Homebirth and defining deviancy down

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In the winter of 1993, Senator Daniel Patrick Moynihan published a deeply influential scholarly paper entitled Defining Deviancy Down.

He started from the premise of sociologist Emil Durkheim that there is a maximum amount of deviance that a society can recognize before that society begins to fall apart. In order to preserve society  if deviancy rises above that level, standards will change so that behavior previously recognized as deviant is no longer considered deviant. In other words, if society is not careful about enforcing standards, standards will constantly be lowered.

Moynihan wrote about crime in New York City, but the analysis has been extended to many disparate areas, and I’d like to extend it further … to homebirth.

Homebirth as a philosophical movement is only legitimate as long as its central premise is legitimate. The central premise is that homebirth is as safer or safer than hospital birth. But as homebirth has risen in popularity, it has become glaringly apparent that homebirth isn’t safe at all. There are far too many deviations from safety, including deaths, brain damage, and other permanent injury, for anyone to rationally conclude that homebirth is safe. Therefore, homebirth advocates have been defining deviancy down, by insisting that what is dangerous is actually safe, that what is a disastrous outcome could not have been avoided, and that there is more to safety than whether the baby or mother lives ordies.

Consider:

1. The magic umbilical cord

It is common knowledge that any baby born blue, struggling to breath or not breathing at all, is a baby who has been compromised and perhaps seriously injured by oxygen deprivation. But in the world of homebirth, an appalling number of babies are born blue and struggling to breath or not breathing at all. How do homebirth advocates reconcile the purported “safety” of homebirth with the many babies born obviously suffering the effects of oxygen deprivation? Simple, they’ve redefined what it means for a baby to be born blue, struggling to breath or not breathing at all.

Instead of acknowledging that these babies are oxygen deprived, homebirth advocates have redefined blue babies to be “normal” and invoked the magical umbilical cord, which purportedly supplies copious amounts of oxygen after birth even though it wasn’t supplying enough oxygen before birth.

Voila! A blue baby is now “normal.”

2. Rejection of risk factors

Homebirth advocates often claim that homebirth is for low risk women, yet encourage high risk women (breech, twins, VBAC) to give birth at home. How does that make sense? It does if you define deviancy down an insist that what were previously considered deviations FROM normal are now merely variations OF normal. Presto-chango! Anyone can give birth at home because everyone is “low risk.”

3. The rejection of risk, aka “the dead baby card”

Homebirth advocates haven’t merely re-defined risk factors, they’ve redefined risk. Previously, when an obstetrician told a woman that she was at risk for a serious complication, she took that advice into consideration. Homebirth advocates have deliberately defined risk down, such that any risk that isn’t 100% isn’t a risk at all, just the obstetrician trying to scare the mother.

4. Any birth that doesn’t result in death is safe

We’ve recently seen this attempt to define safety down in the antics of Ruth and Jared Iorio desperately trying to pretend that Ruth’s birth involving a near death experience from postpartum hemorrhage, transfusions and a 2 day hospitalization is an example of the safety of homebirth. Ruth didn’t die, so homebirth is safe.

5. Dead babies are unavoidable

If you were naive you might think that a dead baby (or mother) was the ultimate example of a homebirth gone wrong. But now homebirth advocates have defined dead babies down, too. Whereas dead babies were previously recognized as homebirth disasters, they are now treated as inevitable deaths so that homebirth can be justified since the baby was going to die anyway.

Contemporary homebirth advocacy is a paradigmatic example of defining deviancy down.

Blue babies are now getting “enough” oxygen.
Risk factors are all variations of normal.
There is no such thing as risk.
If no one died it was a safe homebirth.
And even if the baby or mother died, it was inevitable.

The philosophy of homebirth is legitimate only so long as its central premise, that homebirth is as safe as hospital birth, is true. It can’t survive as a social movement otherwise. Since homebirth is obviously not safe, with mortality rates approaching 1000% higher than hospital birth and brain injury rates exceeding 1800% of hospital birth, homebirth advocates have been forced to define deviations from safety down, proving Durkheim correct. If we are not careful about enforcing standards for safe birth, those standards will be constantly lowered until they are meaningless, as they already are in the world of homebirth.

  • KAndrews

    Some of my old school friends are daughters of a midwife. A couple years ago, I contacted her trying to get more answers about what happened to Abel. She told me she had recently delivered a baby that was not breathing for hours and after a couple hours of being attached and held by the mother, the baby started breathing on his own . . . She said the error my midwives made was that they cut the cord and called 911 . . .

    A year later she attended the birth and death of her own grandchild during a postdate delivery at home . . . justified it somehow and is still practicing. Now that is Defining Deviancy Down.

    • FormerPhysicist

      I cannot like the comment, but I must say I read it. OMG.

    • MaineJen

      Her own…grandchild.

      So, not only can she not *help* a baby who’s not breathing, she cannot even correctly *assess* whether or not a baby is breathing. Awesome.

  • Elizabeth A

    I found this while poking around the internet for information on c-section rates. It’s… wow. It’s awful.

    http://commonhealth.wbur.org/2014/01/interactive-childbirth-massachusetts-hospitals

    For those who don’t want to click through, it’s a bar graph showing c-section rates for hospitals in MA. The Y-axis is labeled with percentages. The X axis has a caption reading simply “Lower is Better.” Hospitals have been compared on four “key indicators” other then c-section rates: VBAC rates, early elective delivery rates, episiotomy rates, and rate of exclusive breastfeeding.

    Maternal and neonatal morbidity and mortality don’t rate a mention.

    • http://Www.awaitingjuno.blogspot.com/ Mrs. W

      Seems sadly par for course.

    • Young CC Prof

      “Large hospitals, including teaching hospitals, often have higher C-section rates. They say it’s
      because they handle more premature and other high-risk deliveries. There is no definitive reason for the big differences between hospitals.”

      Instead of ignoring the reasons for variation in c-sectiion rates, let’s actively deny reasons exist.

    • Amazed

      Ah, the C-section rate again.

      You know, there’s always been this one thing… It keeps bemusing me. Ebil OBs make c-sections out of fear of litigation. A suit follows when there is a bad outcome. Kool-aid to Earth translation: ebil doc has a vested interest in assuring a good outcome. To you birthing ladies who sprout all this nonsense: don’t you have a vested interest in assuring a good outcome?

      For Pete’s sake, don’t you?

  • juniper1991
    • Lisa Murakami

      I am fascinated with her. She is an anti–vaxx quack and I wonder what her real motives are – or if she’s just as crazy as she looks in her picture.

      • Atom

        I think the picture is quite nice. Having said that, she is an anti-vaxx, pro-woo quack for sure. The problem is she has credentials and is well-spoken. I think that she believes what she says (kool-aid drinker). But she certainly appears to have unethical financial relationships with supplement companies and the Fisher-Wallace device. I hope Dr. Amy listens to the show and responds.

        • Lisa Murakami

          I completely respect that different people see different things in pictures but I still see this: A facial expression way too overdramatic for a professional picture. One eyebrow half-arched, a smug, borderline-obnoxious smirk. And wide, crazy-lookiong eyes.

          • Atom

            I see. But I doubt you would say that if she was the opposite of what she was…..meaning reasonable, evidence-based, not a cherry-picking, quote-mining quack. You see crazy looking eyes because you read crazy writing. Another ironic thing, is that by appearance, she has a ton of inappropriate corporate connections- with supplement companies, The Fisher-Wallace simulator. Who knows what the real deal is, of course. But it makes her anti-pharma stuff seem very hypocritical.

          • Dr Kitty

            I think she looks like Alison Brie.
            She’s still a woonatic though.

          • Guest

            Also Brie is very beautiful. I wonder if she agrees with Dr. Brogan that invisible magnetic fields represent a threat to pregnant women for which earthing technology can be a cure.

          • KarenJJ

            Hilarious. Love the product plug for what looks to be some sort of mat that plugs into the house earth? Just touch your kitchen sink, fridge, washing machine, bath. They should all be connected to earth.

            When designing substations, one thing that gets looked at is “step potential”. Substations can release a lot of energy to the earth during a fault. If you are walking in a substation at the time, the distance between your feet on the ground can mean that your feet are at different voltages. With your feet at different voltages, a current can flow through your body and can be dangerous. You wouldn’t want to be enjoying the earth’s energy with bare feet at this stage. The same can happen with lightning strikes or being close to a downed power line.

    • Young CC Prof

      Baby didn’t want to go down, so I tried listening. Other than filling a bingo card, I wasn’t terribly impressed. Wall to wall myth regurgitation in an echo chamber, it wasn’t even interesting. Couple golden quotes, though:

      One was something like, “Obstetricians treat birth as a disaster waiting to happen. Midwives treat it as normal until proven otherwise.” Sounds like a good reason to see an obstetrician?

      The other was the claim that the home birth transfer rate was 3.4%. Say WHAT?

      On the plus side, those women do have nice voices, and Baby CC Prof is asleep now. Clearly, NCB radio is good for something.

      • The Bofa on the Sofa

        “Hope for the best, prepare for the worst” is really a smart way to operate, especially in health care.

        “Assume everything will be ok, and if the shit hits the fan then try deal with it” is not a very sound methodology.

        • Durango

          Witness the West Virginia chemical leak, for example.

        • disqus_FeN6LaMBls

          The motto in my office is “Hope is not a strategy”

          • The Bofa on the Sofa

            Beautiful!

      • Guest
      • Joe Smith

        This seals the deal for me. Anyone who listens for more than 10 minutes wins a gold star.

  • workwithmehere

    I think I missed a previous discussion about the magic of the umbilical cord. Can I have a fill in please?

  • MrG

    You said that: “The central premise is that homebirth is as safer or safer than hospital birth.” Actually, the central premise by homebirth supporters is that homebirth is more fun (see the videos!! See the movie!!) and associated with less interventions (No cesareans because you cannot do those at homel). All about mom and dad, nothing about baby. Because if it would be about the baby then they would not deliver at home).

    • Certified Hamster Midwife

      That’s not how they try to sell it.

    • fiftyfifty1

      No, I think the central premise is that it’s as safe or safer and that’s why you can now shift your focus to the “more fun! see the videos! see the movies!, less interventions!” etc.

  • Expat

    http://abcnews.go.com/GMA/t/video/gisele-bundchen-takes-daughter-helmetless-atv-ride-21524680?source=hp Go Gisele go! Homebirth is safe! Motorcycling with a baby in an ergo is safe! Formula is poison! Hospital birth is cruel to babies!

    • Meerkat

      She is such a tool.

    • Lisa from NY

      ATV accidents are very common, even WITH helmets.

      Gisele, breastfeeding won’t save your baby from trauma.

      http://www.atvsafety.gov/stats.html

      • Karen in SC

        OT: I wondered if your neighbor that had the near miss with her homebirth has changed her view now that some time has gone by.

        • Lisa from NY

          No. The studies purportedly say more babies die in hospitals.

          • Karen in SC

            Sad, but I doubt she’ll have any more children.

    • Fuzzy

      Holy fuck. Trauma nurse, who has seen more bad things come off an ATV than I want to think about….

    • wookie130

      I saw that last night on the news. What is with the new fad of women filming themselves while engaging in unsafe acts while breastfeeding? Riding on bicycles, horseback riding, riding on ATV’s and motorcycles…um…what gives?

      Obviously it’s attention-seeking. “Look at me while I do what’s ‘best’ for my baby!!!” Never mind that she could break her neck, drop the baby, or fall off the vehicle or animal and get trampled/run over, what have you.

      Gisele was annoying before in her stance on birth and infant feeding. Now, she’s just downright moronic.

      • Trixie

        Even trying to breastfeed your baby in a moving vehicle — even with the baby strapped in — is moronic. The mother’s unrestrained torso will fly right into the baby at whatever speed the car was going, crushing the baby and/or overwhelming the weight limit of the seat. But people on BF forums brag about it all the time.

        • yentavegan

          We are all forgetting that breastfeeding transfers maternal protective chemicals that coat the nursing couple in a shield of wonderfulness. Breastmilk cancels out all environmental harm, including reckless parenting.

        • toni

          What about flying with a baby on your lap? I’m flying to India in March with little one. If we go over a bump on the runway will I hurt him?

          • Young CC Prof

            The airlines seem to think it’s safe. Ask for a seat with an extra oxygen mask, the major airlines have a few such seats for parents with lap babies.

          • Trixie

            No, the FAA actually advises against it but thus far hasn’t changed the regulation to require car seats. We always buy a seat for our babies under 2 and install a car seat, or for an older child, use a CARES harness until they’re large enough for the adult belt to actually fit them. The absolute risk of being in a plane accident is low, much lower than automobile travel, but the risk of your baby flying through the air during turbulence is a bit higher. In severe turbulence, you have to stow your baby under the seat like a pocketbook. My friend who was a flight attendant saw a lap baby injured this was. Your arms simply aren’t strong enough in that situation.

          • toni

            ‘In severe turbulence, you have to stow your baby under the seat like a pocketbook’

            Wtf. Why?

          • Trixie

            Because it’s the safest place. Your arms aren’t strong enough to hold onto a baby if you suddenly drop at 120 miles an hour. So they contain the baby in a small space so it can’t fly up and hit the ceiling, or another passenger. Same reason you have to stow pocketbooks, so they don’t become projectiles.

          • Mishimoo

            Over here, some airlines won’t allow car seats because they can’t be secured adequately, but we do have belts for lapbabies that attach to the parent’s belt. They must be buckled in at all times unless going to change them in the bathroom. Speaking of which, changing a baby in a plane bathroom was the most difficult change I’ve done. He kept trying to slide about thanks to some slight shuddering of the plane.

          • Trixie

            Interesting — the FAA specifically prohibits those devices during takeoff and landing because of the risk of the adult’s torso crushing the child.

          • Mishimoo

            My best guess is that they’re used because we haven’t had as many crashes or issues with planes, yet.

          • Karen in SC

            Trixie, years ago, I bought a seat for my toddler and entered the plane with his car seat. The attendant told me that it wouldn’t fit in the overhead bin so I would have to check it. When I told her that I would be using it, she looked like she didn’t believe it. But this was an older style where the seat belt just went into slots on the sides. It was better than nothing and my son was quite used to it and fell right asleep.

          • Karen in SC

            Adding that I definitely needed it at our destination since we would be driving around!

          • Trixie

            Many flight attendants still aren’t sure what to do when you show up with a car seat. I carry a printout of the FAA rules just in case.

          • Trixie

            Here’s a fairly exhaustive review of the subject by a pediatrician and child passenger safety technician instructor. http://www.thecarseatlady.com/airplanes/airplanes.html

          • Trixie

            Flying with a lap baby would terrify me, and I would buy an extra seat and install a car seat in it, and only take the baby out of the seat for feeding and diaper changes, and only then when the fasten seatbelts sign was off. I also wouldn’t check the baby’s car seat as luggage, anyway, because it could be mishandled to the point of being unable to withstand crash forces. But, I’m definitely in the minority on that one, because I’ve never been on a flight with my kids where anyone but mine were using car seats.

            Also worth noting that any kind of carrier you wear the baby in is not allowed by the FAA during takeoff and landing. The FAA thinks the risk of your torso crushing the baby into the seat in front of you is higher than the risk of the baby flying into the air and hitting something.

            Still, international regulations on flights differ, so I’m not sure what to tell you about India.

      • Dr Kitty

        Well, when the pope is on record saying he doesn’t care if you breastfeed in the SIstine chapel during a service, you really have to up your game if you still want the shock value and attention…

        EXTREME BREASTFEEDING: Bungee edition is only a matter of time…

        • Meerkat

          This is a conversation I recently had with a lactivist:
          Lactivist: we have to fight for our right to breastfeed anywhere we want.
          Me: we already have it. I breastfeed anywhere I want.
          Lactivist: yes, but people say mean things.
          Me: nobody has ever said anything, not once.
          Lactivist: you are not helping. You are blind to the issue.

          • Melissa

            I have to wonder how many “I was breastfeeding in public and I got a dirty look” stories are accurate since what might be interpreted as someone giving them a dirty look might, in reality, be someone who doesn’t even notice them and is battling their own indigestion. There’s a level of narcissism in many people who assume that everyone is always judging them, when in reality most people don’t give a crap about them at all.

          • Meerkat

            Absolutely! The only person who ever got upset when I BF in a restaurant was my husband’s friend who accidentally saw my nipple.

          • The Bofa on the Sofa

            I remember the conversation I had one time with a guy who didn’t like it when women were breastfeeding at a restaurant and “sticking their boobs in my face.”

            I was like, how the fuck do you eat dinner?

            When I go to dinner at a restaurant, I don’t spend my time gawking at people at the other tables. I might notice if there is someone I know, especially if they are sitting near me, or if there is a kid in a high chair nearby, but I would have to really go out of the way to even notice someone breastfeeding, and even farther if there was any amount of discretion, which is by far the rule.

            Grandstanding displays (like that woman who plopped down in the middle of the walkway in front of the formula display) are so bloody rare as to be notable when they actually occur.

            “Shoving their boobs in our faces” – what a joke.

            (rule 38)

          • Meerkat

            I don’t know about other women, but I tend to stick my boob in my baby’s face!

          • The Bofa on the Sofa

            BTW, why would he be upset if he saw your nipple?

            Most guys I know would laugh if they saw their friend’s wife’s nipple, “heh….heh…heh…I saw your wife’s nipple….heh…heh…heh…”

          • Meerkat

            Haha!
            I am not sure, but I think he just didn’t want to picture me in a sexual way. I have to say that unless you are breastfeeding, seeing a woman bare her breasts in public places can be a little shocking. I remember a time when a friend nonchalantly pulled out her breast for her toddler in a restaurant, while the waiter was waiting for her order. Toddler sat there for a little while and played with my friend’s nipple and all of us tried not to look. Then the toddler finally latched on and started making really loud smacking and gulping noises. It was like something out of Alien. All of the men at the table got a sudden urge to smoke, even the non- smokers.
            So I understand people who just don’t want to see that. I usually cover up with a scarf, but sometimes my son objects—he wants to nurse and look around.

          • The Bofa on the Sofa

            And note that if 100 people walk by you and 1 makes a comment, you will tell people about how you got that evil comment from someone and it made a bad experience. But 99% of those around you had no problem.

            If you expect 100% of people to do anything, you are going to be disappointed.

          • Young CC Prof

            And then of course there’s the little doubletake. “Wait, what’s that person doing? Oh, feeding a baby. Whatever.”

            If you’re primed to be offended, you might interpret THAT look as judgement.

  • Mel

    I know I say this a lot, but I am horrified that midwifes are willing to deliver human babies with the same shitty technology available to farmers for cattle and much less education.

    Let’s compare:
    Midwives say: Blue is a variation of normal.
    Herdsmen/Vets (HV) say: Oh, s%^*t and start lots of interventions because breathing is really important.

    Midwives say: You can totally HB everything!
    HV say: If a cow survives a major complication that is likely to be repeated, she’s not bred back and sold for beef. (Because, honestly, I don’t know of any slaughter method more sadistic than letting a cow die from a birthing complication. Birthing deaths are brutal for the cow and often emotionally traumatic for the humans who see it.)

    Midwives say: All that matters is a live baby and live mother.
    HV say: Mom needs to be able to produce lots of milk/ care for and raise a calf/ be able to get pregnant again. The baby needs to be healthy enough to eat without intervention. (Higher-level thinking isn’t needed in cattle. If it can eat and gain weight, it’ll be a good-enough cow)

    Midwives: Dead babies are inevitable.
    HV: Dead cows and calves are inevitable with the technology we have. If we could do the intensive monitoring and rapid, non-fatal C/S available to OB’s, we’d have few or no dead calves and dams. Which leads to the horror of finding out that women chose to deliver in situations that are closer to livestock conditions than human conditions….

    • attitude devant

      Actually, I LIKE your animal husbandry stories. Keep ‘em coming! After all, one of the great NCB tropes is that we’re all made to birth. Which we aren’t.

      • DaisyGrrl

        Yes! I participate on a pet forum where people frequently ask about breeding their dog. A frequent piece of advice is to have enough money for an emergency c-section in the bank before even contemplating breeding. The general sentiment is that there are enough companion animals out there that yours should be pretty special to warrant risking her life in breeding *and* you should have money saved to cover medical emergencies. And this is for DOGS! How people can approach the births of their children with less concern is just sad.

        • Bombshellrisa

          When we were researching breeders and I decided on one, she happened to be an L&D nurse. And man oh man, the contract we signed BEFORE we put down a deposit was more exhaustive and honest than anything a homebirth midwife has a client sign. Every complication that could possibly happen to a pregnant and laboring dog was explained and there was no promise of a puppy afterward (but you would get your money back if you didn’t get a puppy after all that).

        • Lisa from NY

          Shouldn’t we be more concerned with the female dog’s emotional experience than the life of the puppy?

          • Mishimoo

            Of course we are! My ex-breeding bitch had an empowering HBAC, with only one pup born still.

            (The breeder checked on her just before dinner, she was fine. Came back an hour or two later and she had delivered half the litter. The stillborn pup had died some time before labour began)

    • Amazed

      Err, Mel… I love your animal analogies but I really have a problem with Midwives say: All that matters is a live baby and live mother part.

      Too often, they bemoan the fact that so many births are detrimental to the mothers because of them interventions… Live baby is not all that matters you know, mother’s mental health is important, too, and an unnatural birth is so much worse for the mother than a dead baby.

      • Lisa Murakami

        Reminds me of my aunt, left infertile and incontinent after she refused doctor’s advice about her VBAC. And what happens to “mother’s mental health” when she buries her baby?

        • Amazed

          Clearly, they are taught to “join in spirit with many mothers who lost their children at birth and take strength from them”. That’s what an OB wrote about her first homebirth transfer at 10 centimeters blog. She also explained how ‘it would have happened in the hospital, too!” looks from the OB side of things.

        • Busbus

          I just heard from an acquaintance that her VBAC left her with huge pelvic issues and that she wishes now she would have just had another c-section. Very sobering.

        • Lisa from NY

          Why was she infertile?

          • Lisa Murakami

            I don’t know – my mom reported this to me and I never asked her about it myself. But this was 30 years ago in obstetrics, 1983. Maybe it wasn’t infertile per se but that another pregnancy would be counter-indicated for extremely high risk? I don’t know exactly. But I can vouch for the incontinence. And her daughter is now a bipolar adult. Personally I don’t believe birth trauma accounts for personality disorders but those who do might want to not consider a discouraged VBAC.

      • Mel

        Oh, that’s a good point. And terrifying. Humans grieve. Losing a child is painful – I’ve watched my parents grieve the loss of my infant brother as well as the parents of a friend who died.
        I have heard through this site and others that births can be traumatic to women. I never want to minimize the pain of women who have been affected by a painful/frightening birth. I can’t imagine, though, that women who had a traumatic birth would prefer a natural birth ending in a dead baby than a traumatic birth with a living baby. I would want all women to have a non-traumatic birth with a healthy baby.

        • Amazed

          Beats me. I cannot fathom how they can have the insolence to say it. Hannah Dahlen, Ina May, Cathy Warwick – they must have all had interventions relieving them of conscience.

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

          Mel, this made me think of an OT blog post I wrote a a while back in reply to Terry England’s “barnyard” statements: http://kumquatwriter.wordpress.com/2012/03/09/beyond-the-barnyard-terry-england-and-fetal-pain/

          • meglo91

            I just went over to your blog and read. Am now crying at my desk. Beautifully written. You strong, strong lady. Thank you.

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

            Thank you!

          • Siri

            Kumquat, you write like a demon, always! Wish there were 3 times as many entries on your blog…

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

      I think you are talking about small farms, because I know for a fact that milk cows are bred to death all the time in factory farming situations. No one cares about them. Mercy for animals has a recent video out about milk cows if anyone wants to check for themselves (warning: it has untreated organ prolapses and ‘downer’ cows being beat by workers).

      sorry this is a bit OT, I just don’t want people to think that animals are generally treated more humanely than people. The vast majority of them are subject to unspeakable cruelty to provide humans with food or products.

      • yentavegan

        hence the vegan in my yenta

        • Fuzzy

          What about all the birds, rodents and such that are killed by the farming of your vegan diet?

          • Trixie

            And groundhogs. So, so many dead groundhogs.

          • yentavegan

            ***sigh***

          • AlisonCummins

            Hey, this is the point and judge blog. Because we have Facts and we are Right we get to call everyone else Stupid for being mistaken or even for having different values.

            (Not vegan yet, but trying.) (And not everyone does the point and judge thing, but when they do they tend not to get called on it.)

          • Fuzzy

            Not calling anyone stupid, just pointing out that no choice comes without cost. The mechanical harvesting of fields kills many small mammals and lizards. Honeybees are needed for fertilization of crops, need to be managed as they are not prevalent in nature, and by existing make more honey than they can use. An old bee tree is full of old and useless comb which promotes wax moths and disease.

            Much grazing land is simply not suitable for managed crops. Habitat for small and large animals is destroyed by creating cleared fields, while managed pasture supports a variety of wildlife.

            Also, while I don’t promote the commercial sale of raw milk, I’ve drunk fresh raw milk from my own grass-fed herd for years without illness or incident.

          • AlisonCummins

            You‘re assuming that yentavegan and I haven’t thought of this.

          • Fuzzy

            Not at all. I assume that you consider habitat destruction and fossil fuel use to be insignificant in the face of not killing any fuzzy little animals, or that you are good at cognitive dissonance.

            Your choice to eat vegan carries no less negative impact on the environment than my locally farmed organic omnivore diet.

          • AlisonCummins

            Never said it didn’t.

      • fiftyfifty1

        She knows *for a fact* that milk cows are bred *to death* *all the time*. *No one* cares about them. Untreated organ prolapse and downer cows being beat by workers is a typical occurrence. The *vast majority* of them are subject to *unspeakable cruelty*.

        Extraordinary claims require extraordinary evidence.

        • Mishimoo

          Down cows are hit sometimes, but with good farmers it is a necessary and lifesaving intervention. Info here: http://www.theguardian.com/commentisfree/2013/dec/09/peta-dairy-farmer-down-cows-abuse

          • Lisa from NY

            In summary, when a cow goes down, it loses circulation n its legs, and may lose its ability to get up. So farmers *scare* the cow into standing up so its legs don’t atrophy.

          • Dr Kitty

            My SIL and her husband have just installed a robot in their milking parlour.
            Now the cows choose when to get milked, and how often, and the machine does it automatically (but won’t milk more than a set maximum number of times).

            As the cows have access to food, some of the smarter ones have worked out how to game the system.
            One of the cows went through the milking robot more than 100 times a day!

            It has made life a lot easier for them-CCTV in the house to check on the cows, and only a brief visit to make sure that any reluctant cows get milked at least twice a day.

            No more 5am milking sessions before BIL starts his actual 9-5 job.

          • AmyP

            That’s fabulous.

            I’ve also seen a TV show (How It’s Made?) where they showed a special automated disinfecting area where they clean udders before milking.

            I was in awe.

          • Dr Kitty

            They also have another robot which cleans the milking parlour (sort of like an industrial Roomba).

            It’s a small (by US standards) family dairy herd, and the cows are grass fed out in the fields (Irish weather permitting).

            I have absolutely no concerns about the welfare of those cows.

          • toni

            Ohhh I thought she meant like cows with Down syndrome. D’oh.

          • Mishimoo

            I thought that the first time I heard the term too! I wondered what it would do to the overheads of running a farm, since individuals with Down’s Syndrome often have health issues, so of course I looked it up and felt stupid.

          • toni

            Well I’m glad I’m not the only dim one haha

      • Fuzzy

        Ahem: seriously mistreated animals die. It’s not very cost effective. Btw, you have to smack a cow pretty hard to get its attention. I use A nice piece of hickory about 3 feet long. The upside is that rather quickly the cow recognizes the cow-whacking stick and doesn’t need to be whacked anymore. Me, I don’t like to get kicked by the cow I’m milking.

      • Mariana Baca

        Mercy for animals has a recent video about one farm that has a mix of incidences of abuse as well as misrepresented scenes that were not abuse. Said farm fired employees for violating their contract that states this is not allowable practice at that farm, and the incident (not the video) had financial repercussions for the farm.

        It is a stretch to say nobody in any large farm anywhere cares for their cows and they are all/mostly mistreated “unspeakably”. Farmers don’t go from being caring and loving for their animals to being animal abuse monsters by virtue of having a larger, more successful farm.

        • Trixie

          I agree, it’s a fallacy to believe that the size of the farm has anything to do with how ethically animals are treated. A small, unsuccessful farmer might have less capital to invest in systems that make the animal’s life better and healthier, or in medical treatment for the herd. Not to mention, around here, many small family dairy farms are turning to raw milk to be able to charge a premium in order to sustain themselves. Which clearly causes harm to people.

          • The Bofa on the Sofa

            But hey, some group called “Mercy for Animals” made a video, so that means it’s a FACT

            Apparently.

          • Trixie

            What I don’t understand about veganism is the end game — I suppose they’d like to see all domesticated animals just simply go extinct. There’d be no ethical reason to keep goats and dogs and pigs and chickens, because using them for food (or food to feed your dog) is unethical. I suppose we should bring back wolves in the Northeast so our deer don’t have to be hunted by people anymore. I, for one, would love roving packs of wolves roaming through my yard when I send my children out to play. I’m sure farmers would appreciate having the wolves take care of the deer that eat their corn, instead of having to shoot them themselves. Because wolves are natural and deer don’t suffer when wolves kill them.

          • The Bofa on the Sofa

            I don’t know anything about that, I was just suggesting that a video produced by a group that calls themselves “Mercy for Animals” might not be the most objective source providing an honest conveyance of “facts.”

          • Young CC Prof

            Ug, we have such a deer problem here. The forest reserve just uphill from me is overrun with them, and they’re damaging the forest.

            They HAVE to be culled in some way, their natural breeding rate is unsustainable. And the only North American animals that can reliably kill deer are the true wolves, which don’t and shouldn’t live in the suburbs, and us.

            Unfortunately, you’ve got a lot of wildlife management decisions being made by people who love fuzzy animals but don’t actually understand the ecosystem. So, the park erodes a little more every year. A tree falls in the forest and the conservancy can’t plant a replacement, since the deer will just eat it immediately.

          • Trixie

            Well, I suppose chronic wasting disease kills them too, and that’s natural, right? Surely slow chronic weight loss is a preferable death!

          • AmyP

            “A small, unsuccessful farmer might have less capital to invest in systems that make the animal’s life better and healthier, or in medical treatment for the herd.”

            Exactly.

            Some of my relatives are small ranchers and they’ve been reading a Temple Grandin book on cattle handling. It’s time to redo the corrals and chute, and they are going to use TG’s ideas while designing the new structures. They are small ranchers, but it’s money that pays for the newer, more humane stuff.

            And bear in mind that cow welfare is closely linked to profitability and ease of management. If the chutes are badly designed, they will be more stressful to the cattle, and also more difficult to work the cattle through (for instance, when they run into a corner, cattle are very likely to get spooked and stuck, rather than moving smoothly forward). Stressed cattle are less profitable cattle.

            If you google “cattle stress profitability” you will find that concern about not stressing beef cattle is very mainstream in the ranching world.

          • Trixie

            My mom grew up butchering hogs and steer on the family farm. When it was time to kill one, they’d shoot it in the field, and once in a great while, they’d miss the brain, and stress the animal out horribly, plus the meat wouldn’t be as good. It was so distressing to her that she became a vegetarian, and that’s how I was raised. I still have no taste for beef or pork. But modern systems for slaughter are much more humane.

      • Mel

        I’m talking about the only farm I know: ours. 1,256 milking cows and heifers. Probably 500 -600 young heifers. Since large dairy operations are defined as 500+, that makes us evil.

        Also, it allows us the cash flow to have full-time monitoring of the cows, trained medical staff and a strong relationship with our local vet. Treating prolapses is an easy vet trip. When we acquired a new farm, one of the workers was using a broom handle to poke cows into moving. My husband got all of the workers together, gathered up all of the broom handles not attached to brooms and broke them over his leg. He informed all of the workers that that was a bad way to move animals; it could hurt the cows and if anyone used that method to move cows again, they would be fired and reported to the police for animal abuse. We take animal safety seriously.

        Small isn’t necessarily better, either. Our vet recently came to our farm for a vet check late. He’d been called to a small beef operation with fewer than 20 head for a crock-pot birth. I didn’t recognize the term and asked. A crock-pot birth happens when a calf dies at term, the cow can’t deliver it, and the owner waits 3 days to call the vet. The dead fetus spends three days decaying inside the mother. I’ll spare you the rest of the details. If you want to see one of those, there’s an episode of The Incredible Dr. Pol where he responds to the same situation.

        In our state, the vet couldn’t report the owner. Animal abuse requires positive action – beatings, refusal to feed – rather than neglecting to intervene in a birth.

      • KAndrews

        I have seen the videos you are talking about but living my whole life in Cattle County, I can attest with what Mel is saying. The small Ranchers are amazingly dedicated to their animals health. That is how they make a living by head count, weight and quality. Now what happens at bigger places that the cattle are often shipped too . . . . no personal knowledge.

  • Guest

    Slightly OT: I was wondering if I could pick your brains about something – my husband and I are considering trying for our third sometime later this year and we are debating who we want to provide care during pregnancy. Our first child was via an OB and it was ok, but somewhat impersonal. I would have no problem going back to an OB, if it were the best decision.

    Our second child was via a hospital-based CNM. I really, really liked their relational skills. I never felt rushed during our appointments. I also liked that during labor they would speak directly to me (as in, they’d talk to my nurse and then have the nurse hand the phone to me and I’d get to discuss our options directly with my care provider. In my first labor my doctor never did that, so it sometimes felt kind of disjointed.) I had decreased fetal movement at 37 weeks and they sent me straight to the hospital. For the most part, I felt they handled my care appropriately.

    Here are my concerns about the CNMs – in order from least concerning to most concerning. First, at about 32 weeks I developed sciatica and my hip completely gave out around 38 weeks. I was miserable and I couldn’t put any weight on it. The CNMs told me point-blank that I was allowed to ask for an induction at 39 weeks, but that they’d try to talk me out of it, that it was a bad idea, that there are way too many elective inductions etc. etc. That felt kind of weird.

    Second, at 39+6 I started having contractions. We went in and it turned out I was in early labor, contracting about every five minutes, but not progressing. However, my son had a few lates when they first put me on the monitors. They ended up keeping me on the monitors for another hour and the decels never happened again. Now, the OB resident told me that if I wasn’t term they’d probably send me home, but since I was due the next day and things weren’t, in her words, “perfect,” they’d prefer to induce. My CNM, on the other hand, said she felt certain that everything was fine and that if I wanted to go home, I could.

    I guess my question boils down to – is that concerning? Slightly concerning, very concerning? I mean, I get that they are trying to get the homebirthing population into the hospital and they really market towards the low-intervention, no pain meds crowd (we have a pretty big homebirth organization in our city, ran by CPMs). I do like some of the froo froo touchy feely stuff that they offer, but I would never want to trade that for safety. (FWIW, my son ended up having a true knot in his cord, but I’m told that wouldn’t cause decels. Other than that, I’m as low risk as they come.) Thoughts? Thanks!

    • FormerPhysicist

      I respect training, and I have a real problem with someone who says point-blank “you can ask, but I’ll try to talk you out of it”. It may be only slightly different than “I am very concerned about the risks of early inductions, and your case would have to rise to quite a level before I was comfortable with a 39-week induction” – but it’s a crucial difference.

      Can you interview a few other OBs and find one you both like and trust?

      It also sounds like you don’t quite trust the that the medical decisions of the CNM are in YOUR interest. So, personally, I wouldn’t go back.

      • Mel

        I’ve looked around before to find medical professionals who have the training and personality characteristics that will lead to a pleasant, fruitful collaboration. For physical therapy, I tried several different offices until I found a group who worked well with my needs – lots of experience in cerebral palsy, takes the time to do good, detailed examinations, and includes me in the treatment plan. I also appreciated that that group assigned one PT/ assistant pair to each patient as much as it was possible. That let us use each appointment very effectively.

    • Trixie

      Are they the only CNM group in town? Or is there an OB group that also has CNMs you can see?

      • Guest

        They are the only group, and the only CNMs that deliver at the hospital I’ll have to deliver at (my husband, who carries our insurance, works there). So it’s them or findinga new OB (my prior OB doesn’t deliver at this hospital either). I think a lot of my quibble with the prior practice I went to was that it was huge and I ended up being delivered by an OB I had never met and who was downright nasty to us. It was bizarre, and I’ve since heard that she’s just a mean lady. Maybe a smaller practice would work because I think this group is pretty into the NCB woo. It really is too bad.

    • Meerkat

      I would go with an OB. Better safe than sorry.

      • Meerkat

        There were several OBs in my practice. I liked some much more than others, but there was one guy who seemed like a real a-hole. I really hoped I wouldn’t go into labor during his hospital shift, but (of course) I did. He ended up doing my C-section, and he took excellent care of me and my son. I am not saying that bedside manner is not important, but I would rather have a really knowledgeable but dismissive OB than less knowledgeable but warm and fuzzy midwife.

    • moto_librarian

      I used the same CNM practice for both of my children, and overall, I felt good about the care…

      BUT, there are a few things that I now wonder about in retrospect. I too had horrible hip pain from SPD, and I asked for a referral to physical therapy. They recommended chiropractic instead, and while it definitely helped, I think PT would have been better in the long run. When I had my 6-week followup after my first hellish birth, they did not draw blood to see if my iron levels were back where they should be after my pph. I only found out that I was still anemic 6 months later when I had a regular checkup with my GP. Lastly, I have a friend who was slightly overdue with her second. She had a BPP and ultrasound, but the midwives gave her a recipe for a concoction to start labor that included castor oil. It worked, but given what castor oil does to your system, that makes me a bit uncomfortable.

      I am still an advocate for CNMs, but it bothers me that you have to be very careful to ascertain whether or not they have partaken of the woo routinely promoted by their “sister” lay midwives. If I were to have a third (which is not in our plans) I would probably go the OB route.

    • almostfearless

      For my second birth I had an OB who was really sweet and awesome. I would try to interview a few and find one you like.

    • Burgundy

      Can you find a CNM practice under an OB? My CNM was under an OB, even though I was care by her through out the pregnancy, the OB checked my at 30 or 32 week mark (I forgot which one). The CNM was not into woo and would seek advised from the OB if needed.

    • meglo91

      I get why you want a CNM. I’m just not sure that THIS CNM is the one for you. Most of us on this page at least know someone who’s lost a baby due to OOH birth, so we’re probably a risk-averse bunch, but I personally prefer the OB’s approach — better safe than sorry — to the CNM’s approach — everything is fine! But maybe you can find a CNM who combines the best of both worlds, the relational approach with the risk-averse one.

    • PJ

      I would be concerned that she didn’t defer to the advice of the obstetrician. I thought the whole point of midwifery care was that they take care of “normal,” and deviations from normal are outside their scope of practice. I come from a country with a public health care system where midwives are the norm and that was how it worked.

      I used a family doctor for my second child in the US and I loved her. She had all the time for me that I wanted, and the care was very personal, but I never got any sense that she had any investment in the ideology of natural birth. It was the perfect combination for me. Plus I like the fact that she is now my children’s doctor. All this is very dependent on individual personality, though.

    • fiftyfifty1

      Baby is term (39+6). Early labor has started. Mom is miserable with sciatica. Mom is willing to augment/induce. Favorable cervix. Proven pelvis. Baby shows signs of distress—Why wait??!!! What could possibly be the benefit? How could your CNM have been “certain everything was fine”? Smells like ideology to me. This is your third baby. You don’t need hand holding or bedside manner. You need good care, free of woo, and the place to get it is with your OB.

    • sarahh.rosanne@gmail.com

      I have had two children under the care of my CNM practice but both deliveries required the assistance of OBs towards the end of labor. If I have another child I will see an OBGYN, I really appreciate what they’ve done for me and my children- two healthy babies, many disasters averted, other disasters escaped. I love a few of the midwives- but I have had a mixed experience.My primary reason for wanting an OBGYN is that I will need assistance to deliver another baby and I would prefer to maintain a relationship with the same doctors. They’ve rushed in at the last minute to save the day for me twice and I would trust them implicitly in an emergency.
      I don’t have any clinical knowledge to dispense, but I have had concerns about my particular CNM practice that probably should have led me away sooner. I feel that there is so much variation in the philosophy and practices of each individual midwife that there isn’t any consistent expectation- much more than I would expect from an OB group. There have been a lot of contradictory recommendations throughout both pregnancies. In labor, you were at the mercy of the on call schedule as to whether you got “Active Management” or “Miss Would Like to Hold My Pink Healing Crystal While You Rush”, or areas in between. The midwife who attended my first birth, whom I had never met before, was a dementor. She turned the room to ice when she came on call. She was very aloof, seemed disappointed, even angry, when I experienced complications that required intervention. I feel that she did not refer complications to a physician at the appropriate time. After the birth she refused to acknowledge anything was “unusual”. It was all “a variation of normal”. With my second,I came in when my primary midwife was on call. She was very supportive and encouraging. When she left, the night shift CNM was a complete change in direction and protocol. Completely different set of opinions. My primary midwife came back on call before my son was born the next morning and she was again fantastic- competent, reassuring, and quickly able to spot that we needed help. No woo-woo from her, nor was there any sensationalism.
      Ultimately, the lack of a unified set of protocol for different situations was a concern. I’m glad your son came through fine and I hope you have a healthy pregnancy and birth with your next :)

  • Mel

    The umbilical cord is pretty awesome, but if the baby is blue, the umbilical cord isn’t working very well.

    Obvious example from farm: Stillborn calves are often still attached to umbilical and dead.

  • Amy Tuteur, MD

    Homebirth has so many bad outcomes that homebirth advocates have been forced to redefine bad outcomes as “good.”

  • Zornorph

    I really just don’t know when giving birth turned into such a performance. Is it because of social media that now everybody can share every little detail of their lives? I remember back in the 1980s when a relative or friend would give birth, all you would know was sex, weight, time of birth and (sometimes) how long they were in labor – but only if it was exceptionally long. Now people want this huge ‘birth story’ – I would think the best ‘birth story’ would be one that’s completely unexceptional. It might be fun years down the road to say you were born in a hurricane but I can’t imagine anybody would want that if they could choose otherwise. I don’t think the angels are going to bend low to the earth playing their harps of gold when you shove your special snowflake out of your vajayjay.

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

      This is a little too dismissive for my taste.One thing I agree with NCBers about is how cathartic having a baby can be. Its seared into your memory forever. I can see why people want to share and talk about it, just like they do for weddings or funerals or graduations.

      • The Bofa on the Sofa

        Um, people don’t really want to hear details about your weddings or funerals or graduations, either.

        Shoot, I’ve never even seen the video of my own wedding (we have one) much less wanting to see a video of others.

        If someone says, “Our oldest son graduated last year”, what is the response?
        “Great, who was the commencement speaker?”
        or
        “Great, what’re their plans for the future?”

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

          I love to read stories about people’s lives. Different strokes and all that. I write fiction so maybe that has something to do with it?

          • The Bofa on the Sofa

            You are always able to ask for more information if you want it. However, if you get more information than you want, all you do is tune it out.

          • KarenJJ

            Sooo, how about that local sporting team?

          • The Bofa on the Sofa

            “I must say, the most recent campus sporting event was quite spectacular.” – Stewie Griffin

        • Are you nuts

          When our wedding video came in the mail, we fast forwarded through most of it. I’m definitely not a “let me tell you my birth story” kind of gal.

      • LibrarianSarah

        I thought people only go to weddings and funerals for the open bar and after there done nobody really talks about them again. Even if they could remember what happened.

        • Dr Kitty

          Are you Irish?
          You sound Irish.

          • KarenJJ

            Or Italian? I still remember my brother’s mother in law being surprised that so many people came to the ceremony as she was expecting most people to skip it and head straight to the reception. She was really chuffed to see so many people there! I was surprised that she was surprised by that.

        • Mishimoo

          The only surviving story from our wedding: “One table drank the entire bar tab, and has never shut up about how proud they are of doing that.”

      • sdsures

        Watching someone die is also cathartic.

    • Antigonos CNM

      I think it became more common when it became more unusual to have a large number of children. Part of the population I’ve dealt with in the past couple of decades has been religious and ultra-Orthodox Jews, who usually have between 5 and 8 children, and often even more. Believe me, all the women want is a quick labor with a healthy baby and hopefully as painlessly as possible. The main concern about C/S is that [1] how it might impact on having many more children [how many C/Ss are feasible] and [2] the 4 day stay in hospital instead of 48 hours means they are likely to go home to a real mess that will take them a long time to get under control [how would you like to use 14 plates, glasses, and sets of cutlery for EVERY meal? I once had a woman who miscarried and wanted to go home immediately after a D&C tell me that even a single night in hospital meant she was greeted with mountains of stuff in the sinks] It’s not about how a C/S is some awful trauma that has to be overcome, or the “disappointment” of not having a “perfect birth experience”. Women who expect to deliver only several times in their lives worry a lot more about that than those who are pregnant every 18 months to 2 years from marriage to menopause.

      • Mel

        In the US, some groups who promote high numbers of children – Quiverfull jumps to mind – are also promoting natural HB. Some of their concerns are financial; some are religious (they take that bit about women paying for sins through suffering in childbirth very literally).

        I’ve recently had two Catholic college acquaintances decide to jump on the HB wagon. From their FB posts, I feel like this is a form of promoting glorious, militant motherhood as a religious duty. I’d prefer to spend time serving through actual service to other than risking my life and my babies in a home birth.

        • Mariana Baca

          I was watching an episode of “Sister Wives” the other day — apparently they opt for homebirth a lot not for woo reasons but because of secrecy. But then one of the wives had an induction with an epidural for their sixth baby because they found a friendly doctor. The lady was all like: I should have had all my births this way.

          I know not all women have epidurals that work or dislike needles or don’t want to induce for valid reasons, but it is interesting to see the opinion of someone who had gone from midwives to doctors not for woo or hating doctors or vice versa being pretty objective about it being like: no, having pain killers and a steady progress in labor is very calming and preferable.

          • Trixie

            That whole family is VERY into the woo with their online supplements business, though.

          • Mariana Baca

            Haven’t watched that far into the series, yet! I’m sure they have lots of woo-iness about them, a lot of fringe groups seem to have it — even so, it was nice of them to have a positive view of medicine in labor.

          • Trixie

            Yeah, and Robyn also had a home birth then. No idea what kind of midwives. And now I’ve revealed how embarrassingly much I know about Sister Wives.

          • Mariana Baca

            Oh, just saw the miscarriage scare episode and it showed the name of their midwife service, dunno if they keep using it for the actual birth: http://www.babys1stday.com/Midwife/ — she seems to be the same lady from the episode and she seems to have CNM training (claims to have a bachelor’s in nursing and a master’s in midwifery) but the website says she practices as a CPM?

            I was googling her name around, some call her CNM, some CPM, can someone “cease” to be a CNM? This is apparently the incident that triggered it: http://blog.placentabenefits.info/?p=75

          • Lisa from NY

            “In August, Certified Nurse Midwife April Kermani performed an emergency D&C on a postpartum mom who was hemorrhaging. She asked the nurse to page the back-up doctor. The bleeding was heavy and persistent and reached the point where she felt that waiting any longer would be unsafe and put the mother in danger. The D&C was outside her scope of privileges as defined by the hospital, but mother and baby are doing great. ”

            If she is doing homebirths now, what will happen if there is a PPH?

          • Trixie

            Interesting. Of course the employer can’t tell their side of the story publicly.
            Can it really be true, as the blog claims, that there aren’t hospital based CNMs there?

      • Dr Kitty

        It was an issue when we admitted an Orthodox Jewish lady on a Friday morning and she panicked that her family would have to eat cereal for the next 3 meals (it was OK, we helped arrange people to bring food and convinced her to stay).

        I was a weird liaison between the consultant (“why can’t her husband just order a Chinese takeaway?”) and the patient (“my children will starve!”) but it all came right in the end.

        • Antigonos CNM

          While I was at Cambridge, I visited the mother of my rabbi [a Brit, who had moved to the US] at Bart’s — she had been admitted for a bad case of psoriasis. She was extremely religious. Just as I entered the ward, she had called for the Sister and demanded, pointing at an Indian lady across from her, “WHAT is that woman eating?”

          Sister was a bit nonplussed, fearing a racialist incident, probably. “Ah, she gets a Hindu vegetarian menu”.

          “Fine! Order me the same thing!” It turned out that the local kosher authority had provided a meat meal, which was a no-no because meat is forbidden for 9 days before the Jewish fast of Tisha b’Av. So the 90 year old lady ate Indian food for a week.

          You can probably manage in future with vegetarian menus, preferably cold foods. [Milk can be a problem; some Orthodox won’t drink standard milk. But surely there’s a rabbi on call for the hospital?

          • Anonymous

            Next time, just call a Rabbi. A woman who has given birth is considered a person whose life is in danger according to Jewish law.
            Any Rabbi would permit her to drink the milk and eat the meat dish (but not together, obviously).
            Likewise, she doesn’t have to fast on Yom Kippur.

          • Dr Kitty

            Oh no, feeding HER wasn’t the problem, the hospital kitchen can manage Kosher. She was freaking out because she hadn’t had time to make the family meals for Friday night and Saturday yet, and had visions of her husband and the (many) kids eating bread and butter or cereal all weekend, because she had come to hospital just before doing her big weekly supermarket run.

            We made some calls for her and got neighbours to bring some acceptable food over for the kids.

            I have a feeling the main anxiety was about her husband’s ability to look after the kids on his own.

          • Trixie

            Gee, I would’ve loved to be able to eat nothing but Indian food during my hospital stays! Yum!

  • Trixie

    You guys, I just got a Facebook invite to go to a chiropractor’s office for a mother’s circle discussion of this month’s issue of this magazine (looks like it’s mostly behind a paywall). What do you think the conclusion will be at this meeting about whether ultrasounds cause autism? I just can’t anymore. http://icpa4kids.org

    • mydoppleganger

      Ahhh I’ve been told the only thing that stands between a VBAC and a csection is driving almost an hour (on the highway-YUCK) to get a chiropractor to adjust me every couple days. The highway freaks me out, and at this point going every couple days does not sound fun. I did get adjusted once but didn’t feel too different to keep up the motivation to go at this point, (Obviously laypeople have told me this, not doctors.) ;)

      • Trixie

        No chiropractor should ever claim to be able to treat anything other than moderate back pain, they should never, ever crack anyone’s neck due to risk of stroke, and they have absolutely no business even touching a pregnant woman or a child.
        The efficacy of the Webster technique was studied by a mail-in survey of chiropractors. Basically it asked them if they ever did the technique on anyone, and did the baby turn head down in the following weeks. Since most babies turn anyway, since the responding chiropractors have a financial motivation to claim it works, and since only the ones who thought it was effective even bothered returning the survey…it proves nothing.

        • Young CC Prof

          Many many things reported cause breech babies to turn. Many many things reportedly cure colds.

          Most colds go away, and most breech babies turn, no matter what anyone does. So, the true believers can find lots of anecdotal evidence.

          • Trixie

            Mine turned between 36-37 weeks. I admit I talked to her and told her to turn. It probably had no effect, but it did make me feel better.

          • Mishimoo

            Mine turned at 36 weeks after talking and laying on my side, hoping she’d flip. We are the Baby Whisperers!

        • mydoppleganger

          The chiro I went to charges about $100 out of pocket to the uninsured (I have insurance). Many homebirth women in the area see this chiro several times in the last weeks of pregnancy.(Sound like a fortune out of pocket!) Despite the most intimate chiro adjustment I’ve ever experienced, my neck and back cracked back to usual places within 45 mins of the adjustment. The chiro advised me to come back every couple days. but that’s just too much commitment for something that remains unproven. Baby was already head down, just not engaged. The chiro also advised me to take this baby in for adjustments right after birth. I won’t be doing that. I know it isn’t an “instant miracle” but I didn’t notice any decrease in pain level, I think it actually made it a little worse!:)

          • Trixie

            Yeah, run away.Cracking your neck can cause a stroke. Babies have been killed and disabled by chiropractors.

            Anything based in actual science that a chiropractor can do, a physical therapist can do better. Chiropractic is woo.

          • meglo91

            See, I disagree. I think it has its place, particularly in circumstances like mine where, like I said, I had a couple of old very bad injuries that had healed imperfectly and which got completely thrown off kilter by pregnancy. The combination of PT + chiro was even better, but I originally just went to the chiro and it helped tremendously. Also, the guy never touched my neck and never suggested I bring my babies in for chiropractic, an absurd practice.
            It’s just crap when all the NCB and homebirth crowd go to the chiro because they think it will help turn a breech baby or turn their babies from a posterior lie or otherwise just give them good vibes or something. That is all ridiculous.

        • meglo91

          I don’t think it’s true that a chiro should never touch a pregnant woman. I have some old back and hip traumas that resurrect themselves duringpregnancy, and for both of my pregnancies my chiro (non-woo as they get, contracted by the military) was able to keep me moving and functioning by weekly adjustments. Mostly he just kept me in alignment and alleviated a ton of back pain for me. I did not ever have any expectation that chiropractic was going to do anything for me vis a vis fetal positioning, however, and I think that women who go to chiros for that are wasting their time.

          • Trixie

            But wouldn’t physical therapy also have done that, without the risk? Also, being military doesn’t automatically mean it’s not woo. The federal government funds all kinds of CAM research in the military.

          • meglo91

            Actually I did both and found the two practices to be complimentary. The PT lady gave me exercises to do; the chiro helped me walk straight. And when I say he was non-woo, trust me — this guy was non-woo. We never talked about vaccines or natural healing or anything. His office was filled with posters of the musculo-skeletal system. He would ask me questions — what’s your pain level this week? Where is the pain? What kind of pain? Limited movement? And then he would give me a couple of extremely quick side-lying adjustments and I would walk out the parking lot a new woman. I don’t think there was anything particularly risky about any of it. I went from lying on the floor crying from back pain during my first pregnancy to moving about pretty normally.

  • almostfearless

    There’s also a weird cognitive dissonance… They don’t trust OBs to deliver babies — because it’s natural and normal — but their plan if something goes wrong is to rush to the OB to have him/her fix it. I won’t let you catch my baby, UNLESS the baby is in distress. I’m pretty sure OBs can catch healthy babies too.

    Also I find it strange that so many studies are focused on c-sections vs. vaginal births. That’s interesting, I guess, but what I’d like to see is: baby deaths, birth injuries, brain damage, PTSD… death is a terrible outcome but so is having a baby with permanent injuries – and that’s not even considered worth tracking? We’re hyper focused on the c-section, misleading women to believe the all outcomes are equal, the only main difference is if you get a c-section or not. It’s an implied lack of risk that is seen even when OBs are talking about (probably because in the hospital that’s true). ACOG says there is a 2-3x increase in neonatal death but doesn’t mention any of the other “near misses” and repairs they have to do to the 10% or so of HB transfers.

    • Amy M

      I think a lot of the brain damage stuff isn’t necessarily apparent right away. A baby that’s deprived of O2 might sustain some damage that doesn’t show up for years, leading everyone to believe that all’s well—baby recovers and behaves normally in the hospital, maybe MRI doesn’t show anything conclusive, and baby could meet normal milestones for a couple of years before deficits become obvious. Various learning disabilities aren’t generally diagnosed until the child is of school -age, for example.

      • Trixie

        At which point these people put their kids on a gluten free dairy free non-GMO paleo diet and blame it on the vaccines.

        • Lisa Murakami

          They sure do! And Amy M is exactly right. My father has seen it happen from a freestanding birthing center. As the pediatrician, he knows they’ll likely discover cognitive damage… years on down the line.

          • Amazed

            About thirty years ago, the conversation between my pediatrician and my parents went on like this:

            Pediatrician: Are you sure she’s using complex sentences?

            My mom: Well, yes.

            My dad (in his head). OMG, OMG, I knew it, I KNEW it. This nasty vacuum, and her head did look quite strange when they finally pulled her out. She’s behind developmentally, oh no.

            Pediatrician: At this age, most children only say words.

            My mom (beaming). Her great-grandfather was so proud that he was her first sentence.

            My dad (realization slowly dawning, in his head). Thank god, she isn’t damaged after all!

            Pediatrician (probably thinking): He does look quite lost. Those men, they never feel at home with us. Why do moms insist on bringing them along?

            Evil vacuum. If not for it, I might have become Queen of the World. Who knows how many brain cells did it lose me.

      • Trixie

        Think of all the indigo children home birth has created!

        • LibrarianSarah

          Ha! I see what you did there!

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

      The business of being born says “its good to have interventions…when they are needed.” so it just turns into a huge debate about when things are needed or not.

      • almostfearless

        It’s double-speak though — oh yes interventions are good when needed, but you can avoid them. Are they needed or avoidable? You know? I think that’s why women who get a c-section after a HB attempt feel like failures (or at least in my circle they did, including myself) because to believe Ina May it’s so very rare if women would just release their fear of birth.

        • EmbraceYourInnerCrone

          Ah yes , Ina May and the “Clap harder if you BELIEVE! and all will be well” theory of child birth. Yeah, No thanks. I think I will rely on modern medicine instead of “affirmations”

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

            It doesn’t even matter if she is right though. Dealing with fear is a skill, and like any other skill each person has a different level of mastery. Some people have anxiety that isn’t responsive to anything but drugs. It isn’t a character flaw, its just normal variation among humans.

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

            Interesting, how “normal variations” =/= “variation of normal”

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

          It isn’t double speak. Its needed when its needed, and not when its not, and putting forth such an argument means that people have to bring up specifics in order to discuss it. It is an amazingly effective tactic for derailing conversation. What they are ignoring is that you have to make these decisions without perfect information about the outcome- you can’t know it was needed until after something went horribly wrong. They make it seem like women who would rather accept the risk of an intervention over the risk of not having it are dupes.

          • The Bofa on the Sofa

            The goal of intervention is to prevent emergencies so you don’t have to resolve them.

    • areawomanpdx

      Exactly! The whole, “OBs don’t know how to deal with normal birth” is another (completely and utterly ridiculous) central tenent of the homebirth religion.

    • Lisa from NY

      Not to mention Erb’s palsy, a partial paralysis of the arm due to SD.

    • Young CC Prof

      I’ve said it before: Tracking c-section rates is just a bad idea, and we should probably stop doing it, or at least stop prominently publishing them. It’s like judging a diabetes clinic based off how many of their Type 2 patients are on insulin. Instead, a reasonable human being judges OUTCOMES.

      • Trixie

        I don’t agree that we should stop tracking or publishing the rates of anything, just because the rates are misused by NCB advocates. Why would we not want to have that information?

        • AlisonCummins

          Because it’s not useful.
          Some places have high rates because they are specialist centres and they get the referrals of complicated cases.
          Some have high rates because they are a teeny hospital far away from specialist care, so as soon as something looks like it might be difficult patients are offered a scheduled c-section or advised to move to the city where they can get more specialized care until the baby is born.
          Some have low rates because they have a policy of having low rates, which is all fine and dandy but what are their rates of perinatal death and permanent injury?

          • Trixie

            Are you really saying there is no circumstance under which the rate of c-sections performed is not meaningless? And that it should never be measured at all, in the context of other outcomes?

          • AlisonCummins

            The hospital will want to look at it. C-sections are expensive. If they can keep complication rates low and also reduce c-sections they probably want to. If their complication rates are high then they might want to see whether they are performing enough c-sections (among many other things). So it’s a useful metric for the hospital itself.
            What is not useful is comparing one hospital to another on the basis of its c-section rates. They may be serving different populations. When comparing one hospital to another you want to look at outcomes: which ones have the lowest rates of death and injury. That’s more helpful.

          • Trixie

            So hospitals should track it, but not release the data, because no one else needs to know? There’s a point at which more c-sections means more complications for women without saving more babies.

            If two hospitals have similar rates of death and injury, and serve similar populations, but one has a c-section rate that’s much higher, isn’t that relevant information?

          • Young CC Prof

            I guess “not tracking” isn’t really a solution, and keeping the data secret is dumb.

            Apparently the real solution is “get the general public to understand that c-section rates are a metric of limited usefulness, and there are better ways to judge the quality of maternity care.”

            Yup, that should be easy, right?

          • Trixie

            I’ll agree with that. My only point is that there is a point of vanishing returns in the c section rate of the whole population, and above which maternal death might start rising, and it’s worth trying to figure out when that is.

          • Elizabeth A

            Keep in mind that the point of diminishing returns for c-section is (a) entirely theoretical, (b) relevant to the population as a whole, but not to each individual hospital, and (c) unfixed.

            A hospital that contains the only Level III NICU in a 100-mile radius will do a lot of c-sections, compared to one half a block away that has only a well-baby nursery. As c-sections get safer (with improvements in anesthesia, anti-sepsis and surgical technique) the tipping point for the “right” number of c-sections changes, and as the population of childbearing women changes, that affects the threshhold also. Forty years ago, most women had children in their twenties. Today. women delay childbearing into their 30s and 40s.

            The important thing about c-sections is not that the rate be kept at a certain level, but that every patient who needs one is able to have one.

          • Trixie

            Yes, I agree with all of that. I was just taken aback by the assertion that the data shouldn’t even be recorded or published.

          • Mariana Baca

            I think it is a problem if the morbidity of the hospital exceeds that of a similar demographic with a different rate of c section, yes. Diminishing returns is one thing, active harm is another.

            I feel this is a stat like “rate of appendectomy” at a hospital if you exclude MRCS. It is abdominal surgery, you don’t want to perform it for no reason because abdominal surgery carries risk of infection as well as other abdominal problems, but if you need it or there is a risk you might need it, you don’t wait until the appendix bursts.

            It is more like — publish the stat, but publish it along with things like “rate of morbidity as a result of c-section”, “rate of morbidity from difficult vaginal birth”, “rate of instrumental vaginal delivery”. It is all a cost-benefit analysis, as to which interventions or lack thereof cause more or less harm.

          • Trixie

            Dr. Amy herself has speculated that the increasing c-section rate may have diminishing returns and may be a factor in increasing maternal mortality in some areas.

      • Amy M

        I agree with Trixie, that we shouldn’t stop tracking just because of misuse, but I like your T2D analogy.

        • Trixie

          Actually, wouldn’t it be a better outcome if more patients were managing their diets and exercise to the point that they didn’t need insulin, or only rarely? I’m pretty sure that is the desired outcome for long term Type 2 diabetes management. I know an RN who was a diabetes counselor, and she’s now diabetic herself, and she manages it completely through diet.

          • Amy M

            Well sure, but if they need insulin, they need insulin, you know? That may depend on when the patient gets to the clinic (in terms of severity of disease when they get there) and how well said patient sticks to the diet, neither of which would be the clinic’s “fault.”

          • Trixie

            True, but the quality of counseling and tools that people are given must have some measurable effect over time, right?

          • Fuzzy

            No. Some people are going to do what they do no matter what you say. Manage the disease while providing counseling to mitigate the risk factors, not wait for magic to happen and the person to give up soda.

          • AlisonCummins

            Clinic A tells all type II diabetics to lose weight, get more exercise and eat their vegetables. Their rate of type II diabetics on insulin is 0% … but their rate of type II diabetics dying of heart disease and kidney failure and going blind and getting things amputated is sky-high.

            Clinic B tells all type II diabetics to lose weight, get more exercise and eat their vegetables. If the patients’ blood sugar levels remain high, they either tell them again to shape up (if they didn’t the first time) or consider prescribing insulin (if they lost weight and exercised but it wasn’t enough). Their rate of type II diabetics on insulin is low … but their rate of type II diabetics dying of heart disease and kidney failure and going blind and getting things amputated is still pretty high.

            Clinic C tells all type II diabetics to lose weight, get more exercise and eat their vegetables. If the patient’ blood sugar is high enough they consider prescribing insulin. Their rate of type II diabetics on insulin is high but their patients have low rates of complications.

            To make things complicated: one or more of these clinics serve(s) areas with high populations of people genetically susceptible to type II diabetes — but I won’t tell you which one(s).

            If I were evaluating the clinics I might look at rates of complications and effectiveness of lifestyle interventions as measured by weight loss. Using “nobody on insulin” as a metric means that clinic A is the best one, but is that really where you want your mom to go?

          • Trixie

            No, of course not — a reduction in insulin use is one outcome among many. I’m not denying that there are other important factors. Just that the goal ultimately is to have both low rates of complications and reduced dependence on insulin through diet and exercise. If my mom were diabetic, she’d be highly compliant and probably would effectively manage it without insulin for the most part, with the right counseling

          • Mariana Baca

            Although it is a bit of a false comparison. Some patients can in fact manage their diabetes and stop depending on insulin and that is desirable.

            Some women can’t birth vaginally or can’t birth vaginally without significant morbidity, and there is no improvement the hospital can make to change that biological fact. A better hospital has a high enough rate of C/S to avoid those women from suffering and that is optimal, not unfortunate. So even if the hospital was dong everything 100% right and the women were in perfect health, there might still be a desirable rate of C/S.

          • AlisonCummins

            A reduction in insulin use can’t be a goal unless complication rates are low and stay low.

            If you have high complication rates, and insulin and complications are weighted equally, then the easiest way to improve your evaluations is to take everyone off insulin. Complications are high anyway, right? But that’s not necessarily in everyone’s best interest.

            The first outcome you’re looking for is low complication rates. If they are high the clinic can try to figure out why by looking at other measures like effectiveness of lifestyle interventions (as measured by weight loss, for instance) or whether everyone who should be getting insulin is getting it. Then they can make any changes that seem needed.

            If people are losing weight and exercising and have low complication rates, what is taking them off insulin going to do to improve care?

    • guest

      As an OB that’s something I’ve never understood–why does someone trust me to handle an emergency well but not to provide them appropriate care their entire pregnancy? I practice in an area with few homebirths (that I’m aware of) but lots of limited or no prenatal care. Everyone just walks in assuming everything will be ok but knowing nothing about the person who will be delivering their child. I’ve heard women state that if their baby is breech they’ll just refuse the C-section. Well, that’s an option but I’m relatively recently trained which means I’ve never done a breech term singleton delivery–want your baby to be my first? If a homebirth transfers in you get whoever is up next for “walk-ins”. That may be the family practicers in town (some of whom attend less than 10 deliveries/yr), me or my partners with our 10% primary C-section rate and 250 deliveries/yr/MD, or the other group in town with their 30-40% C-section rate. As a transfer you have no choices, limited autonomy, and know nothing about your new provider. That has got to be less empowering than routine prenatal care and delivery in a hospital with a provider or group one has had the opportunity to establish a good relationship with.

      • Amy Tuteur, MD
      • Young CC Prof

        Aaand, that’s the other reason vaginal breech doesn’t work any more. 25 years ago, with doctors who knew the tricks to get stuck heads unstuck, we established that c-sections are safer. Now, imagine how much worse it would be now that breech management skills have been lost. Only the oldest doctors know them, and they’re rusty.

        • almostfearless

          It isn’t just a lost art, but c-sections have become safer over time. So 40 years ago a breech delivery made sense risk-wise over a c-section. OBs would still do them if they were safer than c-sections. Unlike midwives, OBs change their approach over time to do whatever is safest. I think the HB community acts like it’s some kind of preference on the OB’s part.

          • Young CC Prof

            Indeed. When my mother was born, (1952) the risk to the mother of a c-section was clearly bigger than the risk of pushing out a frank breech baby. Some babies died from their breech births, but skilled OBs managed to save a lot of them.

            When I was born, (1980) the relative risks of vaginal breech versus c-section were probably pretty similar. Now, thanks to general advances in safe surgery and spinal anesthesia, the scale is clearly tilted the other way.

          • fiftyfifty1

            The young woman who babysits my children is the second of 6 children of her mother. But the first (the only other girl) died at birth due to complications of her breech presentation. So sad. The whole family still mourns her. Even with the most skilled attendant, some breech babies will die if born vaginally. Breech is not a variation of normal :-(

      • fiftyfifty1

        “me or my partners with our 10% primary C-section rate and 250 deliveries/yr/MD, or the other group in town with their 30-40% C-section rate. ”

        Are you saying that the other group in town has a 30-40% primary C-section rate? Because if not, it’s really not fair to compare a primary c-section rate with a overall c-section rate. It’s a way of lying with statistics and it’s a favorite technique of NCB advocates.

        • guest

          Yes. Their primary rate is approximately 25-30% (lots of 39 week unfavorable cervix inductions). Overall is closer to 40%.

          • fiftyfifty1

            Ok, so the other group in your town has a 25-30% primary c-section rate because they are willing to do elective inductions at 39 weeks even if the cervix is not favorable. Your group reportedly has a 10% primary rate, presumably by not offering this option. But what has this got to do with the case you mentioned of the woman walking in without a designated provider? She’s not asking for an induction or a scheduled maternal request c-section, she’s already in labor.

          • Elizabeth A

            I gotta say, I felt pretty empowered by the emergency care I got from the doc who was next up to take walk-ins. Weirdly, it was actually useful that we were starting our relationship up from scratch. There was no tactful discussion of what I wanted and what he preferred. It was more like “Hi, I’m bleeding,” “Dang, you should have a section.” “When?” “Now.” “Oh… kay. Yeah.”

            (There was some groundwork laid in that I had been a patient at a related hospital, my records were available, the EMTs called ahead. But we hadn’t been seeing each other once a month or anything.)

      • fiftyfifty1

        “As an OB that’s something I’ve never understood–why does someone trust me to handle an emergency well but not to provide them appropriate care their entire pregnancy?”

        Because maybe they have heard the reports that your chance of getting a c-section is up to 3 times higher if you go with one OB group in a town rather than another (and the OBs have never taken the time to explain why that is, or actually might not even be reporting their numbers correctly).

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

    I had to research midwifery ethics statements for my lawsuit. Damn near every one had something about accepting death as a natural outcome of childbirth. I think normal people would shit a brick if they heard lay midwives talking about deaths.

    • LynnetteHafkenIBCLC

      Wow, can you post some of those statements and who said them?

  • http://Www.awaitingjuno.blogspot.com/ Mrs. W

    You’re forgetting the redefining of risk and negative outcome – the use of intervention in hospital is redefined as a risk and as a negative outcome. Look at homebirth studies and how they treat the use of the epidural or a cesarean, it is on par with things that are truly negative like a post-partum hemorrhage. So not only do they deviancy down what occurs at home, they deviancy up what happens in hospital.