True to form, the Midwives Alliance of North America continues its deceptions about the risk of death at homebirth.
For the past 5 years, I have been relentlessly publicizing the fact that the Midwives Alliance of North America (MANA) has refused to release their own death rates. It doesn’t take a rocket scientist to realize that the death rates must be hideous, AND recognized as hideous by MANA executives.
After 5 years, and mounting pressure, MANA finally decided how to spin their hideous death rate: pretend that the hideous death rates aren’t hideous!
Isn’t that clever?
They are hoping that journalists will print their bogus conclusion, instead of the actual numbers.
The papers themselves are due to be released later today (at which point I will analyze them in depth), but the press releases include some of the numbers so we can take a look at them now.
According to Citizens for Midwifery:
The overall death rate from labor through six weeks was 2.06 per 1000 when higher risk women (i.e., those with breech babies or twins, those attempting VBAC, or those with preeclampsia or gestational diabetes) are included in the sample, and 1.61 per 1000 when only low risk women are included. This rate is consistent with some published reports of both hospital and home birth outcomes, but is slightly higher than others.
No, it isn’t “slightly” higher. It is MASSIVELY higher.
According to the CDC Wonder database, the neonatal death rate for low risk white women at term from the years 2004-2009 is 0.38/1000. As Judith Rooks, CNM MPH noted in her review of Oregon homebirths, intrapartum death among low risk babies is essentially non-existent in the hospital, so the neonatal + intrapartum death rate for the hospital is still 0.38
As the chart above demonstrates, the MANA death rate for the same years was 5.5X HIGHER. In other words, the MANA death rate was 450% higher than the hospital death rate.
On what planet is a death rate 450% higher than expected a safe outcome? Not on this planet.
MANA and homebirth midwives have been lobbying extensively for a scope of practice that includes breech, twins, VBAC, etc. Now they want to exclude those same births from their statistics. Even then, the MANA death rate is 4.2X higher than hospital birth. So even when homebirth midwives stick to low risk patients, homebirth has a death rate 320% higher than comparable risk hospital birth.
That’s hardly a safe outcome, either.
The results for various risk factors are even more appalling.
Of 222 babies presenting in breech position, 5 died either during labor or the neonatal period.
So the homebirth death rate for breech was 20/1000 compared to approximately 0.8/1000 in the hospital. That’s a breech death rate 25X higher (2400%) than the hospital.
To summarize, the MANA statistics show that homebirth as practiced in the US has a death rate 450% higher than hospital birth.
No wonder MANA has been hiding these numbers for years.
Why did MANA wait 5 years to publish its statistics?
The many deceptions, large and small, in the new MANA statistics paper.
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Uh, all my kids were born at home with an APGAR of 10. Birth is tricky, I think it is a bit rich that Amy whatsherface is cranking off about home birth when every child born in a hospital is totally immeadiately abused with a Hep B vaccine on the day of birth. In the UK if you are unlucky enough to believe the racist slant that Asian people have more TB they inject your baby on the day of birth with a bloody BCG vaccine, that is the one that in real placebo trials over 20 years showed more TB in the vaccined group! Maybe the Asian community should add this up, accusations of higher TB and all given a vaccine known to cause TB!
Erm, no they don’t. You can’t get the TB vaccine until later on, unfortunately. Also, you confuse race with residence. Certainly when mine were babies, ie recently, if you were an Asian living in an area where it’s not routinely offered and had no intention of going to or having a visitor from a country (Asian or otherwise) with high rates, you weren’t always able to get it. If you were white and living in an area where it was, you could. Ask me how I know.
Of course, people who wanted it would lie and say they were going to or having a visitor from x country in a couple of months even if they weren’t. My friend did this. The health visitors totally knew what was going on but they administered it anyway.
Bwahahahahahahah! All your kids were born at home with an APGAR of 10. Thank you for this precious bit of information. You’re revealing yourself as the gullible homebirth meat of this study
https://www.ncbi.nlm.nih.gov/pubmed/24756040
IOW, your “midwives” lied to you and you were so eager to be a homebirth goddess mom that you fell straight for it, oh educated one.
I luuuuurrrrrrve that article. It warms the cockles of my cold obstetrical heart.
You know, you can refuse the BCG?
It’s not race, it’s about likely exposure to TB.
If you go to TB endemic countries three times a year, or you have people from TB endemic countries who have never been vaccinated living under your roof your child is more likely to contract TB than if you go to Blackpool for your holidays and the furthest anyone living under your roof has been is Glasgow.TB is spread by prolonged close contact- you really need to share living quarters.
TB is still endemic in most of Asia and Africa…oddly not in Europe… and oddly only since the development of BCG vaccination….you don’t think there might be any correlation?
My mother was born and raised in Zimbabwe and my Zimbabwean maternal grandmother lived with us for my entire childhood and both my grabdmother’s parents died of TB.
My grandmother had X-ray proven evidence of old TB.
My children were offered BCG on the basis that they have a grandparent born in a high incidence country, who had a household contact with TB.
The fact that my mother, like me, is a doctor and we both had occupational health willing to certify we don’t have latent TB, and I had no plans to take them to Zimbabwe as children was enough for me to decline BCG for them both.
It was not a fraught or difficult conversation- they said “would you like BCG” and I said “no thanks, it makes diagnosis of latent TB more challenging and I don’t think they’ll be at any increased risk for the foreseeable”.
My mother and grandmother are white, FTR.
You’re an idiot.
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siiiiiiiiiigh
So there’s only 1-2 people more per thousand that die at home than at the hospital. I guess percentage wise 450% looks pretty huge but…ultimately the difference is 1-2 people…and 1,998 can deliver without the entire hospital procedure? I think that’s pretty incredible…
If 1-2 children per thousand died of vaccinations would you say they were safe?
Well they might as well be dead, look at the vaccine fall out.
what vaccine fallout?
It’s like the fallout from chernobyl, only less visible. /s
So much less visible, that it has never even been observed or measured yet. But it’s still there.
snigger
Please, if you have credible information to share, do so.
if I showed you a room, and told you that if you turn on the light switch, you have a 1-2 chance in 1000 of being electrocuted to death, would you turn on the light?
and that would be 998 can deliver without the hospital, not 1998, for those of us who can math.
There are almost 4 000 000 babies born each year in the USA. 1 additional death per 1000 birth is 4000 PREVENTABLE death per year.
Still think it isn’t much?
So why is US infant mortality rate around 31! that does not reflect your medical mythical memotrope fallacy about hospitals being a great place, nor doctor care
Because the US sucks at healthcare. Infant mortality is much lower in Canada, despite or medical practices and population being pretty close.
Sooo … that roller coaster that kills 1 person per 1000 riders … are you willing to ride it? I am not.
The risk of dying in an 8 mile drunk drive is about 1/500 000. Yeah, that “10 times riskier than sober driving” sounds like a lot, but ultimately almost a million can drive drunk without anyone dying.
Homebirth midwives seem to think these 1 – 2 people you dismiss so casually are very important, else they would not have rushed to hide them.
At the end, it isn’t about what you (1-2 people, replaceable, I suppose) or I (OMG, 1-2 people, the horrorz!) think about this tiny/huge number. It is about the simple fact that the number should have been there for us to see and form conclusions about.
You seem OK with being lied to. I am not.
Just check out the infant mortality in the US and compare it worldwide, it is about 31 on the scale. No evidence there at all that hospital doctor care is safe! especially the vaccine issue
Wrong stats. Infant mortality is a reflection of pediatric care and it includes every child 346 days old who died in a car crash or just bumped their head. It doesn’t include children who were stillborn because their care provider (who just happens to be an uneducated midwife most often than not, percentage-wise) fucked up. The right measure regarding birth is perinatal mortality.
Since you don’t know such a basic thing, perhaps you should give the idea that you don’t know many things some consideration. Then again, being an anti-vaxxer, you probably already think you know it all.
Considering the US infant mortality rate is so high nationally ie worse than some 3rd world countries, and most babies are medicalised I can’t see why Amy titfuc is trying to create a swerve here.
The problem is not with medicalisation of childcare. It’s with the US healthcare system.
All other first world country have lower infant mortality rate with the same (or even higher) rates of medical intervention.
What the US needs is universal health care.
I’m going to assume you made a typographical error, because certainly you wouldn’t want to undermine your “credibility” by resorting to name-calling.
I don’t know, I believe her use of misspelled profanity has really turned me around on this issue. I mean really, what are 1 or 2 dead babies who didn’t have to die, compared to the ultimate crunchiest of crunchy toilet-water home birth of your dreams? (But I hear they have little fish nets for scooping the feces out of the tub, so it’s all good.) Hell, your midwife might even lie and tell you “the apgar is 10!!” while frantically rubbing your limp infant, or “you didn’t tear, no need for stitches, it’s normal to pee when you cough for the next 50 years!”, or “That amount of blood is totally normal!”
Signed,
Feeling Saucy AF
You … you do realize the reason our infant mortality is so high is lack of medical care, right?
I think that hospital needs to stop controling the mothers body. Yes human moms need help giving birth. However there’s a differences between helping and controling. How are they controling the mother’s body? Well first they’re telling her when to push before her body is ready,or put her body on hold when it is ready. They have her lay on her back(which is the wrost birthing position) and so on. Look I’m not pro natural birth, but the hospitial give to let moms some freedom and stop telling them when and when not to push. Our bodys know when and when not to push. I also forgot to mention that pushing too hard can cause some serious damage towards the mother.
What OB would work somewhere where they would be unable to do an emergency C-section?
Excuse me? Maybe I accidently click the thumbs up button and didn’t notice it until now. And so what if I thumbs-up my own post ? It’s a free country. Now deal with it or don’t.
Also why do you care about if someone up thumbs their own post? That’s really pathetic of you.
Is there a bot out there somewhere, that runs a cycle dropping comments like these on Dr Amy’s blog? They’re so similar in tone and they say the exact same thing over and over. Like this one has the twist of being anti-homebirth, but the NCB “hospitals are bad” sentiment is still here.
Yes I am a robot 😀
In order to assess the relative safety of home versus hospital birth you should read peer- reviewed studies from across the globe, not just the US. Studies undertaken in, for example, the U.K. and Netherlands all come up with similar findings, that home birth is safest for both mother and child in low risk pregnancies.
I have to ask, have you actually read the studies you think claim this? Or are you basing it on what you have heard?
Can you please provide references to the studies that you think support your claim? The Netherlands one, especially…
(also, you might want to look up Pablo’s First Law of Internet Discussion, because you are stepping into it deep)
Studies undertaken in, for example, the U.K. and Netherlands all come up
with similar findings, that home birth is safest for both mother and
child in low risk pregnancies
Well, no, they don’t. As has been noted on other posts on this blog, low risk women in the Netherlands attended by a midwife have higher perinatal mortality than high risk women attended by OBs. One paper in Britain claims that for a select group of very low risk women who have had at least one successful vaginal delivery home birth is no more dangerous than hospital birth. That’s a far cry from home birth being safer.
I second Bofa’s request that you provide any references you believe to support your argument so that they can be evaluated here. I am willing to bet that they do not support your position nearly as well as you believe.
Finally, if you are advising a woman in the US re home birth, the most appropriate studies to reference for her are studies conducted in the US. It doesn’t matter how safe home birth is in the UK if you’re giving birth in the US. (The converse is, of course, also true.)
Home birth in the UK and the Netherlands is practiced by university trained midwives who are required to be educated a certain way (no PEP process or distance learning) and licensed. Until recently, home birth midwives in the US weren’t even required to have a high school diploma. Whatever the studies show for other countries, they show that home birth is not safest as undertaken with the available attendants in the US.
In the US I can buy a gun anywhere, Chicago has higher mortality on the street than the middle east!
Damn, Rebecca was hit and run.
Come back, Rebecca!!!!!
So…these statistics cover fatalities of the infant. Are there statistics for fatalities of the mother?
So she is comparing the all around death rate of home birth to a very specific death rate in hospital. Deliberate misrepresentation of the facts.
Flat out lies.
One quick google search will show that the neonatal death rate in the United States is 6.37, NOT 0.38, making the hospital death rate 320% HIGHER than the home birth rate you cited.
Nice try.
“According to the CDC Wonder database, the neonatal death rate for low risk white women at term from the years 2004-2009 is 0.38/1000.”
You are giving the neonatal death rate across all risk groups. Dr Tuteur clearly states that 0.38 is the death rate in low risk white women.
Children, this is why we don’t rely on Google to make us “educated”.
And the classic, referring to those you disagree with as children to degrade and demean them. Good job.
even for me, an english non-native, your inability to understand written word is amazing
just fyi – she is not referring to you, but to imaginary children as a form of educational remark for them. the pun is hidden in the fact, that a lot of discussions about education today revolve around the topics of memorizing facts vs. gathering and processing information (eg. googling)
you’re welcome
(and yes, this was condescending – unfortunately i cannot stand people like you, who in turn find me annoying and arrogant, which is ok by me)
So she is comparing the all around death rate of home birth to a very specific death rate in hospital. Deliberate misrepresentation of statistics.
Again quoting from the article,
“According to Citizens for Midwifery:
The overall death rate from labor through six weeks was 2.06 per 1000 when higher risk women (i.e., those with breech babies or twins, those attempting VBAC, or those with preeclampsia or gestational diabetes) are included in the sample, and 1.61 per 1000 when only low risk women are included. This rate is consistent with some published reports of both hospital and home birth outcomes, but is slightly higher than others.”
So as you can see, Dr Tuteur does give the death rate for low risk births at home. And it is significantly higher than the low risk death rate in hospital. You can argue about the exclusion of non white women, but it seems that home births in America are far more common amongst white women, so it’s probably a valid exclusion.
Now, an example of deliberate misrepresentation of statistics would be to compare total death rate in hospital across all risk groups with the death rate in home birth when their baseline characteristics should make them lower risk, as you did in your original post.
So the only accurate comparison is the overall rate in hospitals to the overall rate in home births.
6.37 in hospitals to 2.06 at home.
Well, most neonates that die in hospitals die because of prematurity and/or malformations, two conditions that should not be having a homebirth. Source: http://www.ncbi.nlm.nih.gov/m/pubmed/20361522/.
My son was born at 28 weeks of gestation. He had a 10% chance of dying. Had I been able to carry him to term the risk was lower than 1 in 1000.
If you compare two rates you should be comparing two similar things that only have one difference, in this case place of birth. You can compare the neonatal death rate of VBAC in hospital and at home, for example, but the total neonatal death rate in a hospital, a place that looks after very complicated pregnancies, very premature babies, very sick babies with homebirth that should be only dealing with low risk pregnancies in low risk women with low risk babies is simply like comparing my lips with Miss Johansen’s… Another world.
Hospitals also deal with homebirth transfers, and presumably those deaths get put on the hospital’s figures, despite the homebirth having gone so wrong that a transfer was required.
I know, and you know I know.
She is still comparing two different statistics. The mortality rates would have to be examined more closely and control for differences such as these, in order to accurately compare the two.
Far far closer than the statistics you’re trying to compare.
She has done that.
Judith Rooks, a CNM has done that.
Prof. Grunebaum has done that.
Even I have done that. I did run the numbers on the CDC database.
And all of them have found that the neonatal death rate is far higher with homebirths than with comparable low risk pregnancies in the hospital.
She is comparing specifically low risk white women to the overall rate of home birthing women. That is not a controlled comparison.
Check Squillo, just a few comments down. Or do it yourself. The numbers are public.
Again, if you actually read the article, you will see that she does give the home birth neonatal death rate for low risk women. And it’s four times the death rate for a comparable group of women in the hospital.
Dr Amy was being waaay too generous by providing a low-risk/low risk comparison. The midwives claim that ALL women they care for are low-risk. That’s their siren song – we only take low-risk women! And what do they DO with them? What Dr Amy says.
Guys c’mon, this lady probably just watched “Business of Being Born” and read an Ina May book….
No, that’s actually the opposite of what I was saying. A far higher proportion of women who give birth in hospital are high risk compared to those who give birth at home. So it makes no sense whatsoever to try and compare the two groups as you are attempting to, since you have no way of knowing whether the difference in death rate is due to the place of birth or due to the underlying conditions which make the women in question high risk. You need to compare groups with similar risk profiles, which is what Dr Tuteur had done.
OMG..,you really are stupid aren’t you? Do you know what that rate you keep bringing up includes? SIDS! ACCIDENTS!
And congenital defects.
The correct stats to compare are low risk births in the hospital and home birth. And those are the numbers used.
Since most babies born at home do not have congenital defects, since most are discovered during pregnancy and then delivered in the hospital, you must not include congenital defects. And you don’t include those in the home birth starts either. Jesus. This isn’t complicated. Stop twisting the numbers to suit your worldview.
I can’t even find a document (let alone a credible one) that has cites a neonatal death rate in the US of 6.37. Care to share your citation?
6/1000 is about the infant mortality rate in the US. Methinks Kimberly Anne Pennington doesn’t know the right statistic to look at.
And what makes you say that? 6 compared to 6.37, you’re practically in complete agreement with my statement.
Infant mortality are the deaths during the first year of life. Neonatal mortality are the deaths in the first 28 days of life, a much better indicator of birth care. I learnt that during my fourth year in medical school, but apparently not everybody can be bothered…
Can’t be bothered to go to medical school?
Did you attend it? I did. It took me six years, I learnt that interesting bit about the difference in infant and neonatal mortality that I have just shared during the fourth.
You do not seem to know the difference a between infant and neonatal mortality, something that I find strange in people that attend medical school.
Well four years is a long time to take to learn one little figure 😉
Though you probably picked up some excellent education and training along the way.
Still took you four years of medical school to learn 😉
Yes, it took me four years, I learnt quite a lot of other things in the first three and a lot more on the last two.
So why are you being condescending to me for not knowing something you only learned after 4 years of medical education?
Because you are trying to tell me how to compare those numbers. You have been condescending. I am just stating when I learnt that, that it was difficult, it took a lot of effort and you are making a very simple assumption and trying to pass that for knowledge.
I was not condescending to you, dear.
Do we actually know each other? Enough for you to call me dear????
Apparently well enough for you to insinuate I “can’t be bothered”. If you want to argue your points, fine, but there is no need to attack my character.
if you’re not educated enough to understand the issues being discussed, then why did you feel the need to declare that the article was full of lies?
Educated enough to understand the issues is different than educated enough to know the difference between those two terms. She is comparing two inequivalent statistics.
From the looks of it, as cliche as this sounds as a rebuttal, no, that would be you.
I did at first, and it was brought to my attention that neonatal and infant mortality rates are different. The neonatal rates are still 4/1000 in the United States. She is comparing low risk white women in hospitals to all home birthing women.
Since you adamantly refuse to read, I’m going to do it for you:
1.61 ÷ 0.38 rounds off to 4.24.
See, that is pretty important. You are the one doing the wrong comparison, and we have tried to explain as simple as possible why. I have to admit that at some point statistics can get pretty specific and a little bit difficult to simplify.
I will try by explaining something about science. When you perform an experiment, say you want to compare the temperature at which water boils when it has a lot of Salt in it and when it has not Salt at all, for example, you should only change one condition. In this case, the saltiness in the water. If you boil the salty water at sea level and the distilled water at the Everest peak you do not know if the difference in temperatures is due to the Salt or to the altitude. Same happens with populations: when you are comparing rates the populations should he as similar as possible, so if the women that give birth at home are mostly white, low risk, full term, you should not compare them to black, high risk, premature mothers. As almost all of the USA premature babies (first cause of neonatal death) are born at a hospital since they are high risk, you should take them out of the Comparison because they are not being born at home. And this is exactly what Dr. Tuteur has done.
Irrelevant and argumentative, so very much from the NCB playbook.
Argumentative? And being condescending to me is not? No, I have never attended medical school, so it’s reasonable that I would be ignorant of the difference between the two.
Well, YOU started criticizing the piece first. You are the one having to show that your critique is good.
So I made an error, I am not denying that.
So then you’re going to rethink all of your ideas about home birth right? Stands to reason if you were flat out wrong about this, you are likely wrong about other things.
I agree, it is very reasonable that uneducated women are the first ones to let their ignorant flag fly on a pregnancy/birth forum, and with great conviction too.
God, they are slow
Replying to a two year old comment is pretty fast, eh?
If you had been slightly less ‘quick’ with your google search, you’d have discovered what ‘infant mortality’ is, and what it isn’t.
Yeah, apparently vaccines are completely safe and flu vaccines work too! Nice swerve
So educate us, Hansa. What is infant mortality, as a statistic? What does it and does it not capture?
Perhaps a formal education is in order, you seem to lack the capability to perform even basic research and analysis.
So you took deaths in the hospital among “white women” and compared them to all women who had a homebirth to get statistics that make a hospital seem safer? I think that is very scientific of you!
Planned homebirthers are overwhelmingly white, so it seems like the right comparison group to me. Can you suggest a better comparison group?
I ran the numbers for 2005-2009 (MANAStats included November 2004 – December 2009) without excluding any race. Here are the parameters I used to try to match as closely as possible the MANAStats:
In-hospital
Attended by MD/DO/CNM
Gestation 37 weeks and up (it’s hard to make this correspond, as MANAStats didn’t give gestation lengths, but only 2.5% of their mothers “showed clinical signs” of preterm birth)
Singleton and twins (MANAStats didn’t include any higher order multiples)
Vaginal and c/s
Death from <1 hour to 28 days of life
I got an in-hospital neonatal morality rate of 0.84
Excluding deaths from congenital anomalies, as MANA did for no particular reason, the rate falls to 0.40
Excluding deaths from congenital anomalies, "special causes" (terrorism), and external causes (vehicle accidents, poisonings), which I suspect were not part of the MANAStats data either, it falls to 0.37
I did not exclude non-white women, although the MANAStats data overwhelmingly contained white mothers, so "my" data is probably somewhat skewed against hospital birth.
So?
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My mum struggled to give birth to me and she had two experienced midwives helping her. Lucky she was in a hospital because they had to call a doctor who took charge and helped with the delivery.
I recommend you all watch The business of being born…just saying
Some of us able to read and interpret studies. All of us can read papers, as well as historical accounts from the era before evil doctors you decry stepped in. We don’t need anyone to patronize us by visualizing it for us to make it easy because they’re scared it won’t get unto our tiny little brains otherwise, thank you.
The fact is, should something go wrong, it’ll be you running to the doctors crying for them to save you and your baby. It won’t be us running to the midwives.
This fact says enough. Keep indulging in your firsrt world privilege, safe with the knowledge that should the shit hit the fan, the people you insult with such passions will be there to save you, so you can complain about interventions later.
It was because of that ludicrous documentary that I was forced to watch in college that I was actually brainwashed into thinking home births were superior. If you refuse to use your own brain, don’t you dare tell someone else to engage in your brainwashing.
That junk “documentary” is old news around here. We all know its full of crap.
LMFAO!!!!! Should we read an Ina May book while we’re at it too!?
Not to mention that my child was poked so much just to get blood , they kept me 24 he’s longer just cause the forgot about me, of course hospital stats are going to be lower they just cut women open an take the baby out… How hard is that? Women were BUILT to give birth, OBGYNs are glorified surgeons, oh a BTW what about leaving sponges inside women , and all kinds if issues that come with surgery, and the fact that a hospital is full of germs and sick people , where as at home its the same environment moms been in the whole pregnancy … Hospitals smeared midwives when they first started cutting babies out , and they continue to do it , I wouldn’t be surprised if they lied about the stats
You people all really memorize the same script… or cult scriptures, perhaps. If you only knew what robots you sounded like. Crazy robots, to be sure. But robots.
Built by whom?
Edit: Didn’t realize this article was this old, sorry for the gravedig.
“Women were BUILT to give birth”
Sorry, you’re wrong. Women were built to run. I know that for a fact, because I’m a woman and found it very easy to do. Any women that struggle with it aren’t doing it right, poor dears. Hey, if we weren’t all good at running, how would we ever survive as a species?
“of course hospital stats are going to be lower they just cut women open an take the baby out”
That’s kind of the point, isn’t it. Hospitals lower the death rate of babies by recommending and performing interventions, including C-sections when medically indicated, rather than just letting babies die.
Wow I’d say that’s a load of bullshit since a midwife goes to university for 4-8 years in order to become a midwife… How long do drs go to school… And how many residents actually have seen it delivered a baby …. 0 that’s right 0 … When the hospital makes $20,000 on each birth and midwives cost $3000 I’d say the hospital will lie about there stats any day! Do your research people !!
American CPMs require only a high school diploma, and sometimes not even that, along with an unregulated course of study.
OB residents are required to have clinical L&D experience, they may attend more vaginal deliveries during their residency than a CPM will deliver in an entire career.
And flip flops are cheaper than work boots; doesn’t mean that flip flops are a better choice for protecting your feet. CPMs are cheap: no malpractice insurance, no advanced equipment, no advanced education, no use if anything goes wrong.
They use a lot of the same equipment that OBGYNs use and not only that but most reputable midwives are fine with working either with a hospital or have an OBGYN on cal if any complications arise, just because there are some shitty midwives doesn’t mean they all are , just like one shitty Dr doesn’t make them all shitty … But I know they push for women to come in and out quick , they give them a time limit to give birth and if you don’t fall in that time line you get a shit ton of meds and then complications next thing you know your havingna csection… Dr makes money on that too BTW! Its much easier and quicker for an OBGYN to do a csection rather than wait for a mother to deliver naturally….. Women have been told they can’t do it on there own , they are starting to believe it…. Oh an BTW laying on your back with your legs up makes your pelvis narrower, best way to give birth is crouching up right…. But no doctors rather have a higher chance of complications.. Its sickening how they treat it like a business
“They use a lot of the same equipment that OBGYNs use”
Yes, they do – illegally. Since you gave us such a friendly suggestion to watch BOBB, may I return the favour and suggest you google “honest midwife blog” to get acquainted with who CPMs, how they are educated and trained and how they practice.
For the illegal bits type the word *fruit* in the search on that blog, and check out her latest post on cytotec tea: http://www.honestmidwife.com/cytotec-tea/
I like how you brag that midwives illegally use medical-grade apparatus. And then disparage the very people who are qualified and legally entitled to use the same apparatus. It’s amazing. How do you not break your neck jerking it around like that?
Good luck with those ob-gyns on call when a mother is bleeding out on a tarp in her living room, or when an unmonitored baby suffocates in utero. Ambulances don’t carry blood, and doctors can’t resurrect the dead.
This is stupid- laughable actually!
My baby was monitored, I have record of it and I was there in fact (as it was my labor) when my CNM used her doppler to monitor my children’s heartbeats.
She also had oxygen on standby and she carried pitocin in the event of a hemorrhage. (And none of this equipment is illegal in my state mind you).
How-praytell, can a baby that does not breathe on it’s own suffocate in utero?
Babies suffocate in utero if the placenta stops working or the umbilical cord is obstructed. These are well-known pregnancy complications, and the process of labor and delivery is extremely hard on the placenta and occasionally the cord.
It seems PrimaryCareDoc (meaning you don’t deliver babies anyway, right?)
There is no clear cut answer- a) babies cannot just suffocate because they are supplied O2 and b) who said these are “un monitored”. You do not need to be hooked up to a beeping machine to be monitored.
Not everything is electronics and printouts.
Young CC Prof:
And where are your research findings on this?
The umbilical cord rarely gets “obstructed” to the point of not working (it is not a water hose) as it is designed to withstand knots and kinks because of the shape of it, the coil and the Wharton’s Jelly around it. (The cord around the neck sounds more like a “see, don’t sue us for this c-section that you did not need because-aha! your baby was suffocating and it had nothing to do with the pitocin and epidural we gave you…so there”)
My first was born with a Nuchal Cord.
Are you speaking of a natural labor, or one augmented by pitocin, which causes unnatural and unusually forceful contractions that -yes- can be hard on the placenta because they are abnormal contractions?
Or are you talking about a 42 week mother, if that is the case, there is some probability to a lower functioning placenta, but they do not just “cease to work” in most cases.
Of course, there can always be issues and unforeseen problems, you can’t assume that 100% of women will need intervention because you are trained to look for issues.
http://www.skepticalob.com/2015/08/lets-review-trust-umbilical-cords.html
Ever taken care of a baby with a true knot? I have. I’ve attended hundreds of deliveries. What is your experience level and educational background. I’m guessing not too high given your “trust umbilical cords” rhetoric…
If you don’t know the answer to this question, don’t waste our time here.
Squatting position increases the rates of tearing – there was a large study ?Scandinavian, I think, that was reviewed here. Lying on your back with your legs up is one way to help resolve shoulder dystocia (McRoberts), and I’ve seen a paper that showed uterine contractility was better in that position. So it’s not as cut and dried as you are trying to suggest.
It sounds like you’ve had a bad time in the hospital before – I’m sorry to hear that. Unfortunately the solution is not a knee-jerk rejection of all things medical, because that means going back to the bad old days when everyone knew someone who had died in childbirth, and babies weren’t just expected to survive like they are now.
A lot of outraged commenters turn up here and insist if we just watched BOBB we would see the light. It probably seems really attractive – all nice and natural and empowering – but there are a lot of misrepresentations and logical fallacies that fly in the face of the research involving thousands of women and their babies’ births. More women and babies die when they are out of reach of emergency medical care. At least 2-5x as many babies, even. There are some pretty good takedowns of BOBB out there, and I would suggest taking a look if you are brave enough to have your mindset questioned.
Doula Dani has a great blog on BOBB:
http://whatifsandfears.blogspot.hu/2012/12/the-business-of-being-misled.html
Someone’s been watching the “Business of Being Born” again
I think it’s sickening that you’re saying doctors are out to hurt people and make money while doing so. And what about the hippocratic oath? And what about if you need emergency medical help? You’d better not call a doctor, then you’ll be a hypocrite!
ha ha ha ha ha! ok, I’ll bite. even if I take the numbers you provide at face value… ok, so say a midwife “goes to university” for 4-8 years to become a midwife. a doctor “goes to university” for not a random range between 4 and 8 years, but *a full 8 years* just to get the degree. and then a minimum of 3 years more of residency, and usually 4 for OB-gyn… so taking your numbers at face value, OB-gyns have at minimum 4 years more education than your midwife that “goes to university for 4-8 years”. 🙂
and dear jenifer, to ask “how many residents have seen it delivered a baby?” really makes you sound ignorant. clearly, you haven’t gone through residency to know, because I can tell you this — as a medical student I assisted in low-risk deliveries (part of a requirement of medical school, on our OB-gyn rotation) and as a pediatrics resident– yep, that’s right, a pediatrics resident! not even an OB-gyn resident! I’ve attended countless more births, both high-risk and low-risk. I can only imagine how many more countless births an OB-gyn resident attends. 😉
I agree that your stats, while correct, are misleading. When you’r dealing with such low numbers ANY increase is going to appear “massive” when taken out of context. If I pay one person $1 to paint a window and another person $2 to paint a window, I’m paying one 2x more (100% more) than the other…. but I’m still paying both of them less than minimum wage, you know?
Of course, the risk is still low. But I would never ever have taken it. The issue is that homebirth providers are not saying that the risk is higher. I have taken serious risks with my own health for whatever reasons, but I made an informed choice. I knew exactly what I was risking and was told by my care providers in advance. Nobody is trying to forbide homebirth. I would never do it but I defend your right to choose what you want, the problem is that how can you choose if you are not aware of the risks? It is impossible to have an informed consent if you are not informed.
I had a patient once that was presented with a difficult choice, it was basically between a rock and a hard place. I explained everything and a choice was made by the patient. Things turned out less than ideal. I got a thank you letter from the family months later of the episode. The outcome had not been good BUT they were thankful that the patient was able to make the choice and that I had honoured that choice. The patient never regretted that choice.
Go back to 1950 and see how enjoyable a hospital visit was
Interesting you say that. My grandmother had my father in 1951, in a hospital. She has always said the doctor was very nice, and “on her side” you might say. Certainly there was lots about 1950 and its hospitals that we’re all glad to have left behind, but human decency and professionalism did, in fact, exist back then too.
I’ll tell you one thing my grandma didn’t like about having a baby in the hospital in 1951 – no good pain relief. She was thrilled that her granddaughters and grandson’s wives got all the sweet, sweet epidurals they wanted.
Maybe, you say, she just didn’t “trust birth” enough?! Hey, anyone would distrust birth when they were the only child of their parents that didn’t die from being born prematurely. She probably didn’t like having severe pre-eclampsia both times she was pregnant, either.
But, I’ll be sure to call my grandmother tonight and tell her that some internet rando named jenifer thinks she did childbirth wrong.
It occurs to me that history is written by the winners, and certainly the public history of birth-as opposed to how the medical profession talks about it-is the story of grappling with evil doctors who want to take away women’s rights.
Love your grandma’s story. Mum had three kids in the 1960s-was very grateful to her male OB for some kind of knockout drug for a fair bit of my delivery; said the same doctor, as he stitched a bad tear caused when the midwife repeatedly ignored mum’s cries for someone to come as my brother was born, told the midwife off and explained the damage her neglect had caused. The midwife, without examining her, thought she hadn’t laboured long enough to be having the baby. Mum completely felt that doctor was caring for her, on her side, and that he treated her with respect. Certainly with more respect than the midwife did in that case.
Every mother wants “sweet pain relief”. No one wants to feel pain…but an epidural is not the end all be all to pain relief and it is not void of possibilities of complications.
How many of those grand-daughtes and wives also regret the forever pain in their spine they have because of said “sweet pain relief”?
The #1 reason I choose a home birth was so I could not be pressured into an epidural and the risks it can carry (back pain for life and a migraine does not sound like a fair exchange for 3 hours of sleep)
Go back to 1850 and see how enjoyable any birth was.
So what?
Actually, the risk is THE SAME.
That “statistic” included all unassisted births (free birthers and such) and excluded stillborns in hospitals, then it painted midwives as liars when some of those births were not even attended by a trained midwife. I love my homebirths and I would NEVER EVER do it myself. I want my 2 midwives there with me, just like they were 🙂
The sad part is that at a hospital, you are not truly “informed”always.
If I had a hospital birth, I would find one that had CNMs on call and chose natural birth over epidural as standard.
First your stats are misleading.
1. You have no high risk hospital stats.
2. 0.5 vs at most 2 out of 1000 is a meaningless.
3. You do drive a car don’t you?
4. What are the risks of being in a hospital? Infections, unnecessary surgeries…
5. I just assume that you are angry because you can’t schedule and cut out babies all day long…that is easy money I suspect.
Maybe I’m wrong.
to answer your questions:
1.) We DO have high risk hospital stats. But the midwives’ stats (which are SUPPOSED to be on low-risk women) are worse than that hospital high-risk stats.
2.) There is a four-fold difference between 0.5 and 2, and we are talking about many thousands of cases profiled in the MANA stats
3.) yes. and if someone told me I had a 4 x increase risk in dying in my Ford, I’d get a Chevy.
4.) Interesting that, if hospitals are so risky (and I’m not saying that they are), home is riskier.
5.) Not worth responding to.
Yep, you’re wrong.
But overall, the 24 hour death rate in a hospital is 6 deaths per 1000- so what is the % increased risk there?
So, initially a high risk mom may have a worse labor morbidity chance but in the first 24 hours- her baby would be less likely to die at home than it would in the hospital. (If these stats everyone tosses around are correct anyway)
So- if someone told me I would be more likely to get in a car wreck in a chevy, but more likely to die in the Ford, I would choose the Chevy (that is a more accurate representation)
ALSO, stillborns were not included in the hospital data but were in the homebirth deaths so how fair is that?
The data did not say if there was a trained attendant either so an unplanned breech homebirth is very risky business- but should a midwife be faulted if they were not there to begin with?
There are different pathways to becoming a midwife…one where you go to grad school and either have a masters or a DNP (CN/CNM)..other other route – is like a lay midwife..where you can have an apprenticeship and build a sort of portfolio until credentialed (CPM). Some states are now banning the latter.
I have a simple question. If hombirth is so dangerous, why is it allowed Federally and in all States? The government tells us what we are not allowed to eat, to have sex with, and even gives us tickets for driving without a seatbelt, even though doing so harms no one.
My wife is from the Philippines. Where most people give birth in a bamboo hut on a piece of cardboard, and come out fine. Women have been having children for millions of years. Really, does it need a staff of 6, auxiliary staff of 20, and millions of machines? The hospital holding your baby ransom for insurance money (just look at the parents in the news everyday arrested for taking their own kids out of the hospital without permission!).
None of that is necessary. If a basic, normal, human function needed all that help, why don’t we have medical crews helping us poop?
Hospitals are just greedy insurance scammers.
Because you can’t physically prevent a woman from giving birth at home and because it violates medical ethics to force someone to undergo unwanted medical procedures. Also, the maternal mortality rate in the Philippines in 2013 was 120 per 100,000 births (in the US, it was 28) and the neonatal mortality rate was 14 per 1,000 live births (versus 4 in the United States). So, no, birth doesn’t require all those bells and whistles, unless you are okay with more than 4 times as many mothers and 3.5 times as many babies dying from it.
Eh, this guy’s not an advocate of anything, just a troll. I don’t think he’s worth the effort.
Yes, you are right. The thing that gets me is that my husband is from the Phillipines and his father practiced medicine there. While I am sure it has improved over the last couple of decades, the reality that my FIL described was much, much different than what this person is sharing.
I figured that was probably the case given the reference to balut in his screen name, but you know what they say about hope springing eternal.
So what are you planning to do if you or a member of your family gets seriously ill or is in a life-threatening accident? Good luck trying to find help outside of the so called “greedy insurance scammers”. Idiot.
So if it’s not outlawed, it must be perfectly safe? I suggest you take up base jumping. Still legal in all 50 states.
This is BY FAR the most intelligent question and statement raised on here 🙂
We have gone from needing the staff of 6 for a high risk mother, to keeping them in rotation for every laboring mother that comes in the door.
I would rather see OBs care for LESS mothers and be able to give them the attention they need for the 5-10% that are high-risk and leave the others be to let their bodies naturally do what it needs to.
I do think all births should have easy access to help if needed, but don’t use it just because it is there.
One of my closest friends raved and raved about a midwife. It’s lucky she survived and her child barely survived, however, because of the midwife’s poor training he was deprived oxygen to the brain for a while… meaning he is mentally retarded DESPITE how during her entire pregnancy there was absolutely NO threat [he was a healthy fetus and she didn’t smoke, drink or eat a bunch of shit].
Midwives are quacks, and really shouldn’t even be allowed to practice. They do NOT have anywhere near the medical training as a doctor and they do NOT have access to ANY of the medical equipment if a problem should arise during the birthing process.
What happens if there’s a problem – shove the brat back up and hope you get to a hospital before there’s more serious issues.
So you believe your friend is an “idiot” and her child a “bastard”? You would prefer they had died?
Or the midwife is to blame?
I’m very sorry that happened to your friend and your child. What often makes those tragedies worse is the family is shunned by their friends who are still entrenched in the homebirth community.
James, respectfully, chose your words.
Your friend, I presume, is someone you consider to be smart and brave and someone who only wanted the best for her child.
So are most of the people who chose Homebirth.
They honestly think they are making the best, safest, kindest choice for their children, and don’t truly understand the risks of that choice.
They deserve better.
Their precious children deserve better.
Save your ire for the people who actually understand the risks, who decide that they will take on those risks with inadequate training and no indemnity, but who still feel able to charge for their “services”, knowing they have no accountability if it all goes pear shaped.
This is not about shaming women who have been taken in by NCB and unscrupulous CPMs.
There are people here who lost their babies or who are bringing up profoundly damaged children, not because they were dumb, or didn’t care about their children, but because they didn’t understand when they were being lied to, gaslit or manipulated.
Be a bit kinder.
It will cost you nothing.
Agreed!
There are doctors that are in prison right now for malpractice and neglect. They had the education, so what was the reason for them to allow infants to die?
There is one in prison right now that allowed a heart condition to go undiagnosed because the baby was half hispanic. (She LET babies die)
Man you are dumber than dog’s shit aren’t you? Too stupid to see how you contradict yourself twice. Go suck a cock, that’s all a cow like you is good for.
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Anyway thanks all of you for your input and it was really interesting to hear your point of view on this. Incidentally I also tried this on a pro home birth message board. I am off to actually get some more proper research done but this has been a fascinating diversion.
CaitP
Good luck with your paper.
Do not forget that you are looking at Homebirth within a very specific cultural milieu, that of predominantly white, well off women in developed countries, a culture where pregnant women expect to be the centre of attention during labour and delivery, and to be in control of every aspect of their lives.
Their experiences of Homebirth and reasons for choosing it are NOT universal.
For example “acceptability of vocalisation” is specific to cultures which expect and/or allow women to shout and scream during labour.
Some cultures (I’m most familiar with Ethiopian and Sudanese women in this context) expect women to be as quiet as possible during labour, and making a lot of noise is seen as being childish and uncalled for. Women coming from cultures where women give birth at home, but are supposed to do so in a way which draws as little attention to themselves and is as minimally disruptive to others as possible will not see “being able to vocalise freely” as a positive for homebirth. Their relatives will expect them to be in a back room, out of sight and being as quiet and unobtrusive as possible during labour.
Just a thought.
My wife never makes a peep when when she’s in labor. Filipino.
I didn’t either. English American descended from Puritans.
And, your point being?
In case you missed mine, I will spell it out.
CaitP reports that being able to vocalise freely was cited as a reason for choosing Homebirth.
I pointed out that reason only applies
1) if home is somewhere where it IS acceptable to vocalise during labour.
2) if vocalising freely during labour is something that you value.
3) that both of the above points are not culturally universal expectations.
Anyway, you don’t even know the educational standards required to be a CPM, so…
CaitP. A mountain of proof exists that indicates, the notion of ‘control’, regarding birth experience is programmed via the influence of the natural parenting/birth industry. Modern medicine puts the importance of health outcomes above ‘the birth experience’. This is the fundamental difference between modern medicine & the natural birth/parenting industry. By respecting a mother’s wish for ‘control’ over the birth experience, you are validating that it is an acceptable primary goal.
I have a better & more advanced topic for your paper:
How much control should be given to patients, who are being (mis)informed by (self-serving) organizations & laypeople, relating to childbirth?
Sadly the brief has been given and I can’t change it. Thanks for your thoughts though.
There’s always the follow up paper.
I think this comment is in line with my comment below about other situations where we relinquish control. Somehow, there is a narrative that says that not being in control of X things in childbirth somehow ruins the experience. However, when it comes to building a house, there’s no movement that says the experience will be improved if homeowners have a say in the engineering. In this case, we rely on physics and safety codes to guide us, and we don’t complain that our homebuilding experience is ruined because we had to include smoke detectors in every room.
Then again, when you build a house, you don’t romanticize the building process (most people dread it – ours was fun), and your goal is to have a good house in the end.
I really like the comparison. Actually, there is probably more oversight in construction than natural birth. If childbirth had a permit process that was regulated by codes (based on objective scientific data, which places safety as a primary goal & attempts to maintain the affected mortality rate as close to zero as possible), mother’s would only have the safest option available.
I like the comparison, too, because there are some nice parallels. We actually did have a lot of input into our house- it was a custom design (there are of course people who build standard designs who have even less input, and they are perfectly happy with the house), and we even did some changes in the plans during construction (the builder said, “If I move this wall here, it will make the closet bigger” and we were like, YES! As a result, the master closet is one of the best features of the house). However, there were other things that were completely out of our control, and had to be. Those we left to the people who knew what they were doing.
Ok, it is becoming too hard to reply to all the comments! I really should admit that I essentially came here to do a bit of background research for a paper I’m doing about where control lies during the home birth situation. I think that I should clear some things up.
1. Some of my comments were deliberately stirring the pot, I wanted to see what sort of reaction I would get. For example I actually have no real idea who Amy Tuteur is or about her use of facts I was just borrowing from some other comments I’ve read. And you all seem to be relatively articulate people with strong views on the matter.
2. I really am truly impartial. Doesn’t matter to me where a woman gives birth, it’s all academics to me.
3. I am from the UK and we definitely have a very different system to the one in the USA. For example people who have home births are always attended by a trained midwife (three years at university, Bachelors degree minimum, registration with the NMC,) which I gather is quite different from the USA.
4. I am genuinely curious to know more about this and would be greatful if anyone who isn’t too mad about my stirring would point me in the direction of some other literature which they found to be particularly interesting (already had a look at Dr Grunebaum)
Thanks and sorry for poking the proverbial bear!
If you are in the UK, your entire participation here was a massive waste of time. I’d recommend focusing on the problems with your own homebirth system. They are quite different from the ones in the USA.
And you seem to have doomed your paper from the very beginning if you think that control lies with bloggers. Sorry to disappoint you but if you read that Dr Amy or any of us here guards the entrance to homebirth with a gun, it isn’t true.
Oh let’s not say that! The whole thing has been very interesting, the paper is partly a comparison between the home birth debate here and the home birth debate in the US. I realise the issues are totally different.
I also think you misunderstood, I don’t believe bloggers have any control, it’s more about the midwife, woman and healthcare institutions. And at this stage I really am just forming ideas and nosing around the (sometimes murky) depths of the internet, partly for personal interest.
Although do let me say I do seem to have upset you and I am terribly sorry about that! It was never really my intention.
Not at all. This blog thrives on debate. Otherwise it would be a boring echo chamber. Also I completely disagree with the poster who said since you are in the UK this is a waste of time. Dr. Amy blogs on the UK situation often.
Yes I think so too! i find the differences between the ‘home and away’ health care debates absolutely fascinating. It completely intrigues me how some issues we have here about healthcare are not even a blip on the radar for the USA and vice versa. This is just one of the topics which is radically different, but totally interesting.
I love to hear what other people think to and the way in which they react to actual or perceived criticism of their stance.
I’m a UK GP BTW.
Is your paper for a psychology, anthropology, nursing or social work degree?
How narrowly are you defining “control” for the purpose of your paper?
My initial thoughts:
The UK has a unique situation whereby a woman can basically demand a homebirth and has to be facilitated even if her midwives and obstetrician think it is too high risk…in which case the control lies with the woman.
Low risk women who don’t particularly want homebirths can be “encouraged” into them by their GP or midwives- in which case the control lies with the health care institution.
During the labour itself the control largely lies with the midwife- when to transfer, when to administer analgesia, how often to monitor, and what constitutes a problem.
personally, I would never have a homebirth, only one of my patients has had one in the last 5 years and very few seem at all keen to explore the idea.
It’s for a nursing degree.
Control is being used as a pretty wide term so all your points are relevant at this stage, thank you for your thoughts!
I would be interested to know what your thoughts are around the control the woman gains through being able to adjust her environment at home.
And how, in your opinion, the continuity of care differs hospital vs home.
thanks!
Also anyone else who wants to chime in I would be interested to hear anyone’s thoughts on those matters!
I think “control” is a socially mediated concept. Some women will feel in control by picking the best quality hospital and doctor, and leaving it all up to them to exercise their expertise. Other women will exercise control (maybe pathologically) by constructing a conspiracy theory narrative about hospitals and chosing homebirth. Other poor or disenfranchised women will not even have the concept of control in their lexicon because they don’t have the privilege to chose anyway. Finally, the perception of control may not in fact correlate with positive maternal or fetal outcomes.
More productive than pursuing the illusion of control would be the reasonable management of fear. If you’re afraid of losing control by hiring a medical team to assist in your birth, then you will probably be better off addressing the fear (which is real) than looking to control birth (which is not possible).
And I mean the generic “you”, not the specific “you”.
Natural childbirth ideology is built on the premise that with the right preparation and environment, a woman can control the process. This idea is utter fantasy. It really bothers me that women are being told that they can exert influence over a biological process that is unpredictable, and that if they end up desiring pain relief or needing a c-section, it is due to a lack of willpower or trust in the process.
Personally, I think that the argument regarding “adjusting her environment at home” is pure bullshit. Hospitals bend over backwards to allow women to make themselves comfortable in labor. They allow freedom of movement (even if you need CEFM, many have telemetry units), adjust the lighting as desired, play whatever music the mom desires, offer laboring in water and birthing balls, encourage position changes during pushing, etc. A woman’s labor does not stall because she is anxious or in an unfamiliar environment – if this actually happened, we wouldn’t have preterm labor. The cervix is not a sphincter. If dilation stalls, it means something else is going on. At that point, the very interventions that NCB enthusiasts loathe so much (like pitocin and AROM) can often enable a woman to have a vaginal delivery rather than a c-section.
Interesting, thanks!
What would be your opinion on the argument some studies give that women who feel comfortable at home have an increased feeling of control? A lot of the papers I am looking at are citing the women in them as being accepting of the fact that they may have little or no control over the physiological aspect of birthing, but that for them the feeling of being in control, or their perceived control, is as relevant as any type of control?
But what good is “feeling of control” if it puts moms and babies in danger without actually having that control?
They may FEEL they are in control, but a) they aren’t, and b) it’s riskier.
The paper isn’t about the good of feeling in control it’s more about where the control lies. So in the home birth scenario who would you put the control with?
I would say the control is with Mother Nature, who doesn’t care if the mother or baby lives or dies, as long as the species as a whole lives on.
Ah interesting. Do you think there are different degrees of control? Like the mother has a feeling of control so there is some control, the midwife has the expertise to assist the delivery, mother nature represents the uncontrollable elements?
Yes, I think that is accurate. However I think the things that the mother can control are usually going to end up hurting rather than helping her. For example, by choosing to give birth at home, she has control over not being tempted by pain relief, but if she finds she needs that then she no longer has the ability to get it. She has control over whether or not she gets surgery (which incidentally she also has control over in the hospital as the doctor is not allowed to do it without her consent), but if an urgent emergency occurs, she then risks her baby’s life or her own.
For me, a good working definition of control is the ability to act instead of react. Birth is too unpredictable, with too many variables, for anyone to reasonably say they are surely in control of the situation. The best we can do is to be ready to react to whatever variables come into play between where we are and where we want to be (the goal).
This is where good education becomes so important. Not just for the attendant (who should be as educated as possible for obvious reasons), but also for the pregnant woman. A woman who seeks to have some amount of control should know 1) that full control is impossible and 2) what variables are somewhat likely to come into play and 3) what choices are available for reacting to those possibilities. This does not mean endless emphasis on how walking around during labor makes pain go away. It means knowing about likely complications, what those complications mean in terms of risk and outcomes, what technologies and techniques are actually helpful, and knowing when to just trust the experts she hired because the situation has gone beyond her educated ability to evaluate.
If your goal is to end your birth story with a healthy baby, a healthy mother, after the least amount of danger and discomfort in labor possible, then being able to labor on your own couch becomes meaningless in terms of control when you know how little doing so actually changes anything. Staying home limits your ability to act and react to the birth to just above subsistence level.
I don’t think even the species matters too much. Given enough time, she’ll just make a new one.
With the midwife.
Mother has the control only as long as everything is going smoothly. The moment something deviates from the norm, she’s at the mercy of the midwife who might decide to intervene or not… advise to the hospital or not… heed the mother who wants to go to the hospital or not.
What control are you talking about?
Personally, I don’t even understand the question. What are they presumably controlling?
That’s part of it really, it goes back to the ‘what is control’ aspect of it. It is such a hard thing to define and I’m not sure there is an all inclusive definition to fit the situation.
So why use the term if you don’t actually know what it means?
Then again, the mother labouring at home does NOT have control over
1) when she goes into labour
2) how long labour lasts
3) how much pain there will be during labour
4) physical or physiological complications (if she’s GBS positive, that’s irrespective of home or hospital; similarly, SDs can occur in either places)
She does have control over how to respond to the pain or physical/physiological complications, although her options for doing so effectively are less than what is available in the hospital.
So when women claim they feel like they have more control at home, what are THEY talking about?
You brought it up, so I’d hope you have been thinking about what it means.
The brief for the paper is to discuss where control lies in an aspect of childbearing, I would feel a little remiss if I did not mention it. I would remind you I am simply trying to see how other people feel about these things.
Women who feel more in control in the reading I have done relate it to things like ambulatory ability, acceptability of vocalising their pain, social control (i.e. who is present at the birth), environmental control and comfort – leading them to feel more mentally able to cope with labour and being more in control of themselves which is often highlighted as a definer of a good birth experience.
So it is things like that which studies cite – and interestingly there are quite a few which are about choosing a home birth after a hospital birth so from a comparable point of view.
Once again I would remind you these are not arguments or opinions just opening to discussions and what I have discovered so far!
If that’s all you got, then isn’t the answer is, “the topic begs the question,” right?
How so?
Because the answer completely depends on the question of what is meant by control. How can you answer the question of where control lies in childbearing if you haven’t specified what control refers to?
Well that is part of the paper, working to define what control is by looking at the relevant literature. To consider it from all angles is to consider the different types of control. I mentioned somewhere in my discussion with NoLongerCrunching. There are different degrees of control. Ultimately I feel my answer will be that there is no sure fire way to tell exactly where control lies and that multiple types of control can come into play at multiple point along the way.
“acceptability of vocalising their pain”
Do you mean feeling pressured to keep quiet for the neighbors or other children in the context of a home birth?
From the stories that the L&D workers tell here, it seems like screaming in pain is a fairly normal occurrence on those wards.
Interesting that you have ‘acceptability of vocalising their pain’ on that list, but not ‘options to reduce pain.’ Because interventions to decrease extreme pain definitely give those women more control over the process and their decisions in the moment. I think the availability of effective pain management is a very important aspect of control (and effective pain management is not available at home).
I was repeating some of the reasons I found in the paper I was reading, the women in the study cited acceptability of vocalising pain as a positive for home birth. They felt comfortable doing it because they were in their own space largely and because some had had previous experience with being told not to make so much noise in previous hospital births. The reason I didn’t cite that is because it hasn’t come up in my academic research yet.
Because they had some experience being told to not make so much noise in a hospital? Or because someone told them that they wouldn’t be able to make so much noise in the hospital?
As others have suggested, you have to separate the reality from narrative. When you have an NCB propaganda creating the image, everything that gets said has to be evaluated in light of that.
Because of their previous birth experience where they state that they were told not to make so much noise. It was a study and I think that the ones published in reputable academic journals are pretty well scrutinised by ethical committees and probably fairly reliable in terms of impartiality.
Oh, there’s a paper? Can you post the link?
“You have to separate the reality from narrative. When you have an NCB propaganda creating the image, everything that gets said has to be evaluated in light of that.”
Absolutely, especially when looking at the US home birth culture. Things are circulated there as truth – “You only have one position you can labor in at the hospital,” “You can’t make noise at the hospital,” “At the hospital they’ll try to force drugs on you that will hurt your baby” – that aren’t true, and so many women who choose home birth think they are making a choice that will give them more “control,” when really they’d have all those same options at the hospital (multiple labor positions, noise or no noise, no drugs if they want) and MORE. If you’re reading all the US pro-homebirth stuff and thinking that’s what US hospitals are like, you’re going to come off with a very inaccurate portrait of US hospital birth. And that’s part of the reason many women here choose home birth – the home birth propaganda tells them that the hospital will take away all their control and their choices. When, really, it won’t. So they choose home birth, and THINK they have more control at home, when they have the same amount of control or even less (less options for pain control, for interventions if things go wrong, etc.).
With my unmedicated birth, I screamed bloody murder throughout the entire pushing phase. No one suggested that I tone it down – not that it would have mattered, since I could not believe the sounds coming out of my mouth nor controlled them. I was in a hospital.
The closest thing I can come up with to make this even make any sense at all are those stories of nurses telling a mother not to scream because it will scare the other mothers around.
But why is scaring other mothers a problem? Because they will want to do things like, get an epidural to avoid the pain.
So the best I can come up with in terms of admonishment for vocalizing is that it harshes the NCB buzz of others, and if you scream, then others might not get that wonderful NCB they desire.
IOW, it’s all premised on the concept that NCB good, pain relief bad.
So why does it matter then whether women feel they are in control or not? You said that these papers report that women feel in control. However, what relevance is that to the question of whether they do? Then again, see my other comment. You are completely begging the question.
I’m just trying to get a feel for what people think about it, I’m not arguing with you don’t worry.
The control lies with the most competent and responsible party – if there is an attendant present, the ultimate responsibility and control lies with her or him.
Women in labor are not considered to be fully functional and are not held to the same standards as they would at other times.
To use an example – one of the scented candles tips over and catches something alight. Who do you expect to notice that danger and respond in a timely and appropriate manner? The attendant or the laboring woman?
So you would equate responsibility and control?
I would say that it is unreasonable to declare that someone who has decreased function and facility – especially when surrounded by others who are not impaired – has the most control and responsibility for the situation and outcome.
Women have transferred from home births, thinking they were just exhausted from a long labor. That’s what they’ve been told by their attendant. Instead they find out that they are dehydrated or have soaring blood pressure or have a raging fever.
Why didn’t they know how ill they were? Do we expect the women to know? No. Do we expect their attendant to know? Yes.
Why? You can answer: skill, training, experience.
What if the woman was just as skilled, trained and experienced? What would the difference be then?
Pain, exhaustion, illness has impaired function.
The other person is not suffering from those issues, therefore the responsibility transfers to her/him. Their job is to monitor more than physical function, but to be aware of mental and emotion issues.
Yes I see what you are saying here. Some of the stuff I have been reading does suggest that part of a woman’s control is to be able to delegate or relinquish her control in certain situations, to professionals (both hospital and home birth) and I do agree with you that these professionals have a responsibility to take control. Thanks
Um…women can have a fever, or elevated blood pressure at a hospital too. lol
Some of these comments…
But their birth attendant doesn’t have the training or knowledge to know that their client is sick. In the hospital, the staff are trained to monitor and KNOW when something is wrong. Untrained homebirth midwives are often so untrained that they have no idea what to look for or aren’t monitoring their client *at all*.
assuming that the hospital has qualified personnel. That’s not exactly a correct one.
What scented candle? LOL
P.S. I Have been enjoying your name this whole time Bofa is so accurate to some people I know I may recycle it for them!
I just don’t see the relevance of “feeling” like you are in control when in reality, you are not. If you are delivering with a midwife, she is still the person in control of the situation. In the U.S., home birth midwives routinely cajole women into ignoring their instincts (their personal sense of control) to prevent women from transferring to the hospital. So they claim that women have more control, when in reality, they do not.
OK, how about to the woman, surely in order to have a positive birthing experience the woman should feel in control? I mean, nobody likes feeling out of control do they?
Equally do hospitals not sometimes prevent a woman from paying attention to her natural instincts with situations such as birth positions?
There are some people who refuse to fly because they are not the pilot, and don’t like the feeling of not being in control.
Consequently, it takes them a lot longer to travel long distances than it does for others.
We surrender control of things all the time. Usually, we give the control to someone who is better and has more knowledge about what needs to be done than we do. Why should childbirth be any different?
When we built our house, we had some input into what we wanted, and how we wanted it done. However, there were also things that we could not do even if we wanted, for various reasons (safety codes, engineering, physics). Were we in control or not? Was it some sort of abomination because we had to have a support beam in a spot where we didn’t like it? We didn’t have control of that at all. In fact, once we drew up the floorplan, we left it up to the archetect and builder to get it done right.
I would rather be assured that things are going well and to be offered what comfort measures are possible, including effective pain management.
I’ve have two cesareans and the emergent one was the worst experience because no one had the luxury of telling me what was happening because their time and attention was needed to tend to my son.
The second cesarean was better because I was more functional –
a good night’s rest as opposed to being up for 24 hours,
not having been through an exhausting labor,
having experienced the procedure before,
the staff having the time to explain the procedure to me and describe what was happening.
At one point my instincts were to vomit, but a quick word to the ana and my instincts were chemically suppressed. I appreciated having the choice. Some people may prefer to vomit instead of having drugs.
I had a very positive experience, in which I felt totally in control…of my planned pre-labour C-section…
I’ve assisted at enough of them, consented patients for them, managed patients post op that I knew exactly what would happen, how and when.
It was a wonderful experience.
But then, that’s outside the scope of your study.
Hospitals now will literally only prevent a woman from being in a certain position if they can see from the foetal heart tracing that the baby isn’t tolerating that position or if monitoring is necessary for safety and the desired position is interfering with the signal.
I’ve been at hospital deliveries where women were squatting, kneeling on all fours, left lateral, semi recumbent, you name it.
Bar tenders, drug dealers, amusement park carneys- all make a living off of people paying to feel out of control.
I get the wanting to feel in control. I was very very anxious about going to hospital to have my baby. I’d never really felt comfortable with doctors or medical situations. A lot of things about me didn’t add up and with things being implied that it might be all ‘in my head’, I didn’t fancy breaking trust with doctors and so I gave the answers they wanted to hear so that I’d appear like a “normal patient”.
It was a Catch22 situation.
Instead what happened was that a rare periodic fever syndrome was undiagnosed and untreated for a very very long time (since birth). Things that I did to relieve the symptoms and prevent flares were not standard medical treatment (one notable one is when I feel cold and like I’m coming down with a fever I will warm up – my fevers can be triggered from cold temperatures and cooling makes me feel even worse).
It finally all came out in the open, I was diagnosed, had a name for what I’ve got and started getting proper treatment. Instead of saying “yes” and agreeing to everything (and then doing my own thing behind their backs) I’ve now found my voice in medical situations and can speak to doctors as an empowered and informed patient. It makes a HUGE difference to my medical care.
I would wish for other patients to be able to do this, especially minorities and people with different cultural backgrounds. To be empowered enough to negotiate and discuss issues with a medical practitioner is so much more important than “feeling in control”. The only reason I needed that “feeling in control” before was because things were so out of control I couldn’t trust anyone but myself to deal with them.
“OK, how about to the woman, surely in order to have a positive birthing experience the woman should feel in control? I mean, nobody likes feeling out of control do they?”
If the woman isn’t some weak willed individual, she can have pretty much that control all throughout her hospital visitation. It’s known as a birthing plan. My wife, my five female cousins and two sisters have had a birth plan. They have nothing but fantastic experiences with hospital births because they PLANNED.
Midwives and home births you’re giving your life and the life of a child into the hands of some quack, usually someone who barely scraped through 4 years of training vs. 7+ years, and whom has no where near the equipment or items to deal with serious issues.
Most people in the USA who take midwives are of poor quality – the ill and uninsured because hospital births can be very, very expensive.
I agree with the quack part, but I do not think it has anything to do with people being stupid or weak willed individuals – all women are in volatile, vulnerable position during pregnancy and childbirth regardless of how strong their will is or how high their IQ is.
I see many smart and educated women who have been manipulated into succumbing to the totalitarian cult dogma of natural childbirth. Also, the money seems not to be the main reason – if it was, people would not pay extra out of pocket for lay midwives if their hospital birth was covered by insurance, something that often happens, and people would definitely think twice before paying for the services of midwives in full at 36 weeks and then if they have to transfer end up with further hospital bills – these are not rational monetary decisions, they are paying these con artist in order to reinforce their feelings or beliefs. By the time a woman hires a lay midwife, she has usually been thoroughly brainwashed by all the NCB crap that goes on both online and in real life places like pregnancy and childbirth classes or their circle of peers.
If they are quacks, how do they get accredited college educations in the first place? Or State and Federal licenses? And I do not know what planet you are from, but poor people have better health insurance than the rich. We have Medicare, Medicaid, Blue Cross, and Fidelis. Zero co-pay. 100% coverage. And I could not tell you how many times a medical professional asked us for cash and said “Your insurance won’t cover it” and we told them we never pay anything and tell them we have Medicaid and they go “Oh! Well that is the only insurance that actually WILL cover it.”
That’s just the point, most of the the people attending home births in the US are not medically trained, federally or state licensed, are not insured, and are not covered by insurance. Many of the people attending home births have a high school education and have completed what they call an apprenticeship.
You retarded cunt, the government pays because you don’t work.
We have had a lot of bad experiences at hospitals. Not just delivery, but post-partum.
One of the worst things in America about giving birth in a hospital, is that even in a normal delivery, you can’t leave the hospital! You are REQUIRED to stay at least 3 days. And pay for it. You are forced to receive vaccinations, even if the law says you may opt out. And if you try to leave the hospital with your own baby? You will be tazered and arrested and have your baby taken away! That is crazy.
That is not how giving birth is supposed to be like. Surrounded by cold clinitians in masks, told what to do, held prisoner.
I am researching if there is any real evidence to support any home birth dangers. But to be honest, even if there were, it is worth the risk!
A friend of mine left within 24 hours after each of her 4 babies’ uncomplicated births. Her youngest is 1 year old. You can sign out, if you really want to.
I can understand your fear of being tasered because if I saw you walking out a hospital with a baby that’s exactly what I’d do.
How is the midwife in control?
Hospitals are evil and provide a HORRIBLE birthing experience. Then charge you a butload of money like $300 a pill ibuprofen.
Mengele’s hospital was evil. You might find most unpleasant, but that’s a long way from evil
Content-free comments are evil.
So I’m assuming that your mom did a home birth cause it’s pretty obvious you suffered ill-effects in the form of being an asshole.
What hospital were you at? Because I went to the one with the lowest c-sec rate and they put me on a bed with monitoring and an IV, gave me a hospital see it all robe and deprived me of food. Labour, which has been progressing at a 2cm/hour rate at home, stopped completely. So they gave me pitocin, which dilated the cervix, but did not allow the baby to come down, so he was oxygen deprived. No tub, no music, no balls, no pain management other than an epidural (which, at that point, was not that necessary). Needless to say, I ended up in the OR.
If you went to the hospital and required CEFM, it likely means something didn’t look right. Maybe you stopped dilating because your body was not contracting effectively? Pitocin doesn’t make a baby stop descending – there’s usually something else going on that arrests labor. It sounds like your labor wasn’t going normally, and they intervened to keep you and your baby safe.
CaitP, I haven’t read the entire thread, but to respond to your questions, I think that the issue of control would have to be analyzed using different concepts of control.
First, there is “feeling in control”, which means something different for every woman – for example, for one woman, controlling the environment is important, while another needs to not be in excruciating pain in order to feel in control, while a third might not particularly care about the question of being in control altogether as she feels that part of birth is letting go of control. Then, there is social control as in who gets to call the shots in the situation, which would be the individual midwife at home (with no oversight) vs. doctors, nurses etc in the hospitals (with institutional policies in place and a lot of oversight). And, last but not least, there is control over the physical labor and the outcome, over which you have very little control at home and vastly more control at the hospital.
And then there is the difference between expectations and the actual experience. Mothers who choose homebirth often believe that they will have a higher degree of control at home, but that may or may not be the case on all three types of control outlined above. Even in a textbook labor and delivery, the mother might be in so much pain that she ends up feeling completely “out of control” at home. The midwife – who operates without oversight and has therefore much more individual control over the mother and process than any one doctor at a hospital would have – may or may not use that power in beneficial ways (I had an unpleasant experiance with a homebirth midwife at one of my children’s births, and I’ve read lots of stories of outright manipulative or even abusive midwifes; and that’s not even talking about the question of competence – many homebirth midwives in the US lack the basic competence to manage anything else but a textbook labor and won’t recognize problems when they occur, and at home, you are completely dependent on them). And lastly, for most homebirth parents, the question of control over the outcome isn’t truly seen as relevant until something has gone wrong.
Pro-homebirth narratives usually talk about the first two types of control, ie individual experience (feeling in control) and social control. They talk a lot about being on your own turf, so to speak, being able to choose the room/environment and the attendant(s) and not having to follow any institution’s protocols. For women who value this type of “control”, that can sound very alluring. However, none of that matters if it turns out that your baby (or the mother) is in danger and you do not have the option to control the physical process as you would in the hospital (by monitoring, timely intervention and various emergency procedures, if the need arises).
Of my own experience giving birth at home, I can say that I did not realize how much control I was giving up in terms of “physical/medical control”, but had anything gone wrong, that would have become horribly obvious in an instant (I am so thankful it didn’t). I also did not realize how meaningless the room/environment became once real labor pain set in, or that having a midiwfe is not a guarantee for being treated with compassion or for feeling/being in control – individually, socially or medically.
I think that homebirth midwives focus so much on control over the environment (yes, you can have candles and you can decide if you want to give birth in a birth pool) because that is the type of control they can offer. However, they have vastly less control over the outcome than would be possible in a hospital. For obvious reasons, this is usually not made clear. Instead, you will find various narratives – from “babies die in the hospital, too!”, to “hospitals create complications” or “fear creates complications,” all the way to “some babies are meant to die” – that serve to muddle the issue and make it seem as if that wasn’t the case or wasn’t important.
Haha, I get why people would think I am upset. It’s just my way of writing and more importantly, my lack of time to think twice and wrap it in a nicer paper. Don’t worry, I am not crying over a debate on a blog. If I were prone to, I should have killed myself a dozen times over here, we get some really insane posts…
That’s hardly true. There is definitely extremism present in the UK, Australia, Canada and elsewhere.
In America, the almost unregulated CPMs are responsible (or irresponsible) for most home births – but the other countries have their own versions of birth attendants who practice outside of the system.
In the Philippines you hire your neighbor who “know how to get the baby” for like 2 dollars, lots of rum is drank, someone brings a piece of cardboard from the garbage, a few more shots of rum for mom, baby comes out, bamboo shoots from an old rotten fence are but on the cord, it lives naked and you clean up after it’s poop like you would a dog, and then as soon as the kid is 5 or so, you try to hook them up with an 85 year old foreigner so they will pay you more money for rum.
Different life-cycle than the West….
That would be a bit nippy this time of year in Nepal
Wow!
Racist much?
Go back under your bridge.
I did not really think that much about home birth during my first pregnancy. I wasn’t planning to have one, but I also didn’t think it was that big a deal if someone wanted to have one. I also bought into a lot of the rhetoric of natural childbirth – that it was better for the baby to not be exposed to epidural anesthesia, that complications were extremely rare as long as you took good care of yourself, that “natural” would be empowering, etc. As an academic librarian, I am now mortified that I did not look at any of these claims through a critical lens until after I gave birth for the first time.
My first birth changed me profoundly. I did achieve the penultimate goal of NCB: a totally unmedicated vaginal delivery with a certified nurse-midwife. And it was a miserable experience. I was stunned by how terrible the pain was, how out of control I felt during the process. I still remember my midwife describing my birth as “textbook.” When my son was born and they laid him on my chest, I was to exhausted to feel anything. And then the pph started, followed by manual examination of my uterus, and ultimately, a trip to the O.R. for repair of a cervical laceration. In the meantime, our son started showing difficulties with his breathing and was admitted to the NICU for TTN and suspected aspiration pneumonia. Any naivete that I had about childbirth was killed in the cold light of reality. If I had not been in the hospital, I would have died. My son ultimately did not require intubation, but it frightened me to realize that even a full term baby could have breathing issues. As I began to process the experience, I found the SOB. I felt betrayed by other women for propagating false information, even outright lies about the realities of childbirth.
Dr Tuteur’s biography statement is on the sidebar of this website.
The majority of posts written by Dr T are about the USA homebirth sytem; however, there are posts about maternity care in the UK (Australia, Netherlands, and NZ as well). There is a visual archive and a search function which you may find helpful.
“I really am truly impartial. Doesn’t matter to me where a woman gives birth, it’s all academics to me.”
I take issue with this. Again, it may be a woman’s free right to have her baby at home…but you SHOULD care on some level if exercising HER rights increases the risk of her baby dying. I find your personal moral compass disturbing if you have no opinion whatsoever about actions that may kill babies.
Hey now! I do have opinions about actions that might kill babies! That’s not at all what I am saying, I am just saying that it really doesn’t matter to me where a woman gives birth. I just don’t personally marry the two together.
I also can’t force myself into an opinion and I thought I might as well say how I truly felt. I’m sorry you find my moral compass disturbing, I will try harder in future.
Go ahead, 450% death rate… means 450% less chance for idiots and their bastards to survive.
What an idiotic statement.
So that would make you anti-abortion then, right? A womens should make a choice that may cause a child to die? Right?
Shouldnt*
So here’s a similar question for you, d.tiersma: Can a person who believes abortion should be legal also believe that an obstetrician (or other maternity care provider) should be held responsible for providing negligent care that leads to a preventable stillbirth? Why or why not?
I will note that you wrote “a child.”
If you want an answer to your question, you must define “child.”
That depends if you consider a 3mm zygote with yolk sac to be a “child”. If you in anyway consider THAT to be equivalent to a TERM infant, this really isn’t a conversation worth having.
A women who doesn’t want a child goes to have an abortion with competent providers to not have a child. A women who wants a child should go to competent providers to have a child. What would be an analogous example to home birth midwives attempting to help women have children would be to have home birth midwives attempt abortions for women who don’t want children. Either way Homebirth midwives are not qualified. Has nothing to do with pro-life or anti-abortion.
Im so tired of hearing people try to tell women that abortion is wrong while doing nothing to help support the unwanted children that end up on the streets or in foster care. Put your effort and time into those causes instead of yelling at women.
Is your paper on home birth in the UK or in the US?
It’s on both, part of it is the different ways in which cultural norms and different healthcare institutions effect home birth control and debate.
After all the horror stories I’ve read about some of the NPI hospitals, I’m not surprised that many might stay away from hospital birth there.
No, in the USA, they are highly trained. I think they are 6 year degrees. With State and Federal certifications. You know in the States the government regulates every single aspect of our lives. You practically need a government permit to use the loo.
So that is my big thing. Anything in the US that is questionable, the government makes it illegal and gives you a citation and a fee for violating it. Even if it is not bad. Just questionable. If home birth was so deadly, why is it legal Federally, and in all States? Not even one State has banned it.
I am not a proponent of any camp. Just a curious observer.
@bangusbalut:disqus , you may have heard of Certified Nurse Midwives (CNMs) or CMs (Certified Midwives) in the US. The majority practice in hospitals and clinics. CNMs and CMs complete university degrees to obtain this credential.
However, in the US, regulations about how can call themselves “midwife” varies by state. For example, in Utah there is NO legislation about who can call themselves a midwife and charges for their services. Any Utahn could start a midwifery business and charge for services.
http://www.skepticalob.com/2014/03/the-only-degree-a-homebirth-midwife-needs-is-a-high-school-diploma-seriously.html
” Anything in the US that is questionable, the government makes it illegal and gives you a citation and a fee for violating it.” Women in the US have autonomy about seeking medical care (or not doing so). There is no law forcing competent women to seek maternal medical care.
You are confusing certified nurse midwives, who have nursing degrees and usually an advanced degree with a focus on obstetrics, with lay midwives, whose level of regulation varies by state, but they mostly operate in a legal grey zone where they aren’t regulated because they specifically aren’t medical professionals, but then they promote themselves as having the training to handle just about anything.
Seriously dude, don’t talk about things you know nothing about. It just makes you sound like an ignorant fool. Also all the shit spraying outta your mouth totally proves that no one needs a bathroom permit from the government.
To me it seems that the best people to give information on home birth are not those who have any kind of personal view on it. This clouds the facts and it soon becomes too difficult to tell who has put what spin on what information. The most important thing is for women to have the CHOICE to decide for themselves and not be filled with partial advice from either pro or con camps on the subject.
A word on Amy Tuteur, her personal views on home birth, whether she gained them professionally or not, should not be used in such a way. There is probably a reason she isn’t very well published in academic journals.
Ultimately the world we live in today women should be free to make autonomous decisions about their own mode of birth and the facts should be displayed in a straightforward and impartial manner to help these women make their choice.
Quite right.
So women need to know the death and damage rates at home v hospital, the death and damage rate when under professional medical care v under other care, and that there are no differences in outcome in terms of bonding, intelligence or socialisation for caesarian v vaginal delivery and breast v bottle.
Dr T tells the stories of what goes wrong at homebirth, which homebirth supporters hide and whitewash out of their world, including shunning loss familes who might spoil the picture.
Facts are good, and the only people scared of them are the homebirth industry.
>There is probably a reason she isn’t v ery well published in academic journals.
There is. She is not a researcher and thus does not submit papers to academic journals; she was a clinician and now she writes for the general public.
>Ultimately the world we live in today women should be free to make autonomous decisions about their own mode of birth and the facts should be displayed in a straightforward and impartial manner to help these women make their choice.
Do you support a mother scheduling a c-section at 39 weeks for non-medical reasons? Or do you only mean women should be free to choose when their choice is what you approve? (And by “support,” I do not mean saying it’s fine but secretly judging her as less of a woman).
I do not think that you can make a general case of ‘a mother’ there are a multitude of different reasons why a woman would choose to have a planned C-Section, home birth or hospital birth. And my point was not that I only support people who choose certain modes of birth but that I support the woman’s right to choose. If it is what she wants and it does not put any parties at undue risk then i don’t see why anyone would try to interfere with what is ultimately a very personal experience.
If by “parties” you include the baby, then why don’t you consider that homebirth with the statistics we have available is an “undue risk.”?
Many women who chose homebirth are not informed of the higher risk. In fact they are lied to. Are you in favor of women not having all the information?
PS. You haven’t said precisely but I hope you don’t consider Midwifery Today and Ina May’s books to be good sources of scientific studies.
Everyone has a different view over whether or not the ‘baby’ should be considered a party at this point. Some say baby some say foetus. It’s not something which I would comment on.
I am in favour of women having all the information. The good, the bad and the ugly.
Then why are you against those who had seen the ugly side of homebirth speaking up?
The problem is that this is one of the very few places on the internet where the bad and the ugly are brought to light. So most women making the decision are doing so based on incomplete information.
Many of us have a habit of screencapping any homebirth disaster we see on the internet. This is because as soon as someone realizes we’ve seen it, the post disappears. Search this site for Jan Tritten. Read about the emergency she posted about on Facebook and read the comments. They range from idiotic to insane and no one seemed to have any idea that it was an emergent situation.
The baby, Gavin Michael, died because his mother was not given objective information. She is heartbroken. Her family is heartbroken. There is a hole in their lives and it is the size of a baby who did not have to die. Who should have grown up. Who would be crawling around and exploring his world right now. Whose parents and family should be planning all his firsts – first Halloween, first Christmas, first steps, first words.
That’s the bad. The ugly is that American midwives actively erase all signs of their misfeasance from the internet and perpetuate the myth that homebirth is as safe or safer than hospital birth while knowing it’s not true.
So basically what you’re saying is that you are in agreement with Dr. Amy.
What about the baby? She’s putting the baby at risk.
CaitP, how do you clarify “undue risk”?
You’ve just said that you wouldn’t see a reason to interfere in a choice if it wasn’t unduly risky, implying it would be understandable to interfere if the risk was too high.
What is your personal threshold for when a risk becomes too high?
For some people, a quadrupling of perinatal mortality is “too high”, and why they think it is reasonable to try to dissuade women from having a home birth attended by a CPM or a UC.
Note, I said “dissuade”.
Not “ban” or “legislate to prevent ” or “force women to abandon” their plans, merely to dissuade them.
CaitP you ignore something fairly fundamental.
“The best people to give information on home birth are not those who have any kind of personal view on it”
Ok, but don’t you think it is possible, no, inevitable, that in finding out the facts and becoming educated about Home birth, people who didn’t start out with a personal opinion are very likely to acquire one? According to you, as soon as they feel that the facts they have discovered leads them to believe anything about home birth safety, their opinion is no longer valid.
What you’re saying is that the best people to give information are lay people with no personal experience of home birth, no professional expertise in obstetrics and midwifery and no thoughts either way about home birth.
That is like saying that you would like information about the big bang from lay people who have no strong feelings one way or another about the origins of the universe and no personal expertise in astrophysics.
Me, I’d rather listen to Brian Cox or Stephen Hawking explain the origin of the universe than the man down the road who thinks parsecs are a unit of time and isn’t sure whether or not he believes Genesis is literally true.
I think you are interpreting what I said wrong, I didn’t say it should be a man down the road, or someone with no expertise. It just seems to me that someone with such a strong personal view is slightly incapable of giving an unbiased recite of the facts. Her use of statistics across her work is generally pretty skewed and i just think that women deserve and unbiased view about home birth.
In that you can read that I believe that on the front line they deserve information to be given in an unbiased way. I don’t think the information should be given by either pro nor con camps. I think that the place which a woman gives birth in is a very strange thing to develop a strong opinion of. Surely it is not down to anyone other than the woman to choose where she gives birth?
I simply cannot comprehend people who want to interfere with the choice that a woman has, I think it is arrogant and it is against the autonomous society which we strive for.
Dr Tuteur and most of the commenters here aren’t trying to take away anyone’s right to autonomy.
Dr Tuteur has said many times that she believes a woman has a right to give birth at home.
Can you provide evidence for the assertion of skewed statistics?
Which ones don’t you agree with, or feel have been reported in a biased way?
It is not “biased” to provide women with the information that if they give birth at home to a breech baby with a CPM, using the data supplied by MANA, their baby is 28 times more likely to die than if they opt to give birth in a hospital.
It is not “biased” to tell women that as a low risk, middle class white woman, if they opt to have their full term, singleton baby at home with a CPM, using MANA’s own statistics, their baby is almost 5 times more likely to die than if they give birth in the hospital.
Even the UK studies used to support homebirth found that primiparas had statistically significantly raised rates of perinatal death at homebirth.
If you have an issue with how that information is presented, how would you prefer it to be given?
To me, unbiased recite meaning giving the facts. To you, it seems to mean claiming that homebirth is just as safe as hospital birth. The problem is, it isn’t.
Dr Tuteur is biased against homebirth. I am biased against homebirth. Most people here are biased against homebirth. That’s because unbiased stats show that it’s far more dangerous. If you don’t agree, would you please show how Dr Tuteur stats are skewed? Show, don’t just make claims.
I am against homebirth just like I was against my neighbour jumping from my balcony to hers (a problem with missing keys) when we lived on the 5th floor. I refused to let her use my balcony to potentially kill herself. I would have tried to dissuage her from using another neighbour’s balcony, as well, by pointing out that she might kill herself, although I would not bodily restrain her. I am terrible for interfering with her choice, I know.
By the way, nice attempt to disregard doctors. No pro or con camps, great. Let’s see, this excludes all those who had done the studies showing that homebirth is not as safe. Bingo!
I didn’t comment here to mock or be mocked. I was just sharing my opinion on the matter. I am not for or against home birth and I think it is a strange comparison you make. I do not think that birth location is equivalent to jumping between balconies.
I do not attempt to disregard doctors, not all of them will have a opinion on the matter. I’m just saying it is about facts and respecting people’s choices.
I think the facts about the rates of deaths in home births should be given, but ultimately it is a risk which a woman should have the right to take and not be dictated to by you or me or anyone else.
So, then what’s your problem with this blog post? It’s just given the facts, which you seem to feel everyone is entitled to. We seem to be on the same page. No one here is promoting taking away to right to homebirth or even to birth unassisted. We just want people to have the facts.
Is your only problem the fact that Dr. Tuteur is the messenger?
But the only ones trying to interfere with a woman’s choice to take the risk or NOT take one are those who muddle the risks. Have you heard of Sara Snyder? Her blog, Safer Midwifery for Michigan, is on the blogroll here. In short, for her second baby she wanted more personalized care, so she went to midwife-staffed birth centre. When it turned out her baby was breech, she made the choice to have him at the birth centre because the midwives claimed they were experts in breech virth (turned out they watched some videos and had one (1) breech birth there. Oh, and new research was safer for breech babies, they claimed. Later, it turned out the research said that vaginal birth for breeches should only be done in hospital where interventions could be resorted to in a timely fashion if vaginal birth failed which it did for Sara.
Who interfered with Sara’s choice, Dr Amy who claimed “Breech birth are high risk, don’t be insane and try that out of hospital” or the midwives who informed her how much safer vaginal breech delivery was?
Who bears more responsibility for Magnus Snyder’s death?
Where did ANYONE say that they wanted to dictate that women cannot have homebirths? Even Dr. Amy doesn’t want to ban them. I’m not sure where you’re getting this idea. It’s a major misconception. Just because we want people to know that homebirth could kill their baby doesn’t mean we want to ban it. Every woman has the right to do it….but they need to know how dangerous it is and lay midwifery will not tell them that. MANA and homebirth midwives deliberately misinform, lie and obfuscate so that women cannot truly make an informed decision.
THAT’s the behavior we want to ban. Not homebirths.
And others are sharing their opinions about your opinion. That’s the way it works here. We all share our opinions. That doesn’t mean that all opinions are equal. For example…
On what basis do you think it is wrong? Whether homebirth is as risky as jumping between balconies is not a matter of opinion, it’s a matter of fact. So in order to make this type of claim, you need some sort of information on which to base it. We aren’t talking your favorite color or pizza topping, these are questions that have objectively correct answers. Saying that it’s your opinion doesn’t mean anything in this regard unless your opinion has something behind it.
But if the facts say it’s a bad choice, why should I respect anyone who makes it? Many if not most drunk drivers will admit that drunk driving is more dangerous than driving sober, but they choose to do it anyway. Do you respect their decision? They know the risks, they choose to accept them.
Of course, there are the drunk drivers who deny the risks, and claim that they drive better when drunk. Do you respect their decision, even in denying the facts?
It is a matter of fact that homebirth is 5.5 times more dangerous than hospital birth. However, your odds at dying for jumping from balcony to balcony are waaaay higher than .2%, so I would not consider it “just as dangerous”.
That is when you start doing the same thing as the other side and using false comparisons and senseless comments to make a point. Give that number to patients, if they consider that number low enough, they’ll go for it, otherwise, they’ll go to the hospital. (Of course, they also need to consider the infant mortality, bad outcomes and hospital transfer rates as well).
“However, your odds at dying for jumping from balcony to balcony are waaaay higher than .2%, so I would not consider it “just as dangerous”.”
Oh come now! Adjacent balconies in the apartment complex near me are like 2.5 feet from each other. Go over the first railing, keep firm hold of it with one hand, then just lean out a bit and grab hold of the other and transfer feet. Only a baby would have a 1/500 chance of dying doing that! And clearly a 1/500 chance of a baby dying is not reason enough for YOU to recommend against something.
I would not consider your particular situation as “jumping”. That would imply balconies in which being in mid air without touching anything would be necessary. I’m not recommending against anything here. I did a lot of research and there were several factors that clearly indicated that in my case, I needed a hospital, period. But if anybody asked me if it was safe to do it at home, I’d tell them that they have a 0.2% chance of dying and make their own judgments.
The average person doesn’t know what 0.2% means. So I personally would spell it out in plain English:
For every 500 women who choose home birth rather than hospital birth, 1 will end up with a dead baby who would have had a live baby otherwise.
(I would also mention the increased risk of brain damage severe enough to need cooling therapy, in case she cared about that.)
And then yes, she is absolutely free to do what she wants. And then people are absolutely free to think and say that that is a stupid and selfish risk to take, and others are free to think that she is a birth hero, and that 1 out of every 500 babies dying a needless death is a small price to pay for the chance to birth at home.
I don’t understand who you’re answering to on the last paragraph. Anyway, as I’ve stated before, if you bring factors as bad outcomes and transfer rate beside maternal and perinatal deaths, your chances of convincing anyone to go to the hospital are much higher than if you just judge them and make ridiculous comparisons.
Reality is that the home birth movement gained strength as a reaction to the terrible hospital experiences, the unnecessary c-sections and the bad management of labours at the hands of inexperienced residents. And the counter reaction to that has been a much bigger effort done by several hospitals to make the experience better, lessen interventions, use CNMs instead of residents and provide several tools to avoid c.sections, so that you can have the safety of an early intervention without being bed ridden and forcibly tied to a monitor and an IV at the hands of OB wannabes. It’s a win-win situation for everybody. Now the need is to make home birth safer by requiring CNMs to follow guidelines and discourage the usage of CPMs, have backup plans, etc.
I’m not sure that actual terrible hospital experiences are actually a major factor in the home birth movement today. It’s anecdotal, I know, but none of my friends and acquaintances involved in the home birth movement got there through bad experiences of their own. It’s fear and misinformation that are getting them there. They are believing the claims put forward about home birth being just as safe as hospital birth and birth being a natural process that doesn’t need interference.
Most of the “hospitals are terrible” claims I hear include things like routine enemas, shaving and epiosiotomies which are not at all routine anymore.
The simple fact that you are hearing “hospitals are terrible” indicates that it is definitely a factor. And hospital experiences these days are more about continuous monitoring, position limitations due to it and the IV and tons of negligence performed by residents, which is slowly changing and improving, faster in some places than others.
Beliefs about hospitals are a factor, but in most of the cases I know personally the issue is not a terrible prior experience but a belief that hospitals are terrible based on others telling them so.
Yes, you are absolutely correct about that.
I never said it had to be a personal experience. You just hear it from someone else, that heard it from someone else. And 10-15 years ago, it was more common, which is when the movement started slowly gaining momentum.
You claimed it was due to actual problems in the hospital. I am arguing that it is not, at least not for the last decade when I have been in the childbearing years. Hospitals have long since changed the policies this movement was objecting to even 5 years ago.
If the issue is rumour of bad experiences, well then that is pretty much misinformation.
“tons of negligence performed by residents,”
I have a problem with that. I’ve worked in several, large teaching facilities, including the one I currently work in, and I do NOT see “tons of negligence by residents”. Residents are closely supervised by both the RN’s and the attending physician. Yes they are learning, but most residents are very conscientious and are NOT negligent in any way, shape or form.
Lucky you. I’ve seen it a lot.
That’s too bad. What negligence have you experienced and/or seen by residents?
I’ll tell you one personal. I have several more (not only in pregnancy related issues).
I was 37 weeks pregnant and got shingles in one eyelid. I had no idea what it was, never had had it before. My husband (regular guy with no medical knowledge) told me it looked like shingles. My parents on skype (both MDs) told me it looked like shingles/herpes or whatever you want to call it. I went to my prenatal visit and the resident decided that it was something else. He even googled shingles on the eye in front of me!!! Then he refused to call the attending. All he did was giving me a referral for dermatology so that I could be seen 2 months later!!!
I was left on my own to find one that would see me that day, drive for an hour and pay the $100 Valtrex treatment. The dermatologist said that it was good that I had gone and seen him, that the virus could have gotten into my optic nerve and reached the baby. Next week, this resident was still denying that it was 1)Herpes and 2) that urgent. Despite seeing my clear improvement and that he had endangered the baby by failing to act, he insisted it was something else.
Do you have any professional, working experience with residents? Can you be more specific about “tons of negligence” in the hospital setting?
No, I’m not a doctor, only the daughter of one (and I highly respect the profession). I’m a regular person, grown up in a medical community, that unfortunately has been personaly affected by medical mistakes, some of them OB related in hospital settings. I won’t go into details about my story, already gave you a personal truthful example. Certainly, my previous situations are not preventing me from seeking hospital care in this pregnancy, but they definitely prompted me to find another setting with hopefully more oversight. And I’m not the only one, my close circle of friends and family has had situations as well, but that’s not the point of this article. I only made the comment that negligence has been a factor in women’s decisions (specially in an indirect way), and weather you like it or not, it happens a lot. If you can prevent it, do so. But if you only will hear comments from fellow MDs or “professional working experiences”, then I’m not the one to talk to you, it’s sometimes wise to listen to patients instead.
There is a difference between human error and negligence.
Which is why I’m not talking about human errors.
You keep insisting that women are dissatisfied with hospitals and are seeking out home because of medical negligence committed by residents in the hospitals, but you have nothing to back it up except anecdotes that you refuse to tell us.
We have actual studies looking at whether women are happy with their hospital care. They are called the Listening to Mothers studies, and despite being commissioned by The Childbirth Connection (a pro-natural birth group), they find that American mothers are overwhelmingly satisfied with their hospital birthing experiences.
The anti-hospital movement is not driven by actual bad experiences in the hospital any more than the anti-vax movement is driven by actual bad reactions to vaccines. They are movements driven by lies and appeals to vanity (e.g. you’re not one of those sheeple who follows medical advice….).
Funny, I’ve never seen a vaccines debate forum in which there isn’t a complaint about someone affected by them. What people did in the 90s was exploding a few bad experiences and back it up with a fraudulent study. So yes, the antivax movement gained a lot of strength from bad experiences. In that case, most of the ones you read about are merely coincidental or extremely rare, and you can see when common sense is lost. And it is a different scenario in which, every deliberately unvaccinated child is endangering everybody else in that community, which is not the case here.
But in the home birth movement, I provide an example of what happened to me of real negligence, not a rumor, not a tale of the cousin’s neighbor’s fiance, because that way I can say it’s true, and you all act defensively and start attacking me or asking for more, knowing that it would be a breach of confidentiality if I told you some of my dad’s cases.
I think a lot of good things in hospitals are happening because of such movement, among other studies and factors. And people that work to improve not only the short term outcome, but the long one, in the medical system, are doing a good job.
And I think the aim should be to make the birthing experience the safest for mother and baby in the short and long run, in all circumstances (home births included).
But if what you want is studies, check the malpractice lawsuits and verdicts, and what type of doctors have to pay the highest premiums, and then come here and tell me that negligence never occurs.
Ah, so at first you claim that “I won’t go into details about my story” but NOW you claim that the reason you won’t go into details is that it’s NOT your own story, but rather it’s second-hand stories that your father told you and the reason that you hold back is only for confidentiality reasons and that somehow I am “knowingly” trying to get you to break confidentiality. LOL! Let me see if I understand how this works–these stories are OK for your dad to tell, but if YOU told them it would be a HIPAA violation. Got it! And the supposed resident who referred you to a specialist for your rash committed “real negligence” and you had to drive a whole hour and pay $100 for the prescription and boo-hoo.
No, I won’t tell my story because you’re biased and will try whatever you can to discredit it, plus it’s waaay too long. Just by telling a tiny bit not so relevant part of it I got attacked, so I won’t expose myself to people that are just trying to demonize a movement because they have to, specially since I’m not even part of such. And no, I do not feel ethically compelled to tell stories on the web to people that want to use them for attacking others.
And I am also tired of telling my story, I have to do it every single appointment to every single new resident that sees me at the clinic, and it gets tiresome. Fortunately, they’re trying to learn and usually the attending is there, who, unlike you, is sympathetic, has paid attention to my case and is working with me.
And if you really think shingles are boo hoo, get them yourself on the eye with a full term baby inside. The single fact that you consider them boo hoo and that I opted to take care of myself instead of building a malpractice case does not make the resident any less negligent, had I not had the resources and time to search on my own and get what I needed to treat it, the outcome could have been very different, and not on my favor. And it was not a supposed resident, it was an MD in his rotation year, whose face I still remember. (aka a resident, not a supposed one).
So, keep attacking women that think medicine is not perfect. It only proves my point. And it only drives more women away from clinics, which is not exactly what we all want here. I want better and safer care, everywhere, you…. you just want to demonize people that do not think like you.
Negligence occurs. Of course it does. The difference is as follows:
– negligence by a doctor: you can write a complaint at the hospital, it gets filed, answered by the hospital, the doctor’s boss knows about it and be sure that they are taken seriously. In my case you get at least a very uncomfortable conversation with my boss. If that is not enough for you, you can go to the Medical Board. An independent board reviews that complaint. The doctor might face disciplinary action and even get his/her license revoked. If that is not enough you can go to court. For practicing medicine the doctor needs to have an insurance (in my case 1.5 million dollars) and get a compensation. The doctor might have his/her license revoked. The system is not perfect and you can have a malpractice, but AT LEAST you get a compensation.
– you suffer a malpractice by a CPM (not CNM, no CM) or lay midwife. You can write to her board if she is licensed. Her acts are reviewed by her peers, people that she likely has known for ages and they decide if it was wrong or right. If you know of any midwife that has had her license taken away by one of those board a, please let us know, because we have never heard of a single case. You will never be able to get a penny out of them because… They do not carry insurance!!! And going to court, even in the case you get a lawyer, is a complete waste of money, because they will not pay a penny.
Read the story behind Safer Midwifery for Michigan. That happened to a lovely family. They were unable to get anything out of the midwives. And they ended up with a lot of money to pay for their son’s admission.
If you get crap care, please tell. I do not have any interest on sharing a profession with scumbags. And that is another difference: I have never seen a Facebook page or anything of the kind to support doctors accused of malpractice. As I said, I am not happy sharing a profession with someone that practices badly. But there are dozens of pages like that dedicated to midwifes that had the result of a dead baby.
“check the malpractice lawsuits and verdicts, and what type of doctors have to pay the highest premiums, and then come here and tell me that negligence never occurs”
Nobody here has ever stated that negligence can’t or doesn’t occur. What we are arguing against is your assertion that episodes of negligence are what is driving women to homebirth. I suggest you check out the Obstetrics malpractice verdicts yourself. You will find that almost all of them are paid out for failing to provide a C-section (or other high-tech medical intervention) soon enough. Are you trying to have us believe that women are seeing these lawsuits and deciding “Well OBs sometimes don’t do CS fast enough, therefore I will deliver at home, where a CS cannot be done at all.”
Pulling this out so it doesn’t get missed:
The truly shocking thing about homebirth is that even when you include malpractice and negligence in the hospital statistics, homebirth STILL has a death rate that is 450% higher than hospital birth for comparable risk women.
Homebirth is still a fringe choice. 99% of women choose the hospital, not because they love the hospital, but because they love their babies so much that they are willing to endure the lack of “home comforts” in order to ensure that their babies will live.
Making statements like, “tons of negligence” is irresponsible. Just because you grew up in a medical community and have “heard” stories, you don’t know all the facts. You have no professional qualifications or direct clinical experience with said “tons of negligence” to make that claim. Peoples’ perceptions can color the facts, and I believe in looking at both sides. Patients can also request not to have a resident examine or treat them if they have concerns.
Well, sorry to say that your dermatologist was wrong, too. Shingles in the eye will not affect the baby (unless you somehow deliver through your eyeball).
“unless you somehow deliver through your eyeball”
I’ve heard they make you do that in the hospital. First they give your eyeball an enema, then shave it, then strap you down and make you deliver through it!
So, maybe not evidence of negligence, but just a mistaken diagnosis?
“The simple fact that you are hearing “hospitals are terrible” indicates that it is definitely a factor.”
Really? What else should I believe just because I’ve heard it? Should I believe that vaccines cause autism just because I hear it? I’ve heard that Jews are terrible because they kill Christian babies and drink their blood. I suppose that is “definitely a factor” also?
I don’t have to believe every rumor I hear just because you do.
“Reality is that the home birth movement gained strength as a reaction to the terrible hospital experiences, the unnecessary c-sections and the bad management of labours at the hands of inexperienced residents. ”
I disagree. I was raised in a homebirthing family. My mother’s first births were in the hospital. They were positive experiences and had none of the downsides you mention. They were vaginal births, unmedicated, had only intermittent monitoring, and were attended by her own doctor, not a resident. She still chose to reject the hospital, pretending she was “educated”, “knew better”, “independent thinker” blah blah blah. Homebirth had become trendy and it was her way of being special (and pissing off her in-laws at the same time). My youngest sib almost paid with her life.
Cait, it’s pretty common for people to come to the comments and claim that Dr. Amy’s stats are skewed. When we ask for examples, commenters either ignore the question or leave. A few rare ones will provide specific examples and then an illuminating debate occurs wherein both sides learn something and we’re all the richer for it.
Please be that rare commenter. Give us an example of a skewed statistic and let us all debate it intelligently. There are several commenters who have a solid grounding in statistics and can debate this intelligently with you. I, alas, am not one of them. I just like to sit on the sidelines and learn while I watch people far smarter than me pound out math.
Can you provide an example of how her stats are skewed? If that’s the basis for you dismissing her, then you should be able to provide a few examples of what you are talking about.
I simply cannot comprehend people who want to interfere with the choice
that a woman has, I think it is arrogant and it is against the
autonomous society which we strive for.
And, speaking of being unable to take an unbiased look at the facts…No one here is advocating that women be forbidden from giving birth at home. At least, if they are, I haven’t seen it.
I can say for certain that I’m not advocating that women should be forbidden from giving birth at home. Give birth where you please! At home, in the hospital, in a birthing center, by a stream in a thunderstorm (if you can manage the timing), on the floor of the Oval Office (if you can get Obama’s permission to give birth in his work space), wherever you like.
What I don’t think should be allowed is that misinformation should be unchallenged. NCB advocates claim that home birth is not just as safe, but actually safer than hospital birth. This is not true. It is not safer. NCB advocates claim that the pain of labor is usually managable with encouragement or that it is “good” pain or even that it is not really pain at all. While this may be true for some women, it is not true for the majority. NCB advocates claim that women can recover from preeclampsia if they follow a certain diet. This is flat out untrue. I don’t think any of this sort of dangerous advice should go unchallenged.
I don’t necessarily agree with Dr. Tuteur’s every last word and have challenged her at times when I thought she was wrong. By all means, if you see a problem with her statistics or her conclusions, do the same! She welcomes the challenge. You will not be banned unless you move to threats or swearing (in fact the only person I can think of right off who was banned was a person who basically agreed with Dr. Tuteur who was banned for profanity.) Welcome to the debate, change as many minds as you can…or have yours changed if that is how it works out.
I know I’m late in the conversation. But you seem to be missing a very important point: nobody will have the knowledge and experience and not develop a bias one way or the other, it’s just plain human nature. You can go to statistics and studies and make your own analisis and find your own conclusions, or take both sides of the coin, try to bypass all the false propaganda and take only the statements and references that make sense. That’s what I do in every other issue like global warming, vaccines, etc.
“There is probably a reason she isn’t very well published in academic journals”
If you are looking for “just the facts-type” expert information from someone who IS extensively published in academic journals I would suggest Dr. Amos Grunebaum.
But Dr Grunebaum seems to be anti-homebirth, so he isn’t trustworthy either! Never mind that he seems to be anti-homebirth because he did the studies showing that homebirth is wildly dangerous.
You are very funny, I appreciate your humour. But you are wrong about my views and my opinions and it is very clear that you are quite anti home birth and fairly jaded at that.
I came here as a curious undecided and I still leave as one. i didn’t come to argue and am simply having a look at both sides.
Either way I find this whole debate very interesting and we shall see where it goes in the future.
I am absolutely anti homebirth. And I’ll fight tooth and nail for every woman’s right to have one, even if she’s the most riskiest of the riskier cases.
I’ll also fight tooth and nail against the sweet songs of “intimacy”, “less interventions,” “bonding”, and “breastfeeding” being presented as something BETTER than the things that can save a woman’s life or quality of life and a baby’s life or quality of life. Interventions tamper with breastfeeding, oh the horror! Guess what? Dead babies don’t get breastfed.
I’ll also fight tooth and nail against doctors and midwives breaching the standards of their profession by attending high risk women at home because “else she’d just go unattended!” Last time I checked, self-appointed savior wasn’t listed among medical professions.
I’m not anti-homebirth. I’m anti-misinformation, anti-lies, anti-uneducated providers, anti-DEAD BABIES. Since most of those things go on at homebirth, I can see how one might be confused.
Honestly, you seem like an intelligent woman. I hope you will stick around to hear more. You might find the debate here illuminating.
“To me it seems that the best people to give information on home birth are not those who have any kind of personal view on it.”
Yes well we don’t live in a fantasy land. By the time folks get pregnant most have some kind of opinion about homebirth because it is relevant to them. EVERYONE deserves this information.
So you support informed consent from the midwives too, right?
The problem with demanding that all information be presented by a neutral party is that if the data show that one treatment plan is clearly more dangerous than the other, experts will quickly develop a bias. It’s hard to find someone, for example, who is both knowledgable on the treatment of syphillis and neutral on whether penicillin should be given or not. Similarly, it’s hard to look at the statistics on risk of increased perinatal mortality at home birth and not have an opinion on it.
Would you go to a surgeon who was neutral on the issue of whether to remove an inflammed appendix? A doctor who presented both the pros and cons of taking chemotherapy for Hodgkin lymphoma but didn’t advise you to take the treatment? Would a doctor who said, “Well, yes, Hodgkin lymphoma is 100% fatal without treatment and 90+% survivable with treatment but I’m neutral on the issue of whether people should be treated or not” inspire confidence in that practitioner? If not, why would “home birth is associated with a 3 fold or greater chance of the baby dying but I’m neutral on whether you should do it or not” inspire confidence?
So you wouldn’t get information on vaccines from the CDC? Because they are obviously “bias” against not vaccinating your child right? Nor would you get information on evolution from a biologist because they are “bias” against intelligent design. Nor would you get information on global warming from a climate scientist because they are “bias” in favor of anthropic global warming.
In fact, those are exactly the arguments that some people make. Of course, when they make them in other areas, we call them “whackos” or “loons” or “woos”, so that is the company you keep when you take this type of approach.
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Hi, I had trouble using the database to reproduce your 0.38 figure; do you think you could give us a step-by-step guide on how you got there? I couldn’t find the option for “low risk”. Or if anyone else could help me, that’d be great. I’m just not sure where the 0.38 figure comes from. I keep on coming up with a lot closer to 2.
Make sure “age at death” includes only 0-24 hours, 1-6 days, and 7-28 days, not the last row.
Also make sure gestational age is set to 37-42 weeks, and birth weight is more than 2500 grams.
Get those three, even if you don’t include any other risk factors, and the results should be less than 1. Also, go down to “cause of death” and exclude congenital abnormalities.
Ah, fair enough. I get 0.57 in hospital and 1.20 out of hospital. Not quite 4.5x, but still definitely very considerable.
You may find this link useful:
http://www.skepticalob.com/2014/02/calculating-neonatal-mortality-using-the-cdc-wonder-database.html
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I have the feeling this blog is written by a very scared doctor. I’m based in the U.K. that has a world class safe and effective midwifery service where most babies are born under the care of a midwife. They are independent practitioners that work with set of national and local guidlines. The only doctor most women will see anaesthetist unless the midwife detects any problems or the mother is classed as high risk due to medical problems or due to previous problems with births. We have home births and there is no research in the UK that supports your argument that there is an associated risk of death to babies born outside the hospital setting. Oh I have just seen one born every minute USA style, I advise all pregnant women to watch one born every minute uk style then make the decision weather to have a midwife or a doctor you could save mega bucks
So you’re going to argue that the U.S. needs the UK’s version of midwifery? The model where women have to beg for pain relief? The model where “phsiological” birth is valued above the life of infants?” The model being investigated by RCOG because of the shockingly high rate of stillbirths (17 a day)?
No thanks.
P.S., Dr. Amy is RETIRED.
Your feelings are wrong and the UK has worse and worse outcomes every year because of their model.
Where the heck did you get your chart and conclusions??
They are inaccurate: This is the MANA research study
http://onlinelibrary.wiley.com/doi/10.1111/jmwh.12172/full
Per Unicef stats, see pages 35-37 to compare the US with all nations worldwide (or read the whole article):
http://www.savethechildren.org.uk/sites/default/files/images/State_of_World_Mothers_2013.pdf –
http://onlinelibrary.wiley.com/doi/10.1111/jmwh.12172/full
If only 1% of US babies are born at home – explain these stats:
http://www.cbsnews.com/news/us-has-highest-first-day-infant-mortality-out-of-industrialized-world-group-repo
http://www.dailymail.co.uk/health/article-1383244/America-WORST-maternal-death-rate-industrialised-nation.html
You clearly have an interest in the topic, but you might not have a whole lot of background knowledge.
Do you know the difference between perinatal mortality and infant mortality? Which one is a more appropriate measure of obstetric care, and why? How does the USA’s perinatal mortality compare to that of other developed nations?
Here are some basic answers to start you off, feel free to explore the questions further. Perinatal mortality is stillbirths + newborn deaths (up to 28 days.) Infant mortality is deaths up to age 1 of babies born alive. Perinatal mortality is a better measure of obstetric care, as deaths of older babies are rarely related to the circumstances of birth, and stillbirths can often be prevented with good care, especially term stillbirths and intrapartum (during birth) stillbirths. The USA’s perinatal death rate is quite good, lower than that of the UK or the Netherlands, and only slightly worse than Sweden.
And those numbers are drawn directly from MANA’s paper. The authors listed intrapartum stillbirths, early neonatal deaths, and late neonatal deaths separately, presumably to make it less obvious just how terrible the death rates really were.
I am a Midwife with a huge amount of knowledge. You can interpret the stats any way you want and post your slanted opinions.
I am also the mother of 4 adult children, all born at home beginning in 1978.
with my 4th born when I was 40 – at home.
You are incorrect that “stillbirths can often be prevented with good care….,” since most stillbirths are caused by congenital abnormalities – and most happen in the hospital where 98% of babies in the US are born. Deaths of older babies do have to do with standard of care (or lack thereof), by Pediatricians or MD’s since Midwives do not do care past the 6th week, but are usually available to their clients for life on a referral basis, or as I have done – suturing my kids deep cuts & splinting broken fingers.
You did not cite any references better or different than MANA’s or UNICEF’s – as I cited-. The standard the medical establishment decided on is to count neonatal mortality to cover pregnancy thru the first year of a baby’s life. Since babies are born with genetic issues such as a heart malformation, they can possibly live to a year, for example. A lot of these genetic issues have nothing to do with quality of care or place of birth.
Basically all you did was argue with the standard of measurement and state your opinion that studies of infant mortality should be broken down into categories. Again that is your opinion and has nothing to do with my knowledge base, or MANA’s stats. You’re arguing with established standards of collecting data to study infant mortality rates.
Neither UNICEF nor Save The Children agree with you, they agree with MANA.
No, you are wrong and missing the point. Read the recent SOB comments on infant mortality from a few days ago.
Can you cite references that support your claim that most stillbirths are caused by congenital abnormalities?
Even if they are, and? To quote a doctor from Dr Radio, “There are more adults now living with congenital heart problems than there are children.”
IOW, we are getting much better at saving babies with congenital heart problems and they grow up to be healthy adults. So even it were true that most stillbirths are caused by congenital abnormalities, shouldn’t we still be trying to save them? That’s what real medical professionals do.
The World Health Organization defines perinatal death to be deaths during the later part of pregnancy or first month of life. Neonatal deaths are babies born alive who die within 1 month. Infant deaths are babies born alive who die before age 1. These are the definitions used by all major health organizations.
And if you don’t know the basic definitions, and don’t believe people who try to correct you about them, I don’t see how we can have any sort of conversation about statistics! Do some reading on the WHO site.
You may have a “huge amount of knowledge” but much of it appears to be incorrect.
Stillbirth is related to prematurity, APH, diabetes, infection, cord accidents and is often unexplained despite post mortem. The UK, recognising their high stillbirth rate, despite universal access to good antenatal care and high detection rates of congenital anomalies with elective termination as a frequently chosen option after detection, aren’t throwing their hands up and saying that those stillnirth deaths can’t be prevented. There is currently a massive undertaking to identify causes and reduce the rates.
Are those midwives, obstetricians, paediatricians and public health doctors wasting their time?
Pretty sure that having a few babies crawl out of you doesn’t automatically give you training in statistics.
No, you are an idiot. It is blindingly clear that MANA broke up those deaths into separate categories to hide how terrible their stats are.
“The standard the medical establishment decided on is to count neonatal mortality to cover pregnancy thru the first year of a baby’s life.”
Neonatal mortality is death within the first month of life, not year. If you don’t even know that, then you don’t know anything.
A midwife with a huge amount of knowledge. AND a therapist apparently. What other qualifications do you have? What are your professional certifications?
most stillbirths are caused by congenital abnormalities
Actually, not even close. The majority of term stillbirths are unexplained. Only a few occur in fetuses with congenital anomalies and the relationship even there is not clearly causal. Nice try, but not supported by data.
Here’s a review with longer term and more complete data which sets the rate of stillbirth attributable to fetal anomalies at about 14%. Not even close to “most”.
http://www.ncbi.nlm.nih.gov/pubmed/16325593
As I understand it, most first-trimester miscarriages are caused by congenital anomalies, but most later losses are not.
You’re probably right, though I don’t know the numbesr for certain, but a first trimester loss wouldn’t be referred to as a stillbirth.
Except by people who don’t know the definitions of words.
Medical terminology is too technical and “cold”. It would probably intimidate during those long cozy prenatal appointments where they talk about nutrition and “look for drug and alcohol abuse”. Speaking of which, a home birth disaster in my state was based on the fact that the midwife didn’t ask about PRIOR drug abuse, just of the mother was currently using drugs or alcohol.
Whiskey sours in labor are okay, though, right?
Or vodka to get labor going, along with some castor oil. I believe that is Henci Goer’s induction recipe.
“I am a Midwife with a huge amount of knowledge.”
Whooomp! There it is…
I agree with everything said in this article. However, as a parent of a child who was killed during childbirth in a hospital, I must make note that a third group not considered here is also a danger to birthing. That is the extreme branch of the “natural childbirth” movement which sometimes uses hospitals but demonizes parents who want medical procedures that would save their child’s life or prevent brain damage from oxygen deprivation. Their goal is not a healthy birth but rather a birth that has no medical interventions. This is extremely dangerous even in a hospital. Thankfully, most doctors who are not familiar with heart monitors and other modern medical procedures are retired or deceased by now so this group is getting smaller as time goes by. My son was a victim of one such doctor who wasn’t retired and was killed as a result of the doctor ignoring the heart monitor for four hours even though we had our birth in a hospital.
I’m so sorry for your loss.
I am so sorry. Unfortunately, you are far from the only parent who became a victim of the natural childbirth philosophy in a hospital setting. I really cannot remember any case of a baby who died or was injured due to overuse of interventions. I am certain there are some but I cannot think of example. The majority of low-risk hospital deaths are due to the lack of intervention, just like in your case. Comes to prove that even the best equipment is only good as the person wielding it. And this is a problem. Doctors, more than anyone else, should be aware of the latest development in their field.
Once again, I am so sorry.
I don’t know if you’re still reading, but in case you are, I just wanted to say I’m very sorry for your loss!
I’d like to join in as a user. I am British but my first baby was born in The Netherlands. I was not eligible for a home birth, too old at 27, a possibility that had never crossed my mind, anyway.
To get a home birth, you had to attend all your pre natal examinations, expect no complications, have a fully qualified midwife and a helper, usually your mother, and live 20 minutes by ambulance from the hospital. There were a set of times and stages for the birth and if you did not meet those stages, you were immediately removed, sirens blaring to the hospital.
Birth at home was followed by a huge family party, so the new mothers who arrived on my ward, were usually howling with disappointment.
…too old at 27? That is some strict criteria.
Hospitals do not report accurately deaths related to birth. Death certificates are not standardized and do not require reporting of whether or not a woman woman had recently given birth. Cause of death is often “doctored” to reflect something that is laterally true, but perhaps not completely factual.
1) This article is about deaths of newborns, not mothers. There is no reason to believe that dead newborns are being incorrectly recorded as dead adults, for example.
2) As for deaths of mothers, death certificates in the USA WERE changed about 25 years ago to record whether a woman was or had recently been pregnant and whether the coroner considered it a maternal death. After this change, the official maternal death rate DID go up. So, there used to be under-reporting, not so much now.
A) What’s a woman woman?
B) Can you elaborate on this claim? You know this because…..
This Lady is nuts. Find something better to do. Maybe you should check out why hospitals and doctors do so may unnecessary C-sections. Or how many complications to mothers and babies are created by inductions. Or better yet how about all the mistakes (that turn into tragedy) that are made by doctors during surgery or delivery that are swept under the rug. No wonder no one trust the doctors or hospitals anymore. Unfortunately the doctors and hospitals are now making decisions based on $ or the fear of being sued, not what is best for the women and babies.
Well since you know, why don’t you share with us? Please, enlighten us. Link to the journal articles documenting your claims.
No comment on the actual paper discussed in this post though, since dead babies obviously don’t matter to you. Just C-sections and inductions.
They’re not so much in Australia and yet we have a similar c-section rate. Maybe if you got some better ideas as to what’s going on you could share with us?
Really?? And what are YOUR qualifications? Doctor? Nurse? Or, maybe just some disgruntled home birth midwife? And just what do you base your claims of so-called unnecessary C/Sections on? Or mistakes that “turn into tragedy”? In over 10 years of working in many hospitals as an L&D RN, I’ve never seen a decision made based on “$”, but I HAVE seen decisions based on the fear of being sued. And, most of them because of people such as yourself, who spew ungratefulness and contempt for people who are trying to HELP others. If you’re going to make claims on this site, you better be able to back them up! Put your money where your mouth is honey.
Her qualifications? She is a CPM so she has no qualifications. The truth about homebirth deaths threatens her income, so she rails against it.
I know… their blatant arrogance and disrespect really gets under my skin sometimes..
Dr Amy, I won’t expect of you to reveal anything leading to the identity of any of your commenters. I’d like to know, though, is she indeed a CPM? Because it would be quite disingenuous of her to rant like this without mentioning this little detail.
Please, fawn. Enlighten us as to which c sections are the unnecessary ones? And please tell us how we can always know in advance which ones are necessary, and which ones aren’t? Do you perform caesareans? I bet if you did, they would all be absolutely and completely necessary, right? Because you have special powers of knowing. It’s amazing to me that the only people who go on about unnecessary caesareans are people who don’t have the education, training or skills to do them. So easy to have a stupid opinion.
“This Lady is nuts. Find something better to do.”
Solid work burying the header.
The data from the MANA study makes me sick. It demonstrates a disgusting death rate.
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so…are we assuming that we get to through out the c-section rate at hospitals? So the average woman walks into a hospital, has a c-section because someone thinks her baby is too big…Is she then thrown out of the study? Do they reconsider her when her baby is born at a whopping 7#s? when many hospitals have a 40% c-section rate…is it fair to compare only the vaginal births?
If hospitals could only use technology when it scientifically benefitted my baby and me…I’d go.
I’m not sure what you mean by “thrown out of the study.” Death rates in the hospital include all babies. So do c-section rates.
Are you saying that you don’t want to go to the hospital because you might have an unnecessary c-section. I understand your concern, but there’s something you might not be aware of: Most c-sections in hospitals are performed on women with problems that are known in advance, or women with a prior history of c-section.
Here’s a statistic that shocked me when I learned it. When a woman who has previously had vaginal births and has not previously had a c-section goes to the hospital in labor at term, if she’s carrying one head-down baby, the probability that she will have a c-section is only 3%. Not 30%, 3%.
LOL. Unless the mom ‘schedules’ a c-section because she does not want to go thru labor! It happens much more often than you might imagine. Doctors also persuade women to schedule a c-section around the doctor’s vacation.
When I was teaching prepared childbirth classes for people who wanted a natural birth in the hospital, one woman told me her OB had never done a pelvic assessment (the old fashioned way) and she didn’t want to have any ultrasounds. She hired me to be her Doula in the hospital. Her SOB-OB ‘allowed’ her to labor hard & long, had convinced her to have her bag ruptured – which put her on a 24hr time limit. So at hour 22, he checks her pelvis and guess what? her pelvis was Android (male) shaped and would never be able to birth a baby vaginally! She was a true bonafied candidate for a section. It was like he was punishing her for wanting a natural birth & could have prevented her 20+ hrs of extreme painful labor. The baby was also going into distress & passing Mechonium!
What is ‘mechonium’ and ‘bonafied’?
Now, now, don’t criticize her spelling, she’s a highly edumacated CPM with a “huge amount of knowledge”! *snort!*
A ‘different way of knowing’ and a different way of spelling.
Maybe ‘bonafied’ is calcified?
I think she means bona fide, as in genuine.
That doesn’t necessarily make it better, of course.
I like calcified better.
If all you can intelligently comment on is my spelling – you are seriously missing the boat and need to get a life! Everyone makes typos, are tired sometimes and forget to spell check. That means nothing in the real world of things that really matter, such as- lowering the US’s horrible rates of infant mortality!
Read the topic on infant mortality from earlier in October on this site and try again.
usually pointing out spelling errors does not do anything to add to a debate, but when you claim to be educated on a topic and cannot even spell simple terms related to that topic that is pathetic and shows what you are saying isn’t at all true.
It’s because of a social MORAY
(How can it be that these midwives who claim to be so educated, although the only formal education that MANA requires is a high school diploma, manage to continue to write the exact same idiotic things?)
Gotta love those morays!
LOL!
**snort, snort** right back at cha, sweetheart! What the hell does “edumacated” mean?? LOL
You LOL too much to be taken seriously.
If all you can intelligently comment on is my spelling – you are seriously missing the boat and need to get a life! Everyone makes typos, are tired sometimes and forget to spell check, which you so beautifully proved -thank you! Typos mean nothing in the real world of things that really matter, such as- lowering the US’s horrible, shameful rate of infant mortality!
And how many times does someone need to tell you that infant mortality is not the proper statistiic to measure obstetric care???
There you go, you have predictably just mentioned the next misunderstanding on the NCB script.
Next is the 15% C-section rate.
Come on, you know you want to.
Not twice, sweetheart. Not when the typo is pointed out to them in such a comment.
Look, we both know you don’t know how they are spelled. Why don’t you do yourself a favour and stop demonstrating just how justified the comment was?
Repeat after me: infant mortality is not a measure of obstetric care.
Lowering the US’s horrible infant mortality rate has nothing to do with midwifery or natural birth. If you really want to lower infant mortality, here’s what you need to do:
– easily accessible universal health coverage so that poor people can go to the doctor at the first sign of illness.
– supportive public health system that can ensure parents have the resources they need to properly care for their children (including vouchers for transportation to routine medical appointments, and clinics located in the neighbourhoods where people live). Where I live, resources include home visits by public health nurses and free drop-in infant feeding clinics.
– a real maternity leave available to all working women (1 year, funded by government). This will enable women to properly care for their children during the critical first year of life and eliminate barriers to obtaining proper medical care (if you work full time, it’s harder to get baby to his appointments)
Notice how none of this has anything to do with prenatal or obstetric care? Notice how I’m not mentioning breastfeeding bullying going med-free during birth?
I am a biologist. If I didn’t know how to spell simple biology related terms I wouldn’t have a job.
Infant mortality doesn’t have anything to do with maternity care.
If you misspell a technical term you should know how to spell, that points to sloppiness/ignorance.
A typo is when I do something like type “somtehing” instead of “something”.
When my wife was in vet school, they deducted points for spelling, including (I’m sure I’ll spell it wrong) borberyghmy
Borborygmi.
Makes my day if I get to write that in the notes.
Bonus points if I can use malodorous eructation, flatulent dyspepsia and waterbrash.
Usually, when I mention borborygmi to doctors, they say, “Oh, you mean gut sounds?”
Because that way they don’t have to spell borborygmi
Hah, I’m giggling that I’m not the only one who gets a kick out of documenting Borborygmi. Kids got tired of hearing the term a long time ago and the medical record never complains when I smirk at opportunity to use it.
Those aren’t typos, and trying to excuse them as such is lame.
The US doesn’t have a “horrible, shameful rate of infant mortality,” either. Not when you start comparing apples to apples. Much of the infant mortality here in the US is the result of very premature births, not lack of adequate medical care. Stop lying.
Yeah you guys. Get a life!
Mechonium is a baby’s first poop that can be passed when a baby is in distress during labor. It’s dangerous because the baby can aspirate it upon delivery. bonafied was explained to you by another commentr – excuse my mis-spelling, but it does men ‘genuine’. You can Google on-line dictionaries, you kno.
The point, GMA, is that your spelling is atrocious.
It’s bona fide and meconium, both terms I am quite familiar with.
I always have a concern that when people use terms but can’t spell them, they often don’t understand them.
Why don’t you google on-line dictionaries if you know they exist?
So, you are so educated and cannot spell something so simple as meconium? Ridiculous
Remember? Oh Brother Where Art Though? “Mama says he’s bonafied.”
Pretty sure that’s the only place I’ve ever heard that word.
What is ‘mechonium
I’m a horrible speller and really shouldn’t do this, but sometimes a spelling error is just too much fun to resist…Mechonium sounds like something you have to watch out for when a cyborg is giving birth.
“Crap, there’s mechonium all over the place!”
“Quick, call the mechanic!”
I always like to claim it’s the British spelling.
I have no idea whether this comment is pro or anti scheduled c-section. You apparently demand that doctors schedule one in advance for all women who will need it, without doing any unnecessary ones. And you condemn women who prefer to schedule one specifically to prevent hours of exhausting labor followed by emergency surgery.
Well, yes, of course! She has a Mercedes to buy and 99 percent of low risk women don’t want her. Of course she condemns them.
Because as any librarian will tell you, perfect precision and perfect recall is totally possible.
…oh wait…
Sorry, you’re trying to make assumptions about my intent. I never demanded nor did I condemn anyone. I do have little respect for women who schedule a c-section to avoid labor and/ or to maintain a tight vagina. Yes, this does happen. I was not referring to anyone going through “hours of exhausting labor followed by emergency surgery”. Of course a woman should schedule a c-section when there is no doubt they can deliver vaginally. That’s their choice. You might have been picking up on my scarcasm regarding women who schedule one for purely cosmetic reasons. That’s also an individual’s choice, but I don’t have to respect it.
I have little respect for women who are quick to cast judgement on others when they themselves are scientifically illiterate and intellectually lazy. You clearly are both if the only reasons you can come up for having a c-section is fear of labor and wanting a “tight vagina” (by the way, the underlying sentiment in that accusation is disgusting and sexist in the extreme).
“Scheduling” a c-section to avoid labor is perfectly reasonable choice. Given the evidence we have now, a good argument could be made that a planned c-section is the safest choice for both baby and mother. Your ignorance is showing.
Hello!!?? When did I ever say that “fear of labor and wanting a “tight vagina” ” are the ONLY reasons “for having a c-section”??!! Dramatize much?
“Given the evidence we have now, a good argument could be made that a planned c-section is the safest choice for both baby and mother. Your ignorance is showing.”
Please re read your comments I have quoted and use your critical thinking skills – if you have any – to determine who the ignorant one really is. Or an easier, less brain taxing way would be to look at yourself in a mirror and repeat your own statements over and over till you are hypnotized to believe them – like a robot!
Better yet – create your own perceptions & thoughts! What a novel idea! >>> I dare you to become a free thinker.
Well you clearly think that “cosmetic” reasons are not good reasons for having a C-section. What “cosmetic” reasons were you thinking of exactly?
I *AM* a free thinker. I had a long difficult “empowering” homebirth for my first baby. I had watched the Business of Being Born, I adored Ina May, I was “educated”.
Then I actually read the scientific literature and understood the real risks of homebirth. And of dangerous CPM homebirth midwives.
I will never have a homebirth again. How’s that for free thought?
Have YOU read the studies on the safety of C-sections at term? You skipped right over the possibility of scientific evidence to whine about “freethought”.
You become a free thinker first and then we will talk.
I dare you to become a critical thinker.
Boom.
It’s a good thing I don’t need or want your (or anyone’s for that matter) respect when it comes to my birthing choices. I am scheduling a c-section in December because I am wanting to avoid labour *and* maintain a ‘tight vagina’ among other reasons – none of which are necessarily medically indicated (yet).
I am not in a situation where there is ‘no doubt I can’t deliver naturally’, but it is my choice, and my obstetrician and her midwife agree with my reasons so who cares what you think? I am more confident in their judgement than yours from what you’ve posted here. Of course them knowing my medical/obstetric history does make their opinion much more valuable as well.
It’s really a good thing. On the other hand, cheer up. She would have respected your choice to scream yourself hoarse in agony without any pain relief. Of course, the reason would be that that reinforces the belief lining her pockets through other people’s agony. But she would have respected it.
Lol. You’re a caricature. Why do you care what other women want to do with their vaginas?
Also, how do you know who’s going to go through hours of exhausting labour before their c-section? If we had that kind of knowledge then we probably wouldn’t be discussing any of this at all.
I do have little respect for women who schedule a c-section to avoid labor and/ or to maintain a tight vagina.
Why? Is it irrational to fear labor when labor traditionally had and still has a high chance of maiming or killing the laboring woman? Do you still have “little respect” if it is the second labor and the first was characterized by such severe pain that the patient suffered from PTSD afterwards?
And why shouldn’t a woman prioritize sexual satisfaction over the various potential advantages of vaginal delivery? Let’s assume, for the moment, that she really is just looking to maintain a “tight vagina” and not worried about urinary incontinence or fistula or any of the other complications of labor and delivery, but really truly just wanting to continue to have good sex. Why is that a bad thing? Good sex is an important part of quality of life. Men with prostate cancer are counseled to consider sexual function after treatment as a factor in how they make their decisions for which treatment to take. Why shouldn’t woman also take it into consideration when deciding how to deliver?
Because it’s GmaGardner’s income threatened by their choice. What does another woman’s sex life and quality of life matters when Gma has to line her pockets? It isn’t as if Gma can actually be useful in any sensible, safe way to anyone, so why shouldn’t she be useful for her own pockets?
Since scheduled c-sections are extraordinarily safe there is no reason to demonize women who want to avoid labor by scheduling one.
You know what I would have liked to preserve far more than a “tight vagina?” A tight rectum. A tight pelvic floor. To argue that wanting to avoid urinary and bowel incontinence is simply “vanity” simply proves what an idiot you are. I have no respect for midwives like you who sugarcoat the bad outcomes of vaginal delivery.
Gma might like to meet my patient.
After having three, lovely natural vaginal births within five years, to babies weighing over 8lbs, she has uterine prolapse.
Her cervix is at her introitus and she hasn’t had sex for years, because her vagina is full of uterus.
She is now trying to figure out when she can schedule a vaginal hysterectomy and culdosuspension so the recovery will have the least impact on her childcare and work commitments.
Unfortunately less drastic options, such as pessaries, have failed.
She’s in her early 30s with pre-school children and serious marital problems as a direct result of her vaginal births.
She’s losing her uterus and has lost years of full sexual intimacy with her husband because of her vaginal births. I bet she’d rather have had 3 CS, the option of a 4th child and a decent sex life over what she has now.
That poor woman! That is jaw-droppingly awful.
I hope that she’s able to have her procedures done very soon, and that she will be able to reclaim the intimacy in her marriage.
Me too.
The framing of concern about pelvic floor integrity, sexual function, prolapse prevention and continence as “vanity” is so destructive.
We know that for a certain percentage of women, opting for a vaginal birth now means opting for genital organ prolapse, incontinence and sexual dysfunction later, with the subsequent medical and surgical treatments and their risks.
The NCB response seems to consist of denial (VB doesn’t cause vaginal wall laxity or pelvic floor damage, CS doesn’t prevent these problems) or minimisation ( stress incontinence and reduced sexual pleasure after childbirth are “perfectly normal” or “natural” or “no big deal- our foremothers just accepted this!”).
Worst is when any suggestion that you, I don’t know, might like your vagina and vulva the way they are and want to keep them that way is met with an assertion that you’re hoodwinked by the patriarchy, doing it to please your man etc.
Gma illustrated that mindset perfectly.
“Worst is when any suggestion that you, I don’t know, might like your
vagina and vulva the way they are and want to keep them that way is met
with an assertion that you’re hoodwinked by the patriarchy, doing it to
please your man etc.”
Because, in their minds, only men should enjoy sex? Wimmen only have sex to make the babies?
Ugh.
I agree, but my understanding is that the evidence that C/S is protective against pelvic floor dysfunction is equivocal at best. If that is not the case, is there a good paper on this? I had this discussion with my doctor a few years ago and did my reading then and was not impressed with the evidence out there.
Gma Gardner should add “A Walk to Beautiful” to her “huge amount of knowledge”. Although she might realize then that her “huge” amount of knowledge isn’t so huge after all.
By this statement, you completely devalued a woman’s sexual identity. I miss my tight vagina. I previously had amazing orgasms. My vagina and my sex life are important to me, and the resulting decrease in sensation due to its additional looseness since childbirth has been depressing. Choosing surgery over impacting the quality of a sexual organ should not be dismissed as a choice unworthy of respect. I spent a total of 18 hours birthing children over the course of my life and over 10 times that per year having sex. To me it is far more important to protect the vagina for long term.
Why do you have no respect for the function of a woman’s sexual organs, or a woman’s desire t protect them from damage?
And you know this how?
Lots of women with an android pelvis are able to deliver vaginally and manual estimates of pelvis size and shape are not definitive except at the extremes. Are you really suggesting that the doctor should have scheduled a cesarean before labor because of a suspected android pelvis? Without any ultrasound measurement suggesting the baby is too large or poorly positioned to navigate the pelvis? You would have denied this woman a trial of labor?
This is true with a lower birth weight baby. When the client refused US, I think the OB should have done a manual pelvic assessment. (Midwives are trained to do manual measurements). This way the client has more information and can prepare for a possible c-section. A mother can still request a ‘trial of labor’, but 20 hrs. is excessive when a woman does not even have a clue she can’t deliver vaginally. During the final weeks of pregnancy the baby’s approximate weight can be assessed so that a client with all the info of possible risk factors, can further prepare. There are several books written by women who ended up with a c-section would have wanted the respect from their OB’s about ALL the possibilities in order to prepare themselves emotionally for major surgery and what that would mean for bonding, breastfeeding, pain & recovery at home while tending a newborn.
I am saying it was disrespectful of my client’s OB to not assess for ALL risk factors and give her ALL the info necessary so she could make her own informed choices – whatever they might be.
EVERY woman, in EVERY pregnancy, should be prepared for the possibility of needing a cesarean. There is no such thing as zero risk, and any childbirth class should help women understand the process and reasons for this intervention so she could make a truly informed choice without unnecessary fear. Any valuable childbirth class covers the standard technology available during labor and delivery, what this technology actually does, what complications can occur and how this technology can be used to help. A woman may choose to decline any intervention, but it should be a truly informed choice.
To say that an epidural drugs the baby is not TRULY informative. To say that fundal heights and manual pelvic measurements are anywhere near accurate enough to base surgical decisions on is not TRULY informative.
And to imply that anyone other than the person experiencing the pain is an adequate judge of the effectiveness any pain relief option is horrific beyond words.
Boom goes the dynamite.
(Midwives are trained to do manual measurements).
What’s the data on that? What are the false positive and false negative rates for manual measurements? How were these rates assessed? What data are available to suggest that manual measurement of the pelvis leads to better outcomes and what outcomes were measured?
And if your labor is extremely painful, there are extremely effective pain relief options available. You need an anesthesiologist, not a doula, to provide them, but they are very much available.