood and needed fluids, packed red blood cells, and to go on a ventilator. She also had cooling mat treatment, and then she died.

      I’m well aware that hospitals are not magic and doctors are not gods. No one promised me that they could have saved her, but we did talk about what they could have done to try. This was not a planned home birth, and even if it had been, transport to the hospital would have been the solution. I would have loved the opportunity to have had a c-section.

      From where I’m sitting, preventing a disaster is always preferable to trying to fix one.

      • http://kumquatwriter.wordpress.com/ Kumquatwriter

        My heart breaks a little every time I hear your story.

      • Meerkat

        I am so sorry for your loss…

      • hurricanewarningdc

        I’m really sorry for your loss. Really. Your comment about “I would have loved the opportunity to have had a c-section” sucked the air out of me. That’s not a statement that I’ll forget. I just wanted to say “thank you” for sharing your story; it can’t be easy.

    • JennG

      My baby died due to a very similar scenario and I can tell you that your post is anything but caring. The chances that this baby will have a full recovery are very low. If he survives, and I hope that he does, this family will have a long and potentially expensive road ahead of them. The idea that your monitor was wrong and the hospital caught the issue and therefore they suck is really weird…because you clearly do not get the difference between that and OMG! C-section! And a damaged and sick baby.

      • Guestll

        +1

      • caring

        I am very sorry that your baby died. I don’t see how stating that I hope this baby and family recover is not caring. It was a tragic situation. I don’t promote homebirths. All 3 of my children were born in hospitals. I am simply stating that maybe SOME of the policies that hospitals have that turn off people who are inclined to have a homebirth can be changed. The fact that more hospitals have included waterbirth tubs shows that they are changing and hopefully more women will see that it IS possible to have the birth they desire in a hospital.

        • anion

          …or, to be frank, some people could grow up and accept that their Dream Birth is a dangerous fantasy, and that the job of a hospital is to safely deliver their babies, not provide unicorns to dance around the room singing hosannas and chewing placenta jerky at the moment of birth.

          I’m not directing that at you, Caring, it’s a general comment, but really, some people need to check their privilege a little bit. Women in third-world nations would kill for the chance to deliver in an evil uncaring hospital which focuses on saving lives, instead of being forced to have an “experience.”

    • anion

      “I had a wonderful waterbirth in a hospital, but hospitals suck and need to change!”

      • caring

        I didn’t say hospitals suck, but simply stated that maybe there is room for the homebirth ideal and hospital ideal to collaborate at more hospitals. I was stating that I had a great “homebirth” ideal of waterbirth in the hospital and that it is possible for more hospitals to go this route.

        • anion

          No, you said if we want to promote hospital births as the best scenario, we need to focus on changing some of the ways hospitals treat births, and to illustrate that used one story where an issue was caught without any problem, and another where you had the birth you wanted in a hospital. So what exactly do hospitals need to change? Do you honestly not see the contradiction?

          • caring

            Are you people really not getting what I am writing here. I am NOT advocating homebirth. I am advocating that we all work together to help mothers AND babies. I think that we can all agree that not all hospitals and doctors have the same policies regarding how a woman births. And my initial story was simply to point out that doctors and nurses are humans and mistakes happen. I think that it is possible to have a good birth experience in a hospital and that THIS SHOULD be promoted because many women have had bad experiences in hospitals and need to know that it doesn’t HAVE to be one or the other.

          • anion

            Where did I say that you’re advocating homebirth? I understand what you’re saying. I agree women need to be told they can have a good experience in a hospital, and that truth should be discussed and promoted all over the place. I just don’t see what it is hospitals have to change; if anything needs to change, it’s the hospital-are-evil-they-strap-you-down-and-force-meds-on-you lies of the NCB people.

          • Box of Salt

            caring, “Are you people really not getting what I am writing here”

            Yes.

            It’s because you neither stated it well, nor illustrated it well.

            I’m sure you mean well, but that’s not how your original comment came across.

          • fiftyfifty1

            “And my initial story was simply to point out that doctors and nurses are humans and mistakes happen.”

            What mistake did they make? I’m genuinely confused. It sounds to me like the doctors and nurses did everything RIGHT in your case. Sometimes a baby’s heart rate is lost to the monitor as it moves during labor. Then the mother’s pulse is picked up instead. What would you rather have happened instead? That the doctor ignored the slow rate? Do you really consider it a mistake that they gave you oxygen and repositioned you and repositioned the monitor until they re-contacted the baby’s tones? How do YOU think situations like yours should be handled? Can you come up with a better protocol than the one already in use (the one I outlined above)? Or perhaps you saying that you think all babies should have the scalp monitor? That way this issue would be avoided altogether. I guess I’m just confused by what you want.

          • caring

            Again, I am sorry for all the confusion and I will try to clarify a little and be better at my wording in future posts. The story I used to illustrate was not clear. The fact that they discovered it was my heartbeat and not the baby’s was accidental. It was discovered an hour later after I had received oxygen at least 3 times. The repositioning was a result of me sliding too far back on the bed and needing to come forward. So yes, I would say that the protocol SHOULD be to try repositioning the monitor first, but for some reason that wasn’t even considered as a possibility. I don’t mind that I received the oxygen, but my comment on the C-section is that it would have been unnecessary in this case. I am thankful that we have such great medical care here, and that should the need ever arise there are people who can perform C-sections to save mothers and babies. But we do have ridiculously high C-section rates in this country and that could be changed.

          • fiftyfifty1

            ” I had received oxygen at least 3 times.”

            Yep, a baby’s tones can be lost to an external monitor more than once. That’s not uncommon at all because both the baby and the mother may be shifting position as labor progresses. But each time it’s lost and the mother’s pulse is picked up instead the team needs to treat it as if it is a deceleration until proven otherwise or until the deceleration resolves. That means you may be asked to wear the oxygen mask more than once or be asked to reposition more than once. If this is problematic for you, you can avoid this completely by asking for an internal monitor (scalp monitor) rather than belt monitor. But so many NCB types refuse the scalp monitor. How weird because it 100% avoids any such false alarms! But be that as it may, your example still illustrates the opposite of what you intended it to. No medical error occurred. They never once even suggested a c-section to you. So what is it exactly that you want?! I sincerely want to know.

        • Box of Salt

          caring,
          I’m not sure what your point was in your original comment. It was poorly stated and your examples seem irrelevant in contrast to the truly tragic case in the blog post above.

          The fact that you wrote ” I am thankful that they didn’t suggest a C-section ” suggests that you do not understand what constitutes a bad outcome.

    • fiftyfifty1

      “The fetal heart rate monitors are only as good as the people using them.”

      Absolutely! And yours were terrific, don’t you agree? Sounds like they followed an excellent protocol:
      1. Give mom supplemental oxygen. This should be the first step as it can be done quickly and easily and has no down side. Obviously this isn’t as effective as giving oxygen directly to the baby would be, but until somebody invents a way to do that, it’s the next best thing!
      2. Reposition. If it’s a cord being pinched issue, this may fix the problem. Even if it doesn’t fix the problem, placental perfusion is typically best when mom lies on her left side so that’s a smart thing to do.
      3. Make sure the monitor is picking up what we think it is. Make sure it’s baby’s rate and not mom’s. If there is still confusion do a quick ultrasound of baby’s heart so you can SEE the rate. (but obviously don’t wait for confirmation before doing steps 1 and 2!)
      4. If baby’s heart rate really is dangerously low, then call the c-section team and start explaining to mom in a clear but brief way what’s going on. Minutes count!

      Sounds like they got to step # 3 with you. Sounds like they did a perfect job! Only somebody really ignorant would feel that the care you got was substandard, wouldn’t you say?

      • caring

        Where did I say I got “substandard” care? I admit my first post was worded poorly as there has been a lot of confusion. First of all, they didn’t reposition me because of the heartbeat. They gave me oxygen at least 3 times in the course of an hour. The reposition happened because I was sliding back on the bed and needed to come forward, so it was accidental that they discovered that they were tracking my heartbeat. My comment on the C-section was to point out that our C-section rate in this country should be questioned and decreased. It really didn’t fit in with everything else I posted so I am sorry for the confusion and will try to be better at clarity in the future. And I was TRYING to state that hospitals are generally on the right path for birth as they are becoming more open to the homebirth mindset. I can understand a lot of the things a homebirth mother desires and hopes for. I also could never give birth at home because I would be fearful of not being in close proximity to help should the need arise. I was merely trying to point out that more hospitals need to get on board with this. I thankfully live in an area where I have a lot of choice between where I receive my prenatal care and where I birth and who I choose to birth with. In my 3 hospital births, I was attended by 3 very different medical professionals. One was an OB who had a very medical view of birth, one was a CPM who had a very medical view of birth, and one was a CPM who had more of a “homebirth” mentality. If I had to do them all over again I would choose the waterbirth and the CPM with more of a “homebirth” mentality. Many women choose to homebirth as a result of their experiences with previous hospital births. We need to help them see that their experiences do not have to be repeated in the hospital and that there are OBs and CPMs that are really great.

  • BT

    I truly hope you all understand how unethical it is to post a story like this without permission, regardless of how strongly you feel about home birthing or your convictions to prove whatever point (although this story can hardly be generalized to all home birthing just as hospital mistakes can’t be generalized). Not only is it unethical in publication without permission but in that this article is causing great and undue harm to a family already undergoing incredible sadness. Please don’t let anger about the issue override your compassion for the individuals involved – no title or degree proclaims anyone superior over another, nor does instill in anyone the power to publicly shame another individual – especially someone with whom you share no relation (none whatsoever). This story could have been told with just as much impact without the quotes and the link to the Facebook page.

    • Box of Salt

      BT, if you know the family, please pass along my best wishes for baby Thaddeus-James’s recovery.

    • Amy Tuteur, MD

      The story was posted publicly to all 7 billion people in the world.

      I find it unfathomable that a baby has sustained brain damage that did not have to happen and you think the big problem here is that I am telling the story to warn others to prevent it from happening to their babies.

      I’m curious: do you also write to newspapers chiding them for mentioning infant injuries and deaths deaths that occur when their parents don’t buckle them into car seats on the grounds that their parents have suffered a tragedy?

      Homebirth advocates love to prate about taking responsibility for their decisions … right up to the moment when their babies are injured or killed by those decisions. Then they are horrified when anyone dares to hold them responsible.

      • Votre

        Dr. Amy – Thank you for not letting that attempt at moral posturing go unchallenged. It’s wonderful how apologists so frequently – and cluelessly – attempt to assert a fallacious moral highroad.

        @BT – suggestion: take an actual course in ethics someday? Just sayin’…

      • saddened

        “Homebirth advocates love to prate about taking responsibility for decisions…right up to the moment when their babies are injured or killed by those decisions.” It seems like this family doesn’t lay blame on anyone for the outcome of their birth. They recognized the possibility for complications in birth and still chose to birth at home. It is a tragedy that this happened to their child, but just because they chose to homebirth does not mean that the tragedy was certain to happen. Birthing tragedies happen in the hospitals also. Yes, there is quicker access to medical treatment in the hospitals. But I find it sad that you chose to berate this family in the midst of their grief and suffering. Why not reach out to them instead and say that you are sorry this happened to them, rather than unprofessionally chiding them with an “I told you so” air. It seems like your qualms with homebirth lie with midwives, not with the families that choose homebirth. Why make a family suffer more injuries than they already have? I pray that this child receives healing.

        • Captain Obvious

          I feel so sorry for the baby! Who is standing up for the baby? Who is warming this mother and other mothers that this didn’t need to happen? You talk about a grieving family, how about the injured child. When children get hurt as a result of their parents choices (intentional or ignorance), do you just say, hmmph, they are suffering leave them alone?

        • Amy Tuteur, MD

          But they should blame someone for the outcome. It wasn’t inevitable ; it didn’t occur in the moments before birth; it almost certainly could have been prevented in a hospital.

          Yes, babies die in the hospital, but they die at rates 3-10 times higher at homebirth because HOMEBIRTH INJURES AND KILLS BABIES. Unfortunately, Thaddeus-James is merely the latest example.

          • Antigonos CNM

            What hardly ever gets pointed out, in the “babies die in hospitals” [faux] argument is that, while, yes, babies do die in hospitals, it is after everything possible has been done to save them, whereas in homebirth babies are put at the utmost risk of death by not having proper staff/equipment/conditions, etc. to save them.

            Say this however and you’re “playing the dead baby card” as if it is untrue. But, as the saying goes, even paranoiacs have real enemies.

          • Young CC Prof

            Sure, babies die in hospitals. From extreme prematurity or extensive birth defects.

          • Guest

            Also, sometimes from mistakes made in the hospital. It’s rare, yes, but it happens. Let’s not sugar coat reality too much by saying if a baby dies in hospital it’s never the OB or nurse or surgeon’s fault. I think no matter how many babies die or how they die, it’s too many, but let’t not pretend that midwives are the only ones who make mistakes. Everyone is human and does the best they can with the knowledge they have. The problem with homebirth midwives who don’t have extensive training, is just that, they’re not trained. I’ll point out again the student OB who tugged on the umbilical cord of a friend of mine, causing hemorrhage. No one died, thankfully, but shouldn’t he have known better? Or because he’s studying to be and OB is he above reproach?

          • Young CC Prof

            Yes, mistakes do happen in hospitals. But a) There tend to be consequences for the people responsible and b) it’s more likely that rescue will be possible.

          • Guest

            Then the issue should be making home birth safer, getting the midwives more training and experience and having a system in place that has consequences for those involved that make the mistakes. That’s what should be concentrated on, not beating up on a family for making, what they thought, was a good decision for their family and child.

          • Young CC Prof

            Home birth in the USA could be made safer if we adopted a system more like the UK or the Netherlands, where home birth providers are integrated with the hospital system. However, studies show that even in those countries, it’s less safe than hospital birth, and it’s important that mothers understand that.

            The people I am angry at are not mothers. They are people who encourage mothers to make bad choices by claiming that home birth is actually safer, which is never true. Providers who bury mistakes instead of learning from them. Those are the ones who need to be beat up on. Mothers just need information.

          • Eater of Worlds

            Just how much safer though? The numbers coming out of the UK right now are atrocious (Dr. Amy did a recent post about that) and the Netherlands safety data is not the mythically fantastic numbers that people always compare homebirth to.

          • Young CC Prof

            You make an interesting point. Could making US home birth safer actually increase the damage it causes? Right now, home birth is mostly unregulated and very risky, but it’s also a fringe practice. Regulating it, using better trained practitioners and proper guidelines for risking-out and transfer definitely would reduce the rate of adverse outcomes.

            However, regulating it might also make it more mainstream and therefore more popular, which means the total number of avoidable adverse outcomes could potentially go UP.

            Huh. It’s late, my brain’s a weird place right now.

          • Thankfulmom

            American CPM’s don’t want more training and oversight. They also want to handle high risk patients they have no business handling. Even OB’s know when to send their patients to a MFM.

            If it doesn’t get pointed out that what happened to baby Thaddeus could have been prevented people won’t know. How are parents to know home birth is riskier if no one speaks up?

          • Guest

            Anyone who looks into homebirth knows there are risks. But when you birth with a trained professional who has hospital training and education, those risks are much reduced. I remember reading a comment on this blog that someone wrote a while back that “birth is inherently dangerous”. By that statement, I’m putting my life and the life of my baby at risk just by getting pregnant.
            Another comment that stuck with me was, “c-sections are safer than vaginal births”. That struck me as very odd since with any major surgery, you have other risks involved that you wouldn’t have with a vaginal birth.
            I believe in choice and doing what’s best for you, but a lot of women have c-sections believing that it will be easier than a vaginal birth or that they’re scared of vaginal birth. It’s different, but for a lot of women and babies, it’s not easier.
            I’ve never been scared to birth babies, even the first. If there are complications, I’m aware of what can happen, but I’m not scared. We’ll do what we have to and make sure baby and me are fine. They come into this world the way they were meant to, whether it’s vaginally or by a section.

          • Box of Salt

            Guest “Another comment that stuck with me was, “c-sections are safer than vaginal births”.”

            C-sections are safer for the baby.

            The risks to the mom need to be weighed against vaginal delivery as well.

          • Dr Kitty

            It isn’t as if vaginal birth is without risks to the woman.

            The 25 year old mother of three who has such a severe uterine prolapse it makes intercourse impossible and who is looking forward to her hysterectomy.

            The 30 something with faecal incontinence following a fourth degree tear.

            The 40 year old who has to have a TVT because of her urinary incontinence.

            The woman with the second degree tear extending to her clitoris who experienced lifelong sexual dysfunction.

            Uncomplicated CS would have been easier for all those women. Certainly it isn’t as if they got to avoid surgery, because all of them required some form of reconstructive surgery, with variable outcomes.

          • Box of Salt

            Dr Kitty “It isn’t as if vaginal birth is without risks to the woman.” Oh I agree, and I did acknowledge that.

            My point was that when we say “c-sections are safer” it’s because (for example) when we chose a c-section for breech or for failure to progress when there is a risk of infection present, it’s the baby we’re protecting, while the mother assumes the known and immediate risks of the surgery.

          • Guest

            My mum had what I think was fourth degree tearing from her vagina to her anus when she gave birth to me. She was alone in the delivery room, no nurses or doctors with her while she labored and gave birth to an 8&1/2lb baby at 7cm because no one was there to tell her it was too soon to push. She still has problems with bowel movements 30 years later. Very embarrassing to be a grown woman and lose control of your bowels. She’s never been given any options for surgery to correct the problem. She’s still happy to not have had a c-section. Every woman is different.

          • Mac Sherbert

            I am so sorry for what your mom went through. It seems to me that while you are not afraid of natural childbirth your are afraid of c-sections. Of course, there can be complications to c-sections. However, for most women they are not the most horrifying thing to have ever happened to them.

            I have had two c-sections and would have more, if my husband wanted more kids. There is no way I would ever choose to suffer with what your mom has to. Give me my c-sections any day. She is afraid of something she doesn’t understand and has never experienced. It kind of makes me think that is just what she tells herself.

          • Dr Kitty

            You ARE putting your life at risk just by getting pregnant.

            In the developed world you have about a 1 in 10,000 chance of dying due to pregnancy or a pregnancy related complication (not including homicide, suicide or accident).

            A woman in DRC has a 1 in 39 lifetime risk of dying from a cause related to pregnancy or childbirth.

            Just because you have successfully conceived is not a guarantee of a good outcome.

            20% of all conceived pregnancies end in miscarriage, delivery prior to viability or stillbirth. 1 in 200 pregnancies are ectopic- both non viable and life threatening.

            Statistically birth it the most dangerous day of a child’s life.

            Is this something you are unaware of?

          • Guest

            I wasn’t actually aware that the numbers were so high, so thanks for that terrifying thought. I’m really glad that I’m not scared of pregnancy or childbirth, otherwise I don’t think I’d be having my second right now. It begs the question then: why aren’t all women just admitted to the hospital to wait out their planned section at 37-40 weeks?

          • http://kumquatwriter.wordpress.com/ Kumquatwriter

            What a bizarre slippery slope argument.

          • Guest

            Just found what the CDC says based on 2006-2009 numbers:

            How does CDC define pregnancy-related deaths?
            For reporting purposes, a pregnancy-related death is defined as the death of a woman while pregnant or within 1 year of pregnancy termination—regardless of the duration or site of the pregnancy—from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes.

            Many studies show that an increasing number of pregnant women in the United States have chronic health conditions such as hypertension,1 diabetes,2 and chronic heart disease.3 These conditions may put a pregnant woman at higher risk of adverse outcomes.

            So a healthy woman without an underlying health condition would have a much lower risk.

          • Thankfulmom

            The homebirth moms I know talk about how it is so much SAFER to have a home birth. I don’t think they truly understand that it is riskier.

          • Susan

            Agreed. I know for certain when I had a homebirth I believed it actually was safer. It’s part of why I think this blog is so important, because very little attention is spent countering the stance of homebirth advocates.

          • Guestll

            You don’t get it. Birth is inherently dangerous. The day a baby is born is statistically the most dangerous day of his/her life. That’s not a trope or a scare tactic, it’s a fact. Why people pearl clutch when others point this out is beyond me.

          • JennG

            As I said I lost a baby to a mismanaged cord accident. Her life certainly would have been saved by a c-section, so it was much safer for her. I will also note that when a baby dies, the parents’ lives are profoundly impacted, including their health. When a baby experiences brain damage, that child and its family’s lives are profoundly impacted.

            That said, my next OB, an old white guy by the way, listened to my desire for a safe c-section and asked me to wait for 33 weeks to discuss. At that time we discussed it at some length. I have a totally lay understanding but what he told me made quite a bit of sense which is that yes, a c-section is major abdominal surgery and it’s good to avoid it while all the other indicators are basically equal. At the point at which any data indicates otherwise (breech, fetal distress, failure to progress, etc.) then the risk profile changes.

            This is actually one of my biggest issues with NCB thinking on birth. And I was victim. It is “c-sections are bad.” It’s not “c-sections are bad unless this and or that happens.” It is not black and white, and things change really quickly in labour, or can. A little more complexity of thought than “what is better all the time” goes a long way.

          • Guest

            Here I agree with you. There are definitely times when a section is the best way to go. If I knew that there were complications and we had to plan a section, I’d be all over it. This is my last (planned) baby, and I want everything to work out to get me another healthy child. Plus I wouldn’t then be concerned about some of the risks that come with subsequent sections, since we’re not planning on having more. But I’m still going to try to avoid a c-section. Not “at any cost”, but I’d prefer not to be cut open.

          • JennG

            Sure. I actually went on to have two vaginal deliveries, one with an OP baby, and so I have never had a c-section. I think it’s a live-saving intervention that needs to be applied appropriately.

            But NCB advocates do not make the distinction when they compare (see ‘caring”s post above) a dramatically bad outcome like this one to “she might have had to have a c-section!!!!”

          • Young CC Prof

            Definitely. A c-sections are best when conditions dictate that it’s best. Right now, my baby is breech, and I’m planning a section, because it’s safer for us. If he turns, then I will try to deliver him in the traditional fashion. Either way, I’m confident that we are making the best choice for that particular situation.

            This is why I now think that the c-section rate is just not a useful metric. We should be tracking outcomes, including deaths, injuries, complications, etc. No one knows what the ideal c-section rate is, and it presumably varies depending on the population.

          • KarenJJ

            Are the risks really reduced by using professionally qualified midwives with hospital training? Or do they recognise increased risk and refer on to the hospital faster?

            From what I can tell if something bad is going to happen, then it will happen whether you’re at home or at hospital. Problem being at home is that there aren’t the tools to help save you or the baby. Obviously it is an even bigger problem if you have an untrained provider that doesn’t even recognise a problem to start with, but even once it’s recognised you still have to get from A to B ASAP.

          • Young CC Prof

            Direct-entry midwives tend to have fairly low transfer rates, and even praise low transfer rates. The Oregon data set shows an overall transfer rate of 10% for DEMs. That same data set shows a 40% transfer rate for CNMs doing home births, which is similar to the transfer rate in places like the UK, where home birth providers are a “real” part of the healthcare system.
            Transferring at the first sign of a problem, and having the right documents/authority to get your client into the hospital and integrate records quickly, can prevent a lot of home birth disasters.

          • Young CC Prof

            Birth IS dangerous. It’s far safer now than it’s ever been, but women have always brought forth children in fear and pain, not just in joy.

            Life isn’t about absolutely doing the safest thing. I gladly accept the small unavoidable risks of childbearing (and the marks it will leave on my body even in the best case!) as the price of becoming a parent. And I will do everything I can to minimize those risks. The one thing I won’t do is close my eyes to real risks that could be avoided.

          • The Bofa on the Sofa

            I don’t know if you’ve ever heard Pablo’s Birth Scenario:

            A pregnant woman and her husband go to a party. She is not drinking, but he drinks enough to be legally drunk. She goes into labor, and they have to go 8 miles to the hospital. He drives.

            Bad idea, right? Drinking and driving is bad, we all know. However, in this scenario, the chance that she dies in childbirth is 50 times greater than the chance of either of them dying in a car accident. Remember, he’s drunk.

            But that’s just dying. What about collateral damage? He’s a risk to others, right?

            Well so is she. The chance of him getting into an accident that causes damage (no death) is 30 times less than the chance of the baby dying during childbirth. Shoot, the chance that he either gets into an accident OR even gets a DUI is 10 times less than the baby dying.

            This is based on stats from the US, including the USDOT.

            Birth is not safe.

          • Guest

            Again, numbers from the CDC website:

            “Motor vehicle traffic deaths
            Number of deaths: 33,687
            Deaths per 100,000 population: 10.9

            Unintentional poisoning deaths
            Number of deaths: 33,041
            Deaths per 100,000 population: 10.7

            About 650 women die each year in the United States as a result of pregnancy or delivery complications.”

            Even if you account for the fact that there would be men and children in the traffic accident and poisoning deaths, the numbers are still considerably lower than you state for dying during pregnancy or delivery in the US.

          • AlisonCummins

            Guest,
            Can you recalcuate your numbers for deaths per 8 miles? Because we’re trying to decide whether it’s safer for Pablo to drive 8 miles to the hospital or for his wife to give birth at the party.

          • Guest

            Lol. Not sure. Is there an OB or midwife at the party?

          • Young CC Prof

            And the maternal death rate is 16 per 100,000 pregnancies. A woman’s lifelong risk of dying in a car accident is much higher than her risk of dying in childbirth, but during the year of pregnancy, the pregnancy is a bigger threat. On the actual day of delivery (and a few days afterwards) complications of pregnancy are orders of magnitude more likely than dying in a car accident on that particular day.

            This isn’t to say that women are dying in childbirth right and left, just that it’s not the risks ARE large enough to be worth planning around and minimizing.

          • The Bofa on the Sofa

            Exactly. When comparing the risk of doing X vs doing Y, we don’t care about the lifelong risk, or the annual risk, because that is integrated over the number of attempts. In Pablo’s Scenario, which is carefully constructed, it is a question of 1 attempt each: driving 8 miles drunk, or giving birth?

          • Guest

            Well, I don’t drive drunk, so that’s a risk I don’t take myself, but I’ll be giving birth in a couple of months, so I guess I’ll take that risk again.
            Everyone here seems to be so terrified of birth. I think everyone’s read too many horror stories and not enough good birth stories.
            Even one of Dr. Tutuer’s posts talks about how much safer it is for women these days. “Very rare” I think were her words.

          • Young CC Prof

            Terrified? No. (I’m 37 weeks.) In fact, I’m quite confident that the baby and I will be OK, despite the fact that my baby is complete breech. Willing to go out of my way to minimize the risks to both of us? Hell yes.

            I know that if, say, I got stuck in an elevator or something else crazy and wound up giving birth without intervention, the probability of something dreadful happening to the baby is quite high, like double-digit percentage. Luckily, we won’t have to take that gamble.

            We’re not saying that birth is or should be scary to women who have no extraordinary risk factors and access to proper care. We ARE saying that, in the absence of care, the risks are substantial, and even under modern conditions, things can go wrong.

          • The Bofa on the Sofa

            Everyone here seems to be so terrified of birth

            Terriied? Kind of, yeah. I was scared shitless about my wife giving birth, because I knew how risky it was. I was worried about the babies, and I was worried about her. Especially so since she was having C-sections, which are more risky for the mother. That’s why I didn’t want to mess around and take chances with it.

            Seriously, how can you be cavalier about something that has such a potential for problems? Even aside from death, there are things that can go wrong. Hell, even if nothing goes wrong, you still have mom dealing with a lot of pain or other crap as part of the normal process.

          • The Bofa on the Sofa

            If birth doesn’t terrify you, then why should drinking and driving? It’s a lot safer than childbirth.

            The difference, of course, is not in the risk associated, it is in the benefit. Childbirth has massive benefits, that far overcome the risk involved. Drunk driving, not so much (it does have the benefit of avoiding being inconvenienced, but that is deemed not sufficient to overcome the risk).

          • Guest

            Didn’t say I was terrified of drinking and driving. It’s just not safe. If I didn’t think it was safe to give birth, I would have adopted. If I thought there was that big of a risk of dying or having my baby die, I wouldn’t get pregnant.
            The rates in Canada are much lower, 7.8 per 100,000 births in 2009-2010, and in my province even lower.
            Not sure why the numbers are so much larger in the US.
            Maybe that’s why I’m not as worried?

          • Amy Tuteur, MD

            But childbirth is MORE dangerous than drinking and driving.

          • Guest

            Saying it is so, doesn’t make it so. I’ve been looking into this since this thread started. I can’t find anything for the US or Canada that states it. Where’s the proof?
            When I’ve seen proof that I’m wrong about something, I’ve admitted it. No one else here seems to do that. Maybe because it’s easy to interpret studies differently so we can look at the same study and see different things in it? When I’ve posted a study to prove my point the comment thread either goes away or is deleted, but when I admit that I’m wrong, the comments keep on coming. Why is that, just out of curiosity?

          • The Bofa on the Sofa

            I’ve given the numbers for the US that indicate the level of risk.

            This isn’t based on any “study” it’s based on what has happened. There are no “studies” to interpret. Using the US DOT estimate of miles driven per DUI and an estimate of the average length of a drive, this is the answer.

            Now, if you disagree with the US DOT, bring it up with them. If you disagree with my estimate of the average length, I don’t give a shit, because unless you claim that the average length of a drunken drive is 400 miles, then the conclusion is the same. 320 miles if it’s Canada.

          • Guest

            Should have said “stats” not “study”. My apologies.
            If the risks are that high, then why not adopt and not risk your wife?
            Still doesn’t answer my last question. Some of my comments made here are gone.

          • The Bofa on the Sofa

            Who is going to have the babies to adopt?

            I have to tell you, I find your attitude HORRID.

            “Childbirth is too risky for me, so let someone else do it and I will take their baby.”

            I don’t think you realized that is what you said, but it is. I think you should maybe rethink your approach.

            As I have noted, the reason we go through childbirth is not because it is not risky, but because the benefits far outweigh the risks.

          • Guest

            Oh jeez. That’s no what I said at all. There are so many children out there to adopt, I’m not saying to get a surrogate. My attitude is not horrid. I have the same attitude towards pregnancy and childbirth as a lot of people I know, including my GP. She was thrilled when I told her I was pregnant again. In all my prenatals with her, she’s never warned me about the inherent danger of pregnancy and childbirth and she’s a pretty no nonsense kind of lady. She sugar coats nothing for me.

          • The Bofa on the Sofa

            “If the risks are so high, why not adopt”

            But if I am adopting, that means that someone else has to take the risk that I am unwilling to take. That is exactly what you are saying, whether you realize it or not.

            We go through childbirth because the benefits of it are immense, and for that reason, we accept the risks. That does not mean the risks are not high, because they are.

          • The Bofa on the Sofa

            Maybe because it’s easy to interpret studies differently so we can look at the same [stats] and see different things in it?

            What is there to see? The risk of a woman dying in childbirth is something like 10/100000, or 100 out of a million. The risk of dying when you drink and drive, as indicated by the statistics, is 2 in 1 million.

            Cut the risk of dying in childbirth in half and double the risk of drunk driving and it’s still more than a factor of 10.

          • AlisonCummins

            Disqus has problems with heavy comment threads. It starts acting kind of like Facebook, not showing everything.

          • The Bofa on the Sofa

            Using your value of 7.8/100 000 means that childbirth is only 40 times more dangerous than drunk driving.

            I don’t know about drunk driving risk in Canada, but I would be surprised if drunk drivers in Canada were less safe than those in the US.

            Before you answer that, please remember we are talking about the risk per event, so the fact there is less drunk driving in Canada does not affect the risk.

          • Young CC Prof

            Oh, you just made my day asking that question! Seriously, I love to blather about health statistics, it’s important and it’s fascinating.

            There are basically two reasons why the numbers in the US are higher. One is that US authorities use a very comprehensive method of counting maternal deaths, including ANY death of a pregnant or recently postpartum woman in which the coroner believes that pregnancy or childbearing was a factor. (This measure was introduced in the 90′s, and immediately the maternal death numbers rose.) Other countries might not count the same way.

            The other is socioeconomic. A great many young women are poor and have no health insurance. Even when they manage to get decent prenatal care, they many have preexisting problems that were inadequately managed. Obesity is also much more common in the US.

            Still, all first-world countries have a maternal death rate somewhere on the order of one in 10,000 births, so you can use that as a general number.

          • anion

            You know, lots of us are parents ourselves, and have our own “good birth stories.” (I had two fantastic c-sections, myself.) The fact that we know bad ones happen, too, and want to lessen them, doesn’t make us paranoiacs.

            (FYI, your comments haven’t disappeared. Disqus comments rearrange themselves.)

          • Maria

            I am most definitely NOT terrified of birth. I had a wonderful birth (in a hospital, with a fantastic L&D team) and am looking forward to meeting baby #2 in a couple of months. What I AM, and I imagine many of us regular readers are, is realistic about birth. Chances of a complication or emergency happening during my birth are very low given my history, but I am realistic enough to never say “I know my birth will go well and my baby will be fine.” I don’t know that, so it is in my and my babies best interest to make sure we are in a place that will be as hands off as we want as long as things are going fine (yes, in a hospital) but who can jump in within seconds if the sh*t hits the proverbial fan.

          • fiftyfifty1

            “Everyone here seems to be so terrified of birth.”

            Totally not terrified here! It’s just not part of my personality to be a worrywort. I just take reasonable precautions (where my seatbelt, never drive after drinking, give birth in the hospital) and then never worry about it again! Does that sound unreasonable to you?

          • The Bofa on the Sofa

            You are failing to account for the number of attempts.

            How many childbirths are there each year? How many drunken drives are there each year?

            The US DOT estimates that there are 27000 miles driven drunk for every DUI. There are 1.4 million DUIs a year in the US on average. That means that there are 38 BILLION miles of drunk driving each year, or 126 miles PER PERSON (on average).

            If the average length of a drunken drive is 8 miles, that means that there are 4.7 billion drunken drives each year. Approximately 10000 people die in drunk driving accidents each year, which means 1 death for every 472500 drunken drives.

            Using a maternal mortality of 10/100 000, that means that it is 47 times more likely, which is where I get the value of 50.

            The danger posed by drunk driving is not the absolute risk, but by the amount that occurs. See that above – on average, each citizen of the US drinks and drives 15 TIMES A YEAR!!!! That means that there is one person who does it every week for every three who never do.

            If women were given birth 15 times a year, there would be a hell of a lot more than 650 deaths.

          • AlisonCummins

            We’re trying to decide whether it is safer for Pablo, who is legally drunk, to drive 8 miles to the hospital or for his wife to give birth at the party.

            I get my figures this way:
            · There are 1.5 road deaths per 100,000,000 miles driven in the US.
            · Legally intoxicated male drivers are 707 times more likely to be involved in a road death than a sober driver.
            · They are going 8 miles.

            (8*707*1.5)/100,000,000 = .0085% chance of a death associated with Pablo’s drunk drive to the hospital.

            The chance of a death if he were sober would be only 0.000012 % so the entire 0.0085% is an excess risk of death from being drunk.

            *** *** ***
            · The chance of a pregnancy of over 28 weeks resulting in either a stillbirth or a baby who dies within 7 days is about 6.5/1,000.
            · Homebirth increases that rate by a factor of at least 2.5.

            (2.5*6.5)/1000 = 1.63% chance of the baby dying if born at the party.

            Since the chance that the baby would have died in the hospital is 0.65%, the excess chance of death of the baby due to being born at the party is about 0.98%.

            *** *** ***
            · The maternal mortality rate is about 21 per 100,000 live births.
            · Homebirth increases that rate by a factor of about 2.6.

            (2.6*21)/100,000 = 0.055% chance that the mother dies if she gives birth at the party. (Actually it’s less because that number includes deaths associated with pregnancy generally, and she’s survived that long enough to go into labour, but the number is small enough that it doesn’t matter much.)

            Since the chance that the mother would have died in the hospital is 0.021%, the excess chance of death of the mother due to giving birth at the party is about 0.034%.

            *** *** ***
            The chance that either the mother or baby would die if she gives birth at the party is 1.63% + 0.055% = 1.68%

            The chance that either the mother or baby would die if she gives birth at the hospital is 0.65% + 0.021% = 0.67%.

            The chance that one of them dies because of the choice to stay at the party is 1.68% – 0.67% = 1.01%

            *** *** ***
            Total chance of death driving 8 miles drunk to the hospital and giving birth there:
            0.0085% + 0.67% = 0.68%

            Total chance of death staying at the party and giving birth there:
            1.68%

            Excess chance of death due to the choice to not take the risk of driving drunk:
            1.68% – 0.68% = 1.0%

            Relative risk of a birth without a qualified attendant vs the risk of a drunken 8-mile car ride: 1.0% ÷ 0.0085% = 118

            *** *** ***
            http://www.cdc.gov/nchs/data/nvsr/nvsr60/nvsr60_08.pdf
            http://dhmh.md.gov/midwives/Documents/Wax-etal.pdf
            http://www.indexmundi.com/g/r.aspx?v=2223

          • The Bofa on the Sofa

            (8*707*1.5)/100,000,000 = .0085% chance of a death associated with Pablo’s drunk drive to the hospital.

            The key here is your 700 figure. My value for the risk is based on the US DOT estimate of 27000 miles per DUI. The 700 times riskier factor is not consistent with that value.

          • AlisonCummins

            Ok, thanks!
            1 death per 27,000 miles of DUI = 0.030% chance of dying on the road, so I can rewrite that last section this way:

            Total chance of death driving 8 miles drunk to the hospital and giving birth there:
            0.030% + 0.67% = 0.70%

            Total chance of death staying at the party and giving birth there:
            1.68%

            Excess chance of death due to the choice to not take the risk of driving drunk:
            1.68% – 0.70% = 0.98%

            Relative risk of a birth without a qualified attendant vs the risk of a drunken 8-mile car ride: 0.98% ÷ 0.030% = 33

          • The Bofa on the Sofa

            1 death per 27,000 miles of DUI

            No, that is 1 DUI arrest for every 27000 miles driven drunk. At least, that is what the US DOT says. Not 1 death for every 27000 miles, but one DUI.

            There are 1.4 million DUIs/11000 deaths = 127 DUI’s for every death.

          • AlisonCummins

            Ok, thanks! Trying again.
            · 1 DUI arrest per 27,000 miles of drunk driving
            · 1,400,000 DUI arrests/ 11,000 motor vehicle-associated deaths with alcohol involvement
            · They are going 8 miles

            (11,000 deaths/1,400,000 arrests) * (1 arrest/27,000 miles) = 11,000 deaths / 37,800,000,000 miles

            (11,000 deaths / 37,800,000,000 miles) * (8 miles) = 0.00023% of a death on the road, so I can rewrite that last section this way:

            Total chance of death driving 8 miles drunk to the hospital and giving birth there:
            0.00023% + 0.67% = 0.67%

            Total chance of death staying at the party and giving birth there:
            1.68%

            Excess chance of death due to the choice to not take the risk of driving drunk:
            1.68% – 0.67% = 1.01%

            Relative risk of a birth without a qualified attendant vs the risk of a drunken 8-mile car ride: 1.01% ÷ 0.00023% = 4,338

          • Young CC Prof

            That is a beautiful symphony of conditional probability! Of course, if I were Pedro, I’d just ask someone else to drive. ; ).

          • AlisonCummins

            I was thinking about calling 911!

          • Trixie

            And, the hospital generally has to pay out a huge settlement, which is pretty good incentive to take steps to correct any procedures that led to the error.

          • Dr Kitty

            Although controlled cord traction is a recognised technique in active management of the third stage and at least one study has shown it has no impact either way on PPH, so it isn’t like the student OB was doing something totally weird and crazy with a predictably horrible outcome.

            http://www.bmj.com/content/346/bmj.f1541

          • Guest

            But I read a comment here on this blog that a midwife had done it and everyone was shocked and appalled, saying that she shouldn’t have done it. Isn’t it possible then that she was trained on cord traction or is that something that should only be handled by an OB?

          • http://shameonbetterbirth.wordpress.com/ Shameon Betterbirth

            I think this was the discussion of Better Birth. Someone said the owner pulled on their cord at a homebirth, causing a PPH. I can assure you that according to the law in the state she operates in, retaining a placenta is a condition for transfer. It is spelled out in the law. I am sure there is a reason for that.

          • JennG

            My baby died to a hospital screw-up. (Her story is on the site, just search for Emily Hope.) You know what no one ever, ever said to me? “Well babies die in homebirth too you know.” That’s one big difference between the communities.

          • Guest

            I’m sorry for your loss. I personally don’t know anyone who has died during pregnancy or birth, or who lost a baby to child birth and I come from a pretty prolific family, so I can’t even imaging what you and other families go through during such a tragedy.
            Likely no one said that to you because people expect you to give birth in a hospital. And I would never say anything like that to a grieving mother.

          • JennG

            Actually you misunderstood my point. No one said that to me because they were taking responsibility, not pointing the finger of blame at others. It’s like people gunning it through a red light and then saying “well at least I wasn’t driving drunk” or something else. Saying babies die in hospitals too does not negate the risks of homebirth.

          • Guest

            But again, I would never say that to a grieving mother.

          • jenny

            I went and read your daughter’s story. She is beautiful, and she does look so pink and healthy, like she is just sleeping. Except for her little bruised fists from the IV.

            I remember thinking how fat and healthy my daughter looked, too, the first couple days, before the kidney damage made her swell. It didn’t make sense, how could my beautiful baby be dying? When I read your words, I felt like I was reading my own. I remember thinking about therapies and feeding tubes and what I had learned from my time caretaking a woman with severe CP. It took four nurses to lift our daughter the first time we held her.

            I’m so sorry. I’m sorry that the people who had the power to act didn’t.

          • JennG

            I’m so sorry for your loss too jenny. What a sucky club we are in together.

          • http://shameonbetterbirth.wordpress.com/ Shameon Betterbirth

            Yes, I have been there for staff errors that seriously injured or killed babies. One of the worst I can remember was an overdose of powerful IV antibiotics for an already sick baby. Their liver was severely damaged. There was a dispute about if the pharmacy prepared it wrong or if the RN ordered it incorrectly, so there was a formal investigation. The difference is that the hospital sits down and tries to figure out if anything could have been prevented and the patients parents can complain to a licensing body to have them investigated. Charts are available for review. The incident becomes a mark on everyones record as well as a statistic that hospitals can use to improve their protocols. Midwives dodge any and all responsibility because there isn’t proper legislation in place to prevent them from lying about anything they feel like (their credentials, their record, the safety of homebirth, the safety of a specific patients pregnancy, if a transfer was recommended or not, etc).

          • Birthbuddy

            Concentrate now.
            The problem is the homebirth midwives cause this harm at a rate 3-10 time higher in hospital.
            3-10 TIMES HIGHER.

        • Amy Tuteur, MD
        • Thankfulmom

          This family co-owns the birthing service promoted on their page and promote their CPM on their page. A tragedy like Thaddeus James experienced needs to be understood. Was it a placental abruption? Was the baby in distress that could have been detected hours before his birth? What can they do to prevent this from happening to another family that uses their facility? Can they get access to an EFM machine and their midwife learn how to understand a monitoring strip? The mom is thankful we live in a time & place with amazing medical care. Will they offer this amazing medical care of EFM to their clients for the best possible outcome? Is their facility insured so if a client’s baby is injured at their facility the family can get financial help for the nicu medical bills and lifelong care and therapy?

          My son died unexpectedly at 14 months. The PICU doctors didn’t sugarcoat anything for me as they tried to figure out exactly why my son died. They didn’t say “Oh, she is grieving, leave her alone.” I had taken him to his doctor just the day before and our doctor came to the hospital and wanted answers too. The idea that I or my doctor was at fault was agonizing. Did either of us miss something? What could have been done differently? I pondered the whole thing for years because we didn’t get clear enough answers. When a tragedy happens you search for answers and ask how it can be prevented. You bet my friends wanted to know what happened because they didn’t want their children dying. You bet we became freakishly concerned when our subsequent children had croup or even common colds. I took my children in to the pediatrician at the first hint of anything being off. Was I a bit of a pain? Probably, but they understood and were quick to reassure me.

          When something goes tragically wrong and your child dies, you agonize and look for answers. You try to be more vigilant and do things better with your younger children in order to avoid another tragedy.

          This family co-owns a birthing service, they have a responsibility to clients who come to them. Surely they don’t want someone else to go through this.

          EFM isn’t perfect, but it is a very useful tool that can be lifesaving. My seventh baby had a cord prolapse and my nurse called a doctor in after just one decel because she just had a feeling. When the doctor looped her finger around the prolapsed cord they stat paged my OB, anesthesiology, and a team for my baby. My daughter is fine. I’m a big fan of EFM and was always fine with continuous monitoring after that experience. I’ve had some higher risk pregnancies, but my eyes are wide open and I am thankful for the amazing medical care available now and the MFM and L&D staff.

          Dr. Amy is trying to get people to understand that a home birth poses a higher risk to babies. She wants parents to understand how and why EFM works. Hence, her long explanation in her post. She wants them to be truly educated on the risks. She wants parents to know that being 10 minutes away from the hospital isn’t enough if things go sideways. If things go wrong at a birth, most parents want to know what to do differently the next time so mom and baby will be fine.

          I hope baby Thaddeus will recover well.

          • Anonymous

            I am appalled that you felt like you could steal this families story for YOUR gain. You make me sick. This family’s birth is private and is for them to tell the story if they feel like they want to. No yours!!

          • Expat

            I’m appalled that you think that when you post your story publicly on the internet as part of advertisement or justification for your business that a news organization is “stealing” it when they read it and report on it. Amazing. What happened to this family is tragic. When they put it on the internet to justify some questionable medical practices, it is no longer a private tragedy.

          • none

            It seems that the story was on a facebook page that was unknowingly not private, not on some advertisement for their business. Maybe contacting them to ask if they would share their story would have been the more compassionate thing to do. Dr. Amy talks of her compassion for babies and families, but that compassion doesn’t shine through when she attacks a family that is in the midst of raw suffering.

          • Box of Salt

            none “a facebook page that was unknowingly not private”

            If your privacy is important to you, you don’t make that mistake.

          • Amy Tuteur, MD

            caring/none, please pick one screen name and stick to it.

          • anion

            “Leah”‘s comments originally showed for me as being posted by “none,” but that may have been a Disqus issue; I’m just mentioning it in case.

          • Amy Tuteur, MD

            Leah appears to be posting from a different IP address.

          • Amy Tuteur, MD

            It seems to me that the compassionate thing to do is to prevent more disasters like this.

          • AlisonCummins

            caring/none/Leah,
            Surely the grieving family wouldn’t ever want this to happen again, to anyone.

          • Birthbuddy

            Stop homebirth harming and killing babies.

          • Amy Tuteur, MD

            Steal the story? It isn’t stolen if it was publicly posted.

            MY gain? Tell me how I gain?

            I post these stories (and there are many) because I don’t want any other babies to sustain brain damage like this baby did and I don’t want any other families to suffer the tragedy that this family has suffered.

            Frankly, I’m surprised that neither you nor this family wouldn’t want to protect other babies and families from this preventable disaster.

          • Birthbuddy

            What makes me sick is the deadly practise of unskilled homebirth.

          • anion

            I am so very sorry for your loss.

          • thankfulmom

            Thank you

    • Young CC Prof

      Nothing unethical about sharing a story that was already publicly posted on the Internet. And the person who deserves shame in this whole dreadful story is the midwife who did not recognize that there were problems and kept saying everything was fine, even when things were far from fine.

      I have great sympathy for what the family is going through and I pray that the baby recovers well. I also pray that this story might help keep another family from suffering the same dreadful experience.

    • thankfulmom

      I am so very sorry little Thaddeus’ birth didn’t go as expected. I saw in the comments that his IV is out, he is currently being tube fed, and the parents are hopeful his sucking reflexes can be revived.

      I hope other parents will understand how electronic fetal monitoring can prevent a tragic situation like this, that EFM doesn’t just show a heartrate, but indicates when a baby is in distress.

      Again I am so sorry the family and baby Thaddeus are going through this. It is heartbreaking to see stuff like this happen.

    • Dr Kitty

      The family had the choice to send a private email to their friends.
      To notify them by phone.
      To set up a private FB page, or members only blog.
      Or to post only minimal details publicly.

      They opted instead to post everything in public where anyone with a search engine and patience can find it.
      Which is the equivalent of taking out a full page add in a newspaper or putting in on a billboard.

      Dr Amy links back to it ONLY to show that she didn’t make it up herself.

      I am so, so sorry about what happened to their son Thaddeus James. I wish him as good a recovery as possible and pray his parents have the physical, emotional, spiritual and financial resources they will need to draw on in order to care for him.

      The HB tragedies, just like the hospital tragedies, need to be in the public domain. People need to know the risks inherent in the decisions they make.

      “I’ve never heard of a bad HB outcome” can’t be a good way to make such decisions.

    • almostfearless

      “This story could have been told with just as much impact without the quotes and the link to the Facebook page.” I disagree. For homebirthers the denial is so strong, that for this family, even after their baby most likely has brain damage from the terrible medical care they received at home, they presented their story as unavoidable. They praised their midwives for almost killing their child. The links and quotes are neccessary because the entire HB community is in denial.

    • Susan

      The internet is a moving target and I do feel a shaken to hear that this post is causing the family more pain. I think it is possible a family would not “get” that a facebook page that isn’t private is therefore just like publishing their story on the web. Frankly, the web is WORSE than the local paper because the web lives forever in a search engine and more effort has to go into getting the archives of a newspaper ( or at least it used to ). I am very sorry to hear it is adding to their suffering. It is a very hard issue. I hope at the very least you have got the point about why it’s important to link back to the original. I read Dr. Amy everyday and I think she is very compassionate to human suffering and that’s really what she is trying to prevent. Lots of people don’t seem to really care about the individuals hurt by the inadequacies of homebirth midwives and other alternative health providers/advocates. I don’t know where the line should be drawn myself but I do feel uncomfortable every time I read a family is feeling more pain because their blog is being cited as a reference. A web savvy family would get not to put their story out to the public. The power of a story, vs a statistic, to change human behavior is pretty powerful, and their story is on the web for anyone to see. That doesn’t mean I don’t get your point. Not sure what to say except I want to acknowledge what you are saying rather than just dismiss it.

    • attitude devant

      No parent could fail to have compassion for this family.
      Having said that these people are actually part of the problem. Have you looked at their website http://www.stcroixbirth.com ? I have and I find it appalling. It is one long sophisticated multi-page shill for this mother’s ‘services’ and her crackpot ideas about what Jesus wants for my reproductive life. Don’t you lecture me for one minute that she ‘gets’ that her website is public but doesn’t ‘get’ that her FB page is too. Sorry, but if you live by the Web, you can die by it too. If you promote your crazy publically, when your crazy is your publically announced undoing the public has every right to use a public venue to comment.

    • http://shameonbetterbirth.wordpress.com/ Shameon Betterbirth

      There is that. Then there is the baby who is suffering. Who is going to speak for them? Who is going to warn other people about home birth deaths? Certainly not midwives. Someone needs to do it.

      If Dr. Amy did not link to the story I am sure people would accuse her of making it all up.

    • anion

      I think we all have a tremendous amount of compassion for this family.

      But we also have seen that the lady in question is a doula, and runs a Childbirth/Midwifery service. Can we not comment, then, on the level os skill exhibited? Or the fact that on the Midwifery page:

      http://www.stcroixbirth.com/midwifery-care.html

      one of the bullet points is: “Comprehensive emergency plans and equipment if necessary”

      I doubt any woman interested in this service would see the failure to properly monitor/understand when and why problems occurred as part of “skilled and professional” care, and I doubt they would see a tray from the dollar store as serious “emergency equipment.”

      If you were paying a professional, who claimed to be ready for any emergency, to deliver your baby, and she showed up with a dollar-store tray and didn’t understand or recognize when a problem was occurring, I doubt you’d feel you got what you paid for.

      (They also mention that they allow VBAC and “natural, vaginal birth of twins.” Would you trust a midwife who failed to recognize fetal distress in a single birth to handle a twin delivery?)

      Not only is this publicly posted, but it’s posted by someone who wants you to pay her to handle the birth of your baby. Therefore critique of her skill and the service provided is perfectly legitimate.

    • Birthbuddy

      Unskilled homebirth, killing babies with false promises, deserves shaming.

    • Gene

      You cannot “steal” something that is posted publicly and properly cited. If you do not want strangers on the internet to know something, for heaven’s sake, DO NOT POST IT ON THE INTERNET.

      http://www.skepticalob.com/2012/10/response-to-loss-mothers.html

  • Deb

    I don’t promote homebirth, however I do have to wonder if these “clueless midwives” are actually as clueless as you claim when they can resuscitate a baby after 20 minutes. Can YOU do that DOCTOR Amy? Oh…wait, you can just pass the baby off to the trained professionals at that point.

    • Anj Fabian

      I’d prefer to have the NICU team there doing the resus with the proper equipment especially since that was exactly my situation. It didn’t take the trained, experienced, well equipped professionals twenty minutes to do the job. Apgars were 1 and 8.

      Trade that for being at home while the midwives work on my baby for twenty long minutes? That’s Apgars of 0 or 1. The prognosis in those circumstances is obviously much worse than in the previous example.

      Which one situation would you prefer?

    • Burgundy

      Honestly, I rather have a team of train professional working on my baby while the OB DOCTOR working on me. You are not that naive to think a placental abruption won’t have any impact on mom, right?

    • Elizabeth A

      Let’s also not pretend that 20 minutes of resuscitation is an indication of success. That much resus indicates a dire situation that probably has major, lifelong consequences for the baby. And what’s happening to mom while this extended effort goes on? Yes, my children were handed off to pediatric teams at birth, because the ob was doing vital work on me. That’s kind of the whole point of having a hospital team, think of the difficult choices families don’t have to make.

    • Young CC Prof

      Um, yes, an obstetrician works in a hospital, and when a baby is born in need of immediate care, the OB hands him or her off to a neonatal rescucitation team, made of pediatricians and nurses who handle this sort of thing every day. They have a whole collection of equipment on hand. The OB continues to care for the mother and makes sure that she doesn’t, say, hemorrhage.

      That’s called a good plan. Also, most of the time the OB is able to alert the neonatal team BEFORE the birth that there might be a problem.

    • Box of Salt

      Deb ” Can YOU do that DOCTOR Amy?”
      Ressusitation not part of an OB’s job.
      The midwives are clueless because they think it is part of theirs, in spite of not being specialists in it.

      • Antigonos CNM

        No, non-CNM midwives just don’t think anything can go wrong. Trust birth, and all that. Becoming adept at something so obviously medical as resuscitation would open them to the charge of being, Heaven forbid, “medwives”.

        And, if in spite of everything, something does go wrong, that’s karma.

      • Young CC Prof

        Even if a homebirth midwife took a course and listened really carefully, has she ever actually done it before? How many times? How many times in the past year? And how long ago was the course?

    • Amy Tuteur, MD

      I can do BETTER than that. I can make sure that the baby doesn’t need resuscitation in the first place. It is always preferable to prevent a disaster than to treat it.

    • thankfulmom

      It was reassuring to see the nicu team in my labor room (they called nicu before I started pushing). My 33 weeker was handed over to the nicu team while my MFM took care of me. More than two people are needed if both mom and baby have complications. It is good planning to have more than two trained professionals available at a delivery.

      • Antigonos CNM

        If there is any potential for difficulty, as with premature birth, it is usual for the NICU team to be present prior to the birth.

    • Captain Obvious

      OB/GYN are the first responders. We are required to pass NRP every two years and often work with the pediatrician or neonatologist during the resuscitation. You obviously do not work in the field or see the steps in initial neonatal resus.

      • Antigonos CNM

        Residents, in particular, wind up doing quite a lot of resuscitation while the attending physician is with the mother, before the NICU team arrives. Of course, there aren’t any residents in non-teaching hospitals.

    • Dr Kitty

      That’s right Deb, in the rare situation a baby is unexpectedly born needing resuscitation in a hospital the OB will just stand there and look at it until the neonatal team arrive….really? Is that what you think?

    • Antigonos CNM

      Brain cells begin to die after oxygen deprivation for 4 minutes…I’m sure that Dr. Amy has, at some point, done infant resuscitation. I have, as an L&D NURSE* before the pediatric ICU resus team arrived — even in a hospital, unless difficulties are anticipated prior to the actual birth, the staff usually isn’t hanging around in the delivery room [and often there's no warning a baby will emerge in need of resuscitation].

      *Before even becoming a midwife. I was even taught how to intubate, although, thankfully, I’ve never had to do it–there was always someone much more skilled on hand when it was necessary. In my last job, which was an outpatient HMO clinic, all the nurses were required to do yearly CPR refresher courses which included newborn/infant/child resuscitation even though we never saw any children at all [it was a high-risk pregnancy and infertility clinic].

    • Trixie

      Do you really, honestly think that a trained obstetrician is likely to be worse at resuscitation than a high school graduate who passed a correspondence course? Let’s say you have to give birth in a stuck elevator and there’s only one person there to help with whatever crisis comes up — I’d rather be stuck in that elevator with an MD of any kind than a CPM. I have a feeling a podiatrist would be of more practical use than a home birth midwife.

    • JennG

      Both my first, who died as a result of a very similar scenario, and my last child were resuscitated by the appropriate team. That is what I find fabulous about a hospital – it is team of experts working together rather than one midwife trying to prove she is so amazing doing it all.

      • Guest

        There should NEVER be only one midwife in attendance at a home birth. Never. An OB always works with at least one nurse and a midwife should never be working alone.

    • Medwife

      20 minutes doesn’t mean they were just wonderful rescuers. Who knows if they were even giving effective positive pressure ventilation? Nobody knows because unlike in a hospital, no one who knew anything about NRP was observing/taking part in the resuscitation.

    • Birthbuddy

      Missed the point completely.

  • Amy M

    I wonder if someone alerted this mother that Dr. Amy found her FB page, because some of the posts about the baby have disappeared, or been hidden. The latest updates are still there though, they have hope that he is not actually seizing. I guess time will tell.

    • Anj Fabian

      What we say won’t change the outcome. That’s in the hands of the professionals now. (I don’t think the NICU employs lay neonatal specialists…)

      • Amy M

        Oh I know, I was just mentioning. I hope the baby is ok…I don’t wish for bad things for him or for this family.

        • Captain Obvious

          I don’t believe anyone is. Maybe this reconstructive analysis may persuade these parents to have their next child in a hospital.

          • Amy M

            I don’t think anyone is wishing anything bad either, I just figured if the family was reading here, I wanted them to understand that, that’s all. I’m genuinely sorry about the situation, even though I don’t agree with the choices made and I do agree that this sort of information needs to be disseminated so others make better choices. I’m not so articulate in the writing sometimes.

  • drmoss

    So true. I’m not an OB, but an FP. Back in the 80′s I did the mandatory FP training scheme in the UK, two years in hospital jobs as the equivalent of a junior resident, and one year in general practice being supervised by an experienced GP. My two years in hospital included six months as an obstetric SHO/junior resident, and such traces scared me silly. But I had experienced SRN/SCM nurses (back when the UK midwifery training meant they knew as much or more than an obstetrician – goodness, they were smart and experienced!), plus a registrar (senior resident) who would shoo us all into the labour ward’s OR and do a section at a moment’s notice. After that training I moved to Canada, and to a rural hospital that is 50 miles from the nearest OR and anesthetist. The province initially met my complaints about the danger of this situation by saying that using a doppler is just as good as a cardiotocogram. And when I pointed out that their complacence wouldn’t help with a cord prolapse, an unrecognised placenta praevia, any other kind of APH or an unexpected breech they replied that statistically it wasn’t worth worrying about. I lost a lot of credibility in the community by then saying I wasn’t going to deliver any more (after all, I was just as incapable as one of your American CPMs (OK, I could do an episiotomy and outlet forceps), but at least I knew it and was scared by it!) It was also true that one in one call in a remote area was a little trying on both nerves and marriage – never being able to leave home at all? Shortly afterwards the province shut down obstetrics outside regional hospitals on financial grounds, but it was still held against me by the crunchy ladies who wanted a crunchy birth right here. They didn’t know that we all referred to the CP sufferers scissoring along Main Street as X’s babies (where X was the doctor who had been here since the 1940′s, still revered as a god at the time – though he has since died unmourned and forgotten by a public with a very short memory. He did high forceps and forceps rotations – Kiellands without the proper forceps!). I’m now 28 years into that one in one rota, and last took a whole week off in 2006, but I don’t regret stopping deliveries one bit. Around once a year I get someone who either claims she didn’t know of her pregnancy, or who left it too late to travel, so I still have to do an emergency delivery with no current experience or practice, but what can one do in that situation?

    • Dr Kitty

      I’m covered by my indemnity policy for unforeseen emergency deliveries, and provision of routine antenatal care. I’m fine with that.
      I can’t imagine working the job you describe.

  • Guest

    I have a friend who is in her third trimester and planning a homebirth despite having had a near miss at her first birth (also a homebirth; baby arrived limp and floppy and the “awesome midwife” resuscitated him, and no one acknowledges that he probably wouldn’t have been in distress without the very long and post dates labor he’d endured). Stories like this panic me, and I don’t think I’ll feel ok until baby is safely here and mom and baby are doing well. I’m so scared of something like this happening to her, and I don’t know how she can just glibly dismiss any mention of the dangers with “Oh, I’m going to think positive!” (Me and others have sent her a link to this blog; she refuses to check it out).

    • http://shameonbetterbirth.wordpress.com/ Shameon Betterbirth

      People make irrational decisions based on their emotions more than facts. There is some personal reason why she is choosing this and refusing to look at other view points. If you want to talk to her about it talk about feelings, like you feel really concerned.

  • Guest

    So here’s a question: when is the fetal monitor usually put on? I wasn’t attached to one until I got an epidural and was told that if I didn’t have an epidural I didn’t need one, that the OB or nurse or whoever would just listen intermittently to see what was going on. That way I could move around more, hopefully using gravity to keep labor going at a good pace. What’s the policy in other hospitals?

    • me

      I’m sure it varies by hospital. With my first, I was induced, so the monitor was on the entire time. With my second and third (different hospitals each time) I was unmedicated and the nurse listened intermittently about every 15-20 minutes, but also had me get on the monitor continuously for about 20 minutes every couple of hours. It didn’t interfere with my moving around.

      • Guest

        You must have had longer cords or maybe a different type of monitor. Even to get out of the bed to stand beside the bed, we had to take the monitors off and readjust.

        • Susan

          They do vary but there is also telemetry monitoring where moms can walk the halls etc or be monitored in a tub, on the birthing ball etc. I pretty commonly monitor moms in all sort of situations.

      • me

        Oh, forgot to mention, the first 30 minutes or so each time I was monitored to get a ‘base’ reading. Once it was established that they were doing well, they began the combo of intermittent with a continuous period every so often.

        And, yeah, the cords were pretty long. I could get out of bed and sit on the ball if I wanted. for walking/showering/whathaveyou, obviously I had to do that during the intermittent monitoring periods. With my middle child I was 8 cm upon arrival, so it really wasn’t an issue (she was born just a few hours after I arrived). With my third child I was there a lot longer before she was born, but fortunately the timing worked out so that I was really only hooked up to the monitor at times when I wanted to rest in or near the bed anyway. Methinks the nurses paid attention and could see when the best times would be. Nurses are pretty cool that way :)

    • Susan

      It does depend on hospital policy. There are places where electronic fetal monitoring for low risk patients isn’t hospital policy. ACOG doesn’t mandate it either. But where work we always get an initial tracing to make sure baby is fine, and then if mom wants it or if it seems like it would help her labor we monitor twenty minutes out of an hour if she is out of bed walking or moving around a lot. There are all sorts of situations where someone would require continuous monitoring, epidurals, Pitocin, lots of higher risk conditions… and once mom is in the end of first stage and in second stage continuous monitoring is the norm no matter how low risk.

      • Guest

        Cool. Thanks for the info! I was curious if there was a standard policy.

    • Captain Obvious

      How does gravity not promote preterm delivery for nine months, and then all of a sudden gravity helps get the baby out during labor?

      • Jocelyn

        One of the first things we learned in my college chemistry class is that gravity is actually a very weak force. Compared with the force of chemical bonds, it’s practically nothing (otherwise, we’d just sink right through the floor). I think it’s exactly the same with labor – compared with the force of uterine contractions, gravity is nothing. The contractions, and the mother’s pushing, are doing all of the work. The idea that gravity can help at all is really pretty much just a myth.

        • AlisonCummins

          I don’t think so. I think you’re confusing weak bonds that hold different molecules to one another with strong chemical bonds that lock atoms together into molecules.

          If you stretch out a piece of plastic film and put a bowling ball on it, the bowling ball will go right through. It will shear the weak bonds that keep the molecules of plastic sticking together but it will not break the plastic molecules themselves — that is, the bowling ball breaking the plastic film does not generate enough heat to set the plastic on fire.

          A bowling ball will also go right through water, disrupting the weak forces that bind water molecules to one another. It does not break the water molecules down into hydrogen and oxygen.

          A bowling ball sitting on my cervix would place a lot of pressure on the tissues and perhaps tear them. It would not, however, cook me.

          • Young CC Prof

            Nope, gravity is called the “weak force.” The force that holds atoms together is the “strong force.”

          • AlisonCummins

            What holds molecules together?

            Hydrogen bonds are weak relative to chemical bonds, so it’s often them; but oily things like plastic? Do they have enough ions running around to stick themselves together with hydrogen bonds?

          • Box of Salt

            What holds molecules together? Within the molecule, atoms are attracted by electrostatic forces in covalent bonds.

            Using a strict definition, a molecule does not contain ions in its chemical formula, although some types of molecules contain elements which can be ionized.
            Many drugs include those elements specifically so that they can be administered to people as a water soluble salt instead of a blog of grease.

            An ionic compound, on the other hand, is held together by ionic bonds. These are considerably stronger than
            covalent bonds, held together by multiples of: +1charges (the same charge as a proton) and the -1charge of an electron, creating a neutral formula.

            What holds molecules to other molecules? Intramolecular forces, which are still electrostatic, but because they do contain a full charge (that +1 for protons size, -1 for electrons mentioned above) but only partial charges they are considerably weaker.

            Plastics are polymers, and held together lengthwise through covalent bonds. Come are chemically cross linked (covalent bonds again), and some are attracted to the next strand over by the same weaker intramolecular forces attracting other non-p0lymeric molecules but since polymer strands are long they provide more opportunity for the various forces to work.

            There are three basic types of intramolecular forces (listed strongest to weakest), depending on the characteristics of the molecule in question: hydrogen bonds, dipole-dipole forces, and London dispersion forces.

            Hydrogen bonds only operate when the molecule includes an OH, NH, or HF (although molecules with an F-C component can be attracted with hydrogen bonding to an OH or NH). Think water, small alcohols, and sugars.

            Dipole-dipole forces are electrostatic attraction based on an even distribution of electrons with a molecule. It’s fixed with one end of the molecule slightly more positively charged that the other negatively charge one (hence “dipole”). This is what makes acetone a liquid instead of a gas.

            The weakest forces (London dispsersion forces) are temporary dipoles (the imbalance of charge mentioned above) that crop up due to random movement of electrons, and exist for all molecules (but not ionic compounds which are made of ions which have full charges).

            The larger your molecule, the more opportunities for this temporary weak force to occur, and propagate temporarily to another molecule. This is why propane, small molecule, is a gas under normal conditions, but gasoline (larger), is a liquid, and butter – bigger still! – a solid.

            It’s also what holds minimally substituted (as in most C-H atoms in the structure) together because those long strands have plenty of opportunity to interact. For many plastics, however, they do add other chemicals into the mix to modify the properties and introduce more intra- and also intermolecular forces between strands.

            Sorry for the long lesson. Yes, I am a chemist.

          • Box of Salt

            Ha! My “blog” for “blob of grease” was not caught by the spell checker!

            Apologies for suggesting the blog is greasy in any way.

          • AlisonCummins

            Thanks. Yes, I was asking what held molecules to one another.

            So if you and I, Box of Salt, were to hold a steak between our four hands and try to support a bowling ball on it, if the bowling ball tore through the steak and fell on our toes it would be by breaking the hydrogen bonds in the steak that hold all those lovely wet molecules to eachother and not by breaking the covalent bonds that bind atoms into protein molecules. While hydrogen bonds are not “the weak force” or even “a weak force,” they are weaker bonds than covalent bonds.

            On the other hand, if we were to try the same thing with a sheet of plastic film, the bowling ball would tear through the London dispersion forces holding the plastic polymers to one another and not break the

          • Box of Salt

            Note: I’ve just realized I scrambles inter (between) and intra (within = the ionic and covalents bonds) my explanation above. I do know better. Sorry! I blame poor proofreading on wishing to post before I had relocate my laptop to its power source (and I’m awful at proofreading anyway).

            AlisonCummins – yes. Intermolecular forces can overcome gravity to some extent – a good example is the hydrogen bonds of water creating th surface tension to hold up a paper clip:
            (http://ga.water.usgs.gov/edu/surface-tension.html) but it has its limits.

            The chemical bonds (both in the protein and fat) in a raw, unmarinaded steak usually hold together until it’s digested (some marinades as well as cooking may start the process).

            The plastic wrap will stretch a lot more, since it’s designed to do that, but ultimately gravity will overcome its intermolecular forces as well, and it will break along the strands as well. The tear will be jagged as the beginnings and ends of strands don’t line up.

          • drmoss

            Molecular and subatomic forces are pretty much irrelevant to the debate about whether gravity can help progress a labour. Gravity won’t help worth a damn. A seven pound baby dilating a cervix just because of gravity? Don’t make me laugh. One of the hardest jobs I ever had to do was a manual removal of the placenta. Full general anesthesia, a cervix that had only recently been fully dilated, and here I am trying to re-dilate it with my right hand, sweating and cursing while my registrar laughed at me. No, gravity doesn’t cut the mustard when it comes to dilating a cervix.

          • Box of Salt

            drmoss “Molecular and subatomic forces are pretty much irrelevant to the debate about whether gravity”
            Agreed! My post was meant to clarify misunderstood terms from my own specialty, and unfortunately it could not be done well with a short explanation.

          • Jocelyn

            Yeah, that was the point I was (clumsily) originally trying to make. Gravity = weak force compared to force of the uterine muscle.

          • Box of Salt

            The distinction between strong forces and weak forces (which as Young CC Prof notes includes gravity) is made through physics, not chemistry. Since I’m a chemist, not a physicist, I’m not going to weigh in further on that one.

          • Jocelyn

            I’m also not a physicist, I’m a biologist, so I’m not going to try to advance my opinion any more than I already have. Any physicists want to weigh in?

      • Guest

        The closed cervix I would think is what stops the baby from falling out pre-term. After all, for the women who end up with a c-section because their cervix doesn’t dilate, no amount of gravity is going to help if the cervix won’t open. I’ve read that and heard it from so many people. We might all just assume it’s gravity when in fact it’s just the fact that you’re moving around that keeps labor going at a good clip.

        • AlisonCummins

          I thought gravity only helped once labour was underway, the fetus had dropped and the cervix was dilating. (Imagining I have a thin plastic bag which contains rice just fine… until I cut a corner and the rice starts falling out and enlarging the hole, then falling even faster and completely ripping out the corner of the bag.)

          I think Amy Tuteur, MD also says there’s no evidence that walking helps at all, so maybe it doesn’t help even then.

          • Captain Obvious

            Preterm labor management has changed much over the years. Bedrest is kind of absolete. Women can continue to walk and even work (some jobs) despite being dilated.

          • Guest

            Tons of docs and other birthing professionals still recommend it though.

          • Captain Obvious

            Walking is recommended to help alleviate pain not help labor. Get up and stretch out walk a little. Women have tried walking around and curb walks for ever without getting themselves in labor. Getting up, moving around, sitting on a birthing ball helps one tolerate the labor not propagate it.

        • Captain Obvious

          Please then explain how an open cervix of 3-4 cm doesn’t allow the baby to jus slip out. Multips walk around 3-4 cm for weeks before going into labor so often. Can you site any reputable studies showing gravity helps? Hell, even Ina May talked about a monkey giving birth while upside down, now why didn’t gravity keep that baby monkey in? And why can’t I get that John Mayer song out of my head now?

          • Guest

            Because 3-4 cm isn’t big enough to let the baby slip out.
            Can’t comment on the John Mayer song :)

          • Captain Obvious

            Also, explain to me how so many women deliver babies successfully without gravity, just lying in bed or in the water tub? Are you just adding anecdote opinion here or do you have some new evidence to share about using gravity to better birth babies and avoid cesarean? I haven’t read any such paper or experienced this in 21 years of birthing babies.

          • Guest

            I’m just stating things that I’ve read in preparation for labor and birth or that have been told to me by other moms, docs, midwives, etc. Like I said in the first post “hopefully using gravity”, not guaranteeing that gravity would do all the work. It obviously doesn’t always work. I certainly don’t claim to be an expert, as I don’t have 21 years of birthing experience, so I have to rely on information I get from others. I take it then that you’re a health care professional? I apologize if I’ve offended you with any lack of experience. When doing research, I try to stick to sources that have been around for a while that includes both opinions from birth experts, like OBs, . So much information for labor and birth is anecdotal since every woman, labor and birth is different. Since it seems like so many others that post here give opinions and anecdotal information, I thought I was free to do so as well.

          • Guest

            I also never said that it was a way to avoid cesarean.

          • Becky05

            There is evidence (although not a lot of high quality evidence) that upright and mobile positions shorten the first stage and reduces the cesarean section rate. http://summaries.cochrane.org/CD003934/mothers-position-during-the-first-stage-of-labour

          • Captain Obvious

            Yes, low quality studies showing as much as 80 minutes less labor or approximately 20 fewer contractions. Was this the maximum benefits? What was the average decrease in labor time? Still sounds like getting a laboring woman up is more for comfort than speeding labor along. But thanks for the reference. I may quote that.

          • Guest

            Hey that’s almost an hour and a half! I think most women in labor would cut that off their total time if they could!

          • Captain Obvious

            Head to desk. These are low quality studies that showed at best one hour and twenty minutes. Not an hour and a half. And certainly not for everyone. People win playing the lottery, do you play every week because of those odds?

          • Guest

            Sigh. You’re obviously not an optimist. And I think saying “almost” shows that I knew it wasn’t a full 90 minutes. So women shouldn’t try anything then? They should just lay there? I’m really confused by your answers to some of the comments. Most of the time, you must be being sarcastic, but it’s so hard to tell without tone of voice.
            I think it’s worth trying, even if all it does is distract you long enough to get farther along in labor.

          • Captain Obvious

            Are you calling me a pessimist? Maybe I’m a realist. Women in labor do not want to be lied to. Tell them to go walking the halls to speed up labor, and when it doesn’t, you are the one who suggested it. Tell them to go walk the halls to see if it takes their mind off the pain, is a realistic suggestion. An option to definitely try without promises.

          • Guest

            Okay, fair enough. I’m a bit of a realist most of the time, but I like to hope for things to go well. I personally never like to be lied to, so I guess everyone who’s been talking about walking to help labor for years has been lying to unsuspecting women the whole time.
            And I don’t think saying that it “could” help is lying. Saying that yes, it most definitely will help, is lying. Nothing is for sure. But it could help and that’s good enough for some. Some women say it did help them; went for a walk, was then 2 cm more dilated. Maybe just enough time had passed, or maybe it was the walking. We don’t know for certain.

          • fiftyfifty1

            “even if all it does is distract you long enough to get farther along in labor.”

            I’m confused what you mean by this. Are you saying that if you are not distracted you won’t get “farther along in labor”, i.e. your labor will stall if you mind isn’t wandering?

          • Guest

            Not saying that at all, just that being distracted can help the time pass quicker. CAN, not will. Again, depends on the labor.

      • Guest

        It also helps to explain why after a full shift on my feet, it feels like the baby is riding right on my pelvic bone, but if I spend a lot of time sitting, baby is up much higher.

        • Captain Obvious

          Those feeling are probably pelvic varicosities and not the baby’s position.

          • Guest

            I don’t think so. Not when I’m feeling kicks way down beside my hips :)

          • me

            I felt the same thing with my chidren, esp my second and third – they’d feel ‘high up’ in the morning, and significantly lower (to the point where I’d be waddling) by the end of the day. Then right back up again in the morning. No hemorrhoids with any of them.

        • fiftyfifty1

          Wow, I never experienced anything like you say with either of my pregnancies. Worsening hemmorroids after a long day on my feet, but not a lower baby.

          • Guest

            My first I carried really high. She felt like she was pressing on my rib cage by the end. This one feels like I’m carrying in my bladder and it’s worse after a long day on my feet. Once I lay down for a bit, the pressure gets less and it feels like baby has moved up. Obviously I don’t know exactly what’s going on in there, but that’s what it feels like. I didn’t get hemorrhoid with my first and none with this one so far, sorry to hear you did! They’re not fun at all!

    • Former NCB Believer

      I was put on a EFM for 2nd stage (pushing).

    • Amy Tuteur, MD
      • AlisonCummins

        Thanks! Very helpful link.

        There’s a bit I don’t quite get though.

        > The uterus supplies approximately 82 newtons (N) of force.
        > Coach pushing (a Lamaze no-no) with legs adds 47 N and
        > pulling the legs back adds 31 N of additional pushing force
        > for a grand total of 160 N.

        What’s “with legs”? If “coached pushing with legs” adds 47 N and “pulling the legs back” adds 31 N on top of that, what’s the “with legs” in “coached pushing with legs”?

        Is it
        uterus 82 N +
        coached pushing with legs 47 N +
        pulling the legs back 31 N =
        160 N

        Or is it
        uterus 82 N +
        coached pushing 16 N +
        pulling the legs back 31 N =
        129 N
        ?

        Also, if 7 lbs of baby adds the same amount of force as pulling the legs back, is there a reason to favour pulling the legs back over a squatting position? Is coached pushing not possible in a squat?

        • AlisonCummins

          Or is pushing “with legs” pushing with the legs in front?

          • Box of Salt

            AlisonCummins, I believe “pushing with legs” means “legs in stirrups” based on clicking on the summary linked through “force.”

        • Birthbuddy

          It straightens the angle of the pelvis.

      • Guest

        I was asking about the fetal monitors. Just out of curiosity, why post a link to another blog post that you wrote 5 years ago? Why not site the studies that prove that gravity doesn’t help? The one does say that gravity adds to the force, so why not try to make use of it. Will it hurt the mom or baby? In all the discussions lower down, I never claim to know that gravity works, only that it can’t hurt and it’s given as an option by birth professionals, other than midwives.

      • Guest

        Is there a reason why you don’t respond to my comments? The link on your other blog goes to a publication library that doesn’t allow access by the general public, so I can’t look at that study myself, I have to take your word for it. I thought you were all about transparency?

        • Guest

          I read a post that provided links, but it’s not currently active. Not sure why. Here’s what I found.

          Thanks for finding the one study, but here’s what I found by reading the document:

          “However, as the quantitative results show, 28.3% of women who laboured in bed in the labour ward actually wanted to be mobile. Qualitative findings from interviews and focus group discussions with labour ward staff imply that providers do not necessarily know women’s preferences, and are hesitant in allowing women to be mobile because of concern over their safety and the restrictive ward environment. For women’s preferences to be met will require a change in provider attitude as well as training to overcome their fears and concerns. Future research should assess the effects of provider training on informed choice for women, and whether women who are informed about the benefits of mobility and encouraged to be mobile remain in bed or choose to move around when in the labour ward.”

          So in Africa, 10 years ago, doctors and midwives didn’t really allow women to move during labor because they didn’t ask women if they wanted to and didn’t know how to deal with a moving woman. Not really a good illustration of Dr. Tuteur’s point.

          What about the other study? The closest one I could find was this one from 2007:

          METHODS:
          This prospective, randomised, controlled trial included a group of 54 women who were informed and encouraged to adopt the upright position, and a control group of 53 women who were not given this information. The difference between groups was evaluated using the chi2, Wilcoxon and Fisher’s Exact tests. Significance was defined as p<0.05. Risk ratios and 95% confidence intervals were calculated.

          RESULTS:
          No statistically significant differences were found between the groups in baseline characteristics, obstetrical and perinatal outcomes; however, there was a preference among women in both groups for the upright position.

          CONCLUSIONS:
          The upright position during the first stage of labor did not contribute towards a shorter duration of labor; however, it proved to be a safe and well-accepted option for the women of this study.

          So it didn't find that the upright position helped shorten labor, okay, but it was only just over 100 women, has nothing about the Newton force exerted and still said that women preferred being upright, even the ones who weren't informed that they could be upright.

          • Birthbuddy

            Mobile epidural is now quite common.

  • Captain Obvious

    Slightly OT. I live in an area nearly void of homebirths. While receiving report from an ER doc about a patient with an ectopic, he told me she had delivered her first child in a water tub with a midwife. Having this info already, I went in to assess the woman. I asked her where she had delivered? She said in a water tub at a birth center. Now if any of you where asked where you delivered, would you say in a hospital bed? Maybe the hospital name or city and state. She went on for a few minutes talking about her glorious birth without an epidural, but she did tear pretty bad, but still went home in four hours. Without narcotics, just Motrin. I had to be the one to ask whether she had a boy or girl and the birth weight. It really was her birth story, not her son’s :-( She did finally tell me she delivered in Florida after specifically asking, where. I figured it might be Oregon, Washington, Colorado, Missiouri, or Florida.

    • kari

      Uh, yeah, unless asked for further information, they’d get the name of the hospital and the city it’s located in, if I were asked that question. People are strange.

      • Anj Fabian

        I’d assume that they’d be inquiring because they might want to request my medical records. In that case, hospital/city/state is what I would give them. With that information, the only other thing they would need is my consent for release of information. (The dates would also be useful, but aren’t strictly necessary.)

  • schnitzelbank

    It’s really sad when a mother’s short list of postnatal praises includes the dollar store tray.

  • Veronica Rellseb

    Terrifying.

  • Zornorph

    I just remember when my LO was born. There were several different things being charted. I had no idea what they were other than the heartbeat, but I was so glad that all that information was being gathered. I had this nightmare about a stillbirth and that gave me a lot of comfort. And there were a few times when the cords came unattached to my surrogate’s tummy and the signal would stop. Each time, a nurse would have to sign the paper where the signal stopped and give the reason. It really made me feel like they were totally on top of things and that at any sign of distress they would swoop in like angels. I just can’t IMAGINE doing it without that now that those options are there.

  • ngozi

    I just delivered a child 5 weeks ago emergency C-section. It was so emergency that they didn’t even have time to shave me.
    During my last doctor’s appointment I had an ultrasound that was “good” There was a good heartbeat and everything. My doctor just happened to send me upstairs for a NST test and we found out he was not tolerating contractions AT ALL. My baby came out blue and was in the NICU for almost 11 days.
    I understand not liking hospitals and not wanting all the interventions during childbirth, but I don’t know how midwives would be able to catch these things at a person’s home.

    • Amy M

      Congratulations on your new child. Is he ok now?

      • ngozi

        He is fine now. And I recovered from the section nicely. I’m not saying everyone’s section goes well, but mine did. I know that if my OB had gone only by the ultrasound results my child would probably not be spitting up on me as I type.

        • Box of Salt

          ngozi,
          contragratulations to your whole family and continuing best wishes!

    • SarahSD

      Congratulations on your baby! Is he home and doing well now?
      The hb midwives are not able to catch these things at home. Instead, they would claim that somehow the baby’s distress was caused by medical interventions. Or, the shittiest of all, they imply directly or indirectly that bad outcomes are the result of mothers’ fear, anxiety, or otherwise deficient instincts. That’s the insidious part.

  • Lynnie

    I keep looking at those baby monitor strips with the heart beat and the contractions. When I first looked at the heart rate, I was thinking, “Wow, healthy baby.” I am glad that it’s my job to read those strips. I read and reread the explanation and I finally see the problem. I have wondered how these babies that end up seriously injured or die during labor would have “strong heart tones” with a doppler right until they are born almost dead. I am extremely glad that I had constant monitoring when in labor with my son. It was actually reassuring to see and hear my son’s heart rate when in labor with him and to know constantly if he was ok.
    The more and more I read this website, the more and more concerned I am about a friend of mine who is totally immersed in the NCB movement. She and her husband refuse to use birth control and they insist on birthing at home.

  • KayEn

    How do these women wind up with these unqualified people attending a critical time in their lives? Childbirth is a natural process that can naturally go badly very quickly. I wouldn’t want someone who couldn’t save my life or my child’s life at the helm.

    I chose an OB practice for my pregnancy with 4 highly educated, female OBs who had over 110+ combined years of experience delivering babies. Their rotation system guaranteed one of their doctors at the hospital at all times, so your delivery would be with a doctor you knew (prenatal appointments alternated). Our chosen hospital has a dedicated “maternity only” anesthesiologist at all times. The hospital also has a Level 3 NICU.

    I’m lucky this hospital is only 20 minutes from where I live in quite a rural area. I would not deliver anywhere else by choice. First class care, and every single one of these OBs are compassionate, attentive and QUALIFIED to give me the best maternity care.

    After the way each of these 4 women cared for me through my pregnancy, labor and c-section, then postpartum, I DARE anyone to tell me that an OB is just a surgeon. Maybe we didn’t drink tea and knit booties together, but I got something better out of the deal: my healthy, beautiful child and a qualified health care provider for my next pregnancy, as well as my gynecological care.

    • ngozi

      Even on Ricki Lake’s business of being born, that woman at the end was trying to have a homebirth and ended up almost not making it to the hospital. I watched that and almost cried.

      • AmyP

        And had a baby with IUGR, if I”m thinking of the same one.

        None of the BoBB fans ever mention that particular harrowing episode in the documentary.

    • AlisonCummins

      “How do these women wind up with these unqualified people attending a critical time in their lives?” Because unqualified people present themselves as qualified. Since they have state licenses to do what they do, people believe them.

      It’s not up to laypeople to distinguish between qualified and unqualified professionals. If someone is a licensed professional, laypeople are entitled to believe that they are, in fact, licensed professionals. It’s not necessary to be smug.

      • KayEn

        In the age of internet, I googled providers in my area. I found out heir education background, where they had privileges, whether they had any disciplinary actions, etc. I would not just accept someone telling me they were qualified.

        Perhaps it is just my natural disposition, anxiety, or hyper vigilance, but I wasn’t trusting my pregnancy, and thusly, my baby, to just anyone.

        • AlisonCummins

          So do you think it would be ok to do away with licensing of all professions and make each individual responsible for determining whether such-and-such a person is likely to be good at dentistry or law, or engineering? I’d hate that. I’m simply not qualified to evaluate any given individual’s qualifications in these complicated fields. That’s why they are regulated professions with high barriers to entry.

          If someone is a licensed MD, that means that qualified people have determined that this person is qualified to offer medical care. If that MD is also a board-certified obstetrician, then qualified people have determined that this particular MD is qualified to care for pregnant women and deliver babies, both high-risk and low-risk. In addition, because medicine is a regulated profession, I have access to the protection afforded me by insurance and disciplinary boards.

          If someone is a licensed professional midwife, then surely they must belong to a licensed profession and be qualified? And certification is the same as licensing, right? A HUGE problem is that midwives are often “licensed” without any of these protections in place. These licenses are available with low barriers to entry, no insurance and inadequate disciplinary boards. How are ordinary people supposed to know the difference?

          When you suggest that it’s a victim’s fault that she believed a state-authorized health-care provider was competent to care for her, you’re repeating what midwives themselves often say when shirking responsibility: that if an individual woman was not satisfied with the care provided by an incompetent provider, that it was her own fault for not doing her research.

          The whole point is that she shouldn’t HAVE to do her research for something this critical. If someone is state licensed then they should be competent. If you’ve done extra research, then how nice for you.

          • Meerkat

            I agree with you. You made an excellent point about licensing. But I don’t understand you you are being so combative—I don’t think KayEn was was being snarky or blaming victims. She was simply explaining her thought process in choosing care providers. I did the same thing. I don’t think it is a bad thing to tell women to be more careful with their healthcare choices. I researched the OBs in my practice, I researched the hospital they were affiliated with. Unfortunately, even with a true licensed professional (I am not talking about made up CPM credentials) you can get bad results, so being skeptical and prudent in choosing who cares for you is necessary. I had a really bad experience with a dentist, and boy, do I wish I did some research on him now…

          • AlisonCummins

            Meerkat, I think KayEn was going beyond explaining her thought process. She was denying other people’s thought processes.

            She started with a reasonable question: “How do these women wind up with these unqualified people attending a critical time in their lives?”

            But when an answer was supplied — they reasonably believe that these people are qualified, since they are licensed — she rejected the answer. Licensing is not good enough for her. She googled her licensed professionals and so should everyone else. That’s when it became clear that this wasn’t really a question, it was about judging. Kind of like asking, “How could any mother not want to breastfeed?” and then rejecting an explanation with, “When my precious bundle was born I couldn’t imagine not wanting to give my baby the very best!”

          • AlisonCummins

            KayEn “did her research” and “educated herself,” which in her case worked out very well. For other people, “educating themselves” doesn’t work out nearly as well. That doesn’t mean they didn’t care. They did, they took the trouble to “do their research.”

            KayEn is comfortable with the status quo. Presumably it has served her well. (I get it, it’s served me quite well.) Not everyone is so lucky.

            States should not be licensing unqualified people who take advantage of people interested in alternatives.

          • Meerkat

            I agree with you 100%.

      • The Bofa on the Sofa

        I disagree. In the US, at least, birth is done far and wide with OBs in a hospital. Even in the crunchiest of areas, the “birth center with a MW” is still the less common approach.

        Given this, it should be pretty clear that you should be checking it out. And I don’t mean just googling it. Talk to the MWs, sure, but then again, also talk to your doctor. The doctor will tell you the honest truth. The MWs will lie, of course.

        No, I don’t expect laypeople to know that MWs can be unqualified. However, I do expect them to know that OBs ARE qualified, and I don’t care how many times they watched BoBB. As such, they can use OBs for advice.

        If they fall for the OB conspiracy claims, and how you can’t trust doctors, then yes, that is their problem.

        • Guest

          I think it’s unfair of you to say/assume that midwives lie. Maybe some do, but but I’ve also been lied to by a doc. If it wasn’t a lie, then he was misinformed and was later corrected by my GP. It nearly led to a misdiagnosis for sever stomach problems. Turned out to be something much simpler.

          • The Bofa on the Sofa

            From my perspective, I think you shouldn’t trust a single thing you are told by a MW from a birth center. You are talking to a CNM in the hospital and it’s a different ballgame.

            Now, I don’t expect everyone to know that, but I do think it’s absolutely reasonable to expect people in the US to realize that birth in a birthing center is uncommon, and to question why that should be. And to figure that out, they should not just listen to the sales pitch of the birthing center, but should consult the ones they should be expected to be able to rely on, and that is doctors.

            I was going to give an example:
            “The MW says that they are only 5 minutes from the hospital, and so they can easily transfer if something goes wrong. Is that right?”
            Doctor: Gives a long explanation of why this is not necessarily true, starting with the point that the MWs are not affiliated with the hospital and so when you do transfer, they have to treat you like a patient off the street.
            “Oh, the MW didn’t tell me that”

            etc

          • Guest

            Fair enough if the midwife isn’t affiliated with the local hospital, but aren’t some midwives in the US affiliated with hospitals?
            In Canada where I am, they are affiliated with the hospitals and often work very closely with OBs, so arrangements are made for transfer if you choose a home birth. It definitely isn’t pushed on you by any means by the midwives here and in fact, they may suggest a hospital birth if there are early signs of a complication. They may also work in conjunction with an OB for you or even switch your care completely over to an OB.
            It seems like more regulation does need to be in place for midwives in the US so that women can avoid being in that kind of situation if they choose to birth with a midwife, at home or in the hospital. If there were stricter regulations on the education or training a midwife has to have, then there may be less of these tragic stories.

          • The Bofa on the Sofa

            MWs affiliated with hospitals are not in a birth center (unless the “birth center” is in the hospital, which is not what we are talking about)

            The US is not Canada. Not even close.

          • Guest

            Yup. I know there’s huge differences. I’m just saying that it’s a system that seems to be working well here. Although it might only work because of universal health care. If health care was privatized, it might be a lot different. There’s also no birthing centers where I am and I think that leads to more home births. Our local hospital only has a couple of really nice rooms for labor and delivery. There wasn’t even a chair that my husband could sit/sleep in and pull over to the teeny bed I gave birth in! No tub in my room either. If I wanted to get in the tub, I had to head down the hall. It was really not very comfortable for either of us.
            I’m not ragging on the hospital, it is what it is (a hospital, made for saving lives, not necessarily for comfort), but I would have appreciated a few more comforts. I sure missed my yoga ball when after we left home!

          • AmyP

            “Our local hospital only has a couple of really nice rooms for labor and delivery. There wasn’t even a chair that my husband could sit/sleep in and pull over to the teeny bed I gave birth in!”

            I’ve had babies in three different US hospitals, and it’s much cushier in the hospitals I’ve seen here. They really try to produce a hotel-like ambiance, especially in the newer facilities.

          • EmbraceYourInnerCrone

            This point always puzzles me. What e n I was pregnant my ON hD me pre-register with the hospital and he made sure they had a copy of all my test results in case his backup had to deliver my baby. Have these people who home birth never been to an ER? You can’t just swoop in and demand a Csection. They don ‘t have any records and they may very well not just take the word of a midwife for what’s happened so far if she doesn’t have staff privileges. And if there’s a multi car accident a heart attack and a gunshot wound there first you may have a wait…

    • T.

      You are smarter than the avarage people alas.

  • Guest

    What would be even more horrible about this is if the midwife received no punishment for her mistake. If a doc made a mistake that resulted in an infant’s death, there would be serious consequences for that doc. A friend had a student OB tug on the umbilical cord, leading to hemorrhage. Not sure what happened, but I know there were consequences for both him and the supervising OB. It’s so horrible to hear about injuries and deaths that could’ve been prevented, especially when there are no consequences for that person.

  • IDHACN

    I think I’m going to cry.

  • kari

    During two of my labors, the fetal heart rate slowed quite a bit, like down to 60 bpm. They had me change positions and the heartrate sped up again. I was prepped and ready for a c section but never needed it. Is this something that happens often? It happened to me twice – is that normal or no? After this happened during my first labor I refused to get out of bed away from the monitor, although they were encouraging me to get up and walk around. For my 2nd and 3rd labors I stayed in the bed the whole time because I didn’t want to be removed from the monitor. In my case my girls were born healthy despite the low heart rate. I’m confused reading this post, since my girls were obviously not dead or brain damaged, but did have an abnormally low heart rate, although for a short period of time.

    • Andrea

      Your situation is not unusual at all. Babies can have quite deep decelerations during labour but you can tell from the CTG whether they are ominous. There are several features to look at, especially beat to beat variability. In Dr Amy’s picture the variability is absent which is very abnormal, but another trace may have normal variability ( a nice squiggly line) with some quite impressive decels which you could wait on for a while, try dome position changes etc. it’s not uncommon to think “crap, we’re going to need a C Section”, but then the problem resolves and you can continue with labour. Often it’s some cord compression that resolves. Sounds to me like you had some skilled staff working with you who knew how to interpret CTG’s…. That’s great! :-)

      • kari

        Thanks! It creeps me out to think if I’d been at home while my baby’s heart was dropping like that, and I’d not known about it and turned over. What if the cord is compressed for 10 minutes before they check again with the doppler? Does the cord get compressed like that during pregnancy when not in labor? I’m obviously no medical professional so these are things I’ve wondered about. Pregnancy stressed me out with all the what ifs. I was so glad to be done with it with healthy kids.

        • fiftyfifty1

          Typically the amniotic fluid helps keeps the cord from getting pinched on during pregnancy. That and the fact that the uterus isn’t clamping down. That’s one of the reasons it’s important to go in to the hospital when your water breaks. Cord and oxygen problems are way more common during labor than they are prior to labor.

    • Young CC Prof

      Basically, babies are designed to endure a little bit of oxygen deprivation during labor, because it’s inevitable, even in the easiest delivery. Very few naturally-born newborns get a first APGAR of 10, because most are a little blue in the hands and feet. Their bodies direct blood to the brain, and they come through just fine. However, there are limits, and the trick is recognizing the signs of trouble before things get close to that limit.
      The baby described in this post, unfortunately, presumably passed that limit quite a few minutes before birth.

      • Gene

        Or hours, more likely

    • fiftyfifty1

      Sometimes if the cord is being pinched on just right, bloodflow to the baby stops and the heart rate can go really low all of a sudden. But if you move around into a position that it’s not pinching, all will be fine as long as the baby was doing fine prior to the pinching. These are called “variable heart decelerations”. What Dr. Amy is showing above is something different. It doesn’t look as dramatic, but it is more ominous. These are called “late heart decelerations”. They result from a baby that hasn’t been getting enough oxygen for a long time. Often it’s due to the placenta not transferring oxygen very well. This can happen for a lot of different reasons. Because it’s not a sudden severe cut off of blood, but rather a more moderate lack of oxygen that’s been going on for minutes or hours, the body struggles to keep the heart rate in the normal range and is able to do so….until it no longer can. Sadly, it’s a little bit like a drowning kid struggling to keep his nose above water, until he can’t anymore.

  • Captain Obvious

    But an unnecesarean was thwarted successfully.

  • AL

    Ironically, she’s the owner of a birth center…Not sure if anyone has already mentioned this below.

    • attitude devant

      And she went to Carleton College?!?!? How did she graduate from there with such a complete lack of critical thinking?

      • attitude devant

        Oh my goodness. Follow the links back to her business. They have Christian Childbirth Classes to help you have the natural vaginal birth God wants for you. No wonder my pregnancies were so high-risk—I went to the Pagan classes!

        • attitude devant
        • Dr Kitty

          G-d wants me to be happy and healthy and the same for my children.

          I love that idea that an omnipotent being is supposed to be dead set on any particular course of action that has no objective moral or ethical meaning attached to it.

          I’m pretty sure G-d saves the judgement for actual moral failings, not for healthcare decisions.

      • fiftyfifty1

        There is plenty of woo anywhere you go. In addition, Carleton has something of a hippy vibe going on. I’m not at all surprised.

  • Indict Clapper

    It took a while, but I think I’ve done it: I have found what may be the single stupidest thing ever written by a homebirth advocate. This is the holy grail of homebirth idiocy. It was written in response to a horrifying story where a mother checked herself out of the hospital in order to deliver a breech baby at home. The baby was born grey and lifeless and didn’t breathe for ten minutes.

    Here’s the comment:

    “I now question whether it’s a big deal if babies don’t breathe right away, or if they don’t breathe normally right away if they NEED to be resuscitated or if the Natural course of things would take care of them better. Unfortunately, Medicine doesn’t currently ever question its basic premises (like not breathing leads to death always and quickly) so it may be a long time before anything new about breathing is ‘discovered.’”

    That’s right, folks: scientists really need to reevaluate the whole “babies need to breathe” thing.

    http://knowmommy.blogspot.com/2012/02/left-hospital-to-deliver-breech-at-home.html

    • amazonmom

      I can’t even bring myself to click the link. I want to take the poster and lock them in the NICU until they can recite the entire NRP manual by heart.

    • Awesomemom

      100% of the people that die of cancer breath oxygen, she may be on to something.

      • Young CC Prof

        Oxygen is just an addiction. Once you get past the withdrawl, all your problems are over.

    • AlisonCummins

      I’m assuming that the hypothesis that babies may not need to breathe is based on the notion that they are still attached to a functioning placenta. Amy Tuteur, MD has stated clearly that anyone who thinks this is stupid, but people do think this and she hasn’t explained why it’s wrong. (Maybe there’s an earlier post?)

      • Amy Tuteur, MD

        Yes, I did explain it:

        http://www.skepticalob.com/2011/05/ncb-stupid-pulsing-umbilical-cord.html

        But something different is going on in a breech with a trapped head. The umbilical cord is compressed between the stuck head and the bones of the mother’s pelvis. Until the head comes through, the baby may be getting no blood flow from the placenta.

        • AlisonCummins

          Thanks! I was fascinated to read a comment a week or two ago by someone who [quoted someone who] stated that obstetricians weren’t aware of placentas and didn’t know they were still attached to the baby which is why those silly, fretful OBs get all worked up about babies who can’t breathe. I don’t think I’ve ever heard of a worse case of Dunning-Kruger.
          Yep, I understand that breech is different — have known that breech is different since I could read Spock’s Baby and Child Care (which had a section on emergency unplanned home birth) at about eight years old, and have understood why at least since I was in my early teens. I cannot understand why anyone who claims to know anything about delivering babies would not know that breech is different.
          Even if someone didn’t know that breech was different, the fact that their baby was born “grey and lifeless” while simultaneously not breathing should clue them into the fact that something was Very Wrong.

          • attitude devant

            If ‘grey and lifeless’ and ‘not breathing’ don’t clue them in, perhaps the years of ensuing disability will. I just can’t even grok the level of denial in this story.

          • guest

            This is what turned me around from my dyed-in-the-wool NCB stance – watching youtube videos of homebirths (most seemed to be unassisted) and seeing grey floppy babies… I was stunned and extremely distressed to see this more than once. It was enough to wake me up and get me to start reading and thinking…too late for me but not too late for my daughters!

    • jenny

      I just read that and I’m completely disgusted. She has no sense of how incredibly lucky, how incredibly fucking lucky they were. It takes a lot to get me to put my judging hat on, but that there did it. All the fucking congratulations you warrior mama comments.

    • attitude devant

      As previously published in “Squat Magazine.” You cannot make this stuff up.

    • jenny

      Like seriously? The baby doesn’t need to breathe right away? Maybe we should let the natural course of things take place? Did my baby really need resuscitation? FUCK HER. SHE IS TALKING ABOUT LETTING HER BABY DIE.

    • MaineJen

      “Unfortunately, Medicine doesn’t currently ever question its basic premises (like not breathing leads to death always and quickly)”

      Huh. Not breathing…leads to death? Naaaaaaaah. *headdesk* *headdesk* *headdesk*

      • Mac Sherbert

        No sometimes it just leads to brain damage, but hey that’s not a problem.

      • Bethany Barry

        Careful! Excessive *headdesk*s can also lead to brain damage!!

        • Meerkat

          Brain damage is just a variation of normal. :)

    • Mac Sherbert

      I do not understand this woman and all the women encouraging her behavior. This is just crazy. Wow. It really must be so much easier on a baby to be born blue/grey with no heartbeat and need 10 minutes of resuscitation than have been born by a c-section and handed to the mom and dad just few minutes later perfectly fine.

      When we discovered my baby was breech I think I said c-section before my doctor. Why do they demonize a common procedure that can prevent harm to a baby? I totally let my OB take me the OR and I’m proud of my c-section. When I look at my baby I can’t imagine ever have putting him at risk to have avoided a simple c-section.

      • PrimaryCareDoc

        The stupidity in the comments on the website is just mind-boggling. As Orac would say, “The stupid, it burns!”

        I especially like the comment complaining about how the hospital should have let her midwife do the delivery in the hospital if they were so worried.

        Right. Hospitals will just let any unlicensed clown show up and use their facility.

      • Young CC Prof

        My baby is now close to 37 weeks, breech, and asymmetrically growth restricted, with an abdominal circumference of only 28.5 cm, several cm smaller than his head.

        Just this morning the doctor was looking at the situation with me, and as soon as she started to try gently explaining that I would need a c-section, I blurted out, “His body is smaller than his head, so his head would get stuck if he tried to come out that way!” Doctor nodded and smiled.

        I am so grateful to this site, for teaching me about the risks of breech before I found out my baby probably will be.

        • AlisonCummins

          Oh I’m so sorry. Are you concerned?

          • Young CC Prof

            I’ve known for a few weeks now that he’s growth-restricted. They’re probably going to deliver him at 38 weeks.

            Other than his size, everything else looks perfect, from his organs to the placental function to my blood pressure, and he should be fine, though he might need a bit of special care in the beginning.

            And preemie diapers, oh definitely preemie diapers.

          • Burgundy

            In 2 weeks you will have your baby in your arms all cute and cuddly :)
            Wishing you and your baby a safe arrival!

          • Mac Sherbert

            I hope everything goes well…those tiny little premie diapers are so cute. My last was nearly 10 lbs., so the newborn diapers I had didn’t fit for long (ok not at all!).

            Congrats!

          • Amy M

            Those preemie diapers don’t absorb much…hope to get the newborn diapers asap, much better at holding the pee. We had to change my boys’ clothes constantly for the first two weeks because those preemie diapers leaked all over the place and the newborn size was too big.

        • Trixie

          Thinking of you and hoping everything goes smoothly with delivery when the time comes!

        • Dr Kitty

          Best wishes for the safe arrival of you baby, however it happens…

        • Meerkat

          Wishing you a healthy baby and a safe delivery.

      • stenvenywrites

        We found out that our daughter was breach when I had my first ultrasound — when I was 7 cm dilated. The CNM and the OB resident looked quite concerned and tense. I calmly asked if there was an OB on call. I actually *felt* their relief. Why YES, there is, and we will be HAPPY to go get her RIGHT NOW!

        • Mac Sherbert

          I was at 5, very effaced with ruptured membranes. My OB was clearly not happy as up until the ultra sound she kept saying I don’t think the baby is breech. The LD nurse had a small little fit as she just couldn’t believe it and had also missed the baby’s position.

          That is when you realize how nice modern medicine is. That ultrasound machine sure did save us a lot of trouble.

    • ngozi

      I think the natural course of things in this situation would be death. But I went to school for news reporting, not medicine.

      • Young CC Prof

        Hey, perinatal death is perfectly natural. Not desirable, perhaps, but very natural.

    • GiddyUpGo123

      If you’ve ever questioned Dr. Amy’s assertion that for these people birth is just a piece of performance art, here’s a line from that story:

      “We passed by a man that was watering his lawn and I had to stop due to a
      contraction. You could tell he had no idea what was going on; I
      remember the look on his face…shock and awe.”

      Now why would you even think to put that little anecdote in your story if you weren’t so very proud of shocking some poor old guy watering his lawn with your birth performance?

      • Young CC Prof

        I “liked” the part where the police were called, because she was laboring naked in the jacuzzi in the yard and the neighbors thought they were having sex. Definitely performance art.

        • GiddyUpGo123

          I don’t understand why NCBers always have to be naked. Is it because all those unnatural fibers get in the way of the unicorn sparkles?

          • Nashira

            The thing that amuses me about the NCB insistence on nudity, is the fact that they all think my husband is a freak because he hates wearing clothes when it’s hot. Mind you, he does it in the privacy of our house, and not while engaged in Public Great Art*… maybe that’s the difference.

            *I hate my brain because now I’m imagining someone painting watercolors with their genitals. Let’s go coat our bits with toxic pigments, everyone! I call cadmium – ALL the cadmiums.

          • Beth

            I saw one homebirth video where the husband was naked too. I don’t really get the rationale for that. I’m sure they were going for some primal garden of eden type of tableau, but then you had midwives walking around clothed. I could just picture the wife saying “if I have to be on video naked so do you! Strip!”

          • Guest

            Ya, I’m just as glad my husband wasn’t naked too. I mean really, why would he need to be? If I want to touch his skin, I’ll get him to take off his shirt, but keep your pants on babe! I’m the one with a person coming out of there, not you!

          • The Bofa on the Sofa

            No, the whole “husband naked” thing comes from “the baby will be born the way he was conceived.”

            To which I have always responded, does that mean the girls from high school should have had their babies drunk in the back seat of their car?

          • Guest

            I gave birth in the hospital, practically naked. I think by the end all I had on was a nursing bra. It just made it easier to do skin to skin after baby was born and it was SOOOOOO hot in the delivery room! All I wanted to do was cool off! A friend of mine said she just had the urge to strip off all her clothes when she was giving birth, so she did.

          • Trixie

            Yeah, I think this a pretty normal thing and not related to a particular philosophy.

      • AmyH

        Were there feet hanging out of her? That would explain it.

      • Guest

        Ummm…I answered the door while in labor after my water broke. In hindsight, likely not something the mailman wanted to see, but I just can’t leave a door unopened when the doorbell rings! I thought it was pretty funny actually.

        • Mac Sherbert

          That is just plain ridiculous. My water broke and soaked my pants…my husband didn’t even notice. So, I’m sure I could have answered the door without making a display. She could have just not answered the door, had some one else answer or put on a robe.

          The entire story is full of tales of how people gave her looks. It seems very clear drama is her thing. It all about how she thinks the world sees her….look how cool I am and they don’t even know it. Quiet narcissistic really.

    • FF4life

      I feel like it has been proven by science that not breathing will kill you… But what do I know… I’m no midwife.

    • Jocelyn

      That. Is. Unbelievable.

      • Jocelyn

        Aside from the stupidity of the comment you (Indict Clapper) quoted, I just went and read the whole birth story, and what a terrible story it is. What hubris of all those involved.

        This quote was particularly awful: “At that point they realized the baby was not frank breech but in fact footling breech which is a much more complicated type of delivery. David said the midwives and Doula’s looked a little worried at that point. They asked me to get into the tub and might I say walking with feet hanging out of you is a little bizarre.”

        They only “looked a little worried?” A home birth with a frank breech is bad enough, but when they realized it was a footling breech even the midwives should have immediately called the ambulance.

        • Mac Sherbert

          Actually, the part I find most disturbing is the end where she talks about how proud she is of the baby for being so brave. Poor baby. Babies should not have to be brave! Babies should have parents that do their best to protect them so they don’t have to be brave.

    • T.

      Oh my…

      A nurse chime in to say that the baby has likely suffered some brain damage. This idiot answer:

      “Yo, Anonymous– pay some respect to this amazing, intuitive mama who did what she absolutely knew she needed to do for her baby. She trusted herself. It is your job as a provider to support women when they trust themselves. I’m sure you know all the stats and risks of being in a hospital. Either way, it is a mother’s choice, her choice, her choice and her empowerment. This is not sad at all. This is one of the most empowering things I have read about birth in a long time. I, unforunately, did not listen to my intuition. My baby did not die; in the end he is a healthy baby, but the medical, mental, marital, emotional, sense of self fall-out has been huge and longlasting. I think this woman and her baby and her husband are completely amazing. They reclaimed BIRTH!”

      In the end he is an healty baby, but… My brain can proceed the rest.

      • anion

        It’s her job as a provider to support women when they trust themselves? Good lord. So it’s her job as a provider to support, say, a woman who knows that she doesn’t need surgery because through sheer force of will she can grow a new hand? Or a woman who trusts herself to perform her own appendectomy at home? How about someone who thinks their loved one in a coma will come out of it once s/he gets hungry enough, so they should just detach all the machines and trust hunger?

        Her job as a provider is to apply the specialized knowledge she has to heal people and save their lives. How you feel about it really isn’t part of her job (it’s a good thing when medical professionals make the patient feel involved and cared for, but their job is to provide medical care, not to cater to the whims of fools. She’s not a waitress).

    • Beth

      So she is proposing that when babies are born and don’t breathe we should experiment by doing nothing and see if nature works it out? THAT sounds ethical. Yes, clearly the only reason we don’t do this is because modern medicine lacks the openmindedness and intellectual curiosity to question itself.

      I’m pretty sure the insight that not breathing = death was worked out by humans a few thousand years before we even invented medicine. Just….wow.

      • Dr Kitty

        There are plenty of lifeless, grey, floppy babies being born all over the world who DON’T get CPR because there are no appropriately trained attendants at the birth.They die.

        But hey, they’re born in South America, Africa and Asia and so their deaths are more likely due to “nutrition” or “negative attitudes” or “not trusting birth” than because nobody resuscitated them…right?

        Idiotic woman needs to CHECK HER PRIVILEGE.

  • Lisa from NY

    Could someone explain the heart tracing thing? I was looking at it and reading Dr. Amy’s commentary, but I couldn’t figure out how to tell the baby was in distress.

    • Awesomemom

      There is no variability in the heart rate it is basically a high flat line. There is naturally going to be variations in the heartbeat pattern of a healthy baby when they are in the process of being born.

      • AlisonCummins

        What are the top and bottom parts of the tracing?

        • kari

          The top is the fetal heart rate, and the bottom is the contractions. Correct me if I’m wrong. There should be a faster heartrate during a contraction, with a decel after the contraction. Right?

        • attitude devant

          Top is baby’s heart rate. Bottom is contractions. The pattern of absent variability combined with a slight deceleration that resolves after the contraction is particularly ominous. It is worth noting that you cannot HEAR this pattern with a fetoscope. It has to be seen to be discerned.

        • AlisonCummins

          Thanks.

          Though I think Susan downthread says that there is no contraction tracing?

          • attitude devant

            no, she’s just talking about why you need to have a good contraction tracing to interpret the baby’s tracing

          • AlisonCummins

            “With that example of a strip like Dr. Amy posted, it would be very helpful to have a good contraction tracing. If you couldn’t get one, you could mark the beginning and end of the contractions on the paper to get the timing of the decels in relation to the contractions. But ideally, you would want a contraction tracing too.”

            It sounds like Susan doesn’t think there is a contraction tracing, but maybe she forgot about it while she was writing her comment, or just wasn’t as clear as she meant to be.

          • Busbus

            No, Susan was responding to another commenter who had mentioned that during her labor, they couldn’t get a good reading on her contractions.

    • Anne

      A very common mistake/shortcoming with intermittent auscultation with Doppler/fetoscope.
      If you only listen just before the contraction you will hear a heart rate in the normal range (110-160), and the human ear cannot distinguish the reduced beat to beat variability of the baseline ( a sign of fetal acidaemia).

      Hence the need to listen before a contraction (to get the baseline) and as the contraction is finishing for 60 seconds to detect the subtle “late deceleration” which is the hallmark of hypoxia.
      Or put a CTG on.
      Because even with best practice intermittent auscultation (IA), and known clear liquor, the Dublin trial still showed the IA group to have an increased neonatal seizure rate compared with continuous CTG.

  • Meerkat

    I had an emergency C-section because my son’s heart rate was falling during some contractions. I don’t know how much, because I was too out of it with pain, but my husband looked really freaked out when the nurses started calling for a doctor, ANY doctor on a walkie talkie. Somebody on the other end of the walkie talkie started saying that my doctor was with another patient, but then I saw him, running full speed into my delivery room. That’s when I got panicked, too. I felt better once we were in the OR, which was literally next door, and saw a whole bunch of doctors, nurses and interns preparing really quickly and efficiently. I specifically remember OR nurses counting instruments out loud, it made me feel oddly reassured. I think I was in shock, because I remember all these little details in slow motion. I remember being surprised that the whole neonatal team was already in the OR, ready and waiting. I couldn’t figure out how they got to the OR so quickly, it literally took a minute to wheel me full speed from my delivery room to the OR. I kept wanting to ask my doctor to hurry up, but figured that he didn’t need me to say it.
    My son is great, thanks to my doctor, my great hospital, and modern medicine. And Dr. Amy, of course. Thanks to her I realized that an NCB propaganda was completely false and trusted my doctor.

  • R T

    On the 23rd, I was working out with my personal trainer and he accidentally double booked me with another woman. He said if we still wanted to workout he would train us together for free. We agreed and at some point started talking about her children. We had both been confined to hospital bed rest in the same special unit. Then she told me her first child had a severe brain injury form birth. She had experienced a placental abruption that went Undiagnosed by her OB too long. She said the signs were there, but the doctor didn’t act fast enough. By the time the doctor realized what was happening her daughter had suffered a brain injury. She will require life long care. They have a live in care giver who provides medical care. In her situation would the parents be able get a settlement for her care from the hospital and doctor’s malpractice insurance? If that’s the case I think it’s also an important point. This can happen in the hospital but then your child would be able to obtain better care because you can sue the hospital and doctor. You can’t get anything from a homebirth midwife.

    • Deidre

      Seriously ? If this is gonna happen it should happen in a hospital so everyone can get sued? :( Do not agree with this mentality.

      • Susan

        I think it is a problem that homebirth providers rarely carry malpractice insurance because responsible providers have it not just to protect themselves but also their patients. The part where I too make the sad face is the idea that ( and I am not saying this is what RT meant ) any baby with CP for instance necessarily is a victim of malpractice is a fallacy. There does need to be some sort of reform so that insurance in the case of a very high needs baby doesn’t mean that the patient is forced into a position of finding blame; it can be found where there is none… and there lies the possibility of more damage to other lives and careers. Certainly, malpractice exists, in hospitals and at home. But a family with a baby that has extremely high needs shouldn’t have a malpractice claim as their only means to get the care their child will need.

      • Young CC Prof

        Suing isn’t a good outcome, but it’s a form of accountability. If you know you can be sued for screwing up royally, you might be a bit more careful. It really sounds like some of these negligent home birth providers just walk away and keep making the same mistakes.

        • R T

          Most of them walk away with no accountability. We see the same midwives in this situations over and over. If an OB messes up enough times they will face professional consequences!

      • AlisonCummins

        Actually, yes. Not as a form of punishment for people whose best just wasn’t good enough, but as protection. It’s insurance. Bad outcomes can be terrible and if your care provider has insurance to cover it, that helps a bit.

        It’s also a way of changing the system. If a hospital fails to prevent a preventable bad outcome and a patient sues, the insurance company is going to want them to make changes to prevent that bad outcome in the future. If an uninsured midwife fails to prevent a preventable bad outcome she’s free to decide it was the patient’s fault and continue to practice the same way.

        CNMs rarely attend homebirths, partly because the insurance premiums are so high. When they do, the insurance companies require them to refuse high-risk patients. A CPM who is not working with an insurance company is free to take on monozygotic twins if her intuition tells her it’s ok.

      • R T

        If a professional messes up so badly a child requires life long care, they at the very least should be sued! Accountability makes people more careful!

  • Antigonos CNM

    This is one of the reasons I don’t like the “home Dopplers” that can be bought to be used by parents wishing to listen to their baby’s heart beat. A baby can have a perfectly “normal” FHR and be in distress. I bet these homebirth midwives couldn’t even read a EFM strip, or even know what beat to beat variability is, let alone the different kinds of decels and what they indicate. With strong contractions it is very difficult indeed, even with a Doppler sometimes and certainly with a Pinard fetoscope, to hear the FHR. I know — I predate fetal monitoring, which did not come into general use until I’d been working in L&D for about 5 years, and remember well trying desperately to determine fetal heart rates during contractions.

  • Lynnie

    It’s so sad to see poor innocent children suffering for their parents’ misguided ideologies and beliefs. This poor little baby will probably suffer for the rest of his life because “Mom” chose herself over her baby. That made me particularly sad today. I thought being a parent was all about making sacrifices for the well-being of your children. Apparently not in NCB circles, children are dying or being damaged for life for the sake of the “ideal birth”. What kind of narcissistic BS is that?

    • Young CC Prof

      No, the baby is brain-damaged because Mom was systematically brainwashed by the NCB fanatics to believe she was making a good choice for her baby and protecting him from the cold and uncaring hospital staff.

      • Lynnie

        Yeah, the NCB fanatics played in her fantasy of an ideal birth. It is easy to find evidence “proving” your point. If you “research” long enough on the internet you can pretty much find proof for any whacked out conspiracy or belief you can find from jet engines poisoning the US with chemtrails to reptilian aliens taking over our government.

  • Trixie

    I’ve got a semi-off-topic question. What happens when the contraction monitor doesn’t work on you? In neither of my labors were they ever able to get my contractions to register on the monitor, even when (the second time) I was in transition and pushing. Both times there was a parade of people trying to position it so it would work, and it never did. My fundus never got firm with contractions either. The fetal heart monitor worked, and both times the babies seemed fine, but I wonder if they would have picked up on any distress in time without having a good strip (obviously, they could tell when I was contracting by looking at my reaction!). Maybe I’m just a rare case, but it left me a bit skeptical about the efficacy of contraction monitors.

    • Susan

      There are two types of contraction monitors. The external, or tocodynamometer, picks up the tension of your uterus underneath your skin, that tells you only when there is a contraction, not how strong the contraction is, but the majority of the time is sufficient. It’s very dependent on placement, works best if there isn’t a lot of tissue between the uterus and the monitor to soften the reading, needs to be moved when the mom changes position, and is the kind held on by belts.

      The intrauterine pressure catheter does tell how strong the contractions are and also gives a reading of resting tone between contractions. It works well even on moms who are otherwise challenging to monitor, but mom has to have ruptured membranes and be sufficiently dilated in order to place the catheter up inside the uterus.

      With that example of a strip like Dr. Amy posted, it would be very helpful to have a good contraction tracing. If you couldn’t get one, you could mark the beginning and end of the contractions on the paper to get the timing of the decels in relation to the contractions. But ideally, you would want a contraction tracing too.

      Sometimes it matters and sometimes it doesn’t. If they could not get a good tracing on you, and the fetal heart rate looked utterly normal otherwise, it probably wouldn’t be worth using an internal monitor to get a contraction pattern. It becomes more important with Pitocin, or with a pattern suspicious for late decelerations.

      Hope that helps! And it’s not all that rare that it won’t work actually with the external toco.

      http://www.babies.sutterhealth.org/laboranddelivery/ld_fm.html

      • Trixie

        That helps a lot! I am not “fluffy” which is something I remember the nurses saying was another reason it was surprising it didn’t work. But since the front of my uterus never got that hard, I guess that’s why it didn’t work. I mostly felt the contractions in my back. Thanks!

  • http://kumquatwriter.wordpress.com/ Kumquatwriter

    The danger signals that led to my CS included a *high* heart rate in my son – plus developing fever/infection for me. His heart rate was spiking with the contractions. I don’t know how long it would have taken to push him out – almost 40 minutes and he hadn’t moved more than about a half inch down? The OB suggested a cs before it became an emergency, as at the rate he was coming out it would be 2-4 more HOURS of pushing.

    I’m glad HB didn’t appeal to me; I can only imagine how disastrous it could have been.

    • MaineJen

      My daughter also had a *high* heart rate, though it was very early in labor. My waters had been leaking for a while without me realizing it (a weird, slow leak that only became apparent a day or so later) and she was distressed from low fluid by the time we got to the hospital. Luckily, after a bag of IV fluids, she settled down, I got antibiotics for broken waters and GBS+, and we went on to a quick, easy birth. (Well…’easy’ is a relative term. How about ‘uncomplicated?’) If she hadn’t responded to the fluids, I suppose we would have ended up in the OR too. You do what you gotta do.

    • KarenJJ

      I had EFM when I arrived at the hospital in labour with my first after my waters broke and there was meconium (and no dilation and the head wasn’t engaged and baby was post-dates). The heart rate was fine and so my obgyn gave me the option to keep labouring or have a c-section based on the info from the EFM. Without the EFM I suspect my obgyn would have recommended to go straight to c-section.

      At any rate, I still chose c-section. I was sick of buggering around, going nowhere and just wanted my baby safe in my arms. Which is what I got, happily enough.

    • Deidre

      Even if you “had” planned a home birth you would not have been allowed to proceed that way. Those are risk factors that do not indicate that home birth is safe.

      • http://kumquatwriter.wordpress.com/ Kumquatwriter

        Which is only true if you have a midwife who actually risks people out. Most hbmws consider risks as “variations of normal” which is a huge part of why they’re so damned dangerous.

        • AlisonCummins

          Navelgazing Midwife had a post a few years back where she said her own transfer rate had averaged about 30% and absolutely not to trust anyone whose transfer rate was less than 17%. (Or something. Going from memory here.)

          From what I understand, women interested in home birth are more typically encouraged by the pro-homebirh echo chamber to see high transfer rates as a sign of incompetence.

  • attitude devant

    There is none so blind as she who will not see. The willful ignorance is amazing and infuriating. Makes me want to scream.

  • the wingless one

    My son was born at 34w5d via csection because he failed several NSTs and eventually got a 2/10 on a BPP. His heart rate never fell below 150, in fact there was practically no variability at all, which was one of the things my MFM, OB and ante-partum nurses found so worrisome that they suggested a c/s instead of trial of labor. There is no way I would have ever been under the care of a midwife (I was high risk all the way) but it is still terrifying knowing my sweet healthy boy could have easily been a stillbirth without all the high tech and diligent monitoring by my medical team. It’s so upsetting to hear this lie/ignorance repeated over and over again that as long as heart rate is “normal” the baby must be fine. Thank you Dr. Amy for all you do to try and inform people about the truth.

  • amazonmom

    Poor baby. I can’t help but think that he would be ok if only he had been born in the hospital. Maybe he could have been snatched away from the arms of death and disability.

  • Amy M

    I read further down on her page…she has recently become a stillbirthday birth/bereavement doula. Kind of ironic. It doesn’t sound like her son will die, but it sure sounds like he will have some issues. I wonder if this will change her views on homebirth, or if she will always believe it was an unavoidable accident and everything that could have been done was done. I’m guessing it’ll be the 2nd one.

  • Allie

    This story breaks my heart. I can’t understand how everyone involved is not being arrested. I can only hope, in line with the mother’s professed faith, that they will have to face a higher power at some point who will bring them to justice for their folly.

  • Gene

    “For the emergency responders who didn’t give up on my son and rushed him to safety. For living in a time and place with amazing medical care…”

    Yes. That place of safety and amazing medical care would be THE HOSPITAL! You know, the place that might have prevented this in the first place?

    It is very difficult for me to read lay descriptions of events like this because I can read between the lines. I can tell from her description what likely is occurring (like the “areas of concern” in her baby’s MRI and the seizures after re-warming) and it is very very bad.

    • attitude devant

      According to my NRP book, even WITH good fetal monitoring, you’re going to get a baby in need of expert resuscitation 2-5% of the time. Why do that remote from any real assistance?

      • KarenJJ

        Wow. That’s another damn good reason to give birth near expert medical care. I wonder if the midwives in Seattle are going to put that into their informed consent document they’ve been working hard on for the past couple of years?

    • Young CC Prof

      Yeah, generally stories that begin with 20 minutes of CPR don’t end well. What a horrible waste.